scholarly journals In-hospital and mid-term outcome after complex endovascular aortic repair with fenestrated and branched stent-grafts

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
V Makaloski ◽  
D Broger ◽  
S Weiss ◽  
S Jungi ◽  
D Becker ◽  
...  
Keyword(s):  
Stent Graft ◽  
Renal Arteries ◽  
Aortic Aneurysms ◽  
Endovascular Aortic Repair ◽  
Mesenteric Arteries ◽  
Hospital Death ◽  
Stent Grafts ◽  
Term Outcome ◽  
Aortic Repair

Abstract Objective The aim of the study is to evaluate in-hospital and mid-term outcome after complex endovascular aortic repair with fenestrated and branched stent-grafts (fEVAR / bEVAR). Methods This is a single-center retrospective analysis from a prospectively collected database of all patients treated electively with fEVAR or bEVAR for para/suprarenal (PAA) and thoraco-abdominal aortic aneurysm (TAAA) between September 2010 and June 2019. In-hospital and mid-term mortality, major adverse events and re-interventions were assessed. Results Fifty-one patient (84% male) with a mean age of 74±7 years were analysed. Eighteen patients (35%) had TAAA, four patients (8%) suprarenal, and 29 patients (57%) pararenal aortic aneurysms. Mean aneurysm diameter was 64±8 mm. Thirty-eight patients (75%) underwent fEVAR and 13 patients (25%) bEVAR. A total of 157 target vessels were incorporated: 22 celiac trunks (CT), 40 superior mesenteric arteries (SMA), 92 renal arteries (RA), two separate hepatic arteries and one splenic artery. No in-hospital death or stroke was recorded. One patient suffered from early postoperative paraplegia and did not recover and one had paraparesis after 38 days and recovered completely. Six patients (12%) with patent renal arteries experienced acute postoperative kidney injury; one required temporary dialysis. Five in-hospital re-interventions were stent-graft related (four bridging stents angioplasty and one iliac leg extension) and seven re-interventions were not stent-graft related. Mean follow-up was 19±17 months. Eleven patients (22%) died during follow-up: nine were not aortic-related and two were unknown. The Kaplan-Meier estimated survival rates at 1 and 2 years were 81% and 77%, respectively. Five renal stents (5%, 5/92) occluded during follow-up: three were successfully recanalized and two remained occluded. Ten stents (three CT, five SMA, and two RA stents required relining after 13±16 months postoperatively, resulting with estimated primary assisted patency at 2 years of 100%, 100%, 93%, and 95% for the CT, SMA, right RA and left RA, respectively. Conclusion Complex endovascular aortic repair with fEVAR / bEVAR for PAA and TAAA is safe with very low early mortality and morbidity. In-stent stenosis/occlusions occurred within the first two years. However, primary assisted patency was high. A surveillance program to detect potential stent-graft related complications is mandatory.

scholarly journals Endovascular repair of aortic aneurysm: Preliminary results

2009 ◽  
Vol 137 (1-2) ◽  
pp. 10-17 ◽  
Author(s):  
Lazar Davidovic ◽  
Momcilo Colic ◽  
Igor Koncar ◽  
Dejan Markovic ◽  
Dusan Kostic ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Stent Graft ◽  
Endovascular Aneurysm Repair ◽  
Aortic Aneurysms ◽  
Endovascular Stent ◽  
Stent Grafts ◽  
Graft Thrombosis ◽  
Abdominal Aortic

Introduction. Endovascular aneurysm repair (EVAR) has been introduced into clinical practice at the beginning of the 90's of the last century. Because of economic, political and social problems during the last 25 years, the introduction of this procedure in Serbia was not possible. Objective. The aim of this study was to present preliminary experiences and results of the Clinic for Vascular Surgery of the Serbian Clinical Centre in Belgrade in endovascular treatment of thoracic and abdominal aortic aneurysms. Methods. The procedure was performed in 33 patients (3 female and 30 male), aged from 42 to 83 years. Ten patients had a descending thoracic aorta aneurysm (three atherosclerotic, four traumatic - three chronic and one acute as a part of polytrauma, one dissected, two penetrated atherosclerotic ulcers), while 23 patients had the abdominal aortic aneurysm, one ruptured and two isolated iliac artery aneurysms. The indications for EVAR were isthmic aneurismal localisation, aged over 80 years and associated comorbidity (cardiac, pulmonary and cerebrovasular diseases, previous thoracotomy or multiple laparotomies associated with abdominal infection, idiopatic thrombocitopaenia). All of these patients had three or more risk factors. The diagnosis was established using duplex ultrasonography, angiography and MSCT. In the case of thoracic aneurysm, a Medtronic-Valiant? endovascular stent graft was implanted, while for the abdominal aortic aneurysm Medtronic-Talent? endovascular stent grafts with delivery systems were used. In three patients, following EVAR a surgical repair of the femoral artery aneurysm was performed, and in another three patients femoro-femoral cross over bypass followed implantation of aortouniiliac stent graft. Results. During procedure and follow-up period (mean 1.6 years), there were: one death, one conversion, one endoleak type 1, six patients with endoleak type 2 that disappeared during the follow-up period, one early graft thrombosis. No other complications, including aneurysm expansion, collapse, deformity and migration of the endovascular stent grafts, were registered. Conclusion. According to all medical and economic aspects, we recommend EVAR to treat acute traumatic thoracic aortic aneurysm, as well as in elderly and high-risk patients with abdominal or thoracic aneurysms, when open surgery is related to a significantly higher mortality and morbidity.

Hybrid treatment of a post-EVAR aortoenteric fistula

Vascular ◽  
2013 ◽  
Vol 22 (5) ◽  
pp. 385-389 ◽  
Author(s):  
Karl Sörelius ◽  
Magnus Sundbom ◽  
Kevin Mani ◽  
Anders Wanhainen
Keyword(s):  
Stent Graft ◽  
Endovascular Aortic Repair ◽  
Aortoenteric Fistula ◽  
Flap Coverage ◽  
Hybrid Treatment ◽  
Aortic Repair ◽  
Aneurysm Wall ◽  
Local Antibiotic ◽  
Acute Event

This report presents a case of secondary aortoenteric fistula after endovascular aortic repair in a fragile patient: The fistula developed due to aneurysm shrinkage and remodeling of the stent graft, resulting in a kink eroding through the aneurysm wall into the duodenum. The aortoenteric fistula was successfully treated with a hybrid procedure with endovascular aortic repair, followed by open enteroraphy and omental flap coverage of the stent graft and local antibiotic irrigation. Despite the presence of the stent graft in a previously infected field, the patient has recovered from the acute event with no septic recurrence or hemorrhage during four years of follow-up.

Outcomes of open and endovascular repair of inflammatory abdominal aortic aneurysms

Vascular ◽  
2017 ◽  
Vol 26 (2) ◽  
pp. 203-208 ◽  
Author(s):  
África Duque Santos ◽  
Andrés Reyes Valdivia ◽  
María Asunción Romero Lozano ◽  
Enrique Aracil Sanus ◽  
Julia Ocaña Guaita ◽  
...  
Keyword(s):  
Open Surgery ◽  
Aortic Aneurysms ◽  
Endovascular Aortic Repair ◽  
Abdominal Aneurysm ◽  
Aortic Abdominal Aneurysm ◽  
Aortic Repair ◽  
Number Of Patients ◽  
Repair Group

Objective Reports on inflammatory aortic abdominal aneurysm treatment are scarce. Traditionally, open surgery has been validated as the gold standard of treatment; however, high technical skills are required. Endovascular aortic repair has been suggested as a less invasive treatment by some authors offering good results. The purpose of our study was to report our experience and outcomes in the treatment of inflammatory aortic abdominal aneurysm using both approaches. Material and methods A retrospective review and data collection of all patients treated for inflammatory aortic abdominal aneurysm between 2000 and 2015 was done in one academic center. Diagnosis of inflammatory aortic abdominal aneurysm was based on preoperative CT-scan imaging. Type of treatment, postoperative and long-term morbidity and mortality are described. Abdominal compressive symptoms (hydronephrosis) severity and relief after treatment are described. Results Thirty-four patients with intact inflammatory aortic abdominal aneurysm were included. Twenty-nine (85.3%) patients were treated by open means and the remaining five (14.7%) with endovascular aortic repair. Nearly 90% were considered high-risk patients. Median follow-up was 46 months (range 24–112). The two groups were comparable, except for the age and preoperative hydronephrosis. There was no statistical significance in blood transfusion requirements, intensive care hospitalization, 30-day and long-term mortality between the two groups. Preoperative hydronephrosis was diagnosed in four (13.8%) patients in the open surgery group and three (60%) patients in the endovascular aortic repair group. Improvement of hydronephrosis was recognized in three out of the four patients in the open repair group and two out of the three in the endovascular aortic repair group. Renal function remained stable in both groups during follow-up. Conclusions Open surgery remains a safe and valid option for the treatment of inflammatory aortic abdominal aneurysm. Although our study included a small number of patients with endovascular aortic repair treatment, results are promising. Further randomized controlled studies may be necessary to assess long-term effectiveness of endovascular aortic repair treatment in this disease.

Novel Application of Custom-Made Stent Grafts with Inner Branches for Secondary Treatment After Stent Graft Migration of Previous Infrarenal Endovascular Aortic Repair

2020 ◽  
Vol 66 ◽  
pp. 665.e9-665.e15
Author(s):  
Mario D'Oria ◽  
Filippo Griselli ◽  
Davide Mastrorilli ◽  
Francesco Riccitelli ◽  
Filippo Gorgatti ◽  
...  
Keyword(s):  
Stent Graft ◽  
Endovascular Aortic Repair ◽  
Secondary Treatment ◽  
Stent Grafts ◽  
Aortic Repair ◽  
Custom Made ◽  
Graft Migration

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 Thoracic endovascular aortic repair with branched Inoue Stent Graft for arch aortic aneurysms

2017 ◽  
Vol 66 (5) ◽  
pp. 1340-1348.e5 ◽  
Author(s):  
Junichi Tazaki ◽  
Kanji Inoue ◽  
Hirooki Higami ◽  
Nobuya Higashitani ◽  
Masanao Toma ◽  
...  
Keyword(s):  
Stent Graft ◽  
Thoracic Endovascular Aortic Repair ◽  
Aortic Aneurysms ◽  
Endovascular Aortic Repair ◽  
Aortic Repair

High Wall Stress May Predict the Formation of Stent-Graft–Induced New Entries After Thoracic Endovascular Aortic Repair

2018 ◽  
Vol 25 (5) ◽  
pp. 571-577 ◽  
Author(s):  
Claudia Menichini ◽  
Selene Pirola ◽  
Baolei Guo ◽  
Weiguo Fu ◽  
Zhihui Dong ◽  
...  
Keyword(s):  
Stent Graft ◽  
Large Population ◽  
False Lumen ◽  
Wall Stress ◽  
Ct Images ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Aortic Repair ◽  
Type B Dissection

Purpose: To explore the potential role of morphological factors and wall stress in the formation of stent-graft–induced new entries (SINE) based on computed tomography (CT) images after thoracic endovascular aortic repair (TEVAR). Case Report: Two female patients aged 59 years (patient 1) and 44 years (patient 2) underwent TEVAR for type B dissection in the chronic (patient 1) or subacute (patient 2) phase. CT scans at 3-month follow-up showed varying degrees of false lumen thrombosis in both patients. At 14-month follow-up, a SINE was observed in patient 1 while the dissected aorta in the other patient remained stable. Morphological and finite element analyses were performed based on the first follow-up CT images. The computational results showed that the SINE patient had higher stent-graft tortuosity than the non-SINE patient and much higher wall stress in the region close to the distal SINE. Conclusion: This case study suggests that high stent-graft tortuosity can lead to high wall stress, which is potentially linked to the formation of SINE. Further large population-based studies are needed to confirm this preliminary finding.

Endovascular Repair of a Thoracoabdominal Aortic Aneurysm With a Patient-Specific Fenestrated-Branched Stent-Graft

2017 ◽  
Vol 24 (5) ◽  
pp. 665-669 ◽  
Author(s):  
Bernardo C. Mendes ◽  
Lawrence E. Greiten ◽  
Gustavo S. Oderich
Keyword(s):  
Computed Tomography ◽  
Aortic Aneurysm ◽  
Stent Graft ◽  
Open Repair ◽  
Thoracoabdominal Aortic Aneurysm ◽  
Renal Arteries ◽  
Mesenteric Arteries ◽  
Patient Specific ◽  
Technical Aspects

Purpose: To describe the technical aspects of a thoracoabdominal aortic aneurysm (TAAA) repair using a patient-specific fenestrated-branched stent-graft. Technique: The technique is demonstrated in a 69-year-old man with a 6.2-cm asymptomatic type III TAAA. A patient-specific fenestrated-branched stent-graft was designed with 2 down-going directional branches for the celiac and superior mesenteric arteries and 2 reinforced fenestrations for the renal arteries. The procedure was performed under general anesthesia and included sequential stenting of the celiac, superior mesenteric, and bilateral renal arteries. The patient was discharged from the hospital on postoperative day 5 with no complications. Follow-up computed tomography angiography demonstrated exclusion of the aneurysm and patent target vessels at 12-month follow-up. Conclusion: This article and illustrated video highlight the steps for procedure planning and implantation of fenestrated and branched endografts. As these techniques continue to evolve, outcomes are expected to be equivalent or improved as compared to those of long-established open repair.

Fenestrated and Branched Endovascular Aortic Repair of Thoracoabdominal Aortic Aneurysm With More Than 4 Target Visceral Vessels due to Renovisceral Arterial Anatomical Variations: Feasibility and Early Results

2021 ◽  
pp. 152660282110164
Author(s):  
Ahmed Eleshra ◽  
Giuseppe Panuccio ◽  
Konstantinos Spanos ◽  
Fiona Rohlffs ◽  
Nikolaos Tsilimparis ◽  
...  
Keyword(s):  
Anatomical Variations ◽  
Celiac Artery ◽  
Renal Arteries ◽  
Aortic Aneurysms ◽  
Endovascular Aortic Repair ◽  
Technical Success ◽  
Early Results ◽  
The Mean ◽  
Accessory Renal Arteries

Purpose: This study describes technical success, feasibility, and early results of fenestrated and branched endovascular aortic repair (F/B-EVAR) for treatment of thoracoabdominal aortic aneurysms (TAAAs) or pararenal aneurysms with more than 4 target visceral vessels (TVs) due to renovisceral arterial anatomical variations. Materials and Methods: Patients with TAAAs or pararenal aortic aneurysms who had more than 4 TVs due to renovisceral arterial anatomical variations of renal, celiac, and/or superior mesenteric arteries and received F/B-EVAR between January 2017 and September 2019 at a single aortic center were included in this study. We analyzed technical success, feasibility, and early outcomes. Results: Twelve patients (mean age 70±10 years, 9 males) were included. The anatomical variations included 6 right accessory renal arteries, 8 left accessory renal arteries, and 1 celiac artery variant. Stent-grafts were fenestrated, branched or combined in 6, 5, or 1 patients, respectively. The mean operating time was 346±120 minutes, the mean fluoroscopy time was 80±29 minutes, and the mean radiation dose area product was 430±219 Gy·cm2. The mean contrast volume was 129±45 mL. The total number of TVs was 64; 5 TVs in 9 patients, 6 in 2 patients, and 7 in 1 patient. Technical success was achieved in all cases. The mean intensive care unit stay was 6±5 days, and the mean total hospital stay was 14±10 days. One patient died early (30-day). Early morbidities included respiratory complication in 1 patient, renal insufficiency in 1 patient, and wound infection in 2 patients. No spinal cord ischemia, stroke, or bowel ischemia occurred. Early computed tomography angiography showed 100% patency of the bridging covered stents and TVs. The mean follow-up was 13±4.3 months. No mortality or adverse major event occurred during the follow-up. Two patients with developed type Ic endoleak related to 1 right renal artery and 1 celiac artery covered stent. Patency of the TVs during follow-up was 100%. Conclusion: The use of F/B-EVAR for the treatment of TAAA with more than 4 TVs due to renovisceral arterial anatomical variations in our own experience is feasible and not related to increased morbidity and mortality.

Impact of Lymphocyte-Related Blood Parameters on Short- and Long-Term Outcomes of Patients Undergoing Thoracic Endovascular Aortic Repair

Angiology ◽  
2021 ◽  
pp. 000331972110125
Author(s):  
Fan Yang ◽  
Jitao Liu ◽  
Lyufan Chen ◽  
Ruixin Fan ◽  
Hongke Zeng ◽  
...  
Keyword(s):  
Blood Parameters ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Hospital Death ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Inflammatory Status ◽  
Aortic Repair ◽  
Short And Long Term

Lymphocyte-related blood parameters (LRBP), including neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio, and lymphocyte-monocyte ratio, could reflect a patient’s overall inflammatory status. We aimed to clarify the association between preoperative LRBP and outcomes of type B aortic dissection (TBAD) patients undergoing thoracic endovascular aortic repair (TEVAR). A total of 841 patients were enrolled from 2010 to 2017. Twenty-six (3.1%) patients died during hospitalization and 71 (8.7%) patients died after a median follow-up of 47.3 months. Multivariate analyses showed that the NLR was the only independent predictor for in-hospital death (odds ratio, 1.15; 95% confidence interval [CI], 1.09-1.22; P < .001); 4.1 was identified as the optimum threshold for NLR after applying the X-tile program. Propensity score matching (PSM) was performed to diminish bias and yielded 174 matched pairs. Neutrophil-lymphocyte ratio >4.1 was demonstrated to be independently associated with follow-up mortality before (hazard ratio [HR], 2.53; 95% CI, 1.44-4.43; P = .001) and after PSM (HR, 3.11; 95% CI, 1.35-7.15; P = .008). The relationship between LRBP and follow-up reintervention or stroke were not significant ( P > .05 for both). Elevated NLR was an independent indicator for in-hospital and follow-up mortality in patients with TBAD undergoing TEVAR; this might provide additional risk stratification.

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