Erratum: Coupling Bifurcated Stent-grafts to Overcome Anatomic Limitations of Endovascular Repair of Abdominal Aortic Aneurysms

Purpose: To present a cardiac asystole technique that assists in the accurate deployment of stent-grafts during endovascular repair of thoracic or abdominal aortic aneurysms. Technique: In the anesthetized patient, trial doses of intravenous adenosine are delivered until a ≥ 20-second period of asystole is recorded. The endograft procedure then proceeds until the device is ready for deployment. The predetermined dose of adenosine is administered, and the device is deployed during asystole. Adenosine-induced transient asystole has been utilized in 16 patients undergoing balloon-expandable endograft exclusion of 6 thoracic aortic and 10 abdominal aortic aneurysms. Asystole lasted for 20 to 30 seconds, during which time the devices were accurately deployed without interference from the aortic flow. There were no clinical sequelae of this technique in any patient. Conclusions: Pharmacologically induced transient asystole appears to be a safe maneuver to preclude endograft movement by systolic blood flow. The technique permits precise placement of balloon-expandable stent-grafts and is applicable to self-expanding devices as well. Interventionists may wish to incorporate adenosine-induced asystole into their aortic aneurysm exclusion procedures.

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Comparison of Blood Flow in Branched and Fenestrated Stent-Grafts for Endovascular Repair of Abdominal Aortic Aneurysms

Journal of Endovascular Therapy ◽

10.1177/1526602815587261 ◽

2015 ◽

Vol 22 (4) ◽

pp. 578-590 ◽

Cited By ~ 20

Author(s):

Harkamaljot Kandail ◽

Mohamad Hamady ◽

Xiao Yun Xu

Keyword(s):

Blood Flow ◽

Endovascular Repair ◽

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Stent Grafts ◽

Abdominal Aortic

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Temporary Perfusion Branches to Decrease Spinal Cord Ischemia in the Endovascular Treatment of Thoraco-Abdominal Aortic Aneurysms

Aorta ◽

10.12945/j.aorta.2015.14-045 ◽

2015 ◽

Vol 03 (02) ◽

pp. 56-60 ◽

Cited By ~ 6

Author(s):

Parveen Jayia ◽

Jason Constantinou ◽

Hamish Hamilton ◽

Krassi Ivancev

Keyword(s):

Spinal Cord ◽

New York ◽

Endovascular Repair ◽

Spinal Cord Ischemia ◽

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Stent Grafts ◽

Abdominal Aortic ◽

Custom Made ◽

Complete Exclusion

Based on a Presentation at the 2013 VEITH Symposium, November 19–23, 2013 (New York, NY, USA) Background: Spinal cord ischemia (SCI) is one of the most feared complications following the repair of thoraco- abdominal aortic aneurysms (TAAA). Endovascular repair of TAAA is now possible with branched stent grafts, but spinal cord ischaemia rates are still unacceptably high. A number of techniques have been utilized to reduce these levels, however, SCI remains a challenge to endovascular repair of TAAA. The use of sac perfusion branches aims to reduce the incidence of this catastrophic complication. Methods: A retrospective analysis of all patients undergoing branched endovascular aortic repair for all thoraco-abdominal aneurysms (TAAA) using custom made devices during January 2008 to August 2014. We describe a two staged technique in which perfusion of segmental vessels is maintained by a temporary endoleak through an open perfusion branch, incorporated within the branched stent graft, followed by a closure of this branch at a later date to complete exclusion of the aneurysm. Results: Forty-seven patients underwent TAAA repair. Twenty-five (53%) had a two-stage procedure using either a sac perfusion branch or a target vessel to perfuse the sac. Nine patients (19.15%) suffered some form of SCI with eight patients having temporary SCI (lasting less than 72 hours) and one patient having permanent SCI. Of eight patients that had temporary spinal cord ischemia, all had a perfusion strategy. There was one case of permanent SCI (2.13%). Conclusion: Sac perfusion branches provide a safe method for preventing SCI, however this needs to be used in conjunction with controlling MAP and CSF drainage.

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