Skip to main content
SpringerLink
Log in

Endovascular Treatment of Complicated Aortic Aneurysms in Patients with Underlying Arteriopathies

  • Papers Presented to the Peripheral Vascular Surgery Society—Winter Meeting
  • Published:
Annals of Vascular Surgery

Abstract

Patients with arteriopathies including giant cell arteritis, Marfan syndrome, and Takayasu’s disease are at risk for aneurysmal degeneration of the aorta. Aortic repair has been recommended for these patients to prevent rupture. The purpose of this study was to examine outcomes following endovascular stent graft (EVSG) repair of aortic aneurysms in this patient population. Over an 8-year period, 11 patients (six men, five women) with arteriopathies underwent endovascular aortic repair. The mean age was 50 (range 15-81). Diseases included Marfan syndrome (n = 6), Takayasu’s disease (n = 3), and giant cell arteritis (n = 2). Success of EVSG repair was evaluated per the reporting standards of the Society for Vascular Surgery/American Association for Vascular Surgery. Follow-up was a mean of 28.9 months (range 3-68). Six patients underwent EVSG repair of the thoracic aorta, four underwent EVSG repair of the abdominal aorta, and one underwent a staged repair of the thoracic and subsequently the abdominal aorta. Six true aneurysms and six pseudoaneurysms were repaired. Eight patients had previous aortic surgery, including four with multiple aortic operations. For the 12 aneurysms treated, technical success was achieved in 11 (91.7%). One technical failure occurred due to a small iliac access vessel, requiring an eventual iliac conduit for insertion. Early complications (<30 days) occurred in three patients. Type I or III endoleak developed following two repairs (16.7%). Aneurysm expansion occurred following one repair (8.3%). No aneurysm-related deaths occurred during follow-up. EVSG repair of aortic aneurysms is feasible and can be safely performed in patients with arteriopathies. Long-term durability in this younger group of patients who carry an ongoing risk of arterial degeneration remains to be determined.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1.
Fig. 2.

Similar content being viewed by others

References

  1. Dietz HC, Cutting GR, Pyeritz RE, et al. Marfan syndrome caused by a recurrent de novo missense mutation in the fibrillin gene. Nature 1991;352:337-339

    Article  PubMed  CAS  Google Scholar 

  2. Pereira L, Andrikopoulos K, Tian J, et al. Targeting of the gene encoding fibrillin-1 recapitulates the vascular aspect of marfan syndrome. Nat Genet 1997;17:218-222

    Article  PubMed  CAS  Google Scholar 

  3. Gravanis MB. Giant cell arteritis and takayasu aortitis: morphologic, pathogenetic and etiologic factors. Int J Cardiol 2000;75(Suppl 1):S21-S33, S35-S36

    Article  PubMed  Google Scholar 

  4. Sasaki S, Kubota S, Kunihara T, et al. Surgical experience of the thoracic aortic aneurysm due to takayasu’s arteritis. Int J Cardiol 2000;75(Suppl 1):S129-S134

    Article  PubMed  Google Scholar 

  5. EVAR Trial Participants. Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial 1): randomised controlled trial. Lancet 2005;365:2179-2186

    Article  Google Scholar 

  6. Matsumura JS, Brewster DC, Makaroun MS, et al. A multicenter controlled clinical trial of open versus endovascular treatment of abdominal aortic aneurysm. J Vasc Surg 2003;37:262-271

    Article  PubMed  Google Scholar 

  7. Prinssen M, Verhoeven EL, Buth J, et al. A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med 2004;351:1607-1618

    Article  PubMed  CAS  Google Scholar 

  8. Gawenda M, Zaehringer M, Brunkwall J. Open versus endovascular repair of para-anastomotic aneurysms in patients who were morphological candidates for endovascular treatment. J Endovasc Ther 2003;10:745-751

    Article  PubMed  Google Scholar 

  9. Morrissey NJ, Yano OJ, Soundararajan K, et al. Endovascular repair of para-anastomotic aneurysms of the aorta and iliac arteries: preferred treatment for a complex problem. J Vasc Surg 2001;34:503-512

    Article  PubMed  CAS  Google Scholar 

  10. Groenink M, Lohuis TA, Tijssen JG, et al. Survival and complication free survival in marfan’s syndrome: implications of current guidelines. Heart 1999;82:499-504

    PubMed  CAS  Google Scholar 

  11. Ishikawa K, Maetani S. Long-term outcome for 120 Japanese patients with Ttakayasu’s disease: clinical and statistical analyses of related prognostic factors. Circulation 1994;90:1855-1860

    PubMed  CAS  Google Scholar 

  12. Iguchi A, Saiki Y, Oda K, et al. Results of aortic surgery in patients with Marfan syndrome. Surg Today 2005;35:106-111

    Article  PubMed  Google Scholar 

  13. Niinami H, Aomi S, Tagusari O, et al. Extensive aortic reconstruction for aortic aneurysms in marfan syndrome. Ann Thorac Surg 1999;67:1864-1870

    Article  PubMed  CAS  Google Scholar 

  14. Finkbohner R, Johnston D, Crawford ES, et al. Marfan syndrome: long-term survival and complications after aortic aneurysm repair. Circulation 1995;91:728-733

    PubMed  CAS  Google Scholar 

  15. Lombardi JV, Carpenter JP, Pochettino A, et al. Thoracoabdominal aortic aneurysm repair after prior aortic surgery. J Vasc Surg 2003;38:1185-1190

    Article  PubMed  Google Scholar 

  16. Ince H, Rehders TC, Petzsch M, et al. Stent-grafts in patients with Marfan syndrome. J Endovasc Ther 2005;12:82-88

    Article  PubMed  Google Scholar 

  17. Zaman MJ, Carre V, Parvin S, et al. Endovascular stent repair for a dissecting thoracoabdominal aneurysm is feasible in the setting of a district general hospital: a multidisciplinary approach. Heart 2002;88:E4

    Article  PubMed  CAS  Google Scholar 

  18. Fleck TM, Hutschala D, Tschernich H, et al. Stent graft placement of the thoracoabdominal aorta in a patient with Marfan syndrome. J Thorac Cardiovasc Surg 2003;125:1541-1543

    Article  PubMed  Google Scholar 

  19. Matsumura K, Hirano T, Takeda K, et al. Incidence of aneurysms in Takayasu’s arteritis. Angiology 1991;42:308-315

    Article  PubMed  CAS  Google Scholar 

  20. Sharma S, Rajani M, Talwar KK. Angiographic morphology in nonspecific aortoarteritis (Takayasu’s arteritis): a study of 126 patients from north India. Cardiovasc Intervent Radiol 1992;15:160-165

    Article  PubMed  CAS  Google Scholar 

  21. Sheikhzadeh A, Tettenborn I, Noohi F, et al. Occlusive thromboaortopathy (Takayasu disease): clinical and angiographic features and a brief review of literature. Angiology 2002;53:29-40

    Article  PubMed  CAS  Google Scholar 

  22. Sueyoshi E, Sakamoto I, Hayashi K. Aortic aneurysms in patients with Takayasu’s arteritis: CT evaluation. AJR Am J Roentgenol 2000;175:1727-1733

    PubMed  CAS  Google Scholar 

  23. Kieffer E, Chiche L, Bertal A, et al. Descending thoracic and thoracoabdominal aortic aneurysm in patients with Takayasu’s disease. Ann Vasc Surg 2004;18:505-513

    Article  PubMed  Google Scholar 

  24. Sharma S, Rajani M, Kamalakar T, et al. The association between aneurysm formation and systemic hypertension in Takayasu’s arteritis. Clin Radiol 1990;42:182-187

    Article  PubMed  CAS  Google Scholar 

  25. Giordano JM. Surgical treatment of Takayasu’s disease. Cleve Clin J Med 2002;69(Suppl 2):SII146-SII148

    Article  PubMed  Google Scholar 

  26. Miyata T, Sato O, Deguchi J, et al. Anastomotic aneurysms after surgical treatment of Takayasu’s arteritis: a 40-year experience. J Vasc Surg 1998;27:438-445

    Article  PubMed  CAS  Google Scholar 

  27. Shimizu H, Ueda T, Koizumi J, et al. Endoluminal stent-grafting for thoracoabdominal aortic aneurysm in Takayasu’s disease. Ann Thorac Cardiovasc Surg 2001;7:59-61

    PubMed  CAS  Google Scholar 

  28. Taketani T, Morota T, Shibata K, et al. Successful repair of graft failure and abdominal aortic aneurysm following thoraco-abdominal bypass for atypical aortic coarctation. Jpn J Thorac Cardiovasc Surg 2004;52:91-94

    Article  PubMed  Google Scholar 

  29. Nuenninghoff DM, Hunder GG, Christianson TJ, et al. Incidence and predictors of large-artery complication (aortic aneurysm, aortic dissection, and/or large-artery stenosis) in patients with giant cell arteritis: a population-based study over 50 years. Arthritis Rheum 2003;48:3522-3531

    Article  PubMed  Google Scholar 

  30. Evans JM, O’Fallon WM, Hunder GG. Increased incidence of aortic aneurysm and dissection in giant cell (temporal) arteritis. A population-based study. Ann Intern Med 1995;122:502-507

    PubMed  CAS  Google Scholar 

  31. Ginzburg V, Greenber G, Delgado C, et al. Endovascular stent-graft repair of aorto-esophageal fistula causing upper gastrointestinal bleeding. Harefuah 2005;144:82-84, 152

    PubMed  Google Scholar 

  32. Engelke C, Sandhu C, Morgan RA, et al. Endovascular repair of thoracic aortic aneurysm and intramural hematoma in giant cell arteritis. J Vasc Interv Radiol 2002;13:625-629

    Article  PubMed  Google Scholar 

  33. Chieh JJ, Brevetti LS, Scholz PM, et al. Multiple isolated aneurysms in a case of “burned out” Takayasu aortitis. J Vasc Surg 2003;37:1094-1097

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Vascular Surgery, Department of Surgery, Mount Sinai School of Medicine, New York, NY, USA

    Donald T. Baril MD, Alfio Carroccio MD, Eugene Palchik MD, Sharif H. Ellozy MD, Tikva S. Jacobs MD, Victoria Teodorescu MD & Michael L. Marin MD

  2. 5 East 98th Street, Box 1259, New York, NY, 10029-6574, USA

    Donald T. Baril MD

Authors
  1. Donald T. Baril MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alfio Carroccio MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eugene Palchik MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sharif H. Ellozy MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tikva S. Jacobs MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Victoria Teodorescu MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Michael L. Marin MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Donald T. Baril MD.

Additional information

This paper was presented at the Peripheral Vascular Surgery Society Winter Meeting, Park City, UT, January 26-29, 2006.

About this article

Cite this article

Baril, D.T., Carroccio, A., Palchik, E. et al. Endovascular Treatment of Complicated Aortic Aneurysms in Patients with Underlying Arteriopathies. Ann Vasc Surg 20, 464–471 (2006). https://doi.org/10.1007/s10016-006-9091-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10016-006-9091-2

Keywords

Search

Navigation