Spontaneous Type Ia Endoleak Sealing in Patients Undergoing Endovascular Aneurysm Repair With the Ovation Stent Graft

[b]Background:[/b] The aim of our study was to present an innovative endovascular technique – the Aptus™ Heli-FX™ EndoAnchor™ system com bined with the Endurant Stent Graft cuff used as a method of choice for the patient in a very poor general condition with symptomatic abdominal aneurysm and a post-EVAR type IA endoleak.[b]Case study: [/b]An 85-year-old male patient, was operated on in March 2016 with endovascular aneurysm repair (EVAR) of a 9.3 cm in diameter ruptured abdominal aneurysm (RAA), accompanied by disturbance to the coagulation profile (prolonged INR of 3.3 because of anticoagulant treatment with Rivaroxaban due to atrial fibrillation). 9 months later, he developed a severe abdominal pain and was urgently referred to the Vascular Surgery Department, at the John Paul II Hospital, Kraków. The Angio-CT xamination revealed the type IA and II endoleaks and a recurrence of the rupture symptoms. He was successfully operated on using an innovative endovascular repair system, the Aptus™ Heli-FX™ ndoAnchor™ system with a combination of other endovascular procedures, such as Endurant Stent Graft cuff implantation. [b]Conclusions:[/b]The innovative endovascular repair system, Aptus™ Heli-FX™ EndoAnchor™ together with the Endurant Stent Graft cuff was successfully used in the treatment of the patient. This technique prevented him from developing serious complications or even death and gave him a much better quality of life in comparison with open surgery repair.

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Midterm Results of Proximal Aneurysm Sealing With the Ovation Stent-Graft According to On- vs Off-Label Use

Journal of Endovascular Therapy ◽

10.1177/1526602816685581 ◽

2017 ◽

Vol 24 (2) ◽

pp. 191-197 ◽

Cited By ~ 21

Author(s):

Gianmarco de Donato ◽

Francesco Setacci ◽

Luciano Bresadola ◽

Patrizio Castelli ◽

Roberto Chiesa ◽

...

Keyword(s):

Stent Graft ◽

Morphological Changes ◽

Endovascular Aneurysm Repair ◽

Neck Length ◽

Off Label ◽

Aortic Neck ◽

Type Ia ◽

Instructions For Use ◽

Aneurysm Repair

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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Initial experience with polymer endovascular aneurysm repair using the Alto stent graft

Journal of Vascular Surgery Cases and Innovative Techniques ◽

10.1016/j.jvscit.2019.04.007 ◽

2020 ◽

Vol 6 (1) ◽

pp. 6-11 ◽

Cited By ~ 3

Author(s):

Andrew Holden ◽

Sean Lyden

Keyword(s):

Stent Graft ◽

Endovascular Aneurysm Repair ◽

Initial Experience ◽

Aneurysm Repair

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Endoleaks: current concepts and treatments

Journal of the Pakistan Medical Association ◽

10.47391/jpma.03-345 ◽

2021 ◽

Author(s):

Zia Ur Rehman

Keyword(s):

Stent Graft ◽

Treatment Options ◽

Endovascular Aneurysm Repair ◽

Aneurysm Rupture ◽

Special Situation ◽

Type V ◽

Aneurysm Repair ◽

Benign Course ◽

Selection Of

Endoleaks are the most common complications following endovascular aneurysm repair. Depending upon their origin, there are five types of endoleaks, types I-V, which can also be classified as direct and indirect endoleaks. Direct endoleaks type 1 and III have higher risk of aneurysm rupture due to rapid sac expansion, and require immediate correction. Indirect endoleaks types II, IV and V have a relatively benign course compared to direct endoleaks. Most of them resolve with time and very few of them need interventions upon sac enlargement. Type V endotension is a special situation where there is sac enlargement despite no demonstrable endoleak. Proper planning and appropriate selection of stent-graft can prevent most of these endoleaks. With improvement in stent-graft technology, the incidence of endoleaks has been reduced. The current narrative review was planned to describe the pathophysiology, risk factors and treatment options for each type of endoleak. Continuous...

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Comparing polymer-filled versus self-expanding endografts in Chinese patients

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492318810108 ◽

2018 ◽

Vol 26 (9) ◽

pp. 667-676

Author(s):

Yuk Law ◽

Yiu Che Chan ◽

Stephen Wing-Keung Cheng

Keyword(s):

Endovascular Aneurysm Repair ◽

Aortic Aneurysms ◽

The Self ◽

Chinese Patients ◽

Type Ii ◽

Mortality And Morbidity ◽

Type Ia ◽

One Year ◽

Aneurysm Repair

Introduction We performed a single-center nonrandomized study on patients who underwent endovascular aneurysm repair using polymer-filled or other self-expanding endografts. Methods Consecutive patients with asymptomatic infrarenal abdominal aortic aneurysms who underwent endovascular repair were retrospectively reviewed. They were divided into a polymer-filled ( n = 20) or self-expanding group ( n = 42). Baseline characteristics, operative mortality and morbidity, and follow-up data were compared. Results Aneurysm diameter, neck and iliac morphologies did not differ between the two groups. Technical success was 100%. The 30-day mortality was 0% and 2.4% in the polymer-filled and self-expanding group, respectively. At a mean follow-up of 17 months, the changes in sac size were −2.1 mm and −5.1 mm ( p = 0.144) at one year, and −3.5 mm and −7.7 mm ( p = 0.287) at 2 years in the polymer-filled and self-expanding group, respectively. The polymer-filled group had 7 (35%) type II endoleaks, and the self-expanding group had 1 (2.4%) type Ia and 13 (31%) type II endoleaks. Neck diameter remained stable in the polymer-filled stent-grafts whereas there was progressive neck degeneration in the self-expanding group. The rates of reintervention and overall survival were similar in both groups. The presence of an endoleak was the only predictor of non-regression of the aneurysm (odds ratio = 17.00, 95% confidence interval: 4.46–64.88, p < 0.001). Conclusion Polymer-filled endografts had similar safety, effectiveness, and durability to other self-expanding endografts. The major advantage is the small iliofemoral access. They also have the potential long-term benefit of a more stable neck.

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Endovascular Aneurysm Sealing of a Collapsed and Thrombosed Aortic Stent-Graft With Renovisceral Chimney Stent-Grafts

Journal of Endovascular Therapy ◽

10.1177/1526602818811915 ◽

2018 ◽

Vol 26 (1) ◽

pp. 72-75

Author(s):

Fabien Lareyre ◽

Claude Mialhe ◽

Carine Dommerc ◽

Juliette Raffort

Keyword(s):

Stent Graft ◽

Mesenteric Artery ◽

Endovascular Aneurysm Repair ◽

Stent Grafts ◽

Aortic Thrombosis ◽

Aortic Stent Graft ◽

Aneurysm Repair ◽

Stent Graft Implantation ◽

Graft Implantation

Purpose: To report the use of the Nellix endovascular aneurysm sealing (EVAS) system in the management of proximal stent-graft collapse associated with thrombosis following endovascular aneurysm repair (EVAR). Case Report: A 76-year-old man was admitted for proximal collapse of an aortic extension following bifurcated AFX stent-graft implantation associated with chimney grafts in both renal arteries and the superior mesenteric artery 1 month prior. Imaging identified thrombosis of the aortic stent-graft and the iliac limbs. A Nellix EVAS was placed into the AFX stent-graft to recanalize the aneurysm lumen and address the aortic thrombosis. There was no endoleak, and the renovisceral chimney stent-grafts remained patent over a follow-up of 25 months. Conclusion: While further studies are required to generalize its use, EVAS appears to be feasible in the management of aortic stent-graft collapse.

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Endovascular Aneurysm Sealing (EVAS) and Chimney EVAS in the Treatment of Failed Endovascular Aneurysm Repairs

Journal of Endovascular Therapy ◽

10.1177/1526602816675622 ◽

2016 ◽

Vol 24 (1) ◽

pp. 115-120 ◽

Cited By ~ 23

Author(s):

Marwan Youssef ◽

Sebastian Zerwes ◽

Rudolf Jakob ◽

Oroa Salem ◽

Fritz Dünschede ◽

...

Keyword(s):

Endovascular Aneurysm Repair ◽

Multiple Organ ◽

Aortic Aneurysms ◽

Technical Success ◽

Graft Thrombosis ◽

Type Ia ◽

Aneurysm Repair ◽

Chimney Graft ◽

Bifurcated Graft

Purpose: To assess the technical success and clinical outcome of reinterventions using the Nellix Endovascular Aneurysm Sealing (EVAS) System to treat complications after endovascular aneurysm repair (EVAR). Methods: Fifteen consecutive patients (mean age 79 years; 14 men) with prior EVAR were treated with EVAS between March 2014 and December 2015 at 2 institutions. The failed prior EVARs included 13 bifurcated endografts, 1 bifurcated graft plus fenestrated cuff, and 1 tube endograft. Endoleaks were the predominant indications: type Ia in 10 and type III in 5 (3 type IIIa and 2 type IIIb). All patients presented with progressive aortic aneurysms (median 7.85-cm diameter; range 6.5–11). Eight patients were treated on an urgent or emergency basis (6 symptomatic aneurysms and 2 contained ruptures). All patients underwent Nellix relining of the failed stent-graft; 10 had chimney (Ch) procedures in combination with EVAS (chEVAS) because the proximal landing zones were inadequate. Results: Technical success was 100%. All endoleaks were successfully sealed, and no additional intervention was required. No further endoleak after EVAS or chEVAS was recorded. Endobag protrusion occurred in 1 case without sequelae. One elderly patient with ruptured aneurysm died from multiple organ failure 2 months postoperatively. One renal artery guidewire injury led to nephrectomy because of active bleeding. No reinterventions, aneurysm-related mortalities, graft thrombosis, endoleaks, or chimney graft occlusions were observed during a median follow-up of 8 months (range 3–24). Conclusion: The present preliminary experience demonstrates that the use of EVAS/chEVAS is feasible for treatment of failed EVAR. This technique may be used as bailout or an alternative treatment when other established methods are infeasible or not available.

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EndoAnchors Minimize Endoleaks in Chimney-Graft Endovascular Repair of Juxtarenal Abdominal Aortic Aneurysms

Texas Heart Institute Journal ◽

10.14503/thij-17-6520 ◽

2019 ◽

Vol 46 (3) ◽

pp. 183-188 ◽

Cited By ~ 3

Author(s):

Edgar Luis Galiñanes ◽

Eduardo A. Hernandez-Vila ◽

Zvonimir Krajcer

Keyword(s):

Endovascular Aneurysm Repair ◽

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Graft Thrombosis ◽

Complex Anatomy ◽

Aortic Neck ◽

Abdominal Aortic ◽

Type Ia ◽

Aneurysm Repair ◽

Chimney Graft

Juxtarenal abdominal aortic aneurysms (AAAs) are difficult to treat because they often have little or no proximal aortic neck. Patients with this complex anatomy are not usually candidates for an endovascular aneurysm repair (EVAR). Chimney-graft EVAR has been introduced, but type Ia endoleak is a typical risk. We have begun using EndoAnchors to determine whether this risk can be reduced. From July 2013 through July 2014, we used the chimney-graft EVAR technique in 5 patients whose juxtarenal AAAs had a short or no proximal aortic neck. During the procedure, we implanted EndoAnchors as needed. Postprocedurally, at 30 days, and through end of follow-up (duration, 11–18 mo), all patients had patent endografts without type Ia endoleak (our primary endpoint), visceral stent-graft thrombosis, or renal complications. One patient who received 4 chimney grafts had a postprocedural type II endoleak, which was treated with embolization. We found it feasible to use EndoAnchors with the chimney-graft technique to prevent type Ia endoleaks in the treatment of juxtarenal AAAs. Further studies are needed to validate this adjunctive technique and to determine its durability.

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