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Joh JH. Novel Strategies for the Hostile Iliac Artery during Endovascular Aortic Aneurysm Repair. Vasc Specialist Int 2024; 40:8. [PMID: 38475895 DOI: 10.5758/vsi.230119] [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: 11/27/2023] [Revised: 01/29/2024] [Accepted: 02/09/2024] [Indexed: 03/14/2024] Open
Abstract
Successful endovascular aneurysm repair can be achieved with favorable aortic and iliac arterial anatomies. However, patients with challenging iliac anatomy, such as stenotic, calcified, tortuous arteries, or concomitant iliac artery aneurysms, are commonly encountered. Such a hostile iliac anatomy increases the risk of intraprocedural complications and worsens long-term outcomes. This review addresses various technical options for treating patients with a hostile iliac anatomy, including innovative endovascular solutions, physician-modified endografts, and hybrid procedures. These considerations demonstrate the wide scope of therapies that may be offered to patients with an unfavorable iliac anatomy.
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Affiliation(s)
- Jin Hyun Joh
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
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Saldana-Ruiz N, Tachida A, Mossman A, Cure R, Larimore A, Dansey K, Starnes BW, Zettervall SL. Iliac tortuosity increases reinterventions but not adverse outcomes following repair of juxtarenal aneurysms using physician-modified endografts. J Vasc Surg 2024; 79:497-505. [PMID: 37923024 DOI: 10.1016/j.jvs.2023.10.053] [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: 08/31/2023] [Revised: 10/17/2023] [Accepted: 10/24/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE Increased angulation of the proximal aortic neck has been associated with complications following endovascular repair of infrarenal aortic aneurysms, including increased incidence of endoleaks, stent migration, secondary interventions, and conversions. However, knowledge on the impact of aortoiliac tortuosity on outcomes following fenestrated repair remains limited. This study aims to quantify the effect of aortoiliac tortuosity on outcomes following fenestrated repair. METHODS A single-center, retrospective review of all patients who underwent a physician-modified endovascular repair for the treatment of juxtarenal aortic aneurysms under a single physician-sponsored investigation device exemption study from 2011 to 2021 was performed. Center luminal lines and geometric distances were obtained using TeraRecon software (San Mateo, CA). A tortuosity index was calculated (tortuosity index = centerline distance/geometric line distance) for each iliac vessel as well as for the infrarenal aorta according to Society for Vascular Surgery reporting standards. Aortic and iliac tortuosity were assessed independently and stratified as low and high. Demographics, comorbidities, anatomic and operative details, and outcomes were compared using univariable and multivariable analysis. RESULTS A total of 135 patients were identified. Thirty-eight patients (28%) had high aortic tortuosity, and 55 patients (42%) had high iliac tortuosity. Patients with high tortuosity were older (aortic: 78 vs 76 years; P = .04; iliac: 78 vs 75 years; P = .01) and differed by sex. Twenty-two percent of men and 50% of women had high aortic tortuosity (P = .01). Forty-seven percent of men and 20% of women had high iliac tortuosity (P = .01). There were no differences in comorbidities based on aortic tortuosity, but coronary artery disease (high: 58% vs low: 36%; P = .01) and hypertension (high: 69% vs low: 86%; P = .02) differed based on iliac tortuosity. Aneurysm diameter was larger for patients with high iliac tortuosity (72 mm vs 64 mm; P < .01), and fluoroscopy time was longer for patients with high aortic tortuosity (41 vs 31 minutes; P = .02). When outcomes were assessed, high iliac tortuosity was associated with increased rate of reinterventions (hazard ratio, 2.6; 95% confidence interval, 1.2-6.0) and type 1 or 3 endoleak (hazard ratio, 5.2; 95% confidence interval, 1.7-16); however, all other outcomes were similar. CONCLUSIONS Among patients treated with physician-modified endovascular repair for juxtarenal aneurysms, iliac tortuosity but not aortic tortuosity, is associated with increased reinterventions and type 1 or type 3 endoleaks. Long-term follow-up is critical for patients with high iliac tortuosity to ensure that high-risk endoleaks are identified and treated early to avoid the risk of rupture.
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Affiliation(s)
- Nallely Saldana-Ruiz
- University of Washington, Division of Vascular and Endovascular Surgery, Seattle, WA
| | - Ayumi Tachida
- University of Washington, Division of Vascular and Endovascular Surgery, Seattle, WA
| | - Audrey Mossman
- University of Washington, Division of Vascular and Endovascular Surgery, Seattle, WA
| | - Randy Cure
- University of Washington, Division of Vascular and Endovascular Surgery, Seattle, WA
| | - Allison Larimore
- University of Washington, Division of Vascular and Endovascular Surgery, Seattle, WA
| | - Kirsten Dansey
- University of Washington, Division of Vascular and Endovascular Surgery, Seattle, WA
| | - Benjamin W Starnes
- University of Washington, Division of Vascular and Endovascular Surgery, Seattle, WA
| | - Sara L Zettervall
- University of Washington, Division of Vascular and Endovascular Surgery, Seattle, WA.
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Song X, Zhang X, Cui L, Liu X, Chen Y, Zheng Y. Iliac artery tortuosity index in Chinese patients with or without aortic artery aneurysms and related influencing factors. Ann Vasc Surg 2023:S0890-5096(23)00149-8. [PMID: 36906129 DOI: 10.1016/j.avsg.2023.02.034] [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: 08/14/2022] [Revised: 01/28/2023] [Accepted: 02/27/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND Iliac artery tortuosity is an important anatomical factor that influences the endovascular repair of aortic artery aneurysms (EVAR). The influencing factors of the iliac artery tortuosity index (TI) have not been well studied. TI of iliac arteries and related factors in Chinese patients with and without AAA were studied in this study. SUBJECTS AND METHODS One hundred and ten consecutive patients with AAA and 59 patients without AAA were included. For patients with AAA, the diameter of the AAA was 51.9 ± 13.3 mm (24.7-92.9 mm). Those without AAA had no history of definite arterial diseases and came from a cohort of patients diagnosed with urinary calculi. The central lines of the common iliac artery (CIA) and external iliac artery (EIA) were depicted. The actual length (L1) and the straight distance (L2) were measured and used to calculate the TI (L1/L2). Common demographic factors and anatomical parameters were analyzed to identify any related influencing factors. RESULTS For patients without AAA, the total TI of the left and right side was 1.16±0.14 and 1.16±0.13, respectively (p=0.48). For patients with AAAs, the total TI in the left and right side was 1.36±0.21 and 1.36±0.19, respectively (p=0.87). The TI in EIA was more severe than that in CIA both in patients with and without AAAs (p<0.01). Age was the only demographic factor found to be associated with TI in patients with AAA (Pearson's correlation coefficient r≈0.3, p<0.01) and without AAA (r≈0.6, p<0.01). For anatomical parameters, the diameter was positively associated with the total TI (left side: r=0.41, p<0.01; right side: r=0.34, p<0.01). The ipsilateral CIA diameter was also associated with the TI (left side: r=0.37, p<0.01; right side: r=0.31, p<0.01). The length of the iliac arteries was not associated with age or AAA diameter. Reduction of the vertical distance of the iliac arteries may be a common underlying reason for age and AAA. CONCLUSIONS Tortuosity of the iliac arteries was probably an age-related problem in normal individuals. It was also positively correlated with the diameter of the AAA and the ipsilateral CIA in patients with AAA. Attention should be paid to the evolution of iliac artery tortuosity and its influence when treating AAAs.
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Affiliation(s)
- Xitao Song
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoning Zhang
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Liqiang Cui
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaolong Liu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yuexin Chen
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yuehong Zheng
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
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Differences in Cardiac-Pulsatility-Induced Displacement and Geometry Changes between the Cook ZBIS and Gore IBE: Postoperative Comparison Using ECG-Gated CTA Scans. Diagnostics (Basel) 2023; 13:diagnostics13030496. [PMID: 36766601 PMCID: PMC9914023 DOI: 10.3390/diagnostics13030496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023] Open
Abstract
To what extent the stentgraft design of iliac branch devices (IBDs) relates to dynamic deformation is currently unknown. Therefore, this study aimed to quantify and compare displacement and geometry changes during the cardiac cycle of two common IBDs. This paper presents a two-center trial with patients treated with a Zenith bifurcated iliac side (ZBIS) or Gore iliac branch endoprosthesis (IBE). All patients underwent a retrospective electrocardiogram (ECG)-gated computed tomographic angiography (CTA) during follow-up. Cardiac-pulsatility-induced displacement was quantified for the following locations: (neo) bifurcation of the aorta, IBD flow divider, distal markers of the internal iliac artery (IIA) component and first IIA bifurcation. Geometrical parameters (length, tortuosity index, curvature and torsion) were quantified over centerlines. Displacement was more pronounced for the IBE than the ZBIS, e.g., craniocaudal displacement of 0.91 mm (0.91-1.13 mm) vs. 0.57 mm (0.40-0.75 mm, p = 0.004), respectively. The IBDs demonstrated similar geometrical parameters in the neo-common iliac artery and distal IIA, except for the larger dynamic curvature and torsion of the distal IIA in IBEs. The IBEs showed more dynamic length and curvature change compared to the ZBIS in the stented IIA. The IIA trajectory showed more pronounced deformation during the cardiac cycle after placement of an IBE than a ZBIS, suggesting the IBE is more conformable than the ZBIS.
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van Helvert M, Simmering JA, Koenrades MA, Slump CH, Heyligers JM, Geelkerken RH, Reijnen MM. Evaluation of electrocardiogram-gated computed tomography angiography to quantify changes in geometry and dynamic behavior of the iliac artery after placement of the Gore Excluder Iliac Branch Endoprosthesis. THE JOURNAL OF CARDIOVASCULAR SURGERY 2022; 63:454-463. [PMID: 35005875 DOI: 10.23736/s0021-9509.22.11980-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND The GORE® EXCLUDER® Iliac Branch Endoprosthesis (IBE) is designed to treat iliac aneurysms with preservation of blood flow through the internal iliac artery (IIA). Little is known about the influence of IBE placement on the IIA geometry. This study aimed to provide detailed insights in the dynamic behavior and geometry of the common iliac artery (CIA) and IIA trajectory and how these are influenced after treatment with an IBE. METHODS Pre- and postoperative electrocardiogram-gated computed tomography angiography (ECG-gated CTA) scans were acquired in a prospective study design and analyzed with in-house written algorithms designed for aorto-iliac and endoprosthesis deformation evaluation. Cardiac pulsatility-induced motion patterns and pathlengths were computed by tracking predefined locations on the aorto-iliac tract. Centerlines through the CIA-IIA trajectory were used to investigate the static and dynamic geometry, including curvature, torsion, length and Tortuosity Index (TI). RESULTS Fourteen CIA-IIA trajectories were analyzed before and after IBE placement. Cardiac pulsatility-induced motion and pathlengths increased after IBE placement, especially at mid IIA and the first IIA bifurcation (P≤0.04). After IBE placement, static and dynamic curvature, length and TI decreased significantly (P<0.05). Furthermore, the average dynamic torsion increased significantly (P=0.030). The remaining geometrical outcomes were not statistically significant. CONCLUSIONS The placement of an IBE device stiffens and straightens the CIA-IIA trajectory. Its relation with clinical outcome is yet to be investigated, which can be done thoroughly with the ECG-gated CTA algorithms used in this study.
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Affiliation(s)
- Majorie van Helvert
- Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, the Netherlands
- Department of Vascular Surgery, Rijnstate Hospital, Arnhem, the Netherlands
| | - Jaimy A Simmering
- Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, the Netherlands -
- Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Maaike A Koenrades
- Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, the Netherlands
- Department of Medical Technology, Medical 3D lab, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Cornelis H Slump
- Robotics and Mechatronics Group, TechMed Centre, University of Twente, Enschede, the Netherlands
| | - Jan M Heyligers
- Department of Vascular Surgery, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Robert H Geelkerken
- Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, the Netherlands
- Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Michel M Reijnen
- Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, the Netherlands
- Department of Vascular Surgery, Rijnstate Hospital, Arnhem, the Netherlands
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Cornejo J, Cornejo-Aguilar JA, Vargas M, Helguero CG, Milanezi de Andrade R, Torres-Montoya S, Asensio-Salazar J, Rivero Calle A, Martínez Santos J, Damon A, Quiñones-Hinojosa A, Quintero-Consuegra MD, Umaña JP, Gallo-Bernal S, Briceño M, Tripodi P, Sebastian R, Perales-Villarroel P, De la Cruz-Ku G, Mckenzie T, Arruarana VS, Ji J, Zuluaga L, Haehn DA, Paoli A, Villa JC, Martinez R, Gonzalez C, Grossmann RJ, Escalona G, Cinelli I, Russomano T. Anatomical Engineering and 3D Printing for Surgery and Medical Devices: International Review and Future Exponential Innovations. BIOMED RESEARCH INTERNATIONAL 2022; 2022:6797745. [PMID: 35372574 PMCID: PMC8970887 DOI: 10.1155/2022/6797745] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/16/2022] [Accepted: 02/24/2022] [Indexed: 12/26/2022]
Abstract
Three-dimensional printing (3DP) has recently gained importance in the medical industry, especially in surgical specialties. It uses different techniques and materials based on patients' needs, which allows bioprofessionals to design and develop unique pieces using medical imaging provided by computed tomography (CT) and magnetic resonance imaging (MRI). Therefore, the Department of Biology and Medicine and the Department of Physics and Engineering, at the Bioastronautics and Space Mechatronics Research Group, have managed and supervised an international cooperation study, in order to present a general review of the innovative surgical applications, focused on anatomical systems, such as the nervous and craniofacial system, cardiovascular system, digestive system, genitourinary system, and musculoskeletal system. Finally, the integration with augmented, mixed, virtual reality is analyzed to show the advantages of personalized treatments, taking into account the improvements for preoperative, intraoperative planning, and medical training. Also, this article explores the creation of devices and tools for space surgery to get better outcomes under changing gravity conditions.
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Affiliation(s)
- José Cornejo
- Facultad de Ingeniería, Universidad San Ignacio de Loyola, La Molina, Lima 15024, Peru
- Department of Medicine and Biology & Department of Physics and Engineering, Bioastronautics and Space Mechatronics Research Group, Lima 15024, Peru
| | | | | | | | - Rafhael Milanezi de Andrade
- Robotics and Biomechanics Laboratory, Department of Mechanical Engineering, Universidade Federal do Espírito Santo, Brazil
| | | | | | - Alvaro Rivero Calle
- Department of Oral and Maxillofacial Surgery, Hospital 12 de Octubre, Madrid, Spain
| | - Jaime Martínez Santos
- Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA
| | - Aaron Damon
- Department of Neurosurgery, Mayo Clinic, FL, USA
| | | | | | - Juan Pablo Umaña
- Cardiovascular Surgery, Instituto de Cardiología-Fundación Cardioinfantil, Universidad del Rosario, Bogotá DC, Colombia
| | | | - Manolo Briceño
- Villamedic Group, Lima, Peru
- Clínica Internacional, Lima, Peru
| | | | - Raul Sebastian
- Department of Surgery, Northwest Hospital, Randallstown, MD, USA
| | | | - Gabriel De la Cruz-Ku
- Universidad Científica del Sur, Lima, Peru
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Jiakai Ji
- Obstetrics and Gynecology, Lincoln Medical and Mental Health Center, Bronx, NY, USA
| | - Laura Zuluaga
- Department of Urology, Fundación Santa Fe de Bogotá, Colombia
| | | | - Albit Paoli
- Howard University Hospital, Washington, DC, USA
| | | | | | - Cristians Gonzalez
- Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- Institut of Image-Guided Surgery (IHU-Strasbourg), Strasbourg, France
| | | | - Gabriel Escalona
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Santiago, Chile
| | - Ilaria Cinelli
- Aerospace Human Factors Association, Aerospace Medical Association, VA, USA
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Bogdanovic M, Stackelberg O, Lindström D, Ersryd S, Andersson M, Roos H, Siika A, Jonsson M, Roy J. Limb Graft Occlusion Following Endovascular Aneurysm Repair for Infrarenal Abdominal Aortic Aneurysm with the Zenith Alpha, Excluder, and Endurant Devices: a Multicentre Cohort Study. Eur J Vasc Endovasc Surg 2021; 62:532-539. [PMID: 34266764 DOI: 10.1016/j.ejvs.2021.05.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 03/26/2021] [Accepted: 05/08/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Limb graft occlusion (LGO) is a serious complication after endovascular aneurysm repair (EVAR) and while device development enables treatment of increasingly complex aortic anatomy, little is known about how endograft type affects the risk of occlusion. This observational study aimed to explore the incidence of LGO after EVAR for three major endograft systems. METHODS All patients with standard EVAR as the primary intervention for infrarenal abdominal aortic aneurysm (AAA), between January 2012 and December 2018, at five Swedish vascular surgery centres, were included in this multicentre retrospective cohort study. LGO was defined as a total limb occlusion regardless of symptoms, or a treated significant stenosis. A nested case control (NCC) design with incidence density sampling of 1:3 was used for analysis of potential per-operative and morphological risk factors. Conditional logistic regression was used to estimate multivariable odds ratios (OR) with 95% confidence intervals (CI) RESULTS: A total of 924 patients were included. The majority were male (84%), the mean age was 76 years (± 7.5 SD), and median AAA diameter was 59 mm (IQR 55, 67). Patients were treated with Zenith Alpha (n = 315, ZISL limbs), Excluder (n = 152, PLC/PXC limbs), and Endurant (n = 457, ETLW/ ETEW limbs). During median follow up of 37 months (IQR 21, 62), 55 occlusions occurred (5.9%); 39 with Zenith Alpha (12.4%), one with Excluder (0.7%), and 15 with Endurant (3.3%). In the NCC analysis, the Zenith Alpha device (OR 5.31, 95% CI 1.97 - 14.3), external iliac artery (EIA) landing (OR 5.91, 95% CI 1.30 - 26.7), and EIA diameter < 10 mm (OR 4.99, 95% CI 1.46 - 16.9) were associated with an increased risk of LGO. CONCLUSION Endograft device type is an independent risk factor for LGO after EVAR. Specifically, the Zenith Alpha demonstrated an increased risk of LGO compared with the Endurant and Excluder devices. In addition, a narrow EIA and landing zone in EIA are also risk factors for LGO.
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Affiliation(s)
- Marko Bogdanovic
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Otto Stackelberg
- Department of Clinical Science and Education, Karolinska Institutet at Södersjukhuset, Stockholm, Sweden; Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - David Lindström
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - Samuel Ersryd
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden; Centre for Research and Development, Uppsala University/County Council of Gävleborg, Gävle, Sweden
| | - Manne Andersson
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Department of Surgery, Division of Vascular Surgery, Ryhov County Hospital, Jönköping, Sweden
| | - Håkan Roos
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Surgery, Division of Vascular Surgery, Ryhov County Hospital, Jönköping, Sweden
| | - Antti Siika
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Jonsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Joy Roy
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden.
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DeRoo E, Harris D, Olson S, Panthofer A, Meadows W, Pauli T, Peterson B, Schneider D, Matsumura J. Conformability of the GORE EXCLUDER iliac branch endoprosthesis is associated with freedom from adverse iliac events. J Vasc Surg 2021; 74:1558-1564.e1. [PMID: 34082005 DOI: 10.1016/j.jvs.2021.05.026] [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: 01/09/2021] [Accepted: 05/01/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The GORE EXCLUDER iliac branch endoprosthesis (IBE; W.L. Gore & Associates, Flagstaff, Ariz) is designed to preserve internal iliac artery (IIA) patency during endovascular treatment of aneurysms involving the common iliac artery. The device is intended to conform to iliac tortuosity, which may decrease adverse iliac events (AIE). The objective of this study was to evaluate risk factors for AIE after IBE implantation. METHODS This was a post hoc analysis of the prospective, multicenter GORE 12-04 IBE pivotal trial. Patients with preoperative and postoperative axial imaging were included, with analysis based on each treated iliac system. An independent core laboratory performed all scan measurements, including iliac diameters, lengths, and tortuosity. Conformability was analyzed by the changes in tortuosity after IBE deployment, with less change indicating greater conformation. The end point was AIE, defined as ipsilateral radiographic or clinical complications. Critical nonconformation was defined as a threshold change in tortuosity associated with a significant increase in AIE. RESULTS We included 98 patients with 101 treated iliac systems. There were eight AIE (8%; six IIA component occlusions, one iliac branch component occlusion, and one EIA dissection requiring reintervention). Patients with AIE had smaller IIA diameters and less IBE conformability. After multivariable logistic regression analysis, an IIA diameter of less than 10 mm and a change in total iliac tortuosity beyond -15% were independently associated with AIE (odds ratio, 12 [interquartile range, 1.4-110] and odds ratio, 8.2 [interquartile range, 1.5-46], respectively), and the latter was used to define critical nonconformation. Critical nonconformation occurred in 11% of treated systems, and was associated with a high rate of AIE (36% vs 4%; P = .004). CONCLUSIONS Endograft conformation is a novel device property and technical outcome that, along with a larger IIA diameter, is associated with freedom from AIE after IBE deployment. An evaluation of these risk factors may better inform the management of patients with iliac aneurysmal disease. Further research on endograft conformation and patient outcomes is warranted, particularly for those with challenging anatomy undergoing complex procedures.
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Affiliation(s)
- Elise DeRoo
- Division of Vascular Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisc.
| | - Donald Harris
- Division of Vascular Surgery, Department of Surgery, University of Washington, Valley Medical Center, Seattle, Wash
| | - Sydney Olson
- Division of Vascular Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisc
| | - Annalise Panthofer
- Division of Vascular Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisc
| | - Wendy Meadows
- Division of Vascular Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisc
| | - Thomas Pauli
- Division of Vascular Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisc
| | - Brian Peterson
- St. Luke's Heart and Vascular Institute, St. Luke's Hospital, St. Louis, Mo
| | - Darren Schneider
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Jon Matsumura
- Division of Vascular Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisc
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9
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de Niet A, Donselaar EJ, Holewijn S, Tielliu IFJ, Lardenoije JWHP, Zeebregts CJ, Reijnen MMPJ. Endograft Conformability in Fenestrated Endovascular Aneurysm Repair for Complex Abdominal Aortic Aneurysms. J Endovasc Ther 2020; 27:848-856. [PMID: 32567964 PMCID: PMC7536524 DOI: 10.1177/1526602820936185] [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] [Indexed: 11/16/2022]
Abstract
Purpose: To compare the impact of 2 commercially available custom-made fenestrated endografts on patient anatomy. Materials and Methods: The records of 234 patients who underwent fenestrated endovascular aneurysm repair for abdominal aortic aneurysm from March 2002 to July 2016 in 2 hospitals were screened to identify those who had pre- and postoperative computed tomography angiography assessments with a slice thickness of ≤2 mm. The search identified 145 patients for further analysis: 110 patients (mean age 72.4±7.1 years; 94 men) who had been treated with the Zenith Fenestrated (ZF) endograft and 35 patients (mean age 72.3±7.3 years; 30 men) treated with the Fenestrated Anaconda (FA) endograft. Measurements included aortic diameters at the level of the superior mesenteric artery (SMA) and renal arteries, target vessel angles, target vessel clock positions, and the target vessel tortuosity index. Variables were tested for inter- and intraobserver agreement. Results: There was a good agreement between observers in all tested variables. The native anatomy changed in both groups after endograft implantation. In the ZF group, changes were seen in the angles of the celiac artery (p=0.012), SMA (p=0.022), left renal artery (LRA) (p<0.001), and the right renal artery (RRA) (p<0.001); the aortic diameter at the SMA level (p<0.001); and the LRA (p<0.001) and RRA (p<0.001) clock positions. In the FA group, changes were seen in the angles of the LRA (p=0.001) and RRA (p<0.001) and in the SMA tortuosity index (p=0.044). Between group differences in changes were seen for the aortic diameters at the SMA and renal artery levels (p<0.001 for both) and the LRA clock position (p=0.019). Conclusion: Both custom-made fenestrated endografts altered vascular anatomy. The data suggest a higher conformability of the Fenestrated Anaconda endograft compared with the Zenith Fenestrated.
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Affiliation(s)
- Arne de Niet
- Department of Surgery (Division Vascular Surgery), University Medical Center Groningen, University of Groningen, the Netherlands
| | | | - Suzanne Holewijn
- Multi-Modality Medical Imaging Group, Tech Med Centre, University of Twente, Enschede, the Netherlands
| | - Ignace F J Tielliu
- Department of Surgery (Division Vascular Surgery), University Medical Center Groningen, University of Groningen, the Netherlands
| | - Jan Willem H P Lardenoije
- Multi-Modality Medical Imaging Group, Tech Med Centre, University of Twente, Enschede, the Netherlands
| | - Clark J Zeebregts
- Department of Surgery (Division Vascular Surgery), University Medical Center Groningen, University of Groningen, the Netherlands
| | - Michel M P J Reijnen
- Department of Surgery, Rijnstate, Arnhem, the Netherlands.,Multi-Modality Medical Imaging Group, Tech Med Centre, University of Twente, Enschede, the Netherlands
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Iwakoshi S, Nakai T, Ichihashi S, Inoue T, Sakaguchi S, Hirose T, Tabayashi N, Watkins AC, Kichikawa K. Conformability and Efficacy of the Zenith Spiral Z Leg Compared with the Zenith Flex Leg in Endovascular Abdominal Aortic Aneurysm Repair. Ann Vasc Surg 2019; 59:127-133. [DOI: 10.1016/j.avsg.2019.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 02/21/2019] [Accepted: 02/22/2019] [Indexed: 10/26/2022]
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11
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Torres I, De Luccia N. Artificial vascular models for endovascular training (3D printing). Innov Surg Sci 2018; 3:225-234. [PMID: 31579786 PMCID: PMC6604582 DOI: 10.1515/iss-2018-0020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 07/17/2018] [Indexed: 12/27/2022] Open
Abstract
The endovascular technique has led to a revolution in the care of patients with vascular disease; however, acquiring and maintaining proficiency over a broad spectrum of procedures is challenging. Three-dimensional (3D) printing technology allows the production of models that can be used for endovascular training. This article aims to explain the process and technologies available to produce vascular models for endovascular training, using 3D printing technology. The data are based on the group experience and a review of the literature. Different 3D printing methods are compared, describing their advantages, disadvantages and potential roles in surgical training. The process of 3D printing a vascular model based on an imaging examination consists of the following steps: image acquisition, image post-processing, 3D printing and printed model post-processing. The entire process can take a week. Prospective studies have shown that 3D printing can improve surgical planning, especially in complex endovascular procedures, and allows the production of efficient simulators for endovascular training, improving residents’ surgical performance and self-confidence.
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Affiliation(s)
- Inez Torres
- Discipline of Vascular and Endovascular Surgery, Department of Surgery, São Paulo University Medical School, Rua Oscar Freire, 1546, ap 33, Pinheiros, São Paulo - SP 05409-010, Brazil
| | - Nelson De Luccia
- Discipline of Vascular and Endovascular Surgery, Department of Surgery, São Paulo University Medical School, São Paulo, Brazil
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Georgakarakos E, Kratimenos T, Koutsoumpelis A, Georgiadis GS. The Bolton Treo endograft for treatment of abdominal aortic aneurysms: just another trimodular platform? Expert Rev Med Devices 2017; 15:5-14. [DOI: 10.1080/17434440.2018.1419864] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Efstratios Georgakarakos
- Department of Vascular Surgery, Democritus University of Thrace, Alexandroupolis, Greece
- Department of Vascular Surgery, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Theodoros Kratimenos
- Department of Interventional Radiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Andreas Koutsoumpelis
- Department of Vascular Surgery, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - George S. Georgiadis
- Department of Vascular Surgery, Democritus University of Thrace, Alexandroupolis, Greece
- Department of Vascular Surgery, University Hospital of Alexandroupolis, Alexandroupolis, Greece
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Lee K, Hossain S, Sabalbal M, Dubois L, Duncan A, DeRose G, Power AH. Explaining endograft shortening during endovascular repair of abdominal aortic aneurysms in severe aortoiliac tortuosity. J Vasc Surg 2017; 65:1297-1304. [DOI: 10.1016/j.jvs.2016.09.041] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 09/15/2016] [Indexed: 11/29/2022]
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14
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Conformability of GORE Excluder Iliac Branch Endoprosthesis and COOK Zenith Bifurcated Iliac Side Branched Iliac Stent Grafts. Ann Vasc Surg 2016; 36:139-144. [DOI: 10.1016/j.avsg.2016.02.042] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 02/19/2016] [Accepted: 02/23/2016] [Indexed: 11/18/2022]
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15
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Mestres G, Garcia ME, Yugueros X, Urrea R, Tripodi P, Gomez F, Maeso J, Riambau V. Aortic Arch and Thoracic Aorta Curvature Remodeling after Thoracic Endovascular Aortic Repair. Ann Vasc Surg 2016; 38:233-241. [PMID: 27522975 DOI: 10.1016/j.avsg.2016.05.097] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 05/02/2016] [Accepted: 05/06/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND The objective of this study was to analyze the original curvature of the aortic arch and thoracic aorta, and how it is modified after the placement of a thoracic endograft. METHODS We retrospectively analyzed all patients primarily treated for thoracic aortic aneurysms and blunt traumatic aortic injuries by means of an endograft sealed into the aortic arch (zones, Z1-Z3) in 2 different centers (Vascular Surgery Division, Hospital Clinic, UB; and Vascular and Endovascular Surgery Department, Hospital Vall d'Hebron, UAB; Barcelona, Spain), between 2010 and 2015. The last preoperative and early (1-month) postoperative computed tomography angiography (CTA) was obtained for all cases, and an accurate 3-dimensional (3D) center lumen line was created, from the aortic valve to the renal arteries. Angles in 2-dimensional (2D; XY-plane) and 3D (referred to cranial-caudal Z-axis) were analyzed in: the distal ascending aorta, aortic arch, and thoracic aorta (at 5, 10, 15, and 20 cm from the brachiocephalic trunk [BCT]) and celiac trunk (CT). Changes in preoperative-postoperative CTA were compared independently for both diseases. Thirty-six cases were included (20 aneurysms, 16 blunt traumatic injuries; mean age, 69.5 and 42.5 years). RESULTS After placement of an aortic endograft (sealed in Z1-Z2 in 30% of aneurysms and 75% of traumatic injuries; mean endograft length: 22.6 cm and 11.3 cm, respectively), a global left anterior displacement of the ascending aorta was observed (2D examination: -13.1° and -7.5°, P = 0.049 and 0.041, respectively). The 3D examination showed an average increase of the aortic angle at 5 and 10 cm from the BCT in the whole sample (+4.0°, +4.9° in reference to the vertical; P = 0.017, 0.001), softening the curvature of the proximal descending thoracic aorta. In addition, in traumatic injuries, a decrease in the aortic arch angle was observed (-3.5°, P = 0.030). CONCLUSIONS Placement of an endograft into the aortic arch and proximal thoracic aorta engenders a softening of the proximal descending thoracic aorta curvature, increasing its angle from the vertical. In blunt traumatic aortic injuries (with shorter and more proximally sealed endografts), an additional decrease of the aortic arch angle (3.5° more vertical), was observed.
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Affiliation(s)
- Gaspar Mestres
- Vascular Surgery Division, Cardiovascular Institute, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.
| | - Marvin E Garcia
- Vascular and Endovascular Surgery Department, Vall d'Hebron Hospital, UAB, Barcelona, Spain
| | - Xavier Yugueros
- Vascular Surgery Division, Cardiovascular Institute, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Rodrigo Urrea
- Vascular Surgery Division, Cardiovascular Institute, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Paolo Tripodi
- Vascular Surgery Division, Cardiovascular Institute, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Fernando Gomez
- Angioradiology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Jordi Maeso
- Vascular and Endovascular Surgery Department, Vall d'Hebron Hospital, UAB, Barcelona, Spain
| | - Vincent Riambau
- Vascular Surgery Division, Cardiovascular Institute, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
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