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Title: The use of endovascular sealing for the treatment of abdominal aortic aneurysms
Author: Stenson, Katherine Mary
ISNI:       0000 0004 6350 6631
Awarding Body: St George's, University of London
Current Institution: St George's, University of London
Date of Award: 2017
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Endovascular aneurysm sealing (EVAS) offers a novel approach to the treatment of abdominal aortic aneurysm (AAA). Since the commercialisation of the device early in 2013. it has been used to treat infrarenal AAA. More recently, it has been used in combination with chimney grafts (Ch-EVAS) to treat supra- and juxtarenal aneurysms. As a new paradigm in endovascular aortic treatment, very little is known about the effect of EVAS on the incidence of post-implantation syndrome (PIS) and its potential ramifications. There is also no standardised protocol for assessing the three-dimensional aortic morphology before or after the EVAS procedure. This work will address these four areas. 1.2 Methods The clinical outcomes sections will involve retrospective analysis of prospectively collected data on patients undergoing the EVAS procedure and its applications. These data will include pre-, intra-, peri- and postoperative details. PIS will be assessed by evaluating the pre- and postoperative information from two groups of patients who underwent AAA repair with EVAS or EVAR. This will allow comparisons to be made regarding the incidence of PIS. Measurement protocols will be applied to pre- and post-EVAS CT scans by a set of trained observers to detect intra- and interobserver variability and to determine the accuracy and reproducibility of the protocols. 1-3 Results The results from the infrarenal EVAS study show a very high rate of technical success with low rates of unresolved endoleak, but with a worrying incidence of secondary rupture. Fewer adverse events are seen in cases where the instructions for use are adhered to. The results from the Ch-EVAS study show a very high level of technical success with low complication rates and a low stroke rate. In the PIS study, results showed that the incidence was significantly lower following EVAS when compared with EVAR. The measurement protocols yielded results that demonstrated generally low variation between observers. 1.4 Conclusion EVAS is a successful addition to the range of treatments already available for AAA. As with all endovascular treatments, it is most successful when used with the instructions for use. Its use with chimney grafts fills a particular therapeutic gap. Incidence of PIS is significantly decreased when compared with that after EVAR and this is associated with significantly shorter hospital stays. The measurement protocols allow accurate assessment of morphology and will be valuable in determining preoperative suitability for treatment and assessing postoperative performance.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available