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Snorkel graft

Brant W Ullery, Ga-Young Suh, John J Kim, Jason T Lee, Ronald L Dalman, Christopher P Cheng
INTRODUCTION: Aneurysm regression and target vessel patency during early and mid-term follow-up may be related to the effect of stent graft configuration on the anatomy. We quantified geometry and remodeling of the renal arteries and aneurysm following fenestrated (F-) or snorkel/chimney (Sn-) endovascular aneurysm repair (EVAR). METHODS: 29 patients (mean age, 76.8±7.8 years) treated with F- or Sn-EVAR underwent computed tomography angiography at pre-op, post-op, and follow-up...
April 5, 2017: Annals of Vascular Surgery
Adam Tanious, Mathew Wooster, Andrew Jung, Peter R Nelson, Martin R Back, Murray L Shames
BACKGROUND: Proximal fixation loss following endovascular aortic aneurysm repair (EVAR) creates a clinical dilemma. Typically, endovascular salvage requires adequate aortic neck below the renal arteries, in cases with no infrarenal neck proximal extension into the paravisceral aorta using parallel grafts provides an alternative to open graft explant. We present our experience at a tertiary care center with endovascular management of proximal fixation loss following EVAR using parallel stent grafting techniques to preserve renal and visceral branches...
March 1, 2017: Annals of Vascular Surgery
Tao Ma, Zhi Hui Dong, Wei Guo Fu, Bin Chen, Jun Hao Jiang, Yun Shi
We report a reoperation case of a ruptured infectious aortic arch pseudoaneurysm, which was stabilized with thoracic endovascular aortic repair and snorkel bypass of the innominate artery (IA) and the left common carotid artery (LCCA). A 57-year-old Chinese woman with multiple comorbidities and previous open repair for Stanford type A aortic dissection 5 years ago presented with a ruptured 10.7 cm × 7.3 cm aortic arch pseudoaneurysm involving the origins of the LCCA and the left subclavian artery. The patient underwent emergent endovascular aortic repair with placement of a stent graft in both IA and left carotid artery coursing parallel to the aortic arch endograft...
May 2017: Annals of Vascular Surgery
Mathew Wooster, Bruce Zwiebel, Martin Back, Murray Shames
BACKGROUND: Although fenestrated and branched devices for juxtarenal and paravisceral aneurysms are available worldwide, limited ultrasound availability has perpetuated widespread utilization of adjunctive techniques for the endovascular treatment of these aneurysms. The objective of the study is to report on the technical feasibility and short-term durability of parallel grafts for juxtarenal and paravisceral aneurysms. METHODS: We performed a retrospective review of a prospectively collected endovascular aneurysm repair database, including all patients who underwent a parallel stent procedure...
May 2017: Annals of Vascular Surgery
Adam Tanious, Jason T Lee, Murray Shames
The endovascular treatment of juxtarenal abdominal aortic aneurysm (AAA) can be performed by either a standard endovascular stent graft with additional snorkle grafts to aorta branches (snorkel endovascular aneurysm repair) or implantation of a fenestrated stent graft (fenestrated endovascular aneurysm repair). While many vascular surgeons consider snorkel endovascular aneurysm repair and fenestrated endovascular aneurysm repair to be competing techniques or alternate strategies, published procedural outcomes suggest more complementary roles...
March 2016: Seminars in Vascular Surgery
Jason Faulds, Harleen K Sandhu, Anthony L Estrera, Hazim J Safi
The cumulative experience with endovascular aortic repair in the descending thoracic and infrarenal aorta has led to increased interest in endovascular aortic arch reconstruction. Open total arch replacement is a robust operation that can be performed with excellent results. However, it requires cardiopulmonary bypass and circulatory arrest and, therefore, may not be tolerated by all patients. Minimally invasive techniques have been considered as an alternative and include hybrid arch debranching, parallel stent graft deployment in the chimney and snorkel configurations, and complete endovascular branched reconstruction with multi-branched devices...
January 2016: Methodist DeBakey Cardiovascular Journal
Stevo Duvnjak
Approximately 20%-40% of patients with abdominal aortic aneurysms can have unilateral or bilateral iliac artery aneurysms and/or ectasia. This influences and compromises the distal sealing zone during endovascular aneurysm repair. There are a few endovascular techniques that are used to treat these types of aneurysms, including intentional occlusion/over-stenting of the internal iliac artery on one or both sides, the "bell-bottom" technique, and the more recent method of using an iliac branch stent graft. In some cases, other options include the "snorkel and sandwich" technique and hybrid interventions...
March 28, 2016: World Journal of Radiology
George S Georgiadis, Joost A van Herwaarden, George A Antoniou, Athanasios D Giannoukas, Miltos K Lazarides, Frans L Moll
The introduction of fenestrated stent grafts (SGs) to treat abdominal aortic aneurysms (AAAs) with short proximal necks began in 1999. Nowadays, the whole visceral aorta can be treated totally by endovascular means. The established use of fenestrated devices to treat complex AAAs as a first-line management option has been previously reported. An up-to-date evaluation of the literature was performed including all types of publications regarding the use of fenestrated technology to repair complex AAAs. Fenestrated repair is now an established alternative to hybrid/chimney/snorkel repairs...
June 2016: Vascular Medicine
Bernardo C Mendes, Gustavo S Oderich, Leonardo Reis de Souza, Peter Banga, Thanila A Macedo, Randall R DeMartino, Sanjay Misra, Peter Gloviczki
OBJECTIVE: This study evaluated renal artery (RA) and accessory renal artery (ARA) anatomy and implications for endovascular repair using fenestrated, branched, or parallel (chimney, snorkel, and periscope) stent graft techniques. METHODS: We analyzed the digital computed tomography angiograms of 520 consecutive patients treated by open or fenestrated endovascular repair for complex abdominal aortic aneurysms (2000-2012). RA/ARA anatomy was assessed using diameter, length, angles, and kidney perfusion based on analysis of estimated volumetric kidney parenchyma...
May 2016: Journal of Vascular Surgery
Diogo Silveira, Georgios Pitoulias, Giovanni Torsello, Konstantinos P Donas
OBJECTIVE: We set out to present the late 3-year performance of total endovascular treatment of juxtarenal aortic aneurysms in octogenarians by the chimney/snorkel technique. METHODS: At one center, between January 2009 and December 2014, chimney/snorkel technique-endovascular aortic aneurysm repair was performed in 35 high-risk unfit-for-open-repair octogenarian patients with juxtarenal aortic aneurysms. Twenty-five patients were asymptomatic (71.4%), and 10 patients were treated in an urgent care setting...
April 2016: Journal of Vascular Surgery
Michel J Bosiers, Konstantinos P Donas, Nicola Mangialardi, Giovanni Torsello, Vincent Riambau, Frank J Criado, Frank J Veith, Sonia Ronchey, Stefano Fazzini, Mario Lachat
BACKGROUND: To study the performance of the chimney technique in the treatment of aortic arch pathologic conditions. METHODS: We retrospectively evaluated the clinical and procedural outcome data of patients undergoing endovascular treatment in the aortic arch by use of the chimney technique at four European centers between June 2002 and December 2014. The primary endpoint was technical success. The secondary endpoints were type I endoleak, 30-day mortality, stroke, primary patency of the chimney graft, and freedom from reintervention...
June 2016: Annals of Thoracic Surgery
Brant W Ullery, Ga-Young Suh, Jason T Lee, Brian Liu, Robert Stineman, Ronald L Dalman, Christopher P Cheng
OBJECTIVE: The durability of stent grafts may be related to how procedures and devices alter native anatomy. We aimed to quantify and compare renal artery geometry before and after fenestrated (F-) or snorkel/chimney (Sn-) endovascular aneurysm repair (EVAR). METHODS: Forty patients (75 ± 6 years) underwent computed tomographic angiography before and after F-EVAR (n = 21) or Sn-EVAR (n = 19), with a total of 72 renal artery stents. Renal artery geometry was quantified using three-dimensional model-based centerline extraction...
April 2016: Journal of Vascular Surgery
Konstantinos P Donas, Giovanni B Torsello, Gianluca Piccoli, Georgios A Pitoulias, Giovanni Federico Torsello, Theodosios Bisdas, Martin Austermann, Daniele Gasparini
OBJECTIVE: The chimney/snorkel endovascular aortic repair (ch-EVAR) is gaining ever-greater acceptance in the treatment of pararenal pathologic processes. However, the published experience includes mainly short-term clinical results with combinations of several abdominal devices and types of chimney grafts. The aim of this study was the midterm evaluation of the Endurant stent graft (Medtronic, Santa Rosa, Calif) as a standard abdominal device for ch-EVAR. METHODS: Between January 2009 and January 2013, prospectively collected data of high-risk patients with pararenal pathologic processes who underwent ch-EVAR with placement of the Endurant abdominal device were analyzed...
January 2016: Journal of Vascular Surgery
Jon G Quatromoni, Ksenia Orlova, Paul J Foley
Advances in endovascular technology, and access to this technology, have significantly changed the field of vascular surgery. Nowhere is this more apparent than in the treatment of abdominal aortic aneurysms (AAAs), in which endovascular aneurysm repair (EVAR) has replaced the traditional open surgical approach in patients with suitable anatomy. However, approximately one-third of patients presenting with AAAs are deemed ineligible for standard EVAR because of anatomic constraints, the majority of which involve the proximal aneurysmal neck...
September 2015: Seminars in Interventional Radiology
Konstantinos P Donas, Jason T Lee, Mario Lachat, Giovanni Torsello, Frank J Veith
OBJECTIVES: We sought to analyze the collected worldwide experience with use of snorkel/chimney endovascular aneurysm repair (EVAR) for complex abdominal aneurysm treatment. BACKGROUND: EVAR has largely replaced open surgery worldwide for anatomically suitable aortic aneurysms. Lack of availability of fenestrated and branched devices has encouraged an alternative strategy utilizing parallel or snorkel/chimney grafts (ch-EVAR). METHODS: Clinical and radiographic information was retrospectively reviewed and analyzed on 517 patients treated by ch-EVAR from 2008 from 2014 by prearranged defined and documented protocols...
September 2015: Annals of Surgery
Kenneth Tran, Brant W Ullery, Jason T Lee
BACKGROUND: Despite the high technical success and midterm patency of snorkel stents, concerns remain about structural durability and its effect on long-term renal function. We sought to evaluate the luminal stability of renal snorkel stents to investigate morphologic predictive factors of renal dysfunction after snorkel/chimney endovascular aneurysm repair (sn-EVAR). METHODS: Patients with high quality computer tomography angiography after sn-EVAR between 2009 and 2013 were included for analysis...
January 2016: Annals of Vascular Surgery
Mathew Wooster, Alexis Powell, Martin Back, Karl Illig, Murray Shames
BACKGROUND: The aim of this study was to review and compare our experience with 3 upper extremity access techniques (percutaneous single-sheath brachial, multi-sheath brachial cutdown, and axillary cutdown with conduit construction) in the setting of complex endovascular repair of paravisceral aneurysms. METHODS: We performed a retrospective review of a prospectively collected endovascular aneurysm repair database. All patients who underwent parallel stent grafting or fenestrated repair with upper extremity arterial access were included...
November 2015: Annals of Vascular Surgery
Konstantinos P Donas, Diego Telve, Giovanni Torsello, Georgios Pitoulias, Arne Schwindt, Martin Austermann
OBJECTIVE: The aim of this study was the evaluation of the clinical and radiologic outcomes of parallel grafts in the treatment of patients with failed prior endovascular aneurysm repair and type Ia endoleak. METHODS: Prospectively collected clinical and radiologic data of consecutive patients with prior endovascular aneurysm repair and evidence of type Ia endoleak were analyzed. All patients were treated between January 2009 and November 2014 by use of parallel grafts, ie, chimney/snorkel or periscope grafts and abdominal endovascular devices...
September 2015: Journal of Vascular Surgery
Brant W Ullery, Venita Chandra, Ronald L Dalman, Jason T Lee
PURPOSE: To determine the impact of renal artery angulation on time to successful renal artery cannulation and procedure efficiency during fenestrated and snorkel/chimney endovascular aneurysm repair (EVAR). METHODS: The imaging and procedure logs of 77 patients (mean age 74.2 years; 63 men) who underwent complex EVAR (24 fenestrated, 53 snorkel/chimney) from 2009 to 2013 were reviewed. Renal artery angulation was measured on preoperative computed tomographic angiography scans...
August 2015: Journal of Endovascular Therapy
Marco V Usai, Giovanni Torsello, Konstantinos P Donas
PURPOSE: To review the literature on pararenal endovascular aneurysm repair (EVAR) to determine the frequency and clinical relevance of chimney graft occlusions. METHODS: A comprehensive search of the English-language literature abstracted in the Medline and the Cochrane Library databases was performed to identify case series involving pararenal aortic pathologies (degenerative aneurysms, penetrating atherosclerotic ulcers, type Ia endoleaks, and para-anastomotic aneurysms) treated with EVAR and chimney grafts; thoracoabdominal, iliac, or aortic arch chimney graft placements were excluded, as were case reports in which the total number of chimney grafts implanted at the reporting center could not be determined...
June 2015: Journal of Endovascular Therapy
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