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Anahita Dua, Steven Koprowski, Gilbert Upchurch, Cheong J Lee, Sapan S Desai
BACKGROUND: In 2014, we published a series of articles in the Journal of Vascular Surgery that detailed the decrease in volume of open aneurysm repair (OAR) completed for abdominal aortic aneurysm (AAA) by vascular surgery trainees. At that time, only data points from 2000 through 2011 were available, and reliable predictions could only be made through 2015. Lack of data on endovascular aneurysm repair (EVAR) using fenestrated (FEVAR) and branched (BrEVAR) endografts also affected our findings...
October 12, 2016: Journal of Vascular Surgery
Arne de Niet, Michel Mpj Reijnen, Ignace Fj Tielliu, Jan Willem Hp Lardenoije, Clark J Zeebregts
Since the introduction of fenestrated endovascular aneurysm repair (FEVAR) in 1996, great advances have been made in endograft development. Custom-made and off-the-shelf fenestrated and branched endografts have been used to treat patients with complex abdominal aortic and thoraco-abdominal aneurysms. Most experience has been gained with the Cook Zenith® fenestrated endograft (Cook Medical Inc., Limerick, Ireland). The Cook Zenith® endograft is customized with fenestrations, (fixed) inner or outer branches, or a combination of them, to cover a wide range of complex aneurysms...
October 6, 2016: Surgical Technology International
Benjamin W Starnes, Michael T Caps, Zachary M Arthurs, Billi Tatum, Niten Singh
OBJECTIVE: The objective of this study was to evaluate the learning curve for fenestrated endovascular aortic aneurysm repair (FEVAR). METHODS: Data were collected prospectively on all FEVAR procedures conducted by a single surgeon between June 2007 and January 2015. During the study period, 136 FEVARs were performed, and this experience was divided into four quartiles each consisting of 34 cases. Clinical outcomes evaluated included perioperative death and major complications...
August 26, 2016: Journal of Vascular Surgery
Meryl Favier de Lachomette, Nellie Della, Delphine Maucort-Boulch, Ambroise Duprey, Eugenio Rosset, Patrick Feugier, Patrick Lermusiaux, Jean-Noël Albertini, Antoine Millon
BACKGROUND: The purpose of this study was to define predictive factors of early renal impairment after fenestrated or branched endovascular aortic repair (FEVAR or BEVAR) for aortic aneurysm. METHODS: Eighty-two patients underwent FEVAR or BEVAR for aortic aneurysm from January 2008 to December 2014. The primary end point was postoperative renal impairment on day 15 (D15). Renal impairment was defined as a 25% decrease in the glomerular filtration rate (GFR) and a GFR < 60 mL/min/1...
August 27, 2016: Annals of Vascular Surgery
Drosos Kotelis, Karina Schleimer, Houman Jalaie, Jochen Grommes, Michael J Jacobs, Johannes Kalder
PURPOSE: To report operative and midterm outcomes of fenestrated endovascular aneurysm repair (FEVAR) with the Anaconda device. METHODS: A retrospective analysis was conducted of 39 consecutive patients (median age 74 years; 36 men) treated with the fenestrated Anaconda stent-graft between July 2011 and December 2015 at a single center. Indications for FEVAR were abdominal aortic aneurysms (AAAs) with neck anatomy unsuitable for a standard stent-graft. Median infrarenal neck length was 4 mm (range 0-9)...
August 29, 2016: Journal of Endovascular Therapy
Adrien Hertault, Rachel E Clough, Teresa Martin-Gonzalez, Rafaelle Spear, Richard Azzaoui, Jonathan Sobocinski, Stéphan Haulon
PURPOSE: To describe a case of percutaneous retrograde left renal artery cannulation and restenting for severe distortion of a bridging stent diagnosed at the time of fenestrated endovascular aneurysm repair (FEVAR). CASE REPORT: A 79-year-old man underwent 4-vessel FEVAR, during which completion angiography showed a good postoperative result, but cone beam computed tomography (CBCT) demonstrated severe distortion of the proximal part of the left renal stent. An antegrade or hybrid approach to recannulate the vessel was not possible due to the stent architecture and patient comorbidities...
August 19, 2016: Journal of Endovascular Therapy
F Heidemann, H Diener, S Debus, D Perez, T Kölbel, N Tsilimparis
Complex aortic aneurysm such as paravisceral aneurysm represent a challenging condition especially in the case of rupture. The presence of an aortoenteric fistula in this setting is associated with a very high mortality and morbidity. We report the case of a 72-year-old patient with contained ruptured paravisceral aortic aneurysm who underwent surgeon-modified fenestrated EVAR (sm-fEVAR) with fenestrations for multiple renal arteries and the superior mesenteric artery. The patient successfully recovered from the repair but developed an aortogastric fistula on the basis of a pre-existing gastric ulceration so that second-stage atypical gastrectomy was conducted...
July 13, 2016: Annals of Vascular Surgery
Wissam Al-Jundi, Amro Elboushi, Tim Lees, Robin Williams
Treatment of juxtarenal abdominal aortic aneurysms (AAAs) remains challenging. A 79-year-old male who had infrarenal endovascular repair of abdominal aortic aneurysm (EVAR) 13 years previously presented with leaking juxtarenal AAA. Emergency fenestrated EVAR (FEVAR) was performed utilizing a stent graft designed and built for a different patient. Despite the need to embolize the celiac artery prior to covering it with the stent graft in order to achieve adequate proximal seal, the patient had uneventful recovery...
August 2016: Vascular and Endovascular Surgery
A E Rolls, S Rosen, J Constantinou, M Davis, J Cole, M Desai, D Stoyanov, T M Mastracci
OBJECTIVES: Fenestrated endovascular aneurysm repair (FEVAR) exposes operators and patients to considerable amounts of radiation. Introduction of fusion of three-dimensional (3D) computed tomography (CT) with intraoperative fluoroscopy puts new focus on advanced imaging techniques in the operating environment and has been found to reduce radiation and facilitate faster repair. The aim of this study is to evaluate the radiation dose effect of introducing a team-based approach to complex aortic repair...
June 18, 2016: European Journal of Vascular and Endovascular Surgery
David E Timaran, Martyn Knowles, Marilisa Soto-Gonzalez, J Gregory Modrall, Shirling Tsai, Melissa Kirkwood, John Rectenwald, Carlos H Timaran
BACKGROUND: The role of gender on perioperative outcomes after fenestrated endovascular aortic aneurysm repair (FEVAR) has not been established. The aim of this study is to determine the effect of gender on perioperative outcomes after FEVAR for complex abdominal aortic aneurysms using premanufactured devices. METHODS: During a 2-year period, 79 patients (63 men [80%] and 16 women [20%]) underwent FEVAR using Zenith Fenestrated AAA Endovascular Grafts, investigational Zenith pivot branch (p-branch) devices and fenestrated custom-made devices...
June 14, 2016: Journal of Vascular Surgery
Ari J Isaacson, Lauren M B Burke, Raghuveer Vallabhaneni, Mark A Farber
BACKGROUND: Preoperative planning for fenestrated endovascular aortic repair (fEVAR) requires high-quality cross-sectional imaging, most commonly computed tomography angiography (CTA). However, in the setting of chronic kidney disease (CKD), the iodine load delivered during conventional CTA is associated with risk for acute kidney injury (AKI). In this report, we describe the feasibility of using transarterial catheter directed CT angiography (tcd-CTA) with ultralow-dose iodine as an alternative for fEVAR planning in patients with stage 3-4 CKD to lower the risk of AKI...
August 2016: Annals of Vascular Surgery
David E Timaran, Marilisa Soto, Martyn Knowles, J Gregory Modrall, John E Rectenwald, Carlos H Timaran
BACKGROUND: Percutaneous femoral vascular access is frequently used for aortic endovascular procedures, with a local access complication rate of 5% to 16%. Fenestrated endovascular aneurysm repair (FEVAR) has recently emerged as a new technique for the repair of short-neck and juxtarenal abdominal aortic aneurysms. The safety and effectiveness of percutaneous access for FEVAR has not been established to date. METHODS: Since United States Food and Drug Administration approval of the Zenith fenestrated aortic endograft (Cook Medical, Bloomington, Ind), 94 patients (60 Zenith fenestrated, 6 p-Branch, and 28 custom-made devices) have undergone FEVAR...
October 2016: Journal of Vascular Surgery
Kenneth Tran, Andres Fajardo, Brant W Ullery, Christopher Goltz, Jason T Lee
OBJECTIVE: Limited data exist regarding the effect of fenestrated endovascular aneurysm repair (fEVAR) on renal function. We performed a comprehensive analysis of acute and chronic renal function changes in patients after fEVAR. METHODS: This study included patients undergoing fEVAR at two institutions between September 2012 and March 2015. Glomerular filtration rate was estimated using the Modification of Diet in Renal Disease formula with serum creatinine levels obtained during the study period...
May 27, 2016: Journal of Vascular Surgery
Sophia Khan, Joseph V Lombardi, Jeffrey P Carpenter, Jose Trani, James B Alexander, Francis J Caputo
OBJECTIVE: Recent advances in endovascular aneurysm repair have overcome substantial anatomic barriers associated with short and challenging necks. With greater range to treat more difficult anatomy from an endovascular approach, one would assume the need of open surgical repair (OSR) would be diminished. The purpose of our study was to determine the need for OSR for abdominal aortic aneurysms, in a tertiary academic setting, with a moderate volume (10-15 cases/year) of fenestrated endografting being performed...
May 13, 2016: Journal of Vascular Surgery
Arnoud V Kamman, Hector W L de Beaufort, Guido H W van Bogerijen, Foeke J H Nauta, Robin H Heijmen, Frans L Moll, Joost A van Herwaarden, Santi Trimarchi
BACKGROUND: Currently, the optimal management strategy for chronic type B aortic dissections (CBAD) is unknown. Therefore, we systematically reviewed the literature to compare results of open surgical repair (OSR), standard thoracic endovascular aortic repair (TEVAR) or branched and fenestrated TEVAR (BEVAR/FEVAR) for CBAD. METHODS: EMBASE and MEDLINE databases were searched for eligible studies between January 2000 and October 2015. Studies describing outcomes of OSR, TEVAR, B/FEVAR, or all, for CBAD patients initially treated with medical therapy, were included...
2016: PloS One
T Martin-Gonzalez, T Mastracci, T Carrell, J Constantinou, N Dias, A Katsargyris, B Modarai, T Resch, E Verhoeven, S Haulon
OBJECTIVE/BACKGROUND: The objective was to investigate renal outcomes following endovascular repair of thoraco-abdominal aortic aneurysms (TAAA) comparing fenestrations with branches for the renal arteries. METHODS: Renal outcomes following TAAA endovascular repair performed with renal branches were collected from five high volume European centers and compared with renal outcomes following TAAA endovascular repair performed with renal fenestrations at one center...
August 2016: European Journal of Vascular and Endovascular Surgery
Islah Ud Din, Usman Shaikh, Robert K Fisher, Richard G McWilliams
PURPOSE: To report a complication of renal stent crushing during open aneurysmorrhaphy performed 10 years after fenestrated endovascular aneurysm repair (FEVAR). CASE REPORT: A 67-year-old male patient underwent elective FEVAR of a juxtarenal aortic aneurysm. Uncovered balloon-expandable stents were placed through the fenestrations for the superior mesenteric and right renal arteries; the left renal artery received a Jostent covered balloon-expandable stent. The uncovered right renal stent was noted to be crushed on the first imaging after FEVAR, but was left untreated; the right kidney was thereafter significantly smaller than the left...
June 2016: Journal of Endovascular Therapy
Wael Ahmad, Michael Gawenda, Silke Brunkwall, Robert Shahverdyan, Jan Sigge Brunkwall
BACKGROUND: The endovascular aneurysm repair (EVAR) is becoming the preferred method to treat an aortic aneurysm with its better short-term postoperative mortality and morbidity rates in comparison with the open repair. A main drawback of this method is the need to use a nephrotoxic iodinated contrast medium to visualize the aorta and its side branches. CASE REPORT: An 83-year-old man with an asymptomatic infrarenal aortic aneurysm of a 51-mm diameter accompanied by a 42-mm aneurysm of the left common iliac artery was treated with combined fenestrated EVAR (FEVAR) and iliac side branch stent graft (ISBG) under guidance of image fusion (IF) without the intraoperative use of iodinated contrast agent...
May 2016: Annals of Vascular Surgery
Zhongzhou Hu, Yue Li, Ran Peng, Jie Liu, Tao Zhang, Wei Guo
UNLABELLED: To present the early and mid-term results of fenestrated endovascular aneurysm repair (FEVAR) using the Zenith fenestrated device for juxtarenal abdominal aortic aneurysms (JAAAs) at our center in China. DESIGN: Retrospective study.The study included 15 male patients with JAAAs, who underwent FEVAR using the Zenith fenestrated device at our center between February 2011 and June 2015.All custom-made Zenith fenestrated devices were designed according to computed tomography angiography (CTA) images obtained preoperatively...
March 2016: Medicine (Baltimore)
Marwan Youssef, Friedrich Dünschede, Hazem El Beyrouti, Ora Salem, Christian-Friedrich Vahl, Bernhard Dorweiler
Background We demonstrate our initial experience and first results of the endovascular aneurysm sealing (EVAS) technology with chimney grafts for the treatment of paravisceral aneurysms. Methods We present a consecutive series of seven patients with a mean age of 75 years who had been treated by four-vessel-chimney EVAS (ChEVAS) between May 2014 and May 2015. All patients were ASA grade ≥ III and were not eligible for fenestrated/branched endovascular aortic repair (fEVAR/brEVAR) due to urgency (n = 5) or anatomical constraints (n = 2)...
February 18, 2016: Thoracic and Cardiovascular Surgeon
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