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Kontopodis N, Charalambous S, Galanakis N, Lioudaki S, Tzartzalou I, Kehagias E, Tsetis D, Ioannou CV. Late neck related adverse events are rare among patients with wide aortic neck undergoing endovascular aneurysm repair with the Ovation endograft. Ann Vasc Surg 2022; 88:337-345. [DOI: 10.1016/j.avsg.2022.06.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/25/2022] [Accepted: 06/26/2022] [Indexed: 11/17/2022]
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Georgakarakos E, Koutsoumpelis A, Kostoglou P, Tasopoulou KM, Argyriou C. A Misdiagnosed Case of Endoleak Type-III Caused by Inadvertent Bilateral Limb Insertion in the Same Limb Gate of the Ovation Endograft. AORTA 2022; 10:35-37. [PMID: 35640586 PMCID: PMC9179207 DOI: 10.1055/s-0042-1743197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We describe an infrequent case of endoleak Type-III due to an unrecognized, inadvertent bilateral limb deployment into the same limb gate of the Ovation aortic endograft, accompanied by thrombosis and acute ischemia. The following computed tomography angiography revealed the open limb gate with the characteristic of radio-opaque polymer in the sealing rings. Intraoperative angiographies via the brachial route identified the open limb gate and facilitated the successful use of an occluding plug to manage the Type-III endoleak.
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Affiliation(s)
- Efstratios Georgakarakos
- Department of Vascular Surgery, “Democritus” University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Andreas Koutsoumpelis
- Department of Vascular Surgery, “Democritus” University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Panagiotis Kostoglou
- First University Surgical Department, University Hospital of Alexandropoulis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Kalliopi-Maria Tasopoulou
- 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
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de Donato G, Pasqui E, Panzano C, Brancaccio B, Grottola G, Galzerano G, Benevento D, Palasciano G. The Polymer-Based Technology in the Endovascular Treatment of Abdominal Aortic Aneurysms. Polymers (Basel) 2021; 13:1196. [PMID: 33917214 PMCID: PMC8068055 DOI: 10.3390/polym13081196] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/02/2021] [Accepted: 04/04/2021] [Indexed: 12/18/2022] Open
Abstract
An abdominal aortic aneurysm (AAA) is a dilatation of the abdominal aorta that progressively grows until it ruptures. Treatment is typically recommended when the diameter is more than 5 cm. The EVAR (Endovascular aneurysm repair) is a minimally invasive procedure that involves the placement of an expandable stent graft within the aorta to treat aortic disease without operating directly on the aorta. For years, stent grafts' essential design was based on metallic stent frames to support the fabric. More recently, a polymer-based technology has been proposed as an alternative method to seal AAA. This review underlines the two platforms that are based on a polymer technology: (1) the polymer-filled endobags, also known as Endovascular Aneurysm Sealing (EVAS) with Nellix stent graft; and (2) the O-ring EVAR polymer-based proximal neck sealing device, also known as an Ovation stent graft. Polymer characteristics for this particular aim, clinical applications, and durability results are hereby summarized and commented critically. The technique of inflating endobags filled with polymer to exclude the aneurysmal sac was not successful due to the lack of an adequate proximal fixation. The platform that used polymer to create a circumferential sealing of the aneurysmal neck has proven safe and effective.
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Affiliation(s)
- Gianmarco de Donato
- Department of Vascular Surgery, University of Siena, 53100 Siena, Italy; (E.P.); (C.P.); (B.B.); (G.G.); (G.G.); (D.B.); (G.P.)
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Sirignano P, Mansour W, Capoccia L, Cuozzo S, Camparini S, de Donato G, Mangialardi N, Ronchey S, Talarico F, Setacci C, Speziale F. Endovascular aortic repair in patients with challenging anatomies: the EXTREME study. EUROINTERVENTION 2021; 16:e1544-e1550. [PMID: 31793884 PMCID: PMC9725024 DOI: 10.4244/eij-d-19-00547] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this study was to report the 30-day technical and clinical success with endovascular repair using the ultra-low-profile Ovation stent graft in patients judged to be outside the instructions for use (IFU) for conventional endografts, while amenable to treatment within the IFU for Ovation. METHODS AND RESULTS One hundred and twenty-two patients (78.65±7.67 years; 111 male) were enrolled. Patients were evaluated as being outside the IFU for standard endografts because of the absence of a suitable proximal aortic neck in 109 cases (89.3%), of inadequate access vessels in 13 (10.7%), or both in 111 (90.9%). Mean aneurysm (abdominal aortic aneurysm [AAA]) diameter was 52.96±10.1 mm; mean aortic neck length was 7.75±6.05 mm. Technical success (98.4%) was achieved in all but two patients due to a type Ia endoleak. At completion angiography, 15 (12.3%) patients presented a type II endoleak. All patients underwent 30-day follow-up. Primary clinical success at one month was 96.8%, assisted clinical success 98.4%. There were no type I endoleaks, while 12 (9.8%) type II endoleaks were still evident, in the absence of sac expansions. Two patients (1.6%) presented an asymptomatic limb occlusion. CONCLUSIONS Our experience suggests that, in a selected population of patients with challenging anatomy outside the IFU for conventional endografts, endovascular aneurysm repair (EVAR) using the Ovation stent graft can be performed safely with satisfactory immediate outcomes.
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Affiliation(s)
- Pasqualino Sirignano
- Vascular and Endovascular Surgery Division, Policlinico Umberto I, Viale del Policlinico, 155, 00161 Rome, Italy
| | - Wassim Mansour
- Vascular and Endovascular Surgery Unit, Department of Surgery “Paride Stefanini”, Policlinico Umberto I of Rome, “Sapienza” University of Rome, Rome, Italy
| | - Laura Capoccia
- Vascular and Endovascular Surgery Unit, Department of Surgery “Paride Stefanini”, Policlinico Umberto I of Rome, “Sapienza” University of Rome, Rome, Italy
| | - Simone Cuozzo
- Vascular and Endovascular Surgery Unit, Department of Surgery “Paride Stefanini”, Policlinico Umberto I of Rome, “Sapienza” University of Rome, Rome, Italy
| | - Stefano Camparini
- Vascular and Endovascular Surgery Unit, Department of Thoraco-Vascular Surgery, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - Gianmarco de Donato
- Vascular and Endovascular Surgery Unit, Department of Medicine, Surgery, and Neuroscience, University of Siena, Siena, Italy
| | - Nicola Mangialardi
- Department of Vascular Surgery, “San Camillo Forlanini” Hospital, Rome, Italy
| | - Sonia Ronchey
- Department of Vascular Surgery, “San Filippo Neri” Hospital, Rome, Italy
| | - Francesco Talarico
- Division of Vascular and Endovascular Surgery, Ospedale Civico, Palermo, Italy
| | - Carlo Setacci
- Vascular and Endovascular Surgery Unit, Department of Medicine, Surgery, and Neuroscience, University of Siena, Siena, Italy
| | - Francesco Speziale
- Vascular and Endovascular Surgery Unit, Department of Surgery “Paride Stefanini”, Policlinico Umberto I of Rome, “Sapienza” University of Rome, Rome, Italy
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Georgakarakos E, Papatheodorou N, Argyriou C, Tasopoulou KM, Doukas D, Georgiadis GS. An update on the ovation abdominal stent graft for the treatment of abdominal aortic aneurysms: current evidence and future perspectives. Expert Rev Med Devices 2020; 17:1249-1256. [PMID: 33166478 DOI: 10.1080/17434440.2020.1848539] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Introduction: The Ovation stent-graft has presented satisfactory mid-term results in the management of abdominal aortic aneurysms (AAA). Its unique design with uncoupling of fixation and sealing and the lowest profile in the market has expanded the treatment in AAA with challenging neck anatomies and, especially, in the females presenting mostly with narrow iliac access vessels. Morever, a new design modification, the Ovation Alto was recently introduced in the Market, while certain off-label uses of the Ovation in treating either juxtarenal- or short-necked AAA have been proposed. Areas covered: Aim of this article was to present the current articles with the long-term results of the Ovation endograft and discuss the new developments and modifications in its use. Expert commentary: the Ovation stent-graft exhibits very satisfactory clinical long-term results in AAA treated within the instructions-for-use, expands significantly the treatment of AAA in females and overcomes reliably challenging anatomical issues of the infrarenal neck that would render these cases ineligible for treatment with any other endograft. Εxperience with the specific, unique technical features of Ovation as well as careful selection of patients and meticulous preoperative study of the AAA anatomy are key-elements to the successful performance of this endograft.
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Affiliation(s)
- Efstratios Georgakarakos
- Department of Vascular Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace , Alexandroupolis, Greece
| | - Nikolaos Papatheodorou
- Department of Vascular Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace , Alexandroupolis, Greece
| | - Christos Argyriou
- Department of Vascular Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace , Alexandroupolis, Greece
| | - Kalliopi-Maria Tasopoulou
- Department of Vascular Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace , Alexandroupolis, Greece
| | - Damianos Doukas
- Department of Vascular Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace , Alexandroupolis, Greece
| | - George S Georgiadis
- Department of Vascular Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace , Alexandroupolis, Greece
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Kontopodis N, Galanakis N, Tzartzalou I, Tavlas E, Georgakarakos E, Dimopoulos I, Tsetis D, Ioannou CV. An update on the improvement of patient eligibility with the use of new generation endografts for the treatment of abdominal aortic aneurysms. Expert Rev Med Devices 2020; 17:1231-1238. [PMID: 33089719 DOI: 10.1080/17434440.2020.1841629] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Endovascular aneurysm repair (EVAR), performed within device instructions for use (IFU), offers improved outcomes. New endograft designs attempt to increase eligibility rates of abdominal aortic aneurysm (AAA) patients treated within device IFU. We aim to examine the anatomic suitability of the Ovation endograft in our AAA patients and compare it with the other contemporary devices. RESEARCH DESIGN AND METHODS Three-hundred and seven consecutive elective AAA patients treated during a 5-year period were included. Patient-specific anatomic characteristics were based on endograft IFUs to determine eligibility rates of each system. RESULTS Two-hundred-twenty-five patients underwent EVAR and 82 open surgery. Ineligibility for device implantation was significantly lower for the Ovation iX system (32%) compared to other devices (AFX-2:49%, Altura:49%, Anaconda:54%, Endurant II:46%, Excluder:52%, Excluder Conformable:39%, Incraft:43%, E-Tegra:52%, Zenith-Alpha:52%; P-Value<0.001). The Alto system (next-generation Ovation) achieved an even lower ineligibility rate of 30% (P = 0.008). Short proximal aortic neck length followed by access vessel inadequacy were the primary reasons for ineligibility. CONCLUSION The Ovation-iX included more patients with anatomic characteristics within device IFUs resulting in improved eligibility rates compared with the rest of contemporary devices. Its evolution, the Alto system, further improves patient eligibility due to the inclusion of shorter aortic necks. EXPERT OPINION The Ovation iX system presented a significantly better performance and was eligible for use in a greater number of patients in our series of elective AAA repairs, accommodating patient-specific aortic anatomies. Of course, performing EVAR within the endograft's IFU is important to achieve optimal and durable outcomes. The proximal neck length followed by the size of the access vessels are the two more common factors resulting in loss of eligibility. Except for overall eligibility rates, a case by case decision must be made on which is the most suitable device for each patient, based on the specific characteristics of its unique anatomy.
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Affiliation(s)
- Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, University of Crete , Heraklion, Greece
| | - Nikolaos Galanakis
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital of Heraklion, Medical School of Crete , Heraklion, Greece
| | - Ifigeneia Tzartzalou
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, University of Crete , Heraklion, Greece
| | - Emmanouil Tavlas
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, University of Crete , Heraklion, Greece
| | - Efstratios Georgakarakos
- Department of Vascular Surgery, 'Democritus' University of Thrace, University Hospital of Alexandroupolis , Alexandroupolis, Greece
| | - Ioannins Dimopoulos
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, University of Crete , Heraklion, Greece
| | - Dimitrios Tsetis
- Interventional Radiology Unit, Department of Medical Imaging, University Hospital of Heraklion, Medical School of Crete , Heraklion, Greece
| | - Christos V Ioannou
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, University of Crete , Heraklion, Greece
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Mid- to Long-Term Outcome Results of the Ovation Stent Graft. Ann Vasc Surg 2020; 63:129-135. [DOI: 10.1016/j.avsg.2019.06.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/24/2019] [Accepted: 06/28/2019] [Indexed: 12/20/2022]
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Georgakarakos E, Kourdakis D, Apostolidis T, Koutsoumpelis A. Cutting the Gordian Knot of Abdominal Aneurysm Hostile Neck Definitions with the Ovation Stent Graft. Ann Vasc Surg 2020; 65:e294-e295. [PMID: 31931129 DOI: 10.1016/j.avsg.2020.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 01/05/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Efstratios Georgakarakos
- Department of Vascular Surgery, "Democritus" University of Thrace, University Hospital of Alexandroupolis, Greece.
| | | | | | - Andreas Koutsoumpelis
- Department of Vascular Surgery, "Democritus" University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
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Georgakarakos E, Koutsoumpelis A, Tasopoulou KM, Georgiadis GS. Tips to Ensure Optimal Ring Apposition of the Ovation Stent Graft in Challenging Necks of Abdominal Aortic Aneurysms. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2019; 7:67-69. [PMID: 31529432 PMCID: PMC6748839 DOI: 10.1055/s-0039-1688434] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Ovation stent graft has been recently introduced for endovascular repair of abdominal aortic aneurysms. Its sealing mechanism is based on a pair of polymer-filled inflatable rings. Based on our experience, we describe useful tips to optimize the use of Ovation in thrombosed or severely angulated necks.
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Affiliation(s)
- Efstratios Georgakarakos
- Department of Vascular Surgery, University Hospital of Alexandroupolis, "Democritus" University of Thrace, Alexandroupolis, Greece
| | - Andreas Koutsoumpelis
- Department of Vascular Surgery, University Hospital of Alexandroupolis, "Democritus" University of Thrace, Alexandroupolis, Greece
| | - Kalliopi-Maria Tasopoulou
- Department of Vascular Surgery, University Hospital of Alexandroupolis, "Democritus" University of Thrace, Alexandroupolis, Greece
| | - George S Georgiadis
- Department of Vascular Surgery, University Hospital of Alexandroupolis, "Democritus" University of Thrace, Alexandroupolis, Greece
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Alsheekh A, Aurshina A, Chait J, Hingorani A, Ascher E. The great choke, Ovation® aortic body graft stenosis. Vascular 2019; 27:359-362. [PMID: 30739601 DOI: 10.1177/1708538118820442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Abdominal endovascular aneurysm repair is a minimally invasive alternative to major open surgery for the repair of abdominal aortic aneurysms that results in reduced recovery times and early survival rates. Methods The TriVascular Ovation® Abdominal Stent Graft System is a low-profile endovascular device with active fixation used for endovascular aneurysm repair. The stent graft is designed to reline the diseased vasculature, providing an endovascular blood conduit for isolating the aneurysm from the high-pressure flow of blood, thereby reducing the risk of rupture. The stent graft is a modular configuration comprised of an aortic body section, iliac limbs, and iliac extensions as required. Results and Conclusion: We present a case of symptomatic aortic body graft stenosis in the unsupported segment below the O-rings, 26 months after the treatment of abdominal aortic aneurysm with Ovation® Abdominal Stent Graft System. The successful repair was performed by ballooning the stenotic area which resulted in complete resolution of the symptoms.
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11
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Koutsoumpelis A, Georgakarakos E, Tasopoulou KM, Kontopodis N, Argyriou C, Georgiadis GS. A clinical update on the mid-term clinical performance of the Ovation endograft. Expert Rev Med Devices 2018; 16:57-62. [PMID: 30518270 DOI: 10.1080/17434440.2019.1555467] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The Ovation stent-graft uncouples the steps of fixation and sealing via a pair of polymer-filled inflatable rings. Apart from the well-documented early results, newer data emerged for mid-term results of Ovation and are presented in this review. AREAS COVERED Aim of this article was to report all current studies with the mid-term results of the particular endograft, the incidence of complications and failure, and discuss their management. EXPERT COMMENTARY The Ovation stent-graft exhibits very satisfactory clinical mid-term results in abdominal aortic aneurysms treated within the instructions-for-use. It can also have a very promising role in challenging neck anatomies with conical shape and presence of thrombus or calcification. However, this should be not considered a panacea and long-term results are needed to validate this intriguing aspect.
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Affiliation(s)
- Andreas Koutsoumpelis
- a Department of Vascular Surgery , "Democritus" University of Thrace, University Hospital of Alexandroupolis , Alexandroupolis , Greece
| | - Efstratios Georgakarakos
- a Department of Vascular Surgery , "Democritus" University of Thrace, University Hospital of Alexandroupolis , Alexandroupolis , Greece
| | - Kalliopi-Maria Tasopoulou
- a Department of Vascular Surgery , "Democritus" University of Thrace, University Hospital of Alexandroupolis , Alexandroupolis , Greece
| | - Nikolaos Kontopodis
- b Department of Vascular Surgery , University of Crete Medical School , Heraklion , Greece
| | - Christos Argyriou
- a Department of Vascular Surgery , "Democritus" University of Thrace, University Hospital of Alexandroupolis , Alexandroupolis , Greece
| | - George S Georgiadis
- a Department of Vascular Surgery , "Democritus" University of Thrace, University Hospital of Alexandroupolis , Alexandroupolis , Greece
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Lin J, Parikh N, Udgiri N, Wang S, Miller DF, Li C, Panneton J, Nutley M, Zhang Z, Huang Y, Lu J, Zhang J, Wang L, Guidoin R. Laser Fenestration of Aortic Stent-Grafts Followed by Noncompliant vs Cutting Balloon Dilation: A Scanning Electron Microscopy Study. J Endovasc Ther 2018; 25:397-407. [DOI: 10.1177/1526602818772311] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Purpose: To examine the effects of in situ laser fenestration and subsequent balloon dilation (noncompliant vs cutting) on the graft fabric of 4 aortic stent-graft models. Method: In an in vitro setup, the Zenith TX2, Talent, Endurant, and Anaconda aortic stent-grafts (all made of polyester graft material) were subjected to laser fenestration with a 2.3-mm-diameter probe at low and high energy in a physiologic saline solution followed by balloon dilation of the hole. For the first series of tests, 6-mm-diameter noncompliant balloons were used and replaced for the second series by 6-mm-diameter cutting balloons. Each procedure was performed 5 times (5 fenestrations per balloon type). The fenestrations were examined visually and with light and scanning electron microscopy. Results: Each fenestration demonstrated various degrees of fraying and/or tearing regardless of the device. The monofilament twill weave of the Talent endograft tore in the warp direction up to 7.09±0.46 mm at high energy compared with 2.41±0.26 mm for the Endurant multifilament device. The fenestrations of the 3 endografts with multifilament weave (Zenith, Anaconda, and Endurant) showed more fraying; fenestration areas in the multifilament Endurant were >10 mm2 at low and high energy. The fenestrations were free of melted fibers, but minor blackening of the filaments was observed in all devices. Overall, the cutting balloons resulted in worse tearing and damage. Of note, the edges of the dilated laser-formed fenestrations of the Talent and the Endurant grafts demonstrated evidence of additional shredded yarns. Conclusion: In situ fenestration does not cause any melting of the polyester; however, the observed structural damage to the fabric construction must be carefully considered. Cutting balloons caused various levels of tearing compared to the noncompliant balloons and cannot be recommended for use in this application. Rather, noncompliant balloons should be employed, but only with endografts constructed from multifilament yarns. The use of in situ fenestration must be restricted to urgent and emergent cases until long-term durability can be determined.
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Affiliation(s)
- Jing Lin
- Key Laboratory of Textile Science & Technology, Ministry of Education and College of Textiles, Donghua University, Shanghai, China
| | - Niraj Parikh
- Division of Vascular Surgery, Eastern Virginia Medical School, Sentara Heart Hospital, Norfolk, VA, USA
| | - Naval Udgiri
- Division of Vascular Surgery, Eastern Virginia Medical School, Sentara Heart Hospital, Norfolk, VA, USA
| | - Shaoxia Wang
- Key Laboratory of Textile Science & Technology, Ministry of Education and College of Textiles, Donghua University, Shanghai, China
| | - Daniel F. Miller
- Division of Vascular Surgery, Eastern Virginia Medical School, Sentara Heart Hospital, Norfolk, VA, USA
| | - Chaojing Li
- Key Laboratory of Textile Science & Technology, Ministry of Education and College of Textiles, Donghua University, Shanghai, China
- Department of Surgery, Faculty of Medicine, Université Laval and Axe Médecine Régénératrice, Centre de Recherche du CHU, Québec City, Quebec, Canada
| | - Jean Panneton
- Division of Vascular Surgery, Eastern Virginia Medical School, Sentara Heart Hospital, Norfolk, VA, USA
| | - Mark Nutley
- Division of Vascular Surgery and Department of Diagnostic Imaging, University of Calgary, Peter Lougheed Centre, Calgary, Alberta, Canada
| | - Ze Zhang
- Department of Surgery, Faculty of Medicine, Université Laval and Axe Médecine Régénératrice, Centre de Recherche du CHU, Québec City, Quebec, Canada
| | - Yunfan Huang
- Key Laboratory of Textile Science & Technology, Ministry of Education and College of Textiles, Donghua University, Shanghai, China
| | - Jun Lu
- Key Laboratory of Textile Science & Technology, Ministry of Education and College of Textiles, Donghua University, Shanghai, China
| | - Jingyi Zhang
- Key Laboratory of Textile Science & Technology, Ministry of Education and College of Textiles, Donghua University, Shanghai, China
| | - Lu Wang
- Key Laboratory of Textile Science & Technology, Ministry of Education and College of Textiles, Donghua University, Shanghai, China
| | - Robert Guidoin
- Department of Surgery, Faculty of Medicine, Université Laval and Axe Médecine Régénératrice, Centre de Recherche du CHU, Québec City, Quebec, Canada
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Greaves NS, Moore A, Seriki D, Ghosh J. Outcomes of Endovascular Aneurysm Repair using the Ovation Stent Graft System in Adverse Anatomy. Eur J Vasc Endovasc Surg 2018; 55:512-517. [DOI: 10.1016/j.ejvs.2017.11.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 11/20/2017] [Indexed: 11/30/2022]
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Georgakarakos E, Koutsoumpelis A. Commentary: The Unsupported Nitinol Main Body of the Ovation Device: Blamed More Often Than Deserved? J Endovasc Ther 2018; 25:255-256. [PMID: 29552985 DOI: 10.1177/1526602818761049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Efstratios Georgakarakos
- 1 Department of Vascular Surgery, "Democritus" University of Thrace, University Hospital of Alexandroupolis, Dragana, Alexandroupolis, Greece
| | - Andreas Koutsoumpelis
- 1 Department of Vascular Surgery, "Democritus" University of Thrace, University Hospital of Alexandroupolis, Dragana, Alexandroupolis, Greece
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Ni W, Leong S, Chng JK, Tay KH. Extrinsic Compression of the Ovation Stent-Graft Following Glue Embolization for Type II Endoleak: An Unusual Complication. J Endovasc Ther 2018; 25:252-254. [PMID: 29409379 DOI: 10.1177/1526602818757013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To describe a case of extrinsic compression of the Ovation stent-graft following glue embolization for type II endoleak. CASE REPORT A 75-year-old man with a past history of ischemic heart disease and endovascular aneurysm repair with an Ovation stent-graft was admitted for treatment of type II endoleaks from the right L2 and left L4 lumbar arteries with egress via the inferior mesenteric and right L4 lumbar arteries, respectively. Successful embolization was performed via a translumbar sac puncture with a combination of coils and histoacryl glue. On final angiography severe lumen narrowing of the unsupported portion of the Ovation stent-graft was seen owing to extrinsic compression by the glue. This was successfully salvaged with percutaneous transarterial kissing balloon angioplasty. CONCLUSION Aortic lumen narrowing caused by extrinsic compression of an Ovation stent-graft following glue embolization of type II endoleak is an unusual and potentially problematic complication.
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Affiliation(s)
- Wenwen Ni
- 1 Duke-NUS Medical School, Singapore
| | - Sum Leong
- 1 Duke-NUS Medical School, Singapore.,2 Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | - Jack Kian Chng
- 3 Department of Vascular Surgery, Singapore General Hospital, Singapore
| | - Kiang Hiong Tay
- 2 Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
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Sirignano P, Mansour W, Pranteda C, Siani A, Accrocca F, d'Adamo A, Capoccia L, Speziale F. Real-Life Experience with Ovation Stent Graft: Lesson Learned from the First One Hundred Fifty Treated Patients. Ann Vasc Surg 2017; 45:253-261. [DOI: 10.1016/j.avsg.2017.06.140] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 06/16/2017] [Accepted: 06/18/2017] [Indexed: 12/16/2022]
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Sirignano P, Mansour W, Capoccia L, Speziale F. Rationale for a new registry on EVAR: The EXTREME study. Ann Med Surg (Lond) 2017; 21:7-8. [PMID: 28761639 PMCID: PMC5522917 DOI: 10.1016/j.amsu.2017.07.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 07/10/2017] [Accepted: 07/15/2017] [Indexed: 12/20/2022] Open
Abstract
To report rationale of a physician-initiated study: Expanding Indications for Treatment with Standard EVAR in Patients with Challenging Anatomies, a Multi-Centric Prospective Evaluation - EXTREME. Long term result after EVAR for AAA are still considered one of the main limits to the application of this treatment. According with IFU and guidelines, EVAR still has several anatomical limitation. Ovation Stent-Graft is an unique devices allowing to implement the range of patients amendable to be treated by EVAR.
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Affiliation(s)
- Pasqualino Sirignano
- Corresponding author. Vascular and Endovascular Surgery Division, Department of Surgery “Paride Stefanini”, Policlinico Umberto I of Rome, “Sapienza” University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy.Vascular and Endovascular Surgery DivisionDepartment of Surgery “Paride Stefanini”Policlinico Umberto I of Rome“Sapienza” University of RomeViale del Policlinico, 155Rome00161Italy
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Georgakarakos E, Argyriou C, Georgiadis GS, Lazarides MK. Pulse Wave Analysis after Treatment of Abdominal Aortic Aneurysms with the Ovation Device. Ann Vasc Surg 2017; 40:146-153. [DOI: 10.1016/j.avsg.2016.07.080] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/06/2016] [Accepted: 07/06/2016] [Indexed: 11/24/2022]
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Schoretsanitis N, Georgakarakos E, Argyriou C, Ktenidis K, Georgiadis GS. A critical appraisal of endovascular stent-grafts in the management of abdominal aortic aneurysms. Radiol Med 2017; 122:309-318. [DOI: 10.1007/s11547-017-0724-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 01/03/2017] [Indexed: 11/30/2022]
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Georgakarakos E, Souftas V. Commentary: Shortening of the Sealing Zone With the Ovation Endograft. J Endovasc Ther 2017; 24:198-200. [PMID: 28058987 DOI: 10.1177/1526602816685972] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Efstratios Georgakarakos
- 1 Department of Vascular Surgery, "Democritus" University of Thrace, University Hospital of Alexandroupolis, Greece
| | - Vasileios Souftas
- 2 Interventional Radiology Unit, "Democritus" University of Thrace, University Hospital of Alexandroupolis, Greece
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Midterm Results of Proximal Aneurysm Sealing With the Ovation Stent-Graft According to On- vs Off-Label Use. J Endovasc Ther 2017; 24:191-197. [DOI: 10.1177/1526602816685581] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To compare the use of the Ovation stent-graft according to the ≥7-mm neck length specified by the original instructions for use (IFU) vs those treated off-label (OL) for necks <7 mm long. Methods: A multicenter retrospective registry (TriVascular Ovation Italian Study) database of all patients who underwent endovascular aneurysm repair with the Ovation endograft at 13 centers in Italy was interrogated to identify patients with a minimum computed tomography (CT) follow-up of 24 months, retrieving records on 89 patients (mean age 76.4±2.4 years; 84 men) with a mean follow-up of 32 months (range 24–50). Standard CT scans (preoperative, 1-month postoperative, and latest follow-up) were reviewed by an independent core laboratory for morphological changes. For analysis, patients were stratified into 2 groups based on proximal neck length ≥7 mm (IFU group, n=57) or <7 mm (OL group, n=32). Outcome measures included freedom from type Ia endoleak, any device-related reintervention, migration, and neck enlargement (>2 mm). Results: At 3 years, there was no aneurysm-related death, rupture, stent-graft migration, or neck enlargement. There were no differences in terms of freedom from type Ia endoleak (98.2% IFU vs 96.8% OL, p=0.6; hazard ratio [HR] 0.55, 95% CI 0.02 to 9.71 or freedom from any device-related reintervention (92.8% IFU vs 96.4% OL, p=0.4; HR 2.42, 95% CI 0.34 to 12.99). In the sealing zone, the mean change in diameters was −0.05±0.8 mm in the IFU group and −0.1±0.5 mm in the OL group. Conclusion: Use of the Ovation stent-graft in patients with neck length <7 mm achieved midterm outcomes similar to patients with ≥7-mm-long necks. These midterm data show that the use of the Ovation system for the treatment of infrarenal abdominal aortic aneurysm is not restricted by the conventional measurement of aortic neck length, affirming the recent Food and Drug Administration–approved changes to the IFU.
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Kounis NG, Koniari I, Soufras G, Tsigkas G, Hahalis G. Anaphylaxis During Intracardiac and Endovascular Implantations: A Multifactorial Problem Involving Kounis Syndrome. J Cardiothorac Vasc Anesth 2016; 31:804-806. [PMID: 28342591 DOI: 10.1053/j.jvca.2016.12.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Indexed: 12/19/2022]
Affiliation(s)
- Nicholas G Kounis
- Department of Cardiology, University of Patras Medical School, Rion, Patras, Greece.
| | - Ioanna Koniari
- Department of Cardiology, University of Patras Medical School, Rion, Patras, Greece
| | - George Soufras
- Department of Cardiology, University of Patras Medical School, Rion, Patras, Greece
| | - Grigorios Tsigkas
- Department of Cardiology, University of Patras Medical School, Rion, Patras, Greece
| | - George Hahalis
- Department of Cardiology, University of Patras Medical School, Rion, Patras, Greece
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Siani A, Accrocca F, De Vivo G, Mounayergi F, Siani LM, Antonelli R. Anaphylactic Reaction during Implantation of Ovation Abdominal Stent Graft in Patients with Abdominal Aortic Aneurysm. Ann Vasc Surg 2016; 39:289.e1-289.e4. [PMID: 27671457 DOI: 10.1016/j.avsg.2016.06.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 06/17/2016] [Accepted: 06/23/2016] [Indexed: 10/21/2022]
Abstract
The Ovation Abdominal Stent Graft System is a trimodular endoprosthesis planned to overcome the limitations of currently available stent grafts, allowing complex iliac and femoral access and providing a proximal seal in challenge infrarenal neck morphology. The proximal sealing is achieved by means of a network of inflatable rings filled with low-viscosity radiopaque polyethylene glycol-based polymer during stent-graft deployment. The leakage of polymer outside the channel to fill the rings into the vascular system may induce an hypersensitivity reaction and anaphylactic shock. We report a case of anaphylactic reaction during Ovation Abdominal Stent Graft System implantation. The endovascular procedure was successfully concluded.
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Affiliation(s)
- Andrea Siani
- Unit of Vascular and Endovascular Surgery, "San Paolo" Hospital, Civitavecchia, Rome, Italy.
| | - Federico Accrocca
- Unit of Vascular and Endovascular Surgery, "San Paolo" Hospital, Civitavecchia, Rome, Italy
| | - Gennaro De Vivo
- Unit of Vascular and Endovascular Surgery, "San Paolo" Hospital, Civitavecchia, Rome, Italy
| | | | - Luca Maria Siani
- Unit of Vascular and Endovascular Surgery, "San Paolo" Hospital, Civitavecchia, Rome, Italy
| | - Roberto Antonelli
- Unit of Vascular and Endovascular Surgery, "San Paolo" Hospital, Civitavecchia, Rome, Italy
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