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Clayton J Brinster, Ross Milner
Endovascular aortic repair (EVAR) has revolutionized the treatment of infrarenal abdominal aortic aneurysm (AAA), with consistently low reported perioperative morbidity and mortality. Universal applicability of EVAR to treat AAA is hindered by several specific anatomic constraints, however, and many patients cannot be treated with commercially available stent grafts within the device specific instructions for use. Treatment of these complex pararenal aneurysms is increasingly accomplished by extension of EVAR into the visceral segment of the abdominal aorta with branches or fenestrations that allow perfusion of the visceral and renal arteries...
March 19, 2018: Journal of Cardiovascular Surgery
Mimi M Li, Mohamad S Hamady, Colin D Bicknell, Celia V Riga
Flexible robotic catheters are an emerging technology which provide an elegant solution to the challenges of conventional endovascular intervention. Originally developed for interventional cardiology and electrophysiology procedures, remotely steerable robotic catheters such as the Magellan system enable greater precision and enhanced stability during target vessel navigation. These technical advantages facilitate improved treatment of disease in the arterial tree, as well as allowing execution of otherwise unfeasible procedures...
March 19, 2018: Journal of Cardiovascular Surgery
Rafaelle Spear, Jonathan Sobocinski, Adrien Hertault, Matthieu Delloye, Richard Azzauiu, Dominique Fabre, Stéphan Haulon
OBJECTIVES: To evaluate the outcomes of the second generation BeGraft balloon expandable covered stent Graft System (Bentley InnoMed, Hechingen, Germany) implanted as bridging stent grafts during fenestrated endovascular aortic repair (FEVAR) of complex aneurysms. DESIGN: This was a single centre prospective study including all consecutive patients treated by FEVAR performed with second generation BeGraft stent grafts as bridging stents. METHODS: Demographics of patients, diameter and length of the bridging stent grafts, technical success, re-interventions, occlusions, post-operative events, and imaging (Cone Beam CT and/or CT scan, and contrast enhanced ultrasound) were prospectively collected in an electronic database...
February 28, 2018: European Journal of Vascular and Endovascular Surgery
S Keisin Wang, Ashley R Gutwein, Alok K Gupta, Gary W Lemmon, Alan P Sawchuk, Raghu L Motaganahalli, Michael P Murphy, Andres Fajardo
OBJECTIVE: The Zenith Fenestrated (ZFEN; Cook Medical, Bloomington, Ind) aortic stent graft system was approved for commercial use by the Food and Drug Administration in April 2012. We report our single-center experience of 100 consecutive patients treated with the ZFEN platform from October 2012 to March 2017. METHODS: A retrospective review of our prospectively maintained fenestrated endovascular aneurysm repair (FEVAR) database at a tertiary care academic institution located in the Midwest United States was performed for descriptive analysis...
January 27, 2018: Journal of Vascular Surgery
Adeline Schwein, Ponraj Chinnadurai, Greg Behler, Alan B Lumsden, Jean Bismuth, Carlos F Bechara
BACKGROUND: Fenestrated endovascular aneurysm repair (FEVAR) is an evolving technique to treat juxtarenal abdominal aortic aneurysms (AAAs). Catheterization of visceral and renal vessels after the deployment of the fenestrated main body device is often challenging, usually requiring additional fluoroscopy and multiple digital subtraction angiograms. The aim of this study was to assess the clinical utility and accuracy of a computed tomography angiography (CTA)-fluoroscopy image fusion technique in guiding visceral vessel cannulation during FEVAR...
January 30, 2018: Journal of Vascular Surgery
John F Charitable, Thomas S Maldonado
Ischemic complications after fenestrated endovascular aortic aneurysm repair (FEVAR) can result in significant morbidity and mortality. We present a case of a 65-year-old man who underwent a FEVAR complicated by bilateral lower extremity compartment syndrome requiring four-compartment fasciotomies. This ischemic complication was likely caused by sheath occlusion because the patient had no evidence of arterial injury or distal plaque embolization. This case highlights the importance of careful postoperative monitoring after FEVAR, because the larger sheaths required can be occlusive and result in lower extremity ischemia, even for relatively short cases...
March 2017: Journal of Vascular Surgery Cases and Innovative Techniques
Konstantinos Spanos, Nikolaos Tsilimparis, Franziska Heidemann, Fiona Rohlffs, Christian-Alexander Behrendt, Eike Sebastian Debus, Tilo Kölbel
PURPOSE: To describe planning and a technique for fenestrated endovascular repair of a large Crawford type IV thoracoabdominal aortic aneurysm after previous 2-fenestration endovascular aneurysm repair (FEVAR). TECHNIQUE: The first FEVAR procedure performed at another center implanted a standard Zenith device with 2 fenestrations and 1 scallop for a juxtarenal abdominal aortic aneurysm. The diameter of the Crawford type IV thoracoabdominal aortic aneurysm had progressed from 68 to 75 mm within a year after the FEVAR...
February 2018: Journal of Endovascular Therapy
Zaher Fanari, Nilesh J Goswami
Chimney EVAR (CHEVAR) and Fenestrated EVAR (FEVAR) are two options for management of very complex abdominal aortic aneurysm (AAA). While some anatomical factors may favor one strategy over the other, there are some cases where the anatomical challenges may require using a hybrid approach. We are reporting the case of an 84-year-old male with a 6.8×5.7cm infrarenal abdominal aortic aneurysm that arises immediately below the level of the renal arteries and extends down to just above the iliac bifurcation with occluded celiac and inferior mesenteric arteries and severe bilateral renal artery stenosis with caudally oriented right renal and cranially oriented left renal artery...
November 22, 2017: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Sarah E Deery, Robert T Lancaster, Anna M Gubala, Thomas F X O'Donnell, Christopher J Kwolek, Mark F Conrad, Richard P Cambria, Virendra I Patel
BACKGROUND: Early data suggest that fenestrated endovascular aneurysm repair (FEVAR) is feasible but may have higher morbidity and unclear durability compared to open surgical repair (OSR) of complex abdominal aortic aneurysms (CAAAs). We compared the early experience following elective FEVAR to traditional OSR of CAAA in a high-volume open aortic center. METHODS: All patients undergoing FEVAR and OSR for elective CAAA from 1/2010-7/2015 were identified. Univariate, multivariable logistic, and Cox hazards modeling were used to compare perioperative and intermediate outcomes...
December 5, 2017: Annals of Vascular Surgery
Tamer El-Sayed, Ashish S Patel, Jun S Cho, James A Kelly, Francesca E Ludwinski, Prakash Saha, Oliver T Lyons, Alberto Smith, Bijan Modarai
Background -Radiation exposure during fluoroscopically-guided interventions such as endovascular aortic repair (EVAR) is a growing concern for operators. This study aimed to measure DNA damage/repair markers in operators perfoming EVAR. Methods -Expression of the DNA damage/repair marker, gamma-H2AX (γ-H2AX) and DNA damage response (DDR) marker, phosphorylated ataxia telangiectasia mutated (pATM), were quantified in circulating lymphocytes in operators during the peri-operative period of endovascular (infra-renal [IEVAR], branched [BEVAR] and fenestrated [FEVAR]) and open aortic repair using flow cytometry...
October 20, 2017: Circulation
Salvatore T Scali, Moses Kim, Paul Kubilis, Robert J Feezor, Kristina A Giles, Brittney Miller, Javairiah Fatima, Thomas S Huber, Scott A Berceli, Martin Back, Adam W Beck
OBJECTIVE: Spinal cord ischemia (SCI) is a devastating complication after branched or fenestrated endovascular aortic repair (B/FEVAR) for thoracoabdominal aortic disease. The purpose of this analysis was to describe the impact of a bundled clinical care protocol designed to reduce the risk of SCI in this population of patients. METHODS: A bundled SCI prevention protocol including cerebrospinal fluid drainage, blood pressure parameters, transfusion goals, and pharmacologic adjuncts (steroids, naloxone) was initiated in May 2015...
February 2018: Journal of Vascular Surgery
Timothy P Shiraev, Trevor M Y Kwok, Steven R Dubenec
BACKGROUND: Abdominal aortic aneurysms pose a substantial clinical burden, and a significant proportion are not anatomically suitable for open repair or standard endovascular aneurysm repair (EVAR), instead requiring fenestrated EVAR (fEVAR). We sought to compare clinical outcomes and trends over time in patients undergoing fEVAR in Australia. METHODS: We conducted a retrospective analysis of all patients undergoing fEVAR at a tertiary referral centre between 2010 and 2015, including outcomes and complications, both as inpatients and after discharge...
September 18, 2017: ANZ Journal of Surgery
Iain N Roy, Menatalla Gharib, Sebastian Zerwes, Rudolf Jakob, Francesco Torella, Richard G McWilliams, Robert K Fisher
PURPOSE: To determine how many endovascular aneurysm sealing (EVAS) procedures with/without off-label use of chimneys (ChEVAS) could have been performed in a cohort of patients who had undergone fenestrated endovascular aneurysm repair (FEVAR). METHODS: Sixty patients (median age 76.3 years; 54 men) who underwent FEVAR in our institution between 2013 and 2015 were selected for the study. The median aneurysm diameter was 62.0 mm (interquartile range 59.3, 69.0). Preoperative computed tomography angiograms (CTA) were anonymized and sent to 2 physicians with experience of more than 40 ChEVAS interventions...
August 1, 2017: Journal of Endovascular Therapy
C Terry, S Houthoofd, G Maleux, I Fourneau
INTRODUCTION: Infectious complications after FEVAR cause significant problems, with radical surgery considered to be the last resort for treatment. CASE REPORT: A 72 year old man presented with infection 1 month after FEVAR. Conservative therapy with percutaneous abscess drainage and antibiotics suppressed the infection for 10 months; however, when new peri-aortic abscesses developed, the patient agreed to revision surgery. The endograft was explanted and an autologous in situ venous reconstruction was performed...
2017: EJVES Short Reports
Prateek K Gupta, Reshma Brahmbhatt, Kelly Kempe, Shaun M Stickley, Michael J Rohrer
OBJECTIVE: Although few studies have reported outcomes after branched or fenestrated endovascular aortic aneurysm repair (FEVAR) of abdominal aortic aneurysms involving visceral vessels (AAA-Vs), no multi-institutional study has compared FEVAR with open surgery (OS) for AAA-Vs. Our objective was to compare 30-day outcomes after FEVAR vs OS for AAA-Vs. METHODS: Patients who underwent FEVAR (n = 535) and OS (n = 1207) for elective AAA-Vs were identified from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) 2008 to 2013 database...
December 2017: Journal of Vascular Surgery
Jacob Budtz-Lilly, Anders Wanhainen, Jacob Eriksson, Kevin Mani
OBJECTIVE: This study reports the feasibility of adopting a total endovascular approach for the treatment of complex abdominal aortic aneurysms (AAAs) at a European aortic center and compares the short- and midterm results against those from large and multicenter studies. METHODS: All patients treated endovascular aortic repair (EVAR) for juxta/pararenal AAAs or thoracoabdominal aortic aneurysms (TAAAs), both elective and acute, as well as reoperations, from 2010 to 2015 were included...
November 2017: Journal of Vascular Surgery
Karen M Meess, Richard L Izzo, Maciej L Dryjski, Richard E Curl, Linda M Harris, Michael Springer, Adnan H Siddiqui, Stephen Rudin, Ciprian N Ionita
Following new trends in precision medicine, Juxatarenal Abdominal Aortic Aneurysm (JAAA) treatment has been enabled by using patient-specific fenestrated endovascular grafts. The X-ray guided procedure requires precise orientation of multiple modular endografts within the arteries confirmed via radiopaque markers. Patient-specific 3D printed phantoms could familiarize physicians with complex procedures and new devices in a risk-free simulation environment to avoid periprocedural complications and improve training...
February 11, 2017: Proceedings of SPIE
Frances E Colgan, Peter M Bungay, Nicholas Burfitt, Andrew Hatrick, Michael J Clarke, Alun H Davies, Michael Jenkins, David Gerrard, John W Quarmby, Robin Williams
OBJECTIVES: Early and one year outcomes are presented for fenestrated endovascular aneurysm repair (FEVAR) of complex aortic aneurysmal disease with the custom-made Anaconda fenestrated stent graft in 101 patients. METHODS: Retrospective site-reported data from the first 101 elective cases (2010 to 2014) from four UK centres was studied to evaluate patient demographics, aneurysm morphology, clinical success and one year outcomes in patients undergoing fenestrated aneurysm repair with the custom-made Anaconda device...
June 12, 2017: Annals of Vascular Surgery
Caroline Caradu, Julien Morin, Dominique Midy, Sandro Lepidi, Eric Ducasse
PURPOSE: To present early results of fenestrated endovascular aneurysm repair (FEVAR) combined with chimney grafts in a high-volume center. METHODS: From July 2011 to July 2016, 45 patients (mean age 73.0±8.8 years; 39 men) with complex aneurysms who were poor candidates for open repair and anatomically ineligible for standard or custom-made FEVAR were treated with chimney FEVAR (chFEVAR). Eight (18%) cases were treated in emergency. In all, 130 target vessels (2...
June 1, 2017: Journal of Endovascular Therapy
Jürgen Falkensammer, Fadi Taher, Miriam Uhlmann, Kornelia Hirsch, Johannes Strassegger, Afshin Assadian
OBJECTIVE: Endovascular aortic aneurysm repair (EVAR) with a fenestrated device (FEVAR) allows an extension of the proximal sealing zone above the renal arteries to an adequate, healthier segment of the aorta. This feature makes FEVAR an option to treat patients with a diseased aortic neck or type Ia endoleak after EVAR. The aim of this investigation was to present a single-center experience with FEVAR for patients with an abdominal aortic endograft in situ compared with primary FEVAR...
November 2017: Journal of Vascular Surgery
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