scholarly journals Successful Surgical Abdominal Aortic Debranching Preceding Stent Graft Implantation: A Case Report

2018 ◽  
Vol 07 (01) ◽  
pp. e24-e26
Author(s):  
Magdalena Laux ◽  
Michael Erb ◽  
Frank Hoelschermann ◽  
Johannes Albes
Keyword(s):  
Endovascular Aneurysm Repair ◽  
Celiac Trunk ◽  
Safe Alternative ◽  
Aortic Repair ◽  
Abdominal Aortic ◽  
Custom Made ◽  
Open Aortic Repair ◽  
Vein Bypass ◽  
Thoracic And Abdominal ◽  
Aneurysm Repair

Background Acute endovascular aneurysm repair with stent grafts (thoracic endovascular aortic repair [TEVAR]) is safe and feasible. Case Description A 64-year-old female presented with a perforated aortic aneurysm of the thoracic descending aorta. Primary TEVAR resulted in good management of the perforation but a type Ib endoleakage remained postoperatively. To place another stent, abdominal debranching with saphenous vein bypass to the celiac trunk was required. In the same session, another endograft was inserted successfully. Conclusion Abdominal debranching is a safe alternative to open aortic repair in acute thoracic and abdominal aneurysms, instead of waiting for a custom-made device.

Long-Term Renal Function following Endovascular Aneurysm Repair with Infrarenal and Suprarenal Aortic Stent-Grafts

2003 ◽  
Vol 10 (3) ◽  
pp. 397-405 ◽  
Author(s):  
Pierre Alric ◽  
Robert J. Hinchliffe ◽  
Marie-Christine Picot ◽  
Bruce D. Braithwaite ◽  
Shane T.R. MacSweeney ◽  
...  
Keyword(s):  
Renal Function ◽  
Serum Creatinine ◽  
Stent Graft ◽  
Endovascular Aneurysm Repair ◽  
Stent Grafts ◽  
Abdominal Aortic ◽  
Custom Made ◽  
Aneurysm Repair ◽  
The Impact

Purpose: To determine in a retrospective analysis the incidence of renal impairment (RI) following endovascular repair (EVR) of abdominal aortic aneurysm (AAA), to assess the morbidity and mortality in endograft patients with preoperative RI, and to examine the impact of suprarenal stent-grafts on renal function. Methods: From March 1994 to October 2001, 315 AAA patients (289 men; mean age 72.4±7.0 years) undergoing EVR were entered prospectively into a vascular registry. The patients received either an in-house custom-made stent-graft or one of several commercially made devices implanted with infrarenal or suprarenal fixation. Renal function was monitored by serum creatinine measurements prior to discharge and at 3, 6, and 12 months and annually thereafter. Preoperative RI was defined as a serum creatinine > 130 μmol/L and/or long-term dialysis. Postoperative RI referred to a >20% increase in the serum creatinine over baseline. Additional deterioration of renal function in patients with preoperative RI was referred to as postoperatively worsened RI. Results: Of the 315 patients treated, 220 (69.8%) were considered high risk (ruptured AAA or ASA grade III or IV). Sixty-nine (21.9%) patients had preoperative RI (6 [1.9%] on preoperative dialysis). A suprarenal stent-graft was used in 169 (53.7%) patients and infrarenal stent-graft in the remaining 146 (46.3%). The mean follow-up was 30.1 ±22.7 months. Postoperative RI occurred in 53 (16.8%) patients (24 [7.6%] transient, 29 [9.2%] persistent). Patients with preoperative RI had a significantly higher incidence of postoperatively worsened RI (37.7% versus 11.0%, p<0.0001) and a higher mortality related to RI (7.2% versus 1.6%, p=0.02). Suprarenal fixation had no influence on the incidence of RI, on perioperative mortality, or on mortality related to RI. The only significant predictive factor of postoperative RI was preoperative RI (risk ratio 5.09, 95% CI 2.38 to 10.87, p=0.0001). Conclusions: Endovascular AAA repair may lead to persistent postoperative RI in nearly 10% of cases, especially in patients with preoperative RI. Suprarenal stent-graft fixation does not seem to have any deleterious effect on renal function. Further long-term studies are required to confirm the innocuous nature of transrenal stent placement.

Single-stage thoracic and abdominal endovascular aneurysm repair for multilevel aortic disease

Vascular ◽  
2013 ◽  
Vol 22 (1) ◽  
pp. 55-60 ◽  
Author(s):  
Makoto Samura ◽  
Nobuya Zempo ◽  
Yoshitaka Ikeda ◽  
Masaaki Hidaka ◽  
Yoshikazu Kaneda ◽  
...  
Keyword(s):  
Spinal Cord Ischemia ◽  
Endovascular Aneurysm Repair ◽  
Abdominal Aortic Aneurysms ◽  
Aortic Disease ◽  
Aortic Aneurysms ◽  
Single Stage ◽  
Type I ◽  
Abdominal Aortic ◽  
Thoracic And Abdominal ◽  
Aneurysm Repair

This investigation evaluated the results of single-stage thoracic endovascular aneurysm repair (TEVAR) and endovascular aneurysm repair (EVAR) for multilevel aortic disease in a series of nine patients. The lesions repaired included thoracic and abdominal aortic aneurysms ( n = 7) and subacute type B dissections with abdominal aortic aneurysms ( n = 2). All procedures were successfully performed, and none of the patients experienced postoperative stroke or spinal cord ischemia. The median follow-up period for these patients was 18.9 months (range 1.7–31.4 months) and none of the patients exhibited any signs of type I endoleaks or aneurysmal diameter enlargements more than 5 mm. In conclusion, single-stage TEVAR and EVAR procedures for multilevel aortic disease were found to be safe and feasible modalities for high-risk patients.

scholarly journals Salvage endovascular septectomy in patients with chronic abdominal aortic dissection after failed endovascular aneurysm repair

2019 ◽  
Vol 29 (4) ◽  
pp. 621-624
Author(s):  
Hui Zhuang ◽  
Fanggang Cai ◽  
Zhixian Wu ◽  
Tenghui Zhan ◽  
Hongyu Chen ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Abdominal Aorta ◽  
Endovascular Aneurysm Repair ◽  
False Lumen ◽  
Endovascular Aortic Repair ◽  
Study Cohort ◽  
Aortic Repair ◽  
Abdominal Aortic ◽  
Abdominal Aortic Dissection ◽  
Aneurysm Repair

Abstract This study aimed to investigate the efficacy and safety of salvage endovascular septectomy in patients with abdominal chronic aortic dissection (CAD) after endovascular aneurysm repair. A study cohort comprising 6 patients with chronic abdominal aortic dissection after failed endovascular aortic repair [mean age 62.5 (36–69) years] were enrolled to undergo salvage endovascular septectomy. The procedure involved entering the false lumen via the intrinsic visceral entry to perform a confined septectomy using a ‘Gigli wire’ to merge the true and false lumens. The outcomes were assessed by Digital angiography and computed tomography angiography. All 6 patients were successfully operated on; the diameters of the visceral abdominal aorta and the infrarenal abdominal aorta were similar at 1, 3, 6 and 12 months compared with the baseline; the patency of the visceral branch arteries was also stable at 1, 3, 6 and 12 months compared with the baseline; no occlusion of the visceral branch arteries was noted; no major vascular adverse events or deaths were observed. In this preliminary study, it was proven that salvage endovascular septectomy is a potentially advantageous technique that is safe and effective in the treatment of patients with CAD after failed endovascular aortic repair.

scholarly journals Predictive Factors and Strategies to Prevent the Development of Type 2 Endoleaks following Endovascular Aneurysm Repair

2020 ◽  
Vol 37 (04) ◽  
pp. 389-394
Author(s):  
Nicholas Voutsinas ◽  
Edward Kim ◽  
Robert A. Lookstein
Keyword(s):  
Endovascular Aneurysm Repair ◽  
Abdominal Aortic Aneurysms ◽  
Aortic Aneurysms ◽  
Endovascular Aortic Repair ◽  
Potential Complication ◽  
Aortic Repair ◽  
Abdominal Aortic ◽  
Patients At Risk ◽  
Aneurysm Repair

AbstractType 2 endoleaks are a potential complication of endovascular aortic repair for abdominal aortic aneurysms. They are caused by vessels that have been excluded from the aorta lumen, but may still fill the aneurysm sac due to collateral filling. Type 2 endoleaks may lead to increased morbidity and need for additional procedures. Being able to identify patients at risk for Type 2 endoleaks and prevent them is important for any physician who is performing endovascular aortic repair.

Thoracic Grafts May Be an Alternative in Abdominal Aortic Aneurysm with Hostile Neck Anatomy

2016 ◽  
Vol 19 (2) ◽  
pp. 082
Author(s):  
Mete Gursoy ◽  
Egemen Duygu ◽  
Idil Cakir ◽  
Abdulkadir Faruk Hokenek
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Endovascular Aneurysm Repair ◽  
Aneurysm Neck ◽  
Abdominal Aortic ◽  
Hostile Neck ◽  
Neck Anatomy ◽  
Thoracic And Abdominal ◽  
Aneurysm Repair ◽  
Neck Diameter

In cases with a proximal aneurysm neck diameter of higher than 28 mm, standard endovascular aneurysm repair is considered inappropriate. In the present study, we report a successful endovascular treatment using overlapped thoracic and abdominal grafts technique in a patient whose infrarenal aneurysm neck diameter is 38.1 mm.

scholarly journals Endograft Conformability in Fenestrated Endovascular Aneurysm Repair for Complex Abdominal Aortic Aneurysms

2020 ◽  
Vol 27 (5) ◽  
pp. 848-856
Author(s):  
Arne de Niet ◽  
Esmé J. Donselaar ◽  
Suzanne Holewijn ◽  
Ignace F. J. Tielliu ◽  
Jan Willem H. P. Lardenoije ◽  
...  
Keyword(s):  
Renal Artery ◽  
Endovascular Aneurysm Repair ◽  
Aortic Aneurysms ◽  
Left Renal Artery ◽  
Slice Thickness ◽  
Target Vessel ◽  
Abdominal Aortic ◽  
Custom Made ◽  
Aneurysm Repair ◽  
The Impact

Purpose: To compare the impact of 2 commercially available custom-made fenestrated endografts on patient anatomy. Materials and Methods: The records of 234 patients who underwent fenestrated endovascular aneurysm repair for abdominal aortic aneurysm from March 2002 to July 2016 in 2 hospitals were screened to identify those who had pre- and postoperative computed tomography angiography assessments with a slice thickness of ≤2 mm. The search identified 145 patients for further analysis: 110 patients (mean age 72.4±7.1 years; 94 men) who had been treated with the Zenith Fenestrated (ZF) endograft and 35 patients (mean age 72.3±7.3 years; 30 men) treated with the Fenestrated Anaconda (FA) endograft. Measurements included aortic diameters at the level of the superior mesenteric artery (SMA) and renal arteries, target vessel angles, target vessel clock positions, and the target vessel tortuosity index. Variables were tested for inter- and intraobserver agreement. Results: There was a good agreement between observers in all tested variables. The native anatomy changed in both groups after endograft implantation. In the ZF group, changes were seen in the angles of the celiac artery (p=0.012), SMA (p=0.022), left renal artery (LRA) (p<0.001), and the right renal artery (RRA) (p<0.001); the aortic diameter at the SMA level (p<0.001); and the LRA (p<0.001) and RRA (p<0.001) clock positions. In the FA group, changes were seen in the angles of the LRA (p=0.001) and RRA (p<0.001) and in the SMA tortuosity index (p=0.044). Between group differences in changes were seen for the aortic diameters at the SMA and renal artery levels (p<0.001 for both) and the LRA clock position (p=0.019). Conclusion: Both custom-made fenestrated endografts altered vascular anatomy. The data suggest a higher conformability of the Fenestrated Anaconda endograft compared with the Zenith Fenestrated.

In Vivo Fenestration During Endovascular Aneurysm Repair

2018 ◽  
Author(s):  
Abdulrahman Masrani ◽  
Bulent Arslan
Keyword(s):  
Renal Artery ◽  
Endovascular Aneurysm Repair ◽  
Aortic Aneurysms ◽  
Stent Grafting ◽  
Landing Zone ◽  
Aortic Neck ◽  
Abdominal Aortic ◽  
Custom Made ◽  
Aneurysm Repair

Abdominal aortic aneurysms have been managed endovascularly during the past 10–15 years. The main limitations in the ability to treat patients endovascularly are anatomical constraints. The most important factors are aortic neck and iliofemoral access anatomy. This chapter describes a technique to overcome a short neck with a renal artery originating from the aneurysm that does not allow enough proximal landing zone for stent grafting. Several techniques have been developed to overcome this obstacle, including custom-made grafts with fenestrations, back table fenestration, and parallel graft placement. This chapter discusses the in vivo graft fenestration technique to preserve the renal artery lumen during the endovascular repair of an abdominal aortic aneurysm.

Holographically-Guided Endovascular Aneurysm Repair

2019 ◽  
Vol 26 (4) ◽  
pp. 544-547 ◽  
Author(s):  
Paweł Rynio ◽  
Jan Witowski ◽  
Jakub Kamiński ◽  
Jakub Serafin ◽  
Arkadiusz Kazimierczak ◽  
...  
Keyword(s):  
Augmented Reality ◽  
Operating Time ◽  
Endovascular Aneurysm Repair ◽  
Endovascular Aortic Repair ◽  
3 Dimensional ◽  
Head Mounted Display ◽  
Aortic Repair ◽  
Abdominal Aortic ◽  
Lower Radiation Dose ◽  
Aneurysm Repair

Purpose: To demonstrate the feasibility of augmented reality visualization in planning and navigating endovascular aortic repair. Technique: A 77-year-old patient with abdominal aortic aneurysm was treated with endovascular repair. An augmented reality head-mounted display was used during the procedure. The aneurysm and bones were projected as 3-dimensional holograms. The operator controlled the device with gestures and voice commands (movement, rotation, cutting through, and zooming). Moreover, the hologram was placed in front of the angiography monitor and manually registered with fluoroscopy. Conclusion: Augmented reality with holographic rendering is feasible and helpful during endovascular aortic repair. Its routine use could possibly lead to shorter operating time, reduced contrast volume, and lower radiation dose; however, larger studies are required to obtain statistically significant results on the outcomes.

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