Background: The utilisation rate of endovascular aortic aneurysm repair has increased continuously over the past 2 decades. Endovascular aortic aneurysm repair is still performed frequently in patients with an unfavourable proximal seal zone, despite the associated late complications.
Purpose: We aimed to evaluate the mid-term durability of the GORE® EXCLUDER® AAA Endoprosthesis, featuring the C3 delivery system, in patients with a proximal neck anatomy outside the instructions for use (IFU).
Methods: A retrospective sub-analysis of the Global Registry for Endovascular Aortic Treatment including patients treated for abdominal aortic aneurysms with the GORE EXCLUDER AAA Endoprosthesis (W.L. Gore & Associates, Inc, Flagstaff, Arizona) was performed. A "challenging neck" was defined as those treated outside the IFU with an aortic neck length <15 mm and/or aortic neck angle >60°. Cox proportional analyses were used to test for time-to-event differences between those treated within and outside the IFU while accounting for covariates, specifically proximal neck length and neck angle. The main outcomes assessed were 5-year all-cause mortality, 5-year endoleak development (type I or III), and 5-year device-related reinterventions.
Findings: Of the 3,324 patients included in the analysis, 411 (12.4%) had a challenging neck and 2,913 (87.6%) did not. The patients in the challenging neck group were significantly older (74.9 years vs. 73.2 years, p≤0.0001) and had a significantly larger aortic aneurysm diameter at the time of the intervention than those treated within the IFU (61.2 mm vs. 56.4 mm, P< 0.0001), shorter proximal neck length (18 mm vs. 30 mm, P< 0.0001) and larger infrarenal neck angle (60.8° vs. 25.8°, P< 0.0001). In the multivariate analysis, brachial access site and challenging neck were not independent risk factors; increased age was associated with a shorter time to mortality (hazard ratio 1.051, 95% confidence interval 1.039-1.062, P< 0.0001), as was the use of tobacco (hazard ratio 1.329, 95% confidence interval 1.124-1.571, P= 0.0009). The 5-year all-cause mortality (36.2% vs. 27.5%, P= 0.002) and aorta-related mortality (3.8% vs. 1.1%, P= 0.002) were significantly higher in the challenging neck group. The risk of death within 5 years also increased significantly at 1.1% per millimetre increase in the abdominal aortic aneurysm diameter (P= 0.0005). Furthermore, the rates of type Ia endoleak development (7% vs. 1.2%, P< 0.001) and requirement for reintervention (13.3% vs. 9.7%, P< 0.001) were higher in those treated outside the IFU (challenging neck group).
Conclusions: Treatment with the Excluder AAA Endograft outside the IFU was associated with higher 5-year mortality values, increased type Ia endoleak development rates, and a greater need for reintervention compared with treatment within the IFU. This reiterates that fenestrated and open treatments should be strongly considered in cases with aortic neck anatomies outside the IFU. Infrarenal endovascular intervention outside the IFU should only be used when there is no alternative, with meticulous procedural planning and intervention to promote satisfactory outcomes.
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http://dx.doi.org/10.1016/j.avsg.2021.04.032 | DOI Listing |
Facial Plast Surg Aesthet Med
December 2024
Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
Front Plant Sci
December 2024
The Key Laboratory for Crop Production and Smart Agriculture of Yunnan Province, Yunnan Agricultural University, Kunming, Yunnan, China.
Tea leaf diseases are significant causes of reduced quality and yield in tea production. In the Yunnan region, where the climate is suitable for tea cultivation, tea leaf diseases are small, scattered, and vary in scale, making their detection challenging due to complex backgrounds and issues such as occlusion, overlap, and lighting variations. Existing object detection models often struggle to achieve high accuracy in detecting tea leaf diseases.
View Article and Find Full Text PDFJPRAS Open
March 2025
Department of Plastic and Reconstructive Surgery, The Jikei University School of Medicine, Tokyo, Japan.
Objective: This study evaluated the effectiveness of laser Doppler flowmetry (LDF) in detecting perfusion disturbances during microvascular free tissue transfer.
Methods: Conducted at a single centre from December 2020 to September 2022, this prospective study involved 71 patients mainly undergoing head and neck free flap reconstructions, using the Pocket LDF™ for continuous perfusion monitoring.
Results: Out of the 71 cases, data from 69 cases were analysed after excluding those with significant noise or sensor detachment.
Heliyon
December 2024
Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Obstructive Sleep Apnea (OSA) is a common sleep-related breathing disorder characterized by airway obstruction during sleep. Diagnosing pediatric OSA is challenging, particularly in underrepresented populations, leading to disparities in treatment and long-term negative health outcomes. Our study aimed to identify alternative diagnostic tools by investigating genome-wide epigenetic changes and associated transcriptomic alterations in Black female, pediatric patients with OSA.
View Article and Find Full Text PDFNMC Case Rep J
December 2024
Department of Neurosurgery, Fukushima Medical University, Fukushima, Fukushima, Japan.
Although rare, penetrating cervical vascular injury poses significant challenges with a poor patient prognosis, often attributed to severe hemorrhage and accompanying injuries. We encountered a case of hemorrhagic shock resulting from a penetrating injury to the common carotid artery (CCA), which was successfully managed using a combination of endovascular therapy and direct surgical intervention. A 23-year-old man presented with a self-inflicted stab wound on the left side of his neck from a kitchen knife.
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