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Fenestrated stent graft

Athanasios Katsargyris, Pablo Marques de Marino, Hozan Mufty, Luis Mendes Pedro, Ruy Fernandes, Eric L G Verhoeven
OBJECTIVES: Visceral arteries in fenestrated and branched endovascular repair (F/BEVAR) have been addressed by fenestrations or directional side branches. Inner branches, as used in the arch branched device, could provide an extra option for visceral arteries "unsuitable" for fenestrations or directional side branches. Early experience with the use of inner branches for visceral arteries in F/BEVAR is described. METHODS: All consecutive patients treated by F/BEVAR for complex abdominal aortic aneurysm (AAA) or thoraco-abdominal aneurysm (TAAA) using stent grafts with inner branches were included...
March 12, 2018: European Journal of Vascular and Endovascular Surgery
Xin Yang, Xiang-Chen Dai, Jie-Chang Zhu, Yu-Dong Luo, Hai-Lun Fan, Zhou Feng, Yi-Wei Zhang, Fan-Guo Hu
Despite being widely used for several years, the endovascular aortic repair (EVAR) of a thoracoabdominal aneurysm (TAAA) remains challenging, particularly the revascularization of the abdominal aortic visceral branches. A 66-year-old male was admitted to hospital with abdominal bloating and pain. Computed tomographic angiography (CTA) confirmed a Crawford type III TAAA from the distal descending aorta to the suprarenal abdominal aorta that involved the celiac axis, accompanied with an occlusion of the left subclavian artery...
January 1, 2018: Journal of International Medical Research
Frédéric Cochennec, Jean Marzelle
Acute aortic syndromes include aortic dissections, intramural hematomas, penetrating ulcers, ruptured or contained ruptured aortic aneurysms. In presence of acute thoracic or dorsal pain, elevated D-Dimers and if acute coronary artery syndrome has been ruled out, additional imaging should be performed to detect acute aortic pathologies. Acute type A dissections involve the ascending aorta. Emergent open repair is the preferred treatment. Acute type B dissections involve the thoracic descending aorta. Endovascular treatment using thoracic stent grafts is indicated in complicated cases (malperfusion, rupture, uncontrolled hypertension) or in cases where risk factors of aortic degeneration are identified...
March 8, 2018: La Presse Médicale
Neil P Reddy, Sung Wan Ham, Fred A Weaver, Vincent L Rowe, Kenneth R Ziegler, Sukgu M Han
Endovascular aneurysm repair has become the first-line treatment modality for infrarenal aortic aneurysms. However, obtaining successful long-term results frequently require re-interventions. Particularly, delayed type 1a endoleaks pose a challenging problem, as they are often associated with proximal extension of the aneurysmal process to juxta or para-renal aortic segments. We describe two remedial techniques to repair delayed type 1a endoleak by extending the seal zone to the suprarenal aorta, while incorporating the renal arteries...
March 5, 2018: Annals of Vascular Surgery
Hozan Mufty, Athanasios Katsargyris, Sabrina Houthoofd, Inge Fourneau, Eric Verhoeven, Geert Maleux
INTRODUCTION: Fenestrated/branched thoracic endovascular aneurysm repair (F/Br-TEVAR) is a new minimal invasive treatment option for patients with post-dissection thoracoabdominal aortic aneurysms. This specific pathology is challenging to F/Br-TEVAR, especially when target vessels originate from the false lumen. Crossing from the true lumen into the false lumen to catheterize such target vessels may prove cumbersome in the usually thickened dissection flap. TECHNIQUE: We describe a bailout technique when standard catheterization techniques fail, by using a transjugular intrahepatic portosystemic shunt (TIPS)-needle to perforate the dissection flap...
March 6, 2018: Cardiovascular and Interventional Radiology
Nikolas Tsilimparis, Sebastian E Debus, Max Biehl, Konstantinos Spanos, Axel Larena-Avellaneda, Sabine Wipper, Fiona Rohlffs, Tilo Kölbel
OBJECTIVE: The aim of this study was to assess the immediate postoperative and midterm outcome of complex aortic aneurysm treatment necessitating four-vessel revascularization with either a total endovascular approach (fenestrated-branched stent graft [FBSG]) or a hybrid technique of visceral debranching plus stenting. METHODS: The clinical data of consecutively treated patients presenting with a complex aortic aneurysm that necessitated four-vessel revascularization between 2010 and 2015 were retrospectively analyzed...
March 1, 2018: Journal of Vascular 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
N Rudarakanchana, M P Jenkins
BACKGROUND: Recent advances in endovascular technology have enabled minimally invasive repair of the aortic arch, with specifically designed stent-grafts. This article reviews hybrid and total endovascular repair in the management of aortic arch pathology. METHODS: Studies relating to aortic arch management were identified using MEDLINE and Embase, focusing on endovascular repair. RESULTS: Hybrid arch repair is associated with an early mortality rate of some 12 per cent, and carries significant risk of stroke (up to 15 per cent), paraplegia (up to 6 per cent), retrograde dissection (up to 6·5 per cent) and proximal endoleak (6 per cent)...
March 2018: British Journal of Surgery
R E Clough, R Spear, K Van Calster, A Hertault, R Azzaoui, J Sobocinski, D Fabre, S Haulon
BACKGROUND: Surgical repair of aortic arch pathology is complex and associated with significant morbidity and mortality. Alternative approaches have been developed to reduce these risks, including the use of thoracic stent-grafts with fenestrations or in combination with bypass procedures to maintain supra-aortic trunk blood flow. Branched stent-grafts are a novel approach to treat aortic arch pathology. METHODS: Consecutive patients with aortic arch disease presenting to a single university hospital vascular centre were considered for branched stent-graft repair (October 2010 to January 2017)...
March 2018: British Journal of Surgery
Vasileios Saleptsis, Konstantinos Spanos, Nikolaos Tsilimparis, Fiona Rohlffs, Sebastian E Debus, Tilo Kölbel
BACKGROUND: The aim of the present study was to examine the frequency of gas within the aneurysm sac following endovascular aneurysm repair (EVAR) on early postoperative CT-scans, to measure its volume, record the location and analyze anatomical and procedural risk factors of its presence. METHODS: A retrospective analysis of prospectively collected data of patients undergoing standard, fenestrated or branched EVAR between January 2013 and December 2015 was undertaken...
February 23, 2018: Annals of Vascular Surgery
Michael P Jenkins
No abstract text is available yet for this article.
February 21, 2018: European Journal of Vascular and Endovascular Surgery
Matthew G Doyle, Sean A Crawford, Elrasheed Osman, Naomi Eisenberg, Leonard W Tse, Cristina H Amon, Thomas L Forbes
INTRODUCTION: A complication of fenestrated endovascular aneurysm repair is the potential for stent graft rotation during deployment causing fenestration misalignment and branch artery occlusion. The objective of this study is to demonstrate that this rotation is caused by a buildup of rotational energy as the device is delivered through the iliac arteries and to quantify iliac artery geometric properties associated with device rotation. METHODS: A retrospective clinical study was undertaken in which iliac artery geometric properties were assessed from preoperative imaging for 42 cases divided into 2 groups: 27 in the nonrotation group and 15 in the rotation group...
January 1, 2018: 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
Sean A Crawford, Ryan M Sanford, Matthew G Doyle, Mark Wheatcroft, Cristina H Amon, Thomas L Forbes
OBJECTIVE: Advanced endovascular aneurysm repair (EVAR) with fenestrated and branched stent grafts is increasingly being used to repair complex aortic aneurysms; however, these devices can rotate unpredictably during deployment, leading to device misalignment. The objectives of this study were to quantify the short-term clinical outcomes in patients with intraoperative stent graft rotation and to identify quantitative anatomic markers of the arterial geometry that can predict stent graft rotation preoperatively...
January 29, 2018: Journal of Vascular Surgery
Jason G E Zelt, Prasad Jetty, Adnan Hadziomerovic, Sudhir Nagpal
We report a case of infolding of a fenestrated stent graft involving the visceral vessel segment after a juxtarenal abdominal aorta aneurysm repair. The patient remains free of any significant endoleak, and the aortic sac has shown regression. The patient remains asymptomatic, with no abdominal pain, with normal renal function, and without ischemic limb complications. We hypothesize that significant graft oversizing (20%-30%) with asymmetric engineering of the diameter-reducing ties may have contributed to the infolding...
September 2017: Journal of Vascular Surgery Cases and Innovative Techniques
Morgane Michel, Jean-Pierre Becquemin, Jean Marzelle, Céline Quelen, Isabelle Durand-Zaleski
OBJECTIVES: The aim was to assess the cost-effectiveness of fenestrated and branched stent grafts (f/b EVAR) compared with open surgical repair (OSR) in thoraco-abdominal or complex abdominal aortic aneurysms (TAAA/AAA) at 2 years. METHODS: Two matched cohorts of patients with TAAA or complex AAA were compared after a follow-up of two years. Patients included in the WINDOW French multicentre prospective registry were treated by f/b EVAR, and OSR patients were extracted from the French national hospital discharge database...
January 13, 2018: European Journal of Vascular and Endovascular Surgery
Luca Bertoglio, Diletta Loschi, Tommaso Cambiaghi, Daniele Mascia, Andrea Kahlberg, Germano Melissano, Roberto Chiesa
PURPOSE: To evaluate the 1-year outcomes of thoracoabdominal aortic aneurysm (TAAA) repair using fenestrated and branched stent-grafts and a novel balloon-expandable covered stent. METHODS: Between March 2015 and January 2017, 18 patients (median age 74.7 years; 14 men) received 43 LifeStream balloon-expandable covered stents in conjunction with Zenith fenestrated/branched stent-grafts to bridge 11 celiac trunks, 8 superior mesenteric arteries, and 24 renal arteries (total 32 fenestrations and 11 branches)...
January 1, 2018: Journal of Endovascular Therapy
Marwan Youssef, Sebastien Deglise, Piotr Szopinski, Schäfer Jost-Philipp, Amer Jomha, Christian F Vahl, Ahmed Koshty
PURPOSE: To investigate the outcomes of patients who were treated for thoracoabdominal aortic aneurysms (TAAAs) using custom-made fenestrated-branched stent-grafts. METHODS: A consecutive series of 108 patients (mean age 73.5 years; 73 men) with TAAA were treated with E-xtra Design Engineering customized fenestrated-branched stent-grafts between November 2011 and January 2017. Data on baseline characteristics, procedures, and clinical follow-up were collected from 6 regional European surgical centers for retrospective analysis of endoleaks, reinterventions, and target vessel patency...
January 1, 2018: Journal of Endovascular Therapy
Tao Shang, Lu Tian, Dong-Lin Li, Zi-Heng Wu, Hong-Kun Zhang
OBJECTIVES: Endovascular repair of aortic arch pathologies remains challenging. Recently, needle based in situ fenestration (ISF) has shown great potential in endovascular total aortic arch repair (ETAAR). This study aimed to evaluate the feasibility, effectiveness, and safety of ETAAR via needle based ISF, and to present initial experience with this technique. DESIGN AND METHODS: Patients who met the inclusion criteria were enrolled in this prospective study. The supra-arch branches were manually punctured in a retrograde manner using liver biopsy needles (18 gauge/30 cm) in the left common carotid artery (LCCA) and brachiocephalic trunk (BCT), and endo-puncture system or aspiration biopsy needles (21-gauge) in the left subclavian artery (LSA)...
January 3, 2018: European Journal of Vascular and Endovascular Surgery
Luca Garriboli, Antonio Maria Jannello
PURPOSE: To describe the application of uncovered chimney stent grafts with the Nellix endovascular aneurysm sealing technique (ChEVAS) for juxtarenal abdominal aortic aneurysms (JAAAs). CASE REPORT: Two patients with JAAA and multiple comorbidities were considered unfit for open surgery and were selected for an endovascular approach. Fenestrated and branched endografts were too expensive, and a chimney endovascular approach was considered inappropriate for the relatively high incidence of proximal type I endoleak and graft migration...
February 2018: Vascular and Endovascular Surgery
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