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Ketting S, Zoethout AC, Heyligers J, Wiersema AM, Yeung KK, Schurink GW, Verhagen HJ, de Vries JPP, Reijnen MM, Mees BM. Nationwide experience with EVAS relining of previous open or endovascular AAA treatment in the Netherlands. Ann Vasc Surg 2022; 84:250-264. [DOI: 10.1016/j.avsg.2021.12.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 12/20/2021] [Accepted: 12/30/2021] [Indexed: 11/16/2022]
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2
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D'Oria M, Budtz-Lilly J, Lindstrom D, Lundberg G, Jonsson M, Wanhainen A, Mani K, Unosson J. Comparison of Early and Mid-Term Outcomes After Fenestrated-Branched Endovascular Aortic Repair in Patients With or Without Prior Infrarenal Repair. J Endovasc Ther 2021; 29:544-554. [PMID: 34781751 DOI: 10.1177/15266028211058686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The purpose of this study was to compare short- and mid-term outcomes of fenestrated-branched endovascular repair (F-BEVAR) of pararenal (PRAA)/thoracoabdominal (TAAA) aortic aneurysms in patients with or without prior endovascular/open (EVAR/OAR) infrarenal aortic repair. METHODS Data from consecutive F-BEVAR (2010-2019) at two high-volume aortic centers were retrospectively reviewed. Primary endpoints were technical success, 30-day mortality, and overall survival. Secondary endpoints included 30-day major adverse events (MAE), freedom from type I/III endoleaks, reinterventions, sac expansion, and target vessel (TV) primary patency. RESULTS A total of 222 consecutive patients were included for analysis; of these 58 (26.1%) had prior infrarenal repair (EVAR=33, OAR=25) and 164 (73.9%) had native PRAA/TAAA. At baseline, patients with prior infrarenal repair were older (mean age=75.1 vs 71.6 years, p=.005) and the proportion of females was lower (8.6% vs 29.3%, p=.002). Technical success was 97.8% (n=217) in the entire cohort, without any significant differences between study groups (94.8% vs 98.8%, p=.08). At 30 days, there were no significant differences between patients with prior infrarenal repair as compared with those without in rate of MAE (44.8% vs 54.9%, p=.59). The 5-year estimate of survival for those who underwent native aortic repair was 61.6%, versus 61.3% for those who had a previous repair (p=.67). The 5-year freedom from endoleaks I/III estimates were significantly lower in patients who had prior infrarenal repair as compared with patients undergoing treatment of native aneurysms (57.1% vs 66.1%, p=.03), mainly owing to TV-related endoleaks (ie, type IC and/or IIIC endoleaks). No significant differences were found between study groups in rates of reinterventions and TV primary patency. Five-year estimates of freedom from sac increase >5mm were significantly lower in patients who received F-BEVAR after previous infrarenal repair as compared with those who underwent treatment of native aneurysms (48.6% vs 77.5%, p=.002). CONCLUSIONS F-BEVAR is equally safe and feasible for treatment of patients with prior infrarenal repair as compared with those undergoing treatment for native aneurysms. Increased rates of TV-related endoleaks were observed which could lead to lower freedom from aneurysm sac shrinkage during follow-up. Nevertheless, the 5-year rates of reinterventions and TV patency were similar, thereby indicating that overall effectiveness of treatment remained satisfactory at mid-term.
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Affiliation(s)
- Mario D'Oria
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.,Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste-ASUGI, Trieste, Italy
| | - Jacob Budtz-Lilly
- Division of Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - David Lindstrom
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - Goran Lundberg
- Vascular Surgery, Department of Molecular Medicine and Surgery, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Jonsson
- Vascular Surgery, Department of Molecular Medicine and Surgery, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Anders Wanhainen
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.,Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Kevin Mani
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - Jon Unosson
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
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Pitoulias GA, Fazzini S, Donas KP, Scali ST, D'Oria M, Torsello G, Veith FJ, Puchner SB. Multicenter Mid-Term Outcomes of the Chimney Technique in the Elective Treatment of Degenerative Pararenal Aortic Aneurysms. J Endovasc Ther 2021; 29:226-239. [PMID: 34605299 DOI: 10.1177/15266028211047940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Chimney endovascular abdominal aortic aneurysm repair (CHEVAR) has predominantly been described as an alternative technique for the management of urgent presentations of degenerative pararenal aortic aneurysms (dPAAs). However, the role of CHEVAR in the treatment of asymptomatic patients remains unknown. The aim of current multinational study was to evaluate the outcomes of elective CHEVAR of dPAAs. MATERIAL AND METHODS Retrospective analysis of 267 consecutive dPAA patients treated with elective CHEVAR at 13 European and US centers from 2008 to 2014. Primary endpoints were 30 days and out of hospital CHEVAR-related mortality. Secondary endpoints included persistent type Ia endoleak or endotension, angiographically confirmed occlusion and/or high-grade chimney graft (CG) or involved splanchnic vessel stenosis identified at index procedure and/or during follow-up, as well as CHEVAR-related re-intervention. RESULTS Mean follow-up time was 25.5±13.3 months. The 442 visceral vessels were involved and mean number of CGs per patient was 1.63±0.7. 436 targeted vessels were successfully cannulated. The aortic graft intentionally covered 6 renal arteries and immediate technical success was 98.6%. The 30 days mortality was 1.9% (n=5), while the in-hospital complication rate was 10.1% (n=27) including 3 strokes, 1 permanent dialysis, and 1 intestinal ischemia. No 30 day type Ia endoleaks were detected and 3.2% of CGs (n=14, including the intentionally covered) had evidence of occlusion and/or stenosis. The overall CHEVAR-related mortality was 2.2% (n=6). Freedom from primary and secondary type Ia endoleak/endotension rates at 3 years was 93.0% and 98.0%, respectively. Primary and secondary CG patency was 87.0% and 89.0%. Primary and secondary endovascular freedom from any endpoint at 3 years was 81.0% and 94.0% respectively. CONCLUSION Elective use of CHEVAR in the management of dPAAs seems to be durable. These results are comparable to published outcomes with other total endovascular strategies, which justifies an expanded role for CHEVAR in the treatment of asymptomatic patients presenting with dPAAs.
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Affiliation(s)
- Georgios A Pitoulias
- Division of Vascular Surgery, 2nd Department of Surgery, School of Medicine, Aristotle University of Thessaloniki, G. Gennimatas Hospital, Thessaloniki, Greece.,Department of Vascular Surgery, Research Vascular Centre, Asklepios Clinic Langen, University of Frankfurt, Langen, Germany
| | - Stefano Fazzini
- Department of Vascular Surgery, San Filippo Neri Hospital, Rome, Italy
| | - Konstantinos P Donas
- Department of Vascular Surgery, Research Vascular Centre, Asklepios Clinic Langen, University of Frankfurt, Langen, Germany
| | - Salvatore T Scali
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, FL, USA
| | - Mario D'Oria
- Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Cattinara ASUITs, Trieste, Italy
| | - Giovanni Torsello
- Department of Vascular Surgery, St. Franziskus Hospital Münster, Münster, Germany
| | - Frank J Veith
- New York University and Cleveland Clinic Foundation, New York, NY, USA
| | - Stefan B Puchner
- Department of Radiology and Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
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Gallitto E, Sobocinski J, Mascoli C, Pini R, Fenelli C, Faggioli G, Haulon S, Gargiulo M. Fenestrated and Branched Thoraco-abdominal Endografting after Previous Open Abdominal Aortic Repair. Eur J Vasc Endovasc Surg 2020; 60:843-852. [DOI: 10.1016/j.ejvs.2020.07.071] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 07/03/2020] [Accepted: 07/22/2020] [Indexed: 12/13/2022]
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Chisci E, Pigozzi C, Alberti A, Masciello F, Troisi N, Turini F, Michelagnoli S. Staged in situ aorto-iliac hybrid technique: an original technique to treat complex juxtarenal and iliac aneurysms. INT ANGIOL 2020; 39:517-524. [PMID: 33140625 DOI: 10.23736/s0392-9590.20.04457-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND To report a novel staged hybrid technique to treat complex juxtarenal abdominal aortic aneurysm (JAAA) associated with at least one iliac artery aneurysm (IA) with no adequate distal fixation zone. METHODS The novel technique herein described has two main "staged" steps. The first step consists in creating an adequate distal fixation zone by endovascular means; after hypogastric embolization an iliac stent-graft has placed from 5 mm above the aortic bifurcation to the external iliac artery. The second step is the surgical resection of the JAAA and graft placement sutured distally to the stent-graft which was always performed the day after. RESULTS The five cases included (mean age 74 years), were rejected for fenestrated or branched endovascular aortic repair or iliac branch devices. Four tube grafts and one aorto-bi-iliac graft were sutured to one stent-graft (N.=3), two stent-grafts in iliac kissing configuration (N.=1) and to a main body of a bifurcated stent-graft (N.=1). Mean follow-up duration was 14 (4-27) months with no mortality. Technical success was obtained in all cases (2 suprarenal clamping). Postoperative complications included two pleural effusions, two transient gluteal intermittent claudications, and one renal failure. CONCLUSIONS The technique herein described seems to be a feasible and cost-effective alternative treatment for selected concomitant complex JAAAs and IAs unsuitable for totally endovascular treatment.
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Affiliation(s)
- Emiliano Chisci
- Unit of Vascular and Endovascular Surgery, Department of Surgery, San Giovanni di Dio Hospital, Florence, Italy -
| | - Clara Pigozzi
- Unit of Vascular and Endovascular Surgery, Department of Surgery, San Giovanni di Dio Hospital, Florence, Italy
| | - Aldo Alberti
- Unit of Vascular and Endovascular Surgery, Department of Surgery, San Giovanni di Dio Hospital, Florence, Italy
| | - Fabrizio Masciello
- Unit of Vascular and Endovascular Surgery, Department of Surgery, San Giovanni di Dio Hospital, Florence, Italy
| | - Nicola Troisi
- Unit of Vascular and Endovascular Surgery, Department of Surgery, San Giovanni di Dio Hospital, Florence, Italy
| | - Filippo Turini
- Unit of Vascular and Endovascular Surgery, Department of Surgery, San Giovanni di Dio Hospital, Florence, Italy
| | - Stefano Michelagnoli
- Unit of Vascular and Endovascular Surgery, Department of Surgery, San Giovanni di Dio Hospital, Florence, Italy
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D'Oria M, Griselli F, Mastrorilli D, Gorgatti F, Bassini S, Riccitelli F, Calvagna C, Zamolo F, Lepidi S. Secondary Relining With Focal Flaring of Novel-Generation Balloon-Expandable Covered Stents for Endovascular Treatment of Significant Diameter Mismatch in the Aorto-Iliac Territory. Vascular 2020; 29:207-212. [PMID: 32731800 DOI: 10.1177/1708538120945056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim of this study was to report on the safety and feasibility of secondary relining with focal flaring of novel-generation balloon-expandable covered stents for endovascular treatment of significant diameter mismatch in the aorto-iliac territory. Significant diameter mismatch was defined as >20% difference in the nominal diameter between the intended proximal and distal landing zones. METHODS Patient A was an 84-year-old man with prior abdominal aortic aneurysm open repair with a straight 20 mm Dacron tube. He presented with a right common iliac artery aneurysm (Ø88 mm) with contained rupture. The Gore Viabahn endoprosthesis (9 mm × 5 cm) was inserted proximally about 15 mm above the occluded ostium of the internal iliac artery. Subsequently, the BeGraft Aortic® (16 mm × 48 mm) was inserted proximally up to the common iliac artery origin; its proximal portion was flared to 22 mm. Patient B was a 77-year-old man with prior endovascular abdominal aortic aneurysm repair with a Medtronic Endurant stent-graft. He presented with occlusion of the right limb of the aortic endoprosthesis and thrombosis that extended down to the level of the superficial femoral artery. After mechanical thrombectomy, two Gore Viabahn endoprosthesis (first one, 8 mm × 10 cm; second one, 10 mm × 15 cm) were inserted into the right iliac limb. Subsequently, the BeGraft Aortic® (12mm × 39mm) was inserted proximally up to the gate of the aortic stent-graft; its proximal portion was flared to 16 mm. RESULTS Technical success and clinical success were achieved in both patients. Imaging follow-up (6 months for Patient A, 12 months for Patient B) showed correct placement of all stent-grafts without any graft-related adverse event. The patients remained free from new reinterventions or recurrent symptoms. Patient A died 8 months after the index procedure from acute respiratory failure after community acquired pneumonia. CONCLUSION Secondary relining with focal flaring of novel-generation balloon-expandable covered stents for endovascular treatment of significant diameter mismatch in the aorto-iliac territory is safe and feasible. Although mid-term results seem to be effective, longer follow-up is warranted to establish durability of the technique.
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Affiliation(s)
- Mario D'Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Cattinara ASUIGI, Trieste, Italy
| | - Filippo Griselli
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Cattinara ASUIGI, Trieste, Italy
| | - Davide Mastrorilli
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Cattinara ASUIGI, Trieste, Italy
| | - Filippo Gorgatti
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Cattinara ASUIGI, Trieste, Italy
| | - Silvia Bassini
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Cattinara ASUIGI, Trieste, Italy
| | - Francesco Riccitelli
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Cattinara ASUIGI, Trieste, Italy
| | - Cristiano Calvagna
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Cattinara ASUIGI, Trieste, Italy
| | - Francesca Zamolo
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Cattinara ASUIGI, Trieste, Italy
| | - Sandro Lepidi
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Cattinara ASUIGI, Trieste, Italy
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Pitoulias GA, Torsello G, Austermann M, Pitoulias AG, Pipitone MD, Fazzini S, Donas KP. Outcomes of elective use of the chimney endovascular technique in pararenal aortic pathologic processes. J Vasc Surg 2020; 73:433-442. [PMID: 32473338 DOI: 10.1016/j.jvs.2020.05.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 05/13/2020] [Indexed: 01/24/2023]
Abstract
OBJECTIVE In the treatment of pararenal abdominal aortic aneurysms and aortic pathologic processes, chimney endovascular aneurysm repair (CHEVAR) represents an alternative technique for urgent cases. The aim of the study was to evaluate the outcomes of CHEVAR in the elective setting. METHODS We performed a retrospective analysis of prospectively collected records of 165 consecutive asymptomatic CHEVAR patients who were treated between March 2009 and January 2018 with the Endurant stent graft (Medtronic, Santa Rosa, Calif). A total of 244 chimney grafts (CGs) were implanted. The primary end point was clinical success, defined as freedom from procedure-related mortality, persistent type IA endoleak, occlusion or high-grade stenosis (>70%) of CGs, and any chimney technique-related secondary procedure for the entire follow-up period. Secondary clinical success included patients with successful treatment of a primary end point with a secondary endovascular procedure. RESULTS All 244 targeted chimney vessels were successfully cannulated. Total perioperative morbidity was 7.8% (n = 13), including 3 (1.8%) cases of bowel ischemia, 1 (0.6%) patient with renal ischemia, and 1 patient (0.6%) with stroke. Median follow-up was 25.5 ± 2.2 months. Both 30-day and follow-up procedure-related mortality rates were 1.8% (n = 3). Primary and secondary freedom from persistent type IA endoleak rates were 96.4% (n = 159) and 99.4% (n = 164), respectively. Primary and secondary CG patency rates were 92.2% (n = 225) and 95.9% (n = 234), respectively. The rate of reinterventions related to the chimney technique was 10.9% (n = 18), and 83.3% of them were performed by endovascular means. The estimated cumulative primary patency and freedom from persistent type IA endoleak were 87.5% and 95.3%, respectively, and the primary and secondary clinical successes rates at midterm were 80.3% and 87.5%, respectively. CONCLUSIONS The elective use of CHEVAR with the Endurant stent graft in our series showed favorable midterm clinical results, which are similar to the published results of other total endovascular modalities. A prospective randomized trial of elective treatment of pararenal abdominal aortic aneurysms and aortic pathologic processes with current endovascular options is needed to assess the value of CHEVAR in the elective setting.
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Affiliation(s)
- Georgios A Pitoulias
- Department of Vascular Surgery, St. Franziskus Hospital Münster, Münster, Germany; Second Department of Surgery, Division of Vascular Surgery, School of Medicine, Aristotle University of Thessaloniki, "G. Gennimatas" Hospital, Thessaloniki, Greece.
| | - Giovanni Torsello
- Department of Vascular Surgery, St. Franziskus Hospital Münster, Münster, Germany
| | - Martin Austermann
- Department of Vascular Surgery, St. Franziskus Hospital Münster, Münster, Germany
| | - Apostolos G Pitoulias
- Second Department of Surgery, Division of Vascular Surgery, School of Medicine, Aristotle University of Thessaloniki, "G. Gennimatas" Hospital, Thessaloniki, Greece
| | - Marco D Pipitone
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Cattinara ASUITs, Trieste, Italy
| | - Stefano Fazzini
- Department of Vascular Surgery, St. Franziskus Hospital Münster, Münster, Germany
| | - Konstantinos P Donas
- Department of Vascular Surgery, Research Vascular Centre, Asklepios Clinic Langen, University of Frankfurt, Langen, Germany
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D'Oria M, Mastrorilli D, Calvagna C, Riccitelli F, Gorgatti F, Zamolo F, Griselli F. Secondary Endovascular Repair of Recurring Lesions and Perioperative Complications after Open Aortic Repair: The Complementary Role of Different Technical Solutions. Ann Vasc Surg 2020; 63:99-107. [DOI: 10.1016/j.avsg.2019.06.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 04/27/2019] [Accepted: 06/02/2019] [Indexed: 10/26/2022]
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9
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D'Oria M, Griselli F, Mastrorilli D, Riccitelli F, Gorgatti F, Bassini S, Calvagna C, Zamolo F, Lepidi S. Novel Application of Custom-Made Stent Grafts with Inner Branches for Secondary Treatment After Stent Graft Migration of Previous Infrarenal Endovascular Aortic Repair. Ann Vasc Surg 2020; 66:665.e9-665.e15. [PMID: 31904516 DOI: 10.1016/j.avsg.2019.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE We present a novel application of custom-made stent grafts (CMSGs) with inner branches to incorporate target vessels (TVs) as an alternative to fenestrations or directional branches for secondary treatment after stent graft migration of previous infrarenal endovascular aortic repair (EVAR). CASE REPORT Two consecutive patients with stent graft migration of previous EVAR were electively treated at our institution from January 1, 2018 through December 31, 2018. Stent graft migration was defined as radiologic evidence of stent graft displacement >10 mm. In both cases, a proximal type I endoleak was noted, and the residual infrarenal aorta above the previous endograft was unsuitable as the proximal landing zone for a nonfenestrated cuff. Repair was planned by means of a CMSG with 4 inner branches. The procedures were conducted in two-stage fashion to minimize the risk of spinal cord ischemia. The procedures were technically successful with a total of 8 TVs stented. Both patients did not suffer from any early (i.e., up to 30 days) major adverse events, and no access-site complications were noted. At one-year follow-up, computed tomography angiography showed regular placement of the CMSGs, widely patent TVs, absence of any type I or III endoleak, and stable sac size. No late reinterventions were recorded. CONCLUSIONS Secondary treatment of stent graft migration after previous EVAR is safe and feasible using CSMGs with 4 inner branches. This technique is effective as showed by stable sac size and 100% freedom from TVI at mid-term imaging follow-up. Larger cohorts and longer follow-up are needed to confirm the preliminary results.
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Affiliation(s)
- Mario D'Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Cattinara ASUITs, Trieste, Italy.
| | - Filippo Griselli
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Cattinara ASUITs, Trieste, Italy
| | - Davide Mastrorilli
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Cattinara ASUITs, Trieste, Italy
| | - Francesco Riccitelli
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Cattinara ASUITs, Trieste, Italy
| | - Filippo Gorgatti
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Cattinara ASUITs, Trieste, Italy
| | - Silvia Bassini
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Cattinara ASUITs, Trieste, Italy
| | - Cristiano Calvagna
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Cattinara ASUITs, Trieste, Italy
| | - Francesca Zamolo
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Cattinara ASUITs, Trieste, Italy
| | - Sandro Lepidi
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Cattinara ASUITs, Trieste, Italy
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D’Oria M, Mirza AK, Tenorio ER, Kärkkäinen JM, DeMartino RR, Oderich GS. Physician-Modified Endograft With Double Inner Branches for Urgent Repair of Supraceliac Para-Anastomotic Pseudoaneurysm. J Endovasc Ther 2019; 27:124-129. [DOI: 10.1177/1526602819890108] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To demonstrate the feasibility of a physician-modified endograft (PMEG) with inner branches for 2 mesenteric arteries as an alternative to fenestrations or directional branches. Technique: A symptomatic 60-year-old man presented with supraceliac para-anastomotic pseudoaneurysm involving an antegrade aorta to celiac artery and superior mesenteric artery bypass. Since an off-the-shelf multibranched endograft was inappropriate, a Zenith Alpha thoracic stent-graft was modified with 2 inner branches fashioned of 8-mm Viabahn endoprostheses with preloaded guidewires. The procedure was technically successful, and the patient had no postoperative complications. Conclusion: Inner branches might offer an alternative to fenestrations or directional branches in patients with narrow aortas.
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Affiliation(s)
- Mario D’Oria
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Aleem K. Mirza
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Emanuel R. Tenorio
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Jussi M. Kärkkäinen
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Gustavo S. Oderich
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
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Sveinsson M, Kristmundsson T, Dias N, Sonesson B, Mani K, Wanhainen A, Resch T. Juxtarenal endovascular therapy with fenestrated and branched stent grafts after previous infrarenal repair. J Vasc Surg 2019; 70:1747-1753. [DOI: 10.1016/j.jvs.2019.01.078] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 01/17/2019] [Indexed: 10/26/2022]
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12
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Abdul Jabbar A, Chanda A, White CJ, Jenkins JS. Percutaneous endovascular abdominal aneurysm repair: State‐of‐the art. Catheter Cardiovasc Interv 2019; 95:767-782. [DOI: 10.1002/ccd.28576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 08/27/2019] [Accepted: 10/25/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Ali Abdul Jabbar
- Interventional CardiologyOchsner Clinic Foundation New Orleans Louisiana
| | - Arijit Chanda
- Interventional CardiologyOchsner Clinic Foundation New Orleans Louisiana
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Marchiori E, Herten M, Bosiers M, Schwindt A, Bisdas T, Austermann M, Torsello G, Stavroulakis K. Effectiveness of Intra-Arterial Aneurysm Sac Embolization for Type Ia Endoleak after Endovascular Aneurysm Repair. J Vasc Interv Radiol 2019; 30:531-538. [PMID: 30879869 DOI: 10.1016/j.jvir.2018.11.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 11/25/2018] [Accepted: 11/25/2018] [Indexed: 10/27/2022] Open
Abstract
PURPOSE To evaluate the effectiveness and durability of intra-arterial aneurysm sac embolization for the treatment of type Ia endoleak after endovascular aneurysm repair (EVAR). MATERIALS AND METHODS From February 2011 to December 2016, 22 patients underwent embolization of a type Ia endoleak after EVAR. Four patients (18%) were treated during the index EVAR and 18 (82%) in follow-up. Five patients (23%) were treated urgently and 17 (77%) electively. The embolization was performed with the use of liquid embolic agent, coils, and/or plugs. Adjunctive neck procedures were performed in 55% (n = 12) of the patients. The primary endpoint of this study was freedom from sac enlargement. Key secondary endpoints were technical success and freedom from endoleak-related reinterventions. RESULTS Technical success was 100%. The 30-day mortality was 5% (n = 1; acute coronary syndrome). At a mean follow-up of 15.4 months (range 0.1-65.4) the freedom from sac enlargement rate was 76% (16 out of 21). Reintervention-free survival rates at 6, 12, and 24 months were 80%, 68% and 68%, respectively. CONCLUSIONS In patients with persistent type Ia endoleak the embolization of the aneurysm sac with or without adjunctive neck procedures can be safely performed, leading to acceptable clinical and radiologic outcomes.
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Affiliation(s)
- Elena Marchiori
- Clinic of Vascular and Endovascular Surgery, University of Münster, Albert-Schweitzer Campus 1, 48145 Muenster, Germany.
| | - Monika Herten
- Clinic of Vascular and Endovascular Surgery, University of Münster, Albert-Schweitzer Campus 1, 48145 Muenster, Germany
| | - Michel Bosiers
- Department of Vascular and Endovascular Surgery, Saint Franziskus Hospital, Münster, Germany
| | - Arne Schwindt
- Department of Vascular and Endovascular Surgery, Saint Franziskus Hospital, Münster, Germany
| | - Theodosios Bisdas
- Department of Vascular and Endovascular Surgery, Saint Franziskus Hospital, Münster, Germany
| | - Martin Austermann
- Department of Vascular and Endovascular Surgery, Saint Franziskus Hospital, Münster, Germany
| | - Giovanni Torsello
- Clinic of Vascular and Endovascular Surgery, University of Münster, Albert-Schweitzer Campus 1, 48145 Muenster, Germany; Department of Vascular and Endovascular Surgery, Saint Franziskus Hospital, Münster, Germany
| | - Konstantinos Stavroulakis
- Clinic of Vascular and Endovascular Surgery, University of Münster, Albert-Schweitzer Campus 1, 48145 Muenster, Germany
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Jayet J, Bounkong G, Sylvestre R, Javerliat I, Coggia M, Coscas R. A Very Unlucky Intraoperative Event During a Chimney Technique for Juxtarenal Aneurysm Exclusion. Cardiovasc Intervent Radiol 2019; 42:1036-1040. [PMID: 30843094 DOI: 10.1007/s00270-019-02197-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 03/04/2019] [Indexed: 11/30/2022]
Abstract
A two-vessel Ch-EVAR procedure was scheduled within the instructions for use of the devices. After deploying, it appeared that the long sheath inserted through an arm access was discovered to be trapped behind the aortic stentgraft barbs. Trying to remove the sheath, the graft was displaced upward and the procedure was converted for a three-vessel Ch-EVAR incorporating the superior mesenteric artery. Simultaneous ballooning of the target vessels and the stentgraft permitted to exert a strong pullback traction on the blocked sheath, allowing its removal. A segment of the sheath distal end was left trapped in the aortic stentgraft. At 12 months follow-up, the patient is free of any complications and there are no occlusions of the abdominal visceral branches or embolic events in peripheral arteries.
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Affiliation(s)
- Jérémie Jayet
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), 9 Avenue Charles de Gaulle, 92104, Boulogne Cedex, 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
| | - Gael Bounkong
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), 9 Avenue Charles de Gaulle, 92104, Boulogne Cedex, 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
| | - Raphaelle Sylvestre
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), 9 Avenue Charles de Gaulle, 92104, Boulogne Cedex, 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
| | - Isabelle Javerliat
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), 9 Avenue Charles de Gaulle, 92104, Boulogne Cedex, 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
| | - Marc Coggia
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), 9 Avenue Charles de Gaulle, 92104, Boulogne Cedex, 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
| | - Raphaël Coscas
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), 9 Avenue Charles de Gaulle, 92104, Boulogne Cedex, 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.
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15
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D’Oria M, Pipitone M, Riccitelli F, Mastrorilli D, Calvagna C, Zamolo F, Griselli F. Successful Off-Label Use of an Iliac Branch Device to Rescue an Occluded Aortofemoral Bypass Graft. J Endovasc Ther 2018; 26:128-132. [DOI: 10.1177/1526602818815699] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To report an alternative approach for rescue of an occluded aortofemoral bypass using the Gore Excluder Iliac Branch Endoprosthesis (IBE). Case Report: A 52-year-old man presented with acute right limb ischemia because of displaced and occluded iliac stents and was treated with aortofemoral bypass. On the third postoperative day, there was early bypass failure due to distal embolization from aortic thrombus. After fluoroscopy-guided balloon thrombectomy of the bypass, an endovascular bailout strategy was used. The Gore Excluder IBE was deployed below the renal arteries (with the external iliac limb opening in the surgical prosthesis and the gate opening within the aortic lumen). After antegrade catheterization of the gate, a Gore Viabahn endoprosthesis was inserted as the bridging endograft and deployed so that it landed just above the preimplanted aortoiliac kissing stents without overlapping them. Completion angiography showed technical success without complications; results were sustained at 1-year follow-up. Conclusion: The Gore Excluder IBE may represent a versatile solution for the rescue of complex cases when open surgery would be associated with a considerable risk. This off-label application of a well-recognized endovascular device is safe and feasible and may prove useful as a valuable alternative in properly selected patients.
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Affiliation(s)
- Mario D’Oria
- Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Cattinara ASUITs, Trieste, Italy
| | - Marco Pipitone
- Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Cattinara ASUITs, Trieste, Italy
| | - Francesco Riccitelli
- Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Cattinara ASUITs, Trieste, Italy
| | - Davide Mastrorilli
- Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Cattinara ASUITs, Trieste, Italy
| | - Cristiano Calvagna
- Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Cattinara ASUITs, Trieste, Italy
| | - Francesca Zamolo
- Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Cattinara ASUITs, Trieste, Italy
| | - Filippo Griselli
- Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Cattinara ASUITs, Trieste, Italy
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Karaolanis GI, Pipitone MD, Torsello G, Austermann M, Donas KP. Endovascular treatment of proximal para-anastomotic aneurysms after previous surgical repair of infrarenal aortic aneurysms by the chimney technique. Vascular 2018; 27:3-7. [PMID: 30282531 DOI: 10.1177/1708538118805304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To evaluate the use of chimney grafts in the treatment of para-anastomotic aneurysms after previous abdominal aortic aneurysms open repair with short neck. METHODS A retrospective analysis of prospectively collected data of consecutive patients who underwent endovascular repair for proximal aortic para-anastomotic aneurysms following previous open repair for infrarenal abdominal aortic aneurysms was performed. All included patients had a short infrarenal aortic neck (<10 mm) excluding standard endovascular aortic repair. Five patients were symptomatic at the admission needed urgent treatment. RESULTS Twelve patients with para-anastomotic aneurysms underwent placement of chimney grafts. The median time between the original operations to redo endovascular procedure was 11 years (interquartile range, 9.5 years). The mean infrarenal length was 4.3 mm (1-9 mm). A total of 28 chimneys grafts were deployed for the 12 patients. The technical success rate was 91.7%. At a median radiologic follow-up of 16 months (2.0-29.4, 95% confidence interval), one patient died, while two late endoleaks and two reinterventions at one and three years for type Ia endoleak were performed by proximal extension and triple chimney graft placement. CONCLUSION The results of the present study show that ch-endovascular aortic repair is a safe technique for patients who suffered from proximal para-anastomotic aneurysms and having short neck unsuitable for standard endovascular repair. Longer follow up warranted to evaluate the durability of ch-endovascular aortic repair for this specific indication.
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Affiliation(s)
| | | | - Giovanni Torsello
- Department of Vascular Surgery, St. Franziskus Hospital, Münster, Germany
| | - Martin Austermann
- Department of Vascular Surgery, St. Franziskus Hospital, Münster, Germany
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17
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Lucatelli P, Cini M, Benvenuti A, Saba L, Tommasino G, Guaccio G, Munneke G, Neri E, Ricci C. Custom-Made Endograft for Endovascular Repair of Thoraco-Abdominal Aneurysm and Type B Dissection: Single-Centre Experience. Cardiovasc Intervent Radiol 2018; 41:1174-1183. [PMID: 29725810 DOI: 10.1007/s00270-018-1975-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 04/23/2018] [Indexed: 02/04/2023]
Abstract
AIMS To report a series of patients treated with the Jotec custom-made endograft for thoraco-abdominal aneurysms and dissections and identify predictive factors for re-intervention. METHODS We retrospectively analysed 49 patients unsuitable for surgery, treated between 2011 and 2017 (71.3 ± 9.5 years; 15 females). Indications included Crawford type 4 aneurysm in 25 patients, type 3 in 13, type 2 in 4, type 1 in 2 and chronic aneurysmal dilatation of the false lumen following dissection in 5 cases. Mean aneurysm diameter was 58.7 ± 8.4 mm. The study aims were to assess procedural success, complications rate, mortality and long-term follow-up. We also analysed factors that predicted the need for re-intervention. RESULTS The endograft was successfully deployed in all patients, catheterization of the fenestration and/or branches was achieved in 152/156 (97.4%) vessels. Early complications occurred in 10 patients (3 paraplegia, 3 haemorrhages, pancreatitis, aortic rupture, iliac artery rupture, 2 strokes). Thirty-day mortality was 10.2% and 180-day mortality 14.3%; two non procedure related deaths occurred. Mean follow-up was 23.6 ± 29.9 months [range 1-80]. No patients needed surgical explantation or developed significant renal impairment. Endoleak rate was 34.6% and re-intervention rate 9.7%. The aneurysm sac reduced or was stable in 36/49, and enlarged in 9/49 patients prompting re-intervention. Primary, primary-assisted and secondary patency of fenestrations/branches at 80 months was 90, 96 and 100%. Re-intervention was required more frequently in braches than in fenestrations, most commonly the external type branches. CONCLUSIONS The results of the Jotec endograft are comparable to other devices, with acceptable complication and re-intervention rates. Fenestration and inner-branch should be preferred due to lower re-intervention rates.
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Affiliation(s)
- Pierleone Lucatelli
- Vascular and Interventional Radiology Unit, Azienda Ospedaliera Universitaria Senese, Viale Mario Bracci, 16, 53100, Siena, Italy. .,Vascular and Interventional Radiology Unit, Sapienza University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy.
| | - Marco Cini
- Vascular and Interventional Radiology Unit, Azienda Ospedaliera Universitaria Senese, Viale Mario Bracci, 16, 53100, Siena, Italy
| | - Antonio Benvenuti
- Cardiac and Great Vessels Surgery Unit, University of "Siena", Viale Mario Bracci, 16, 53100, Siena, Italy
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (AOU), di Cagliari - Polo di Monserrato s.s. 554, 09045, Monserrato (Cagliari), Italy
| | - Giulio Tommasino
- Cardiac and Great Vessels Surgery Unit, University of "Siena", Viale Mario Bracci, 16, 53100, Siena, Italy
| | - Giulia Guaccio
- Cardiac and Great Vessels Surgery Unit, University of "Siena", Viale Mario Bracci, 16, 53100, Siena, Italy
| | | | - Eugenio Neri
- Cardiac and Great Vessels Surgery Unit, University of "Siena", Viale Mario Bracci, 16, 53100, Siena, Italy
| | - Carmelo Ricci
- Vascular and Interventional Radiology Unit, Azienda Ospedaliera Universitaria Senese, Viale Mario Bracci, 16, 53100, Siena, Italy
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18
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Spanos K, Kölbel T, Kouvelos G, Tsilimparis N, Debus SE, Giannoukas AD. Endovascular treatment of para-anastomotic aneurysms after open abdominal aortic surgery. THE JOURNAL OF CARDIOVASCULAR SURGERY 2018; 61:159-170. [PMID: 29430886 DOI: 10.23736/s0021-9509.18.10145-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The repair of long-term complications of open abdominal aortic repair such as para-anastomotic aneurysm (PAA) and pseudoaneurysm (PSA) is very challenging. The aim of this study was to assess the outcomes of endovascular repair of PAA/PSA after previous open aortic surgery for aneurismal or occlusive disease. EVIDENCE ACQUISITION A systematic review was undertaken; a search was performed (PRISMA) in MEDLINE, CENTRAL, Cochrane databases and key references of all studies of endovascular treatment of PAA/PSA after open aortic surgery. EVIDENCE SYNTHESIS Eighteen studies included totally 433 patients (86.3% males) with mean age of 71±2.5 years were identified. Most of the patients were asymptomatic (76%) and diagnosed with PAA (60.5%), while 81.6% had history of open aortic reconstruction for aneurismal disease. The mean diameter of para-anastomotic aneurysms was 59.7 mm (from 23 mm to 110 mm) and the mean duration until their diagnosis was 10±2 years. Standard bifurcated (23.7%), fenestrated (23.4%) and aorto-uni-iliac stent-grafts (16.3%) were mostly used. The technical success rate was 97.8% (391/400) with 1.4% (6/433) 30 day-mortality rate and mean hospital stay of 6±3 days. The mean 1- and 2- year survival rate was 87.8% and 78.8%, respectively. The follow-up ranged from 9 to 43 months, with presenting complications such as endoleak type I (24/378; 6.3%), type II (15/354; 4.3%), type III (3/378;0.8%), migration (4/378; 1%) and limb occlusion (5/310;1.6%). Additionally, 5.7% (19/332) of the patients underwent open conversion, while the total re-intervention rate was 11.4% (39/340; time of reintervention ranged from 7 to 30 months). In cases in which a stent was used for splanchnic vessels (renal artery: 188, superior mesenteric artery: 98, celiac artery: 64), the primary patency rate was 97.4% (341/350). CONCLUSIONS Endovascular treatment of PAAs and PSAs after previous open aortic surgery is a feasible and efficient option with high technical success rate, low 30-day mortality and good mid-term outcomes.
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Affiliation(s)
- Konstantinos Spanos
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center, Hamburg, Germany -
| | - Tilo Kölbel
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center, Hamburg, Germany
| | - George Kouvelos
- Department of Vascular Surgery, School of Health Sciences, Faculty of Medicine, University Hospital of Larissa, Larissa, Greece
| | - Nikolaos Tsilimparis
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center, Hamburg, Germany
| | - Sebastian E Debus
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center, Hamburg, Germany
| | - Athanasios D Giannoukas
- Department of Vascular Surgery, School of Health Sciences, Faculty of Medicine, University Hospital of Larissa, Larissa, Greece
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19
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Chisci E, Bellandi G, Michelagnoli S. Thoracic Endovascular Aneurysm Sealing of a Complex Thoracoabdominal Aneurysm. J Endovasc Ther 2017; 25:62-67. [PMID: 29264997 DOI: 10.1177/1526602817749309] [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: 11/17/2022]
Abstract
PURPOSE To report bailout treatment of a thoracoabdominal aortic aneurysm using a single Nellix stent and parallel stents. CASE REPORT A 74-year-old man with multiple comorbidities and a previous fenestrated Anaconda stent-graft for a 60-mm juxtarenal aneurysm was diagnosed with a type IV thoracoabdominal aneurysm on the 2-year computed tomography angiography (CTA) scans. The imaging showed >10-mm downward migration of the proximal Anaconda stent with a massive type Ia endoleak and aneurysmal evolution of the distal descending thoracic aorta; the superior mesenteric artery (SMA) and renal artery covered stents were patent and intact. Open conversion or a second custom-made endograft was not feasible. A plan was devised to use off-the-shelf materials, including the deployment of a single Nellix stent extending from the descending thoracic aorta into the stented area of the fenestrated endograft, with parallel chimney stent-grafts into the SMA and right renal artery; the left renal artery was treated with a bare stent in a periscope configuration. Transient paraparesis was resolved with cerebrospinal fluid drainage. At 6-month CTA, ongoing aneurysm exclusion with patent SMA and renal arteries was confirmed. CONCLUSION Thoracic endovascular aneurysm sealing with visceral and renal stenting seems to be a feasible bailout alternative treatment for urgent, complex cases without reconstruction options.
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Affiliation(s)
- Emiliano Chisci
- 1 Department of Surgery, Vascular and Endovascular Surgery Unit "San Giovanni di Dio" Hospital, Florence, Italy
| | - Guido Bellandi
- 1 Department of Surgery, Vascular and Endovascular Surgery Unit "San Giovanni di Dio" Hospital, Florence, Italy
| | - Stefano Michelagnoli
- 1 Department of Surgery, Vascular and Endovascular Surgery Unit "San Giovanni di Dio" Hospital, Florence, Italy
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20
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Conical neck is strongly associated with proximal failure in standard endovascular aneurysm repair. J Vasc Surg 2017; 66:1686-1695. [DOI: 10.1016/j.jvs.2017.03.440] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 03/23/2017] [Indexed: 11/22/2022]
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21
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Donas KP, Torsello GF, Torsello GB. Factors Influencing Decision Making in the Treatment of Complex Pararenal Aortic Pathologies: The APPROACH Concept. J Endovasc Ther 2017; 24:889-891. [PMID: 29130422 DOI: 10.1177/1526602817734377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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22
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Tsilimparis N, Heidemann F, Rohlffs F, Diener H, Wipper S, Debus ES, Kölbel T. Outcome of Surgeon-Modified Fenestrated/Branched Stent-Grafts for Symptomatic Complex Aortic Pathologies or Contained Rupture. J Endovasc Ther 2017; 24:825-832. [DOI: 10.1177/1526602817729673] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Nikolaos Tsilimparis
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center of Hamburg, Germany
| | - Franziska Heidemann
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center of Hamburg, Germany
| | - Fiona Rohlffs
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center of Hamburg, Germany
| | - Holger Diener
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center of Hamburg, Germany
| | - Sabine Wipper
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center of Hamburg, Germany
| | - E. Sebastian Debus
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center of Hamburg, Germany
| | - Tilo Kölbel
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center of Hamburg, Germany
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Reyes Valdivia A, Pitoulias G, Duque Santos Á, Fabregate Fuente M, Pitoulias AG, Ocaña Guaita J, Gandarias C. No Difference in Neck Enlargement for Patients Treated With Double Proximal Self-Expandable Suprarenal Fixation Endografting. Vasc Endovascular Surg 2017; 51:460-465. [PMID: 28782415 DOI: 10.1177/1538574417723156] [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: 11/15/2022]
Abstract
INTRODUCTION Neck enlargement is well described in patients treated with self-expandable endografts for abdominal aortic aneurysms. Double endografting (ie, overlapping of stent grafts) occurs in patients with proximal cuffs or bifurcated to monoiliacal configuration conversions. When the aortic neck of patients receives 2 suprarenal fixation endografts, it may behave differently in terms of radial force and interaction of additional suprarenal stents extending to the visceral aorta. METHODS We performed a retrospective study comparing 2 groups. Group 1 included 18 patients treated with 2 proximal self-expandable endografts. Group 2 included 17 patients treated with 1 self-expandable endograft who were consecutively treated during the period of treatment in group 1. Neck measurements were analyzed in both groups preoperatively and in the last computed tomography scan during follow-up. Suprarenal, interrenal, juxtarenal, and infrarenal (at 5 and 10 mm) diameters, as well as interrenal and infrarenal (5 mm) areas, were measured. RESULTS There was no significant difference in baseline characteristics, initial neck measurements, and aneurysmal sac evolution including endoleaks between the groups. Both groups showed neck enlargement. Group comparisons of all parameters in posttreatment neck measurements showed no statistical change. Univariate analysis showed oversizing to be significant in interrenal diameter and area and infrarenal at 10 mm diameter; however, 2-way analysis of variance analysis showed that the interaction between oversizing and the number of stent grafts was not significant. CONCLUSION Neck enlargement occurs in patients with self-expandable endografts with a tendency to reach the size of the endograft in the long term. Double endografting seems to interact in the same way as simple endografting in the aortic neck. Although the main limitation of our study lies in the small sample size, the presence of an additional "double" stent graft does not appear to result in any differences in aortic neck dilatation when compared to a single stent graft.
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Affiliation(s)
- Andrés Reyes Valdivia
- 1 Department of Vascular and Endovascular Surgery, Ramón y Cajal University Hospital, Madrid, Spain
| | - Georgios Pitoulias
- 2 Department of Surgery, Gennimatas Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - África Duque Santos
- 1 Department of Vascular and Endovascular Surgery, Ramón y Cajal University Hospital, Madrid, Spain
| | - Martín Fabregate Fuente
- 3 Department of Internal Medicine, Endothelial Pathology Unit, Ramón y Cajal University Hospital, Madrid, Spain
| | - Apostolos G Pitoulias
- 4 Division of Vascular Surgery, 2nd Department of Surgery, "G. Gennimatas" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Julia Ocaña Guaita
- 1 Department of Vascular and Endovascular Surgery, Ramón y Cajal University Hospital, Madrid, Spain
| | - Claudio Gandarias
- 1 Department of Vascular and Endovascular Surgery, Ramón y Cajal University Hospital, Madrid, Spain
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Duque Santos A, Romero Lozano M, Reyes Valdivia A, Aracil Sanus E, Ocaña Guaita J, Gandarias Zúñiga C. Tratamiento híbrido de los aneurismas del arco aórtico. Nuestra experiencia ☆. ANGIOLOGIA 2017. [DOI: 10.1016/j.angio.2016.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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25
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Reyes Valdivia A, Santos AD, Guaita JO, Gandarias C. Hypogastric Chimney Patency in Aortic Monoiliacal Endograft Thrombosis: A Life Saved by Collateral Pelvic Circulation. Int J Angiol 2017; 27:46-49. [PMID: 29483767 DOI: 10.1055/s-0037-1602373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Background To report a case of a high-risk patient treated with hypogastric chimney and aortic endograft for a native infrarenal aorta aneurysmal degeneration, 20 years after an aortobifemoral bypass procedure for severe iliac occlusive disease. Methods A two-stage procedure was planned. The first stage was right internal iliac artery (IIA) embolization and simple angioplasty of left IIA. The second stage consisted of aortouniiliac endograft with femoral crossover and left IIA chimney. Results Femoral crossover complicated with early thrombosis, but a decision on conservative medical treatment with anticoagulation was made based on no rest pain or severe claudication. After 3 months the patient presented with moderate claudication alone. Scheduled computed tomography scan showed femoral crossover graft and aortic endograft thrombosis with left IIA patency. The axillofemoral bypass was scheduled a week later, and the patient discharged home. Conclusion Preservation of pelvic circulation is mandatory to avoid life-threatening complications. The chimney technique demonstrates good patency and should be considered in the endovascular approach armamentarium for hypogastric artery revascularization.
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Affiliation(s)
- Andrés Reyes Valdivia
- Department of Vascular and Endovascular Surgery, Ramón y Cajaĺs University Hospital, Madrid, Spain
| | - Africa Duque Santos
- Department of Vascular and Endovascular Surgery, Ramón y Cajaĺs University Hospital, Madrid, Spain
| | - Julia Ocaña Guaita
- Department of Vascular and Endovascular Surgery, Ramón y Cajaĺs University Hospital, Madrid, Spain
| | - Claudio Gandarias
- Department of Vascular and Endovascular Surgery, Ramón y Cajaĺs University Hospital, Madrid, Spain
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Multicenter European Registry for Patients with AAA Undergoing EVAR Evaluating the Performance of the 36-mm-Diameter Endurant Stent-Graft. Cardiovasc Intervent Radiol 2017; 40:1514-1521. [DOI: 10.1007/s00270-017-1665-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 04/21/2017] [Indexed: 11/27/2022]
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27
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A Word of Caution for Extra Large Self-expandable Nitinol Stents. Ann Vasc Surg 2017; 42:305.e1-305.e5. [PMID: 28389291 DOI: 10.1016/j.avsg.2016.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 12/15/2016] [Accepted: 12/19/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND To report an unsuccessful use of large nitinol stent to prevent proximal endoleak in endograft treatment for juxtarenal aortic aneurysm. CASE REPORT An 82-year-old male presented coronary disease and severe chronic obstructive pulmonary disease requiring oxygen support. A large 80-mm juxtarenal aneurysm was found on routine urological examination. Neck features were as follows: 7 mm and high anterior-posterior angulation. ASA risk score IV was given. Patient wanted to be treated. We decided a 1-shot intervention based on self-expandable suprarenal fixation endograft with adjunctive extra large self-expandable (high radial force) nitinol stent. Control computed tomography scan demonstrates nitinol stent severe infolding and a possible perforation of the primary endograft. At 6-month follow-up, sac reveals enlargement of 5 mm and 6% volume increase. Patient does not want further treatments due to high risk of procedures. CONCLUSIONS Extreme caution should be taken when using self-expandable extra large nitinol stents for preventive matters. Oversizing should be carefully considered, not necessarily reaching the endograft chosen size. When short and angulated neck morphology co-exists, other devices or procedures may be a better option.
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Uso de sistema de endograpado para prevención y tratamiento de fugas proximales de endoprótesis aórticas abdominales. ANGIOLOGIA 2017. [DOI: 10.1016/j.angio.2016.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Jongsma H, Bekken JA, Bekkers WJJ, Zeebregts CJ, van Herwaarden J, Hoksbergen A, Cuypers P, de Vries JPPM, Verhagen HJ, Fioole B. Endovascular Treatment of Common Iliac Artery Aneurysms With an Iliac Branch Device. J Endovasc Ther 2016; 24:239-245. [DOI: 10.1177/1526602816679132] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To evaluate the efficacy, feasibility, and long-term outcomes of the Zenith ZBIS iliac branch device (IBD) to preserve internal iliac artery (IIA) perfusion in a large Dutch multicenter cohort. Methods: Between September 2004 and August 2015, 140 patients (mean age 70.9±7.4 years; 130 men) with 162 IBD implantations were identified in 7 vascular centers. The indication for IBD implantation was an abdominal aortic aneurysm >55 mm with a concomitant common iliac artery (CIA) aneurysm >20 mm (n=40), a CIA aneurysm with a diameter >30 mm (n=89), or revision of a type Ib endoleak after endovascular aneurysm repair (n=11). Results: Technical success (aneurysm exclusion, no type I or III endoleak, and a patent IIA) was obtained in 157 (96.9%) of 162 IBD implantations. Six (4.3%) patients developed major complications; 2 (1.4%) died. Mean follow-up was 26.6±24.1 months, during which 17 (12.1%) IBD-associated secondary interventions were performed. Including technical failures and intentional IIA embolizations, 15 (9.3%) IIA branch occlusions were identified; buttock claudication developed in 6 of these patients. The freedom from secondary intervention estimate was 75.9% (95% confidence interval 59.7 to 86.3) at 5 years. Conclusion: CIA aneurysms can be treated safely and effectively by IBDs with preservation of antegrade flow to the IIA. Secondary interventions are indicated in >10% of patients during follow-up but can be performed endovascularly in most.
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Affiliation(s)
- Hidde Jongsma
- Department of Vascular Surgery, Maasstad Hospital, Rotterdam, the Netherlands
| | - Joost A. Bekken
- Department of Vascular Surgery, Maasstad Hospital, Rotterdam, the Netherlands
| | | | - Clark J. Zeebregts
- Department of Vascular Surgery, University Medical Center, Groningen, the Netherlands
| | - Joost van Herwaarden
- Department of Vascular Surgery, University Medical Center, Utrecht, the Netherlands
| | - Arjan Hoksbergen
- Department of Vascular Surgery, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - Philip Cuypers
- Department of Vascular Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | | | - Hence J. Verhagen
- Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Bram Fioole
- Department of Vascular Surgery, Maasstad Hospital, Rotterdam, the Netherlands
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