scholarly journals PC082 Effect of Stent Design on Branch Vessel Outcomes in Fenestrated Endografting of Complex Aortic Aneurysms

2017 ◽  
Vol 65 (6) ◽  
pp. 161S
Author(s):  
Behzad S. Farivar ◽  
Agenor Dias ◽  
Corey S. Brier ◽  
Yuki Kuramochi ◽  
Federico Ezequiel. Parodi ◽  
...  
Keyword(s):  
Aortic Aneurysms ◽  
Stent Design ◽  
Branch Vessel

Creation of a Flow-Modulating Stent Using Multilayered Wallstents for Aneurysm Exclusion

2018 ◽  
Author(s):  
S. Lowell Kahn
Keyword(s):  
The United States ◽  
Aortic Aneurysms ◽  
Male Predominance ◽  
Abdominal Aortic ◽  
New Development ◽  
Potential Applications ◽  
Branch Vessel ◽  
Vessel Flow ◽  
Developed World

Abdominal aortic aneurysms (AAAs) are a common pathology that is found in 4–9% of patients in the developed world. Risk factors for AAAs include age, male sex, family history, comorbid cardiovascular disease, and smoking. Despite the male predominance of the disease, rupture occurs at a smaller diameter in females, and the outcomes are poorer in this subgroup. Flow-modulating stents are a relatively new development and consist of multilayered bare-metal self-expanding stents. Despite the inherent porosity of the stents, the interconnected stent matrix features flow-diverting properties that preserve luminal and branch vessel flow while simultaneously depressurizing the aneurysm sac, resulting in shrinkage and thrombosis. Flow-modulating stents are unavailable in the United States. This chapter discusses in vivo construction of a flow-modulating stent and its potential applications and complications.

Correlations Between Branch Vessel Catheterization and Procedural Complexity in Fenestrated and Branched Endovascular Aneurysm Repair

2019 ◽  
Vol 53 (4) ◽  
pp. 277-283 ◽  
Author(s):  
Jacob Budtz-Lilly ◽  
Krister Liungman ◽  
Anders Wanhainen ◽  
Kevin Mani
Keyword(s):  
Pearson Correlation ◽  
Endovascular Aneurysm Repair ◽  
Strong Relationship ◽  
Aortic Aneurysms ◽  
Skin Dose ◽  
Long Term Treatment ◽  
Significant Difference ◽  
Branch Vessel ◽  
Aneurysm Repair

Introduction: The use of fenestrated and branched endovascular technologies in complex aortic aneurysm repair (F/BEVAR) is increasing, with a trend toward using longer sealing zones and incorporating more target vessels. Successful aneurysm exclusion and prevention of long-term treatment failure need to be balanced against the increased complexity of more extensive procedures. The aim of this study was to analyze relationships between the number of catheterized vessels and multiple operative variables as a means for evaluating procedural complexity. Methods: Operative data from consecutive F/BEVAR procedures performed at a single center from 2012 to 2015 were analyzed. An equal number of EVAR procedures, randomly selected, from this period were also analyzed. Only intact aneurysms were included. Complex aneurysms were grouped based on the required number of target vessel catheterization. Ten procedural variables, categorized as perioperative, postoperative, and radiologic-related, were compared. Pearson correlation analysis and regression analysis were performed. The correlation coefficients, r, were classified using Cohen boundaries, r ≥ 0.5 indicating a strong relationship. Results: There were 63 EVAR, 40 FEVAR, and 22 BEVAR procedures. There was no significant difference in patient comorbidities between conventional EVAR and complex procedure groups. The complex procedures included 23 two-vessel, 20 three-vessel, and 19 four-vessel catheterizations. Strong linear relationships between the number of branch vessel catheterizations and the following variables were identified: accumulated skin dose ( r = .504), contrast volume ( r = .652), fluoroscopy duration ( r = .598), number of angiography series ( r = .650), anesthesiology duration ( r = .742), procedure duration ( r = .554), and total length of stay ( r = .533). Conclusion: The complexity of FEVAR and BEVAR procedures reveals strong correlations between multiple peri- and postoperative variables. These exposures and risks should be borne in mind when considering treatment of complex abdominal aortic aneurysms as well as long-term clinical outcomes.

Dynamic Remeshing for Fluid Structure Interaction: Application to Modelling Aortic Dissection

2007 ◽  
Author(s):  
Keri R. Moyle ◽  
Yiannis Ventikos
Keyword(s):  
Aortic Dissection ◽  
Rate Increase ◽  
False Lumen ◽  
Aortic Aneurysms ◽  
True Lumen ◽  
Structure Interaction ◽  
Abdominal Aortic ◽  
Branch Vessel ◽  
Ruptured Abdominal Aortic Aneurysms ◽  
Acute Condition

Aortic dissection is an acute condition occurring more frequently than ruptured abdominal aortic aneurysms, with a mortality rate increase of 1% per hour if left untreated [1]. Dissection occurs following creation of an entrance tear, through which blood can force its way into the wall, forming a pocket that propagates longitudinally. The membrane of the dissection flap separates the true lumen (through which the organs are supplied with blood), from a false lumen (the pocket created by the dissection). The total obstruction of the true lumen by the motion of the vessel flap, or organ starvation due to branch vessel compression by the false lumen, can be fatal. Figure 1 shows an idealised representation of an aortic dissection model.

scholarly journals Evolution of Branch Vessel Incorporation During Emergent Endovascular Repair of Ruptured or Symptomatic Suprarenal and Thoracoabdominal Aortic Aneurysms

2021 ◽  
Vol 74 (3) ◽  
pp. e119-e120
Author(s):  
Helen A. Potter ◽  
Gregory A. Magee ◽  
Alyssa J. Pyun ◽  
Miguel Manzur ◽  
Fred A. Weaver ◽  
...  
Keyword(s):  
Endovascular Repair ◽  
Aortic Aneurysms ◽  
Branch Vessel

The molecular mechanism of mechanotransduction in vascular homeostasis and disease

2020 ◽  
Vol 134 (17) ◽  
pp. 2399-2418
Author(s):  
Yoshito Yamashiro ◽  
Hiromi Yanagisawa
Keyword(s):  
Shear Stress ◽  
Blood Vessels ◽  
Vessel Wall ◽  
Vascular Diseases ◽  
Cell Interactions ◽  
Aortic Aneurysms ◽  
Cyclic Stretch ◽  
Mechanical Stimuli ◽  
Vascular Homeostasis ◽  
Matrix Cell

Abstract Blood vessels are constantly exposed to mechanical stimuli such as shear stress due to flow and pulsatile stretch. The extracellular matrix maintains the structural integrity of the vessel wall and coordinates with a dynamic mechanical environment to provide cues to initiate intracellular signaling pathway(s), thereby changing cellular behaviors and functions. However, the precise role of matrix–cell interactions involved in mechanotransduction during vascular homeostasis and disease development remains to be fully determined. In this review, we introduce hemodynamics forces in blood vessels and the initial sensors of mechanical stimuli, including cell–cell junctional molecules, G-protein-coupled receptors (GPCRs), multiple ion channels, and a variety of small GTPases. We then highlight the molecular mechanotransduction events in the vessel wall triggered by laminar shear stress (LSS) and disturbed shear stress (DSS) on vascular endothelial cells (ECs), and cyclic stretch in ECs and vascular smooth muscle cells (SMCs)—both of which activate several key transcription factors. Finally, we provide a recent overview of matrix–cell interactions and mechanotransduction centered on fibronectin in ECs and thrombospondin-1 in SMCs. The results of this review suggest that abnormal mechanical cues or altered responses to mechanical stimuli in EC and SMCs serve as the molecular basis of vascular diseases such as atherosclerosis, hypertension and aortic aneurysms. Collecting evidence and advancing knowledge on the mechanotransduction in the vessel wall can lead to a new direction of therapeutic interventions for vascular diseases.

Ruptured abdominal aortic aneurysms: Clinical presentation in Auckland 1993-1997

2001 ◽  
Vol 71 (6) ◽  
pp. 341-344
Author(s):  
Johanna Rose ◽  
Ian Civil ◽  
Timothy Koelmeyer ◽  
David Haydock ◽  
Dave Adams
Keyword(s):  
Clinical Presentation ◽  
Abdominal Aortic Aneurysms ◽  
Aortic Aneurysms ◽  
Abdominal Aortic ◽  
Ruptured Abdominal Aortic Aneurysms

Automated software supported versus manual aorto-iliac diameter measurements in CT angiography of patients with abdominal aortic aneurysms: Assessment of inter- and intraobserver variation

VASA ◽  
2005 ◽  
Vol 34 (4) ◽  
pp. 255-261 ◽  
Author(s):  
Diehm ◽  
Baumgartner ◽  
Silvestro ◽  
Herrmann ◽  
Triller ◽  
...  
Keyword(s):  
Ct Angiography ◽  
Iliac Artery ◽  
Automatic Measurement ◽  
Random Order ◽  
Aortic Aneurysms ◽  
Intraobserver Variability ◽  
Automatic Method ◽  
Left Common Iliac Artery ◽  
Abdominal Aortic ◽  
Intraobserver Variation

Background: Open surgical or endovascular abdominal aortic aneurysm (AAA) relies on precise preprocedual imaging. Purpose of this study was to assess inter- and intraobserver variation of software-supported automated and manual multi row detector CT angiography (MDCTA) in aortoiliac diameter measurements before AAA repair. Patients and methods: Thirty original MDCTA data sets (4 times 2mm collimation) of patients scheduled for endovascular AAA repair were studied on a dedicated software capable of creating two-dimensional reformatted planes orthogonal to the aortoiliac center-line. Measurements were performed twice with a four-week interval between readings. Data were analysed by two blinded readers at random order. Two different measurement methods were performed: reader-assisted freehand wall-to-wall measurement and semi-automatic measurement. Results: Aortoiliac diameters were significantly underestimated by the semi-automatic method as compared to reader-assisted measurements (p < 0.0031). Intraobserver variability of AAA diameter calculation was not significant (p > 0.15) for reader-assisted measurements except for the diameter of the left common iliac artery in reader 2 (p = 0.0045) and it was not significant (p > 0.14) using the semi-automatic method. Interobserver variability was not significant for AAA diameter measurements using the reader-assisted method and for proximal neck analysis with the semi-automatic method (p > 0.27). Relevant interobserver variation was observed for semi-automatic measurement of maximum AAA (p = 0.0007) and iliac artery diameters (p = 0.024). Conclusions: Dedicated MDCTA software provides a useful tool to minimize aortoiliac diameter measurement variation and to improve imaging precision before AAA repair. For reliable AAA diameter analysis the reader-assisted freehand measurement method is recommended to be applied to a set of reformatted CT data as provided by the software used in this study.

Current evidence and prospects for medical treatment of abdominal aortic aneurysms

VASA ◽  
2005 ◽  
Vol 34 (4) ◽  
pp. 217-223 ◽  
Author(s):  
Diehm ◽  
Schmidli ◽  
Dai-Do ◽  
Baumgartner
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Medical Treatment ◽  
Endovascular Treatment ◽  
Abdominal Aortic Aneurysms ◽  
Aortic Aneurysms ◽  
Current Evidence ◽  
Significant Morbidity ◽  
Abdominal Aortic ◽  
Risk Of Rupture

Abdominal aortic aneurysm (AAA) is a potentially fatal condition with risk of rupture increasing as maximum AAA diameter increases. It is agreed upon that open surgical or endovascular treatment is indicated if maximum AAA diameter exceeds 5 to 5.5cm. Continuing aneurysmal degeneration of aortoiliac arteries accounts for significant morbidity, especially in patients undergoing endovascular AAA repair. Purpose of this review is to give an overview of the current evidence of medical treatment of AAA and describe prospects of potential pharmacological approaches towards prevention of aneurysmal degeneration of small AAAs and to highlight possible adjunctive medical treatment approaches after open surgical or endovascular AAA therapy.

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