A truly non-occlusive stent-graft moulding balloon for thoracic endovascular aortic repair

Abstract Endovascular treatment of thoracic aortic pathologies has recently progressed towards more proximal pathologies, including those of the aortic arch and ascending aorta where there is a higher risk for stent-graft migration during the deployment or the moulding procedure due to the beating and ejecting heart. Typical measures to prevent dislodgement of the balloon or the stent-graft during the procedure are rapid pacing or pharmacologically induced hypotension. We present a circular and fully non-occlusive stent-graft moulding balloon that does not require any reduction of cardiac output or hypotension during inflation, moulding and deflation of the balloon.

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Feasibility of the Endovascular Treatment of the Ascending Aorta and the Aortic Arch in Stanford type A Aortic Dissections

Annals of Vascular Surgery ◽

10.1016/j.avsg.2018.08.026 ◽

2018 ◽

Vol 53 ◽

pp. 14

Author(s):

Aude Grognet ◽

Antoine Millon ◽

Fadi Farhat (CHU Lyon) ◽

Jean-Pierre Favre ◽

Manuela Cherchi ◽

...

Keyword(s):

Endovascular Treatment ◽

Aortic Arch ◽

Type A ◽

Ascending Aorta ◽

Aortic Dissections

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Handmade stent graft fenestration to preserve left subclavian artery in thoracic endovascular aortic repair†

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezz049 ◽

2019 ◽

Vol 56 (3) ◽

pp. 587-594 ◽

Cited By ~ 5

Author(s):

Huey-Shiuan Kuo ◽

Jih-Hsin Huang ◽

Jer-Shen Chen

Keyword(s):

Carotid Artery ◽

Stent Graft ◽

Subclavian Artery ◽

Common Carotid Artery ◽

Left Subclavian Artery ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Technical Success ◽

Aortic Stent Graft ◽

Aortic Pathologies

Abstract OBJECTIVES This study aimed to evaluate the efficacy and safety of a handmade fenestrated stent graft over an aortic stent graft for preserving the left subclavian artery (LSA) in thoracic endovascular aortic repair (TEVAR). METHODS From July 2015 to October 2018, a total of 32 consecutive patients with various thoracic aortic pathologies who underwent TEVAR in which handmade fenestration over a thoracic aortic stent graft was used for LSA were included. Outcomes including technical success, procedure-related complications, perioperative mortality and morbidity and graft patency were analysed. RESULTS Twenty-four patients (75.00%) presented with aortic dissection, 5 patients (15.63%) with thoracic aortic aneurysm and 2 patients (6.25%) with penetrating aortic ulcer; 1 patient (3.13%) required re-TEVAR due to endoleak and sac expansion from previous TEVAR for thoraco-abdominal aneurysm. TEVAR was performed in a zone 2 landing with single fenestration for LSA (26 patients, 81.25%), zone 1 landing with double fenestration for both LSA and left common carotid artery (5 patients, 15.63%) or zone 1 landing with single fenestration for LSA and a chimney graft for left common carotid artery (1 patient, 3.13%). The technical success rate, defined as the successful alignment of fenestration to LSA, was 93.75%. At a mean follow-up of 17.3 months, 4 cases of endoleak and 2 cases of stent graft-induced new entry were noted, 3 of which were treated endovascularly. CONCLUSIONS Our preliminary results demonstrate the viability of preserving LSA blood flow in TEVAR using a handmade stent graft fenestration to treat various aortic pathologies in various clinical situations and the technical feasibility and short-term results that may justify the use of this method in emergency cases.

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A 3-Dimensional Printed Aortic Arch Template to Facilitate the Creation of Physician-Modified Stent-Grafts

Journal of Endovascular Therapy ◽

10.1177/1526602818792266 ◽

2018 ◽

Vol 25 (5) ◽

pp. 554-558 ◽

Cited By ~ 10

Author(s):

Pawel Rynio ◽

Arkadiusz Kazimierczak ◽

Tomasz Jedrzejczak ◽

Piotr Gutowski

Keyword(s):

Aortic Arch ◽

Stent Graft ◽

Left Subclavian Artery ◽

Thoracic Endovascular Aortic Repair ◽

Stent Grafts ◽

Landing Zone ◽

3 Dimensional ◽

Improve Accuracy ◽

3D Printed ◽

Radiopaque Markers

Purpose: To demonstrate the utility of a 3-dimensional (3D) printed template of the aortic arch in the construction of a fenestrated and scalloped physician-modified stent-graft (PMSG). Case Report: A 73-year-old woman with descending thoracic aneurysm was scheduled for thoracic endovascular aortic repair after being disqualified for open surgery. Computed tomography angiography (CTA) revealed no proximal landing zone as the aneurysm began from the level of the left subclavian artery, so a fenestrated/scalloped PMSG was planned. To facilitate accurate placement of the openings in the graft, a 3D printed aortic arch template was prepared from the CTA data and gas sterilized. In the operating room, a Valiant stent-graft was inserted into the 3D printed template and deployed. Using ophthalmic cautery, a fenestration and a scallop were created; radiopaque markers were added. The PMSG was successfully deployed with no discrepancy between the openings and the target vessels. Conclusion: A 3D printed aortic arch template facilitates handmade fenestrations and scallops in PMSGs and may improve accuracy and quality.

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Morphometric Study of the Aortic Arch, with Application to the Endovascular Treatment of Aortic Pathologies

Annals of Vascular Surgery ◽

10.1016/j.avsg.2015.06.023 ◽

2015 ◽

Vol 29 (6) ◽

pp. 1052

Author(s):

Elie Girsowicz ◽

Yannick Georg ◽

Mickael Ohana ◽

Fabien Thaveau ◽

Nabil Chakfe

Keyword(s):

Endovascular Treatment ◽

Aortic Arch ◽

Morphometric Study ◽

Aortic Pathologies

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Outcomes of single physician-modified fenestrated stent grafts for endovascular repair of thoracic aortic lesions involving the distal aortic arch

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivaa295 ◽

2020 ◽

Author(s):

Jiechang Zhu ◽

Chao Ma ◽

Xiangchen Dai ◽

Zheng Wang ◽

Hailun Fan ◽

...

Keyword(s):

Aortic Arch ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Acute Type ◽

Type B ◽

Stent Grafts ◽

Aortic Repair ◽

Type B Dissection ◽

Aortic Pathologies ◽

Aortic Lesions

Abstract OBJECTIVES Our goal was to evaluate the outcomes of fenestrated thoracic endovascular aortic repair of thoracic aortic lesions involving the distal aortic arch using single physician-modified stent grafts. METHODS This single-centre, retrospective study included 58 consecutive patients (mean age, 57 ± 14 years; 11 women) who underwent fenestrated thoracic endovascular aortic repair for thoracic aortic pathologies involving the distal aortic arch using single physician-modified stent grafts between November 2015 and December 2018. Indications included complicated acute type B dissection or intramural haematoma with an unfavourable proximal landing zone (n = 49), type Ia endoleak subsequent to thoracic endovascular aortic repair due to acute type B dissection (n = 1) and distal arch degenerative aneurysms <15 mm from the left subclavian artery (n = 8). RESULTS The technical success rate was 94.8%. The 30-day mortality was 1.7%, and the perioperative ischaemic stroke rate was 1.7%. The incidence of perioperative complications was 10.3%. At a mean follow-up of 26.3 months (range, 7–44), all target vessels were patent. All-cause mortality was 5.2%. Estimated 1-, 2- and 3-year survival was 98.3 ± 1.7%, 96.4 ± 2.5% and 93.2 ± 3.9%, respectively. CONCLUSION The single fenestrated stent graft technique is feasible and effective for endovascular repair of thoracic aortic pathologies involving the distal aortic arch.

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