scholarly journals A Novel Endosurgical Prosthesis to Treat Thoracoabdominal Aortic Aneurysm in Complex Anatomy or Emergency Settings

Aorta ◽  
2020 ◽  
Vol 08 (02) ◽  
pp. 025-028
Author(s):  
Guglielmo Saitto ◽  
Antonio Scafuri ◽  
Saimir Kuci ◽  
Alfred Ibrahimi ◽  
Jacob Zeitani
Keyword(s):  
High Risk ◽  
Aortic Aneurysm ◽  
Endovascular Aneurysm Repair ◽  
Thoracoabdominal Aortic Aneurysm ◽  
Morbidity Rate ◽  
Emergency Setting ◽  
Principal Characteristic ◽  
Complex Anatomy ◽  
Endovascular Prosthesis ◽  
Custom Made

Abstract Background Despite improvements in operative techniques, open thoracoabdominal aortic aneurysm (TAAA) repair is complex and characterized by high mortality and morbidity rate. Less invasive techniques have been developed since 2005 for the treatment of TAAA. Unfortunately, many of these devices require custom fabrication, resulting in delay of many weeks until treatment can be delivered but crucial in critical emergency cases. We present a novel hybrid endovascular and surgical prosthesis, which was tested on five pigs, with the aim of reducing the barrier issues of endovascular therapy in such particular cases. Methods The principal characteristic of the proposed hybrid endovascular prosthesis is to combine a proximal and distal stented zones and, in between, a classical surgical blood tied Dacron prosthesis. The device was tested in five pigs where feasibility of implantation and acute postoperative outcomes were evaluated, including bleeding, bowel ischemia, renal function, and peripheral blood perfusion. Results In all cases, following laparotomy, the endoprosthesis was successfully implanted under fluoroscopy and the surgical prosthesis zone could be easily detected by the radio-opaque markers. No major bleeding or cardiac events occurred throughout preparation and implantation. One hour after prosthesis implantation and surgical anastomoses of all vessels were completed, normal urine output was registered, and no acidosis was detected. Conclusions This novel graft has shown ease of endoprosthesis and visceral vessels implantation without the need of thoracotomy or extracorporeal circulation and may be useful in an emergency setting or high risk and complex anatomy TAAA unsuitable for traditional endovascular aneurysm repair, or to avoid an excess waiting time for a “custom made” prosthesis. The great adaptability of this “hybrid” prosthesis in complex anatomy for the majority of TAAA could be important in high-risk patients and in some difficult situations, such as a high risk of imminent rupture.

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

2017 ◽  
Vol 25 (1) ◽  
pp. 16-20 ◽  
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.

Long-Term Results of Endovascular Aneurysm Repair with Aortouni-iliac Custom-Made Stent Grafts

Vascular ◽  
2006 ◽  
Vol 14 (3) ◽  
pp. 136-141 ◽  
Author(s):  
Albert G. Hakaim ◽  
W. Andrew Oldenburg ◽  
Ricardo Paz-Fumagalli ◽  
J. Mark McKinney ◽  
Louis Lau ◽  
...  
Keyword(s):  
High Risk ◽  
Aortic Aneurysm ◽  
Endovascular Aneurysm Repair ◽  
Abdominal Aortic Aneurysm Repair ◽  
Aneurysm Rupture ◽  
Long Term Results ◽  
Custom Made ◽  
The Mean ◽  
Aneurysm Repair ◽  
Aortic Aneurysm Repair

The purpose of this study was to review the outcome of endovascular abdominal aortic aneurysm repair (EVAR) using custom-made aortouni-iliac (AUI) devices with femorofemoral bypass. Between June 1999 and March 2001, 23 consecutive patients (1 female, 22 male) at high risk of open aortic aneurysm repair underwent EVAR with custom devices in an AUI configuration. The mean follow-up was 37 months (range 2–72 months), and the mean age was 76.8 years (range 67.5–88.7 years). Increased surgical risk was evidenced by 92% and 69% of patients with significant pulmonary or cardiac disease, respectively. The preoperative mean aneurysm diameter ( n = 23) 62 ± 8.2 mm was significantly greater than the postoperative diameter, ( n = 23) 54 ± 16.4 mm. Ten endoleaks occurred. Migration of the stent graft occurred in 9% ( n = 2). Secondary interventions were necessary in 23%, whereas tertiary interventions were required in 9%. Patients at high risk of open aneurysm repair received sufficient protection from aneurysm rupture with custom-made AUI devices.

Staged hybrid open and endovascular exclusion of a symptomatic thoracoabdominal aortic aneurysm in a high-risk patient

Vascular ◽  
2013 ◽  
Vol 22 (4) ◽  
pp. 280-285 ◽  
Author(s):  
Christine Chung ◽  
Rajesh Malik ◽  
Michael Marin ◽  
Peter Faries ◽  
Sharif Ellozy
Keyword(s):  
High Risk ◽  
Aortic Aneurysm ◽  
Hybrid Approach ◽  
High Risk Patient ◽  
Thoracoabdominal Aortic Aneurysm ◽  
The Elderly ◽  
Aortic Aneurysms ◽  
Risk Patient ◽  
Abdominal Aortic ◽  
Thoracic Aneurysms

Thoracoabdominal aortic aneurysms have a higher prevalence in the elderly, who are often poor surgical candidates. These extensive aneurysms may be lethal if left untreated. Conventional open repair has proven to be a major task, involving cardiopulmonary bypass, aortic cross-clamping and expeditious repair of an inaccessible structure involving two body cavities. Endovascular repair has become a viable option to treat isolated descending thoracic aneurysms and infrarenal abdominal aortic aneurysms. However, endovascular techniques alone have been less applicable for treating complex aortic aneurysms, including those involving visceral vessels. Therefore, a hybrid open and endovascular approach with visceral debranching has become an increasingly favorable alternative for patients with these complex conditions. We report a case in which a staged hybrid approach was used for successful exclusion of an extensive thoracoabdominal aortic aneurysm in a symptomatic, high-risk patient who would not have been an appropriate candidate for open surgical repair.

Complex Endovascular Aortic Repair With a Branched Endograft to Revascularize 5 Renovisceral Vessels and an Intercostal Artery in a Marfan Patient

2019 ◽  
Vol 26 (5) ◽  
pp. 736-741 ◽  
Author(s):  
Ahmed S. Eleshra ◽  
Giuseppe Panuccio ◽  
Fiona Rohlffs ◽  
Martin Scheerbaum ◽  
Nikolaos Tsilimparis ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Stent Graft ◽  
Thoracoabdominal Aortic Aneurysm ◽  
Renal Arteries ◽  
Endovascular Aortic Repair ◽  
Intercostal Artery ◽  
Maximum Diameter ◽  
Aortic Repair ◽  
Custom Made ◽  
Marfan Patient

Purpose: To report a case of thoracoabdominal aortic aneurysm (TAAA) repair treated with a multibranched stent-graft including a prophylactic branch for a large intercostal artery in a Marfan patient at risk for spinal cord ischemia (SCI). Case Report: A 43-year-old man with Marfan syndrome presented with a type IV thoracoabdominal aortic aneurysm (TAAA) and history of multiple previous cardiac and aortic operations over the past 28 years. The maximum diameter of the aneurysm was 60 mm. The patient had 2 right renal arteries and 2 reimplanted segmental arteries (1 occluded). With the goal of preserving both right renal arteries and the large intercostal artery, a 6-branch, custom-made stent-graft was planned and manufactured. Bilateral femoral and right brachial artery access was used. The intercostal artery was catheterized and connected to the retrograde branch from a femoral access. Final angiography and predischarge computed tomography angiography (CTA) showed unimpeded flow to all 6 target vessels. The patient was discharged on postoperative day 10 without clinical signs of SCI. Six-month follow-up CTA demonstrated exclusion of the TAAA and patency of all 6 branches. Conclusion: Multibranched endovascular aortic repair with a branch to a large intercostal artery was technically feasible and clinically successful.

scholarly journals Repair of Thoracoabdominal Aortic Aneurysm with Thrombosed Infrarenal Component: A Modified Hybrid Technique without Aortic Cross Clamping

2017 ◽  
Vol 2017 ◽  
pp. 1-6
Author(s):  
Hussam Abou-Al-Shaar ◽  
Khaled J. Zaza ◽  
Muhammad Anees Sharif ◽  
Samer Koussayer
Keyword(s):  
High Risk ◽  
Aortic Aneurysm ◽  
Thoracoabdominal Aortic Aneurysm ◽  
Hybrid Procedure ◽  
Single Stage ◽  
Hybrid Technique ◽  
Iliac Arteries ◽  
Aortic Clamping ◽  
Type Iii ◽  
Common Iliac Arteries

The authors report the successful repair of a Crawford type III thoracoabdominal aortic aneurysm (TAAA) with a thrombosed infrarenal component using a modified hybrid technique without aortic clamping in a high-risk patient. A 64-year-old male with a history of hypertension, diabetes, and severe chronic obstructive pulmonary disease presented with acute on chronic backache and bilateral short distance claudication. A computerized tomography scan demonstrated a large, nonleaking Crawford type III TAAA with thrombosed infrarenal component of the aneurysm. In addition, both common iliac arteries were occluded with the chronic thrombus. A single-stage, modified hybrid procedure involving an aortobifemoral bypass without aortic clamping, debranching of right renal, superior mesenteric, and celiac arteries as well as an endovascular repair of the thoracic aneurysm was performed. Unfortunately, despite a technically sound repair, the patient died postoperatively from a massive pulmonary embolism. TAAA with a thrombosed infrarenal aorta and bilateral common iliac arteries can be repaired using a single-stage modified hybrid procedure without aortic clamping in high-risk patients who cannot tolerate thoracotomy and aortic cross clamping.

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