KINKING DE RAMO DE EVAR — DIAGNÓSTICO INTRA-OPERATÓRIO
DOI:
https://doi.org/10.48750/acv.231Palavras-chave:
Aneurisma da aorta abdominal, Procedimentos endovasculares, Oclusão de enxerto vascularResumo
Introdução: O kinking de ramo de endoprótese subsiste como uma das principais causas de intervenções secundárias e re-hospitalização após a reparação endovascular de aneurisma abdominal. No entanto, a importância de otimizar a permeabilidade dos ramos é pouco abordada na literatura. A própria definição de kinking não é clara, com considerável variabilidade na literatura relativamente à apresentação clínica e história natural. O objetivo deste trabalho é realizar uma revisão da literatura focada no diagnóstico intraoperatório de kinking de ramo.
Métodos: Uma revisão de literatura foi realizada na base de dados MEDLINE.
Resultados: Existem diversos métodos de imagem descritos na literatura para diagnóstico de kinking de ramo, com vantagens e desvantagens. A angiografia final é realizada por rotina após a remoção de fios-guia rígidos, mas é considerada um método inadequado de determinar ramos de endoprótese em risco de kinking/trombose. A tomografia computadorizada de feixe cónico demonstrou ser uma opção viável tanto para planeamento de EVAR como para avaliação final intraoperatória para detetar complicações desvalorizadas na angiografia final. O EcoDoppler, a medição de gradiente de pressão e a ultrassonografia intravascular também foram propostas como adjuvantes na avaliação intraoperatória de ramos de endoprótese.
Discussão: A padronização dos critérios para o diagnóstico de kinking hemodinamicamente significativo é necessária para definir os doentes que poderão beneficiar de intervenções adicionais para reduzir o risco de trombose de ramo. São necessários mais estudos para aumentar a consciencialização para esta complicação, que pode levar à trombose de ramo de EVAR e à perda de membro, a fim de estabelecer um diagnóstico e um protocolo de follow-up adequados.
Downloads
Não há dados estatísticos.
Referências
1. Georgakarakos E, Raptis A, Schoretsanitis N, Bisdas T, Beropoulis E, Georgiadis GS, et al. Studying the interaction of stent-grafts and treated abdominal aortic aneurysms: time to move caudally! J Endovasc Ther. 2015;22(3):413-20. doi: 10.1177/1526602815583494.
2. Ronsivalle S, Faresin F, Franz F, Pedon L, Rettore C, Zonta L, et al. A new management for limb graft occlusion after endovascular aneurysm repair adding a vollmar ring stripper: the unclogging technique. Ann Vasc Surg. 2013;27(8):1216-22. doi: 10.016/j.avsg.2013.02.018. Epub Sep 5.
3. van Zeggeren L, Bastos Goncalves F, van Herwaarden JA, Zandvoort HJ, Werson DA, Vos JA, et al. Incidence and treatment results of Endurant endograft occlusion. J Vasc Surg. 2013;57(5):1246-54; discussion 54. doi: 10.016/j.jvs.2012.11.069. Epub 3 Feb 6.
4. Hallett JW, Jr., Marshall DM, Petterson TM, Gray DT, Bower TC, Cherry KJ, Jr., et al. Graft-related complications after abdominal aortic aneurysm repair: reassurance from a 36-year population-based experience. Journal of vascular surgery. 1997;25(2):277-84; discussion 85-6.
5. Hertzer NR, Mascha EJ, Karafa MT, O'Hara PJ, Krajewski LP, Beven EG. Open infrarenal abdominal aortic aneurysm repair: the Cleveland Clinic experience from 1989 to 1998. Journal of vascular surgery. 2002;35(6):1145-54.
6. Coulston J, Baigent A, Selvachandran H, Jones S, Torella F, Fisher R. Lack of Iliac Engagement Correlates With Iliac Limb Complications Following Standard EVAR. Vasc Endovascular Surg. 2015;49(7):201-5. doi: 10.1177/1538574415614403. Epub 2015 Oct 29.
7. Koutouzi G, Pfister M, Breininger K, Hellstrom M, Roos H, Falkenberg M. Iliac artery deformation during EVAR. Vascular. 2019:1708538119840565.
8. Bianchini Massoni C, Gargiulo M, Giovanetti F, Freyrie A, Faggioli G, Gallitto E, et al. Adjunctive stenting of endograft limbs during endovascular treatment of infrarenal aortic and iliac aneurysms according to 3-projection completion angiography. Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists. 2011;18(4):585-90.
9. Oshin OA, Fisher RK, Williams LA, Brennan JA, Gilling-Smith GL, Vallabhaneni SR, et al. Adjunctive iliac stents reduce the risk of stent-graft limb occlusion following endovascular aneurysm repair with the Zenith stent-graft. J Endovasc Ther. 2010;17(1):108-14. doi: 10.1583/09-2854.1.
10. Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery. 2007;33 Suppl 1:S1-75.
11. Sivamurthy N, Schneider DB, Reilly LM, Rapp JH, Skovobogatyy H, Chuter TA. Adjunctive primary stenting of Zenith endograft limbs during endovascular abdominal aortic aneurysm repair: implications for limb patency. J Vasc Surg. 2006;43(4):662-70. doi: 10.1016/j.jvs.2005.11.044.
12. Schulz CJ, Schmitt M, Bockler D, Geisbusch P. Intraoperative contrast-enhanced cone beam computed tomography to assess technical success during endovascular aneurysm repair. Journal of vascular surgery. 2016;64(3):577-84.
13. Tornqvist P, Dias N, Sonesson B, Kristmundsson T, Resch T. Intra-operative cone beam computed tomography can help avoid reinterventions and reduce CT follow up after infrarenal EVAR. Eur J Vasc Endovasc Surg. 2015;49(4):390-5. doi: 10.1016/j.ejvs.2015.01.009. Epub Feb 27.
14. White RA, Donayre C, Kopchok G, Walot I, Wilson E, de Virgilio C. Intravascular ultrasound: the ultimate tool for abdominal aortic aneurysm assessment and endovascular graft delivery. J Endovasc Surg. 1997;4(1):45-55.
15. Amesur NB, Zajko AB, Orons PD, Makaroun MS. Endovascular treatment of iliac limb stenoses or occlusions in 31 patients treated with the ancure endograft. Journal of vascular and interventional radiology : JVIR. 2000;11(4):421-8.
16. Mazzaccaro D, Farina A, Petsos K, Nano G. The Role of Duplex Ultrasound in Detecting Graft Thrombosis and Endoleak after Endovascular Aortic Repair for Abdominal Aneurysm. Annals of vascular surgery. 2018;52:22-9.
17. Harrison GJ, Oshin OA, Vallabhaneni SR, Brennan JA, Fisher RK, McWilliams RG. Surveillance after EVAR based on duplex ultrasound and abdominal radiography. European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery. 2011;42(2):187-92.
18. Coulston J, Baigent A, Selvachandran H, Jones S, Torella F, Fisher R. The impact of endovascular aneurysm repair on aortoiliac tortuosity and its use as a predictor of iliac limb complications. Journal of vascular surgery. 2014;60(3):585-9.
19. Blom AS, Troutman D, Beeman B, Yarchoan M, Dougherty MJ, Calligaro KD. Duplex ultrasound imaging to detect limb stenosis or kinking of endovascular device. J Vasc Surg. 2012;55(6):1577-80. doi: 10.016/j.jvs.2011.12.058. Epub 2 Feb 16.
20. Karthikesalingam A, Kumar S, Anandarajah JJ, Hinchliffe RJ, Poloniecki JD, Thompson MM, et al. Predictive value of peak systolic velocity for the development of graft limb complications after endovascular aneurysm repair. J Endovasc Ther. 2012;19(3):428-33. doi: 10.1583/11-3739MR.1.
21. Chaikof EL, Brewster DC, Dalman RL, Makaroun MS, Illig KA, Sicard GA, et al. The care of patients with an abdominal aortic aneurysm: the Society for Vascular Surgery practice guidelines. Journal of vascular surgery. 2009;50(4 Suppl):S2-49.
22. Wanhainen A, Verzini F, Van Herzeele I, Allaire E, Bown M, Cohnert T, et al. European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery. 2018.
23. Cochennec F, Becquemin JP, Desgranges P, Allaire E, Kobeiter H, Roudot-Thoraval F. Limb graft occlusion following EVAR: clinical pattern, outcomes and predictive factors of occurrence. European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery. 2007;34(1):59-65.
24. Torsello G, Troisi N, Tessarek J, Torsello GF, Dorigo W, Pulli R, et al. Endovascular aortic aneurysm repair with the Endurant stent-graft: early and 1-year results from a European multicenter experience. Journal of vascular and interventional radiology : JVIR. 2010;21(1):73-80.
25. Carpenter JP, Neschis DG, Fairman RM, Barker CF, Golden MA, Velazquez OC, et al. Failure of endovascular abdominal aortic aneurysm graft limbs. J Vasc Surg. 2001;33(2):296-302; discussion -3. doi: 10.1067/mva.2001.112700.
26. Fairman RM, Baum RA, Carpenter JP, Deaton DH, Makaroun MS, Velazquez OC, et al. Limb interventions in patients undergoing treatment with an unsupported bifurcated aortic endograft system: a review of the Phase II EVT Trial. Journal of vascular surgery. 2002;36(1):118-26.
2. Ronsivalle S, Faresin F, Franz F, Pedon L, Rettore C, Zonta L, et al. A new management for limb graft occlusion after endovascular aneurysm repair adding a vollmar ring stripper: the unclogging technique. Ann Vasc Surg. 2013;27(8):1216-22. doi: 10.016/j.avsg.2013.02.018. Epub Sep 5.
3. van Zeggeren L, Bastos Goncalves F, van Herwaarden JA, Zandvoort HJ, Werson DA, Vos JA, et al. Incidence and treatment results of Endurant endograft occlusion. J Vasc Surg. 2013;57(5):1246-54; discussion 54. doi: 10.016/j.jvs.2012.11.069. Epub 3 Feb 6.
4. Hallett JW, Jr., Marshall DM, Petterson TM, Gray DT, Bower TC, Cherry KJ, Jr., et al. Graft-related complications after abdominal aortic aneurysm repair: reassurance from a 36-year population-based experience. Journal of vascular surgery. 1997;25(2):277-84; discussion 85-6.
5. Hertzer NR, Mascha EJ, Karafa MT, O'Hara PJ, Krajewski LP, Beven EG. Open infrarenal abdominal aortic aneurysm repair: the Cleveland Clinic experience from 1989 to 1998. Journal of vascular surgery. 2002;35(6):1145-54.
6. Coulston J, Baigent A, Selvachandran H, Jones S, Torella F, Fisher R. Lack of Iliac Engagement Correlates With Iliac Limb Complications Following Standard EVAR. Vasc Endovascular Surg. 2015;49(7):201-5. doi: 10.1177/1538574415614403. Epub 2015 Oct 29.
7. Koutouzi G, Pfister M, Breininger K, Hellstrom M, Roos H, Falkenberg M. Iliac artery deformation during EVAR. Vascular. 2019:1708538119840565.
8. Bianchini Massoni C, Gargiulo M, Giovanetti F, Freyrie A, Faggioli G, Gallitto E, et al. Adjunctive stenting of endograft limbs during endovascular treatment of infrarenal aortic and iliac aneurysms according to 3-projection completion angiography. Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists. 2011;18(4):585-90.
9. Oshin OA, Fisher RK, Williams LA, Brennan JA, Gilling-Smith GL, Vallabhaneni SR, et al. Adjunctive iliac stents reduce the risk of stent-graft limb occlusion following endovascular aneurysm repair with the Zenith stent-graft. J Endovasc Ther. 2010;17(1):108-14. doi: 10.1583/09-2854.1.
10. Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery. 2007;33 Suppl 1:S1-75.
11. Sivamurthy N, Schneider DB, Reilly LM, Rapp JH, Skovobogatyy H, Chuter TA. Adjunctive primary stenting of Zenith endograft limbs during endovascular abdominal aortic aneurysm repair: implications for limb patency. J Vasc Surg. 2006;43(4):662-70. doi: 10.1016/j.jvs.2005.11.044.
12. Schulz CJ, Schmitt M, Bockler D, Geisbusch P. Intraoperative contrast-enhanced cone beam computed tomography to assess technical success during endovascular aneurysm repair. Journal of vascular surgery. 2016;64(3):577-84.
13. Tornqvist P, Dias N, Sonesson B, Kristmundsson T, Resch T. Intra-operative cone beam computed tomography can help avoid reinterventions and reduce CT follow up after infrarenal EVAR. Eur J Vasc Endovasc Surg. 2015;49(4):390-5. doi: 10.1016/j.ejvs.2015.01.009. Epub Feb 27.
14. White RA, Donayre C, Kopchok G, Walot I, Wilson E, de Virgilio C. Intravascular ultrasound: the ultimate tool for abdominal aortic aneurysm assessment and endovascular graft delivery. J Endovasc Surg. 1997;4(1):45-55.
15. Amesur NB, Zajko AB, Orons PD, Makaroun MS. Endovascular treatment of iliac limb stenoses or occlusions in 31 patients treated with the ancure endograft. Journal of vascular and interventional radiology : JVIR. 2000;11(4):421-8.
16. Mazzaccaro D, Farina A, Petsos K, Nano G. The Role of Duplex Ultrasound in Detecting Graft Thrombosis and Endoleak after Endovascular Aortic Repair for Abdominal Aneurysm. Annals of vascular surgery. 2018;52:22-9.
17. Harrison GJ, Oshin OA, Vallabhaneni SR, Brennan JA, Fisher RK, McWilliams RG. Surveillance after EVAR based on duplex ultrasound and abdominal radiography. European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery. 2011;42(2):187-92.
18. Coulston J, Baigent A, Selvachandran H, Jones S, Torella F, Fisher R. The impact of endovascular aneurysm repair on aortoiliac tortuosity and its use as a predictor of iliac limb complications. Journal of vascular surgery. 2014;60(3):585-9.
19. Blom AS, Troutman D, Beeman B, Yarchoan M, Dougherty MJ, Calligaro KD. Duplex ultrasound imaging to detect limb stenosis or kinking of endovascular device. J Vasc Surg. 2012;55(6):1577-80. doi: 10.016/j.jvs.2011.12.058. Epub 2 Feb 16.
20. Karthikesalingam A, Kumar S, Anandarajah JJ, Hinchliffe RJ, Poloniecki JD, Thompson MM, et al. Predictive value of peak systolic velocity for the development of graft limb complications after endovascular aneurysm repair. J Endovasc Ther. 2012;19(3):428-33. doi: 10.1583/11-3739MR.1.
21. Chaikof EL, Brewster DC, Dalman RL, Makaroun MS, Illig KA, Sicard GA, et al. The care of patients with an abdominal aortic aneurysm: the Society for Vascular Surgery practice guidelines. Journal of vascular surgery. 2009;50(4 Suppl):S2-49.
22. Wanhainen A, Verzini F, Van Herzeele I, Allaire E, Bown M, Cohnert T, et al. European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery. 2018.
23. Cochennec F, Becquemin JP, Desgranges P, Allaire E, Kobeiter H, Roudot-Thoraval F. Limb graft occlusion following EVAR: clinical pattern, outcomes and predictive factors of occurrence. European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery. 2007;34(1):59-65.
24. Torsello G, Troisi N, Tessarek J, Torsello GF, Dorigo W, Pulli R, et al. Endovascular aortic aneurysm repair with the Endurant stent-graft: early and 1-year results from a European multicenter experience. Journal of vascular and interventional radiology : JVIR. 2010;21(1):73-80.
25. Carpenter JP, Neschis DG, Fairman RM, Barker CF, Golden MA, Velazquez OC, et al. Failure of endovascular abdominal aortic aneurysm graft limbs. J Vasc Surg. 2001;33(2):296-302; discussion -3. doi: 10.1067/mva.2001.112700.
26. Fairman RM, Baum RA, Carpenter JP, Deaton DH, Makaroun MS, Velazquez OC, et al. Limb interventions in patients undergoing treatment with an unsupported bifurcated aortic endograft system: a review of the Phase II EVT Trial. Journal of vascular surgery. 2002;36(1):118-26.
Downloads
Publicado
2020-08-05
Como Citar
1.
Coelho A, Lobo M, Nogueira C, Campos J, Augusto R, Coelho N, et al. KINKING DE RAMO DE EVAR — DIAGNÓSTICO INTRA-OPERATÓRIO. Angiol Cir Vasc [Internet]. 5 de agosto de 2020 [citado 8 de janeiro de 2026];16(2):87-91. Disponível em: https://acvjournal.com/index.php/acv/article/view/231
Edição
Secção
Artigo de Revisão
