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Book: Endovascular treatment of aortic aneurysms

Donas, Konstantinos / Torsello, Giovanni / Ouriel, Kenneth

standard and advanced techniques

2018

Author's details	Konstantinos P. Donas, Giovanni Torsello, Kenneth Ouriel
Keywords	Aortic Aneurysm / surgery ; Endovascular Procedures / methods ; Aorta / surgery
Subject code	617.4/130597
Language	English
Size	xiv, 121 Seiten, Illustrationen, 25 cm
Publisher	Elsevier
Publishing place	St. Louis, Missouri
Publishing country	United States
Document type	Book
HBZ-ID	HT020114673
ISBN	978-0-323-51148-3 ; 0-323-51148-1
Database	Catalogue ZB MED Medicine, Health

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2019 A 1234	available for loan (reading room)	Lesesaal EG

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Article ; Online: Update thorakale endovaskuläre Aneurysmareparatur : Neue Stentgraft-Designs.

Torsello, Giovanni Federico

Radiologie (Heidelberg, Germany)

2022 Volume 62, Issue 7, Page(s) 551–555

Abstract: Background: In the last decade, new stent graft designs have evolved to tackle challenges in thoracic endovascular aortic repair. A specific focus on access vessel issues has led to the introduction of new low-profile endograft designs for most of the ... ...

Title translation	Update on thoracic endovascular aneurysm repair : New stent graft designs.
Abstract	Background: In the last decade, new stent graft designs have evolved to tackle challenges in thoracic endovascular aortic repair. A specific focus on access vessel issues has led to the introduction of new low-profile endograft designs for most of the major products. Objective: The main objective of this article is to provide an overview of the available publications on new stent graft designs. Materials and methods: Assessing recent publications on the major reiterations of thoracic endografts, benefits and drawbacks are discussed. Results: Recent reiterations of major endografts for thoracic aortic endovascular repair have focused mainly on the development of low-profile devices. Through alterations on graft fabric as well as stent material and design, delivery systems were reduced in profile, thus, reducing access vessel complications or enabling an endovascular procedure altogether. Long-term data are already available for one endoprosthesis. Other refinements include in situ adaptation of the stent graft to the aortic arch curvature as well as the option of staged deployment to allow more precision and reduce manipulation close to supra-aortic branches. Conclusions: Especially in the case of low-profile endografts, preliminary and long-term results of access vessel complications are promising. In order to draw final conclusions as to how durable the results of aneurysm exclusion are, more long-term studies are warranted.
MeSH term(s)	Aortic Aneurysm, Abdominal/complications ; Aortic Aneurysm, Thoracic/surgery ; Blood Vessel Prosthesis/adverse effects ; Blood Vessel Prosthesis Implantation/adverse effects ; Endovascular Procedures/adverse effects ; Humans ; Postoperative Complications/etiology ; Prosthesis Design ; Retrospective Studies ; Stents/adverse effects ; Treatment Outcome
Language	German
Publishing date	2022-06-27
Publishing country	Germany
Document type	Journal Article ; Review
ISSN	2731-7056
ISSN (online)	2731-7056
DOI	10.1007/s00117-022-01032-4
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Article ; Online: Endovaskuläre Aneurysmareparatur (EVAR) : Update D.

Torsello, Giovanni Federico

Radiologie (Heidelberg, Germany)

2022 Volume 62, Issue 7, Page(s) 580–585

Abstract: Background: Abdominal aortic aneurysms can either be treated by open surgery or endovascular repair. In both cases, prostheses are implanted to prevent potentially lethal aortic ruptures.: Objectives: Studies seeking to identify the optimal treatment ...

Title translation	Endovascular aneurysm repair (EVAR) : Update D.
Abstract	Background: Abdominal aortic aneurysms can either be treated by open surgery or endovascular repair. In both cases, prostheses are implanted to prevent potentially lethal aortic ruptures. Objectives: Studies seeking to identify the optimal treatment came to diverging conclusions. The goal of this article is to shed light on the discussion of which treatment option is to be preferred. Materials and methods: This article summarizes the relevant studies on elective and emergency abdominal aortic aneurysm repair. The presented studies are discussed, and results are interpreted and compared. Results: While most studies indicate lower short-term mortality rates in endovascular aneurysm repair (EVAR), mortality rates converged in multiple trials and even showed a lower mortality rate for open repair in mid-term analyses. Most recent studies indicate long-term equivalence in terms of mortality and a higher rate of secondary interventions in EVAR patients. Conclusions: The current body of literature indicates no real advantage of one therapy over another. The choice of therapy should depend on anatomic, clinical, and logistic criteria.
MeSH term(s)	Aortic Aneurysm, Abdominal/surgery ; Aortic Rupture ; Blood Vessel Prosthesis Implantation/adverse effects ; Elective Surgical Procedures/methods ; Endovascular Procedures/adverse effects ; Humans
Language	German
Publishing date	2022-06-27
Publishing country	Germany
Document type	Journal Article ; Review
ISSN	2731-7056
ISSN (online)	2731-7056
DOI	10.1007/s00117-022-01020-8
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Article ; Online: Treatment of Femoropopliteal Artery Disease with Polymer-Coated Drug-Eluting Stent: 5-Year Results of a Prospective, Non-Randomized Study Including the Halo Phenomenon.

Torsello, Giovanni Federico / Stavroulakis, Konstantinos / Bisdas, Theodosios / Cardona, Yamel / Wichmann, Katrin / Torsello, Giovanni Battista

Cardiovascular and interventional radiology

2024 Volume 47, Issue 2, Page(s) 177–185

Abstract: Purpose: To investigate the long-term results of the Eluvia drug-eluting stent (DES) implantation for femoropopliteal arterial disease, including the 'halo' phenomenon. Long-term data of DES is scarce. A focal reaction ('halo') following Eluvia DES ... ...

Abstract	Purpose: To investigate the long-term results of the Eluvia drug-eluting stent (DES) implantation for femoropopliteal arterial disease, including the 'halo' phenomenon. Long-term data of DES is scarce. A focal reaction ('halo') following Eluvia DES deployment has been described. However, the long-term clinical impact of this phenomenon remains unclear. Methods: This prospective, non-randomized, single-arm study included 130 consecutive patients treated with an Eluvia DES for symptomatic femoropopliteal disease between March 2016 and December 2018. Clinical outcomes and imaging were assessed after 6 months and annually thereafter for up to 5 years. The primary outcome measure was primary patency. Secondary outcomes were freedom from clinically driven target lesion revascularization (CD-TLR), freedom from major amputation, overall survival and amputation-free survival rates. Results: The primary patency was 65% at 5 years. The freedom from CD-TLR and from major amputation at 5 years was 79 and 96%, respectively. The overall survival and amputation-free survival rates were 88 and 83% at 60 months, respectively. Out of the 27 patients with a halo sign, two showed an increased (7.4%) and 6 (22.2%) a decreased diameter. In 19 cases (70.4%), the diameter remained unchanged at the latest follow-up. The presence of the 'halo' sign was associated with increased primary patency (87% versus 59%, HR: 2.48, 95%CI 1.19-5.16, P = .015). Conclusions: The presented patient cohort treated with the Eluvia DES for femoropopliteal artery lesions indicates durable efficacy and a good safety profile regardless of the halo phenomenon. The results need to be confirmed in a larger patient cohort. Level of evidence iii: Non-randomized controlled cohort/follow-up study.
MeSH term(s)	Humans ; Femoral Artery/diagnostic imaging ; Femoral Artery/pathology ; Popliteal Artery/diagnostic imaging ; Popliteal Artery/pathology ; Drug-Eluting Stents ; Follow-Up Studies ; Treatment Outcome ; Paclitaxel/therapeutic use ; Prospective Studies ; Polymers ; Peripheral Arterial Disease/diagnostic imaging ; Peripheral Arterial Disease/therapy ; Vascular Patency
Chemical Substances	Paclitaxel (P88XT4IS4D) ; Polymers
Language	English
Publishing date	2024-01-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	603082-8
ISSN	1432-086X ; 0342-7196 ; 0174-1551
ISSN (online)	1432-086X
ISSN	0342-7196 ; 0174-1551
DOI	10.1007/s00270-023-03652-2
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Article ; Online: Association of Genetic Polymorphisms with Abdominal Aortic Aneurysm in the Processes of Apoptosis, Inflammation, and Cholesterol Metabolism.

Nugroho, Nyityasmono Tri / Herten, Monika / Torsello, Giovanni F / Osada, Nani / Marchiori, Elena / Sielker, Sonja / Torsello, Giovanni B

Medicina (Kaunas, Lithuania)

2023 Volume 59, Issue 10

Abstract: Background and ... ...

Abstract	Background and Objectives
MeSH term(s)	Humans ; Male ; Aged ; Aged, 80 and over ; Female ; Case-Control Studies ; Genetic Predisposition to Disease ; Polymorphism, Single Nucleotide/genetics ; Aortic Aneurysm, Abdominal/genetics ; Risk Factors ; Inflammation ; Apoptosis ; Cholesterol ; ras GTPase-Activating Proteins/genetics
Chemical Substances	Cholesterol (97C5T2UQ7J) ; DAB2IP protein, human ; ras GTPase-Activating Proteins
Language	English
Publishing date	2023-10-17
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2188113-3
ISSN	1648-9144 ; 1010-660X
ISSN (online)	1648-9144
ISSN	1010-660X
DOI	10.3390/medicina59101844
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Book ; Online ; Thesis: Neue Stent-Graft-Designs in der Behandlung von thorakalen, thorakoabdominellen und abdominellen Aortenaneurysmen

Torsello, Giovanni Federico [Verfasser]

2021

Author's details	Giovanni Federico Torsello
Keywords	Medizin, Gesundheit ; Medicine, Health
Subject code	sg610
Language	German
Publisher	Medizinische Fakultät Charité - Universitätsmedizin Berlin
Publishing place	Berlin
Document type	Book ; Online ; Thesis
Database	Digital theses on the web

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Article ; Online: Cost Analysis of Target Lesion Revascularisation in Patients With Femoropopliteal In Stent Re-Stenosis or Occlusion: The COSTLY-TLR Study.

Saratzis, Athanasios / Torsello, Giovanni B / Cardona-Gloria, Yamel / Van Herzeele, Isabelle / Messeder, Sarah J / Zayed, Hany / Torsello, Giovanni F / Chisci, Emiliano / Isernia, Giacomo / D'Oria, Mario / Stavroulakis, Konstantinos

European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery

2024

Abstract: Objective: To report the cost of target lesion revascularisation procedures (TLR) for femoropopliteal peripheral artery disease (PAD) following stenting, from a healthcare payer's perspective.: Methods: European multicentre study involving ... ...

Abstract	Objective: To report the cost of target lesion revascularisation procedures (TLR) for femoropopliteal peripheral artery disease (PAD) following stenting, from a healthcare payer's perspective. Methods: European multicentre study involving consecutive patients requiring femoropopliteal TLR (January 2017 - December 2021). The primary outcome was overall cost (euros) associated with a TLR procedure from presentation to discharge. Exact costs per constituent, clinical characteristics, and early outcomes were reported. Results: This study included 482 TLR procedures (retrospectively, 13 hospitals, six countries): 56% were female, mean age was 75 ± 2 years, 61% were Rutherford class 5 or 6, 67% had Tosaka class 3 disease, and 16% had common femoral or iliac involvement. A total of 52% were hybrid procedures and 6% involved open surgery only. Technical success was 70%, 30 day mortality rate was 1%, and the 30 day major amputation rate was 4%. Most costs were for operating time during the TLR (healthcare professionals' salaries, indirect and estate costs), with a mean of: €21 917 ± €2 110 for all procedures; €23 337 ± €8 920 for open procedures; €12 903 ± €3 108 for endovascular procedures; and €22 806 ± €3 977 for hybrid procedures. In a regression analysis, procedure duration was the main parameter associated with higher overall TLR costs (coefficient, 2.77; standard error, 0.88; p < .001). The mean cost per operating minute of TLR (indirect, estate costs, all salaried staff present included) was €177 and the mean cost per night stay in hospital (outside intensive care unit) was €356. The mean cost per overnight intensive care unit stay (minimum of 8 hours per night) was €1 193. Conclusion: The main driver of the considerable peri-procedure costs associated with femoropopliteal TLR was procedure time.
Language	English
Publishing date	2024-02-07
Publishing country	England
Document type	Journal Article
ZDB-ID	1225869-6
ISSN	1532-2165 ; 1078-5884
ISSN (online)	1532-2165
ISSN	1078-5884
DOI	10.1016/j.ejvs.2024.02.001
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Zs.A 2283: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Fatigue Resistance of the Advanta V12/iCast and Viabahn Balloon-Expandable Stent-Graft as Bridging Stents in Experimental Fenestrated Endografting.

Torsello, Giovanni / Müller, Marcus / Litterscheid, Sarah / Berekoven, Bärbel / Austermann, Martin / Torsello, Giovanni-Federico

Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists

2021 Volume 28, Issue 3, Page(s) 463–468

Abstract: Purpose: Bridging stents undergo millions of cycles during respiratory movements of the kidneys throughout the patient's life. Thus, understanding the response of fabric and endoskeleton of the stent to cyclic loading over the time is crucial. In this ... ...

Abstract	Purpose: Bridging stents undergo millions of cycles during respiratory movements of the kidneys throughout the patient's life. Thus, understanding the response of fabric and endoskeleton of the stent to cyclic loading over the time is crucial. In this study, we compare the fatigue resistance of the Viabahn Balloon-Expandable stent-graft (VBX) with the widely used Advanta V12/iCast under prolonged stress induction. Materials and methods: A polyester test sheet with 10 fenestrations was used simulating a fenestrated endograft. Five 6×59 mm VBX stent-grafts and five 6×58 mm Advanta stent-grafts were implanted into 6×6 mm fenestrations. The stents were flared with a 10×20 mm PTA (percutaneous transluminal angioplasty) catheter and connected with a fatigue stress machine. All stent-grafts were evaluated by microscopy and radiography at baseline and after regular intervals until 50,000,000 cycles were applied, simulating a life span of approximately 75 months. Freedom from fracture (FF), freedom from initial polytertafluoroethylene (PTFE) changes (FIC), and from PTFE breakpoint (FBP, all-layer defect) were calculated. Results: Digital radiographic images did not show any stent fracture in both groups after 50,000,000 cycles. The VBX stent-graft was free from any all-layer defects at the conclusion of 50,000,00 cycles resulting in a significant higher FBP compared with Advanta V12 (50,000,000 vs 33,400,000; p<0.01). All-layer defects were observed only in the Advanta group. Two of 5 Advanta stents showed early penetration of the nitinol ring causing a defect of PTFE. Regarding FIC, there was no significant difference between the stents (3,400,000 in VBX vs 3,200,000 in Advanta). Conclusions: In fatigue tests simulating respiration movements, VBX and Advanta V12 performed equally well in terms of fracture resistance and freedom from initial PTFE changes. VBX maintained freedom from PTFE breakpoint throughout the full 50,000,000 cycles. All-layers defects were detected only in Advanta and were mainly caused by penetration of the nitinol ring through the PTFE.
MeSH term(s)	Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation/adverse effects ; Humans ; Prosthesis Design ; Stents ; Treatment Outcome
Language	English
Publishing date	2021-02-25
Publishing country	United States
Document type	Journal Article
ZDB-ID	2006618-1
ISSN	1545-1550 ; 1526-6028
ISSN (online)	1545-1550
ISSN	1526-6028
DOI	10.1177/1526602821996724
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Article ; Online: A meta-analysis of safety and efficacy of endovascular aneurysm repair in aneurysm patients with severe angulated infrarenal neck.

Bernardini, Giulia / Litterscheid, Sarah / Torsello, Giovanni Battista / Torsello, Giovanni Federico / Beropoulis, Efthymios / Özdemir-van Brunschot, Denise

PloS one

2022 Volume 17, Issue 2, Page(s) e0264327

Abstract: Objectives: A growing number of abdominal aortic aneurysms with severe angulated neck anatomy is treated by endovascular means. However, contradictory early and late outcomes have been reported. Our review and outcome analysis attempted to evaluate the ... ...

Abstract	Objectives: A growing number of abdominal aortic aneurysms with severe angulated neck anatomy is treated by endovascular means. However, contradictory early and late outcomes have been reported. Our review and outcome analysis attempted to evaluate the available literature and provide clinicians with a base for clinical implementation and future research. Materials and methods: A systematic review of the literature was undertaken to identify the outcomes of endovascular aneurysm repair in patients with severe infrarenal neck angulation (SNA ≥ 60°) vs non-severe neck angulation (NSNA). Outcome measures included perioperative complications, type 1a endoleak, neck-related secondary procedures, stent graft migration, aneurysm rupture, increase (>5mm) in sac diameter, all-cause and aneurysm-related mortality (PROSPERO Nr.: CRD42021233253). Results: Six observational studies reporting on 5981 patients (1457 with SNA and 4524 with NSNA) with a weighted mean follow-up period of 1.8 years were included. EVAR in SNA compared with NSNA was associated with a higher rate of type 1a endoleak at 30 days (4.0% vs 1.8%; p< 0.00001), at 1 year (2.8% vs 1.9%; p<0.03), at 2 years (4.9% vs 2.1%; p< 0.0002), at 3 years (5.6% vs 2.6%; p< 0.0001). The rate of neck-related secondary procedures was significantly higher at 1 year (6.6% vs 3.9%; p<0.05) and at 3 years (13.1% vs 9%; p<0.05). Graft migration, aneurysm sack increase, aneurysm rupture and all-cause mortality were not statistically different at mid-term. Conclusions: The use of EVAR in severely angulated infrarenal aortic necks is associated with a high rate of early and mid-term complications. However, aortic related and all-causes mortality are not higher compared to patients with NSNA. Therefore, EVAR should be cautiously used in patients with SNA.
MeSH term(s)	Aortic Aneurysm, Abdominal/mortality ; Aortic Aneurysm, Abdominal/pathology ; Aortic Aneurysm, Abdominal/surgery ; Endovascular Procedures/adverse effects ; Endovascular Procedures/mortality ; Humans ; Postoperative Complications ; Treatment Outcome
Language	English
Publishing date	2022-02-24
Publishing country	United States
Document type	Journal Article ; Meta-Analysis ; Systematic Review
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0264327
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Article ; Online: Long-term Results of Angulated Versus Hyperangulated Neck in Endovascular Aneurysm Repair With Endurant Endoprosthesis.

Özdemir-van Brunschot, Denise M D / Torsello, Giovanni Battista / Bernardini, Giulia / Litterscheid, Sarah / Torsello, Giovanni Frederico / Beropoulis, Efthymios

Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists

2022 Volume 30, Issue 1, Page(s) 91–97

Abstract: Purpose: Patients with a hyperangulated (>60°) proximal aortic neck and at high risk of open surgery have been treated with endovascular aortic repair (EVAR). However, long-term outcomes are not well reported. The aim of this study is to compare the ... ...

Abstract	Purpose: Patients with a hyperangulated (>60°) proximal aortic neck and at high risk of open surgery have been treated with endovascular aortic repair (EVAR). However, long-term outcomes are not well reported. The aim of this study is to compare the technical and clinical success of EVAR in angulated (45°-60°) and hyperangulated (>60°) proximal neck angulation. Materials and methods: The data of all consecutive patients undergoing EVAR treated between November 2007 and February 2020 were collected. A retrospective analysis of this prospective database was performed. The primary measure outcome was technical and clinical success. In addition, we evaluated sack evolution, type IA endoleak, secondary procedures, aneurysm rupture, mortality, aneurysm-related mortality, and migration. Results: In all, 246 of 1353 EVAR patients presented with an angulation of the proximal neck >45°, 130 patients presented with an infrarenal angulation >60°, while 116 patients had an angulation between 45° and 60°. Patients with a hyperangulated infrarenal aortic neck were significantly more often women (8.6% vs 26.9%), older (73.9 vs 76.7 years), and had less often diabetes mellitus (20.7% vs 10.8%). Suprarenal neck angulation and reversed tapered neck were significantly more frequent in the hyperangulated group so that propensity scores were generated using these anatomical parameters to create a matched cohort group. No significant differences in technical (87.9% vs 94.8%) and clinical success (66.4% vs 69.8%) were observed. After a mean clinical follow-up of 58.9 months significantly more secondary procedures were performed in the hyperangulated group (23.3% vs 12.9% p=0.04); however, neck-related secondary procedures were comparable (1.7% vs 6.0%; p=0.09). Also, all-cause and aneurysm-related mortality, sack evolution, type IA endoleak, aneurysm rupture, and migration were comparable for both groups. Conclusion: Compared with less angulated proximal aortic neck, hyperangulated neck anatomy did not reduce the technical and clinical success of EVAR but increased the risk of secondary procedures. In patients who are not good candidates for open surgery, EVAR is a reasonable alternative.
MeSH term(s)	Humans ; Female ; Blood Vessel Prosthesis/adverse effects ; Blood Vessel Prosthesis Implantation/adverse effects ; Retrospective Studies ; Aortic Aneurysm, Abdominal/diagnostic imaging ; Aortic Aneurysm, Abdominal/surgery ; Aortic Aneurysm, Abdominal/complications ; Endovascular Aneurysm Repair ; Endoleak/diagnostic imaging ; Endoleak/etiology ; Stents/adverse effects ; Treatment Outcome ; Risk Factors ; Endovascular Procedures/adverse effects ; Aortography/methods ; Time Factors
Language	English
Publishing date	2022-01-31
Publishing country	United States
Document type	Journal Article
ZDB-ID	2006618-1
ISSN	1545-1550 ; 1526-6028
ISSN (online)	1545-1550
ISSN	1526-6028
DOI	10.1177/15266028221075228
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