Complementary surgical/interventional techniques for nonresective management of 'inoperable' aneurysms

A second look

George J. Todd, Joseph DeRose, Eric C. Martin

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Induced thrombosis ('nonresective' therapy) of aortic aneurysms by distal arterial ligation, coil/wire embolization, and extraanatomic bypass was devalued by anecdotal reports emerging during the mid-1980s. Nevertheless, we have recently found the technique to be life-saving in occasional cases and worth revisiting. Since 1990, standard aortic aneurysm repair has been performed in 231 patients (99.1% survival), endovascular aortic aneurysm repair in 6 patients (83.3% survival), and combined surgical/interventional 'nonresective' repair of a variety of aneurysms in 10 patients (100% survival). Mean age of the group was 67.9 years. Repair was performed for aortoiliac aneurysms (4), common iliac aneurysms (3), internal iliac aneurysms (2), and a large proximal subclavian artery pseudoaneurysm (1). Four of the patients had been explored and declared to be 'inoperable' (retroperitoneal fibrosis) prior to transfer to the Columbia-Presbyterian Medical Center. All patients survived. Aneurysm rupture has not occurred in any patient, but one patient with a presumably thrombosed subclavian pseudoaneurysm presented 26 months postcoil-induced thrombosis with progressive aneurysm enlargement due to incomplete aneurysm thrombosis and required repair using circulatory arrest. Eight of the patients remain alive (80%) at a mean follow-up of 40.3 months (range 14-88 months). Two patients died of malignancy (30 months) and cardiac disease (15 months). It is concluded that combined surgical/interventional techniques can be life- saving in the rare instances when conventional or endovascular aneurysm repair is not advisable but that complete aneurysm thrombosis is essential and occasionally difficult to achieve. Since small proximal portions of the aneurysm may remain patent and not be visualized on magnetic resonance imaging (MRI) or computed tomography (CT) scans, contrast angiographic documentation of complete aneurysm thrombosis is essential prior to hospital discharge and close follow-up is necessary to ascertain long-term adequacy of the repair. Incomplete thrombosis is suspected as a major factor in earlier reports of aneurysm rupture after seemingly successful nonresective therapy.

Original languageEnglish (US)
Pages (from-to)248-254
Number of pages7
JournalAnnals of Vascular Surgery
Volume12
Issue number3
DOIs
StatePublished - May 1998
Externally publishedYes

Fingerprint

Aneurysm
Thrombosis
Aortic Aneurysm
Iliac Aneurysm
False Aneurysm
Survival
Rupture
Retroperitoneal Fibrosis
Subclavian Artery
Documentation
Ligation
Heart Diseases
Age Groups
Tomography
Magnetic Resonance Imaging
Therapeutics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Complementary surgical/interventional techniques for nonresective management of 'inoperable' aneurysms : A second look. / Todd, George J.; DeRose, Joseph; Martin, Eric C.

In: Annals of Vascular Surgery, Vol. 12, No. 3, 05.1998, p. 248-254.

Research output: Contribution to journalArticle

@article{60231f5bd92b4cabb4e7d0390c32874a,
title = "Complementary surgical/interventional techniques for nonresective management of 'inoperable' aneurysms: A second look",
abstract = "Induced thrombosis ('nonresective' therapy) of aortic aneurysms by distal arterial ligation, coil/wire embolization, and extraanatomic bypass was devalued by anecdotal reports emerging during the mid-1980s. Nevertheless, we have recently found the technique to be life-saving in occasional cases and worth revisiting. Since 1990, standard aortic aneurysm repair has been performed in 231 patients (99.1{\%} survival), endovascular aortic aneurysm repair in 6 patients (83.3{\%} survival), and combined surgical/interventional 'nonresective' repair of a variety of aneurysms in 10 patients (100{\%} survival). Mean age of the group was 67.9 years. Repair was performed for aortoiliac aneurysms (4), common iliac aneurysms (3), internal iliac aneurysms (2), and a large proximal subclavian artery pseudoaneurysm (1). Four of the patients had been explored and declared to be 'inoperable' (retroperitoneal fibrosis) prior to transfer to the Columbia-Presbyterian Medical Center. All patients survived. Aneurysm rupture has not occurred in any patient, but one patient with a presumably thrombosed subclavian pseudoaneurysm presented 26 months postcoil-induced thrombosis with progressive aneurysm enlargement due to incomplete aneurysm thrombosis and required repair using circulatory arrest. Eight of the patients remain alive (80{\%}) at a mean follow-up of 40.3 months (range 14-88 months). Two patients died of malignancy (30 months) and cardiac disease (15 months). It is concluded that combined surgical/interventional techniques can be life- saving in the rare instances when conventional or endovascular aneurysm repair is not advisable but that complete aneurysm thrombosis is essential and occasionally difficult to achieve. Since small proximal portions of the aneurysm may remain patent and not be visualized on magnetic resonance imaging (MRI) or computed tomography (CT) scans, contrast angiographic documentation of complete aneurysm thrombosis is essential prior to hospital discharge and close follow-up is necessary to ascertain long-term adequacy of the repair. Incomplete thrombosis is suspected as a major factor in earlier reports of aneurysm rupture after seemingly successful nonresective therapy.",
author = "Todd, {George J.} and Joseph DeRose and Martin, {Eric C.}",
year = "1998",
month = "5",
doi = "10.1007/s100169900148",
language = "English (US)",
volume = "12",
pages = "248--254",
journal = "Annals of Vascular Surgery",
issn = "0890-5096",
publisher = "Elsevier Inc.",
number = "3",

}

TY - JOUR

T1 - Complementary surgical/interventional techniques for nonresective management of 'inoperable' aneurysms

T2 - A second look

AU - Todd, George J.

AU - DeRose, Joseph

AU - Martin, Eric C.

PY - 1998/5

Y1 - 1998/5

N2 - Induced thrombosis ('nonresective' therapy) of aortic aneurysms by distal arterial ligation, coil/wire embolization, and extraanatomic bypass was devalued by anecdotal reports emerging during the mid-1980s. Nevertheless, we have recently found the technique to be life-saving in occasional cases and worth revisiting. Since 1990, standard aortic aneurysm repair has been performed in 231 patients (99.1% survival), endovascular aortic aneurysm repair in 6 patients (83.3% survival), and combined surgical/interventional 'nonresective' repair of a variety of aneurysms in 10 patients (100% survival). Mean age of the group was 67.9 years. Repair was performed for aortoiliac aneurysms (4), common iliac aneurysms (3), internal iliac aneurysms (2), and a large proximal subclavian artery pseudoaneurysm (1). Four of the patients had been explored and declared to be 'inoperable' (retroperitoneal fibrosis) prior to transfer to the Columbia-Presbyterian Medical Center. All patients survived. Aneurysm rupture has not occurred in any patient, but one patient with a presumably thrombosed subclavian pseudoaneurysm presented 26 months postcoil-induced thrombosis with progressive aneurysm enlargement due to incomplete aneurysm thrombosis and required repair using circulatory arrest. Eight of the patients remain alive (80%) at a mean follow-up of 40.3 months (range 14-88 months). Two patients died of malignancy (30 months) and cardiac disease (15 months). It is concluded that combined surgical/interventional techniques can be life- saving in the rare instances when conventional or endovascular aneurysm repair is not advisable but that complete aneurysm thrombosis is essential and occasionally difficult to achieve. Since small proximal portions of the aneurysm may remain patent and not be visualized on magnetic resonance imaging (MRI) or computed tomography (CT) scans, contrast angiographic documentation of complete aneurysm thrombosis is essential prior to hospital discharge and close follow-up is necessary to ascertain long-term adequacy of the repair. Incomplete thrombosis is suspected as a major factor in earlier reports of aneurysm rupture after seemingly successful nonresective therapy.

AB - Induced thrombosis ('nonresective' therapy) of aortic aneurysms by distal arterial ligation, coil/wire embolization, and extraanatomic bypass was devalued by anecdotal reports emerging during the mid-1980s. Nevertheless, we have recently found the technique to be life-saving in occasional cases and worth revisiting. Since 1990, standard aortic aneurysm repair has been performed in 231 patients (99.1% survival), endovascular aortic aneurysm repair in 6 patients (83.3% survival), and combined surgical/interventional 'nonresective' repair of a variety of aneurysms in 10 patients (100% survival). Mean age of the group was 67.9 years. Repair was performed for aortoiliac aneurysms (4), common iliac aneurysms (3), internal iliac aneurysms (2), and a large proximal subclavian artery pseudoaneurysm (1). Four of the patients had been explored and declared to be 'inoperable' (retroperitoneal fibrosis) prior to transfer to the Columbia-Presbyterian Medical Center. All patients survived. Aneurysm rupture has not occurred in any patient, but one patient with a presumably thrombosed subclavian pseudoaneurysm presented 26 months postcoil-induced thrombosis with progressive aneurysm enlargement due to incomplete aneurysm thrombosis and required repair using circulatory arrest. Eight of the patients remain alive (80%) at a mean follow-up of 40.3 months (range 14-88 months). Two patients died of malignancy (30 months) and cardiac disease (15 months). It is concluded that combined surgical/interventional techniques can be life- saving in the rare instances when conventional or endovascular aneurysm repair is not advisable but that complete aneurysm thrombosis is essential and occasionally difficult to achieve. Since small proximal portions of the aneurysm may remain patent and not be visualized on magnetic resonance imaging (MRI) or computed tomography (CT) scans, contrast angiographic documentation of complete aneurysm thrombosis is essential prior to hospital discharge and close follow-up is necessary to ascertain long-term adequacy of the repair. Incomplete thrombosis is suspected as a major factor in earlier reports of aneurysm rupture after seemingly successful nonresective therapy.

UR - http://www.scopus.com/inward/record.url?scp=0031899799&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0031899799&partnerID=8YFLogxK

U2 - 10.1007/s100169900148

DO - 10.1007/s100169900148

M3 - Article

VL - 12

SP - 248

EP - 254

JO - Annals of Vascular Surgery

JF - Annals of Vascular Surgery

SN - 0890-5096

IS - 3

ER -