Endoanchor stenting for the repair of a Type I endoleak in the aortic arch following the endovascular repair of a Kommerrell's diverticulum

2016 ◽  
Vol 31 (8) ◽  
pp. 541-543 ◽  
Author(s):  
Rohan S. Menon ◽  
Corbin Muetterties ◽  
George William Moser ◽  
Grayson H. Wheatley
Keyword(s):  
Aortic Arch ◽  
Endovascular Repair ◽  
Type I ◽  
Type I Endoleak

Homemade Fenestrated Stent-Grafts for Complete Endovascular Repair of Aortic Arch Dissections

2019 ◽  
Vol 26 (5) ◽  
pp. 645-651 ◽  
Author(s):  
Ludovic Canaud ◽  
Baris Ata Ozdemir ◽  
Lucien Chassin-Trubert ◽  
Julien Sfeir ◽  
Pierre Alric ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Stent Graft ◽  
Endovascular Repair ◽  
Covered Stent ◽  
Type I ◽  
Type Ii ◽  
Stent Grafts ◽  
Fenestrated Stent Graft ◽  
Type I Endoleak

Purpose: To evaluate outcomes of homemade fenestrated stent-grafts for complete endovascular aortic repair of aortic arch dissections. Materials and Methods: From July 2014 through September 2018, 35 patients (mean age 66±11 years; 25 men) underwent homemade fenestrated stent-graft repair of acute (n=16) or chronic (n=10) complicated type B aortic dissections (n=16) and dissecting aortic arch aneurysms subsequent to surgical treatment of acute type A dissections (n=9). Nineteen (54%) procedures were emergent. Results: Zone 2 single-fenestrated stent-grafts were used in 25 cases; the remaining 10 were double-fenestrated stent-grafts deployed in zone 0. Median time for stent-graft modification was 18 minutes (range 16–20). Technical success was achieved in all cases. An immediate distal type I endoleak was treated intraoperatively. Among the double-fenestrated stent-graft cases, the left subclavian artery fenestration could not be cannulated in 2 patients and revascularization was required. Partial coverage of the left common carotid artery necessitated placement of a covered stent in 3 cases. One (3%) patient had a stroke without permanent sequelae. Two type II endoleaks required additional covered stent placement at 5 and 7 days postoperatively, respectively. The 30-day mortality was 6% (2 patients with ruptured aortic arch aneurysm). During a mean follow-up of 17.6±13 months, there was no aortic rupture or retrograde dissection. One late type I endoleak was treated with additional proximal fenestrated stent-graft placement. One type II endoleak is currently under observation. One additional patient died (unrelated to the aorta); overall mortality was 9%. All supra-aortic trunks were patent. Conclusion: The use of homemade fenestrated stent-grafts for endovascular repair of aortic arch dissections is feasible and effective for total endovascular aortic arch repair. Durability concerns will need to be assessed in additional studies with long-term follow-up.

Application of an extracorporeal prefenestrated stent graft in endovascular repair of ascending aorta and aortic arch lesions

Vascular ◽  
2020 ◽  
pp. 170853812095087
Author(s):  
Liang Wang ◽  
Lei Bai ◽  
Yujing Zhang ◽  
Jianglong Liu ◽  
Xiaodong Li
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Endovascular Repair ◽  
Spinal Cord Ischemia ◽  
False Lumen ◽  
Ascending Aorta ◽  
Type I ◽  
Stent Grafting ◽  
Surgical Methods ◽  
Type I Endoleak

Objectives Aortic dissection involving the ascending aorta and aortic arch is a serious condition. Treatment using traditional surgical methods has certain disadvantages. This study investigated the effectiveness of thoracic endovascular repair of aortic dissection using an external prefenestrated stent. Methods We present a series of aortic dissection cases involving the ascending aorta and aortic arch treated with an external prefenestrated stent. Results Postoperative follow-up of the patients showed that all stents were released at the proper position and that branch vessels were not occluded, and there were no instances of type I endoleak. One patient died suddenly one week after surgery; another experienced retrograde type A aortic dissection in the second week; and type I endoleak occurred in one patient in the first week, although this resolved within six months. No serious complications such as cerebrovascular events, acute spinal cord ischemia, and paraplegia occurred during the perioperative period. All patients had false lumen thrombosis in the ascending aorta and aortic arch. Conclusion Prefenestrated stent grafting is a feasible treatment option for repairing an entry tear in the ascending aorta.

Type I Endoleak Five Year after Endovascular Repair of Abdominal Aortic Aneurysm

2011 ◽  
Vol 27 (2) ◽  
pp. 76-79 ◽  
Author(s):  
Ei Jun Park ◽  
Hyoung Tae Kim ◽  
Won Hyun Cho ◽  
Young Hwan Kim
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Endovascular Repair ◽  
Type I ◽  
Abdominal Aortic ◽  
Type I Endoleak

scholarly journals Traumatic Thoracic Aorta Injuries: Outcomes up to 15 years Post Thoracic Endovascular Aortic Repair

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Varun J Sharma
Keyword(s):  
Endovascular Repair ◽  
Motor Vehicle ◽  
Common Mechanism ◽  
High Morbidity ◽  
Type I ◽  
Graft Thrombosis ◽  
Hand Ischemia ◽  
Aortic Injuries ◽  
Type I Endoleak

Background Aortic injuries are one of the leading causes of death following trauma, with a 75% pre-hospital and 50% in-hospital mortality. Endovascular repair is technically easier with fewer complications, but unproven in the long term. Methods Retrospective analysis of patients who underwent endovascular repair of thoracic aortic injuries from 2001-2018 at Liverpool Hospital. Primary endpoint was death, secondary endpoints were re-interventions, hand ischemia, access vessel repair, cardiopulmonary, neurological and ischemic complications. Results 24 patients, 10 female, most common mechanism was motor-vehicle injuries (75%) in Zone 3 (71%). Deployment was proximal (n=11), on (n=2) or distal (n=11) to the Left Subclavian Artery (LSCA). Average follow up 5.4 years ±5.1 years (Range 0.1-15.2 years), with 2 deaths. At <90 days, complications were hand ischemia (n=4, n=1 needing intervention), access vessel endarterectomy (n=1) and conversion to open bypass (n=1).  At >90 days, complications were hand ischemia needing intervention (n=1), bird-beaking (n=2) and minor graft thrombosis (n=1). Type I endoleak was the only statistically significant predictor of reintervention (RR 21.00, p=0.002) and hand ischemia (RR 4.7, p=0.02). Survival free from any complication in Zone 2 was 50% at less than 5 years; Zone 3 was 58.8% at 5 years, 42.9%at 10 and 15 years; Zone 4 was 100% at 5 years. Conclusions Endovascular repair for thoracic aortic injuries has low levels of mortality and morbidity. The LSCA can be covered without arm ischemia, and Type I endoleak carries high morbidity. At up to 15 years follow up, graft complications remain low. 

Endovascular Treatment of Aortic Arch Lesions Using Scalloped Endografts

2017 ◽  
Vol 52 (1) ◽  
pp. 22-26 ◽  
Author(s):  
Leopoldo Fernández-Alonso ◽  
Sebastián Fernández Alonso ◽  
Esther Martínez Aguilar ◽  
Estéfana Santamarta Fariña ◽  
Jordi Alegret Solé ◽  
...  
Keyword(s):  
Ct Scan ◽  
Aortic Arch ◽  
Stent Graft ◽  
Blood Pressure Level ◽  
Type I ◽  
Strong Argument ◽  
Custom Made ◽  
Type I Endoleak ◽  
Rapid Pacing ◽  
Aortic Lesions

Objective: To present our early and midterm results using thoracic endovascular aortic repair (TEVAR) with a custom-made proximal scalloped stent graft to accommodate left common carotid artery (LCCA) and innominate artery (IA) in treating aortic lesions involving the arch. Materials and Methods: Between February 2014 and April 2017, select patients presenting with aortic arch lesions and short proximal landing zone were treated by proximal scalloped Relay Plus stent grafts. Patient demographics, operative details, clinical outcomes, and complications were analyzed. Results: Six patients (50% male) with a median age of 71 years (range, 60-82) underwent scalloped TEVAR using thoracic custom-made Relay Plus stent graft to preserve flow in the proximal supra-aortic trunks. Target vessels for the scallop were LCCA in 5 cases and IA in 1 case. The technical success rate was 100%, and proximal seal was achieved in all cases with no type I endoleaks on completion angiography. The median follow-up period was 20 (7-32) months. No conversion to open surgical repair and no aortic rupture occurred. One patient had a distal type I endoleak on the 6-month computed tomography (CT) scan, and 1 patient had a proximal type I endoleak on the 12-month CT scan. There was no stroke, paraplegia, retrograde type A dissection, or other aortic-related complication. We routinely used temporary rapid right ventricular pacing to obtain a near-zero blood pressure level during the graft deployment. No complications were observed related to the use of rapid pacing. Conclusion: When anatomy allows, proximal scalloped stent graft to accommodate LCCA and IA is a viable therapeutic option in treating aortic lesions involving the arch with short proximal landing zones. In addition, these findings represent a strong argument for the use of temporary rapid pacing during graft deployment.

Adjunctive Procedures for the Treatment of Proximal Type I Endoleak: The Role of Peri-Aortic Ligatures and Palmaz Stenting

2003 ◽  
Vol 10 (2) ◽  
pp. 233-239 ◽  
Author(s):  
Elias Tzortzis ◽  
Robert J. Hinchliffe ◽  
Brian R. Hopkinson
Keyword(s):  
Endovascular Repair ◽  
Type I ◽  
Long Term Effects ◽  
Single Center Experience ◽  
Abdominal Aortic ◽  
Type I Endoleak ◽  
Secondary Procedures ◽  
Invasive Techniques

Purpose: To investigate the feasibility, efficacy, and long-term effects of peri-aortic ligatures and Palmaz stenting used to treat proximal type I endoleak after endovascular repair (EVR) of abdominal aortic aneurysm (AAA). Methods: An 8-year single-center experience with proximal type I endoleak was reviewed; the records of the 55 identified cases were examined to ascertain the methods of treatment used. Among these, all 22 patients who were treated with peri-aortic ligatures and Palmaz stenting were segregated for analysis. Results: The 22 patients (14 men; mean age 74.6 years, range 66–85) with proximal type I endoleak (18 early, 4 late) selected for analysis underwent 23 secondary procedures: 15 involving peri-aortic ligatures and 8 Palmaz stent implantations. Of the 18 early endoleaks, 11 were treated intraoperatively and 7 were observed. Ten (45%) patients died within 30 days of endoleak treatment: 8 had early endoleaks. Five of the 10 deaths occurred in patients successfully treated with peri-aortic ligatures (3/10) or Palmaz stenting (2/7). The 12 (54%) surviving patients suffered no aneurysm-related deaths or secondary endoleaks over a median follow-up of 20 months (range 4–75) Conclusions: Endoleak is an important mode of failure after endovascular repair. Peri-aortic ligatures and Palmaz stenting are feasible techniques for the treatment of proximal endoleak; however, the perioperative mortality of peri-aortic ligatures was higher when compared with other less invasive techniques. In contrast to other therapeutic options, these methods are more effective in the short and medium term.

Pre-fenestration endovascular repair of aortic diseases in patients with zone 2 segment: A single-center experience

Vascular ◽  
2020 ◽  
pp. 170853812097987
Author(s):  
Yu-Jing Zhang ◽  
Lei Bai ◽  
Liang Wang ◽  
Hong-Rui Shi ◽  
Jiang-Long Liu ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Stent Graft ◽  
Endovascular Repair ◽  
Aortic Rupture ◽  
Type I ◽  
Aortic Diseases ◽  
Technical Success Rate ◽  
Thoracic Endovascular Repair ◽  
Aortic Lesions

Objective The present study aims to analyze the outcomes of three cases of pre-fenestration and branch stent-graft endovascular repair of aortic disease with zone 2 aortic lesions. Methods From August 2017 to June 2018, three patients with zone 2 aortic lesions underwent thoracic endovascular repair with innominate artery, left common carotid artery, and left subclavian artery recannulation using pre-fenestration and branched stent-grafts to preserve the patency of the aortic arch branches. Results The technical success rate was 100%. One patient had a proximal type I endoleak with no need for additional treatment. The overall mortality was 0%. All branches were patent. The follow-up period lasted for 2–15 months, with one patient lost to follow-up. There were no conversions to open surgical repair, aortic rupture, paraplegia, or retrograde type A aortic dissection. Conclusion The use of a pre-fenestration and branch stent-graft for the thoracic endovascular repair of zone 2 aortic lesions is a feasible and effective method for aortic arch branch revascularization. The risk of this surgical procedure is high, requiring significant expertise. The procedure should be conducted only in experienced centers. Durability concerns should be assessed in future studies with long-term follow-up.

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