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Mendes BC, Oderich GS. Endovascular repair of thoracoabdominal aortic aneurysm using the off-the-shelf multibranched t-Branch stent graft. J Vasc Surg 2016; 63:1394-1399.e2. [DOI: 10.1016/j.jvs.2016.02.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 02/01/2016] [Indexed: 10/21/2022]
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Ramanan B, Fernandez CC, Sobel JD, Gasper WJ, Vartanian SM, Reilly LM, Chuter TAM, Hiramoto JS. Low-profile versus standard-profile multibranched thoracoabdominal aortic stent grafts. J Vasc Surg 2016; 64:39-45. [PMID: 26994953 DOI: 10.1016/j.jvs.2016.01.038] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 01/19/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study compared midterm results using low-profile stent grafts (LPSGs; 18F) and standard-profile stent grafts (SPSGs; 22F-24F) for endovascular pararenal and thoracoabdominal aortic aneurysm (TAAA) repair. METHODS From July 2005 to March 2015, 134 asymptomatic patients underwent endovascular repair of a pararenal or TAAA using multibranched aortic stent grafts. In March 2011, we started using a LPSG with nitinol stents and thin-walled polyester fabric. Prospectively collected data on operative repair, complications, and outcomes were compared between the two groups. RESULTS LPSGs were used in 37 patients (8 women [21.6%]; mean ± standard deviation age, 72.5 ± 8 years) and SPSGs in 97 patients (25 [26%] women; mean age, 73 ± 8 years). Medical comorbidities, aneurysm size, and aneurysm extent were similar in the LPSG and SPSG groups. Mean follow-up time was longer in the SPSG group (3.1 ± 2 years) than in the LPSG group (1.3 ± 0.9 years; P < .001). Operative time, renal failure, stroke, myocardial infarction, and perioperative death were not significantly different between the two groups (P > .05). Aneurysm-related death, rupture, stent graft migration, type I or III endoleaks, aneurysm enlargement >5 mm, branch vessel occlusion, and reintervention rates were similar between the two groups (P > .05). However, the combined outcome of conduit use or access artery injury occurred at a lower rate in the LPSG group than in the SPSG group (16% vs 36%; P = .03). Women experienced significantly higher rates of conduit use and access artery injury than men after repair with SPSGs (64% vs 26%, respectively; P = .001) but similar rates after repair with the LPSG (25% vs 14%, respectively; P = .45). CONCLUSIONS LPSGs had similar safety profile and midterm outcomes compared with the SPSGs for treatment of pararenal and TAAA. The substitution of LPSGs for SPSGs lowered the number of patients who required conduit insertion to avoid access artery injury, especially in women, thereby reducing an otherwise striking gender difference.
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Affiliation(s)
- Bala Ramanan
- Division of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, Calif
| | - Charlene C Fernandez
- Division of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, Calif
| | - Julia D Sobel
- Division of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, Calif
| | - Warren J Gasper
- Division of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, Calif
| | - Shant M Vartanian
- Division of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, Calif
| | - Linda M Reilly
- Division of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, Calif
| | - Timothy A M Chuter
- Division of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, Calif
| | - Jade S Hiramoto
- Division of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, Calif.
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Mendes BC, Rathore A, Ribeiro MS, Oderich GS. Off-the-shelf fenestrated and branched stent graft designs for abdominal aortic aneurysm repair. Semin Vasc Surg 2016; 29:74-83. [DOI: 10.1053/j.semvascsurg.2016.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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54
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Oderich GS. Commentary: Physician-Modified vs Off-the-Shelf Fenestrated and Branched Endografts: Is This a Fair Comparison? J Endovasc Ther 2016; 23:110-4. [PMID: 26763258 DOI: 10.1177/1526602815613520] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Gustavo S Oderich
- Division of Vascular and Endovascular Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
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Affiliation(s)
- Theodosios Bisdas
- Department of Vascular Surgery, St. Franziskus Hospital, Münster, Germany
| | - Martin Austermann
- Department of Vascular Surgery, St. Franziskus Hospital, Münster, Germany
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Sweet MP, Starnes BW, Tatum B. Endovascular treatment of thoracoabdominal aortic aneurysm using physician-modified endografts. J Vasc Surg 2015. [DOI: 10.1016/j.jvs.2015.05.036] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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57
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Georgiadis GS, van Herwaarden JA, Antoniou GA, Hazenberg CEVB, Giannoukas AD, Lazarides MK, Moll FL. Systematic Review of Off-the-Shelf or Physician-Modified Fenestrated and Branched Endografts. J Endovasc Ther 2015; 23:98-109. [DOI: 10.1177/1526602815611887] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To determine the safety and efficacy of off-the-shelf fenestrated/branched grafts (OSFGs) and physician-modified stent-grafts (PMSGs) for the treatment of complex abdominal aortic aneurysms. Methods: A systematic search of the MEDLINE database via PubMed from January 2001 through March 2015 retrieved 23 relevant articles evaluating the clinical outcomes following the management of patients with pararenal or thoracoabdominal aortic aneurysms. The 15 articles on PMSGs and 8 on OSFGs contained data on 308 patients (mean age 72.93±2.89 years; 213 men). The safety endpoint was major adverse events; the efficacy outcome measure was clinical treatment success (aneurysm exclusion without type I/III endoleak, permanent paralysis, long-term dialysis, or unresolved major complications). Extracted outcome data were pooled and compared between groups; data are given as the pooled proportions and 95% confidence interval (CI). Clinical data are presented as the weighted mean. Results: Of the 308 patients analyzed, almost one third were operated on an emergency basis. The mean aneurysm diameters were 75.9±17.3 mm (range 56–115) for the PMSGs and 68.1±13.7 mm (range 60–100) for the OSFGs. A total of 936 renal and visceral vessels were targeted. Major adverse events (safety) occurred in 24 (12.8%) PMSG patients (95% CI 8.6% to 18.7%) and in 9 (7.4%) OSFG patients (95% CI 3.7% to 14%). Clinical treatment success (efficacy) was observed in 171/187 (91.4%) PMSG patients (95% CI 86.2% to 94.9%) and in 115/121 (95%) OSFG patients (95% CI 89.1% to 98.0%). Corresponding cumulative 30-day target vessel and branch stent perfusion rates were 97.2% (95% CI 95.1% to 98.4%) and 97.6% (95% CI 95.5% to 98.8%) for the PMSG group and 99.6% (95% CI 98.3% to 99.9%) and 98.4% (95% CI 96.5% to 99.4%) for the OSFG group. Six (3.2%) deaths occurred in the PMSG group only; 2 (1.1%) were aneurysm related. Overall branch patency was recorded in 443/458 (96.7%) and in 468/478 (97.9%) of target vessels in the PMSG and OSFG groups, respectively. Conclusion: Off-the-shelf and physician-modified technology seems effective and safe, in both the elective and acute settings, for the treatment of complex aortic aneurysms. Future research within a randomized trial should investigate the true limitations of these devices.
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Affiliation(s)
- George S. Georgiadis
- Department of Vascular Surgery, University Medical Center Utrecht, the Netherlands
- Department of Vascular Surgery, “Democritus” University of Thrace, University General Hospital of Alexandroupolis, Greece
| | | | - George A. Antoniou
- Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, UK
| | | | | | - Miltos K. Lazarides
- Department of Vascular Surgery, “Democritus” University of Thrace, University General Hospital of Alexandroupolis, Greece
| | - Frans L. Moll
- Department of Vascular Surgery, University Medical Center Utrecht, the Netherlands
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Banno H, Marzelle J, Becquemin JP. Who should do endovascular repair of complex aortic aneurysms and how should they do them? Surgeon 2015; 13:286-91. [DOI: 10.1016/j.surge.2015.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 01/15/2015] [Accepted: 03/31/2015] [Indexed: 10/23/2022]
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Langdon SE, Motta JC, Kulik A, Imami I, Kernicky L, Lee WA. Branched endograft repair of an aortic stump aneurysm. J Vasc Surg Cases 2015; 1:177-179. [PMID: 31724587 PMCID: PMC6849909 DOI: 10.1016/j.jvsc.2015.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 05/02/2015] [Indexed: 11/28/2022] Open
Abstract
We present a patient with an aortic stump aneurysm that was repaired with a custom-made, four-branched thoracoabdominal endograft. The repair was performed in two stages using a special delivery system designed to be introduced in an antegrade manner through a median sternotomy due to a lack of iliofemoral access. At 1 year, the patient remains in good health, with his aneurysm completely excluded and decreased in size, without migration, and all branch vessels patent. This report represents a unique endovascular repair of a complex aortic pathology in a patient without other surgical options.
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Affiliation(s)
- Sarah E. Langdon
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Fla
| | - John C. Motta
- Christine E. Lynn Heart and Vascular Institute, Boca Raton, Fla
| | - Alexander Kulik
- Christine E. Lynn Heart and Vascular Institute, Boca Raton, Fla
| | - Irfan Imami
- Holmes Regional Medical Center, Melbourne, Fla
| | | | - W. Anthony Lee
- Christine E. Lynn Heart and Vascular Institute, Boca Raton, Fla
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Chuter TAM. Commentary: from bespoke to off-the-shelf: the t-branch stent-graft for total endovascular TAAA repair. J Endovasc Ther 2014; 20:726-7. [PMID: 24325685 DOI: 10.1583/13-4428c.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Timothy A M Chuter
- Division of Vascular Surgery, University of California at San Francisco Medical Center, San Francisco, California, USA
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61
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Bisdas T, Donas KP, Bosiers MJ, Torsello G, Austermann M. Custom-made versus off-the-shelf multibranched endografts for endovascular repair of thoracoabdominal aortic aneurysms. J Vasc Surg 2014; 60:1186-1195. [PMID: 24993949 DOI: 10.1016/j.jvs.2014.06.003] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 06/02/2014] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This study compared early outcomes between the custom-made and the new off-the-shelf multibranched endograft (mbEVAR, t-branch; Cook Medical, Bloomington, Ind) for the endovascular repair of thoracoabdominal aortic aneurysms (TAAAs). METHODS Between January 2010 and January 2013, 46 consecutive patients with TAAAs underwent endovascular aortic repair with mbEVARs. A custom-made device was used in 24 patients (group A, 52%), with Crawford classification type I, 2 (8%); type II, 4 (17%); type III, 9 (38%); and type IV/V, 9 (38%), and the a t-branch endograft was used in 22 patients (group B, 47%), with type II, 9 (41%); type III, 12 (55%); and type IV/V, 1 (4%). The main outcome measure was technical success, defined as successful target revascularization without occlusion of the bridging endografts or type I or III endoleak at the completion angiography. Secondary end points were mortality, unplanned reinterventions, branch occlusion, paraplegia, and persistent (after discharge) paraparesis. RESULTS Technical success was 100% in both groups. The 30-day mortality was 8% in group A (n = 2) and 0% in group B (P = .51). Survival rates at 6 months were 71% in group A (mean follow-up, 13 ± 11 months) and 94% in group B (mean follow-up, 6 ± 3 months; (P = .04). There was only one procedure-related death caused by cerebral bleeding and herniation in group A. The freedom-from-reintervention rate at 6 months was 100% in group A (mean follow-up, 12 ± 11.5 months) and 90% in group B (mean follow-up, 6 ± 3.9 months; P = .07). No branch occlusions were observed in group A, whereas a branch occlusion occurred in three patients in group B (in all cases the bridging endograft for the renal artery). In two patients, the possible reason for branch occlusion was a thrombophilic disorder, whereas in one patient, the reason remains unknown. Paraplegia was observed in one patient in each group (group A: 4%; group B: 5%; P = .51) and persistent paraparesis in two patients in group A (8%) and in one patient (5%) in group B (P = .94). CONCLUSIONS The t-branch device, with the unique advantage of direct implantation without any delay for manufacturing, showed 100% technical success and comparable clinical outcomes to the traditional custom-made mbEVARs. Further long-term evaluation remains mandatory.
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Affiliation(s)
- Theodosios Bisdas
- Department of Vascular Surgery, St. Franziskus Hospital and University Clinic of Muenster, Muenster, Germany.
| | - Konstantinos P Donas
- Department of Vascular Surgery, St. Franziskus Hospital and University Clinic of Muenster, Muenster, Germany
| | - Michel J Bosiers
- Department of Vascular Surgery, St. Franziskus Hospital and University Clinic of Muenster, Muenster, Germany
| | - Giovanni Torsello
- Department of Vascular Surgery, St. Franziskus Hospital and University Clinic of Muenster, Muenster, Germany
| | - Martin Austermann
- Department of Vascular Surgery, St. Franziskus Hospital and University Clinic of Muenster, Muenster, Germany
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Oderich GS, Mendes BC, Correa MP. Preloaded guidewires to facilitate endovascular repair of thoracoabdominal aortic aneurysm using a physician-modified branched stent graft. J Vasc Surg 2014; 59:1168-73. [PMID: 24268717 DOI: 10.1016/j.jvs.2013.09.054] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 09/23/2013] [Accepted: 09/25/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Gustavo S Oderich
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn.
| | - Bernardo C Mendes
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Mateus P Correa
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
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63
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Bosiers MJ, Bisdas T, Donas KP, Torsello G, Austermann M. Early Experience With the First Commercially Available Off-the-Shelf Multibranched Endograft (t-Branch) in the Treatment of Thoracoabdominal Aortic Aneurysms. J Endovasc Ther 2013; 20:719-25. [DOI: 10.1583/13-4428r.1] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Bisdas T, Donas KP, Bosiers M, Torsello G, Austermann M. Anatomical Suitability of the T-Branch Stent-Graft in Patients With Thoracoabdominal Aortic Aneurysms Treated Using Custom-Made Multibranched Endografts. J Endovasc Ther 2013; 20:672-7. [DOI: 10.1583/13-4400mr.1] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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