Endovascular repair of recurrent aortic coarctation with a custom made hourglass shaped stent graft

Abstract Purpose To report the technical details and outcomes of the endovascular repair of two cases of de novo post-stenotic aortic coarctation aneurysms complicated by complex collateral supply. Case presentations Two patients with thoracic aortic aneurysms complicated by complex aneurysm sac collaterals distal to a previously untreated thoracic aortic coarctation have been treated at our institution. Open surgical intervention was deemed to carry a high risk of haemorrhage due to the degree and complexity of arterial collateralisation. In the first case, selective embolisation of collateral vasculature was performed prior to successful exclusion of the aneurysm with a thoracic endovascular stent-graft and then balloon-expandable stent dilatation of the coarctation stenosis. In the second case, the additional technique of using a jailed sheath within the aneurysm sac allowed for selective embolisation of previously inconspicuous collaterals after deployment of the stent-graft and stent combination. Results Technical success was achieved in both patients with successful occlusion of the aneurysm, with no recorded complications or aneurysm sac perfusion in the long and medium term follow up periods respectively. Conclusion De novo post stenotic aortic coarctation aneurysms are rare. Endovascular repair is a safe and durable technique that provides a less invasive alternative to open surgical repair. The use of a jailed sheath allows for complete selective embolisation of complex collaterals avoiding a type II aneurysm endoleak.

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A Modified Proximal Stent-Graft for Spinal Cord Preconditioning During Staged Endovascular Repair of Thoracoabdominal Aortic Aneurysms

Journal of Endovascular Therapy ◽

10.1177/1526602820926969 ◽

2020 ◽

Vol 27 (5) ◽

pp. 764-768

Author(s):

Enrico Rinaldi ◽

Niccolò Carta ◽

Germano Melissano ◽

Roberto Chiesa ◽

Luca Bertoglio

Keyword(s):

Spinal Cord ◽

Stent Graft ◽

Endovascular Repair ◽

Aortic Wall ◽

Outer Part ◽

Aortic Aneurysms ◽

Additional Tool ◽

Repair Technique ◽

Custom Made ◽

Thoracic Stent Graft

Purpose: To describe a new custom-made thoracic device able to seal against the aortic wall and occlude intercostal arteries for spinal cord preconditioning during the first thoracic stage of a thoracoabdominal endovascular repair. Technique: The custom-made device, based on the Zenith Alpha stent-graft, combines different features from 2 previously described devices: the outer part is designed with a bell-bottom configuration similar to the “Embo” stent-graft, while the inner part mimics the “2 in 1” design. The outer stent-graft is designed to span the entire length of the thoracic aorta and cover as many intercostal arteries as possible during the first stage to effectively precondition the spinal cord. The sutured inner component is customizable in diameter and 20 to 40 mm shorter than the outer stent-graft. The technique has been used in 5 patients. Conclusion: The use of this new custom-made thoracic stent-graft might represent an additional tool for effectively preconditioning the spinal cord during fenestrated and branched staged procedures whenever a proximal thoracic proximal component is needed.

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Endovascular Repair of Thoracic Aortic Aneurysm Using a Custom-made Fenestrated Stent Graft to Preserve the Left Subclavian Artery

Soonchunhyang Medical Science ◽

10.15746/sms.12.036 ◽

2012 ◽

Vol 18 (2) ◽

pp. 163-166

Author(s):

Keun Her

Keyword(s):

Aortic Aneurysm ◽

Stent Graft ◽

Subclavian Artery ◽

Endovascular Repair ◽

Thoracic Aortic Aneurysm ◽

Left Subclavian Artery ◽

Custom Made ◽

Fenestrated Stent Graft

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Endovascular Repair of a Penetrating Aortic Ulcer with a Custom-made Relay Stent Graft Featuring a Single Celiac Trunk Fenestration and a Superior Mesenteric Artery Scallop

Annals of Vascular Surgery ◽

10.1016/j.avsg.2018.03.030 ◽

2018 ◽

Vol 52 ◽

pp. 314.e1-314.e5

Author(s):

Giuseppe Natalicchio ◽

Antonella Biello ◽

Giuseppe Castriotta ◽

Maria Grazia La Marca ◽

Giuseppe Sorino ◽

...

Keyword(s):

Superior Mesenteric Artery ◽

Stent Graft ◽

Endovascular Repair ◽

Mesenteric Artery ◽

Celiac Trunk ◽

Penetrating Aortic Ulcer ◽

Custom Made

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TCTAP C-190 Endovascular Repair of Abdominal Aortic Aneurysm Combined with Huge Bilateral Iliac Arterial Aneurysms with Custom-Made Branched Stent Graft

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2015.03.474 ◽

2015 ◽

Vol 65 (17) ◽

pp. S403-S404

Author(s):

Pyung Chun Oh ◽

Woong Chol Kang ◽

Myeong Gun Kim ◽

Eak-Kyun Shin

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Stent Graft ◽

Endovascular Repair ◽

Abdominal Aortic ◽

Custom Made ◽

Arterial Aneurysms

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Endovascular Repair Using a 7-Branch Stent-Graft for a Thoracoabdominal Aortic Aneurysm With Variant Renovisceral Artery Anatomy

Journal of Endovascular Therapy ◽

10.1177/1526602819892557 ◽

2019 ◽

Vol 27 (2) ◽

pp. 231-236 ◽

Cited By ~ 1

Author(s):

Ahmed Eleshra ◽

Konstantinos Spanos ◽

Giuseppe Panuccio ◽

Catharina Gronert ◽

Fiona Rohlffs ◽

...

Keyword(s):

Aortic Aneurysm ◽

Stent Graft ◽

Endovascular Repair ◽

Thoracoabdominal Aortic Aneurysm ◽

Covered Stent ◽

Covered Stents ◽

Femoral Access ◽

Type Iv ◽

Custom Made ◽

Artery Disease

Purpose: To present a case of endovascular repair using a custom-made 7-branch stent-graft for a thoracoabdominal aortic aneurysm (TAAA) in a patient with variations in the renovisceral artery anatomy. Case Report: A 70-year-old asymptomatic man presented with a 60-mm-diameter type IV TAAA. Due to severe coronary artery disease, an endovascular approach was elected. In the preoperative computed tomography angiography (CTA) scans, variations in the renovisceral artery anatomy included the common hepatic and splenic arteries deriving separately from the aorta and bilateral double renal arteries (RAs). A custom-made 7-branch stent-graft was manufactured to preserve all renovisceral arteries. The 7 branches were catheterized and connected with a steerable sheath from a femoral access. All branches were bridged to the target vessel (TV) with a self-expanding covered stent; 4 TVs also had balloon-expandable covered stents implanted. Final angiography and predischarge CTA showed patency of all 7 target vessels and corresponding visceral organs, with no endoleak. The patient was discharged on postoperative day 8 without complications. Six-month follow-up CTA demonstrated exclusion of the TAAA and patency of all 7 target vessels. Conclusion: Successful treatment of a TAAA in a patient with multiple variant renovisceral arteries was feasible with a custom-made 7-branch stent-graft, achieving a good early outcome.

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Endovascular Repair of Aortic Coarctation Pseudoaneurysm Using an Off-Label “Hourglass” Stent-Graft Configuration

Journal of Endovascular Therapy ◽

10.1177/1526602815581595 ◽

2015 ◽

Vol 22 (3) ◽

pp. 460-465 ◽

Cited By ~ 1

Author(s):

Young Erben ◽

Gustavo S. Oderich ◽

Audra A. Duncan

Keyword(s):

Stent Graft ◽

Endovascular Repair ◽

Aortic Coarctation ◽

Off Label

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Technique for Fenestrated Stent-Graft Implantation as a Proximal Extension to a Previous Fenestrated Endovascular Repair for Abdominal Aortic Aneurysm

Journal of Endovascular Therapy ◽

10.1177/1526602817745779 ◽

2017 ◽

Vol 25 (1) ◽

pp. 16-20 ◽

Cited By ~ 1

Author(s):

Konstantinos Spanos ◽

Nikolaos Tsilimparis ◽

Franziska Heidemann ◽

Fiona Rohlffs ◽

Christian-Alexander Behrendt ◽

...

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Stent Graft ◽

Endovascular Repair ◽

Endovascular Aneurysm Repair ◽

Thoracoabdominal Aortic Aneurysm ◽

Efficient Treatment ◽

Type Iv ◽

Abdominal Aortic ◽

Custom Made

Purpose: To describe planning and a technique for fenestrated endovascular repair of a large Crawford type IV thoracoabdominal aortic aneurysm after previous 2-fenestration endovascular aneurysm repair (FEVAR). Technique: The first FEVAR procedure performed at another center implanted a standard Zenith device with 2 fenestrations and 1 scallop for a juxtarenal abdominal aortic aneurysm. The diameter of the Crawford type IV thoracoabdominal aortic aneurysm had progressed from 68 to 75 mm within a year after the FEVAR. Since the celiac trunk was already occluded, a 3-fenestration 22-×172-mm stent-graft was chosen to extend the existing stent-graft further proximally. A tapered 38/22-×179-mm Zenith custom-made device was designed for the thoracic component. The technique addresses several issues that arise during a FEVAR-in-FEVAR case, such as the orientation of the new stent-graft and its fenestrations, the absence of space between the 2 devices for maneuvers, and the difficulty in catheterizing target vessels with existing bridging stents, for which a bailout “snare-ride” maneuver is described. Conclusion: FEVAR after previous FEVAR is a feasible and efficient treatment option. The modified “snare-ride” technique can be used to catheterize target vessels in the absence of an Indy snare.

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