Effect of celiac axis compression on target vessel-related outcomes during fenestrated-branched endovascular aortic repair

Purpose: To describe a bailout technique to stabilize target vessel catheterization in branched endovascular aortic repair. Technique: The technique is demonstrated in a 75-year-old patient with a 75-mm symptomatic type III thoracoabdominal aortic aneurysm that was treated with a t-Branch endograft. If a catheter cannot be advanced for exchange to a more stable guidewire after target vessel catheterization, the balloon-anchoring technique can be applied to stabilize the through-the-branch hydrophilic guidewire. Through a femoral access a catheter and hydrophilic wire are passed outside the device into the target vessel and exchanged with a stiff wire; a semicompliant balloon is advanced over the Rosen wire and inflated in the target vessel, stabilizing the through-the-branch hydrophilic wire and facilitating its exchange with a stiff wire over a catheter or advancement of the bridging covered stent directly. Conclusion: The balloon-anchoring technique adds to the spectrum of bailout techniques that can be applied in cases of challenging target vessel access.

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Target vessel displacement during fenestrated and branched endovascular aortic repair and its implications for the role of traditional computed tomography angiography roadmaps

Quantitative Imaging in Medicine and Surgery ◽

10.21037/qims-20-1077 ◽

2021 ◽

Vol 0 (0) ◽

pp. 0-0

Author(s):

Marloes M. Jansen ◽

Merel van der Stelt ◽

Stefan P. M. Smorenburg ◽

Cornelis H. Slump ◽

Joost A. van Herwaarden ◽

...

Keyword(s):

Computed Tomography ◽

Computed Tomography Angiography ◽

Endovascular Aortic Repair ◽

Target Vessel ◽

Aortic Repair

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Retrospective Cohort Study on Vessel Deformation During Fenestrated or Branched Endovascular Aortic Repair; Traditional CTA Roadmaps Provide Insufficient and Inadequate Guidance During Target Vessel Cannulation

European Journal of Vascular and Endovascular Surgery ◽

10.1016/j.ejvs.2019.09.192 ◽

2019 ◽

Vol 58 (6) ◽

pp. e680-e681

Author(s):

Marloes M. Jansen ◽

Merel van der Stelt ◽

Stefan P.M. Smorenburg ◽

Joost A. van Herwaarden ◽

Constantijn E.V.B. Hazenberg

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Endovascular Aortic Repair ◽

Target Vessel ◽

Aortic Repair

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Preliminary Outcomes of Viabahn Balloon-Expandable Endoprosthesis as Bridging Stent in Renal Arteries During Fenestrated Endovascular Aortic Repair

Journal of Endovascular Therapy ◽

10.1177/15266028211012403 ◽

2021 ◽

pp. 152660282110124

Author(s):

Luca Mezzetto ◽

Davide Mastrorilli ◽

Nicola Leone ◽

Stefano Gennai ◽

Roberto Silingardi ◽

...

Keyword(s):

Renal Artery ◽

Endovascular Aneurysm Repair ◽

Renal Arteries ◽

Endovascular Aortic Repair ◽

Type I ◽

Target Vessel ◽

Technical Success ◽

Transverse Axis ◽

Aortic Repair

Purpose: To report preliminary outcomes of Viabahn Balloon-Expandable Endoprosthesis (VBX) stent-graft as bridging stent for renal arteries in fenestrated endovascular aneurysm repair (FEVAR). Materials and Methods: Between 2018 and 2019, patients undergoing FEVAR at 3 referral Italian university hospitals were prospectively collected. During the study period, VBX was the first-line choice as bridging stent for renal arteries. Procedural and anatomical data were analyzed, including renal artery (RA) configuration. A dedicated software (3Mensio, Vascular Imaging, Bilthoeven, The Netherlands) was used and RA anatomy classified as follow: upward-oriented in case of any angle >30° above the horizontal or transverse axis perpendicular to the aortic axis, downward-oriented if there was an angle >30° measured below the transverse axis and downward + upward in case of an angle <30° associated with a renal artery angulation >90°. Primary endpoints were technical success, defined as complete deployment of the fenestrated endograft without target vessel (TV) loss, limb stenosis or occlusion and type I or III endoleak, and freedom from target artery instability (TAI), defined by target vessel-related death, occlusion, rupture or reintervention for stenosis, endoleak or disconnection. Secondary endpoints were target artery patency rate and freedom from reinterventions. Results: A total of 26 elective FEVAR for juxta/pararenal aneurysm (20), thoracoabdominal type II (3) and type IV (3) were included. Fifty-one RA were planned for revascularization. Of these, 32 were downward, 10 horizontal, 6 upward, 4 were downward + upward. Technical success was achieved in 88.5% (23/26) of patients and 94.2% (48/51) of the TVs. One occlusion (2.1%) occurred within 30 days in a patient with previous endovascular aortic repair and suprarenal fixation. During follow-up (median 10 months), there was 1 type IC endoleak after 6 months (2.1%) in a patient with upward plus downward arterial orientation. Freedom from TAI was 96.1% (CI = 0.89 to 1.04) at first month and 92.3% (CI = 0.82 to 1.03) at 6 months. No aneurysm-related mortality and renal insufficiency occurred during follow-up. Conclusion: The use of VBX as bridging stent of RA in FEVAR is safe and feasible. Previous EVAR and tortuosity of RA may be a challenging on target vessel fate.

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Reverse Cheese-Wire Septotomy to Create a Distal Landing Zone for Thoracic Endovascular Aortic Repair

Journal of Endovascular Therapy ◽

10.1177/15266028211070966 ◽

2022 ◽

pp. 152660282110709

Author(s):

Jordan R. Stern ◽

Xuan-Binh D. Pham ◽

Jason T. Lee

Keyword(s):

False Lumen ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Celiac Axis ◽

Reverse Direction ◽

Landing Zone ◽

Aortic Repair ◽

Aortic Replacement ◽

Single Lumen ◽

The Right

Purpose: The objective of this study is to describe a novel method for creating a distal landing zone for thoracic endovascular aortic repair (TEVAR) in chronic aortic dissection. The technique is described in a patient with prior total arch and descending aortic replacement, with false lumen expansion. Technique: A cheese-wire endovascular septotomy was desired to create a single lumen above the celiac axis. To avoid dividing the septum caudally across the visceral segment, we performed a modified septotomy in a cephalad direction. Stiff wires were passed into the prior surgical graft, through true lumen on the right and false lumen on the left. An additional wire was passed across an existing fenestration at the level of the celiac axis, and snared and externalized. 7F Ansel sheaths were advanced and positioned tip-to-tip at the fenestration. Using the stiff wires as tracks, the through-wire was pushed cephalad to endovascularly cut the septum. Angiogram demonstrated successful septotomy, and TEVAR was performed to just above the celiac with successful aneurysm exclusion and no endoleak or retrograde false lumen perfusion. Follow-up computed tomography angiogram (CTA) showed continued exclusion without false lumen perfusion. Conclusions: This novel modification in a reverse direction provides an alternative method for endovascular septotomy, when traditional septotomy may threaten the visceral vessels.

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