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Endovascular treatment of aneurysms using fenestrated-branched endografts with distal inverted iliac limbs. J Vasc Surg 2016; 64:600-4. [DOI: 10.1016/j.jvs.2016.02.058] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 02/19/2016] [Indexed: 11/23/2022]
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Gallitto E, Gargiulo M, Freyrie A, Bianchini Massoni C, Mascoli C, Pini R, Faggioli GL, Ancetti S, Stella A. Fenestrated and Branched Endograft after Previous Aortic Repair. Ann Vasc Surg 2016; 32:119-27. [DOI: 10.1016/j.avsg.2015.10.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 10/10/2015] [Accepted: 10/15/2015] [Indexed: 10/22/2022]
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Georgiadis GS, van Herwaarden JA, Antoniou GA, Giannoukas AD, Lazarides MK, Moll FL. Fenestrated stent grafts for the treatment of complex aortic aneurysm disease: A mature treatment paradigm. Vasc Med 2016; 21:223-38. [DOI: 10.1177/1358863x16631841] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The introduction of fenestrated stent grafts (SGs) to treat abdominal aortic aneurysms (AAAs) with short proximal necks began in 1999. Nowadays, the whole visceral aorta can be treated totally by endovascular means. The established use of fenestrated devices to treat complex AAAs as a first-line management option has been previously reported. An up-to-date evaluation of the literature was performed including all types of publications regarding the use of fenestrated technology to repair complex AAAs. Fenestrated repair is now an established alternative to hybrid/chimney/snorkel repairs. However, specific criteria and prerequisites are required for the use and improvement of this method. Multiple device morphologies have been used incorporating the visceral arteries in various combinations. This modular strategy connects different devices (bridging covered stents and bifurcated SGs) with the aortic main body, thus excluding the aneurysm from the circulation. Precise deployment of the fenestrated SG is mandatory for successful visceral vessel revascularization. Accurate SG sizing and customization, a high level of technical skill, and facilities with modern imaging techniques including 3D road mapping and dedicated hybrid rooms are required. Most experience has been with the custom-made Zenith Cook platform, although off-the-shelf devices have been recently implanted. More complex repairs have been performed over the last few years, but device complexity has also increased. Perioperative, mid-term, and a few recently reported long-term results are encouraging. Secondary interventions remain the main problem, similar to that observed after traditional endovascular abdominal aortic aneurysm repair (EVAR).
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Affiliation(s)
- George S Georgiadis
- Department of Vascular Surgery, University Medical Center, Utrecht, The Netherlands
- Department of Vascular Surgery, ‘Demokritus’ University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | | | - George A Antoniou
- Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, UK
| | | | - Miltos K Lazarides
- Department of Vascular Surgery, ‘Demokritus’ University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Frans L Moll
- Department of Vascular Surgery, University Medical Center, Utrecht, The Netherlands
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Lindström D, Wahlgren CM, Sonesson B, Resch T. Disintegration of the Top Stent on Zenith Abdominal Aortic Stent-Grafts. J Endovasc Ther 2016; 23:302-6. [DOI: 10.1177/1526602815626559] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To describe a heretofore unreported complication involving the Zenith Low Profile (LP) stent-graft. Case Report: Two men, aged 75 and 67 years, respectively, underwent abdominal aortic aneurysm repair with a Zenith LP device. At 4 and 3 years, respectively, computed tomography angiography revealed separation of the proximal fixation stent from the stent-graft. In the first patient, there was stent-graft migration but no evidence of an endoleak; however, the aneurysm had grown. A fenestrated cuff was placed, sealing distally in the previous LP graft. The second patient had a type I endoleak. Open surgery was performed, and the main body of the graft was explanted. Postoperative examination of the device revealed that the fixation sutures on the suprarenal stent were still attached to the stent and had eroded through the graft material. Conclusion: Physicians should be aware of the potential for top stent separation from the Zenith LP stent-graft as a cause of endoleak and migration.
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Affiliation(s)
- David Lindström
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Carl Magnus Wahlgren
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Björn Sonesson
- Vascular Center, Skåne University Hospital, Malmö, Sweden
| | - Timothy Resch
- Vascular Center, Skåne University Hospital, Malmö, Sweden
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Donas KP, Torsello G. Commentary: Could the Chimney Technique Become the "Holy Grail" of Endovascular Treatment for Type Ia Endoleaks After EVAR? J Endovasc Ther 2015; 22:575-7. [PMID: 26187978 DOI: 10.1177/1526602815592855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Konstantinos P Donas
- Department of Vascular Surgery, St. Franziskus Hospital Münster, and Department of Vascular and Endovascular Surgery, University of Münster, Germany
| | - Giovanni Torsello
- Department of Vascular Surgery, St. Franziskus Hospital Münster, and Department of Vascular and Endovascular Surgery, University of Münster, Germany
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Use of parallel grafts to save failed prior endovascular aortic aneurysm repair and type Ia endoleaks. J Vasc Surg 2015; 62:578-84. [PMID: 26087878 DOI: 10.1016/j.jvs.2015.04.395] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 04/15/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of this study was the evaluation of the clinical and radiologic outcomes of parallel grafts in the treatment of patients with failed prior endovascular aneurysm repair and type Ia endoleak. METHODS Prospectively collected clinical and radiologic data of consecutive patients with prior endovascular aneurysm repair and evidence of type Ia endoleak were analyzed. All patients were treated between January 2009 and November 2014 by use of parallel grafts, ie, chimney/snorkel or periscope grafts and abdominal endovascular devices. Primary outcome of the study was the technical success. Secondary outcomes were patency of the chimney grafts and shrinkage of aneurysm morphology. RESULTS Technical success was 94.4% (17 of 18). One patient showed evidence of persistent type Ia endoleak after triple chimney graft placement and treated by Onyx embolization (Covidien, Plymouth, Minn) successfully. The mean preoperative and postoperative aneurysm diameters were 7.1 ± 1.7 and 7.0 ± 2 cm. Primary patency of the chimney grafts was 96.7% and assisted patency was 100% after successful retrograde recanalization of an acute occlusion of the superior mesenteric artery from the celiac trunk and the gastroduodenal artery. One patient who had undergone the sandwich technique with transfemoral placement of the flexible Viabahn (W. L. Gore & Associates, Flagstaff, Ariz) due to impossible catheterization of the target vessel from the upper extremity presented with contained rupture caused by gutter-associated endoleak and underwent urgent embolization with Onyx successfully. No procedure-related death or open conversion was observed in the entire follow-up period. CONCLUSIONS Use of parallel grafts showed midterm safety and feasibility with low incidence of persistent endoleaks requiring intervention or progression of aneurysm diameter. Reproducible results from other vascular centers will establish the chimney technique in the treatment of type I endoleaks as a viable endovascular modality.
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Houdek K, Třeška V, Čertík B, Mírka H, Korčáková E, Moláček J, Šulc R, Čechura M. Initial experience of follow up of patients after the endovascular treatment of abdominal aortic aneurysms using contrast-enhanced ultrasound. COR ET VASA 2015. [DOI: 10.1016/j.crvasa.2015.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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de Vries JPP, Ouriel K, Mehta M, Varnagy D, Moore WM, Arko FR, Joye J, Jordan WD, Jordan WD, Paul de Vries J, Joye J, Eckstein H, van Herwaarden J, Arko FR, Bove P, Bohannon W, Fioole B, Setacci C, Resch T, Riambau V, Scheinert D, Clair D, Moursi M, Farber M, Tessarek J, Torsello G, Fillinger M, Glickman M, Henretta J, Hodgson K, Jim J, Katzen B, Lipsitz E, Cox M, Naslund T, Ramaiah V, Schermerhorn M, Schneider P, Starnes BW, Donayre C, Mehta M, Zipfel B, Malhotra N, Varnagy D, Moore W, Cheshire N, Bicknell C, Back M, Muhs B, Malas MB, Hussain S, Gupta N, Bockler D, Verhoeven E, Reijnen M. Analysis of EndoAnchors for endovascular aneurysm repair by indications for use. J Vasc Surg 2014; 60:1460-7.e1. [DOI: 10.1016/j.jvs.2014.08.089] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 08/12/2014] [Indexed: 11/28/2022]
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Orr N, Minion D, Bobadilla JL. Thoracoabdominal aortic aneurysm repair: current endovascular perspectives. Vasc Health Risk Manag 2014; 10:493-505. [PMID: 25170271 PMCID: PMC4145733 DOI: 10.2147/vhrm.s46452] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Thoracoabdominal aneurysms account for roughly 3% of identified aneurysms annually in the United States. Advancements in endovascular techniques and devices have broadened their application to these complex surgical problems. This paper will focus on the current state of endovascular thoracoabdominal aneurysm repair, including specific considerations in patient selection, operative planning, and perioperative complications. Both total endovascular and hybrid options will be considered.
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Affiliation(s)
- Nathan Orr
- Vascular and Endovascular Surgery, Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - David Minion
- Vascular and Endovascular Surgery, Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - Joseph L Bobadilla
- Vascular and Endovascular Surgery, Department of Surgery, University of Kentucky, Lexington, KY, USA
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