scholarly journals A Study on the Effects of Struts of Z-Shaped Stent-Grafts on Radial Forces

2017 ◽  
Author(s):  
Xuelian Gu ◽  
Kai Yu ◽  
Licheng Lu ◽  
Wenjing Tang
Keyword(s):  
Stent Graft ◽  
Endovascular Aneurysm Repair ◽  
Great Influence ◽  
Radial Force ◽  
Type I ◽  
Stent Grafts ◽  
Element Analysis ◽  
Landing Zone ◽  
Post Surgery ◽  
Aneurysm Repair

Endovascular aneurysm repair (EVAR) techniques have been widely used for the treatment of abdominal aortic aneurysm (AAA). EVAR is associated with lower postoperative morbidity and mortality than traditional surgical procedure to treat AAA [1]. However, during the patient’s follow-up, postoperative complications may occur and secondary interventions are required [2]. Stent-grafts fixation in the vessel affects the success of endovascular aneurysm repair. Researches indicate that insufficient stent-graft radial force is attributed to post-surgery complications, such as prosthesis migration and endoleak type I [3, 4]. Endoleak type I happens when there is not a complete contact between stent graft rings and vessel wall. A great radial force can prevent full obturation in the landing zone. The distal endograft fixation also has a great influence on proximal endograft migration after EVAR [5]. Therefore the radial force of the stent plays a significant role. Single stent-graft ring comprise a series of expandable Z-shaped structural elements (known as “struts”). Currently, there are series of Z-shaped stent-grafts on the market and the struts number ranges from 5 to 12. This work intends to analyze the influence of stent-graft struts number on the radial force. Finite-element analysis (FEA) and experimental method are used.

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.

scholarly journals Endovascular Aneurysm Sealing of a Collapsed and Thrombosed Aortic Stent-Graft With Renovisceral Chimney Stent-Grafts

2018 ◽  
Vol 26 (1) ◽  
pp. 72-75
Author(s):  
Fabien Lareyre ◽  
Claude Mialhe ◽  
Carine Dommerc ◽  
Juliette Raffort
Keyword(s):  
Stent Graft ◽  
Mesenteric Artery ◽  
Endovascular Aneurysm Repair ◽  
Stent Grafts ◽  
Aortic Thrombosis ◽  
Aortic Stent Graft ◽  
Aneurysm Repair ◽  
Stent Graft Implantation ◽  
Graft Implantation

Purpose: To report the use of the Nellix endovascular aneurysm sealing (EVAS) system in the management of proximal stent-graft collapse associated with thrombosis following endovascular aneurysm repair (EVAR). Case Report: A 76-year-old man was admitted for proximal collapse of an aortic extension following bifurcated AFX stent-graft implantation associated with chimney grafts in both renal arteries and the superior mesenteric artery 1 month prior. Imaging identified thrombosis of the aortic stent-graft and the iliac limbs. A Nellix EVAS was placed into the AFX stent-graft to recanalize the aneurysm lumen and address the aortic thrombosis. There was no endoleak, and the renovisceral chimney stent-grafts remained patent over a follow-up of 25 months. Conclusion: While further studies are required to generalize its use, EVAS appears to be feasible in the management of aortic stent-graft collapse.

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.

Early Computed Tomographic Angiography after Endovascular Aneurysm Repair: Worthwhile or Worthless?

Vascular ◽  
2008 ◽  
Vol 16 (5) ◽  
pp. 253-257 ◽  
Author(s):  
Evert J. Waasdorp ◽  
Joost A. van Herwaarden ◽  
Rob H.W. van de Mortel ◽  
Frans L. Moll ◽  
Jean-Paul P.M. de Vries
Keyword(s):  
Stent Graft ◽  
Endovascular Aneurysm Repair ◽  
Computed Tomographic Angiography ◽  
Type I ◽  
Type Ii ◽  
Graft Thrombosis ◽  
Computed Tomographic ◽  
Tomographic Angiography ◽  
Aneurysm Repair

This study evaluated the value of computed tomographic angiography (CTA) early after an endovascular aneurysm repair (EVAR) in relation to CTA 3 months after EVAR. We retrospectively reviewed all elective EVAR patients with available postprocedural and 3-month follow-up CTAs who were treated between 1996 and 2006. CTAs were analyzed for EVAR-related complications in terms of endoleaks, migration, and stent graft thrombosis. Secondary procedures and other complications within a 4-month time interval after EVAR were noted and analyzed for any association with the postprocedural CTA. During the study period, 291 patients (275 men), with a mean age of 71 years, underwent elective EVAR. All had postprocedural and 3-month follow-up CTAs, which detected 93 (32%) endoleaks (8 type I, 84 type II, 1 type III) and 1 stent graft thrombosis. These findings resulted in four secondary interventions (one interposition cuff, two extension cuffs, one conversion). All reinterventions were successfully done in an elective setting. During the first 3 postoperative months, five other reinterventions were required for acute ischemia in four patients (three Fogarty procedures, one femorofemoral crossover bypass) or groin infection in one patient. Eight patients died, but none of the deaths were related to abdominal aortic aneurysm or EVAR (four cardiac, two pulmonary, one gastric bleeding, one carcinoma). At 3 months, 43 endoleaks (3 type I, 40 type II), 3 stent graft thromboses, and 1 stent graft migration were seen. In two patients (0.7%), a new endoleak was diagnosed compared with the postprocedural CTAs. In 287 (99%) of 291 patients, the postprocedural CTA did not influence our treatment policy in the first 3 months after EVAR. More than half of the early endoleaks were self-limiting, and new endoleaks were seen in only two patients (< 1%) at the 3-month follow-up CTA. After an uneventful EVAR procedure, it is safe to leave out the early postprocedural CTA.

scholarly journals Short and Intermediate Outcome of Endovascular Aortic Aneurysmal Repair, A multicenteric Study

2021 ◽  
Vol 9 (B) ◽  
pp. 1494-1498
Author(s):  
Mohamed Hosny Sayed ◽  
Mohammed Ali Hassan ◽  
Ahmed Samir Hosny ◽  
Hisham Rashid ◽  
Mohamed Hosni El Dessoki
Keyword(s):  
Stent Graft ◽  
Survival Curve ◽  
Rapid Evolution ◽  
Endovascular Aneurysm Repair ◽  
Aortic Aneurysms ◽  
Stent Grafts ◽  
College Hospital ◽  
Aneurysm Morphology ◽  
Multicenter Prospective Study ◽  
Aneurysm Repair

BACKGROUND: The availability of aortic stent-grafts has permitted an obvious change in the management of abdominal aortic aneurysms (AAA). For elective cases open surgical repair has been widely superseded by the use of stent-graft. With the rapid evolution of the endovascular technology, a significant development in stent-graft techniques was achieved in conjunction with a better understanding of how to utilize stent-grafts. METHODS: A multicenter prospective study in which 49 patients were enrolled, they underwent an elective endovascular aneurysm repair (EVAR) procedure for infrarenal AAA in two different institutions, Kasr Al-ainy School of Medicine, Cairo University and King’s College Hospital in London, the selected patients were followed up for 6 months after the procedure. Data relating to demographics and pre-operative comorbidities were recorded. Aneurysm morphology was reviewed by computed tomography angiography scans. Clinical data was collected through operative records and afterward through outpatient clinic follow-up sessions. RESULTS: Overall survival was 94% over a period of 6 months calculated using KaplanMeier Survival Curve. CONCLUSIONS: Endovascular repair resulted in fewer perioperative deaths. This study provides insight into clinical parameters that can be used to stratify patients’ post-EVAR surveillance and need for re-intervention and it came to the conclusion that EVAR could be considered as the standard repair for uncomplicated infrarenal AAA.

SP5.2.4 Stent-graft endobypass for non-infected femoral pseudoaneurysms in high-risk surgical patients: acceptable short-to-mid-term results

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Arindam Chaudhuri ◽  
Ramita Dey ◽  
Weronika Stupalkowska
Keyword(s):  
Stent Graft ◽  
Endovascular Aneurysm Repair ◽  
Case Series ◽  
Graft Occlusion ◽  
Stent Grafts ◽  
Small Series ◽  
Percutaneous Coronary ◽  
Aneurysm Repair ◽  
Lost To Follow Up

Abstract Aim Stent-grafts are finding a place in the treatment of femoral pseudoaneurysms (FpsAs), having been described in the treatment of infected pseudoaneurysms. We present the results of endovascular treatment of non-infected FpsAs using stent-grafts. Methods Case series of patients who underwent stent-graft coverage of FpsAs from January 2016 to December 2020. Stent-graft fractures, occlusions and reinterventions, length of stay (LOS) and 30-day mortality were assessed. Results 11 patients (mean age 75±10.3 years, 7 males; all ASA 3 or 4) underwent stent-graft coverage of FpsAs. Original procedures linked to the formation of FpsA were iliofemoral bypass (n = 3), femorofemoral crossover (n = 3), percutaneous coronary interventions (n = 2), aortobifemoral bypass (n = 1), endovascular aneurysm repair (n = 1) and femoral endarterectomy (n = 1). 3 patients had previous open FpsA repair. Technical success of deployment was 100%. Stent-grafts used included Viabahn Endoprosthesis (WL Gore & Associates, Flagstaff USA; n = 8), Viabahn VBX (WL Gore & Associates; n = 1) and BeGraft (Bentley InnoMed GmbH, Hechingen, Germany; n = 2). All patients were maintained on either antiplatelets or anticoagulant. 10 patients were available for analysis (1 lost to follow-up); radiological follow-up included initial computed tomography angiography and later combined duplex ultrasonography/plain radiography. Median LOS was 4 days (IQR 4). 30-day mortality was 0%. Median survival was 12 months (IQR 17). There was one stent-graft occlusion requiring thrombectomy but no fractures were observed in this series. Conclusions This small series suggests that there may be a role for stent-grafts in treatment of FpsAs in carefully selected patients. Given lack of data on long-term outcomes, continued surveillance is recommended.

The use of thoracic stent grafts for endovascular repair of abdominal aortic aneurysms

Vascular ◽  
2017 ◽  
Vol 26 (3) ◽  
pp. 278-284 ◽  
Author(s):  
VP Bastiaenen ◽  
MGJ Snoeijs ◽  
JGAM Blomjous ◽  
J Bosma ◽  
VJ Leijdekkers ◽  
...  
Keyword(s):  
Endovascular Repair ◽  
Endovascular Aneurysm Repair ◽  
Aortic Aneurysms ◽  
Type I ◽  
Stent Grafts ◽  
Aortic Neck ◽  
Abdominal Aortic ◽  
Median Diameter ◽  
Aneurysm Repair

Objectives Stent grafts for endovascular repair of infrarenal aneurysms are commercially available for aortic necks up to 32 mm in diameter. The aim of this study was to evaluate the feasibility of endovascular repair with large thoracic stent grafts in the infrarenal position to obtain adequate proximal seal in wider necks. Methods All patients who underwent endovascular aneurysm repair using thoracic stent grafts with diameters greater than 36 mm between 2012 and 2016 were included. Follow-up consisted of CT angiography after six weeks and annual duplex thereafter. Results Eleven patients with wide infrarenal aortic necks received endovascular repair with thoracic stent grafts. The median diameter of the aneurysms was 60 mm (range 52–78 mm) and the median aortic neck diameter was 37 mm (range 28–43 mm). Thoracic stent grafts were oversized by a median of 14% (range 2–43%). On completion angiography, one type I and two type II endoleaks were observed but did not require reintervention. One patient experienced graft migration with aneurysm sac expansion and needed conversion to open repair. Median follow-up time was 14 months (range 2–53 months), during which three patients died, including one aneurysm-related death. Conclusions Endovascular repair using thoracic stent grafts for patients with wide aortic necks is feasible. In these patients, the technique may be a reasonable alternative to complex endovascular repair with fenestrated, branched, or chimney grafts. However, more experience and longer follow-up are required to determine its position within the endovascular armamentarium.

Long-Term Renal Function following Endovascular Aneurysm Repair with Infrarenal and Suprarenal Aortic Stent-Grafts

2003 ◽  
Vol 10 (3) ◽  
pp. 397-405 ◽  
Author(s):  
Pierre Alric ◽  
Robert J. Hinchliffe ◽  
Marie-Christine Picot ◽  
Bruce D. Braithwaite ◽  
Shane T.R. MacSweeney ◽  
...  
Keyword(s):  
Renal Function ◽  
Serum Creatinine ◽  
Stent Graft ◽  
Endovascular Aneurysm Repair ◽  
Stent Grafts ◽  
Abdominal Aortic ◽  
Custom Made ◽  
Aneurysm Repair ◽  
The Impact

Purpose: To determine in a retrospective analysis the incidence of renal impairment (RI) following endovascular repair (EVR) of abdominal aortic aneurysm (AAA), to assess the morbidity and mortality in endograft patients with preoperative RI, and to examine the impact of suprarenal stent-grafts on renal function. Methods: From March 1994 to October 2001, 315 AAA patients (289 men; mean age 72.4±7.0 years) undergoing EVR were entered prospectively into a vascular registry. The patients received either an in-house custom-made stent-graft or one of several commercially made devices implanted with infrarenal or suprarenal fixation. Renal function was monitored by serum creatinine measurements prior to discharge and at 3, 6, and 12 months and annually thereafter. Preoperative RI was defined as a serum creatinine > 130 μmol/L and/or long-term dialysis. Postoperative RI referred to a >20% increase in the serum creatinine over baseline. Additional deterioration of renal function in patients with preoperative RI was referred to as postoperatively worsened RI. Results: Of the 315 patients treated, 220 (69.8%) were considered high risk (ruptured AAA or ASA grade III or IV). Sixty-nine (21.9%) patients had preoperative RI (6 [1.9%] on preoperative dialysis). A suprarenal stent-graft was used in 169 (53.7%) patients and infrarenal stent-graft in the remaining 146 (46.3%). The mean follow-up was 30.1 ±22.7 months. Postoperative RI occurred in 53 (16.8%) patients (24 [7.6%] transient, 29 [9.2%] persistent). Patients with preoperative RI had a significantly higher incidence of postoperatively worsened RI (37.7% versus 11.0%, p<0.0001) and a higher mortality related to RI (7.2% versus 1.6%, p=0.02). Suprarenal fixation had no influence on the incidence of RI, on perioperative mortality, or on mortality related to RI. The only significant predictive factor of postoperative RI was preoperative RI (risk ratio 5.09, 95% CI 2.38 to 10.87, p=0.0001). Conclusions: Endovascular AAA repair may lead to persistent postoperative RI in nearly 10% of cases, especially in patients with preoperative RI. Suprarenal stent-graft fixation does not seem to have any deleterious effect on renal function. Further long-term studies are required to confirm the innocuous nature of transrenal stent placement.

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.

scholarly journals The Polymer-Based Technology in the Endovascular Treatment of Abdominal Aortic Aneurysms

Polymers ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 1196
Author(s):  
Gianmarco de Donato ◽  
Edoardo Pasqui ◽  
Claudia Panzano ◽  
Brenda Brancaccio ◽  
Gaia Grottola ◽  
...  
Keyword(s):  
Stent Graft ◽  
Endovascular Aneurysm Repair ◽  
Invasive Procedure ◽  
Aortic Disease ◽  
Aortic Aneurysms ◽  
Metallic Stent ◽  
Stent Grafts ◽  
Abdominal Aortic ◽  
Aneurysmal Neck ◽  
Aneurysm Repair

An abdominal aortic aneurysm (AAA) is a dilatation of the abdominal aorta that progressively grows until it ruptures. Treatment is typically recommended when the diameter is more than 5 cm. The EVAR (Endovascular aneurysm repair) is a minimally invasive procedure that involves the placement of an expandable stent graft within the aorta to treat aortic disease without operating directly on the aorta. For years, stent grafts’ essential design was based on metallic stent frames to support the fabric. More recently, a polymer-based technology has been proposed as an alternative method to seal AAA. This review underlines the two platforms that are based on a polymer technology: (1) the polymer-filled endobags, also known as Endovascular Aneurysm Sealing (EVAS) with Nellix stent graft; and (2) the O-ring EVAR polymer-based proximal neck sealing device, also known as an Ovation stent graft. Polymer characteristics for this particular aim, clinical applications, and durability results are hereby summarized and commented critically. The technique of inflating endobags filled with polymer to exclude the aneurysmal sac was not successful due to the lack of an adequate proximal fixation. The platform that used polymer to create a circumferential sealing of the aneurysmal neck has proven safe and effective.

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