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Orrico M, Marino M, Vona A, Lorido A, Mangialardi ML, Nesi F, Mangialardi N. EVAR with Aortic Placement of a Single JOTEC E-iliac Stent-graft System in a Patient with Poliomyelitis Aortoiliac Deformities. Ann Vasc Surg 2020; 69:454.e7-454.e11. [PMID: 32768550 DOI: 10.1016/j.avsg.2020.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/04/2020] [Accepted: 07/13/2020] [Indexed: 10/23/2022]
Abstract
Small-sized vessels can represent a contraindication to standard endovascular aortic repair (EVAR), and more specifically, aortoiliac deformities resulting from poliomyelitis may add an adjunctive challenge for total endovascular repair. Herein we report a case of a 62-year-old man with a 55 mm abdominal aortic aneurysm (AAA) and a history of poliomyelitis. More specifically, a computed tomography angiogram (CTA) showed a very narrow infrarenal aortic neck, measuring 13 mm in maximum diameter, and severely atrophic external iliac and common femoral arteries. A total endovascular repair was planned and realized with a single aortic JOTEC iliac branch and contralateral VBX placement. All prosthetic materials were delivered from the nonatrophic side. At the 1-year CTA, the aneurysm was successfully excluded and both iliofemoral axes were patent.
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Affiliation(s)
- Matteo Orrico
- Department of Vascular and Endovascular Surgery, San Camillo Forlanini Hospital, Rome, Italy.
| | - Mario Marino
- Department of Vascular and Endovascular Surgery, San Camillo Forlanini Hospital, Rome, Italy
| | - Alessio Vona
- Department of Vascular and Endovascular Surgery, San Camillo Forlanini Hospital, Rome, Italy
| | - Antonio Lorido
- Department of Vascular and Endovascular Surgery, San Camillo Forlanini Hospital, Rome, Italy
| | - Maria Lucia Mangialardi
- Department of Vascular and Endovascular Surgery, San Camillo Forlanini Hospital, Rome, Italy
| | - Fabrizio Nesi
- Department of Vascular and Endovascular Surgery, San Camillo Forlanini Hospital, Rome, Italy
| | - Nicola Mangialardi
- Department of Vascular and Endovascular Surgery, San Camillo Forlanini Hospital, Rome, Italy
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Gemayel G. Endovascular Treatment of an Abdominal Aortic FALSE Aneurysm with a Very Narrow Distal Aorta and Aortic Lumen Using an Iliac Branch Device. Ann Vasc Surg 2020; 69:452.e1-452.e4. [PMID: 32634556 DOI: 10.1016/j.avsg.2020.06.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/04/2020] [Accepted: 06/28/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION A narrow distal aorta (NDA) makes endovascular aortic repair (EVAR) challenging and prone to immediate and late complications. We describe a case of an abdominal aortic false aneurysm (AAFA) with an NDA and iliac occlusive disease that was treated by an iliac branch device (IBD) placed at the aortic bifurcation. CASE REPORT A 76-year-old male patient suffering from severe bilateral calf claudication presented to our clinic. He had a history of ischemic heart disease, diabetes mellitus, and left colectomy for colon cancer. His workup revealed an AAFA with severe iliac occlusive disease. His aortic lumen and his aortic bifurcation were very narrow (10 mm) precluding a classic bifurcated EVAR. An open repair was not possible because of his multiple comorbidities. We successfully used an IBD by placing its Y configuration at the level of the aortic bifurcation, bridging the branch into one iliac artery with a balloon-expandable covered stent and extending the main component proximally up to the renal arteries with an aortic cuff. CONCLUSIONS Bifurcated EVAR may not be suitable in patients with an NDA. Using an IBD at the level of the aortic bifurcation is feasible. This technique offers a total endovascular solution in high-risk patients for open repair.
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Affiliation(s)
- Gino Gemayel
- Vascular surgery, La Tour Hospital, Meyrin, Switzerland.
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Condino S, Piazza R, Viglialoro RM, Mocellin DM, Turini G, Berchiolli RN, Micheletti F, Rossi F, Pini R, Ferrari V, Ferrari M. Novel EM Guided Endovascular Instrumentation for In Situ Endograft Fenestration. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2020; 8:1900208. [PMID: 32219042 PMCID: PMC7082146 DOI: 10.1109/jtehm.2020.2973973] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/20/2019] [Accepted: 01/27/2020] [Indexed: 01/28/2023]
Abstract
Objective: This work aims at providing novel endovascular instrumentation to overcome current technical limitations of in situ endograft fenestration including challenges in targeting the fenestration site under fluoroscopic control and supplying mechanical support during endograft perforation. Technology: Novel electromagnetically trackable instruments were developed to facilitate the navigation of the fenestration device and its stabilization at the target site. In vitro trials were performed to preliminary evaluate the proposed instrumentation for the antegrade in situ fenestration of an aortic endograft, using a laser guidewire designed ad hoc and the sharp end of a commercial endovascular guidewire. Results: In situ fenestration was successfully performed in 22 trials. A total of two laser tools were employed since an over bending of laser guidewire tip, due to its manufacturing, caused the damage of the sensor in the first device used. Conclusions: Preliminary in vitro trials demonstrate the feasibility of the proposed instrumentation which could widespread the procedure for in situ fenestration. The results obtained should be validated performing animal studies. Clinical Impact: The proposed instrumentation has the potential to expand indications for standard endovascular aneurysm repair to cases of acute syndromes.
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Affiliation(s)
- S Condino
- 1Information Engineering DepartmentUniversity of Pisa56122PisaItaly.,2EndoCAS CenterDepartment of Translational Research and New Technologies in Medicine and SurgeryUniversity of Pisa56126PisaItaly
| | - R Piazza
- 1Information Engineering DepartmentUniversity of Pisa56122PisaItaly.,2EndoCAS CenterDepartment of Translational Research and New Technologies in Medicine and SurgeryUniversity of Pisa56126PisaItaly
| | - R M Viglialoro
- 2EndoCAS CenterDepartment of Translational Research and New Technologies in Medicine and SurgeryUniversity of Pisa56126PisaItaly
| | - D M Mocellin
- 3Vascular Surgery UnitCisanello University Hospital AOUP56126PisaItaly
| | - G Turini
- 2EndoCAS CenterDepartment of Translational Research and New Technologies in Medicine and SurgeryUniversity of Pisa56126PisaItaly.,4Computer Science DepartmentKettering UniversityFlintMI48504USA
| | - R N Berchiolli
- 2EndoCAS CenterDepartment of Translational Research and New Technologies in Medicine and SurgeryUniversity of Pisa56126PisaItaly.,3Vascular Surgery UnitCisanello University Hospital AOUP56126PisaItaly
| | - F Micheletti
- 5Institute of Applied Physics "Nello Carrara," National Research Council50019Sesto FiorentinoItaly
| | - F Rossi
- 5Institute of Applied Physics "Nello Carrara," National Research Council50019Sesto FiorentinoItaly
| | - R Pini
- 5Institute of Applied Physics "Nello Carrara," National Research Council50019Sesto FiorentinoItaly
| | - V Ferrari
- 1Information Engineering DepartmentUniversity of Pisa56122PisaItaly.,2EndoCAS CenterDepartment of Translational Research and New Technologies in Medicine and SurgeryUniversity of Pisa56126PisaItaly
| | - M Ferrari
- 2EndoCAS CenterDepartment of Translational Research and New Technologies in Medicine and SurgeryUniversity of Pisa56126PisaItaly.,3Vascular Surgery UnitCisanello University Hospital AOUP56126PisaItaly
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Jayet J, Heim F, Coggia M, Chakfe N, Coscas R. An Experimental Study of Laser in situ Fenestration of Current Aortic Endografts. Eur J Vasc Endovasc Surg 2018; 56:68-77. [DOI: 10.1016/j.ejvs.2018.03.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 03/12/2018] [Indexed: 10/17/2022]
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Glorion M, Coscas R, McWilliams RG, Javerliat I, Goëau-Brissonniere O, Coggia M. A Comprehensive Review of In Situ Fenestration of Aortic Endografts. Eur J Vasc Endovasc Surg 2016; 52:787-800. [PMID: 27843111 DOI: 10.1016/j.ejvs.2016.10.001] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 10/10/2016] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Despite technical advances of fenestrated and branched endografts, endovascular exclusion of aneurysms involving renal, visceral, and/or supra-aortic branches remains a challenge. In situ fenestration (ISF) of standard endografts represents another endovascular means to maintain perfusion to such branches. This study aimed to review current indications, technical descriptions, and results of ISF. METHOD A review of the English language literature was performed in Medline databases, Cochrane Database, Web of Science, and Scopus using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Sixty-seven relevant papers were selected. Thirty-three papers were excluded, leaving 34 articles as the basis of the present review. RESULTS Most experimental papers evaluated ISF feasibility and assessed the consequences of ISF on graft fabric. Regarding clinical papers, 73 ISF procedures have been attempted in 58 patients, including 26 (45%) emergent and three (5%) bailout cases. Sixty-five (89%) ISF were located at the level of the arch, and eight (11%) in the abdominal aorta. Graft perforation was performed by physical, mechanical, or unspecified means in 33 (45%), 38 (52%), and two vessels (3%), respectively. ISF was technically successful in 68/73 (93%) arteries. At 30 days, two (3.4%) patients died in the setting of an aorto-bronchial fistula and an aorto-oesophageal fistula, respectively. No post-operative death, major complication, or endoleak was described as secondary to the ISF procedure. With follow-up between 0 and 72 months, four (6.9%) late deaths were noted, unrelated to the aorta. One (1.7%) LSA stent was stenosed without symptoms. CONCLUSIONS Although there may be publication bias, multiple techniques were described to perform ISF with satisfactory short-term results. Long-term data remain scarce. Aortic endograft ISF is an off-label procedure that should not be used outside emergent bailout techniques or investigational studies. A comparison with alternative techniques of preserving aortic side branches is needed.
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Affiliation(s)
- M Glorion
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Boulogne-Billancourt, France; Faculté de Médecine Paris-Ile de France-Ouest, UFR des sciences de la santé Simone Veil, Université Versailles Saint-Quentin en Yvelines, Montigny-le-Bretonneux, France
| | - R Coscas
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Boulogne-Billancourt, France; Faculté de Médecine Paris-Ile de France-Ouest, UFR des sciences de la santé Simone Veil, Université Versailles Saint-Quentin en Yvelines, Montigny-le-Bretonneux, France; UMR 1018, Inserm-Paris11 - CESP, Versailles Saint-Quentin-en-Yvelines University, Paris-Saclay University, Paul Brousse Hospital, Villejuif, France.
| | - R G McWilliams
- Radiology Department, Royal Liverpool University Hospital, Liverpool, UK
| | - I Javerliat
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Boulogne-Billancourt, France
| | - O Goëau-Brissonniere
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Boulogne-Billancourt, France; Faculté de Médecine Paris-Ile de France-Ouest, UFR des sciences de la santé Simone Veil, Université Versailles Saint-Quentin en Yvelines, Montigny-le-Bretonneux, France; UMR 1018, Inserm-Paris11 - CESP, Versailles Saint-Quentin-en-Yvelines University, Paris-Saclay University, Paul Brousse Hospital, Villejuif, France
| | - M Coggia
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Boulogne-Billancourt, France; Faculté de Médecine Paris-Ile de France-Ouest, UFR des sciences de la santé Simone Veil, Université Versailles Saint-Quentin en Yvelines, Montigny-le-Bretonneux, France
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8
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Crawford SA, Sanford RM, Forbes TL, Amon CH, Doyle MG. Clinical outcomes and material properties of in situ fenestration of endovascular stent grafts. J Vasc Surg 2016; 64:244-50. [DOI: 10.1016/j.jvs.2016.03.445] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 03/18/2016] [Indexed: 01/29/2023]
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