Use of a Custom-made Four-Vessel Fenestrated Endograft to Repair an Enlarging Juxtarenal Aneurysm With Type IA Endoleak After Prior ZFEN Repair

AbstractAn 81-year-old patient presented to the emergency room 5 years after infrarenal endovascular aneurysm repair, with a Type Ia endoleak and a presumable infection of the graft material with Listeria monocytogenes. He was treated with a custom-made fenestrated endograft to seal the endoleak and lifelong antibiotic therapy to suppress the infection. Full explantation of graft material is not always preferable, and endovascular treatment combined with antibiotic suppressive therapy is in some cases an appropriate alternative.

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Custom-made Fenestrated Endograft for Patients with Type 1 Endoleak and Previous Endovascular Aneurysm Repairs: A Promising Endovascular Alternative Approach to Open Surgery

10.1055/s-0041-1729839 ◽

2017 ◽

Author(s):

Muhammad Affan Zamir ◽

Nich Burfitt ◽

Colin Bicknell ◽

Michael Jenkins ◽

Richard Gibbs ◽

...

Keyword(s):

Open Surgery ◽

Alternative Approach ◽

Custom Made ◽

Fenestrated Endograft

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Treatment of a type Ia endoleak following EVAR using a custom-made inner branch device.

Vascular ◽

10.1177/17085381211062743 ◽

2021 ◽

pp. 170853812110627

Author(s):

Gino Gemayel GG ◽

Michel Montessuit MM ◽

Anouche Gemayel GA

Keyword(s):

Abdominal Aortic Aneurysm ◽

Open Surgery ◽

Type I ◽

Novel Technology ◽

Abdominal Aortic ◽

Custom Made ◽

Type Ia ◽

Type I Endoleak ◽

Aortic Cuff

Objectives We represent two cases of late proximal type I endoleak following EVAR with aneurysm expansion that were treated with a custom-made graft with inner branches. Methods Two patients of 87 and 82 years old were operated by EVAR 6 and 8 years ago for abdominal aortic aneurysm. Both had proximal type I endoleak with aneurysm sac expansion. Open surgery had a high risk, and a proximal aortic extension with a simple aortic cuff was not possible neither because previous EVAR grafts were already at the level of the renal arteries. A custom-made endograft with inner branches was planned as a fenestrated graft was not technically possible. Results We successfully treated both patients using a custom-made graft with four inner branches from Jotec (Cryolife, Kennesaw, GA). Three months’ follow-up CT scan did not show any endoleaks. All target vessels were patent with good conformability of the bridging stents. Conclusion The treatment of proximal type I endoleak using inner branches’ endografts is feasible. This novel technology might broaden the indications for complex aortic repair in a group of patients where fenestrated endografts are not possible.

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Gutter Characteristics and Stent Compression of Self-Expanding vs Balloon-Expandable Chimney Grafts in Juxtarenal Aneurysm Models

Journal of Endovascular Therapy ◽

10.1177/1526602820915262 ◽

2020 ◽

Vol 27 (3) ◽

pp. 452-461

Author(s):

Jorn P. Meekel ◽

Theodorus G. van Schaik ◽

Rutger J. Lely ◽

Gerie Groot ◽

Bram B. van der Meijs ◽

...

Keyword(s):

Computed Tomography ◽

Fold Increase ◽

The Other ◽

Stent Grafts ◽

Computed Tomography Scans ◽

Different Types ◽

Type Ia ◽

Juxtarenal Aneurysm ◽

Chimney Graft

Purpose: To assess in silicone juxtarenal aneurysm models the gutter characteristics and compression of different types of chimney graft (CG) configurations. Materials and Methods: Fifty-seven combinations of Excluder C3 or Conformable Excluder stent-grafts (23, 26, and 28.5 mm) were deployed in 2 silicone juxtarenal aneurysm models with 3 types of CGs: Viabahn self-expanding (VSE; 6 and 13 mm) or Viabahn balloon-expandable (VBX; 6, 10, and 12 mm) stent-grafts and Advanta V12 balloon-expandable stent-grafts (ABX; 6 and 12 mm). Setups were divided into 4 groups on the basis of increasing CG and main graft (MG) diameters. Two independent observers assessed gutter size and type as well as CG compression on computed tomography scans using postprocessing software. Results: In the smaller diameter combinations (6-mm CG and 23-, 26-, and 28.5-mm MGs), both VSE (p=0.006 to 0.050) and ABX (p=0.045 to 0.050) showed lower gutter areas and volumes compared with VBX. In turn, the VBX showed a nonsignificant tendency to decreased compression, especially compared to ABX. Use of the Excluder C3 showed a 6-fold increase in type A1 gutters (related to type Ia endoleak) as compared to the Conformable Excluder (p=0.018). Balloon-expandable stent-grafts (both ABX and VBX) showed a 3-fold increase in type A1 gutters in comparison with self-expanding stent-grafts (p=0.008). Conclusion: The current study suggests that use of the Conformable Excluder in combination with VSE chimney grafts is superior to the other tested CG/MG combinations in terms of gutter size, gutter type, and CG compression.

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Novel Technique for the Treatment of Type Ia Endoleak After Endovascular Abdominal Aortic Aneurysm Repair

Journal of Endovascular Therapy ◽

10.1177/15266028211010469 ◽

2021 ◽

pp. 152660282110104

Author(s):

Piotr M. Kasprzak ◽

Karin Pfister ◽

Waclaw Kuczmik ◽

Wilma Schierling ◽

Georgios Sachsamanis ◽

...

Keyword(s):

Aortic Aneurysm ◽

Abdominal Aortic Aneurysm Repair ◽

Main Body ◽

Mortality And Morbidity ◽

Landing Zone ◽

Low Profile ◽

Custom Made ◽

Type Ia ◽

Aneurysm Repair ◽

Aortic Aneurysm Repair

Purpose Open surgical repair of type Ia endoleak after endovascular aortic aneurysm repair/sealing (EVAR/EVAS) is associated with significant perioperative mortality and morbidity. Current endovascular redo techniques face limitations, especially when the infrarenal landing zone is inadequate and the previous endograft is rigid and features a short or no main body. We present a novel concept for the treatment of type Ia endoleak using a custom-made branched device. Technique The 5-branch-device (Cook Medical, Bloomington, IN, USA) consists of a nitinol skeleton with branches, covered with a low-profile polyester fabric loaded in an 18F sheath. The device features a minimum of 2 proximal sealing stents and includes branches for renovisceral vessels as well as an additional 8 mm branch for the contralateral iliac limb. Implantation and sealing in the renovisceral vessels is carried out in standard fashion, using transfemoral and transaxillary access. Distal sealing is achieved by tapering the branched component into the ipsilateral iliac limb and using a bridging balloon-expandable or self-expandable stent-graft through the additional branch to the preexisting contralateral iliac limb. Conclusion Treatment of type Ia endoleak with a new custom-made device enables sufficient proximal seal while minimizing suprarenal aortic coverage and facilitates adequate component overlap. The low profile branched design accommodates implantation through the preexisting endograft and catheterization of target vessels.

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Endoleak outcomes with different stent-graft generations in a 25-years thoracic endovascular aortic repair experience

Vascular ◽

10.1177/17085381211051486 ◽

2021 ◽

pp. 170853812110514

Author(s):

Stefano Gennai ◽

Nicola Leone ◽

Luigi A Maria Bartolotti ◽

Tea Covic ◽

Antonio Lauricella ◽

...

Keyword(s):

Risk Factor ◽

Stent Graft ◽

Protective Factor ◽

Endovascular Aneurysm Repair ◽

Secondary Outcome ◽

Type I ◽

Custom Made ◽

Type Ia

Introduction To compare endoleak outcomes after thoracic endovascular aneurysm repair (TEVAR) with different stent-graft generations into long-term follow-up. Design retrospective, observational, and single-center cohort study. Methods TEVAR procedures performed between November 1995 and December 2020 were analyzed. The primary endpoint of this study was the freedom from endoleak (type I/III) in four stent-graft generations during the follow-up period. The first generation (GEN1) included: Vanguard; AneuRx and Talent; Stentor; Excluder; Endologix; EndoFit. The second generation (GEN2) included: TAG and TX. The third (GEN3) included: Relay Plus; Valiant Captivia; Zenith Alpha and custom-made. The fourth (GEN4) included: Relay Pro; Conformable C-TAG; Navion; E-Vita; Najuta; Nexus; standard and custom-made thoraco-abdominal devices. Nonaortic and aorta-related survival was considered as secondary outcome. Results A total of 509 TEVAR were included with a 44.3 ± 42.5 months mean follow-up. Freedom from endoleak at 5 years was 65.6%, 61.4%, 76.2%, and 69.1% for GEN1, GEN2, GEN3, and GEN4, respectively ( p = 0.368). The first two generations demonstrated a higher endoleak rate when compared with the two most recent ones (27.2 vs 18.2%, respectively; p = 0.043). GEN1 was an independent risk factor ( p = 0.014) and GEN4 was an independent protective factor ( p = 0.001) for endoleak. GEN1 was found to be a risk factor for type-Ia endoleak ( p = 0.059). GEN4 demonstrated a protective association regarding type-Ib endoleak ( p = 0.012). Overall survival was 75.3%, 44.4%, 27.2%, and 17.6% at 1, 5, 10, and 15 years, respectively. Survival distinguished as non-related versus aortic-related was 86.7% vs 23.5%, 52.7% vs 9.8%, 32.9% vs 2.0%, 21.2% vs 0% at 1, 5, 10, and 15 years, respectively ( p< 0.000). Conclusion Endoleak occurred in a non-negligible percentage of TEVAR patients. A significant reduction of endoleak incidence over evolving stent-grafts generations was registered. Newer stent-graft generations demonstrated better long-term endoleak. Data about long-term outcomes require ongoing updates to prove both the reliability and the durability of newer stent-graft generations.

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