Mid-term follow-up of transluminal endovascular graft placement with INOUE stent graft for aortic aneurysms and dissection: single center experience

Purpose: To describe a hybrid procedure that avoids cardiopulmonary bypass to treat patients with true ascending aortic aneurysms without a suitable proximal landing zone for endovascular repair. Material and Methods: Thirteen consecutive patients (mean age 75.9±6.5 years; 8 women) with true ascending aortic aneurysms were treated with the endovascular hybrid repair of true aortic aneurysms (EHTA) approach, which consists of a conventional sternotomy with double wrapping of the ascending aorta followed by staged stent-graft placement. Via sternotomy, a polypropylene mesh trimmed to downsize the aneurysm is placed around the dilated ascending aorta and sutured to the adventitia. A similarly trimmed polytetrafluoroethylene graft is placed loosely around the first wrap to avoid adhesions and secure the proximal landing zone. There is no need for cardiopulmonary bypass. A few days later, a standard thoracic stent-graft is deployed via either a transaxillary or transfemoral access; chimney or bypass grafts are used as needed to revascularize the supra-aortic vessels. Results: The ascending aortic diameter was reduced from a mean 5.7 cm (range 4.8–6.5) to 3.9 cm (range 3.2–4.3) after wrapping. The mean interval between surgery and stent-graft placement was 5 days. In this interval, 2 patients with significant reduction in the diameter of the ascending aorta elected to forego placement of a stent-graft. Of the 11 patients who underwent the full hybrid EHTA procedure, the ascending aortic stent-graft was combined with a chimney graft in the innominate artery in 4 cases. In 1 patient, a supra-aortic debranching procedure using a bifurcated Dacron graft to the innominate and left common carotid arteries was performed after wrapping with the polypropylene mesh. There was no mortality or neurological complication. A sternal wound infection required a prolonged hospital stay. At a mean follow-up of 13.8 months (range 3–24), there has been no death, type I endoleak, or sign of aneurysm enlargement on imaging. Conclusion: This technique permits complete endovascular exclusion of an ascending aortic aneurysm in a less invasive approach than standard open repair. Although this is only a small cohort of patients without long-term follow-up, it seems that this hybrid procedure is associated with low morbidity and mortality. It offers a beating-heart approach to treat true ascending aortic aneurysms in selected high-risk patients.

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Not Only the Proximal Neck. Comment on “Initial Single-center Experience with the Ovation Stent-graft System in the Treatment of Abdominal Aortic Aneurysms: Application to Challenging Iliac Access Anatomies”

Annals of Vascular Surgery ◽

10.1016/j.avsg.2015.05.010 ◽

2015 ◽

Vol 29 (7) ◽

pp. 1480-1482 ◽

Cited By ~ 1

Author(s):

Paqualino Sirignano ◽

Danilo Menna ◽

Laura Capoccia ◽

Wassim Mansour ◽

Francesco Speziale

Keyword(s):

Stent Graft ◽

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Single Center ◽

Proximal Neck ◽

Single Center Experience ◽

Abdominal Aortic

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Results of Endovascular Therapy of Ureteroarterial Fistulas: A Single Center Experience

10.21203/rs.3.rs-266941/v1 ◽

2021 ◽

Author(s):

Bjoern Simon ◽

Jakob Neubauer ◽

Martin Schoenthaler ◽

Simon Hein ◽

Fabian Bamberg ◽

...

Keyword(s):

Stent Graft ◽

Endovascular Therapy ◽

Iliac Artery ◽

Coil Embolization ◽

Clinical Success ◽

Hypovolemic Shock ◽

Case Series ◽

Single Center ◽

Single Center Experience

Abstract Background Ureteroarterial fistula (UAF) is a rare but potentially life threatening disease. The aim of this study was to evaluate the outcome of endovascular therapy for UAF treatment.Methods This retrospective case series evaluates a single center experience of percutaneous stent graft angioplasty and/or coil embolization for UAF. Patient follow-up included technical and early clinical success, complications and revisional procedures. Results We identified 17 UAF in 16 consecutive patients (12 male, 4 female, mean age 69.8 ±11.3 years) who underwent endovascular UAF therapy at our tertiary hospital. All patients presented with hematuria. 5/17 presented with flank pain, in 7 of 17 cases patients were in hypovolemic shock. Risk factors of UAF included chronic indwelling ureteral stents in all ﬁstulas, pelvic exstirpatory surgery in 13 cases. In 6 cases stent grafts were placed from the common iliac artery (CIA) to the external iliac artery (EIA) following coil embolization of the proximal internal iliac artery (IIA). Stent graft placement without previous coil embolization was performed in 10 fistulas. In one case only coil embolization of the IIA was performed. Mean follow-up was 654 (range: 1 – 3269) days. All procedures were technically successful and no procedure related deaths occurred during follow-up. During the initial hospital stay hematuria disappeared in 14/17 cases. Overall, four patients suffered recurrent hematuria, which in three cases resolved after a secondary intervention. One recurrent UAF related death occurred during follow-up 229 days after initial treatment.Conclusion Endovascular therapy proves to be a safe and efficient method in UAF treatment.Evidence-based medicineLevel 4, case series.

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Parallel stent grafts for the treatment of complex aortic aneurysms: A single center study

Vascular ◽

10.1177/1708538118761736 ◽

2018 ◽

Vol 26 (5) ◽

pp. 490-497 ◽

Cited By ~ 1

Author(s):

Daniel Silverberg ◽

Uri Rimon ◽

Daniel Raskin ◽

Avner BarDayan ◽

Moshe Halak

Keyword(s):

Endovascular Aneurysm Repair ◽

Primary Patency ◽

Aortic Aneurysms ◽

Single Center ◽

Technical Success ◽

Perioperative Morbidity ◽

Single Center Experience ◽

Invasive Techniques ◽

Aneurysm Repair

Background “Chimney” techniques with parallel grafts used in order to extend the landing zones in endovascular aneurysm repair (ch-EVAR) are increasingly being reported. Conflicting data has been reported regarding the success and durability of the repair. We report a single center experience using ch-EVAR in treating complex aortic pathologies. Methods We performed a retrospective review of all patients treated with ch-EVAR in our institution between 2013 and 2017. Data collected included patients demographics, indications for surgery, configuration of parallel grafts, technical success, and perioperative morbidity and mortality. Follow-up data included aortic sac size, reintervention rate, and overall mortality. Results Thirty-five patients underwent treatment of their aneurysms with parallel grafts. Sixty parallel grafts were placed. Mean age was 75 years (range 59–93) and 30 (85%) were male. Technical success was achieved in 32 (91%) patients. Mean follow up was 12 months. Sac size decreased in diameter or remained unchanged in 26 of the 30 (86.6%) patients. Four patients were found to have enlarging aneurysms due to gutter endoleaks. All were treated successfully with endovascular methods. The estimated primary patency was 95% at 12 months. Probability of freedom from intervention was 75% at 12 months. No late aneurysm related mortality occurred. Conclusion The use of ch-EVAR in treating complex aortic aneurysms is technically feasible and safe. Gutter endoleaks are encountered only in a minority of the cases, and can be treated with minimally invasive techniques. Longer term follow up is required to evaluate the patency of these parallel grafts and the durability of the aneurysm exclusion.

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The Zenith Aortic Stent-Graft: A 5-Year Single-Center Experience

Journal of Endovascular Therapy ◽

10.1177/152660280200900602 ◽

2002 ◽

Vol 9 (6) ◽

pp. 719-728 ◽

Cited By ~ 28

Author(s):

Pierre Alric ◽

Robert J. Hinchliffe ◽

Shane T.R. MacSweeney ◽

Peter W. Wenham ◽

Simon C. Whitaker ◽

...

Keyword(s):

High Risk ◽

Stent Graft ◽

Survival Rates ◽

Artery Occlusion ◽

Aortic Aneurysms ◽

Renal Infarction ◽

Single Center Experience ◽

Midterm Outcome ◽

Secondary Procedures

Purpose: To evaluate the efficacy and midterm results of the Zenith stent-graft in the treatment of abdominal aortic aneurysms (AAA). Methods: Since March 1994, 364 patients have undergone endovascular repair of infrarenal AAA. Of the 94 who were treated with the Zenith stent-graft from 1996 to 2002, 88 patients (82 men; mean age 72.6 ± 6.5 years, range 47–88) with at least 6-month follow-up were analyzed. Sixty-one (69.3%) patients were considered at high risk for intervention; 7 ruptured AAAs were treated emergently. In all, 68 (77.3%) bifurcated stent-grafts (including 18 TriFab systems) and 20 aortomonoiliac configurations were used. Cumulative data on endoleak, migration, secondary procedures, and survival were evaluated with Kaplan-Meier analyses. Results: Implantation success was 97.7%; 2 (2.3%) access-related failures were converted to open repair (1 immediate, 1 at 3 months). There were 3 (3.4%) graft limb thromboses (2 immediate, 1 late), 3 (3.4%) cases of colon ischemia due to embolization in 1 and hypogastric artery occlusion in 2, and 1 (1.1%) renal infarction due to embolism. Three (3.4%) patients died within 30 days. Eleven (12.5%) endoleaks and 1 (1.1%) late endograft migration were recorded. The 5-year cumulative endoleak and migration rates were 15% and 7%, respectively. Sixty-three (71.6%) patients did not present any complication related to the repair during a mean follow-up of 20.6 ± 14.9 months (range 6–68); notably, no complications were associated with the 18 TriFab systems. Six (6.8%) secondary procedures were performed (31% 5-year cumulative secondary procedural rate). All 6 (6.8%) aneurysm-related deaths (the 3 perioperative, 2 from late AAA rupture, and 1 during a secondary procedure) and 14 of 18 (20.4%) non-aneurysm—related deaths occurred in high-risk patients; the 5-year cumulative survival rates were 57% for any death and 92% for aneurysm-related deaths. Conclusions: The Zenith stent-graft appears both safe and effective in terms of midterm outcome of endovascular aortic aneurysm repair.

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