scholarly journals Hemodynamic effects of stent-graft introducer sheath during thoracic endovascular aortic repair

2022 ◽  
Author(s):  
Yonghui Qiao ◽  
Le Mao ◽  
Yan Wang ◽  
Jingyang Luan ◽  
Yanlu Chen ◽  
...  
Keyword(s):  
Stent Graft ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Introducer Sheath ◽  
Hemodynamic Effects ◽  
Aortic Repair

scholarly journals Thoracic Endovascular Aortic Repair of Esophageal Cancer-Associated Aortoesophageal Fistula: A Case Report and Literature Review

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Akiko Sasaki ◽  
Hideto Egashira ◽  
Shinnosuke Tokoro ◽  
Chikamasa Ichita ◽  
Satoshi Takizawa ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Stent Graft ◽  
Postoperative Management ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Stent Insertion ◽  
Aortoesophageal Fistula ◽  
Bridge To Surgery ◽  
Aortic Repair ◽  
T4 Esophageal Cancer

Background. Thoracic endovascular aortic repair of an aortoesophageal fistula is an effective emergency treatment for patients with T4-esophageal cancer, as it prevents sudden death, and is a bridge to surgery. However, the course of unresectable malignant aortoesophageal fistula treated with thoracic endovascular aortic repair alone is not well-known. Case Presentation. We report a 67-year-old Japanese man with T4-esophageal cancer who experienced a chemoradiation-induced aortoesophageal fistula and was rescued with thoracic endovascular aortic repair. He recovered after the procedure and survived for 4 additional months with management of a mycotic aneurysm and secondary aortoesophageal fistula with the exposure of the stent graft into the esophagus. Thoracic endovascular aortic repair of aortoesophageal fistula with T4-esophageal cancer extended life for nearly an average of 4 months in the reported cases. As a postoperative complication, the exposure of the stent graft into the esophagus is rare but life-threatening; the esophageal stent insertion was effective. Conclusions. With postoperative management advances, thoracic endovascular aortic repair can improve survival and increase the quality of life of patients with T4-esophageal cancer.

Methods and clinical outcomes of in situ fenestration for aortic arch revascularization during thoracic endovascular aortic repair

Vascular ◽  
2020 ◽  
Vol 28 (4) ◽  
pp. 333-341 ◽  
Author(s):  
HL Li ◽  
YC Chan ◽  
HY Jia ◽  
SW Cheng
Keyword(s):  
Stent Graft ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Current Evidence ◽  
Type Ii ◽  
Technical Success ◽  
Landing Zone ◽  
Short Term Result ◽  
Aortic Repair

Objective Despite endovascular advances in fenestrated and branched devices, thoracic endovascular aortic repair (TEVAR) for arch pathologies remains challenging. The aim of this study was to provide a contemporary review on the current evidence for in situ fenestration during TEVAR and to evaluate its short- and mid-term clinical outcome in the management of arch pathology. Methods A systematic literature review on in situ fenestration of thoracic aortic stent-graft from January 2003 to September 2018 was performed under the instruction of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. Results Our initial search yielded 169 studies, of which 21 articles were relevant to the topic and were finally included. One hundred and forty-five in situ fenestration procedures in 99 patients were reviewed, involving 25 innominate arteries (17%), 33 left common carotid arteries (23%) and 87 left subclavian arteries (60%). Twelve patients (12/99, 12%) had two-vessel fenestration and three-vessel fenestration was performed in 17 patients (17/99, 17%). Technical success was achieved in 136 arteries (136/145, 93%). Talent/Valiant with monofilament twill woven polyester fabric was the most common (50/99, 51%) stent-graft used for fenestration. Three methods reported for in situ fenestration were needle, laser and radiofrequency. Needle was the most frequently used device for fenestration, which was performed in 60 patients (60/99, 61%). Three patients (3/99, 3%) died with 30 days, none were in situ fenestration TEVAR procedure-related. Perioperative complications including one (1%) retrograde type A aortic dissection, two (2%) type II endoleaks, and three (3%) strokes were reported. The pooled estimate for overall technical success, perioperative mortality and stroke was 88.3% (95% CI, 78.6%–93.9%), 5.9% (95% CI, 2.5%–13.4%) and 9.5% (95% CI, 4.1%–20.6%), respectively. Four patients (4/96, 4%) died during follow-up, none were aortic-related. All the fenestration bridging stents were reportedly patent, with only 1 (1/96, 1%) asymptomatic left subclavian stent stenosis. Two patients (2/96, 2%) with type II endoleak from left subclavian artery required secondary intervention. Conclusion In situ fenestration appeared to be a feasible and effective method to extend proximal landing zone during TEVAR. It had an acceptable short-term result with high technical success and low fenestration related morbidity. Long-term durability data were lacking, and there was no high level evidence to recommend the routine use of in situ fenestration TEVAR for the management of arch pathology.

scholarly journals Thoracic endovascular aortic repair with branched Inoue Stent Graft for arch aortic aneurysms

2017 ◽  
Vol 66 (5) ◽  
pp. 1340-1348.e5 ◽  
Author(s):  
Junichi Tazaki ◽  
Kanji Inoue ◽  
Hirooki Higami ◽  
Nobuya Higashitani ◽  
Masanao Toma ◽  
...  
Keyword(s):  
Stent Graft ◽  
Thoracic Endovascular Aortic Repair ◽  
Aortic Aneurysms ◽  
Endovascular Aortic Repair ◽  
Aortic Repair

High Wall Stress May Predict the Formation of Stent-Graft–Induced New Entries After Thoracic Endovascular Aortic Repair

2018 ◽  
Vol 25 (5) ◽  
pp. 571-577 ◽  
Author(s):  
Claudia Menichini ◽  
Selene Pirola ◽  
Baolei Guo ◽  
Weiguo Fu ◽  
Zhihui Dong ◽  
...  
Keyword(s):  
Stent Graft ◽  
Large Population ◽  
False Lumen ◽  
Wall Stress ◽  
Ct Images ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Aortic Repair ◽  
Type B Dissection

Purpose: To explore the potential role of morphological factors and wall stress in the formation of stent-graft–induced new entries (SINE) based on computed tomography (CT) images after thoracic endovascular aortic repair (TEVAR). Case Report: Two female patients aged 59 years (patient 1) and 44 years (patient 2) underwent TEVAR for type B dissection in the chronic (patient 1) or subacute (patient 2) phase. CT scans at 3-month follow-up showed varying degrees of false lumen thrombosis in both patients. At 14-month follow-up, a SINE was observed in patient 1 while the dissected aorta in the other patient remained stable. Morphological and finite element analyses were performed based on the first follow-up CT images. The computational results showed that the SINE patient had higher stent-graft tortuosity than the non-SINE patient and much higher wall stress in the region close to the distal SINE. Conclusion: This case study suggests that high stent-graft tortuosity can lead to high wall stress, which is potentially linked to the formation of SINE. Further large population-based studies are needed to confirm this preliminary finding.

A New Adjustable Puncture Device for In Situ Fenestration During Thoracic Endovascular Aortic Repair

2018 ◽  
Vol 25 (4) ◽  
pp. 474-479 ◽  
Author(s):  
Lixin Wang ◽  
Xiushi Zhou ◽  
Daqiao Guo ◽  
Kai Hou ◽  
Zhenyu Shi ◽  
...  
Keyword(s):  
Stent Graft ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Technical Success Rate ◽  
New Device ◽  
Puncture Needle ◽  
Aortic Repair ◽  
Type B Dissection ◽  
Steerable Sheath

Purpose: To describe a new adjustable puncture system for in situ fenestration in thoracic endovascular aortic repair (TEVAR). Technique: An adjustable puncture needle for use in conjunction with a steerable 8-F, 55-cm Fustar sheath is demonstrated in a 65-year-old man with acute complicated type B dissection involving the left subclavian artery (LSA). The puncture device features an inflatable balloon at the tip, a central lumen for 0.018-inch guidewires, and a 3-level puncture depth. After thoracic stent-graft deployment at zone 2, the needle/sheath combination was delivered from a left brachial artery access. The needle was adjusted perpendicular to the fabric of the stent-graft with the assistance of the steerable sheath. The balloon at the tip was inflated to center the needle, and the puncture depth was selected on the puncture needle system. Holding the sheath and puncture needle together, a hole was created in the graft fabric. The aperture was sequentially dilated to accommodate the mating stent selected to maintain perfusion to the LSA. This new device has been successfully applied in 6 patients treated with TEVAR for different arch pathologies. Conclusion: This new puncture device could assist in situ fenestration and improve the technical success rate.

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