Endologix PowerWeb System EPW?
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1 Endologix PowerWeb System EPW? Endologix PowerWeb System EPW (AAA) AAA mm 53.5mm EPWEPW 1 2 proximal neck PN 15mm 3 PN 23mm 4 distal neck DN 15mm 5 DN 23mm 6 distal landing zone DLZ 10mm 7 DLZ 6mm 8 DLZ 13mm 9 PN approach route EPW AAA 43.2 EPW PN 26mm 55.1 PN EPW device EPW system AAA Endovascular repair: ER 1 8 FDA AneuRx device Ancure device Excluder device Tel: AAA ER AAA ER Endologix PowerWeb System EPWAAA
2 13 6 AAA mm 53.5mm 155 ER 21 Table 1 EPW 1 ER 2 proximal neck PN 15mm 3 PN 23mm 4 distal neck DN 15mm 5 DN 23mm 6 distal landing zone DLZ 10mm 7 DLZ 6mm 8 DLZ 13mm PN Table 2 3 5mm spiral CT ER ER proximal neck PN 15mm PN 23mm distal neck DN 15mm 5 DN 23mm distal landing zone DLZ 10mm 7 DLZ 6mm DLZ 13mm PN EPW(Table 3) AAAER ICU AAA AAA ER Table 1 Patients characteristics Patients 176 Gender (M/F) 155 / 21 Age (y) (mean 72) Location Infrarenal abdominal 176 Iliac 0 Max. diameter (mm) (mean 53.5) Procedure Open repair / Endovascular repair 155 / 21 Table 2 Exclusion criteria for endovascular repair by EPW System 1) Occlusion of bilateral internal iliac arteries 2) Proximal neck length<15mm 3) Proximal neck diameter 23mm 4) Distal neck length<15mm 5) Distal neck diameter 23mm 6) Distal landing zone length<10mm 7) Distal landing zone diameter<6mm 8) Distal landing zone diameter 13mm 9) Proximal neck angle 60 10) Problems of approach route #6) 8); distal landing zone exist at iliac arteries Moore 11 AAA 15 aorto-uniiliac stent-graft AAA , 24 Ouriel 23 Ancure AneuRx Excluder Talent Zenith 5 AncureExcluder endoleakzenith AbuRahma 24 Ancure AneuRx Excluder 3 8
3 EPW Table 3 Primary reasons for endovascular repair ineligibility by EPW System (N=176) 1) Occlusion of bilateral internal iliac arteries : 23 cases (13.1%) 2) Proximal neck length<15mm : 14 (8.0) 3) Proximal neck diameter 23mm : 24 (13.6) 4) Distal neck length<15mm : 5) Distal neck diameter 23mm : 1 (0.6) 6) Distal landing zone length<10mm : 7) Distal landing zone diameter<6mm : 3 (1.7) 8) Distal landing zone diameter 13mm : 14 (8.0) 9) Proximal neck angle 60 : 21 (11.9) 10) Problems of approach route : 12 (6.8) #Total 100 (56.8) #6) 8); distal landing zone exist at iliac arteries including repetitive cases Ancure AAA ER 3 EPW 1 EPW AAA PN Arko AneuRx AAA PN EPW endoleak 21Fr main body 2 EPW Endologix PowerLink System PN 26mm AAA EPW PN 60 2, 4, 6 8 EPWPN EPW 2, 4, 6 8 PN 18 PN AAA EPW 50PNPN 26mm 55.1 PN 9
4 EPW PN 1 Carpenter, J. P.: Multicenter trial of the PowerLink bifurcated system for endovascular aortic aneurysm repair. J. Vasc. Surg., 36: , Hansen, C. J., Aziz, I., Kim, B. B., et al.: Results from the Endologix PowerLink multicenter trial. Seminars in Vascular Surgery, 16: , PowerWeb TM system Bush, R. L., Najibi, S., Lin, P. H., et al.: Early experience with the bifurcated Excluder endoprosthesis for treatment of the abdominal aortic aneurysm. J. Vasc. Surg., 33: , Sternbergh, W. C. III, Money, S. R., Greenberg, R. K., et al.: Influence of endograft oversizing on device migration, endoleak, aneurysm shrinkage, and aortic neck dilation: results from the Zenith multicenter trial. J. Vasc. Surg., 39: 20-26, Carpenter, J. P., Anderson, W. N., Brewster, D. C., et al.: Multicenter pivotal trial results of the Lifepath System for endovascular aortic aneurysm repair. J. Vasc. Surg., 39: 34-43, Criado, F. J., Fairman, R. M. and Becker, G. J.: Talent LPS AAA stent graft: results of a pivotal clinical trial. J. Vasc. Surg., 37: , Ayerdi, J., McLafferty, R. B., Markwell, S.J., et al.: Indications and outcomes of AneuRx Phase III Trial versus use of commercial AneuRx stent graft. J. Vasc. Surg., 37: , Terramani, T. T., Chaikof, E. L., Rayan, S. S., et al.: Secondary conversion due to failed endovascular abdominal aortic aneurysm repair. J. Vasc. Surg., 38: , Elkouri, S., Martelli, E., Gloviczki, P., et al.: Most patients with abdominal aortic aneurysm are not suitable for endovascular repair using currently approved bifurcated stent-grafts. J. Endovasc. Ther., 10: I-16, Moore, W. S. and Rutherford, R. B.: Transfemoral endovascular repair of abdominal aortic aneurysm: results of the North American EVT phase 1 trial. J. Vasc. Surg., 23: , Moritz, J. D., Rotermund, S., Keating, D. P., et al.: Infrarenal abdominal aortic aneurysms: implications of CT evaluation of size and configuration for placement of endovascular aortic grafts. Radiology, 198: , Bayle, O., Branchereau, A., Rosset, E., et al.: Morphologic assessment of abdominal aortic aneurysms by spiral computed tomographic scanning. J. Vasc. Surg., 26: , Chuter, T. A. M., Green, R. M., Ouriel, K., et al.: Infrarenal aortic aneurysm structure: implications for transfemoral repair. J. Vasc. Surg., 20: 44-50, Balm, R., Stokking, R., Kaatee, R., et al.: Computed tomographic angiographic imaging of abdominal aortic aneurysms: implications for transfemoral endovascular aneurysm management. J. Vasc. Surg., 26: , Schumacher, H., Eckstein, H. H., Kallinowski, F., et al.: Morphometry and classification in abdominal aortic aneurysms: patient selection for endovascular and open surgery. J. Endovasc. Surg., 4: 39-44, Wolf, Y. G., Fogarty, T. J., Olcott, C. IV, et al.: Endovascular repair of abdominal aortic aneurysms: eligibility rate and impact on the rate of open repair. J. Vasc. Surg., 32: , Arko, F. R., Filis, K. A., Seidel, S. A., et al.: How many patients with infrarenal aneurysms are candidates for endovascular repair? The northern California experience. J. Endovasc. Ther., 11: 33-40, Hill, B. B., Wolf, Y. G., Lee, W. A., et al.: Open versus endovascular AAA repair in patients who are morphological candidates for endovascular treatment. J. Endovasc. Ther., 9: , Arko, F. R., Hill, B. B., Olcott, C. IV, et al.: Endovascular repair reduces early and late morbidity compared to open surgery for abdominal aortic aneurysm. J. Endovasc. Ther., 9: , Ouriel, K., Clair, D. G., Greenberg, R. K., et al.: Endovascular repair of abdominal aortic aneurysms: de- 10
5 EPW vice-specific outcome. J. Vasc. Surg., 37: , AbuRahma, A. F.: Endovascular repair of abdominal aortic aneurysms using 3 commercially available devices: midterm results. J. Endovasc. Ther., 11: I-2, How Many Patients with Abdominal Aortic Aneurysm are Suitable for Endovascular Repair using an Endologix PowerWeb System (EPW)? Hirofumi Midorikawa, Tomohiro Ogawa, Kouichi Satou and Shunichi Hoshino Cardiovascular Center, Fukushima Daiichi Hospital Key words: Abdominal aortic aneurysm, Stent-graft, EPW system We report how many patients with abdominal aortic aneurysm (AAA) will be suitable for endovascular repair using Endologix PowerWeb System (EPW). We enrolled 176 patients with non-ruptured infrarenal AAA between July 1993 and November 2003 in our center. Exclusion criteria were as follows; 1) occlusion of bilateral internal iliac arteries due to endovascular repair, 2) proximal neck (PN) length < 15mm, 3) PN diameter 23mm, 4) distal neck (DN) length < 15mm, 5) DN diameter 23mm, 6) distal landing zone (DLZ) length < 10mm, 7) DLZ diameter < 6mm, 8) DLZ diameter 13mm, 9) PN angle 60, 10) problems of approach route. The reasons for ineligibility was 1) in 23 (13.1%) patients, 2) in 14 (8.0), 3) in 24 (13.6), 5) in 1 (0.6), 7) in 3 (1.7), 8) in 14 (8.0), 9) in 21 (11.9) and 10) in 12 (6.8). AAAs were morphologically suitable for an EPW in 76 patients (43.2%). The main reason for exclusion from EPW was an inadequate proximal aortic neck. This study shows that changes in the proximal size of devices and the improvement of proximal attachment techniques will be very important to increase the number of suitable cases for endovascular repair using EPW. Jpn. J. Vasc. Surg., 13: ,
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