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Long-Term Results of Endovascular Aortic Repair Acta Universitatis Tamperensis 2200

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Long-Term Results of Endovascular Aortic Repair Acta Universitatis Tamperensis 2200 SUVI VÄÄRÄMÄKI Long-term Results of Endovascular Aortic Repair SUVI VÄÄRÄMÄKI Long-term Results of Endovascular Acta Universitatis Tamperensis 2200 SUVI VÄÄRÄMÄKI Long-term Results of Endovascular Aortic Repair AUT 2200 AUT SUVI VÄÄRÄMÄKI Long-term Results of Endovascular Aortic Repair ACADEMIC DISSERTATION To be presented, with the permission of the Board of the School of Medicine of the University of Tampere, for public discussion in the small auditorium of building M, Pirkanmaa Hospital District, Teiskontie 35, Tampere, on 9 September 2016, at 12 o’clock. UNIVERSITY OF TAMPERE SUVI VÄÄRÄMÄKI Long-term Results of Endovascular Aortic Repair Acta Universitatis Tamperensis 2200 Tampere University Press Tampere 2016 ACADEMIC DISSERTATION University of Tampere, School of Medicine Tampere University Hospital, Department of Surgery Finland Supervised by Reviewed by Docent Juha-Pekka Salenius MD, PhD Pekka Jaakkola University of Tampere University of Eastern Finland Finland Finland Docent Jukka Perälä University of Oulu Finland The originality of this thesis has been checked using the Turnitin OriginalityCheck service in accordance with the quality management system of the University of Tampere. Copyright ©2016 Tampere University Press and the author Cover design by Mikko Reinikka Layout by Sirpa Randell Distributor: [email protected] https://verkkokauppa.juvenes.fi/ Acta Universitatis Tamperensis 2200 Acta Electronica Universitatis Tamperensis 1699 ISBN 978-952-03-0201-6 (print) ISBN 978-952-03-0202-3 (pdf) ISSN-L 1455-1616 ISSN 1456-954X ISSN 1455-1616 http://tampub.uta.fi Suomen Yliopistopaino Oy – Juvenes Print Tampere 2016 CONTENTS Abstract ............................................................................................................................................. 7 Tiivistelmä ........................................................................................................................................ 9 List of original publications ........................................................................................................ 11 Abbreviations ................................................................................................................................ 12 1 Introduction ..................................................................................................................... 13 2 Review of the Literature ................................................................................................. 15 2.1 Aortic aneurysms ................................................................................................. 15 2.1.1 Types of aortic aneurysm ....................................................................... 15 2.1.2 Epidemiology ........................................................................................... 16 2.1.3 Aetiology, risk factors and pathophysiology ...................................... 16 2.1.4 Rupture risk .............................................................................................. 17 2.1.5 Diagnosis and treatment ........................................................................ 19 2.2 Aortic dissection ................................................................................................. 20 2.2.1 Classification ........................................................................................... 20 2.2.2 Epidemiology .......................................................................................... 21 2.2.3 Aetiology, risk factors and pathophysiology .................................... 21 2.2.4 Complication risk .................................................................................. 22 2.2.5 Diagnosis and treatment ....................................................................... 22 2.3 Endovascular aneurysm repair (EVAR) ........................................................ 24 2.3.1 Technique ................................................................................................ 24 2.3.2 First-generation stent-graft Vanguard® .............................................. 25 2.3.3 Second-generation stent-graft Zenith® .............................................. 26 2.3.4 Follow-up ................................................................................................. 27 2.3.5 Graft-related complications ................................................................. 28 2.3.6 EUROSTAR Registry and randomized EVAR trials .................... 30 2.3.6.1 Short-term results .................................................................. 32 2.3.6.2 Mid- and long-term results .................................................. 32 2.3.7 REVAR .................................................................................................... 34 2.4 Thoracic endovascular aortic repair (TEVAR) ............................................ 34 2.4.1 Technique ................................................................................................ 34 2.4.2 Complications ......................................................................................... 36 2.4.3 Follow-up ................................................................................................. 36 2.4.4 Short-term results ................................................................................... 36 2.4.5 Mid- and long-term results ................................................................... 37 2.5 Hybrid repair of a thoracoabdominal aortic aneurysm .............................. 39 2.6 The chimney, sandwich, FEVAR and BEVAR techniques ........................ 40 3 Aims of the Study ............................................................................................................ 43 4 Materials And Methods ................................................................................................. 44 4.1 Study population ................................................................................................ 44 4.2 Methods ................................................................................................................ 45 4.2.1 Indication for treatment ....................................................................... 45 4.2.2 Operative technique .............................................................................. 45 4.2.3 Follow-up ................................................................................................. 46 4.2.4 Primary outcome measures .................................................................. 46 4.2.5 Secondary outcome measures .............................................................. 47 4.2.6 Statistical methods ................................................................................. 47 5 Results ................................................................................................................................ 48 5.1 Long-term results of EVAR using the first-generation Vanguard® stent-graft (I) ........................................................................................................ 48 5.1.1 Operative and 30-day results ............................................................... 48 5.1.2 Long-term results ................................................................................... 49 5.1.2.1 Late survival ............................................................................ 49 5.1.2.2 Complications ........................................................................ 49 5.1.2.3 Secondary interventions ....................................................... 50 5.2 Long-term results of EVAR using the second-generation Zenith® stent-graft (II) ....................................................................................................... 51 5.2.1 Operative details and 30-day results ................................................... 51 5.2.2 Long-term results ................................................................................... 52 5.2.2.1 Late survival ............................................................................ 52 5.2.2.2 Complications ........................................................................ 54 5.2.2.3 Secondary interventions ........................................................ 55 5.3 Long-term results of TEVAR ........................................................................... 56 5.3.1 Operative details and technical success ............................................. 56 5.3.2 30-day outcomes ..................................................................................... 59 5.3.3 Long-term results ................................................................................... 60 5.3.3.1 Late survival ............................................................................ 60 5.3.3.2 Complications ........................................................................ 62 5.3.3.3 Secondary interventions ....................................................... 63 5.4 Results of hybrid repair for thoracoabdominal aortic aneurysm ............. 63 5.4.1 Operative details and 30-day outcomes ............................................ 63 5.4.2 Long-term results ................................................................................... 65 5.4.2.1 Late survival ............................................................................ 65 5.4.2.2 Complications and secondary interventions ................... 65 6 Discussion ........................................................................................................................
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