We have located links that may give you full text access.
Journal Article
Multicenter Study
Endovascular treatment of aneurysms using fenestrated-branched endografts with distal inverted iliac limbs.
Journal of Vascular Surgery 2016 September
BACKGROUND/OBJECTIVE: Open aortoiliac grafts have typically been constructed with a short aortic bifurcation sewn near or to the visceral vessels to avoid limb kinking. Similarly, the majority of endovascular bifurcated stent grafts have short aortic main body ranging from 3 to 5 cm. In these patients, endovascular salvage with fenestrated stent grafts is technically challenging because of the short distance between the renal arteries and the flow divider of the graft. Custom fenestrated stent grafts can be extended into the prior open surgical graft or stent graft using a short distal bifurcated stent graft with inverted iliac limb for the contralateral gate. The aim of this study was to evaluate outcomes of patients treated with fenestrated stent grafts coupled with inverted iliac limbs for salvage of failed open surgical and endovascular stent grafts.
METHODS: The clinical data of three U.S. aortic centers that use fenestrated stent grafts was entered into prospectively maintained databases from 2011 to 2014. All patients received customized distal bifurcated devices constructed with a main body less than 70 mm and an inverted iliac limb to dock the contralateral gate. End points were technical success, 30-day mortality, type I or III endoleak, limb occlusion, and secondary reintervention. The Institutional Review Board of each institution approved the use of the modified graft, and each patient provided informed consent.
RESULTS: There were 56 patients (41 male), with mean age of 75 years treated by fenestrated stent grafts using distal bifurcated devices with inverted iliac limbs. Forty-seven patients had a previous aortic repair with a short main body device, and nine had short distances between the native renal artery and aortic bifurcation requiring inverted limbs. A total of 184 visceral arteries were targeted by fenestrations. Technical success was 96.4% with no 30-day deaths. At a mean follow-up of 11 months, seven patients developed endoleaks, with one device migration, no occlusions, or other complications associated with the inverted limb. On the inverted iliac limb side, there were four complications. Two patients developed type Ib endoleaks treated by limb extension and angioplasty, and one patient developed distal limb ischemia secondary to embolization treated by thrombectomy. One additional patient developed a component separation of the inverted limb discovered with follow-up imaging treated with aortouni-iliac repair.
CONCLUSIONS: Patients with a short distance between the renal arteries and the aortic bifurcation can be challenging for endovascular treatment using currently available devices. The use of inverted limb custom devices avoids the need for aortouni-iliac repair with femoral-femoral bypass preserving antegrade perfusion. In the short term, rates of complication are similar to what has been reported for universal bifurcated devices with noninverted iliac limbs.
METHODS: The clinical data of three U.S. aortic centers that use fenestrated stent grafts was entered into prospectively maintained databases from 2011 to 2014. All patients received customized distal bifurcated devices constructed with a main body less than 70 mm and an inverted iliac limb to dock the contralateral gate. End points were technical success, 30-day mortality, type I or III endoleak, limb occlusion, and secondary reintervention. The Institutional Review Board of each institution approved the use of the modified graft, and each patient provided informed consent.
RESULTS: There were 56 patients (41 male), with mean age of 75 years treated by fenestrated stent grafts using distal bifurcated devices with inverted iliac limbs. Forty-seven patients had a previous aortic repair with a short main body device, and nine had short distances between the native renal artery and aortic bifurcation requiring inverted limbs. A total of 184 visceral arteries were targeted by fenestrations. Technical success was 96.4% with no 30-day deaths. At a mean follow-up of 11 months, seven patients developed endoleaks, with one device migration, no occlusions, or other complications associated with the inverted limb. On the inverted iliac limb side, there were four complications. Two patients developed type Ib endoleaks treated by limb extension and angioplasty, and one patient developed distal limb ischemia secondary to embolization treated by thrombectomy. One additional patient developed a component separation of the inverted limb discovered with follow-up imaging treated with aortouni-iliac repair.
CONCLUSIONS: Patients with a short distance between the renal arteries and the aortic bifurcation can be challenging for endovascular treatment using currently available devices. The use of inverted limb custom devices avoids the need for aortouni-iliac repair with femoral-femoral bypass preserving antegrade perfusion. In the short term, rates of complication are similar to what has been reported for universal bifurcated devices with noninverted iliac limbs.
Full text links
Related Resources
Trending Papers
Challenges in Septic Shock: From New Hemodynamics to Blood Purification Therapies.Journal of Personalized Medicine 2024 Februrary 4
Molecular Targets of Novel Therapeutics for Diabetic Kidney Disease: A New Era of Nephroprotection.International Journal of Molecular Sciences 2024 April 4
The 'Ten Commandments' for the 2023 European Society of Cardiology guidelines for the management of endocarditis.European Heart Journal 2024 April 18
A Guide to the Use of Vasopressors and Inotropes for Patients in Shock.Journal of Intensive Care Medicine 2024 April 14
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app
All material on this website is protected by copyright, Copyright © 1994-2024 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.
By using this service, you agree to our terms of use and privacy policy.
Your Privacy Choices
You can now claim free CME credits for this literature searchClaim now
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app