Antegrade in situ Needle Assisted Fenestration During Endovascular Aortic Repair for Preserving Renal Arteries

2022 ◽  
Author(s):  
Zhenjiang Li ◽  
Yangyan He ◽  
Hongkun Zhang
Keyword(s):  
Renal Arteries ◽  
Endovascular Aortic Repair ◽  
Aortic Repair

scholarly journals Patient-Specific Computational Analysis of the Impact of Fenestrated and Chimney Endovascular Aortic Repair on Haemodynamics in Renal Arteries

2019 ◽  
Vol 58 (6) ◽  
pp. e761-e762
Author(s):  
Sabrina Ben Ahmed ◽  
Theodorus M.J. van Bakel ◽  
Eugenio Rosset ◽  
Jean-Pierre Favre ◽  
Jean-Noel Albertini ◽  
...  
Keyword(s):  
Computational Analysis ◽  
Renal Arteries ◽  
Endovascular Aortic Repair ◽  
Patient Specific ◽  
Aortic Repair ◽  
The Impact

Complex Endovascular Aortic Repair With a Branched Endograft to Revascularize 5 Renovisceral Vessels and an Intercostal Artery in a Marfan Patient

2019 ◽  
Vol 26 (5) ◽  
pp. 736-741 ◽  
Author(s):  
Ahmed S. Eleshra ◽  
Giuseppe Panuccio ◽  
Fiona Rohlffs ◽  
Martin Scheerbaum ◽  
Nikolaos Tsilimparis ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Stent Graft ◽  
Thoracoabdominal Aortic Aneurysm ◽  
Renal Arteries ◽  
Endovascular Aortic Repair ◽  
Intercostal Artery ◽  
Maximum Diameter ◽  
Aortic Repair ◽  
Custom Made ◽  
Marfan Patient

Purpose: To report a case of thoracoabdominal aortic aneurysm (TAAA) repair treated with a multibranched stent-graft including a prophylactic branch for a large intercostal artery in a Marfan patient at risk for spinal cord ischemia (SCI). Case Report: A 43-year-old man with Marfan syndrome presented with a type IV thoracoabdominal aortic aneurysm (TAAA) and history of multiple previous cardiac and aortic operations over the past 28 years. The maximum diameter of the aneurysm was 60 mm. The patient had 2 right renal arteries and 2 reimplanted segmental arteries (1 occluded). With the goal of preserving both right renal arteries and the large intercostal artery, a 6-branch, custom-made stent-graft was planned and manufactured. Bilateral femoral and right brachial artery access was used. The intercostal artery was catheterized and connected to the retrograde branch from a femoral access. Final angiography and predischarge computed tomography angiography (CTA) showed unimpeded flow to all 6 target vessels. The patient was discharged on postoperative day 10 without clinical signs of SCI. Six-month follow-up CTA demonstrated exclusion of the TAAA and patency of all 6 branches. Conclusion: Multibranched endovascular aortic repair with a branch to a large intercostal artery was technically feasible and clinically successful.

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.

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.

scholarly journals In Situ Antegrade Laser Fenestrations During Endovascular Aortic Repair

2018 ◽  
Vol 56 (3) ◽  
pp. 356-362 ◽  
Author(s):  
Thomas Le Houérou ◽  
Dominique Fabre ◽  
Carlos G. Alonso ◽  
Philippe Brenot ◽  
Ryiad Bourkaib ◽  
...  
Keyword(s):  
Endovascular Aortic Repair ◽  
Aortic Repair
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