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Gallitto E, Faggioli G, Austermann M, Kölbel T, Tsilimparis N, Dias N, Melissano G, Simonte G, Katsargyris A, Oikonomou K, Mani K, Pedro LM, Cecere F, Haulon S, Gargiulo M. Urgent endovascular repair of juxtarenal/pararenal aneurysm by off-the-shelf multibranched endograft. J Vasc Surg 2024:S0741-5214(24)01500-3. [PMID: 38992807 DOI: 10.1016/j.jvs.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 07/01/2024] [Accepted: 07/03/2024] [Indexed: 07/13/2024]
Abstract
OBJECTIVE To report outcomes of urgent juxtarenal/pararenal aneurysms (J/P-AAAs) managed by off-the-shelf multibranched thoracoabdominal endografts (Cook, T-branch). METHODS In this observational, multicenter, retrospective study, patients with J/P-AAAs treated by urgent endovascular repair by T-branch in 23 European aortic centers, from 2013 to 2023, were analyzed. Contained J/P-AAAs rupture, presence of related symptoms, and aneurysm diameter of >70 mm were considered as indication for urgent repair. Technical success (TS), spinal cord ischemia (SCI), and 30-day/hospital mortality were assessed as early outcomes. Survival, freedom from reinterventions, and target artery instability (TAI) were evaluated during follow-up. RESULTS Overall, 197 patients (J-AAAs, n = 64 [33%]; P-AAAs, n = 95 [48%]; previous failed endovascular aneurysm repair (EVAR), n = 38 [19%]) were analyzed. The mean age and aneurysm diameter was 75 ± 8 years and 76 ± 4 mm, respectively. The American Society of Anesthesiologists score was 3 and 4 in 118 (60%) and 79 (40%) patients. Rupture, symptoms, and diameter of >70 mm were present in 51 (26%), 110 (56%), and 53 (27%) patients, respectively. An adjunctive proximal thoracic endograft was used in 28 cases (14%). The mean aortic coverage between the upper portion of the endograft and the lowest renal artery was 154 ± 49 mm. Single-stage repair and cerebrospinal fluid drainage were reported in 144 (73%) and 53 (27%) cases, respectively. TS was achieved in 182 (92%) cases (rupture, 84% vs no rupture, 95%; P = .02). Failures consist of TA loss (11 [6%]: renal artery, 9; celiac trunk, 2), type I to III endoleaks (2 [1%]), and 24-h mortality (2 [1%]). Rupture was a risk factor for technical failure (P = .02; odds ratio [OR], 3.8; 95% confidence interval [CI], 1.1-12.1). Overall, 15 patients (8%) had persistent SCI (rupture, 14% vs no rupture, 5%) with 11 (6%) , of paraplegia (rupture, 10% vs no rupture, 5%; P = .001). Rupture (P = .04; OR, 3.1; 95% CI, 1.1-8.9) and adjunctive proximal thoracic endograft (P = .01; OR, 4.1; 95% CI, 1.3-12.9) were risk-factors for SCI. Twenty-two patients (11%) died within 30 days or during a prolonged hospitalization. Previous failed EVAR (P = .04; OR, 3.6; 95% CI, 1.1-12.3), paraplegia (P < .001; OR, 9.9; 95% CI, 1.6-62.2) and postoperative mesenteric complications (P = .03; OR, 10.4; 95% CI, 1.2-93.3), as well as cardiac (P = .03; OR, 8.2; 95% CI, 2.0-33.0) and respiratory (P < .001; OR, 10.1; 95% CI, 2.9-35.2) morbidities were associated with 30-day/hospital mortality. The mean follow-up was 19 ± 5 months. The estimated 3-year survival and freedom from reinterventions was 58% and 77%, respectively. TAI occurred in 27 patients (14%) (occlusion, 15; endoleak, 14) with an estimated 3-year freedom from TAI of 72%. CONCLUSIONS Urgent repair of J/P-AAAs by T-branch is feasible and effective with satisfactory TS and 30-day/hospital mortality in high-risk patients. However, extensive aortic coverage is necessary, leading to a non-negligible SCI rate, especially in case of aortic rupture or when adjunctive thoracic endografts are necessary. Previous failed EVAR and postoperative mesenteric complications, as well as cardiac and respiratory morbidities were associated with 30-day/hospital mortality and should be subjected to more research for the purposes of improving outcomes.
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Affiliation(s)
- Enrico Gallitto
- Vascular Surgery, University of Bologna - DIMEC, Bologna, Italy; Vascular Surgery Unit, IRCCS, University Hospital Policlinico S. Orsola, Bologna, Italy.
| | - Gianluca Faggioli
- Vascular Surgery, University of Bologna - DIMEC, Bologna, Italy; Vascular Surgery Unit, IRCCS, University Hospital Policlinico S. Orsola, Bologna, Italy
| | - Martin Austermann
- Department of Vascular and Endovascular Surgery, St. Franziskus Hospital, Münster, Germany
| | - Tilo Kölbel
- German Aortic Center, Department of Vascular Medicine, University Medical Center Eppendorf (UKE), Hamburg, Germany
| | - Nikolas Tsilimparis
- Department of Vascular Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Nuno Dias
- Vascular Centre, Department of Thoracic Surgery and Vascular Diseases, Skåne University Hospital and Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Germano Melissano
- Division of Vascular Surgery, Vita - Salute University, Scientific Institute H. San Raffaele, Milan, Italy
| | - Gioele Simonte
- Vascular and Endovascular Surgery Unit, Hospital S. Maria Misericordia, University of Perugia, Perugia, Italy
| | | | - Kyriakos Oikonomou
- Vascular and Endovascular Surgery, University Hospital and Wolfgang Goethe University Frankfurt, Frankfurt, Germany
| | - Kevin Mani
- Division of Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Luis Mendes Pedro
- Department of Vascular Surgery, Centro Hospitalar Universitário Lisboa Norte, Faculdade de Medicina da Universidade de Lisboa, Centro Cardiovascular da Universidade de Lisboa, Lisbon, Portugal
| | - Fabrizio Cecere
- Vascular Surgery, University of Bologna - DIMEC, Bologna, Italy
| | - Stephan Haulon
- Vascular Surgery, Hospital Marie Lannelongue, Paris, France
| | - Mauro Gargiulo
- Vascular Surgery, University of Bologna - DIMEC, Bologna, Italy; Vascular Surgery Unit, IRCCS, University Hospital Policlinico S. Orsola, Bologna, Italy
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Endovascular Abdominal Aortic Aneurysm Repair: Overview of Current Guidance, Strategies, and New Technologies, Perspectives from the United Kingdom. J Clin Med 2022; 11:jcm11185415. [PMID: 36143063 PMCID: PMC9506302 DOI: 10.3390/jcm11185415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/05/2022] [Accepted: 09/13/2022] [Indexed: 11/17/2022] Open
Abstract
Endovascular aortic aneurysm repair has changed the management of patients affected by this condition, offering a minimally invasive solution with satisfactory outcomes. Constant evolution of this technology has expanded the use of endovascular devices to more complex cases. The purpose of this review article is to describe the current strategies, guidance, and technologies in this field, with a particular focus on practices in the United Kingdom.
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Physician-modified fenestrated endograft for postdissection thoracoabdominal aortic aneurysm following provisional extension to induce complete attachment and renal artery stenting. J Vasc Surg Cases Innov Tech 2022; 8:367-371. [PMID: 35898571 PMCID: PMC9309576 DOI: 10.1016/j.jvscit.2022.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/25/2022] [Indexed: 11/23/2022] Open
Abstract
We have described a patient with a history of type A-11 dissection repair, who subsequently underwent thoracic endovascular aortic repair with distal bare metal dissection stents (provisional extension to induce complete attachment) and renal artery stenting for malperfusion. During the next 3 years, the thoracoabdominal aorta had continued to enlarge to 6.9 cm, despite false lumen embolization and thoracic endovascular aortic repair extension. Given the continued aortic enlargement, physician-modified fenestrated endovascular aortic repair was performed within the prior aortic and renal stents with successful aneurysm sealing. The results from the present case have illustrated that continued aneurysmal degeneration can occur after provisional extension to induce complete attachment and that subsequent physician-modified fenestrated endovascular aortic repair is feasible.
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Tenorio ER, Oderich GS, Kölbel T, Gargiulo M, Timaran CH, Bertoglio L, Modarai B, Jama K, Eleshra A, Lima GBB, Scott C, Chiesa R, Jakimowicz T. Outcomes of off-the-shelf multibranched stent grafts with intentional occlusion of directional branches using endovascular plugs during endovascular repair of complex aortic aneurysms. J Vasc Surg 2022; 75:1142-1150.e4. [PMID: 34748899 DOI: 10.1016/j.jvs.2021.09.050] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/24/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To evaluate the technique and outcomes of intentional occlusion of directional branches (DBs) using endovascular plugs during branched endovascular aortic repair using off-the-shelf Zenith t-Branch thoracoabdominal (TAAA) stent grafts. METHODS We reviewed the clinical data and outcomes of all consecutive patients treated by branched endovascular aortic repair using off-the-shelf Zenith t-Branch TAAA stent-graft (Cook Medical, Bloomington, Ind) in seven academic centers from 2013 to 2019. All patients had at least one DB intentionally occluded using extension of the branch with balloon or self-expandable covered stent, followed by placement of endovascular plugs. Intentional occlusion was indicated in patients with variations in the normal four-vessel renal-mesenteric anatomy, pre-existing dialysis, or in those who failed catheterization of a target vessel. End points were 30-day/in-hospital mortality, major adverse events, secondary interventions, target artery (TA) patency, TA instability, and patient survival. RESULTS There were 100 patients, 65 male and 35 female, with median age of 71 years (interquartile range [IQR], 66-75 years). Of these, 31 patients (31%) had urgent/emergent operations for symptomatic/contained ruptured aneurysms. The median aneurysm diameter was 72 mm (IQR, 61-85 mm). A total of 290 renal-mesenteric arteries were incorporated with a median of three (IQR, 3-3) vessels/patient. Indications for DB occlusion were less than four suitable renal-mesenteric targets in 84 patients or pre-existing dialysis and inability to catheterize a target vessel in eight patients each. There were 110 DBs occluded by vascular plugs, including 48 celiac axis, one superior mesenteric artery, and 61 renal DBs. Thirty-day/in-hospital mortality was 10%, including 9% for elective and 13% for urgent/emergent procedures. Major adverse events occurred in 44 patients (44%), including acute kidney injury in 19 patients (19%), estimated blood loss >1 L in 12 patients (12%), respiratory failure and new onset dialysis in six patients (6%) each, bowel ischemia in five patients (5%), and myocardial infarction and paraplegia in two patients (2%) each. The median follow-up was 5 months (range, 1-13 months). Eighteen patients (18%) required secondary interventions, none for problems related to the occluded DB. There were no endoleaks related to the occluded DB. At 2 years, primary and secondary patency and freedom from TA instability were 93% ± 3%, 97% ± 2%, and 91% ± 4%, respectively. Freedom from secondary interventions and patient survival were 75% ± 6% and 63% ± 7%, respectively. CONCLUSIONS Intentional occlusion of DBs using endovascular plugs allows versatile use of a four-vessel off-the-shelf multi-branched TAAA stent graft in patients with variations in the normal renal and mesenteric anatomy or when technical difficulties prevent successful target vessel stenting. There were no endoleaks or secondary interventions associated with the occluded DB.
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Affiliation(s)
- Emanuel R Tenorio
- Department of Cardiothoracic and Vascular Surgery, Advanced Aortic Research Program at the University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Tex
| | - Gustavo S Oderich
- Department of Cardiothoracic and Vascular Surgery, Advanced Aortic Research Program at the University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Tex.
| | - Tilo Kölbel
- German Aortic Center, Department of Vascular Medicine, University Heart Center Hamburg, Hamburg, Germany
| | - Mauro Gargiulo
- Department of Vascular Surgery, University of Bologna, University Hospital Policlinico S. Orsola, Bologna, Italy
| | - Carlos H Timaran
- Division of Vascular and Endovascular Surgery, University of Texas Southwestern, Dallas, Tex
| | - Luca Bertoglio
- Division of Vascular Surgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milano, Italy
| | - Bijan Modarai
- Guy's and St Thomas' NHS Foundation Trust and King's College London, King's Health Partners, London, United Kingdom
| | - Katarzyna Jama
- Department of General, Vascular and Transplant Surgery, Medical University of Warsaw, Warszawa, Poland
| | - Ahmed Eleshra
- German Aortic Center, Department of Vascular Medicine, University Heart Center Hamburg, Hamburg, Germany
| | - Guilherme B B Lima
- Department of Cardiothoracic and Vascular Surgery, Advanced Aortic Research Program at the University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Tex
| | - Carla Scott
- Division of Vascular and Endovascular Surgery, University of Texas Southwestern, Dallas, Tex
| | - Roberto Chiesa
- Division of Vascular Surgery, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milano, Italy
| | - Tomasz Jakimowicz
- Department of General, Vascular and Transplant Surgery, Medical University of Warsaw, Warszawa, Poland
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Kliewer M, Pelanek-Völk E, Plimon M, Taher F, Assadian A, Falkensammer J. Exclusion of complex aortic aneurysm with chimney endovascular aortic repair is applicable in a minority of patients treated with fenestrated endografts. Interact Cardiovasc Thorac Surg 2021; 32:460-466. [PMID: 33221882 DOI: 10.1093/icvts/ivaa272] [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] [Received: 05/25/2020] [Revised: 10/10/2020] [Accepted: 10/13/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The Medtronic Endurant II stent graft has recently received Conformité Européenne (CE) approval for the use in chimney endovascular aortic repair (ChEVAR) for the treatment for juxtarenal aortic aneurysms. The aim of this study was to assess the percentage of patients treated by fenestrated endovascular repair who would have been alternatively suitable for the treatment by the CE approved Medtronic ChEVAR. METHODS Preoperative computed tomography scans of 100 patients who underwent fenestrated endovascular aortic repair (FEVAR) between April 2013 and February 2017 were retrospectively assessed for the applicability of the ChEVAR technique according to the Medtronic instructions for use. Eligibility criteria included an aortic neck diameter of 19-30 mm, a minimum infrarenal neck length of 2 mm, a total proximal sealing zone of at least 15 mm, thrombus in the aortic neck in ˂25% of the circumference, and maximum aortic angulations of 60° in the infrarenal, 45° in the suprarenal segment and ˂45° above the superior mesenteric artery. RESULTS According to CE-approved inclusion criteria, 19 individuals (19%) would have been eligible for ChEVAR. In 81 patients, at least 1 measure was found outside instructions for use: (i) excluding factor was detected in 26 patients, (ii) incongruous measures in 28 patients and in 27 patients, 3-5 measures were outside the instructions for use. The most frequently identified excluding factor was an insufficient infrarenal neck at ˂2 mm length (n = 63; 63%). CONCLUSIONS Patients with juxta- or pararenal aneurysm treated by FEVAR are in 19% of the cases alternatively suitable for the treatment by ChEVAR within CE-approved instructions for use. While ChEVAR is suitable in many emergency cases, FEVAR offers a broader applicability in an elective setting.
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Affiliation(s)
- Miriam Kliewer
- Department of Vascular and Endovascular Surgery, Hospital Ottakring, Vienna, Austria
| | | | - Markus Plimon
- Department of Vascular and Endovascular Surgery, Hospital Ottakring, Vienna, Austria
| | - Fadi Taher
- Department of Vascular and Endovascular Surgery, Hospital Ottakring, Vienna, Austria
| | - Afshin Assadian
- Department of Vascular and Endovascular Surgery, Hospital Ottakring, Vienna, Austria
| | - Jürgen Falkensammer
- Department of Vascular and Endovascular Surgery, Hospital Ottakring, Vienna, Austria
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Paludetto G, Van der Meulen S, Ouriel K, Patarca R. Physician Modified Low Profile Endograft for Endovascular Repair of Juxtarenal Abdominal Aortic Aneurysms in Patients with Small Access Vessels. EJVES Vasc Forum 2021; 51:9-12. [PMID: 34036294 PMCID: PMC8138719 DOI: 10.1016/j.ejvsvf.2021.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 03/02/2021] [Accepted: 03/30/2021] [Indexed: 10/31/2022] Open
Abstract
Introduction Urgent or emergency treatment of patients with abdominal aortic aneurysms that are anatomically unsuitable for conventional repair because of short proximal necks, small diameters and access vessel calcification, and high risk for open repair can be performed with commercially available branched or fenestrated aortic endografts or physician modified stent grafts. Report A technique is described for modification and successful implantation of a commercially available standard aortic stent graft with a low profile main body in two patients at high risk for open repair, with small access vessels and requiring uni- or bilateral renal artery fenestration for juxtarenal aneurysm repair. Discussion Based on two case experiences, the use of physician modified off the shelf endografts appears to be a feasible and effective alternative to fenestrated endovascular repair in patients with juxtarenal abdominal aortic aneurysms at high risk for open surgical repair. Studies comparing effectiveness of the different options, including chimney/snorkel technique and debranching, are warranted.
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Affiliation(s)
- Gustavo Paludetto
- Division of Endovascular Surgery, Santa Lucia Hospital, Brasília, DF, Brazil
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Wang F, Li C, Guidoin R, Mohammed A, Douglas G, Zhao F, Dionne G, Zhang Z, Ramesh H, Wang L, Nutley M. Customized and in situ fenestrated stent-grafts: A reinforced poly-ε-caprolactone branch cuff designed to prevent type III endoleaks and enhance hemodynamics. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2021. [DOI: 10.1016/j.medntd.2020.100055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Sveinsson M, Sonesson B, Dias N, Björses K, Kristmundsson T, Resch T. Five Year Results of Off the Shelf Fenestrated Endografts for Elective and Emergency Repair of Juxtarenal Abdominal Aortic Aneurysm. Eur J Vasc Endovasc Surg 2021; 61:550-558. [PMID: 33455820 DOI: 10.1016/j.ejvs.2020.12.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 11/22/2020] [Accepted: 12/14/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Fenestrated endovascular aneurysm repair (FEVAR) is a well established treatment for complex abdominal aortic aneurysms (AAAs). FEVAR with custom made devices (CMDs) has limitations in both the emergency and elective settings due to time consuming manufacture. "Off the shelf" (OTS) fenestrated stent grafts are a potential solution. The primary goal was to evaluate the five year outcome of the COOK Zenith p-Branch OTS device at a single centre. METHODS Patients with juxtarenal AAA meeting the inclusion criteria for the COOK Zenith p-Branch device were enrolled in a prospective, non-randomised, non-comparative trial from July 2012 to September 2015. Demographic, anatomical, procedure related, and five year follow up data were collected, analysed, and adjudicated by a core laboratory. The primary aims were to assess intervention free survival and overall survival at five years. RESULTS Twenty-three patients were treated and 21 completed follow up. Mean time to p-Branch implantation after patient presentation was 28 hours (range 0-122 hours) in emergency cases and 67 days (range 20-112 days) in elective cases. Median procedure time was 283 minutes (range 161-475 minutes) and technical success was 91%. Mean follow up was 45 months (standard deviation ± 24.4 months). The most common adverse events were renal injuries. Primary target vessel patency was 96.4% and 94.0% after one and five years respectively. Mean time to first re-intervention was 469 days (range 0-1 567 days). Survival during the follow up period was 76%, with no aneurysm related deaths. CONCLUSION FEVAR with the COOK Zenith p-Branch device is safe and effective for juxtarenal AAA in a selected patient population, in both elective and emergency settings. Long term outcomes are acceptable although inferior to CMDs. Mid and long term outcomes emphasise the p-Branch as a possible endovascular treatment for juxtarenal aortic pathology where CMD is not an option. Further innovation to address target vessel complications is needed, as these seem more prevalent than after repair with CMDs.
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Affiliation(s)
- Magnus Sveinsson
- Helsingborg Regional Hospital, Helsingborg, Sweden; Vascular Centre, Skåne University Hospital, Malmö, Sweden
| | - Björn Sonesson
- Vascular Centre, Skåne University Hospital, Malmö, Sweden
| | - Nuno Dias
- Vascular Centre, Skåne University Hospital, Malmö, Sweden
| | | | | | - Timothy Resch
- Vascular Centre, Skåne University Hospital, Malmö, Sweden; Rigshospitalet University Hospital, Copenhagen, Denmark.
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Končar IB, Jovanović AL, Dučič SM. The role of fEVAR, chEVAR and open repair in treatment of juxtarenal aneurysms: a systematic review. THE JOURNAL OF CARDIOVASCULAR SURGERY 2020; 61:24-36. [PMID: 32079378 DOI: 10.23736/s0021-9509.19.11187-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Open repair (OR), fenestrated endovascular aneurysm repair (fEVAR) and endovascular exclusion using parallel graft (chEVAR) are complementary procedures used for treatment of juxtarenal abdominal aortic aneurysm (jrAAA). The aim of our study was to assess available literature and analyze dispersion of OR, fEVAR and chEVAR procedures among reported papers related to treatment of jrAAA. EVIDENCE ACQUISITION The PubMed database was systematically searched using predefined strategy and key words related to treatment of jrAAA on September 28th, 2019. Studies were assessed for eligibility using the inclusion and exclusion criteria with at least five patients treated with at least one of the procedures while systematic reviews, meta-analysis, reviews, comments, editorials and letters were excluded as well as studies without clear classification of the location of the aneurysm, studies not specifying the number of patients treated with each of the techniques or not discriminated between aortic pathologies (juxtarenal, paravisceral and thoracoabdominal), hybrid procedures, endoanchors or with branched stent-graft. EVIDENCE SYNTHESIS Overall, 1533 papers were identified while papers that met inclusion criteria were either representing experience of single institution (87 papers) or from multicenter studies (6 papers), national or international registries (18 papers). In the period between January 1977 and December 2017, treatment of 5664 patients with jrAAA was reported in 87 papers as a single institution report. Out of them 2531 (45%) were treated with OR, 2592 (46%) with fEVAR and 541 (9%) with chEVAR. Out of 29 institutions reporting OR, there were 11 (37.9%) with more than 100 treated patients while 21 (41.1%) out of 51 institutions that reported more than 50 jrAAA treated with fEVAR. Only four institutions reported results of all three treatment modalities. CONCLUSIONS Based on the results reported in the literature, regardless of its complexity and costs, fEVAR for jrAAA has been accepted in substantial number of hospitals worldwide, while number of reported procedures is reaching OR.
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Affiliation(s)
- Igor B Končar
- Clinic for Vascular and Endovascular Surgery, Serbian Clinical Center, Belgrade, Serbia - .,Faculty of Medicine, University of Belgrade, Belgrade, Serbia -
| | - Aleksa L Jovanović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Stefan M Dučič
- Clinic for Vascular and Endovascular Surgery, Serbian Clinical Center, Belgrade, Serbia
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Farber MA, Oderich GS, Timaran C, Sanchez LA, Dawson Z. Results from a prospective multicenter feasibility study of Zenith p-Branch stent graft. J Vasc Surg 2019; 70:1409-1418.e3. [PMID: 31255472 DOI: 10.1016/j.jvs.2019.03.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 03/12/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the Cook Zenith p-Branch stent graft (William A. Cook Australia, Brisbane, Queensland, Australia) for the treatment of patients with asymptomatic juxtarenal or pararenal abdominal aortic aneurysms in a prospective, nonrandomized, multicenter, feasibility study conducted in the United States. METHODS The off-the-shelf p-Branch endograft incorporates a celiac scallop, superior mesenteric artery (SMA) fenestration, and two conical-shaped pivot renal fenestrations. Patients were eligible if the aneurysm did not extend above the distal margin of the SMA and the anatomy of renal and visceral arteries were compatible with one of the two p-Branch configurations (configuration A, renal fenestrations at the same longitudinal position; configuration B, offset renal fenestration). RESULTS A total of 30 patients (93% men; mean age, 73 years; mean aneurysm diameter, 64.7 ± 11.4 mm) were enrolled from January 2013 to June 2015. The mean follow-up period was 28.7 ± 12.5 months (as of October 2017). The technical success rate was 93% (28/30), with technical failure occurring in the first two study cases (device deliberately repositioned below the renal arteries because of difficulty in cannulating the renal arteries in one and an inability to place a renal stent in the other; both patients survived the procedure and withdrew from the study before the 12-month follow-up visit). No additional technical failures occurred after these first two cases, when an updated physician training and proctoring program was implemented. No 30-day mortality occurred. Of the remaining 28 patients, three died during the follow-up period; none within 30 days and none related to the device or procedure as determined by Clinical Events Committee adjudication. No treated aneurysm ruptures, conversion, or core laboratory-reported migration, or stent fracture were reported. The primary renal artery patency (interval to occlusion or reintervention for stenosis) rate was 88.6% ± 4.4% at 1 and 2 years. Two patients (7%) developed renal insufficiency secondary to a right renal artery stenosis in one patient and progression of chronic renal insufficiency in one patient. No patient required dialysis or developed mesenteric ischemia. Of the 28 patients, nine (32%) had undergone 13 secondary interventions for renal artery occlusion (n = 2), SMA occlusion (n = 1), renal or SMA stenosis (5 interventions in 4 patients), renal stent kinking (n = 1), lower extremity claudication (n = 2 in the same patient), type III endoleak between the p-Branch and renal stent (n = 1), and type II endoleak (n = 1). CONCLUSIONS These early and intermediate results, which incorporated physician learning curves, support the safety and feasibility of the off-the-shelf Zenith p-Branch device. Follow-up examinations through 5 years will continue to assess the long-term results.
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Affiliation(s)
- Mark A Farber
- Division of Vascular Surgery, University of North Carolina, Chapel Hill, NC.
| | | | - Carlos Timaran
- Division of Vascular Surgery, University of Texas Southwestern, Dallas, Tex
| | - Luis A Sanchez
- Division of Vascular Surgery, Washington University Medical Center, St. Louis, Mo
| | - Zach Dawson
- Cook Research Incorporated, West Lafayette, Ind
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Patient and operating room staff radiation dose during fenestrated/branched endovascular aneurysm repair using premanufactured devices. J Vasc Surg 2018; 68:1281-1286. [PMID: 30369410 DOI: 10.1016/j.jvs.2018.02.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 02/17/2018] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Fenestrated endovascular aneurysm repair (FEVAR) is the highest radiation dose procedure performed by vascular surgeons. We sought to characterize the radiation dose to patients and staff during FEVAR procedures with different premanufactured devices. METHODS A single-center prospective study of FEVARs was performed over 24 months. Three FEVAR devices were included: off-the-shelf (OTS; t-Branch, p-Branch), Zenith Fenestrated (ZFen), and investigational custom-made devices (CMDs). Radiation doses to the surgeon, trainee, anesthesiologist, and scrub/circulating nurses were measured using a personal dosimetry system (DoseAware, Philips Healthcare, Amsterdam, The Netherlands). Procedure type, patient body mass index (BMI), reference air kerma (RAK), and kerma area product (KAP) were recorded. RAK and KAP were corrected for BMI based on an exponential fit of fluoroscopy dose rate and the dose per radiographic frame. Operator dose was corrected for BMI by the ratio of corrected to actual KAP. A one-sided Wilcox rank-sum test was used to compare personnel radiation doses, RAKs, and KAPs between procedure types. Statistical significance was set at P ≤ .05. RESULTS There were 80 FEVARs performed by a single surgeon on a Philips Allura XperFD20 fluoroscopy system equipped with Clarity technology. Average BMI was 27 kg/m2. Sixty CMDs (36 four-, 21 three-, and 3 two-vessel fenestrations), 11 ZFens (8 three- and 3 two-vessel fenestrations), and 9 OTS devices (4 p-Branch, 5 t-Branch) were included. ZFens had significantly lower patient (1800 mGy vs 2950 mGy; P = .004), operator (120 μSv vs 370 μSv; P = .004), assistant (60 μSv vs 210 μSv; P = .003), circulator (10 μSv vs 30 μSv; P = .049), and scrub nurse dose (10 μSv vs 40 μSv; P = .02) compared with CMDs. OTS devices had significantly lower operator (220 μSv vs 370 μSv; P = .04), assistant (110 μSv vs 210 μSv; P = .02), and circulator doses (4 μSv vs 30 μSv; P = .001) compared with CMDs. Four-vessel fenestrated devices had significantly higher patient dose (3020 mGy) compared with three-vessel FEVARs (2670 mGy; P = .03) and two-vessel FEVARs (1600 mGy; P = .0007), and significantly higher operator dose (440 μSv) compared with three-vessel FEVARs (170 μSv; P = .0005). Patient dose was lowest with ZFens. Operating room personnel dose was lower with ZFens and OTS devices compared with CMDs. Four-vessel fenestrations required significantly more radiation compared with those involving three-vessel fenestrations; however, the dose increase was only 12% and should not preclude operators from extending coverage, if anatomically required. CONCLUSIONS Overall, patient and personnel radiation doses during FEVAR with all devices were within acceptable limits and lower in our series than previously reported.
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Schanzer A. Invited commentary. J Vasc Surg 2018; 67:702-703. [DOI: 10.1016/j.jvs.2017.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 09/06/2017] [Indexed: 10/18/2022]
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Farber MA, Eagleton MJ, Mastracci TM, McKinsey JF, Vallabhaneni R, Sonesson B, Dias N, Resch T. Results from multiple prospective single-center clinical trials of the off-the-shelf p-Branch fenestrated stent graft. J Vasc Surg 2017; 66:982-990. [DOI: 10.1016/j.jvs.2017.01.068] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 01/28/2017] [Indexed: 10/19/2022]
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Couture T, Coscas R, Lamas H, Mlynski A, Javerliat I, Goeau-Brissonniere O, Coggia M. Physician-Modified C3 Excluder Endograft as the Preferred Solution to Treat a Juxtarenal Para-Anastomotic Aneurysm. Ann Vasc Surg 2017; 39:287.e1-287.e5. [DOI: 10.1016/j.avsg.2016.08.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 08/05/2016] [Indexed: 10/20/2022]
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15
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Changes in Renal Anatomy After Fenestrated Endovascular Aneurysm Repair. Eur J Vasc Endovasc Surg 2017; 53:95-102. [DOI: 10.1016/j.ejvs.2016.10.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 10/24/2016] [Indexed: 11/21/2022]
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Ou J, Tang A, Chiu T, Chow K, Chan Y, Cheng S. Haemodynamic Variations of Flow to Renal Arteries in Custom-Made and Pivot Branch Fenestrated Endografting. Eur J Vasc Endovasc Surg 2017; 53:133-139. [DOI: 10.1016/j.ejvs.2016.10.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 10/25/2016] [Indexed: 11/28/2022]
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17
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Schroeder M, Donas KP, Stavroulakis K, Stachmann A, Torsello G, Bisdas T. Anatomical Suitability of the Zenith Off-the-Shelf (p-Branch) Endograft in Juxtarenal Aortic Aneurysms Previously Treated Using the Chimney Technique. J Endovasc Ther 2017; 24:223-229. [DOI: 10.1177/1526602816684628] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To examine the suitability of the Zenith off-the-shelf (p-branch) endograft in patients with juxta- or pararenal abdominal aortic aneurysms (J/PRAA) previously treated with endovascular aneurysm repair incorporating the chimney technique (chEVAR). Methods: Between January 2012 and December 2014, high-resolution computed tomography angiograms and clinical data from 50 patients (mean age 79 years; 45 men) with J/PRAAs treated with chEVAR were retrospectively reviewed. Primary anatomical suitability was evaluated according to the Investigational Device Exemption protocol for the Zenith p-branch endograft in a dedicated 3-dimensional vascular workstation. Secondary suitability was defined as any additional intervention needed to overcome adverse anatomical conditions at the access vessels. The Zenith p-branch endograft is available in 2 configurations (A and B), with the main difference being the distance between the superior mesenteric artery (SMA) and the renal fenestrations. Results: The p-branch endograft showed a primary suitability of 54% (n=27). Each configuration was suitable in 18 (36%) patients. Main anatomical limitations were the clock position of the left renal artery (LRA; n=7, 14%), the distance between the SMA and LRA (A: n=16, 32%; B: n=16, 32%), and significantly narrowed or calcified iliac arteries. If additional interventions at the access vessels were employed, a secondary suitability of 64% (n=32) could be achieved. Conclusion: In this specific group of patients treated with chEVAR, the Zenith p-branch system would be suitable in about half of the patients, which could be raised to two-thirds with ancillary access vessel procedures. A prospective clinical study is warranted to evaluate these results.
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Affiliation(s)
- Martin Schroeder
- Department of Vascular Surgery, University of Münster, Germany
- St. Franziskus Hospital Münster, Germany
| | - Konstantinos P. Donas
- Department of Vascular Surgery, University of Münster, Germany
- St. Franziskus Hospital Münster, Germany
| | - Konstantinos Stavroulakis
- Department of Vascular Surgery, University of Münster, Germany
- St. Franziskus Hospital Münster, Germany
| | - Arne Stachmann
- Department of Vascular Surgery, University of Münster, Germany
- St. Franziskus Hospital Münster, Germany
| | - Giovanni Torsello
- Department of Vascular Surgery, University of Münster, Germany
- St. Franziskus Hospital Münster, Germany
| | - Theodosios Bisdas
- Department of Vascular Surgery, University of Münster, Germany
- St. Franziskus Hospital Münster, Germany
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Lin J, Udgiri N, Guidoin R, Panneton J, Guan X, Guillemette M, Wang L, Du J, Zhu D, Nutley M, Zhang Z. In Vitro Laser Fenestration of Aortic Stent-Grafts: A Qualitative Analysis Under Scanning Electron Microscope. Artif Organs 2016; 40:E241-E252. [DOI: 10.1111/aor.12777] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 04/08/2016] [Accepted: 05/09/2016] [Indexed: 12/22/2022]
Affiliation(s)
- Jing Lin
- Key Laboratory of Textile Science & Technology of Ministry of Education and College of Textiles; Donghua University; Shanghai China
| | - Naval Udgiri
- Division of Vascular Surgery; Eastern Virginia Medical School, Sentara Heart Hospital; Norfolk VA USA
| | - Robert Guidoin
- Department of Surgery, Faculty of Medicine; Laval University and Axe Médecine Régénératrice, Centre de Recherche CHU; Québec QC
| | - Jean Panneton
- Division of Vascular Surgery; Eastern Virginia Medical School, Sentara Heart Hospital; Norfolk VA USA
| | - Xiaoning Guan
- Key Laboratory of Textile Science & Technology of Ministry of Education and College of Textiles; Donghua University; Shanghai China
| | - Maxime Guillemette
- Department of Surgery, Faculty of Medicine; Laval University and Axe Médecine Régénératrice, Centre de Recherche CHU; Québec QC
| | - Lu Wang
- Key Laboratory of Textile Science & Technology of Ministry of Education and College of Textiles; Donghua University; Shanghai China
| | - Jia Du
- Key Laboratory of Textile Science & Technology of Ministry of Education and College of Textiles; Donghua University; Shanghai China
| | - Dajie Zhu
- Key Laboratory of Textile Science & Technology of Ministry of Education and College of Textiles; Donghua University; Shanghai China
| | - Mark Nutley
- Division of Vascular Surgery and Department of Diagnostic Imaging; University of Calgary, Peter Lougheed Center; Calgary AB Canada
| | - Ze Zhang
- Department of Surgery, Faculty of Medicine; Laval University and Axe Médecine Régénératrice, Centre de Recherche CHU; Québec QC
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Lawton J, Touma J, Sénémaud J, de Boissieu P, Brossier J, Kobeiter H, Desgranges P. Computer-assisted study of the axial orientation and distances between renovisceral arteries ostia. Surg Radiol Anat 2016; 39:149-160. [PMID: 27344346 DOI: 10.1007/s00276-016-1718-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 06/15/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE Endovascular navigation in aortic, renal and visceral procedures are based on precise knowledge of arterial anatomy. Our aim was to define the anatomical localization of the ostia of renovisceral arteries and their distribution to establish anatomical landmarks for endovascular catheterization. METHODS Computer-assisted measurements performed on 55 CT scans and patients features (age, sex, aortic diameter) were analyzed. p values <0.05 were considered statistically significant. RESULTS The mean axial angulation of CeT and the SMA origin was 21.8° ± 10.1° and 9.9° ± 10.5°, respectively. The ostia were located on the left anterior edge of the aorta in 96 % of cases for the CeT and 73 % for the SMA. CeT and SMA angles followed Gaussian distribution. Left renal artery (LRA) rose at 96° ± 15° and in 67 % of cases on the left posterior edge. The right renal artery (RRA) rose at -62° ± 16.5° and in 98 % of cases on the right anterior edge of the aorta. RRA angle measurements and cranio-caudal RRA-LRA distance measurements did not follow Gaussian distribution. The mean distances between the CeT and the SMA, LRA, and RRA were 16.7 ± 5.0, 30.7 ± 7.9 and 30.5 ± 7.7 mm, respectively. CeT-SMA distance showed correlation with age and aortic diameter (p = 0.03). CeT-LRA distance showed correlation with age (p = 0.04). The mean distance between the renal ostia was 3.75 ± 0.21 mm. The RRA ostium was higher than the LRA ostium in 52 % of cases. RRA and LRA origins were located at the same level in 7 % of cases. CONCLUSION Our results illustrate aortic elongation with ageing and high anatomical variability of renal arteries. Our findings are complementary to anatomical features previously published and might contribute to enhance endovascular procedures safety and efficacy for vascular surgeons and interventional radiologists.
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Affiliation(s)
- James Lawton
- Department of Vascular Surgery, Henri Mondor University Hospital, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.
| | - Joseph Touma
- Department of Vascular Surgery, Henri Mondor University Hospital, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Jean Sénémaud
- Department of Vascular Surgery, Henri Mondor University Hospital, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Paul de Boissieu
- Department of Research and Innovation, Robert Debré Hospital, Reims University Hospitals, rue du Général Koenig, 51100, Reims, France
| | - Julien Brossier
- Department of Vascular Surgery, Henri Mondor University Hospital, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Hicham Kobeiter
- Department of Radiology, Henri Mondor University Hospital, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Pascal Desgranges
- Department of Vascular Surgery, Henri Mondor University Hospital, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
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Crawford SA, Doyle MG, Tse LW, Roche-Nagle G. 'In-stock' fenestrated stent graft for the urgent repair of an abdominal aortic aneurysm. BMJ Case Rep 2016; 2016:bcr-2016-215093. [PMID: 27207986 DOI: 10.1136/bcr-2016-215093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Endovascular aneurysm repair (EVAR) is a minimally invasive method for the treatment of abdominal aortic aneurysms; however, the implementation of this technique is often limited by the aortic pathology, especially in the urgent or emergent setting. An 82-year-old male with a 7.3 cm symptomatic juxtarenal aneurysm presented at our centre for assessment. He was diagnosed as a high-risk candidate for open repair and therefore, not suitable for a conventional EVAR. Fortunately, a custom two-vessel fenestrated stent graft, which was originally constructed for another patient, was available. This device was implanted with no complications and all branches remain unobstructed; clear of aneurysms at 1 year. We present the use of 'in-stock' fenestrated grafts as a potential option to be considered in the urgent or emergent repair of abdominal aortic aneurysms.
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Affiliation(s)
- Sean A Crawford
- Toronto General Hospital, Toronto, Ontario, Canada Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Matthew G Doyle
- Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
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Fernandez CC, Sobel JD, Gasper WJ, Vartanian SM, Reilly LM, Chuter TA, Hiramoto JS. Standard off-the-shelf versus custom-made multibranched thoracoabdominal aortic stent grafts. J Vasc Surg 2016; 63:1208-15. [DOI: 10.1016/j.jvs.2015.11.035] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 11/03/2015] [Indexed: 10/22/2022]
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Schoretsanitis N, Argyriou C, Georgiadis GS, Lazaridis MK, Georgakarakos E. Hostile Neck in Abdominal Aortic Aneurysms: Does it Still Exist? Vasc Endovascular Surg 2016; 50:208-10. [PMID: 26975605 DOI: 10.1177/1538574416637447] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Nikolaos Schoretsanitis
- Department of Vascular Surgery, "Democritus" University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Christos Argyriou
- Department of Vascular Surgery, "Democritus" University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - George S Georgiadis
- Department of Vascular Surgery, "Democritus" University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Miltos K Lazaridis
- Department of Vascular Surgery, "Democritus" University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Efstratios Georgakarakos
- Department of Vascular Surgery, "Democritus" University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
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Cheng S. Novel endovascular procedures and new developments in aortic surgery. Br J Anaesth 2016; 117 Suppl 2:ii3-ii12. [DOI: 10.1093/bja/aew222] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2016] [Indexed: 12/17/2022] Open
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Khanafer A, Khashram M, Ruiz CM, Mann D, Laing A. Use of the Off-the-Shelf t-Branch Device to Treat an Acute Type Ia Endoleak in a Symptomatic Juxtarenal Abdominal Aortic Aneurysm. J Endovasc Ther 2015; 23:212-5. [PMID: 26637838 DOI: 10.1177/1526602815618493] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To report the use of the off-the-shelf Zenith t-Branch Thoracoabdominal Endovascular Graft for the treatment of a symptomatic acute type Ia endoleak subsequent to previous infrarenal bifurcated endovascular aneurysm repair. CASE REPORT A 72-year-old man presented 4 years after implantation of an Anaconda stent-graft with sac expansion and type II endoleak, which was treated over the next 18 months with repeated coil and glue embolization of the leak and sac. Six months after the last attempt, imaging disclosed a new type Ia endoleak. Sac enlargement became symptomatic, and emergent treatment was performed using the off-the-shelf Zenith b-Branch device. The 4 visceral arteries were bridged with Fluency stent-grafts. The Anaconda stent-graft precluded the use of a standard Zenith universal distal body bifurcated device below the t-Branch graft, so a reversed tapered 16×20×82-mm iliac limb was placed to bridge the t-Branch to the larger Anaconda limb; the smaller 12-mm contralateral Anaconda limb was occluded. The procedure was concluded with a femorofemoral bypass. At 10 months after the procedure, the patient is well; the sac diameter has decreased, and there is no endoleak on imaging. CONCLUSION The multibranched Zenith t-branch device may be useful in treating proximal endoleaks in bifurcated stent-grafts.
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Affiliation(s)
- Adib Khanafer
- Vascular, Endovascular, & Renal Transplant Unit, Christchurch Hospital, Christchurch, New Zealand
| | - Manar Khashram
- Department of Vascular Surgery, University of Otago, Christchurch, New Zealand
| | - Carmen-Maria Ruiz
- Vascular, Endovascular, & Renal Transplant Unit, Christchurch Hospital, Christchurch, New Zealand
| | - Dana Mann
- Interventional Radiology, Christchurch Hospital, Christchurch, New Zealand
| | - Andrew Laing
- Interventional Radiology, Christchurch Hospital, Christchurch, New Zealand
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Hertault A, Haulon S. Part One: For the Motion. Branched/Fenestrated EVAR Procedures are Better than Snorkels, Chimneys, or Periscopes in the Treatment of Most Thoracoabdominal and Juxtarenal Aneurysms. Eur J Vasc Endovasc Surg 2015; 50:551-7. [PMID: 26602952 DOI: 10.1016/j.ejvs.2015.07.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- A Hertault
- Aortic Centre, CHRU de Lille, INSERM U1008, Université Lille Nord de France, Lille, 59037, France
| | - S Haulon
- Aortic Centre, CHRU de Lille, INSERM U1008, Université Lille Nord de France, Lille, 59037, France.
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Hertault A, Haulon S, Lee JT. Debate: Whether branched/fenestrated endovascular aneurysm repair procedures are better than snorkels, chimneys, or periscopes in the treatment of most thoracoabdominal and juxtarenal aneurysms. J Vasc Surg 2015; 62:1357-65. [DOI: 10.1016/j.jvs.2015.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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A Systematic Review of Fenestrated Endovascular Repair for Juxtarenal and Short-Neck Aortic Aneurysm: Evidence So Far. Ann Vasc Surg 2015; 29:1680-8. [DOI: 10.1016/j.avsg.2015.06.074] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 05/15/2015] [Accepted: 06/04/2015] [Indexed: 11/21/2022]
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Georgiadis GS, van Herwaarden JA, Antoniou GA, Hazenberg CEVB, Giannoukas AD, Lazarides MK, Moll FL. Systematic Review of Off-the-Shelf or Physician-Modified Fenestrated and Branched Endografts. J Endovasc Ther 2015; 23:98-109. [DOI: 10.1177/1526602815611887] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To determine the safety and efficacy of off-the-shelf fenestrated/branched grafts (OSFGs) and physician-modified stent-grafts (PMSGs) for the treatment of complex abdominal aortic aneurysms. Methods: A systematic search of the MEDLINE database via PubMed from January 2001 through March 2015 retrieved 23 relevant articles evaluating the clinical outcomes following the management of patients with pararenal or thoracoabdominal aortic aneurysms. The 15 articles on PMSGs and 8 on OSFGs contained data on 308 patients (mean age 72.93±2.89 years; 213 men). The safety endpoint was major adverse events; the efficacy outcome measure was clinical treatment success (aneurysm exclusion without type I/III endoleak, permanent paralysis, long-term dialysis, or unresolved major complications). Extracted outcome data were pooled and compared between groups; data are given as the pooled proportions and 95% confidence interval (CI). Clinical data are presented as the weighted mean. Results: Of the 308 patients analyzed, almost one third were operated on an emergency basis. The mean aneurysm diameters were 75.9±17.3 mm (range 56–115) for the PMSGs and 68.1±13.7 mm (range 60–100) for the OSFGs. A total of 936 renal and visceral vessels were targeted. Major adverse events (safety) occurred in 24 (12.8%) PMSG patients (95% CI 8.6% to 18.7%) and in 9 (7.4%) OSFG patients (95% CI 3.7% to 14%). Clinical treatment success (efficacy) was observed in 171/187 (91.4%) PMSG patients (95% CI 86.2% to 94.9%) and in 115/121 (95%) OSFG patients (95% CI 89.1% to 98.0%). Corresponding cumulative 30-day target vessel and branch stent perfusion rates were 97.2% (95% CI 95.1% to 98.4%) and 97.6% (95% CI 95.5% to 98.8%) for the PMSG group and 99.6% (95% CI 98.3% to 99.9%) and 98.4% (95% CI 96.5% to 99.4%) for the OSFG group. Six (3.2%) deaths occurred in the PMSG group only; 2 (1.1%) were aneurysm related. Overall branch patency was recorded in 443/458 (96.7%) and in 468/478 (97.9%) of target vessels in the PMSG and OSFG groups, respectively. Conclusion: Off-the-shelf and physician-modified technology seems effective and safe, in both the elective and acute settings, for the treatment of complex aortic aneurysms. Future research within a randomized trial should investigate the true limitations of these devices.
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Affiliation(s)
- George S. Georgiadis
- Department of Vascular Surgery, University Medical Center Utrecht, the Netherlands
- Department of Vascular Surgery, “Democritus” University of Thrace, University General Hospital of Alexandroupolis, Greece
| | | | - George A. Antoniou
- Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, UK
| | | | | | - Miltos K. Lazarides
- Department of Vascular Surgery, “Democritus” University of Thrace, University General Hospital of Alexandroupolis, Greece
| | - Frans L. Moll
- Department of Vascular Surgery, University Medical Center Utrecht, the Netherlands
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F-EVAR does not Impair Renal Function more than Open Surgery for Juxtarenal Aortic Aneurysms: Single Centre Results. Eur J Vasc Endovasc Surg 2015; 50:432-41. [DOI: 10.1016/j.ejvs.2015.04.028] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 04/25/2015] [Indexed: 12/29/2022]
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Kristmundsson T, Sveinsson M, Björses K, Törnqvist P, Dias N. Suitability of the Zenith p-Branch Standard Fenestrated Endovascular Graft for Treatment of Ruptured Abdominal Aortic Aneurysms. J Endovasc Ther 2015; 22:760-4. [DOI: 10.1177/1526602815601096] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To evaluate the anatomic suitability of the Zenith pivot branch (p-branch) fenestrated device in ruptured abdominal aortic aneurysms (rAAA). Methods: Contrast-enhanced computed tomography (CT) images of 206 patients (mean age 75±8 years; 175 men) with rAAA were evaluated in a dedicated 3-dimensional vascular workstation. All aneurysms found unsuitable for standard infrarenal repair were evaluated for Zenith p-branch suitability according to the Investigational Device Exemption protocol for both device configurations (A, pivot fenestrations at the same level; B, right renal fenestration located more cranially). Results: The suitability of the p-branch (A or B configuration) for short neck aneurysms (<15 mm; n=89) was 49%; of the 26 different combinations of exclusion criteria, a mismatch between a renal artery takeoff and the positioning of the corresponding fenestration was the most common. For juxta- and pararenal aneurysms (neck length <10 mm; n=66), suitability was 48%. Suitability assessed by target vessel positioning only (excluding all other limiting factors) was 58% for short neck aneurysms (n=52) and 55% for juxta- and pararenal aneurysms (n=36). Conclusion: Approximately half of patients with short neck rAAAs would be suitable for the Zenith p-branch fenestrated device according to the instructions for use. In almost 60%, the pivot fenestrations can accommodate the corresponding target vessels. More studies are needed to confirm these findings.
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Affiliation(s)
| | | | | | - Per Törnqvist
- Vascular Center, Skåne University Hospital, Malmö, Sweden
| | - Nuno Dias
- Vascular Center, Skåne University Hospital, Malmö, Sweden
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Georgakarakos E, Xenakis A, Bisdas T, Georgiadis GS, Schoretsanitis N, Antoniou GA, Lazarides M. The shear stess profile of the pivotal fenestrated endograft at the level of the renal branches: A computational study for complex aortic aneurysms. Vascular 2015; 24:368-77. [PMID: 26232391 DOI: 10.1177/1708538115598726] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE This study investigated the impact of the variant angulations on the values and distribution of wall shear stress on the renal branches and the mating vessels of a pivotal fenestrated design. METHODS An idealized endograft model of two renal branches was computationally reconstructed with variable angulations of the left renal branch. These ranged from the 1:30' to 3:30' o'clock position, corresponding from 45° to 105° with increments of 15°. A fluid-structure-interaction analysis was performed to estimate the wall shear stress. RESULTS The proximal part of the renal branch preserved quite constant wall shear stress. The transition zone between its distal end and the renal artery showed the highest values compared to the proximal and middle segments, ranging from 8.9 to 12.4 Pa. The lowest stress values presented at 90° whereas the highest at 45°. The post-mating arterial segment showed constantly low stress values regardless of the pivotal branch angle (6.3 to 6.6 Pa). The 45° configuration showed a distribution of the highest stress posteriorly whereas the 105°-angulation anteriorly. CONCLUSIONS The variant horizontal branch orientation influences the wall shear stress distribution across its length and affects its values only at its transition with the mating vessel. These findings and their potential association with adverse effects deserve further clinical validation.
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Affiliation(s)
- Efstratios Georgakarakos
- Department of Vascular Surgery, "Democritus" Medical School, University Hospital of Alexandroupolis, Greece
| | - Antonios Xenakis
- Fluids Section, School of Mechanical Engineering, National Technical University of Athens, Athens, Greece
| | - Theodosios Bisdas
- Department of Vascular Surgery, St. Franziskus Hospital and University Clinic of Münster, Germany
| | - George S Georgiadis
- Department of Vascular Surgery, "Democritus" Medical School, University Hospital of Alexandroupolis, Greece
| | - Nikolaos Schoretsanitis
- Department of Vascular Surgery, "Democritus" Medical School, University Hospital of Alexandroupolis, Greece
| | - George A Antoniou
- Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, UK
| | - Miltos Lazarides
- Department of Vascular Surgery, "Democritus" Medical School, University Hospital of Alexandroupolis, Greece
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Ronchey S, Serrao E, Kasemi H, Pecoraro F, Fazzini S, Alberti V, Mangialardi N. Endovascular Treatment Options for Complex Abdominal Aortic Aneurysms. J Vasc Interv Radiol 2015; 26:842-54. [DOI: 10.1016/j.jvir.2015.02.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 02/02/2015] [Accepted: 02/21/2015] [Indexed: 11/28/2022] Open
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Ou J, Cheng SW, Chan YC. The compatibility of p-branch “off-the-shelf” fenestrated endovascular graft in Asian patients with juxtarenal aortic aneurysm. J Vasc Surg 2015; 61:1417-23. [DOI: 10.1016/j.jvs.2014.12.061] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 12/20/2014] [Indexed: 10/24/2022]
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Rao R, Lane TR, Franklin IJ, Davies AH. Open repair versus fenestrated endovascular aneurysm repair of juxtarenal aneurysms. J Vasc Surg 2015; 61:242-55. [DOI: 10.1016/j.jvs.2014.08.068] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 08/11/2014] [Indexed: 11/29/2022]
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Mazzaccaro D, Malacrida G, Nano G. Variability of Origin of Splanchnic and Renal Vessels From the Thoracoabdominal Aorta. Eur J Vasc Endovasc Surg 2015; 49:33-8. [DOI: 10.1016/j.ejvs.2014.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 10/07/2014] [Indexed: 10/24/2022]
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Anatomic feasibility of off-the-shelf fenestrated stent grafts to treat juxtarenal and pararenal abdominal aortic aneurysms. J Vasc Surg 2014; 60:839-47; discussion 847-8. [DOI: 10.1016/j.jvs.2014.04.038] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 04/11/2014] [Indexed: 11/19/2022]
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Vemuri C, Oderich GS, Lee JT, Farber MA, Fajardo A, Woo EY, Cayne N, Sanchez LA. Postapproval outcomes of juxtarenal aortic aneurysms treated with the Zenith fenestrated endovascular graft. J Vasc Surg 2014; 60:295-300. [DOI: 10.1016/j.jvs.2014.01.071] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 01/30/2014] [Accepted: 01/30/2014] [Indexed: 10/25/2022]
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Hertault A, Sobocinski J, Kristmundsson T, Maurel B, Dias NV, Azzaoui R, Sonesson B, Resch T, Haulon S. Results of F-EVAR in Octogenarians. Ann Vasc Surg 2014; 28:1396-401. [DOI: 10.1016/j.avsg.2014.02.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Revised: 01/06/2014] [Accepted: 02/04/2014] [Indexed: 11/16/2022]
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Chimney and Periscope Technique for Emergent Treatment of Spontaneous Aortic Rupture. Ann Vasc Surg 2014; 28:1324-8. [DOI: 10.1016/j.avsg.2014.01.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 12/23/2013] [Accepted: 01/14/2014] [Indexed: 12/20/2022]
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Farber MA, Vallabhaneni R, Marston WA. "Off-the-shelf" devices for complex aortic aneurysm repair. J Vasc Surg 2014; 60:579-84. [PMID: 24797555 DOI: 10.1016/j.jvs.2014.03.258] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 03/17/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Fenestrated devices currently require a 3- to 4-week manufacturing period before implantation; as such, there have been efforts to develop "off-the-shelf" (OTS) devices to reduce the time before definitive treatment can be accomplished. We examined all patients treated for complex aortic problems at our institution during the past 12 months to evaluate the suitability and early outcomes of the OTS devices vs commercially available endovascular options. METHODS Between July 2012 and September 2013, patients undergoing aortic aneurysm repair were extracted from a prospectively managed aortic database. Two OTS devices, the Cook (Bloomington, Ind) p-Branch and the Endologix (Irvine, Calif) Ventana device, were being evaluated through clinical trials during this time frame. The custom Cook Zenith fenestrated endovascular (ZFEN) device was also available and approved by the U.S. Food and Drug Administration (FDA) during the study period. RESULTS Of 224 aortic aneurysms treated at our institution during this period, there were a total of 85 patients with type IV thoracoabdominal aneurysms including juxtarenal aneurysms. Only 23 patients (27%) met anatomic criteria for OTS devices, with 16 patients having these investigational devices implanted. The major exclusion criterion for the p-Branch device was renal axial or circumferential position; the limiting factor for Ventana was infrasuperior mesenteric artery neck length restriction. Five of the patients who would have fit criteria for an OTS device had an FDA-approved (ZFEN) device implanted instead, and two patients opted for open repair as a result of follow-up requirements. An additional 25 patients received custom-designed (ZFEN) devices (n = 30; 35%), whereas 37 (44%) others did not meet criteria for any available endovascular device and were repaired with alternative management strategies. The mean age and maximal aortic diameter of the two cohorts (OTS and ZFEN) were 71.8 years and 72.7 years (P = NS) and 61.3 mm and 58.5 mm (P = NS), respectively. Technical success was 100%, with an overall 30-day mortality of 2.1% (n = 1, ZFEN). Major complications occurred in eight patients (17%; two OTS, six ZFEN). CONCLUSIONS Whereas OTS device strategies will reduce the waiting times for patients with complex aortic aneurysmal disease, a significant number will still require custom-made device repair until additional device designs become available. Early experience with OTS devices does not demonstrate any significant renal risks; however, the treatment numbers are low and should be interpreted with caution until larger confirmatory studies are published. Further studies comparing the outcomes of these techniques are required to establish the best approach to handle endovascular repair of complex aortic aneurysm.
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Affiliation(s)
- Mark A Farber
- Division of Vascular Surgery, University of North Carolina, Chapel Hill, NC.
| | | | - William A Marston
- Division of Vascular Surgery, University of North Carolina, Chapel Hill, NC
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Georgakarakos E, Xenakis A, Georgiadis G, Argyriou C, Antoniou G, Schoretsanitis N, Lazarides M. The Hemodynamic Impact of Misalignment of Fenestrated Endografts: A Computational Study. Eur J Vasc Endovasc Surg 2014; 47:151-9. [DOI: 10.1016/j.ejvs.2013.09.029] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 09/27/2013] [Indexed: 10/26/2022]
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Liao TH, Watson JJ, Mansour MA, Cuff RF, Banegas SL, Chambers CM, Slaikeu JD, Wong PY. Preliminary results of Zenith Fenestrated abdominal aortic aneurysm endovascular grafts. Am J Surg 2013; 207:417-21; discussion 421. [PMID: 24581767 DOI: 10.1016/j.amjsurg.2013.09.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 08/29/2013] [Accepted: 09/01/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Patients with juxtarenal aortic aneurysms who are unfit for open repair may be considered for fenestrated endovascular repair (fenEVAR). We report our initial experience with fenEVAR. METHODS We reviewed the data on all our patients receiving fenEVAR for juxtarenal aortic aneurysms. RESULTS Eight patients, average age 75 years, underwent fenEVAR. Endografts were designed from details obtained from preoperative computed tomography angiography. There were 6 grafts with superior mesenteric scallops and bilateral renal fenestrations, 1 with bilateral renal scallops, and 1 with a single renal fenestration. All patients survived 30 days. There was no renal failure requiring dialysis. At 10 weeks, 1 patient died from acute intestinal ischemia and multisystem organ failure, and another died from respiratory failure. CONCLUSIONS It is feasible to offer fenEVAR to patients who are poor candidates for open repair. However, these procedures are technically challenging. Early outcomes are less favorable than other aortic endovascular procedures.
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Affiliation(s)
- Timothy H Liao
- Department of Surgery, Spectrum Health Medical Group, Grand Rapids Medical Education Partners, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Jennifer J Watson
- Department of Surgery, Spectrum Health Medical Group, Grand Rapids Medical Education Partners, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - M Ashraf Mansour
- Department of Surgery, Spectrum Health Medical Group, Grand Rapids Medical Education Partners, Michigan State University College of Human Medicine, Grand Rapids, MI, USA.
| | - Robert F Cuff
- Department of Surgery, Spectrum Health Medical Group, Grand Rapids Medical Education Partners, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Shonda L Banegas
- Department of Surgery, Spectrum Health Medical Group, Grand Rapids Medical Education Partners, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Christopher M Chambers
- Department of Surgery, Spectrum Health Medical Group, Grand Rapids Medical Education Partners, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Jason D Slaikeu
- Department of Surgery, Spectrum Health Medical Group, Grand Rapids Medical Education Partners, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Peter Y Wong
- Department of Surgery, Spectrum Health Medical Group, Grand Rapids Medical Education Partners, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
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Bisdas T, Donas KP, Bosiers M, Torsello G, Austermann M. Anatomical Suitability of the T-Branch Stent-Graft in Patients With Thoracoabdominal Aortic Aneurysms Treated Using Custom-Made Multibranched Endografts. J Endovasc Ther 2013; 20:672-7. [DOI: 10.1583/13-4400mr.1] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Stephen E, Joseph G, Sen I, Chacko S, Premkumar P, Varghese L, Selvaraj D. A Novel Cautery Instrument for On-Site Fenestration of Aortic Stent-Grafts: A Feasibility Study of 18 Patients. J Endovasc Ther 2013; 20:638-46. [DOI: 10.1583/13-4304mr.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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45
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Off-the-Shelf Branched Endograft for Emergent Aneurysm Repair. Ann Vasc Surg 2013; 27:972.e11-5. [DOI: 10.1016/j.avsg.2012.10.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 09/20/2012] [Accepted: 10/02/2012] [Indexed: 11/22/2022]
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Melas N, Perdikides T, Saratzis A, Lazaridis J, Saratzis N. A novel approach to minimize sealing defects: EndoAnchors reduce gutter size in an in vitro chimney graft model. J Endovasc Ther 2013; 20:506-13. [PMID: 23914860 DOI: 10.1583/13-4228c.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Nikolaos Melas
- 1st Department of Surgery, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece.
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Bisdas T, Donas KP, Torsello G, Austermann M. Technical Assessment of the Preloaded Fenestrated Stent-Graft in the Management of Pararenal Aortic Aneurysms. J Endovasc Ther 2013; 20:461-8. [DOI: 10.1583/13-4310.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Quiñones-Baldrich WJ, Holden A, Mertens R, Thompson MM, Sawchuk AP, Becquemin JP, Eagleton M, Clair DG. Prospective, multicenter experience with the Ventana Fenestrated System for juxtarenal and pararenal aortic aneurysm endovascular repair. J Vasc Surg 2013; 58:1-9. [DOI: 10.1016/j.jvs.2012.12.065] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Revised: 12/13/2012] [Accepted: 12/14/2012] [Indexed: 10/26/2022]
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Centerline is Not as Accurate as Outer Curvature Length to Estimate Thoracic Endograft Length. Eur J Vasc Endovasc Surg 2013; 46:82-6. [DOI: 10.1016/j.ejvs.2013.04.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Accepted: 04/04/2013] [Indexed: 11/17/2022]
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Endovascular Repair of Complex Aortic Pathology. CURRENT SURGERY REPORTS 2013. [DOI: 10.1007/s40137-013-0019-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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