000			05028nam a22007217a 4500
008			170512s20172017 xxu||||| |||| 00| 0 eng d
022			_a0890-5096
040			_aOvid MEDLINE(R)
099			_a28479422
245			_aManagement of difficult access during EVAR.
251			_aAnnals of Vascular Surgery. 44:77-82, 2017 Oct.
252			_aAnn Vasc Surg. 44:77-82, 2017 Oct.
253			_aAnnals of vascular surgery
260			_c2017
260			_fFY2017
266			_d2017-05-24
501			_aAvailable online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007
520			_aCONCLUSIONS: EVAR can be successfully performed in patients with bilateral small iliac arteries. Adjunctive procedures might increase the technical success rate of EVAR in these patients, and should definitely be considered in patients with iliac arteries less than 5mm in diameter. Next generation and "low-profile" devices might minimize the need for adjunctive procedures and facilitate EVAR in these patients.
520			_aCopyright � 2017. Published by Elsevier Inc.
520			_aMETHODS: Data from all patients undergoing EVAR at a tertiary academic medical center between 2009 and 2013 was collected retrospectively, including demographics, size of iliac arteries, type of device used, approach to managing difficult access, and outcomes. The median follow-up was 38 months. Difficult access (DA) was defined as iliac arteries with a diameter of less than 7mm bilaterally. Fenestrated and snorkel repairs were excluded.
520			_aOBJECTIVES: To describe a large single institutional experience in managing challenging access situations during endovascular aneurysm repair (EVAR).
520			_aRESULTS: Out of 400 EVARs performed during the study period, 191 (48%) were done in patients with DA. Of the DA patients, 35 (18.3%) underwent 42 adjuncts prior to introduction of the main body device: including 15 dilators, 11 balloon angioplasties, 9 Aortouniiliac (AUI) devices, 3 SoloPath sheaths, 1 retroperitoneal cutdown and 3 iliac stents. In another 29 patients, iliac stents were used to correct stenoses or kinks in the limbs after EVAR devices were deployed. The average diameter of the iliac artery used to deliver main body component was 4.6mm in the group of patients requiring adjuncts and 5.4mm in the remainder of the patients with small iliac arteries (p=.008). The median size of the main body device was 28mm. Two cases were aborted due to inability to deliver the device. Other complications included 7 (3.6%) iliac ruptures, 3(1.6%) instances of limb ischemia, and 5 (2.6%) patients needed early reoperation (within 30 days). Two patients (1%) had type I endoleaks at the conclusion of EVAR. During follow-up, 12 (6.3%) of patients required EVAR revisions. Seven patients (3.6%) had limb thrombosis which occurred only in patients who did not have adjective procedures during the initial EVAR. Limb thrombosis and rate of revisions in patients with DA were not significantly different from the rates observed in non-DA patients. Perioperative mortality after elective repairs was 1.6% in DA patients and 0% in non-DA patients (p=0.12).
546			_aEnglish
650			_a*Aortic Aneurysm, Abdominal/su [Surgery]
650			_a*Blood Vessel Prosthesis Implantation/ae [Adverse Effects]
650			_a*Endovascular Procedures/ae [Adverse Effects]
650			_a*Iliac Artery/su [Surgery]
650			_a*Postoperative Complications/et [Etiology]
650			_aAged
650			_aAged, 80 and over
650			_aAortic Aneurysm, Abdominal/dg [Diagnostic Imaging]
650			_aAortic Aneurysm, Abdominal/mo [Mortality]
650			_aBlood Vessel Prosthesis
650			_aBlood Vessel Prosthesis Implantation/is [Instrumentation]
650			_aBlood Vessel Prosthesis Implantation/mo [Mortality]
650			_aEndovascular Procedures/is [Instrumentation]
650			_aEndovascular Procedures/mo [Mortality]
650			_aFemale
650			_aHospitals, University
650			_aHumans
650			_aIliac Artery/dg [Diagnostic Imaging]
650			_aMale
650			_aMiddle Aged
650			_aPhiladelphia
650			_aPostoperative Complications/dg [Diagnostic Imaging]
650			_aPostoperative Complications/mo [Mortality]
650			_aPostoperative Complications/su [Surgery]
650			_aProsthesis Design
650			_aReoperation
650			_aRetrospective Studies
650			_aRisk Factors
650			_aStents
650			_aTertiary Care Centers
650			_aTime Factors
650			_aTreatment Outcome
651			_aMedStar Washington Hospital Center
656			_aSurgery/Vascular Surgery
657			_aJournal Article
700			_aWoo, Edward Y
790			_aBaig A, Carpenter JP, Etkin Y, Fairman RM, Foley PJ, Jackson BM, Wang GJ, Woo EY
856			_uhttps://dx.doi.org/10.1016/j.avsg.2017.03.190 _zhttps://dx.doi.org/10.1016/j.avsg.2017.03.190
942			_cART _dArticle
999			_c3445 _d3445