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Master Thesis

Évaluation mono-centrique du traitement des Anévrysmes Aortiques Abdominaux juxta-rénaux par voie endovasculaire

Abstract : The objective was to evaluate anatomic characteristics and midterm results of juxta-renal abdominal aortic aneurysm endovascular repair (JR-AAA) by fenestrated grafts (F-EVAR) or chimney grafts (C-EVAR) in patients contraindicated for open surgery. 121 consecutive patients were included in the CHU Bordeaux, from January 2010 to January 2015, 90 F-EVAR (88 men) and 31 C-EVAR (26 men with 13% treated on emergent setting (p=0.001)). Mean age was 71.33 versus (vs.) 75.26 respectively (p=0.021). Mean aneurysm diameter was significantly smaller in F-EVAR (58.29±9.78 vs. 67.58±17.48 mm respectively (p=0.0004). Mean number of reconstructed target vessels per patient was significantly higher in F-EVAR (3.02±0.61 vs. 1.29±0.52 (p < 0.0001)) with 271 vessels vs. 39. Peri-operative mortality rate was significantly higher in C-EVAR with 16 vs. 3% respectively (p=0.015). Complications rates were comparable. Mean follow-up was 16.45 vs. 15.46 months with an overall survival rate of 86.2 vs. 72.2% (p=0.171), survival without reintervention of 91.9 vs. 77.7% (p=0.298), respectively with no significant difference. The target vessels overall primary patency rate was 96.6 vs. 85.3% (p=0.015) respectively. At last follow-up there was s! ignificantly more type I endoleaks (EL) in C-EVAR (14 EL (12 type II, 2 type III) vs. 7 EL (2 type I, 5 type II)). Aneurysm exclusion was found in 76.9 vs. 83.3% respectively, with no significant difference. C-EVAR presented with more type I EL and lower primary patency rates. However, complications rates, survival and survival without reintervention were comparable. C-EVAR could represent an interesting and effective alternative in the treatment of JR-AAA in emergent settings but also on elective surgery when F-EVAR seems technically challenging or contraindicated, allowing an enlargement of eligible patients for endovascular repair. However available data are still scarce and long-term results are still needed.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01187914
Contributor : Bu Carreire Université de Bordeaux <>
Submitted on : Friday, August 28, 2015 - 9:12:35 AM
Last modification on : Wednesday, August 23, 2017 - 4:41:14 PM
Long-term archiving on: : Sunday, November 29, 2015 - 10:20:34 AM

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Caroline Caradu. Évaluation mono-centrique du traitement des Anévrysmes Aortiques Abdominaux juxta-rénaux par voie endovasculaire. Médecine humaine et pathologie. 2015. ⟨dumas-01187914⟩

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