Thoracic Aortic Stent Grafting in Patients with Connective Tissue Disorders: A Word of Caution

2007 ◽  
Vol 2 (4) ◽  
pp. 184-187 ◽  
Author(s):  
Siamak Mohammadi ◽  
Jean-Pierre Normand ◽  
Pierre Voisine ◽  
François Dagenais
Keyword(s):  
Connective Tissue ◽  
Stent Graft ◽  
Balloon Dilatation ◽  
False Aneurysm ◽  
Type I ◽  
Connective Tissue Disorders ◽  
Stent Grafts ◽  
Descending Aorta ◽  
Stent Grafting ◽  
Marfan Patient

Objective Use of thoracic Stent-graft in patients with connective tissue disorders (CTD) remains limited. We herein report 3 patients with CTD who underwent stent grafting. Methods and Results Case 1; A male Marfan patient was operated for thoraco-abdominal aneurysm. On computed tomography (CT), large false aneurysm at the proximal anastomosis was documented which was excluded with a 30 mm Talent stent-graft with 10–15% oversize. Case 2; A female with Ehlers-Danlos syndrome had undergone resection of descending aortic thoracic aneurysm presented with an enlarging aneurysm distal to the graft. Three Talent stent-grafts (15% oversize) were deployed with balloon dilatation to exclude the aneurysm. The immediate postoperative period was complicated by an extensive intramural hematoma of the descending aorta with hemothorax, managed conservatively. Case 3; A female Marfan patient had undergone Bentall procedure and mitral repair followed with resection of the proximal descending aorta. Three months later a false aneurysm at the distal anastomosis was treated with a 24 mm Valiant stent-graft (30% oversize). Aortic dissection distal to stent was documented on the early postoperative CT. The dissected aneurysm enlarged significantly with a type I distal endoleak during follow-up. Concomitantly, the patient presented a class III dyspnea owing to a severe mitral regurgitation. The patient underwent a successful MVR and stent-graft explantation with replacement of the descending aorta. Conclusion Significant complications supervened when stent-grafts were deployed in native aorta. We thus recommend that deploying a stent-graft in a CTD diseased aorta should be considered a relative contraindication. In cases with prohibitive or high risk surgery, use of a stent-graft with minimal radial force and minimal oversizing without balloon dilatation should be considered.

Distribution of Air Embolization During TEVAR Depends on Landing Zone: Insights From a Pulsatile Flow Model

2019 ◽  
Vol 26 (4) ◽  
pp. 448-455 ◽  
Author(s):  
Vladimir Makaloski ◽  
Fiona Rohlffs ◽  
Constantin Trepte ◽  
E. Sebastian Debus ◽  
Bent Øhlenschlaeger ◽  
...  
Keyword(s):  
Stent Graft ◽  
Flow Model ◽  
Aortic Flow ◽  
Type I ◽  
Stent Grafts ◽  
Descending Aorta ◽  
Landing Zone ◽  
The Mean ◽  
The Right ◽  
Common Carotid Arteries

Purpose: To analyze the distribution of air bubbles in the supra-aortic vessels during thoracic stent-graft deployment in zones 2 and 3 in an aortic flow model. Materials and Methods: Ten identical, investigational, tubular, thoracic stent-grafts were deployed in a glass aortic flow model with a type I arch: 5 in zone 2 and 5 in zone 3. A pulsatile pump generated a flow of 5 L/min with systolic and diastolic pressures (±5%) of 105 and 70 mm Hg, respectively. The flow rates (±5%) were 300 mL/min in the subclavian arteries, 220 mL/min in the vertebral arteries, and 400 mL/min in the common carotid arteries (CCAs). The total amounts of air released in each supra-aortic branch and in the aorta were recorded. Results: The mean amounts of air measured were 0.82±0.23 mL in the zone-2 group and 0.94±0.28 mL in the zone-3 group (p=0.49). In the zone-2 group compared with zone 3, the amounts of released air were greater in the right subclavian artery (0.07±0.02 vs 0.02±0.02 mL, p<0.01) and right CCA (0.30±0.8 vs 0.18±07 mL, p=0.04). There were no differences between the groups concerning the mean amounts of air measured in the right vertebral and all left-side supra-aortic branches. The amount of air released in the descending aorta was significantly higher in the zone-3 group vs the zone-2 group (0.48±0.12 vs 0.13±0.08 mL, p<0.01). Small bubbles were observed continuously during deployment, whereas large bubbles appeared more commonly during deployment of the proximal stent-graft end and after proximal release of the stent-graft. Conclusion: Air is released into all supra-aortic branches and the descending aorta during deployment of tubular thoracic stent-grafts in zones 2 and 3 in an aortic flow model. Higher amounts of air were observed in right-side supra-aortic branches during deployment in zone 2, whereas significantly greater amounts of air were observed in the descending aorta during deployment in zone 3.

Acute Type A Aortic Dissection Treated Using a Tubular Stent-Graft in the Ascending Aorta and a Multibranched Stent-Graft in the Aortic Arch

2016 ◽  
Vol 24 (1) ◽  
pp. 75-80 ◽  
Author(s):  
Tilo Kölbel ◽  
Christian Detter ◽  
Sebastian W. Carpenter ◽  
Fiona Rohlffs ◽  
Yskert von Kodolitsch ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Stent Graft ◽  
Open Surgery ◽  
Type A ◽  
Ascending Aorta ◽  
Type I ◽  
Acute Type ◽  
Stent Grafts ◽  
Type A Aortic Dissection ◽  
Custom Made

Purpose: To describe the combined use of a tubular stent-graft for the ascending aorta and an inner-branched arch stent-graft for patients with acute type A aortic dissection. Technique: The technique to deploy these modular, custom-made stent-grafts is demonstrated in 2 patients with acute DeBakey type I aortic dissections and significant comorbidities precluding open surgery. Both emergent procedures were made possible by the availability of suitable devices manufactured for elective repair in other patients. After preliminary carotid-subclavian bypass, a long Lunderquist guidewire was introduced from the right femoral artery to the left ventricle for delivery of the Zenith Ascend and Zenith Branched Arch Endovascular Grafts under inflow occlusion. Bridging stent-grafts were delivered to the innominate and left common carotid arteries to connect to the 2 inner branches; the left subclavian artery was occluded. Both cases were technically successful and resulted in exclusion of the false lumen in the ascending aorta. The operating and fluoroscopy times did not exceed those of comparable elective procedures. The patients were rapidly extubated shortly after the procedure and without serious immediate complications. One patient survived 11 months with a satisfactory repair; the other succumbed to complications of recurrent pneumonia after 23 days. Conclusion: Endovascular treatment of patients with acute type A aortic dissection using a combination of tubular and branched stent-grafts in the ascending aorta is feasible and offers an alternative strategy to open surgery.

scholarly journals Beyond the Aortic Root: Staged Open and Endovascular Repair of Arch and Descending Aorta in Patients With Connective Tissue Disorders

2016 ◽  
Vol 101 (3) ◽  
pp. 906-912 ◽  
Author(s):  
Eric E. Roselli ◽  
Jay J. Idrees ◽  
Ashley M. Lowry ◽  
Khalil Masabni ◽  
Edward G. Soltesz ◽  
...  
Keyword(s):  
Connective Tissue ◽  
Endovascular Repair ◽  
Aortic Root ◽  
Connective Tissue Disorders ◽  
Descending Aorta

Type IIIb Endoleak After Endovascular Aneurysm Repair Using the Zenith Stent Graft

2019 ◽  
Vol 53 (6) ◽  
pp. 515-519
Author(s):  
Toshiya Nishibe ◽  
Toru Iwahashi ◽  
Kentaro Kamiya ◽  
Masaki Kano ◽  
Keita Maruno ◽  
...  
Keyword(s):  
Stent Graft ◽  
Endovascular Aneurysm Repair ◽  
Aneurysm Rupture ◽  
Type I ◽  
Stent Grafts ◽  
System Type ◽  
Type Iiib ◽  
Type I Endoleak ◽  
Aneurysm Repair

We present 3 cases of type IIIb endoleak after endovascular aneurysm repair (EVAR) using the Zenith stent graft system. Type III endoleak, like type I endoleak, is a high-pressure, high-risk leak that increases sac pressure up to or even above arterial pressure, and is associated with an increased frequency of open conversions or risk of aneurysm rupture. Type IIIb endoleak is rare but there is much concern that the incidence of type IIIb endoleak is likely to increase hereafter; the mechanism of type IIIb endoleak is deterioration of graft fabric in conjunction with stent sutures. Type IIIb endoleak is difficult to diagnose before rupture. The possibility of type IIIb endoleak should be highly suspected when the continued growth of an excluded aneurysm sac without direct radiologic evidence is observed during follow-up. Type IIIb endoleak can be repaired by relining of the stent graft with additional stent grafts.

Covered Stents for True Subclavian Aneurysms in Patients with Degenerative Connective Tissue Disorders

2003 ◽  
Vol 10 (3) ◽  
pp. 647-652 ◽  
Author(s):  
Karthikeshwar Kasirajan ◽  
Brian Matteson ◽  
John M. Marek ◽  
Mark Langsfeld
Keyword(s):  
Connective Tissue ◽  
Stent Graft ◽  
Subclavian Artery ◽  
Case Reports ◽  
The Other ◽  
Long Term Results ◽  
Covered Stents ◽  
Connective Tissue Disorders ◽  
Invasive Treatment ◽  
Cystic Medial Necrosis

Purpose: To report the endovascular repair of rare true aneurysms of the subclavian artery in patients with degenerative connective tissue disorders. Case Reports: Two patients, one with Marfan syndrome and the other with idiopathic cystic medial necrosis, presented with 3 subclavian artery aneurysms. A Wallgraft and 2 Viabahn covered stents were used to successfully exclude these aneurysms. After 3 months, the Wallgraft thrombosed, but the contralateral Viabahn remained patent at the most recent examination 13 months after treatment. The other patient with the unilateral aneurysm had a patent Viabahn stent-graft at 10 months. Conclusions: Patients with degenerative connective tissue disorders may benefit from less invasive treatment with stent-grafts. The more flexible Viabahn stent-graft may be better able to adapt to arterial tortuosity. However, the long-term results of this new technique have not yet been established.

Transapical Access for Antegrade Catheterization of the Inner Branches of an Arch Stent-Graft Deployed Distal to an Ascending Arch Stent-Graft

2018 ◽  
Vol 25 (5) ◽  
pp. 542-546 ◽  
Author(s):  
Yuk Law ◽  
Tilo Kölbel ◽  
Johannes Schirmer ◽  
Shadi Aleed ◽  
John Mogensen ◽  
...  
Keyword(s):  
Stent Graft ◽  
Aortic Rupture ◽  
Past History ◽  
Type I ◽  
Stent Grafts ◽  
Landing Zone ◽  
Aortic Repair ◽  
History Of ◽  
Arch Aneurysm ◽  
Transapical Access

Propose: To describe a technique for antegrade cannulation and bridging of the supra-aortic branches through a transapical access in the treatment of an arch aneurysm using combined ascending and branched arch stent-grafts. Technique: An 81-year-old man with a past history of open infrarenal aortic repair, emergent endovascular aortic repair for thoracic aortic rupture, and later perivisceral 4-vessel branched endovascular repair of type I thoracoabdominal aneurysm presented for repair of a concomitant 7.5-cm arch aneurysm. Because of a 44-mm ascending aorta, a tapered 50/44-mm ascending stent-graft was delivered through a transapical access to establish an adequate landing zone before implantation of a 46-mm inner branched arch device via a transfemoral route. Innominate and left subclavian arteries were antegradely cannulated and bridged through the existing transapical path. Conclusion: Our case demonstrates the feasibility of transapical access for cannulation of an arch branched device, while introducing the theoretical possibility of completing the entire procedure through a transapical access.

Midterm Outcomes of Thoracic Aortic Stent-Grafts: Complications and Imaging Techniques

2003 ◽  
Vol 10 (3) ◽  
pp. 494-504 ◽  
Author(s):  
Valérie Chabbert ◽  
Philippe Otal ◽  
Louis Bouchard ◽  
Philippe Soula ◽  
Tuan Tran Van ◽  
...  
Keyword(s):  
Stent Graft ◽  
Chest Radiography ◽  
Imaging Techniques ◽  
Traumatic Rupture ◽  
Entire Group ◽  
Stent Grafts ◽  
Elliptical Cross ◽  
Stent Grafting ◽  
Subgroup Analyses

Purpose: To evaluate the midterm outcomes of thoracic aortic stent-grafting and the performance of computed tomographic angiography (CTA), radiography, and magnetic resonance angiography (MRA) in endograft surveillance. Methods: Forty-seven patients with traumatic thoracic aortic ruptures (n=16), aneurysms (n=14), false aneurysms (n=3), penetrating ulcers (n=3), and dissections (n=11) treated with stent-grafts were monitored in follow-up using chest radiography and CTA in all patients and MRA in 23 patients. Two perpendicular maximal aortic diameters, the sum of these diameters, and the elliptical cross-sectional area were determined and compared to baseline for the entire group and in subgroup analyses according to lesion type. CTA, MRA, and radiography were compared for their ability to detect endoleak, monitor stent-graft configuration, and measure aortic diameters. Results: The mortality rate was 8.5%. Severe complications were observed in 14.8% (6% neurological complications); 12 (25.5%) patients had primary endoleaks. Over a mean 11-month follow-up (range 0.25–46 months), the aortic diameters decreased for all patients without endoleak (p<0.001). In the diameter/area subgroup analyses, only the traumatic rupture cohort demonstrated significant decreases in all 4 measurements. CTA and MRA measurements correlated well, but chest radiography was superior to both for visualizing stent-graft shape. In terms of endoleak detection, MRA missed only 1 (12.5%) endoleak (type II) seen on CTA; there were no false positive results with MRA. Conclusions: Morbidity and mortality observed after thoracic stent-grafting are acceptable. Radiography is better for monitoring stent-graft conformation, while CTA provides the best overall morphological information. The performance of MRA in endoleak detection is encouraging.

Deployment Finesse of the Cook Zenith Stent Graft

2018 ◽  
Author(s):  
John Fritz Angle
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Stent Graft ◽  
Evidence Based ◽  
Type I ◽  
Stent Grafts ◽  
Standards Of Practice ◽  
Abdominal Aortic ◽  
Type I Endoleak

For all abdominal aortic aneurysm endografts, the major challenge is minimizing the risk of a type I endoleak. Percutaneous placement of an abdominal aortic endograft has become a widely-performed procedure. With several devices available on the market, there are many device-specific and experience-based considerations in planning and performing these procedures safely and with good outcomes. Although not always evidence-based, reviewing some case-specific scenarios can introduce techniques or lead to standards of practice that reduce suboptimal outcomes or prevent complications in future procedures. This chapter discusses deployment finesse of the Cook Zenith Flex and Zenith LP stent grafts, but many of the described concepts apply to other abdominal endografts and even thoracic endograft procedures.

Type III Endoleak from a Thoracic Aortic Stent-Graft

2002 ◽  
Vol 9 (4) ◽  
pp. 535-538 ◽  
Author(s):  
Conrad Lange ◽  
Asbjørn Ødegård ◽  
Jan Lundbom ◽  
Staal Hatlinghus ◽  
Hans O. Myhre
Keyword(s):  
Stent Graft ◽  
Late Complication ◽  
Thoracoabdominal Aortic Aneurysm ◽  
Aortic Aneurysms ◽  
Stent Grafts ◽  
Stent Grafting ◽  
Thoracic Aortic Aneurysms ◽  
Type Iii ◽  
Aortic Stent Graft ◽  
Type V

Purpose: To present an as yet unreported late complication of an Excluder thoracic endograft. Case Report: A 78-year-old man underwent surgery for a ruptured type V thoracoabdominal aortic aneurysm in 1996. Four years later, an aneurysm was detected in the proximal thoracic aorta and repaired with 2 Excluder endoprostheses. At 12 months, computed tomography showed an increase in the aneurysm sac diameter and a type III endoleak, which was traced to a hole in the stent-graft fabric on arteriography. No fracture of the metal components was detected in the stent-grafts. Another Excluder device was implanted within the distal endograft. Satisfactory exclusion of the leak has been maintained for 6 months. Conclusions: The risk of type III leaks must be minimized before stent-grafting can be regarded as a routine procedure in the treatment of thoracic aortic aneurysms.

Stent-Graft Treatment of Pseudoaneurysms and Arteriovenous Fistulae in the Carotid Artery

Vascular ◽  
2006 ◽  
Vol 14 (3) ◽  
pp. 123-129 ◽  
Author(s):  
Claudio Schönholz ◽  
Zvonimir Krajcer ◽  
Juan Carlos Parodi ◽  
Esteban Mendaro ◽  
Christopher Hannegan ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Doppler Ultrasound ◽  
Stent Graft ◽  
Venous Catheter ◽  
Stent Grafts ◽  
Arteriovenous Fistulae ◽  
Autologous Vein ◽  
Graft Placement ◽  
Stent Grafting

The purpose of this study was to assess the safety and efficacy of stent-graft placement in the management of arteriovenous fistulae (AVF) and pseudoaneurysms (PAs) involving the carotid artery (CA). Twenty-two patients (16 men, 6 women) with a CA AVF ( n = 5) or PA ( n = 17) owing to a gunshot or stab wound, carotid endarterectomy, blunt trauma, a tumor, spontaneous dissection, or a central venous catheter were treated with percutaneous placement of stent grafts. The patients presented with tumor, bruit, headache, mouth and tracheostomy bleeding, transitory hemiparesis, seizure, or stroke. Diagnoses were made by using computed tomographic angiography (CTA) and digital subtraction angiography. Fourteen lesions were in the common CA; eight were in the internal CA. Homemade devices and stent grafts from a variety of manufacturers were employed. Follow-up evaluations included clinical, CTA, and Doppler ultrasound assessments. All patients had resolution of the PA or AVF. In one patient with a large petrous PA, acute occlusion of the CA developed after placement of three balloon-expandable stent grafts, but there were no neurologic complications because the circle of Willis was functional. During follow-up ranging from 2 months to 13 years, asymptomatic 90% stenosis owing to stent compression was observed on Doppler ultrasound and angiographic examinations in a patient with an autologous vein–covered stent graft in the internal CA. Three other patients died of causes unrelated to stent-graft placement. In all other patients, the stent graft remained patent. Our results indicate that stent grafting is an acceptable alternative to surgery in the treatment of AVF and PAs in the CA.

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