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Katsarou M, Auyang PL, Chinnadurai P, Bismuth J. "Octafen": A Noninvestigational Alternative Endograft Configuration for the Treatment of Thoracoabdominal Aortic Aneurysms. J Endovasc Ther 2024; 31:19-25. [PMID: 35869618 DOI: 10.1177/15266028221113752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
PURPOSE To demonstrate the feasibility of Octafen technique, a novel endovascular configuration for the treatment of thoracoabdominal aortic aneurysms (TAAA). TECHNIQUE Two patients with complex TAAA and high surgical risk were treated with Octafen endograft configuration in a hybrid operating room with computed tomography (CT)-fluoroscopy image fusion guidance, using 3D-3D fusion techniques to facilitate procedural success. The procedure is a modification of the previously-described Octopus technique for endovascular repair of TAAA. The main advantage of this technique is the ability to use devices to repair a TAAA with the combination of off-the-shelf and noninvestigational custom-made devices. The devices used are readily available to most practicing vascular surgeons, which provides an alternative treatment in case of limited access to investigational devices, in time-sensitive cases, and in patients with limited functional capacity who cannot undergo open repair. In the modification described herein, we use a combination of standard bifurcated endovascular aneurysm repair (EVAR) devices (Excluder; W.L. Gore & Associates, Flagstaff, Arizona) in combination with a 2-vessel renal fenestrated device (Z-Fen; Cook Medical, Bloomington, Indiana). The article describes a step-by-step approach to this technique to elucidate pitfalls, benefits, and advantages. CONCLUSION The Octafen technique might offer an alternative option for thoracoabdominal aneurysm treatment circumventing the need for access to custom-made, investigational devices. CLINICAL IMPACT In this manuscript, we describe a technique for endovascular repair of thoraco-abdominal aortic aneurysms that involves the combination of off-the-shelf and non-investigational, custom-made devices. The 'Octafen' technique provides a treatment alternative in case of limited access to investigational devices and can be adjusted according to patient anatomy.
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Affiliation(s)
- Maria Katsarou
- Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
- Section of Vascular Surgery, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Philip L Auyang
- Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Ponraj Chinnadurai
- Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
- Advanced Therapies, Siemens Medical Solutions, Malvern, PA, USA
| | - Jean Bismuth
- Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
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Mid-Term Outcomes of Chimney Endovascular Aortic Aneurysm Repair: A Systematic Review and Meta-analysis. Ann Vasc Surg 2021; 79:359-371. [PMID: 34666145 DOI: 10.1016/j.avsg.2021.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/11/2021] [Accepted: 08/15/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND To provide an overview of the literature on the mid-term outcomes of chimney EVAR (ChEVAR) for the treatment of juxtarenal abdominal aortic aneurysms (JAAA). METHODS Different electronic databases were searched for published articles up to January 2020. The eligibility criteria were studies describing mid- or long-term outcomes of chimney EVAR (mean follow-up at least 1 year) for treatment of JAAA, including more than 10 cases, published in English, and with full text available. The outcomes measure were overall survival rate, target vessel patency, and freedom from reintervention at 3 years. Quality of the included studies was analyzed using the MINORS criteria. Pooled effect estimates were analyzed using random-effect models and heterogeneity was tested using I2 statistics. RESULTS Thirteen articles met the inclusion criteria. The included studies described 1,019 patients. According to the quality assessment, methodological quality was moderate to poor. The pooled overall survival, freedom from reintervention, and target vessel patency at 3 year was 81.4 % (95%CI 73.8-87.9), 85.7% (95%CI 75.6-93.5), and 95.1% (95%CI 89.3-98.7) respectively. CONCLUSIONS The results of this review show good to acceptable short and mid-term survival and good mid-term durability, which supports that ChEVAR as a suitable alternative in high-risk JAAA. However, proper patient selection for ChEVAR seems essential to attain good mid-term outcomes, and further large prospective and good quality studies are required to demonstrate its long-term results and enable conclusions on specific determinants for outcome.
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Özdemir-van Brunschot DMD, Torsello GB, Bernardini G, Litterscheid S, Torsello GF, Beropoulis E. Use of Chimney Technique Does Not Improve the Outcome of Endovascular Aneurysm Repair in Patients With a Hyperangulated and Short Proximal Aortic Neck. J Endovasc Ther 2021; 29:361-369. [PMID: 34622699 DOI: 10.1177/15266028211050315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE We hypothesized that extending the proximal landing zone with the chimney technique could be beneficial in patients with a hyperangulated proximal aortic neck, defined as more > 60 degrees. MATERIAL AND METHODS We retrospectively analyzed the outcome of prospectively collected data of patients treated by endovascular aneurysm repair (EVAR) for infrarenal aortic aneurysm with a hyperangulated proximal aortic neck. In all, 104 out of 130 patients were treated without (Group A) and 24 with the chimney endovascular aortic repair (ChEVAR, Group B). Primary outcome was technical and clinical success according to the reporting standards of the Society of Vascular Surgery. RESULTS The use of the chimney technique was associated with a significantly longer operation duration (167 vs. 93 min, p < .001), longer fluoroscopy time (44 vs.30 min, p = < .001), and larger amount of contrast medium used (149 vs. 127 ml, p = .03) but did not significantly improve technical (79.2% vs. 87.7%) and clinical success (54.2% vs. 68.9%). Aneurysm-related mortality was higher in group B (8.3% vs. = 0%, p < .001). Type IA endoleak was high in both groups at completion angiography (11.3% in Group A vs. 12.5% in Group B) and at follow-up (10.4% in Group A vs. 4.5% in Group B) without significant difference between the groups. CONCLUSIONS Our data did not show a benefit of the primary use of the chimney technique in patients with a hyperangulated and short neck, although more studies are required to support this conclusion. Other strategies or new technologies are required for improving EVAR results in aneurysm patients with severe angulated proximal and short neck.
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Affiliation(s)
| | | | - Giulia Bernardini
- Department of Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Catania, Italy
| | - Sarah Litterscheid
- Institute for Vascular Research, St. Franziskus Hospital, Münster, Germany
| | - Giovanni Federico Torsello
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Charité Campus Virchow-Klinikum, Charité University Medicine, Berlin, Germany
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Vento V, Lejay A, Kuntz S, Ancetti S, Heim F, Chakfé N, Gargiulo M. Current status on aortic endografts. THE JOURNAL OF CARDIOVASCULAR SURGERY 2020; 61:544-554. [PMID: 32964901 DOI: 10.23736/s0021-9509.20.11614-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Endovascular treatment has become widespread to treat aneurysmal disease, especially located in the aorta. The modern era of abdominal aortic aneurysm repair started between 1986 and 1991, and in the last 30 years, Endovascular Treatment for abdominal aortic aneurysms evolved both due to the development of new materials and devices and the increasing appeal and effectiveness of the endovascular therapy itself. Vascular surgeons are using nowadays different solutions of Endovascular Treatment to treat all the expressions of aortic pathology (aneurysms, dissections and trauma) both in the acute and elective setting. Despite its use in every location of the aorta (the ascending aorta, the aortic arch, the thoracic aorta, thoraco-abdominal aorta, pararenal, iuxtarenal and infrarenal aortic aneurysms and iliac aneurysms), its safety and efficiency, endovascular treatment for aortic aneurysms presents some drawbacks: despite a lower short-term morbi-mortality, reinterventions and long-term patency are higher compared to open repair. In this review, we detail the most used types of endografts according to location, their performances and durability for each device. We conclude by discussing options to overcome ET limitations. Therefore, an obvious question arises: what we need in the future? What can the technological progress gives to physicians to further improve this new way of treating aorta?
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Affiliation(s)
- Vincenzo Vento
- Unit of Vascular Surgery, Department of Experimental Diagnostic and Specialty Medicine (DIMES), S. Orsola-Malpighi Polyclinic, University of Bologna, Bologna, Italy.,Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Anne Lejay
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Salomé Kuntz
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Stefano Ancetti
- Unit of Vascular Surgery, Department of Experimental Diagnostic and Specialty Medicine (DIMES), S. Orsola-Malpighi Polyclinic, University of Bologna, Bologna, Italy
| | - Frédéric Heim
- Laboratory of Physics and Textile Mechanics, University of Upper Alsace, Mulhouse, France
| | - Nabil Chakfé
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Mauro Gargiulo
- Unit of Vascular Surgery, Department of Experimental Diagnostic and Specialty Medicine (DIMES), S. Orsola-Malpighi Polyclinic, University of Bologna, Bologna, Italy -
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Duong WQ, Fujitani RM, Grigorian A, Kabutey NK, Kuo I, de Virgilio C, Lekawa M, Nahmias J. Evolving Utility of Endovascular Treatment of Juxtarenal, Pararenal, and Suprarenal Abdominal Aortic Aneurysms Associated With Increased Risk of Mortality Over Time. Ann Vasc Surg 2020; 71:428-436. [PMID: 32889159 DOI: 10.1016/j.avsg.2020.08.103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/19/2020] [Accepted: 08/10/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Continued advances in endovascular technologies are resulting in fewer open abdominal aortic aneurysm (AAA) repairs. In addition, more complex juxtarenal, pararenal, and suprarenal (JPS) AAAs are being managed with various endovascular techniques. This study sought to evaluate the evolving trends in endovascular aneurysm repair (EVAR) of AAAs, hypothesizing increased rate of JPS AAA repair by EVAR. We also sought to evaluate the risk for morbidity and mortality for EVAR and open aneurysm repair (OAR) of JPS AAAs over time. METHODS The 2011-2017 American College of Surgeons National Surgical Quality Improvement Program Procedure-Targeted Vascular database was queried for patients undergoing OAR or EVAR for AAAs. A multivariable logistic regression analysis was performed for both infrarenal and JPS AAA repairs. RESULTS Of 18,661 patients who underwent AAA repair, 3,941 (21.1%) were OAR and 14,720 (78.9%) were EVAR. The rate of OAR decreased from 29.5% in 2011 to 21.3% in 2017 (P < 0.001) with a geometric-mean-annual decrease of 27.8%. The rate of EVAR increased from 70.5% to 78.7% during the same time period (P < 0.001) with a geometric-mean-annual increase of 11.6%. These trends remained true for both infrarenal and JPS AAAs. After adjusting for covariates, there was no difference in associated risk of 30-day mortality, renal complications, or ischemic colitis for either OAR or EVAR over each incremental year for infrarenal AAAs (P > 0.05). However, in patients undergoing EVAR for JPS AAAs, the associated risk of mortality increased with each incremental year (odds ratio [OR]: 1.30, confidence interval [CI]: 1.01-1.69, P = 0.039), whereas there was no difference in the risk of mortality for OAR of JPS AAAs with each incremental year (OR: 1.11, CI: 0.99-1.23, P = 0.067). CONCLUSIONS The rate of OAR for AAA has decreased over the past seven years with an increase in EVAR, particularly for more complex JPS AAAs. The associated risk for morbidity and mortality for treatment of infrarenal AAAs was not significantly affected by this increased utility of EVAR. The associated risk of mortality for JPS AAAs treated by EVAR increased over time, whereas this trend for associated risk of mortality was not seen for OAR of JPS AAAs. These findings, especially the increased associated risk of mortality over time with EVAR for JPS AAAs, warrant careful prospective analysis.
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Affiliation(s)
- William Q Duong
- University of California, Irvine, Department of Surgery, Orange, CA.
| | - Roy M Fujitani
- University of California, Irvine, Department of Surgery, Orange, CA
| | - Areg Grigorian
- University of California, Irvine, Department of Surgery, Orange, CA
| | - Nii-Kabu Kabutey
- University of California, Irvine, Department of Surgery, Orange, CA
| | - Isabella Kuo
- University of California, Irvine, Department of Surgery, Orange, CA
| | | | - Michael Lekawa
- University of California, Irvine, Department of Surgery, Orange, CA
| | - Jeffry Nahmias
- University of California, Irvine, Department of Surgery, Orange, CA
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Spampinato B, Settembrini AM, Romagnoli S, D'Alessio I, Domanin M, Gabrielli L. Concomitant Renal Artery and Aortic Aneurysm: Is Endovascular Surgery the Correct Approach? Ann Vasc Surg 2019; 61:473.e1-473.e5. [PMID: 31394217 DOI: 10.1016/j.avsg.2019.05.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 05/26/2019] [Accepted: 05/29/2019] [Indexed: 11/17/2022]
Abstract
Our case illustrates the concomitant presence of a giant aneurysm of the left renal artery at the ostium and an abdominal aortic aneurysm, in presence of a complex aortic anatomy. Type of approach and timing of the treatment is still not well established for the rare coexistence of these 2 pathologies. In case of surgical high-risk patients, endovascular therapy is considered now the best choice to exclude arterial and aortic aneurysms although there are chances to do further interventions in the follow-up. For this reason, we simultaneously treated both the aneurysms through an embolization with plugs and coils of renal aneurysm and endovascular exclusion of aortic aneurysm; in the follow-up, renal function of the patient worsened until hemodialysis and we saw the reperfusion of renal aneurysm and the onset of endoleak I type A from above the aortic and renal aneurysm and B from iliac legs of the previous endograft. We performed a parallel graft technique on visceral vessels to exclude the refilling of both aneurysms and preserve visceral vascularization. Follow-up at 12 months showed the complete exclusion of the aneurysms and the patency of stents in celiac trunk and superior mesenteric artery.
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Affiliation(s)
- Benedetta Spampinato
- Division of Vascular Surgery, Fondazione Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Alberto M Settembrini
- Division of Vascular Surgery, Fondazione Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
| | - Silvia Romagnoli
- Division of Vascular Surgery, Fondazione Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Ilenia D'Alessio
- Division of Vascular Surgery, Fondazione Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Maurizio Domanin
- Division of Vascular Surgery, Fondazione Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy; Department of Clinical and Community Sciences, University of Milan, Milano, Italy
| | - Livio Gabrielli
- Division of Vascular Surgery, Fondazione Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy; Department of Clinical and Community Sciences, University of Milan, Milano, Italy
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Li Z, Yan F, Yang J, Chen Y, Xu Z, Jiang W, Yuan D. Hemodynamics and Oxygen Transport through Pararenal Aortic Aneurysm Treated with Multilayer Stent: A Numerical Study. Ann Vasc Surg 2018; 54:290-297. [PMID: 30081175 DOI: 10.1016/j.avsg.2018.05.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 05/14/2018] [Accepted: 05/28/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND As opposed to an endoluminal stent graft, a multilayer stent (MS) consists of a porous mesh, which allows for the possibility of treating pararenal aortic aneurysms (PRAAs) that involve a significant branch vessel. However, the choice of the density of the MS plays a vital role in isolating the aneurysm and allowing unobstructed blood flow in the branch vessel. METHOD In the present study, we examined 3 cases (without a stent and with single-layer and double-layer stents) via numerical simulations to explore the feasibility of the MSs used in the treatment of such aneurysms and estimate whether there is a more appropriate or optimal stent density. RESULTS With stent intervention, the velocity of blood flow in the sac decreased, but the pressure on the surface of the aneurysm did not decrease although it became more uniform. In addition, the "region of double low" (with low wall shear stress and a low Sherwood number) enlarged after stent implantation. Even with the double-layer stent, however, the flux of the branch vessel was still above normal, and we could predict that the optimal stent porosity was approximately 49.9%. CONCLUSIONS Unlike in previous studies, an MS could not be feasibly applied to high-risk PRAAs. However, an MS can induce sac thrombosis in the later stages while maintaining visceral vessel patency, and our results suggest that the optimal stent may be a 4-layer stent.
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Affiliation(s)
- Zhongyou Li
- Department of Applied Mechanics, Sichuan University, Chengdu, China
| | - Fei Yan
- Department of Applied Mechanics, Sichuan University, Chengdu, China
| | - Jingru Yang
- School of Manufacturing Science & Engineering, Sichuan University, Chengdu, China
| | - Yu Chen
- Department of Applied Mechanics, Sichuan University, Chengdu, China.
| | - Zhizhi Xu
- Department of Applied Mechanics, Sichuan University, Chengdu, China
| | - Wentao Jiang
- Department of Applied Mechanics, Sichuan University, Chengdu, China.
| | - Ding Yuan
- Department of Vascular Surgery of West China Hospital, Sichuan University, Chengdu, China
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Maeda K, Ohki T, Kanaoka Y. Endovascular Treatment of Various Aortic Pathologies: Review of the Latest Data and Technologies. Int J Angiol 2018; 27:81-91. [PMID: 29896040 DOI: 10.1055/s-0038-1645881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The technologies and innovations applicable to endovascular treatment for complex aortic pathologies have progressed rapidly over the last two decades. Although the initial outcomes of an endovascular aortic repair have been excellent, as long-term data became available, complications including endoleaks, endograft migration, and endograft infection have become apparent and are of concern. Previously, the indication for endovascular therapy was restricted to descending thoracic aortic aneurysms and abdominal aortic aneurysms. However, its indication has expanded along with the improvement of techniques and devices, and currently, it has become possible to treat pararenal aortic aneurysms and Crawford type 4 thoracoabdominal aortic aneurysm (TAAA) using the off-the-shelf devices. Additionally, custom-made devices allow for the treatment of arch or more extensive TAAAs. Endovascular treatment is applied not only to aneurysms but also to acute/chronic dissections. However, long-term outcomes are still unclear. This article provides an overview of available devices and the results of endovascular treatment for various aortic pathologies.
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Affiliation(s)
- Koji Maeda
- Division of Vascular Surgery, Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Yuji Kanaoka
- Division of Vascular Surgery, Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
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Overeem SP, Donselaar EJ, Boersen JT, Groot Jebbink E, Slump CH, de Vries JPPM, Reijnen MMPJ. In Vitro Quantification of Gutter Formation and Chimney Graft Compression in Chimney EVAR Stent-Graft Configurations Using Electrocardiography-Gated Computed Tomography. J Endovasc Ther 2018; 25:387-394. [DOI: 10.1177/1526602818762399] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To assess the dynamic behavior of chimney grafts during the cardiac cycle. Methods: Three chimney endovascular aneurysm repair (EVAR) stent-graft configurations (Endurant and Advanta V12, Endurant and Viabahn, and Endurant and BeGraft) were placed in silicone aneurysm models and subjected to physiologic flow. Electrocardiography (ECG)-gated contrast-enhanced computed tomography was used to visualize geometric changes during the cardiac cycle. Endograft and chimney graft surface, gutter volume, chimney graft angulation over the center lumen line, and the D-ratio (the ratio between the lengths of the major and minor axes) were independently assessed by 2 observers at 10 time points in the cardiac cycle. Results: Both gutter volumes and chimney graft geometry changed significantly during the cardiac cycle in all 3 configurations (p<0.001). Gutters and endoleaks were observed in all configurations. The largest gutter volume (232.8 mm3) and change in volume (20.7 mm3) between systole and diastole were observed in the Endurant-Advanta configuration. These values were 2.7- and 3.0-fold higher, respectively, compared to the Endurant-Viabahn configuration and 1.7- and 1.6-fold higher as observed in the Endurant-BeGraft configuration. The Endurant-Viabahn configuration had the highest D-ratio (right, 1.26–1.35; left, 1.33–1.48), while the Endurant-BeGraft configuration had the lowest (right, 1.11–1.17; left, 1.08–1.15). Assessment of the interobserver variability showed a high correlation (intraclass correlation >0.935) between measurements. Conclusion: Gutter volumes and stent compression are dynamic phenomena that reshape during the cardiac cycle. Compelling differences were observed during the cardiac cycle in all configurations, with the self-expanding (Endurant–Viabahn) chimney EVAR configurations having smaller gutters and less variation in gutter volume during the cardiac cycle yet more stent compression without affecting the chimney graft surface.
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Affiliation(s)
- Simon P. Overeem
- MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
- Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, Utrecht, the Netherlands
| | - Esmé J. Donselaar
- Department of Vascular Surgery, Rijnstate Hospital, Arnhem, the Netherlands
| | - Jorrit T. Boersen
- MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
- Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, Utrecht, the Netherlands
- Department of Vascular Surgery, Rijnstate Hospital, Arnhem, the Netherlands
| | - Erik Groot Jebbink
- MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
- Department of Vascular Surgery, Rijnstate Hospital, Arnhem, the Netherlands
| | - Cornelis H. Slump
- MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
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Maeda K, Ohki T, Kanaoka Y, Baba T, Tezuka M, Nakagawa H. Concomitant Coil Embolization for Gutter Leak during Endovascular Aortic Repair with the Snorkel Technique. Ann Vasc Surg 2017; 45:265.e13-265.e16. [DOI: 10.1016/j.avsg.2017.06.129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 06/08/2017] [Indexed: 12/20/2022]
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11
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Thompson M, Youssef M, Jacob R, Zerwes S, Reijnen M, Szopinski P, Berg P, Oszkinis G, Holden A. Early Experience With Endovascular Aneurysm Sealing in Combination With Parallel Grafts for the Treatment of Complex Abdominal Aneurysms: The ASCEND Registry. J Endovasc Ther 2017; 24:764-772. [DOI: 10.1177/1526602817731103] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
| | - Marwan Youssef
- Department of Vascular Surgery, University Hospital, Mainz, Germany
| | - Rudolf Jacob
- Department of Vascular Surgery, Augsburg Hospital, Augsburg, Germany
| | - Sebastian Zerwes
- Department of Vascular Surgery, Augsburg Hospital, Augsburg, Germany
| | - Michel Reijnen
- Department of Vascular Surgery, Rijnstate Hospital, Arnhem, the Netherlands
| | | | - Patrick Berg
- Department of Vascular Surgery, Marienhospital Kevelaer, Germany
| | | | - Andrew Holden
- Department of Interventional Radiology, Auckland City Hospital, Auckland, New Zealand
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12
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Fadda GF, Marino M, Kasemi H, Di Angelo CL, Dionisi CP, Cammalleri V, Setacci C. Aortic aneurysm endovascular treatment with the parallel graft technique from the aortic arch to the iliac axis. THE JOURNAL OF CARDIOVASCULAR SURGERY 2017; 60:589-598. [PMID: 28548474 DOI: 10.23736/s0021-9509.17.09899-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The chimney technique has been developed for the treatment of complex aortic aneurysms. We analyzed the midterm to long-term outcomes of this approach from a single-center experience. METHODS From October 2008 to July 2016, 58 patients underwent endovascular aortic aneurysm repair using the chimney technique. Indications for treatment were thoracic aortic aneurysm (TAA) (N.=11), thoracoabdominal aortic aneurysm (TAAA) (N.=2), pararenal aortic aneurysm (PAAA) (N.=15), aortoiliac/isolated hypogastric artery aneurysm (N.=25), type I endoleak after previous TEVAR/EVAR (N.=4), proximal pseudoaneurysm after AAA open repair (N.=1). Elective (82.8%) and emergent (17.2%) procedures were included. RESULTS The immediate technical success was 100%. Single, double and triple chimneys were performed in 46, 10, and two patients, respectively. Overall, 61 target vessels (three left common carotid arteries, eight left subclavian arteries, three celiac trunks, three superior mesenteric arteries, 19 renal arteries and 25 hypogastric arteries) were involved. Postoperative mortality was 0. No neurologic complications were registered. Primary patency rate of the chimney stent/stent graft was 98.3%. Low-flow type I endoleak was observed in four patients (6.9%). Postoperative chimney graft re-intervention rate was 1.7%. The median follow-up was 32±20 months (range 3-96 months). Overall estimated survival at 12, 50, and 80 months was 100%, 89% and 44%, respectively. Estimated freedom from endoleak at 1, 12, 24, and 36 months was 96.5%, 95%, 95%, and 93%, respectively. One hypogastric artery stent-graft occluded at the 3rd month of follow-up. No reintervention was performed. CONCLUSIONS Our experience with the chimney technique for aortic aneurysms from the aortic arch to the iliac axis shows promising and durable mid- and long-term results. Endograft oversizing, associated with the chimney graft diameter and length choice remain fundamental to reduce the risk of the most frequent procedure complications: type I endoleak and CG occlusion. The wider use of this technique should be justified in patients considered at high risk for open repair and/or not suitable for the custom-made branched/fenestrated endografts.
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Affiliation(s)
- Gian Franco Fadda
- Unit of Vascular and Endovascular Surgery, Department of Surgery, San Francesco Hospital, Nuoro, Italy
| | - Mario Marino
- Unit of Vascular and Endovascular Surgery, Department of Surgery, San Francesco Hospital, Nuoro, Italy
| | - Holta Kasemi
- Unit of Vascular and Endovascular Surgery, Department of Surgery, San Francesco Hospital, Nuoro, Italy -
| | - Costantino L Di Angelo
- Unit of Vascular and Endovascular Surgery, Department of Surgery, San Francesco Hospital, Nuoro, Italy
| | - Carlo P Dionisi
- Unit of Vascular Surgery, Department of Surgery, Cardinal Panico Hospital, Tricase, Lecce, Italy
| | - Valeria Cammalleri
- Unit of Cardiology, Department of Cardiovascular Disease, Tor Vergata University, Rome, Italy
| | - Carlo Setacci
- Unit of Vascular and Endovascular Surgery, Department of Medicine, Surgery and Neurological Sciences, University of Siena, Siena, Italy
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Overeem SP, Boersen JT, Schuurmann RCL, Groot Jebbink E, Slump CH, Reijnen MMPJ, de Vries JPPM. Classification of gutter type in parallel stenting during endovascular aortic aneurysm repair. J Vasc Surg 2016; 66:594-599. [PMID: 27743807 DOI: 10.1016/j.jvs.2016.08.087] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 08/05/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Gutters can be described as the loss of continuous apposition between the main body of the endograft, the chimney stent graft, and the aortic wall. Gutters have been associated with increased risk of type IA endoleaks and are considered to be the Achilles' heel of chimney endovascular aneurysm repair (ch-EVAR). However, there is no classification yet to classify and quantify gutter types after ch-EVAR. METHODS Different gutter types can be distinguished by their morphologic appearance in two- and three-dimensional views and reconstructed slices perpendicular to the center lumen line. RESULTS Three main categories are defined by (1) the most proximal beginning of the gutter, (2) the length of gutter alongside the endograft, and (3) its distal end. Type A gutters originate at the proximal fabric of an endograft, type B gutters originate as loss of apposition of the chimney stent graft in the branch vessel, and type C gutters start below the fabric of the endograft. To determine eventual changes of gutter size during follow-up computed tomography angiograms (CTAs), measurements may be performed with dedicated software on the follow-up CTA scan to assess the extent of gutters over the aortic circumference, ranging from 0° to 360° of freedom, together with the maximum gap between the endograft material and the aortic wall as it appears on reconstructed axial CTA scan slices. CONCLUSIONS The proposed gutter classification enables a uniform nomenclature in the current ch-EVAR literature and a more accurate risk assessment of gutter-associated endoleaks. Moreover, it allows monitoring of eventual progression of gutter size during follow-up.
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Affiliation(s)
- Simon P Overeem
- MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands; Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
| | - Johannes T Boersen
- MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands; Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands; Department of Vascular Surgery, Rijnstate Hospital, Arnhem, The Netherlands
| | - Richte C L Schuurmann
- MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands; Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Erik Groot Jebbink
- MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands; Department of Vascular Surgery, Rijnstate Hospital, Arnhem, The Netherlands
| | - Cornelis H Slump
- MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
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A Case of Successful Coil Embolization for a Late-Onset Type Ia Endoleak after Endovascular Aneurysm Repair with the Chimney Technique. Case Rep Vasc Med 2016; 2016:5307416. [PMID: 27699077 PMCID: PMC5028801 DOI: 10.1155/2016/5307416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 08/16/2016] [Indexed: 11/24/2022] Open
Abstract
Juxtarenal aortic aneurysms (JRAAs) are challenging to treat by endovascular aneurysm repair (EVAR) procedures. The chimney technique with EVAR (Ch-EVAR) is one of the feasible and less invasive treatments for JRAAs. However, the main concern of Ch-EVAR is the potential risk of “gutters,” which can lead to type Ia endoleak (EL). Most type Ia ELs after Ch-EVAR procedures occurred intraoperatively, and these ELs could be treated using an endovascular technique. However, late-onset type Ia ELs could be extremely rare, which might have a fear of conservative treatment. Type Ia ELs are associated with an increased risk of aneurysm rupture; therefore reintervention is recommended as soon as possible, and we should be aware of the occurrence of type Ia ELs after the Ch-EVAR procedure.
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Hertault A, Haulon S, Lee JT. Debate: Whether branched/fenestrated endovascular aneurysm repair procedures are better than snorkels, chimneys, or periscopes in the treatment of most thoracoabdominal and juxtarenal aneurysms. J Vasc Surg 2015; 62:1357-65. [DOI: 10.1016/j.jvs.2015.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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