Impact of Stent Graft Design on External Iliac Artery Limb Occlusion Rates After Endovascular Aneurysm Repair: Post-hoc Analysis of a Japanese Multicentre Database
It was hypothesised that a helical stent with expanded polytetrafluoroethylene (ePTFE) grafts could provide a preventive effect for external iliac artery (EIA) limb occlusion following endovascular aortic aneurysm repair (EVAR). Therefore, a post-hoc analysis of a Japanese multicentre database was c...
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| Veröffentlicht in: | European journal of vascular and endovascular surgery 2019-12, Vol.58 (6), p.839-847 |
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| creator | Shintani, Tsunehiro Obara, Hideaki Matsubara, Kentaro Hayashi, Keita Hayashi, Masanori Ono, Shigeshi Shimogawara, Tatsuya Shibutani, Shintaro Watada, Susumu Sekimoto, Yasuhito Uchida, Norio Asami, Atsunori Fujii, Taku Harada, Hirohisa Fujimura, Naoki Sato, Yasunori Kitagawa, Yuko |
| description | It was hypothesised that a helical stent with expanded polytetrafluoroethylene (ePTFE) grafts could provide a preventive effect for external iliac artery (EIA) limb occlusion following endovascular aortic aneurysm repair (EVAR). Therefore, a post-hoc analysis of a Japanese multicentre database was conducted to assess the impact of the stent graft design on EIA limb occlusion rates.
Patients who underwent EVAR with EIA limb deployment between 2008 and 2016 were evaluated. The stent graft limbs were divided into two groups: group A comprised stent graft limbs made of a helical stent with ePTFE grafts (Excluder; n = 255), and group B comprised stent graft limbs made of a Z stent with polyester grafts (Zenith, Flex and Endurant; n = 173). The main outcome was the incidence of limb occlusion and severe limb stenosis (EIA related limb complications). The risk factors for EIA related limb complications were analysed and the midterm results between groups A and B compared. Fine–Gray generalisation of the proportional hazards model was used after propensity score matching to calculate the hazard ratio (HR).
One complication occurred in group A and 10 complications occurred in group B. The risk factors for EIA related limb complications for the entire group were a stent graft limb size ≤10 mm (HR 5.41; p = .01) and inclusion in group B (HR 14.9; p = .009). After propensity matching, group A (n = 159) was matched with group B (n = 159). The cumulative incidence function of EIA related limb complications at five years was 0.66% in group A and 7.8% in group B (HR 8.67; p = .039).
Stent graft design can affect limb patency in EIA limb deployment. When EIA limb deployment is necessary for patients with a small EIA, such as Japanese patients, stent graft limbs made of a helical stent with ePTFE should be used to reduce the risk of limb occlusion. |
| doi_str_mv | 10.1016/j.ejvs.2019.03.025 |
| format | Article |
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Patients who underwent EVAR with EIA limb deployment between 2008 and 2016 were evaluated. The stent graft limbs were divided into two groups: group A comprised stent graft limbs made of a helical stent with ePTFE grafts (Excluder; n = 255), and group B comprised stent graft limbs made of a Z stent with polyester grafts (Zenith, Flex and Endurant; n = 173). The main outcome was the incidence of limb occlusion and severe limb stenosis (EIA related limb complications). The risk factors for EIA related limb complications were analysed and the midterm results between groups A and B compared. Fine–Gray generalisation of the proportional hazards model was used after propensity score matching to calculate the hazard ratio (HR).
One complication occurred in group A and 10 complications occurred in group B. The risk factors for EIA related limb complications for the entire group were a stent graft limb size ≤10 mm (HR 5.41; p = .01) and inclusion in group B (HR 14.9; p = .009). After propensity matching, group A (n = 159) was matched with group B (n = 159). The cumulative incidence function of EIA related limb complications at five years was 0.66% in group A and 7.8% in group B (HR 8.67; p = .039).
Stent graft design can affect limb patency in EIA limb deployment. When EIA limb deployment is necessary for patients with a small EIA, such as Japanese patients, stent graft limbs made of a helical stent with ePTFE should be used to reduce the risk of limb occlusion.</description><identifier>ISSN: 1078-5884</identifier><identifier>EISSN: 1532-2165</identifier><identifier>DOI: 10.1016/j.ejvs.2019.03.025</identifier><identifier>PMID: 31607678</identifier><language>eng</language><publisher>England: Elsevier B.V</publisher><subject>Abdominal aortic aneurysm ; Aged ; Aged, 80 and over ; Aortic Aneurysm, Abdominal - surgery ; Arterial Occlusive Diseases - diagnostic imaging ; Arterial Occlusive Diseases - epidemiology ; Arterial Occlusive Diseases - etiology ; Blood Vessel Prosthesis - adverse effects ; Computed Tomography Angiography ; EIA limb occlusion ; Endovascular aortic aneurysm repair ; Endovascular Procedures - adverse effects ; Endovascular Procedures - instrumentation ; Female ; Follow-Up Studies ; Graft Occlusion, Vascular - diagnostic imaging ; Graft Occlusion, Vascular - epidemiology ; Graft Occlusion, Vascular - etiology ; Humans ; Iliac Artery - diagnostic imaging ; Iliac Artery - pathology ; Imaging, Three-Dimensional ; Japan - epidemiology ; Japanese ; Lower Extremity ; Male ; Prospective Studies ; Prosthesis Design - adverse effects ; Risk Assessment ; Risk Factors ; Stents - adverse effects ; Treatment Outcome</subject><ispartof>European journal of vascular and endovascular surgery, 2019-12, Vol.58 (6), p.839-847</ispartof><rights>2019 European Society for Vascular Surgery</rights><rights>Copyright © 2019 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c466t-a89a97e528f89a19f51146b9b5120a9b428acb765292b9178cc810d4efc94d733</citedby><cites>FETCH-LOGICAL-c466t-a89a97e528f89a19f51146b9b5120a9b428acb765292b9178cc810d4efc94d733</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1078588419302059$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31607678$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Shintani, Tsunehiro</creatorcontrib><creatorcontrib>Obara, Hideaki</creatorcontrib><creatorcontrib>Matsubara, Kentaro</creatorcontrib><creatorcontrib>Hayashi, Keita</creatorcontrib><creatorcontrib>Hayashi, Masanori</creatorcontrib><creatorcontrib>Ono, Shigeshi</creatorcontrib><creatorcontrib>Shimogawara, Tatsuya</creatorcontrib><creatorcontrib>Shibutani, Shintaro</creatorcontrib><creatorcontrib>Watada, Susumu</creatorcontrib><creatorcontrib>Sekimoto, Yasuhito</creatorcontrib><creatorcontrib>Uchida, Norio</creatorcontrib><creatorcontrib>Asami, Atsunori</creatorcontrib><creatorcontrib>Fujii, Taku</creatorcontrib><creatorcontrib>Harada, Hirohisa</creatorcontrib><creatorcontrib>Fujimura, Naoki</creatorcontrib><creatorcontrib>Sato, Yasunori</creatorcontrib><creatorcontrib>Kitagawa, Yuko</creatorcontrib><title>Impact of Stent Graft Design on External Iliac Artery Limb Occlusion Rates After Endovascular Aneurysm Repair: Post-hoc Analysis of a Japanese Multicentre Database</title><title>European journal of vascular and endovascular surgery</title><addtitle>Eur J Vasc Endovasc Surg</addtitle><description>It was hypothesised that a helical stent with expanded polytetrafluoroethylene (ePTFE) grafts could provide a preventive effect for external iliac artery (EIA) limb occlusion following endovascular aortic aneurysm repair (EVAR). Therefore, a post-hoc analysis of a Japanese multicentre database was conducted to assess the impact of the stent graft design on EIA limb occlusion rates.
Patients who underwent EVAR with EIA limb deployment between 2008 and 2016 were evaluated. The stent graft limbs were divided into two groups: group A comprised stent graft limbs made of a helical stent with ePTFE grafts (Excluder; n = 255), and group B comprised stent graft limbs made of a Z stent with polyester grafts (Zenith, Flex and Endurant; n = 173). The main outcome was the incidence of limb occlusion and severe limb stenosis (EIA related limb complications). The risk factors for EIA related limb complications were analysed and the midterm results between groups A and B compared. Fine–Gray generalisation of the proportional hazards model was used after propensity score matching to calculate the hazard ratio (HR).
One complication occurred in group A and 10 complications occurred in group B. The risk factors for EIA related limb complications for the entire group were a stent graft limb size ≤10 mm (HR 5.41; p = .01) and inclusion in group B (HR 14.9; p = .009). After propensity matching, group A (n = 159) was matched with group B (n = 159). The cumulative incidence function of EIA related limb complications at five years was 0.66% in group A and 7.8% in group B (HR 8.67; p = .039).
Stent graft design can affect limb patency in EIA limb deployment. When EIA limb deployment is necessary for patients with a small EIA, such as Japanese patients, stent graft limbs made of a helical stent with ePTFE should be used to reduce the risk of limb occlusion.</description><subject>Abdominal aortic aneurysm</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Aortic Aneurysm, Abdominal - surgery</subject><subject>Arterial Occlusive Diseases - diagnostic imaging</subject><subject>Arterial Occlusive Diseases - epidemiology</subject><subject>Arterial Occlusive Diseases - etiology</subject><subject>Blood Vessel Prosthesis - adverse effects</subject><subject>Computed Tomography Angiography</subject><subject>EIA limb occlusion</subject><subject>Endovascular aortic aneurysm repair</subject><subject>Endovascular Procedures - adverse effects</subject><subject>Endovascular Procedures - instrumentation</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Graft Occlusion, Vascular - diagnostic imaging</subject><subject>Graft Occlusion, Vascular - epidemiology</subject><subject>Graft Occlusion, Vascular - etiology</subject><subject>Humans</subject><subject>Iliac Artery - diagnostic imaging</subject><subject>Iliac Artery - pathology</subject><subject>Imaging, Three-Dimensional</subject><subject>Japan - epidemiology</subject><subject>Japanese</subject><subject>Lower Extremity</subject><subject>Male</subject><subject>Prospective Studies</subject><subject>Prosthesis Design - adverse effects</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Stents - adverse effects</subject><subject>Treatment Outcome</subject><issn>1078-5884</issn><issn>1532-2165</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU1v1DAQhiMEoh_wBzggH7kk2E6cOIjLqt2WRVsVFThbE2cCXuULj7Nif0__KF5t4cjJY_mdZ8Z6kuSN4Jngony_y3C3p0xyUWc8z7hUz5JzoXKZSlGq57HmlU6V1sVZckG045wrkauXyVkuSl6VlT5PHjfDDDawqWNfA46B3XroArtGcj9GNo1s_TugH6Fnm96BZSsfrwe2dUPD7q3tF3Ix9AABia26-MbWYzvtgezSg2erERd_oIE94AzOf2BfJgrpzymCIvNAjo6TgX2GGUYkZHdLH5yNi3hk1xCgAcJXyYsOesLXT-dl8v1m_e3qU7q9v91crbapLcoypKBrqCtUUnexEnWnhCjKpm6UkBzqppAabFOVStayqUWlrdWCtwV2ti7aKs8vk3cn7uynXwtSMIMji30fV5sWMjLnqqh0yUWMylPU-onIY2dm7wbwByO4OcoxO3OUY45yDM9NlBOb3j7xl2bA9l_LXxsx8PEUwPjLvUNvyDocLbbOow2mndz_-H8AUJqh2Q</recordid><startdate>201912</startdate><enddate>201912</enddate><creator>Shintani, Tsunehiro</creator><creator>Obara, Hideaki</creator><creator>Matsubara, Kentaro</creator><creator>Hayashi, Keita</creator><creator>Hayashi, Masanori</creator><creator>Ono, Shigeshi</creator><creator>Shimogawara, Tatsuya</creator><creator>Shibutani, Shintaro</creator><creator>Watada, Susumu</creator><creator>Sekimoto, Yasuhito</creator><creator>Uchida, Norio</creator><creator>Asami, Atsunori</creator><creator>Fujii, Taku</creator><creator>Harada, Hirohisa</creator><creator>Fujimura, Naoki</creator><creator>Sato, Yasunori</creator><creator>Kitagawa, Yuko</creator><general>Elsevier B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201912</creationdate><title>Impact of Stent Graft Design on External Iliac Artery Limb Occlusion Rates After Endovascular Aneurysm Repair: Post-hoc Analysis of a Japanese Multicentre Database</title><author>Shintani, Tsunehiro ; Obara, Hideaki ; Matsubara, Kentaro ; Hayashi, Keita ; Hayashi, Masanori ; Ono, Shigeshi ; Shimogawara, Tatsuya ; Shibutani, Shintaro ; Watada, Susumu ; Sekimoto, Yasuhito ; Uchida, Norio ; Asami, Atsunori ; Fujii, Taku ; Harada, Hirohisa ; Fujimura, Naoki ; Sato, Yasunori ; Kitagawa, Yuko</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c466t-a89a97e528f89a19f51146b9b5120a9b428acb765292b9178cc810d4efc94d733</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Abdominal aortic aneurysm</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Aortic Aneurysm, Abdominal - surgery</topic><topic>Arterial Occlusive Diseases - diagnostic imaging</topic><topic>Arterial Occlusive Diseases - epidemiology</topic><topic>Arterial Occlusive Diseases - etiology</topic><topic>Blood Vessel Prosthesis - adverse effects</topic><topic>Computed Tomography Angiography</topic><topic>EIA limb occlusion</topic><topic>Endovascular aortic aneurysm repair</topic><topic>Endovascular Procedures - adverse effects</topic><topic>Endovascular Procedures - instrumentation</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Graft Occlusion, Vascular - diagnostic imaging</topic><topic>Graft Occlusion, Vascular - epidemiology</topic><topic>Graft Occlusion, Vascular - etiology</topic><topic>Humans</topic><topic>Iliac Artery - diagnostic imaging</topic><topic>Iliac Artery - pathology</topic><topic>Imaging, Three-Dimensional</topic><topic>Japan - epidemiology</topic><topic>Japanese</topic><topic>Lower Extremity</topic><topic>Male</topic><topic>Prospective Studies</topic><topic>Prosthesis Design - adverse effects</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Stents - adverse effects</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Shintani, Tsunehiro</creatorcontrib><creatorcontrib>Obara, Hideaki</creatorcontrib><creatorcontrib>Matsubara, Kentaro</creatorcontrib><creatorcontrib>Hayashi, Keita</creatorcontrib><creatorcontrib>Hayashi, Masanori</creatorcontrib><creatorcontrib>Ono, Shigeshi</creatorcontrib><creatorcontrib>Shimogawara, Tatsuya</creatorcontrib><creatorcontrib>Shibutani, Shintaro</creatorcontrib><creatorcontrib>Watada, Susumu</creatorcontrib><creatorcontrib>Sekimoto, Yasuhito</creatorcontrib><creatorcontrib>Uchida, Norio</creatorcontrib><creatorcontrib>Asami, Atsunori</creatorcontrib><creatorcontrib>Fujii, Taku</creatorcontrib><creatorcontrib>Harada, Hirohisa</creatorcontrib><creatorcontrib>Fujimura, Naoki</creatorcontrib><creatorcontrib>Sato, Yasunori</creatorcontrib><creatorcontrib>Kitagawa, Yuko</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of vascular and endovascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Shintani, Tsunehiro</au><au>Obara, Hideaki</au><au>Matsubara, Kentaro</au><au>Hayashi, Keita</au><au>Hayashi, Masanori</au><au>Ono, Shigeshi</au><au>Shimogawara, Tatsuya</au><au>Shibutani, Shintaro</au><au>Watada, Susumu</au><au>Sekimoto, Yasuhito</au><au>Uchida, Norio</au><au>Asami, Atsunori</au><au>Fujii, Taku</au><au>Harada, Hirohisa</au><au>Fujimura, Naoki</au><au>Sato, Yasunori</au><au>Kitagawa, Yuko</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of Stent Graft Design on External Iliac Artery Limb Occlusion Rates After Endovascular Aneurysm Repair: Post-hoc Analysis of a Japanese Multicentre Database</atitle><jtitle>European journal of vascular and endovascular surgery</jtitle><addtitle>Eur J Vasc Endovasc Surg</addtitle><date>2019-12</date><risdate>2019</risdate><volume>58</volume><issue>6</issue><spage>839</spage><epage>847</epage><pages>839-847</pages><issn>1078-5884</issn><eissn>1532-2165</eissn><abstract>It was hypothesised that a helical stent with expanded polytetrafluoroethylene (ePTFE) grafts could provide a preventive effect for external iliac artery (EIA) limb occlusion following endovascular aortic aneurysm repair (EVAR). Therefore, a post-hoc analysis of a Japanese multicentre database was conducted to assess the impact of the stent graft design on EIA limb occlusion rates.
Patients who underwent EVAR with EIA limb deployment between 2008 and 2016 were evaluated. The stent graft limbs were divided into two groups: group A comprised stent graft limbs made of a helical stent with ePTFE grafts (Excluder; n = 255), and group B comprised stent graft limbs made of a Z stent with polyester grafts (Zenith, Flex and Endurant; n = 173). The main outcome was the incidence of limb occlusion and severe limb stenosis (EIA related limb complications). The risk factors for EIA related limb complications were analysed and the midterm results between groups A and B compared. Fine–Gray generalisation of the proportional hazards model was used after propensity score matching to calculate the hazard ratio (HR).
One complication occurred in group A and 10 complications occurred in group B. The risk factors for EIA related limb complications for the entire group were a stent graft limb size ≤10 mm (HR 5.41; p = .01) and inclusion in group B (HR 14.9; p = .009). After propensity matching, group A (n = 159) was matched with group B (n = 159). The cumulative incidence function of EIA related limb complications at five years was 0.66% in group A and 7.8% in group B (HR 8.67; p = .039).
Stent graft design can affect limb patency in EIA limb deployment. When EIA limb deployment is necessary for patients with a small EIA, such as Japanese patients, stent graft limbs made of a helical stent with ePTFE should be used to reduce the risk of limb occlusion.</abstract><cop>England</cop><pub>Elsevier B.V</pub><pmid>31607678</pmid><doi>10.1016/j.ejvs.2019.03.025</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1078-5884 |
| ispartof | European journal of vascular and endovascular surgery, 2019-12, Vol.58 (6), p.839-847 |
| issn | 1078-5884 1532-2165 |
| language | eng |
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| source | MEDLINE; Elsevier ScienceDirect Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Abdominal aortic aneurysm Aged Aged, 80 and over Aortic Aneurysm, Abdominal - surgery Arterial Occlusive Diseases - diagnostic imaging Arterial Occlusive Diseases - epidemiology Arterial Occlusive Diseases - etiology Blood Vessel Prosthesis - adverse effects Computed Tomography Angiography EIA limb occlusion Endovascular aortic aneurysm repair Endovascular Procedures - adverse effects Endovascular Procedures - instrumentation Female Follow-Up Studies Graft Occlusion, Vascular - diagnostic imaging Graft Occlusion, Vascular - epidemiology Graft Occlusion, Vascular - etiology Humans Iliac Artery - diagnostic imaging Iliac Artery - pathology Imaging, Three-Dimensional Japan - epidemiology Japanese Lower Extremity Male Prospective Studies Prosthesis Design - adverse effects Risk Assessment Risk Factors Stents - adverse effects Treatment Outcome |
| title | Impact of Stent Graft Design on External Iliac Artery Limb Occlusion Rates After Endovascular Aneurysm Repair: Post-hoc Analysis of a Japanese Multicentre Database |
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