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Lu C, Wang H, Yang P, Liu Y, Zhang Y, Xu Z, Xie Y, Hu J. Early Results of the Newly-Designed Flowdynamics Dense Mesh Stent for Residual Dissection After Proximal Repair of Stanford Type A or Type B Aortic Dissection: A Preliminary Single-Center Report From a Multicenter, Prospective, and Randomized Study. J Endovasc Ther 2024; 31:984-994. [PMID: 36978288 DOI: 10.1177/15266028231163057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
BACKGROUND Negative remodeling of the distal aorta due to residual dissection significantly impacts the long-term outcomes of dissection patients after proximal repair of acute aortic dissection. Branched/fenestrated aortic stents are technically demanding, and studies of the first generation of multilayer flow modulators for tackling this clinical scenario are few and limited. The single-center results from a multicenter, prospective, and randomized controlled study aimed to verify the safety and effectiveness of a newly-designed flowdynamics dense mesh stent for treating residual dissection after proximal repair. METHODS Patients with nonchronic residual dissection involving visceral branches were prospectively enrolled in 3 centers (ChiCTR1900023638). Eligible patients were randomly assigned to the flowdynamics dense mesh stent (FDMS) group and control group. Follow-up visits were arranged at 1, 3, 6, and 12 months after recruitment. The primary endpoints were all-cause and aortic-related mortality. The secondary endpoints included visceral branch occlusion, reintervention, and severe adverse events. Morphological changes were analyzed to exhibit the therapeutic effect. Our center participated in the multicenter prospective randomized controlled trial, and the preliminary single-center experience was reported. RESULTS Thirty-six patients were enrolled in our center, and the baseline characteristics of the 2 groups were comparable. Thirty-four patients completed the 12 month follow-up. Freedom from all-cause and aortic-related death were 94.4% and 100%. All visceral branches remained patent in the FDMS group. Increased area of the true lumen (1.03±0.38 vs 0.48±0.63 cm2 at the plane below renal arteries, p=0.006; 1.27±0.80 vs 0.32±0.50 cm2 at the plane 5 cm below renal arteries, p<0.001) and decreased area of the false lumen at the plane below renal arteries (-1.03±0.84 vs -0.15±1.21 cm2, p=0.023) were observed in the FDMS group compared with those parameters in the control group. The FDMS group showed a significant increase in true lumen volume (p<0.001) and a significant decrease in false lumen volume (p=0.018). CONCLUSIONS This newly-designed FDMS for endovascular repair of residual dissection after the proximal repair is safe and effective at 12 months. CLINICAL IMPACT One-year results of the randomized controlled clinical trial indicated the short-term safety and promising effect of FDMS on treating non-chronic residual dissection after proximal repair. At the 12th-month follow-up, the true lumen expanded, the false lumen shrunk and all visceral arteries kept patent. As far as I'm concerned, this is the first randomized controlled study concerning utilizing multilayer flow mesh stent treating aortic dissection. Despite a preliminary single-center report, our results are supposed to provide high-quality evidence to guide clinical practice and fill the gap in the application of FDMS.
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Affiliation(s)
- Chen Lu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Haiyue Wang
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Peng Yang
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yu Liu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yu Zhang
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Zhenyuan Xu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yi Xie
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Jia Hu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
- Department of Cardiothoracic Surgery, Guang'an Hospital, West China Hospital, Sichuan University, Guang'an, People's Republic of China
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Lu C, Duan W, Li Z, Wang C, Yang P, Liu Y, Zuo J, Hu J. One-year results of the Flowdynamics Dense Mesh Stent for residual dissection after proximal repair of stanford type A or type B aortic dissection: a multicenter, prospective, and randomized study. Int J Surg 2024; 110:4151-4160. [PMID: 38597396 PMCID: PMC11254268 DOI: 10.1097/js9.0000000000001440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 02/23/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVE Negative remodeling of the distal aorta following proximal repair for acute aortic dissection has garnered growing attention. This clinical scenario has spurred the development of techniques and devices. A multicenter, prospective, and randomized controlled study was conducted with the aim of confirming the safety and effectiveness of a newly-designed flowdynamics dense mesh stent for the treatment of residual dissection after proximal repair. METHODS Patients with nonchronic residual dissection affecting visceral branches were prospectively enrolled at three centers and randomly allocated to either the FDMS group or the control group. Primary endpoints encompassed all-cause and aortic-related mortality, while the patency of branch arteries is indeed a key focal metric. Morphological changes (diameter, area, and volume) were analyzed to demonstrate the therapeutic effect. RESULTS One hundred twelve patients were recruited in the clinical trial, and 103 patients completed the 12-month follow-up. The rate of freedom from all-cause and aortic-related death in the FDMS group was 94.64 and 100%, respectively. All visceral branches remained patent. The FDMS group exhibited a substantial expansion in TL and a notable shrinkage in FL at the planes below renal arteries (ΔArea TL : FDMS vs. Control, 0.74±0.46 vs. 0.34±0.66 cm 2 , P <0.001; ΔArea FL : FDMS vs. Control, -0.72±1.26 vs. -0.12±0.86 cm, P =0.01) and 5 cm below renal arteries (ΔArea TL : FDMS vs. Control, 1.06±0.75 vs. 0.16±0.63 cm 2 , P <0.001; ΔArea FL : FDMS vs. Control, -0.53±1.43 vs. -0.25±1.00 cm, P =0.27). Meanwhile, the FDMS group demonstrated an increase of 22.55±11.14 cm 3 in TL ( P <0.001) and a corresponding reduction of 21.94±11.77 cm 3 in FL ( P =0.08). CONCLUSIONS This newly-designed FDMS for endovascular repair of residual dissection following the proximal repair is demonstrated to be safe and effective at 12 months.
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Affiliation(s)
- Chen Lu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University
| | - Weixun Duan
- Department of Cardiovascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi Province
| | - Zhen Li
- Department of Endovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, People’s Republic of China
| | - Chenhao Wang
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University
| | - Peng Yang
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University
| | - Yu Liu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University
| | - Jian Zuo
- Department of Cardiovascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi Province
| | - Jia Hu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University
- Cardiovascular Surgery Research Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan
- Department of Cardiothoracic Surgery, West China Guang'an Hospital, Sichuan University, Guang’an, Sichuan Province
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Antkiewicz M, Kuliczkowski W, Protasiewicz M, Zubilewicz T, Terlecki P, Kobielarz M, Janczak D. Aneurysm Sac Pressure during Branched Endovascular Aneurysm Repair versus Multilayer Flow Modulator Implantation in Patients with Thoracoabdominal Aortic Aneurysm. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14563. [PMID: 36361444 PMCID: PMC9655300 DOI: 10.3390/ijerph192114563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/31/2022] [Accepted: 11/03/2022] [Indexed: 06/16/2023]
Abstract
Open thoracoabdominal repair is the gold standard in the TAAA treatment. However, there are endovascular techniques, that sometimes may be an alternative, such as branched endovascular aneurysm repair (BEVAR) or implantation of the multilayer flow modulator (MFM). In this study, we aimed to assess differences in the aneurysm sac pressure (ASP) between patients undergoing BEVAR and MFM implantation. The study included 22 patients with TAAA (14 patients underwent BEVAR, while eight MFM implantation). The pressure sensor wire was placed inside the aneurysm. A measurement of ASP and aortic pressure (AP) was performed during the procedure. The systolic pressure index (SPI), diastolic pressure index (DPI), and pulse pressure index (PPI) were calculated as a quotient of the ASP and AP values. After the procedure, SPI and PPI were lower in the BEVAR group than in the MFM group. During a procedure, a drop in SPI and PPI was noted in patients undergoing BEVAR, while no changes were revealed in the MFM group. This indicates that BEVAR, but not MFM, is associated with a reduction in systolic and pulse pressure in the aneurysm sac in patients with TAAA.
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Affiliation(s)
- Maciej Antkiewicz
- Department of Vascular, General and Transplantation Surgery, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Wiktor Kuliczkowski
- Department of Cardiology, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Marcin Protasiewicz
- Department of Cardiology, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Tomasz Zubilewicz
- Department of Vascular Surgery and Angiology, Medical University of Lublin, 20-059 Lublin, Poland
| | - Piotr Terlecki
- Department of Vascular Surgery and Angiology, Medical University of Lublin, 20-059 Lublin, Poland
| | - Magdalena Kobielarz
- Department of Mechanics, Materials Science and Biomedical Engineering, Wroclaw University of Science and Technology, 50-370 Wroclaw, Poland
| | - Dariusz Janczak
- Department of Vascular, General and Transplantation Surgery, Wroclaw Medical University, 50-367 Wroclaw, Poland
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Zhang Y, Lu Q, Zhang S, Liang Z, Cui J, Jing Z. Endovascular treatment of complicated aortic aneurysms using a modified flow-diverting strategy: Mid- to long-term outcome from a multicenter cohort study. Br J Radiol 2022; 95:20210859. [PMID: 35180007 PMCID: PMC10993961 DOI: 10.1259/bjr.20210859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 01/29/2022] [Accepted: 02/07/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Frequently reported adverse events following flow-diverting stents' treatment of aortic aneurysms indicate further refinements of this technique are required. This study aims at evaluating the clinical efficacy of an improved flow-diverting strategy. METHODS A modified flow-diverting procedure was utilized in selected patients, in which stent-grafts were used to cover the non-branched segment of the aneurysmal lesion while flow-diverting multilayered bare metal stents were applied to cover the reno-visceral segment. The safety and efficacy of this joint procedure were assessed by regular follow-up. RESULTS We screened 497 patients and included 67 cases (mean age: 67.07 ± 12.14 years; 53 males) between February 2012 and March 2018. The median number of stent-grafts and bare metal stents used in the procedure were 1 (range: 1 to 3) and 3 (range: 2 to 4), respectively. During a mean follow-up period of 34.54 ± 20.28 months, aneurysm maximum diameter decreased from 64.79 ± 10.31 to 59.32 ± 10.20 mm (p = 0.002), while sac thrombosis ratio increased from 26.01±10.99% to 98.46±4.84% (p<0.001). Aneurysm-related death or conversion to open repair was documented in three patients. The majority side-branches (198/201) remained patent during follow-up. Overall clinical success rate reached 91.04% (61/67). CONCLUSIONS The joint procedure is characterized by significant aneurysm thrombosis along with high aneurysm stabilization/shrinkage and side-branches' patency rate. It might represent a potential improvement of the flow-diverting strategy in treating complex aortic lesions, yet large-scale, prospective, and randomized trials are anticipated to draw a robust conclusion. ADVANCES IN KNOWLEDGE The joint procedure could potentially exclude complex aortic aneurysms from circulation while maintaining the collateral branches.
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Affiliation(s)
- Yongxue Zhang
- Department of Vascular Surgery, Changhai
Hospital, Shanghai,
China
- Department of Interventional Radiology, Bethune International
Peace Hospital, Shijiazhuang,
China
| | - Qingsheng Lu
- Department of Vascular Surgery, Changhai
Hospital, Shanghai,
China
| | - Simeng Zhang
- Department of Pediatric Cardiac Surgery, State Key Laboratory
of Cardiovascular Disease, Fuwai Hospital,
Beijing, China
| | - Zhihui Liang
- Department of Interventional Radiology, Bethune International
Peace Hospital, Shijiazhuang,
China
| | - Jinguo Cui
- Department of Interventional Radiology, Bethune International
Peace Hospital, Shijiazhuang,
China
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai
Hospital, Shanghai,
China
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Vahabli E, Mann J, Heidari BS, Lawrence‐Brown M, Norman P, Jansen S, Pardo EDJ, Doyle B. The Technological Advancement to Engineer Next-Generation Stent-Grafts: Design, Material, and Fabrication Techniques. Adv Healthc Mater 2022; 11:e2200271. [PMID: 35481675 DOI: 10.1002/adhm.202200271] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/04/2022] [Indexed: 12/12/2022]
Abstract
Endovascular treatment of aortic disorders has gained wide acceptance due to reduced physiological burden to the patient compared to open surgery, and ongoing stent-graft evolution has made aortic repair an option for patients with more complex anatomies. To date, commercial stent-grafts are typically developed from established production techniques with simple design structures and limited material ranges. Despite the numerous updated versions of stent-grafts by manufacturers, the reoccurrence of device-related complications raises questions about whether the current manfacturing methods are technically able to eliminate these problems. The technology trend to produce efficient medical devices, including stent-grafts and all similar implants, should eventually change direction to advanced manufacturing techniques. It is expected that through recent advancements, especially the emergence of 4D-printing and smart materials, unprecedented features can be defined for cardiovascular medical implants, like shape change and remote battery-free self-monitoring. 4D-printing technology promises adaptive functionality, a highly desirable feature enabling printed cardiovascular implants to physically transform with time to perform a programmed task. This review provides a thorough assessment of the established technologies for existing stent-grafts and provides technical commentaries on known failure modes. They then discuss the future of advanced technologies and the efforts needed to produce next-generation endovascular implants.
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Affiliation(s)
- Ebrahim Vahabli
- Vascular Engineering Laboratory Harry Perkins Institute of Medical Research QEII Medical Centre Nedlands and the UWA Centre for Medical Research The University of Western Australia Perth 6009 Australia
- School of Engineering The University of Western Australia Perth 6009 Australia
| | - James Mann
- Vascular Engineering Laboratory Harry Perkins Institute of Medical Research QEII Medical Centre Nedlands and the UWA Centre for Medical Research The University of Western Australia Perth 6009 Australia
- School of Engineering The University of Western Australia Perth 6009 Australia
| | - Behzad Shiroud Heidari
- Vascular Engineering Laboratory Harry Perkins Institute of Medical Research QEII Medical Centre Nedlands and the UWA Centre for Medical Research The University of Western Australia Perth 6009 Australia
- School of Engineering The University of Western Australia Perth 6009 Australia
- Australian Research Council Centre for Personalised Therapeutics Technologies University of Western Australia Perth 6009 Australia
| | | | - Paul Norman
- Vascular Engineering Laboratory Harry Perkins Institute of Medical Research QEII Medical Centre Nedlands and the UWA Centre for Medical Research The University of Western Australia Perth 6009 Australia
- Medical School The University of Western Australia Perth 6009 Australia
| | - Shirley Jansen
- Curtin Medical School Curtin University Perth WA 6102 Australia
- Department of Vascular and Endovascular Surgery Sir Charles Gairdner Hospital Perth WA 6009 Australia
- Heart and Vascular Research Institute Harry Perkins Medical Research Institute Perth WA 6009 Australia
| | - Elena de Juan Pardo
- School of Engineering The University of Western Australia Perth 6009 Australia
- School of Mechanical Medical and Process Engineering Queensland University of Technology Brisbane Queensland 4059 Australia
- T3mPLATE Harry Perkins Institute of Medical Research QEII Medical Centre Nedlands and the UWA Centre for Medical Research The University of Western Australia Perth WA 6009 Australia
| | - Barry Doyle
- Vascular Engineering Laboratory Harry Perkins Institute of Medical Research QEII Medical Centre Nedlands and the UWA Centre for Medical Research The University of Western Australia Perth 6009 Australia
- School of Engineering The University of Western Australia Perth 6009 Australia
- Australian Research Council Centre for Personalised Therapeutics Technologies University of Western Australia Perth 6009 Australia
- British Heart Foundation Centre for Cardiovascular Science The University of Edinburgh Edinburgh EH16 4TJ UK
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Salvati S, Bilman V, Melloni A, Baccellieri D, Kahlberg A, Melissano G, Chiesa R, Bertoglio L. Late surgical conversion of failed Multilayer Flow Modulator stenting in thoraco-abdominal aneurysms. Interact Cardiovasc Thorac Surg 2022; 34:111-119. [PMID: 34999791 PMCID: PMC8923416 DOI: 10.1093/icvts/ivab224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/27/2021] [Accepted: 07/13/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The aim of this study was to report the outcomes of open or hybrid repair of failed thoraco-abdominal aortic aneurysm endovascular treatment with Multilayer Flow Modulator (MFM) stents. METHODS All patients who underwent open or hybrid repair of a failed MFM aortic treatment were retrospectively analysed. Perioperative and postoperative data, as well as midterm survival, were assessed. RESULTS Between 2013 and 2020, 39 patients received an open or hybrid conversion after endovascular treatment. Five of them [13%; 4 males; median age 68 years (interquartile range 66-76)] were previously treated with aortic MFM stents (Cardiatis, Isnes, Belgium). Among these, the median interval between index repair and conversion was 84 months (interquartile range 75-84). The median aneurysm diameter was 9.6 cm (interquartile range 8-10). Renovisceral vessels steno-occlusion was highly prevalent: 2 renal arteries were occluded; 3 coeliac trunks, 2 renal arteries and 1 superior mesenteric artery had a >70% ostial stenosis. Open standard thoraco-abdominal aneurysm conversion was performed in 3 fit patients, while a hybrid approach with visceral debranching and tube endografting was performed in 2 high-risk patients. Two patients (2 open repairs) died intraoperatively, and 1 (hybrid repair) postoperatively. The 2 successfully treated patients are alive at 4- and 34-month follow-up, respectively, with patent visceral branches. CONCLUSIONS Open or hybrid thoraco-abdominal aortic aneurysm treatment after failed endovascular aortic repair with MFM stents might be the only surgical option to address sac enlargements and ruptures or branch-related failures. However, both procedures had a poor prognosis due to both the impaired preoperative patient's status and the surgical complexity in the presented series.
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Affiliation(s)
- Simone Salvati
- Division of Vascular Surgery, IRCCS San Raffaele Scientific Institute, “Vita-Salute” University, Milan, Italy
| | - Victor Bilman
- Division of Vascular Surgery, IRCCS San Raffaele Scientific Institute, “Vita-Salute” University, Milan, Italy
| | - Andrea Melloni
- Division of Vascular Surgery, IRCCS San Raffaele Scientific Institute, “Vita-Salute” University, Milan, Italy
| | - Domenico Baccellieri
- Division of Vascular Surgery, IRCCS San Raffaele Scientific Institute, “Vita-Salute” University, Milan, Italy
| | - Andrea Kahlberg
- Division of Vascular Surgery, IRCCS San Raffaele Scientific Institute, “Vita-Salute” University, Milan, Italy
| | - Germano Melissano
- Division of Vascular Surgery, IRCCS San Raffaele Scientific Institute, “Vita-Salute” University, Milan, Italy
| | - Roberto Chiesa
- Division of Vascular Surgery, IRCCS San Raffaele Scientific Institute, “Vita-Salute” University, Milan, Italy
| | - Luca Bertoglio
- Division of Vascular Surgery, IRCCS San Raffaele Scientific Institute, “Vita-Salute” University, Milan, Italy
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Massara M, Alberti A, Cutrupi A, Alberti V, Franco G, Volpe P. A Case of Multilevel Aortic Disease Treated Using Cardiatis Multilayer Flow Modulator. Ann Vasc Dis 2021; 14:264-266. [PMID: 34630771 PMCID: PMC8474089 DOI: 10.3400/avd.cr.21-00031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 05/31/2021] [Indexed: 11/26/2022] Open
Abstract
A recent systematic review and meta-analysis shows that synchronous and metachronous thoracic and abdominal aortic aneurysms are present in 19.2% of cases. The management remains controversial: elective simultaneous TEVAR and EVAR could increase morbidity due to increased aortic coverage during a single procedure, longer operative times, increased blood loss, and greater contrast exposure. Conversely, simultaneous thoracic endovascular aortic repair (TEVAR) and endovascular aneurysms repair (EVAR) prevent the need for two interventions, reduces future access site complications, and obviates interval aortic complications. We present a case of a multilevel aortic disease treated in three stages: EVAR, TEVAR, and exclusion of an increasing aortic visceral penetrating aortic ulcer through a multilayer flow modulator endograft with an optimal result.
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Affiliation(s)
- Mafalda Massara
- Unit of Vascular and Endovascular Surgery, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli," Reggio Calabria, Italy
| | - Antonino Alberti
- Unit of Vascular and Endovascular Surgery, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli," Reggio Calabria, Italy
| | - Andrea Cutrupi
- Unit of Vascular and Endovascular Surgery, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli," Reggio Calabria, Italy
| | - Vittorio Alberti
- Unit of Vascular and Endovascular Surgery, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli," Reggio Calabria, Italy
| | - Gaetana Franco
- Intensive Care Unit, Emergency-Urgency Department, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli," Reggio Calabria, Italy
| | - Pietro Volpe
- Unit of Vascular and Endovascular Surgery, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli," Reggio Calabria, Italy
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Bontinis V, Antonopoulos CN, Bontinis A, Sfyroeras GS, Kontopodis N, Ioannou CV, Ktenidis K, Geroulakos G. A systematic review and meta-analysis of the streamliner multilayer flow modulator stent for treatment of complex aortic lesions. J Vasc Surg 2021; 74:646-656.e9. [PMID: 34019986 DOI: 10.1016/j.jvs.2021.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 03/14/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We evaluated the safety and efficacy of multilayer flow modulator (MFM) stents (Cardiatis, Isnes, Belgium) for the treatment of complex aortic lesions. METHODS A systematic electronic research was conducted for studies reported from December 2008 to May 2020. Data extracted from 15 eligible case series (CS) were appropriately pooled and analyzed in a meta-analysis. The patient baseline characteristics were recorded, and 16 outcomes of interest were studied. The primary end points included 30-day all-cause and aneurysm-related mortality, aneurysm-related mortality at 1 year, vessel patency, and any endoleaks, ruptures, reinterventions, and aneurysm exclusion at the end of follow-up. RESULTS A total of 39 studies (15 CS and 24 case reports), involving 429 patients, met the inclusion criteria. Overall, 436 lesions were treated, and 1521 aortic branches were covered by the multilayer stent. The mean follow-up for the 15 CS with 404 patients was 14.6 months. Compliance with the instructions for use was reported by eight CS, with 75% of the procedures performed within the instructions for use. However, 41% of the patients reported by 12 CS had undergone a previous aortic intervention. The pooled 30-day all-cause and 30-day aneurysm-related mortality rates were 0.56% (95% confidence interval [CI], 0.00%-2.54%) and 0.00% (95% CI, 0.00%-0.80%), respectively. The pooled aneurysm-related mortality at 1 year of follow-up was 5.25% (95% CI, 0.07%-14.91%). The pooled vessel patency at the end of follow-up was 99.12% (95% CI, 97.73%-99.93%). The pooled reintervention and endoleak rates at the end of follow-up were 10.94% (95% CI, 3.64%-20.67%) and 10.70% (95% CI, 4.45%-18.66%), respectively. The crude spinal cord ischemia and renal failure rates were 0.69% and 1.8%, respectively. CONCLUSIONS The results from the present review and meta-analysis have indicated the safety and efficacy of MFM stents for treating challenging aortic pathologic lesions when used as first-line treatment and within the instructions for use. The almost zero pooled 30-day all-cause and aneurysm-related mortality rates combined with the low crude spinal cord ischemia and renal failure rates indicate the use of MFM stents is a good treatment option for complex aortic lesions in the short- and mid-term periods. The lack of long-term follow-up warrants further research concerning the efficacy of the device in the long term.
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Affiliation(s)
- Vangelis Bontinis
- Department of Vascular Surgery, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece.
| | - Constantine N Antonopoulos
- Department of Vascular Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Alkis Bontinis
- Department of Vascular Surgery, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece
| | - George S Sfyroeras
- Department of Vascular Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital Heraklion, University of Crete Medical School, Heraklion, Greece
| | - Christos V Ioannou
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital Heraklion, University of Crete Medical School, Heraklion, Greece
| | - Kiriakos Ktenidis
- Department of Vascular Surgery, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece
| | - George Geroulakos
- Department of Vascular Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
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Baptista-Strazzi APW, Aun R, Sincos IR, Tobita AM, Portugal MFC, de Paula VP, Kaufmann O, Wolosker N. Multilayer stents affect the final diameter of aortic aneurysms and maintain renal artery patency for a short time in a swine experimental model. Clinics (Sao Paulo) 2021; 76:e2812. [PMID: 34037071 PMCID: PMC8112104 DOI: 10.6061/clinics/2021/e2812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/13/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES We sought to analyze the hemodynamic effects of the multilayer flow-modulated stent (MFMS) in Thoracoabdominal aortic aneurysms (TAAAs). METHODS The hemodynamic effects of MFMS were analyzed in aortic thoracoabdominal aneurysms in experimental swine models. We randomly assigned 18 pigs to the stent or control groups and underwent the creation of an artificial bovine pericardium transrenal aneurysm. In the stent group, an MFMS (Cardiatis, Isnes, Belgium) was immediately implanted. After 4 weeks, we evaluated aneurysm sac thrombosis and renal branch patency by angiography, duplex scan, and morphological analysis. RESULTS All the renal arteries remained patent after re-evaluation in both groups. Aneurysmal sac thrombosis was absent in the control group, whereas in the stent group it was present in 66.7% of aneurysmal sacs (p=0.061).The mean final aneurysm sac diameter was significantly lower in the stent group (mean estimated reduction, 6.90 mm; p=0.021). The proximal neck diameter decreased significantly in the stent group (mean difference, 2.51 mm; p=0.022) and grew significantly in the control group (mean difference, 3.02 mm; p=0.007). The distal neck diameter increased significantly in the control group (mean difference, 3.24 mm; p=0.017). There were no significant findings regarding distal neck measurements in the stent group. CONCLUSION The MFMSs remained patent and did not obstruct the renal arteries within 4 weeks. In the stent group, the device was also associated with a significant decrease in aneurysmal sac diameter and a large proportion (albeit non-significant) of aneurysmal sac thrombosis.
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10
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Elhelali A, Sultan S, Hynes N, Delassus P, Kavanagh EP, Fahy P, Stefanov F, Morris L. Evaluation of aortic arch aneurysms treated with the streamliner multilayer flow modulator. ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2020. [DOI: 10.23736/s1824-4777.20.01444-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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11
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Vento V, Lejay A, Kuntz S, Ancetti S, Heim F, Chakfé N, Gargiulo M. Current status on aortic endografts. THE JOURNAL OF CARDIOVASCULAR SURGERY 2020; 61:544-554. [PMID: 32964901 DOI: 10.23736/s0021-9509.20.11614-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Endovascular treatment has become widespread to treat aneurysmal disease, especially located in the aorta. The modern era of abdominal aortic aneurysm repair started between 1986 and 1991, and in the last 30 years, Endovascular Treatment for abdominal aortic aneurysms evolved both due to the development of new materials and devices and the increasing appeal and effectiveness of the endovascular therapy itself. Vascular surgeons are using nowadays different solutions of Endovascular Treatment to treat all the expressions of aortic pathology (aneurysms, dissections and trauma) both in the acute and elective setting. Despite its use in every location of the aorta (the ascending aorta, the aortic arch, the thoracic aorta, thoraco-abdominal aorta, pararenal, iuxtarenal and infrarenal aortic aneurysms and iliac aneurysms), its safety and efficiency, endovascular treatment for aortic aneurysms presents some drawbacks: despite a lower short-term morbi-mortality, reinterventions and long-term patency are higher compared to open repair. In this review, we detail the most used types of endografts according to location, their performances and durability for each device. We conclude by discussing options to overcome ET limitations. Therefore, an obvious question arises: what we need in the future? What can the technological progress gives to physicians to further improve this new way of treating aorta?
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Affiliation(s)
- Vincenzo Vento
- Unit of Vascular Surgery, Department of Experimental Diagnostic and Specialty Medicine (DIMES), S. Orsola-Malpighi Polyclinic, University of Bologna, Bologna, Italy.,Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Anne Lejay
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Salomé Kuntz
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Stefano Ancetti
- Unit of Vascular Surgery, Department of Experimental Diagnostic and Specialty Medicine (DIMES), S. Orsola-Malpighi Polyclinic, University of Bologna, Bologna, Italy
| | - Frédéric Heim
- Laboratory of Physics and Textile Mechanics, University of Upper Alsace, Mulhouse, France
| | - Nabil Chakfé
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Mauro Gargiulo
- Unit of Vascular Surgery, Department of Experimental Diagnostic and Specialty Medicine (DIMES), S. Orsola-Malpighi Polyclinic, University of Bologna, Bologna, Italy -
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12
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Costache VS, Meekel JP, Costache A, Melnic T, Bucurenciu C, Chitic A, Candea G, Solomon C, Yeung KK. One-Year Single-Center Results of the Multilayer Flow Modulator Stents for the Treatment of Type B Aortic Dissection. J Endovasc Ther 2020; 28:20-31. [PMID: 32873130 PMCID: PMC7816551 DOI: 10.1177/1526602820950720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Purpose To report a single-center series of patients with type B aortic dissection treated with the Multilayer Flow Modulator (MFM). Materials and Methods Over a 36-month period, 23 patients (median age 53 years; 20 men) with complicated type B aortic dissections (2 acute, 5 subacute, and 16 chronic) were treated with the MFM. Primary endpoints of rupture or dissection-related death, overall mortality, and reintervention were evaluated using the Kaplan-Meier method; estimates for freedom from the endpoints are reported with the 95% confidence interval (CI). Secondary outcomes included technical success, adverse events, and aortic remodeling. Clinical and imaging data were collected preoperatively, directly postoperatively, and annually to 36 months for analysis using computational fluid dynamics (CFD). Results Initial technical success was 91.3%. The estimates of the endpoints at 12 months were 100% for freedom from rupture or aortic-related death, 95.7% for freedom from overall mortality, and 91.3% for freedom from reintervention. No device-related neurological or systemic complications occurred, and no additional reinterventions were needed during follow-up. A total of 144 branches overstented by the MFM remained patent. Morphologic analysis of the aortic dissection showed progressive true lumen volume increase (75.9%, p<0.001) with concomitant false lumen volume decrease (42.8%, p<0.001); the CFD analyses showed increased laminar flow. Conclusion In the current series, the MFM provided a safe and feasible treatment option for complicated acute, subacute, and chronic type B aortic dissections, with high technical success, low mortality, and active aortic remodeling. Further studies should elucidate the long-term safety of the MFM and its effectiveness in a larger patient cohort.
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Affiliation(s)
- Victor S Costache
- NEXTcardio Project, Lucian Blaga University, Sibiu, Romania.,Cardiovascular Department, Polisano European Hospital, Sibiu, Romania
| | - Jorn P Meekel
- NEXTcardio Project, Lucian Blaga University, Sibiu, Romania.,Department of Vascular Surgery, Amsterdam University Medical Centers, Amsterdam, the Netherlands.,Department of Surgery, Zaans Medisch Centrum, Zaandam, the Netherlands.,Amsterdam Cardiovascular Sciences, VU University Medical Center Amsterdam, the Netherlands
| | - Andreea Costache
- NEXTcardio Project, Lucian Blaga University, Sibiu, Romania.,Cardiovascular Department, Polisano European Hospital, Sibiu, Romania
| | - Tatiana Melnic
- NEXTcardio Project, Lucian Blaga University, Sibiu, Romania.,Cardiovascular Department, Polisano European Hospital, Sibiu, Romania
| | | | - Anca Chitic
- NEXTcardio Project, Lucian Blaga University, Sibiu, Romania.,Cardiovascular Department, Polisano European Hospital, Sibiu, Romania
| | | | - Crina Solomon
- NEXTcardio Project, Lucian Blaga University, Sibiu, Romania
| | - Kak K Yeung
- NEXTcardio Project, Lucian Blaga University, Sibiu, Romania.,Department of Vascular Surgery, Amsterdam University Medical Centers, Amsterdam, the Netherlands.,Amsterdam Cardiovascular Sciences, VU University Medical Center Amsterdam, the Netherlands
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13
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Sultan S, Acharya Y, Hynes N. Commentary: When Promising Innovators Lack Strategic Vision: The Concept of Flow Modulation in Aortic Dissection. J Endovasc Ther 2020; 28:32-35. [DOI: 10.1177/1526602820954450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Sherif Sultan
- Western Vascular Institute, Department of Vascular and Endovascular Surgery, University Hospital Galway, National University of Ireland, Galway, Ireland
- Department of Vascular and Endovascular Surgery, Galway Clinic, Doughiska, Royal College of Surgeons in Ireland, and National University of Ireland, Galway Affiliated Hospital, Galway, Ireland
| | - Yogesh Acharya
- Western Vascular Institute, Department of Vascular and Endovascular Surgery, University Hospital Galway, National University of Ireland, Galway, Ireland
- Department of Vascular and Endovascular Surgery, Galway Clinic, Doughiska, Royal College of Surgeons in Ireland, and National University of Ireland, Galway Affiliated Hospital, Galway, Ireland
| | - Niamh Hynes
- Department of Vascular and Endovascular Surgery, Galway Clinic, Doughiska, Royal College of Surgeons in Ireland, and National University of Ireland, Galway Affiliated Hospital, Galway, Ireland
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14
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Zhang Y, Huang Y, Teng Z, Cui J, Lu Q, Jing Z. Biomechanical insight of the stent-induced thrombosis following flow-diverting strategy in the management of complicated aortic aneurysms. INT ANGIOL 2020; 40:52-59. [PMID: 32594671 DOI: 10.23736/s0392-9590.20.04447-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The flow-diverting stent (FDS) emerges as an alternative strategy in treating complicated aortic aneurysms. However, the biomechanical behavior of the stent-induced thrombus (SIT) remains little understood. This study sought to investigate the impact of SIT on aneurysm wall stress and strain distribution and offer basic evidences for its large-scale application. METHODS Aortic aneurysms treated with FDS and followed up over 5 years were selected. Case-specific models were created based on the pre-operative and 12 months follow-up imaging. The aortic central line was generated, perpendicular to which the slice with maximum aneurysm diameter was selected for two-dimensional modeling. Pre- and post-stenting models were compared, with emphasis laid on wall stress distribution and risk factors leading to local stress concentration. Clinical follow-up data was recorded to verify the biomechanical findings. RESULTS A total of 6 cases (3 females, average age 56.3±17.2 years) were enrolled in this study. Complete sac thrombosis was documented in 5 cases at 12 months, while residual perfusion was seen in the remaining one. With the formation of SIT, the average wall tensile stress dropped from 58.60±11.11 KPa to 23.56±12.05 KPa (P=0.001) at diastolic phase, and from 88.00±15.94 KPa to 36.02±18.31 KPa (P=0.001) at systolic phase. Intra-wall calcium plaque and irregular, spontaneous intraluminal thrombus were recognized as risk factors for local stress concentration, which could be mitigated by the regular, well-organized SIT. Long-term follow-up at 5 years showed significant aneurysm shrinkage from 57.7±16.2 mm to 51.0±13.7 mm (P=0.009). CONCLUSIONS The formation of SIT after FDS implantation might protect the aneurysm by reducing the wall tensile stress and erasing the local stress concentration. Clinical follow-up data seems to support the biomechanical role of SIT, but a larger study cohort is needed. A comprehensive understanding of SIT including both biomechanical and biological perspectives is warranted to draw an exhaustive conclusion.
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Affiliation(s)
- Yongxue Zhang
- Department of Surgery, Handan Medical Center, Bethune International Peace Hospital, Handan, China.,Department of Interventional Radiology, Bethune International Peace Hospital, Shijiazhuang, China
| | - Yuan Huang
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Zhongzhao Teng
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Jinguo Cui
- Department of Interventional Radiology, Bethune International Peace Hospital, Shijiazhuang, China
| | - Qingsheng Lu
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China -
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China
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15
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Kankılıç N, Aydın MS. Results of a three-year follow-up after endovascular therapy with multilayer flow modulator in complex thoracoabdominal aortic aneurysm: A case report. Vascular 2020; 29:35-39. [PMID: 32552505 DOI: 10.1177/1708538120933516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Studies on the short-, medium and long-term effects of flow guiding stents are still limited. In this case report, we present three-year follow-up of the multilayer flow modulator stent in a 55-year-old patient with Crawford Type 2 thoracoabdominal aortic aneurysm. METHODS A 55-year-old male patient with Crawford Type 2 thoracoabdominal aortic aneurysm had applied to our medical center. The aneurysm involved coeliac truncus and superior mesenteric artery and extended to the renal artery ostia. Multilayer flow modulator stent was successfully placed, and follow-up CT (Computed tomography) angiographic examination images recorded intermittently (36 months). RESULTS After three years, it was observed that the left renal artery was thrombosed and the left kidney went to atrophy. Other major vascular branches were observed to be open. During this time, the aneurysm was completely closed with thrombus, but the diameter of the aneurysm continued to increase. CONCLUSIONS Multilayer flow modulator stents are safe in complex aortic aneurysms. The device increases the thrombus load in the aortic aneurysm and maintains the flow of the main vascular branches. But re-interventions, dilatation of the aneurysm sac and visceral branch obstructions are still challenging for multilayer flow modulator stents.
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Affiliation(s)
- Nazım Kankılıç
- Department of Cardiovascular Surgery, Medical School of 52966Harran University, Şanlıurfa, Turkey
| | - Mehmet S Aydın
- Department of Cardiovascular Surgery, Medical School of 52966Harran University, Şanlıurfa, Turkey
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16
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Costache VS, Meekel JP, Costache A, Melnic T, Solomon C, Chitic AM, Bucurenciu C, Moldovan H, Antoniac I, Candea G, Yeung KK. Geometric Analysis of Type B Aortic Dissections Shows Aortic Remodeling After Intervention Using Multilayer Stents. MATERIALS 2020; 13:ma13102274. [PMID: 32429089 PMCID: PMC7287707 DOI: 10.3390/ma13102274] [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: 03/23/2020] [Revised: 04/16/2020] [Accepted: 04/20/2020] [Indexed: 12/26/2022]
Abstract
Recently, multilayer stents for type B aortic dissections (TBAD) have been proposed to decrease false lumen flow, increase and streamline true lumen flow, and retain branch vessel patency. We aimed to provide a protocol with standardized techniques to investigate aortic remodeling of TBAD by multilayer flow modulators (MFM) in static geometric and hemodynamic analyses. Combining existing literature and new insights, a standardized protocol was designed. Using pre- and postoperative CT scans, geometric models were constructed, lumen dimensions were calculated, computational fluid dynamics (CFD) models were composed, and velocity and pressures were calculated. Sixteen TBAD cases treated with MFM were included for analysis. For each case, aortic remodeling was analyzed using post-processing medical imaging software. After 3D models were created, geometrical anatomical measurements were performed, and meshes for finite element analysis were generated. MFM cases were compared pre- and postoperatively; true lumen volumes increased (p < 0.001), false lumen volumes decreased (p = 0.001), true lumen diameter at the plane of maximum compression (PMC) increased (p < 0.001), and false lumen index decreased (p = 0.008). True lumen flow was streamlined, and the overall fluid velocity and pressures decreased (p < 0.001 and p = 0.006, respectively). This protocol provided a standardized method to evaluate the effects of MFM treatments in TBAD on geometric analyses, PMC, and CFD outcomes.
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Affiliation(s)
- Victor S. Costache
- NextCardio Project, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania; (V.S.C.); (J.P.M.); (T.M.); (C.S.); (A.M.C.); (C.B.); (G.C.); (K.K.Y.)
| | - Jorn P. Meekel
- NextCardio Project, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania; (V.S.C.); (J.P.M.); (T.M.); (C.S.); (A.M.C.); (C.B.); (G.C.); (K.K.Y.)
- Department of Vascular Surgery, Amsterdam University Medical Centers, 1105 AZ Amsterdam, The Netherlands
- Surgery Department, Zaans Medisch Centrum, 1502 DV Zaandam, The Netherlands
| | - Andreea Costache
- NextCardio Project, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania; (V.S.C.); (J.P.M.); (T.M.); (C.S.); (A.M.C.); (C.B.); (G.C.); (K.K.Y.)
- Correspondence:
| | - Tatiana Melnic
- NextCardio Project, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania; (V.S.C.); (J.P.M.); (T.M.); (C.S.); (A.M.C.); (C.B.); (G.C.); (K.K.Y.)
| | - Crina Solomon
- NextCardio Project, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania; (V.S.C.); (J.P.M.); (T.M.); (C.S.); (A.M.C.); (C.B.); (G.C.); (K.K.Y.)
| | - Anca M. Chitic
- NextCardio Project, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania; (V.S.C.); (J.P.M.); (T.M.); (C.S.); (A.M.C.); (C.B.); (G.C.); (K.K.Y.)
| | - Cristian Bucurenciu
- NextCardio Project, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania; (V.S.C.); (J.P.M.); (T.M.); (C.S.); (A.M.C.); (C.B.); (G.C.); (K.K.Y.)
| | - Horatiu Moldovan
- Department of Cardiac Surgery, Titu Maiorescu University, 040441 Bucharest, Romania;
| | - Iulian Antoniac
- Materials Science and Engineering Faculty, University Politehnica of Bucharest, 060042 Bucharest, Romania;
| | - Gabriela Candea
- NextCardio Project, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania; (V.S.C.); (J.P.M.); (T.M.); (C.S.); (A.M.C.); (C.B.); (G.C.); (K.K.Y.)
| | - Kak K. Yeung
- NextCardio Project, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania; (V.S.C.); (J.P.M.); (T.M.); (C.S.); (A.M.C.); (C.B.); (G.C.); (K.K.Y.)
- Department of Vascular Surgery, Amsterdam University Medical Centers, 1105 AZ Amsterdam, The Netherlands
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17
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Treatment of High Surgical Risk Thoracoabdominal Aortic Aneurysms with Stent Graft and Multilayer Bare Stents Joint Technique: Mid-Long-Term Clinical Results. Ann Vasc Surg 2019; 63:108-116. [PMID: 31536795 DOI: 10.1016/j.avsg.2019.06.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 06/20/2019] [Accepted: 06/30/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND This study aims to present the performance data on stent-graft and multilayer bare stents (MBS) joint technique in the treatment of high-risk thoracoabdominal aortic aneurysm (TAAA). METHODS From May 2012 to December 2015, 8 selective TAAA cases (ages 46-75 years) ineligible for surgical repair underwent the stent-graft and MBS joint procedure, and were closely followed up for a median of 32 months (range 14-58). Using computed tomography images, the aneurysm size, luminal blood flow diameter, and the covered visceral branches were analyzed. RESULTS Technical success was achieved in all patients (100%, 8/8). Twenty-four visceral branches were covered by MBS in total. There was no complication or death during hospital stay. During follow-up period, no death or complication occurred. Aneurysm shrinkage (maximum diameter decrease ≥5 mm) was observed in 7 patients. No aneurysm expansion was observed. Total aneurysm sac thrombosis was observed in all patients. The majority of covered side branches (23/24) were successfully preserved. No visceral ischemia or bleeding complications was observed during follow-up. CONCLUSIONS Total endovascular repair of TAAA using stent-graft and MBS joint technique may be a safe and effective alternative in high surgical risk patients. More approving clinical evidences about the safety and efficacy of this procedure are anticipated.
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18
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Pua U, Tan GWL, Kolvenbach RR, Quek LHH. Use of Multilayer Stent and Fenestrated Endograft in a Single Session to Treat Long-Segment Aorta. Ann Vasc Surg 2019; 61:471.e17-471.e21. [PMID: 31394240 DOI: 10.1016/j.avsg.2019.05.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 05/24/2019] [Accepted: 05/24/2019] [Indexed: 11/27/2022]
Abstract
A 72-year-old man with suprarenal aneurysm and 2 large penetrating ulcers (PAUs) in the descending aorta was referred for endovascular treatment. To avoid long-segment aortic coverage and the attendant risk of spinal ischemia, combination of 2 different stent technologies was used. A multilayer flow modulator was implanted in the thoracic aorta for the PAU, followed by implantation of a customized 4-vessel fenestrated stent graft for the suprarenal aneurysm. The patient remained well at 2 years with computed tomography evidence of exclusion of the suprarenal aneurysm and involution of the PAU.
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Affiliation(s)
- Uei Pua
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | | | - Ralf R Kolvenbach
- Department of Vascular Surgery and Endovascular Therapy, Catholic Hospital Group, Duesseldorf, Germany
| | - Lawrence Han Hwee Quek
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore; Lee Kong Chian School of Medicine, Nanyang Technologicial University, Singapore, Singapore
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Finotello A, Faggiano E, Conti M, Spinella G, Pane B, Palombo D, Auricchio F. Medical image analysis to measure the follow-up geometry of thoraco-abdominal aortic aneurysms treated with multilayer flow modulator stent. COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING-IMAGING AND VISUALIZATION 2019. [DOI: 10.1080/21681163.2019.1617195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Alice Finotello
- Department of Experimental Medicine, University of Genoa, Genoa, Italy
| | - Elena Faggiano
- Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy
| | - Michele Conti
- Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy
| | - Giovanni Spinella
- Vascular and Endovascular Surgery Unit, Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Bianca Pane
- Vascular and Endovascular Surgery Unit, Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Domenico Palombo
- Vascular and Endovascular Surgery Unit, Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Ferdinando Auricchio
- Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy
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Editor's Choice – Current Options and Recommendations for the Treatment of Thoracic Aortic Pathologies Involving the Aortic Arch: An Expert Consensus Document of the European Association for Cardio-Thoracic Surgery (EACTS) & the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2019; 57:165-198. [DOI: 10.1016/j.ejvs.2018.09.016] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Czerny M, Schmidli J, Adler S, van den Berg JC, Bertoglio L, Carrel T, Chiesa R, Clough RE, Eberle B, Etz C, Grabenwöger M, Haulon S, Jakob H, Kari FA, Mestres CA, Pacini D, Resch T, Rylski B, Schoenhoff F, Shrestha M, von Tengg-Kobligk H, Tsagakis K, Wyss TR, Debus S, de Borst GJ, Di Bartolomeo R, Lindholt J, Ma WG, Suwalski P, Vermassen F, Wahba A, von Ballmoos MCW. Current options and recommendations for the treatment of thoracic aortic pathologies involving the aortic arch: an expert consensus document of the European Association for Cardio-Thoracic surgery (EACTS) and the European Society for Vascular Surgery (ESVS). Eur J Cardiothorac Surg 2019; 55:133-162. [PMID: 30312382 DOI: 10.1093/ejcts/ezy313] [Citation(s) in RCA: 277] [Impact Index Per Article: 55.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- Martin Czerny
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
| | - Jürg Schmidli
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sabine Adler
- Department for Rheumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jos C van den Berg
- Department of Radiology, Centro Vascolare Ticino, Ospedale Regionale di Lugano, Lugano, Switzerland.,Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luca Bertoglio
- Division of Vascular Surgery, "Vita salute" University, Ospedale San Raffaele, Milan, Italy
| | - Thierry Carrel
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roberto Chiesa
- Division of Vascular Surgery, "Vita salute" University, Ospedale San Raffaele, Milan, Italy
| | - Rachel E Clough
- Division of Imaging Sciences and Biomedical Engineering, St Thomas' Hospital, King's College London, London, UK
| | - Balthasar Eberle
- Department for Anesthesiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christian Etz
- Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | | | - Stephan Haulon
- Aortic Center, Hôpital Marie Lannelongue, Université Paris Sud, Le Plessis-Robinson, France
| | | | - Fabian A Kari
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
| | - Carlos A Mestres
- University Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | | | - Timothy Resch
- Department of Vascular Surgery, Vascular Center Skåne University Hospital, Malmö, Sweden
| | - Bartosz Rylski
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
| | - Florian Schoenhoff
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Malakh Shrestha
- Department of Cardio-thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Hendrik von Tengg-Kobligk
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Thomas R Wyss
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Spinella G, Finotello A, Faggiano E, Pane B, Conti M, Gazzola V, Auricchio F, Palombo D. Midterm Follow-up Geometrical Analysis of Thoracoabdominal Aortic Aneurysms Treated with Multilayer Flow Modulator. Ann Vasc Surg 2018; 53:97-104.e2. [DOI: 10.1016/j.avsg.2018.04.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 04/18/2018] [Accepted: 04/19/2018] [Indexed: 10/28/2022]
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23
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Costache VS, Yeung KK, Solomon C, Popa R, Melnic T, Sandu M, Bucurenciu C, Candea G, Santa A, Costache A. Aortic Remodeling After Total Endovascular Aortic Repair With Multilayer Stents: Computational Fluid Dynamics Analysis of Aortic Remodeling Over 3 Years of Follow-up. J Endovasc Ther 2018; 25:760-764. [PMID: 30354915 DOI: 10.1177/1526602818808049] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To report Multilayer Flow Modulator (MFM) implantation from the sinotubular junction to the distal infrarenal aorta in the treatment of type B aortic dissection (TBAD) and demonstrate aortic remodeling using computational fluid dynamics (CFD) analysis over the course of 3-year follow-up. CASE REPORT A hypertensive patient with complicated TBAD required thoracic endovascular aortic repair due to severe thoracic pain associated with rapid progression of the false lumen aneurysm toward the distal aortic arch. Under general anesthesia, 2 aortic multilayer stents were placed over a 0.035-inch stiff guidewire in the compressed true lumen. The aorta was covered with 2 MFM stents between the sinotubular junction and the distal infrarenal aorta. Serial computed tomography scans showed progressive remodeling of the entire dissected aortic wall, with an excellent result at 24 months. Morphological and CFD vascular analysis confirmed the aortic remodeling, with a false lumen index drop from a preoperative 4.04 to 0.01 at 36 months. CONCLUSION Endovascular aortic repair with multilayer stents is a promising treatment for complicated TBAD due to the unique ability of these devices to stabilize the entire aortic wall without compromising the flow in the major aortic side branches.
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Affiliation(s)
| | - Kak K Yeung
- 2 Department of Vascular Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Crina Solomon
- 1 NextCardio Project ULBS, Lucian Blaga University, Sibiu, Romania
| | - Radu Popa
- 1 NextCardio Project ULBS, Lucian Blaga University, Sibiu, Romania
| | - Tatiana Melnic
- 1 NextCardio Project ULBS, Lucian Blaga University, Sibiu, Romania
| | - Mihai Sandu
- 1 NextCardio Project ULBS, Lucian Blaga University, Sibiu, Romania
| | | | - Gabriela Candea
- 1 NextCardio Project ULBS, Lucian Blaga University, Sibiu, Romania
| | - Adrian Santa
- 1 NextCardio Project ULBS, Lucian Blaga University, Sibiu, Romania
| | - Andreea Costache
- 1 NextCardio Project ULBS, Lucian Blaga University, Sibiu, Romania
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Ibrahim W, Spanos K, Gussmann A, Nienaber CA, Tessarek J, Walter H, Thalwitzer J, Debus SE, Tsilimparis N, Kölbel T. Early and midterm outcome of Multilayer Flow Modulator stent for complex aortic aneurysm treatment in Germany. J Vasc Surg 2018; 68:956-964. [DOI: 10.1016/j.jvs.2018.01.037] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 01/13/2018] [Indexed: 11/17/2022]
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Oderich GS. Evidence of use of multilayer flow modulator stents in treatment of thoracoabdominal aortic aneurysms and dissections. J Vasc Surg 2018; 65:935-937. [PMID: 28342519 DOI: 10.1016/j.jvs.2016.12.092] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 12/22/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Gustavo S Oderich
- Advanced Endovascular Aortic Research Program, Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
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Treatment of Aortic and Iliac Artery Aneurysms with Multilayer Flow Modulator: Single Centre Experiences. Int J Vasc Med 2018; 2018:7543817. [PMID: 29955396 PMCID: PMC6000868 DOI: 10.1155/2018/7543817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 02/20/2018] [Indexed: 11/29/2022] Open
Abstract
Objective Presenting early and midterm results of aortic and iliac artery aneurysms treated with Multilayer Flow Modulators (MFM). Methods We retrospectively reviewed the medical records of 23 patients (19 males and 4 females) who are admitted to our clinic between April of 2014 and February of 2016, diagnosed with thoracoabdominal aortic aneurysm and/or iliac aneurysm, and treated using MFM. The patients were followed up for the development of potential clinical presentations for 12 months. Results MFM implantation was successfully completed in all the patients. During the process, two patients developed endoleak and so they were treated with postdilatation that was performed through balloon intervention, whereby the patients fully recovered. Although a short-term ischemic cerebrovascular event occurred in one of the patients 36 hours after the MFM, the patient recuperated without any noticeable neurological sequelae. Overall, three patients died after the procedure, one of whom died in hospital three days following the intervention due to acute renal failure, while the second one lost his life at the end of the first month due to the occlusion of superior mesenteric and celiac arteries. The third patient died at the end of the third month due to acute myocardial infarction. The rest of the patients developed no complications or had no mortality at their 12-month follow-ups. Conclusion MFM can be preferred as an alternative approach in the treatment of aorta and iliac artery aneurysms including major lateral branches. The present results should be confirmed with additional future studies conducted with larger patient groups for longer periods.
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Kolvenbach RR. Contemporary strategies for repair of complex thoracoabdominal aortic aneurysms: real-world experiences and multilayer stents as an alternative. J Vasc Bras 2017; 16:293-303. [PMID: 29930663 PMCID: PMC5944306 DOI: 10.1590/1677-5449.011417] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Thoracoabdominal aortic aneurysms (TAAA) present special challenges for repair due to their extent, their distinctive pathology, and the fact that they typically cross the ostia of one or more visceral branch vessels. Historically, the established treatment for TAAA was open surgical repair, with the first procedure reported in 1955. Endovascular repair of TAAA with fenestrated and/ or branched endografts, has been studied since the beginning of the current century as a means of mechanical aneurysm exclusion. More recently, flow modulator stents have been employed with the aim at reducing shear stress on aortic aneurysmal wall. In this review we present technical and main results of these techniques, based on literature review and personal experience.
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Affiliation(s)
- Ralf Robert Kolvenbach
- Catholic Hospital Group Duesseldorf, Department of Vascular Surgery and Endovascular Therapy, Augusta Hospital, Duesseldorf, Germany
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