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Funnel technique for wide infrarenal aneurysm neck with Lifetech Ankura™ Stent Graft System. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2021; 29:304-310. [PMID: 34589248 PMCID: PMC8462105 DOI: 10.5606/tgkdc.dergisi.2021.21183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 06/15/2021] [Indexed: 11/24/2022]
Abstract
Background
In this study, we present our mid-term results in patients undergoing treatment with the funnel technique and describe technical issues for this bailout technique in extra-wide infrarenal necks.
Methods
Between January 2018 and June 2020, a total of seven male, symptomatic patients (median: 74.5 years; range, 64 to 84 years) who had comorbidities and were in the American Society for Anesthesiologists Class IV and treated by the funnel technique in an endovascular fashion were included. Pre- and post-procedural data of the patients, early mortality and technical success rates were evaluated.
Results
There was no early mortality. Technical success rate was 100%. There was no type I or III endoleaks at the completion angiography. All patients were discharged without any problem on the second or third day of the procedure. The median follow-up was 13 (range, 6 to 28) months. The aneurysm sac shrinkage was achieved in all patients over six months of follow up. During the follow-up period, no proximal endoleak or infrarenal aortic neck diameter enlargement was found.
Conclusion
Based on our limited experience, the funnel technique may be considered more than a bailout procedure under special circumstances.
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Goudeketting SR, Wille J, van den Heuvel DAF, Vos JA, de Vries JPPM. Midterm Single-Center Results of Endovascular Aneurysm Repair With Additional EndoAnchors. J Endovasc Ther 2018; 26:90-100. [PMID: 30514134 DOI: 10.1177/1526602818816099] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To review midterm clinical outcomes of EndoAnchor placement during or after endovascular aneurysm repair (EVAR) or chimney EVAR (ch-EVAR). MATERIALS AND METHODS A retrospective analysis was conducted of 51 consecutive patients [median age 75 years; 38 men] who underwent EVAR/ch-EVAR with EndoAnchor placement between June 2010 and December 2016 to prevent seal failures (31, 61%) or to treat type Ia endoleak and/or migration (20, 39%). Median aortic neck diameter was 27.7 mm and median neck length was 9.0 mm. Thirty-three (65%) had a conical neck; 48 (94%) had at least 1 hostile neck characteristic. Thirty-two (63%) patients had severe comorbidities (ASA score ⩾III). Eight patients had a single ch-EVAR procedure. Baseline patient characteristics, anatomic variables, procedure details, early and late complications, reinterventions, and aneurysm-related and all-cause mortality rates were recorded. Follow-up imaging was performed with computed tomography angiography (CTA) or duplex ultrasonography. RESULTS Median procedure time was 100 minutes; a median of 6 EndoAnchors were implanted. There were 10 (10%) residual type Ia endoleaks at the end of the procedure; 9 had resolved by the first postoperative CTA. One residual and 2 new type Ia endoleaks were identified at the first postoperative imaging. Median follow-up for the entire cohort was 24.0 months, during which 3 new type Ia endoleaks were identified. Five of the 6 type Ia endoleaks were treated, 1 resolved spontaneously. There was 1 endograft limb occlusion without clinical consequences, 1 chimney graft occlusion without possibilities for a reintervention, 1 rupture after type IV endoleak (a Nellix device was successfully deployed within the main device), and 1 complete graft explantation for infection. There was no new-onset hemodialysis. Kaplan-Meier estimates of freedom from type Ia endoleak, proximal neck-related reinterventions, and aneurysm-related mortality at 2 years were 87.3%, 92.2%, and 94.0%, respectively. CONCLUSION EndoAnchors are helpful in the endovascular treatment of unfavorable proximal aortic necks, with fair midterm results.
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Affiliation(s)
- Seline R Goudeketting
- 1 Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, the Netherlands.,2 MIRA Institute of Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
| | - Jan Wille
- 1 Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
| | | | - Jan-Albert Vos
- 3 Department of Interventional Radiology, St Antonius Hospital, Nieuwegein, the Netherlands
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Bonardelli S, Nodari F, De Lucia M, Botteri E, Benenati A, Cervi E. Late open conversion after endovascular repair of abdominal aneurysm failure: Better and easier option than complex endovascular treatment. JRSM Cardiovasc Dis 2018; 7:2048004017752835. [PMID: 29568519 PMCID: PMC5858687 DOI: 10.1177/2048004017752835] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 11/22/2017] [Accepted: 11/23/2017] [Indexed: 11/25/2022] Open
Abstract
AIM Conversion to open repair becomes the last option in case of endovascular repair of abdominal aneurysm failure, when radiological interventional procedures are unfeasible. While early conversion to open repair generally derives from technical errors, aetiopathogenesis and results of late conversion to open repair often remain unclear. METHODS We report data from our Institute's experience on late conversion to open repair. Twenty-two late conversion to open repairs out of 435 consecutive patients treated during a 18 years period, plus two endovascular repair of abdominal aneurysms performed in other centres, are analysed. The indication for conversion to open repair was aneurysm enlargement because of type I, type III, type II endoleak and endotension. Even if seven cases (23%) had shown an initial aneurysmal shrinkage, in a later phase, the sac began to enlarge again. In 12 patients, conversion to open repair was the last chance after unsuccessful secondary endovascular procedures. RESULTS Three cases (12.5%) were treated in emergency. Aortic cross-clamping was only infrarenal in 10 cases, only or temporarily suprarenal in 14 and temporarily supraceliac in 9 cases, for 19 total and 5 partial endograft excisions. Two patients died for Multiple Organ Failure (MOF), on 42nd (endovascular repair of abdominal aneurysm infection) and 66th postoperative day. No other conversion to open repair-related deaths or major complications were revealed by follow-up post-conversion to open repair (mean: 68 months ranging from 24 to 180 months). CONCLUSION Late conversion to open repair is often an unpredictable event. It represents a technical challenge: specifically, the most critical point is the proximal aortic clamping that often temporarily excludes the renal circulation. In our series, conversion to open repair can be performed with a low rate of complications. In response to an endovascular repair of abdominal aneurysm failure, before applying complex procedures of endovascular treatment, conversion to open repair should be taken into account.
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Affiliation(s)
- Stefano Bonardelli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Franco Nodari
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Maurizio De Lucia
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Emanuele Botteri
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Alice Benenati
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Edoardo Cervi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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Bubble Trouble: Air Embolism during Multiple EndoAnchor Application. J Vasc Interv Radiol 2017; 28:768-770. [PMID: 28431655 DOI: 10.1016/j.jvir.2016.12.1211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 12/11/2016] [Accepted: 12/12/2016] [Indexed: 11/20/2022] Open
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Predeployed aortic extension cuff (kilt) in EVAR with hostile neck anatomy using Endurant II system: preliminary results. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2017; 13:334-339. [PMID: 28096831 PMCID: PMC5233764 DOI: 10.5114/kitp.2016.64876] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 11/24/2016] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Various modifications of standard endovascular aortic aneurysm repair (EVAR) have been developed to solve the problem of difficult neck anatomy. AIM The authors propose the implantation of a predeployed extension cuff (kilt) using on-shelf Endurant II elements. In a vast majority of cases, the proposed method provides a solution for the hostile neck problem using standard Endurant II elements available in all centers performing subrenal EVAR procedures. MATERIAL AND METHODS The early outcomes of kilt implantation were evaluated in 11 patients (three with ruptured abdominal aortic aneurysms, one symptomatic) in 2 vascular centers in Silesia (Poland). All patients presented with hostile neck anatomy defined as neck length < 10 mm, diameter > 28 mm, angulation > 60°, mural thrombus or calcium > 2 mm in thickness or > 180° circumference. RESULTS No intraoperative type I endoleak or device migration was observed. Two perioperative deaths occurred in patients in a severe condition with ruptured aneurysms. One case of type III endoleak was managed by the implantation of an additional iliac extension with complete endoleak sealing. CONCLUSIONS The proposed method seems to be effective in early endoleak prevention in patients with hostile neck anatomy undergoing EVAR procedures; however, studies with long-term follow-up are needed.
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Quatromoni JG, Orlova K, Foley PJ. Advanced Endovascular Approaches in the Management of Challenging Proximal Aortic Neck Anatomy: Traditional Endografts and the Snorkel Technique. Semin Intervent Radiol 2015; 32:289-303. [PMID: 26327748 DOI: 10.1055/s-0035-1558825] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Advances in endovascular technology, and access to this technology, have significantly changed the field of vascular surgery. Nowhere is this more apparent than in the treatment of abdominal aortic aneurysms (AAAs), in which endovascular aneurysm repair (EVAR) has replaced the traditional open surgical approach in patients with suitable anatomy. However, approximately one-third of patients presenting with AAAs are deemed ineligible for standard EVAR because of anatomic constraints, the majority of which involve the proximal aneurysmal neck. To overcome these challenges, a bevy of endovascular approaches have been developed to either enhance stent graft fixation at the proximal neck or extend the proximal landing zone to allow adequate apposition to the aortic wall and thus aneurysm exclusion. This article is composed of two sections that together address new endovascular approaches for treating aortic aneurysms with difficult proximal neck anatomy. The first section will explore advancements in the traditional EVAR approach for hostile neck anatomy that maximize the use of the native proximal landing zone; the second section will discuss a technique that was developed to extend the native proximal landing zone and maintain perfusion to vital aortic branches using common, off-the-shelf components: the snorkel technique. While the techniques presented differ in terms of approach, the available clinical data, albeit limited, support the notion that they may both have roles in the treatment algorithm for patients with challenging proximal neck anatomy.
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Affiliation(s)
- Jon G Quatromoni
- Division of Vascular Surgery, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Ksenia Orlova
- Division of Vascular Surgery, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Paul J Foley
- Division of Vascular Surgery, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
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Results of the ANCHOR prospective, multicenter registry of EndoAnchors for type Ia endoleaks and endograft migration in patients with challenging anatomy. J Vasc Surg 2014; 60:885-92.e2. [DOI: 10.1016/j.jvs.2014.04.063] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 04/22/2014] [Indexed: 11/19/2022]
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Scali ST, McNally MM, Feezor RJ, Chang CK, Waterman AL, Berceli SA, Huber TS, Beck AW. Elective endovascular aortic repair conversion for type Ia endoleak is not associated with increased morbidity or mortality compared with primary juxtarenal aneurysm repair. J Vasc Surg 2014; 60:286-294.e1. [PMID: 24684769 PMCID: PMC4143905 DOI: 10.1016/j.jvs.2014.02.046] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 02/18/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Type Ia endoleak after endovascular aortic repair (EVAR) can be a challenging complication to manage, and due to concerns regarding morbidity and mortality of open surgical conversion (OSC), reports of complex endoluminal salvage techniques are increasing. Despite development of these endovascular remedial strategies, many patients ultimately require OSC. The purpose of this analysis was to outcomes of elective OSC for type Ia endoleak and compare them with elective primary open juxtarenal aneurysm repair (OJAR) to determine if these concerns are warranted. METHODS From 2000 to 2012, 54 patients underwent EVAR OSC at median time of 27 months (interquartile range, 9-55 months). Indications included endograft thrombosis in 2 (4%), intraoperative EVAR failure in 3 (6%), rupture in 5 (9%), graft infection in 6 (11%), and type Ia endoleak in 25 (all: 38 [70%]). Because many OSCs are performed for emergency indications without endovascular options, we chose elective type Ia endoleak patients as our study group. These 25 patients were compared with an elective OJAR cohort matched by anatomy and comorbidities. Primary end points were 30-day and 1-year mortality. Secondary end points included early complications, cross-clamp time, procedure time, blood loss, and length of stay. RESULTS Demographic and comorbidity data in the OSC and OJAR groups did not differ, with the exception that OJAR patients presented with smaller aneurysm diameter and a higher rate of chronic obstructive pulmonary disease (P = .03). OSC patients more frequently underwent a nontube graft repair (OSC, n = 20 [80%] vs OJAR, n = 6 [24%]; P = .0002), required longer procedure times (P = .03), and received more plasma transfusions (P = .03). The 30-day mortality was 4% in both groups (observed difference in rates, 0%; 95% confidence interval for difference in mortality rates, -14.0% to 14.0%; P = 1). A similar rate of major complications occurred (OSC, n = 9 [36%] vs OJAR, n = 8 [32%]; P = 1). One-year survival was 83% in OSC and 91% in OJAR (observed difference, 7%; 95% confidence interval, -15% to 29%; P = .65). CONCLUSIONS Despite many advances in EVAR technology, the need for OSC persists and will likely become more common as older-generation devices fail or providers attempt EVAR in more anatomically complex patients. Elective OSC for type Ia endoleak can be technically challenging but is not associated with increased morbidity or mortality compared with OJAR in appropriately selected patients. These results should be considered before pursuing complex endovascular remediation of EVAR failures.
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Affiliation(s)
- Salvatore T Scali
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla.
| | - Michael M McNally
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla
| | - Robert J Feezor
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla
| | - Catherine K Chang
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla
| | - Alyson L Waterman
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla
| | - Scott A Berceli
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla
| | - Thomas S Huber
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla
| | - Adam W Beck
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla
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Melas N, Perdikides T, Saratzis A, Lazaridis J, Saratzis N. A novel approach to minimize sealing defects: EndoAnchors reduce gutter size in an in vitro chimney graft model. J Endovasc Ther 2013; 20:506-13. [PMID: 23914860 DOI: 10.1583/13-4228c.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Nikolaos Melas
- 1st Department of Surgery, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece.
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Kasprzak P, Pfister K, Janotta M, Kopp R. EndoAnchor Placement in Thoracic and Thoracoabdominal Stent-Grafts to Repair Complications of Nonalignment. J Endovasc Ther 2013; 20:471-80. [DOI: 10.1583/12-4125.1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Bail DHL, Walker T, Giehl J. Vascular Endostapling Systems for Vascular Endografts (T)EVAR—Systematic Review—Current State. Vasc Endovascular Surg 2013; 47:261-6. [DOI: 10.1177/1538574413478474] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: Recently, vascular endostapling systems were developed to achieve better sealing at the proximal neck of the aneurysm and to prevent endograft migration. The purpose of this study was to provide a systematic review about the current state and possible options of vascular endostapling systems. Results: No randomized controlled trials were published. The results showed that the use of an endostaple system considerably reduced the rates of endoleaks type 1a and endograft migration. Regarding the use of endostaples in different types of endografts, only a few results were available. Conclusion: The results are not conclusive. With endostaple systems, patients with difficult anatomic features and high risk can potentially be treated. These systems might reduce the high reintervention rates after endovascular aneurysm repair. Controlled randomized trials with larger number of patients are warranted with endostapling use in primary endograft implantation and for use in reintervention for late endoleaks or endograft migrations.
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Affiliation(s)
- Dorothee H. L. Bail
- KCQ - Competence-Center Quality Assurance, Medical Service of Statutory Healthcare Insurance, Tuebingen, Germany
| | - Tobias Walker
- Department of Thoracic-, Cardiac- and Vascular Surgery, University Hospital Tuebingen, Tuebingen, Germany
| | - Johannes Giehl
- KCQ - Competence-Center Quality Assurance, Medical Service of Statutory Healthcare Insurance, Tuebingen, Germany
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Perdikides T, Melas N, Lagios K, Saratzis A, Siafakas A, Bountouris I, Kouris N, Avci M, Van den Heuvel DAF, de Vries JPPM. Primary EndoAnchoring in the Endovascular Repair of Abdominal Aortic Aneurysms With an Unfavorable Neck. J Endovasc Ther 2012; 19:707-15. [DOI: 10.1583/jevt-12-4008r.1] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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