Intraoperative Proximal Endoleaks during AAA Stent-Graft Repair: Evaluation of Risk Factors and Treatment with Palmaz Stents

2001 ◽  
Vol 8 (3) ◽  
pp. 268-273 ◽  
Author(s):  
Nuno V. Dias ◽  
Timothy Resch ◽  
Martin Malina ◽  
Bengt Lindblad ◽  
Krassi Ivancev
Keyword(s):  
Stent Graft ◽  
Therapeutic Option ◽  
Balloon Dilation ◽  
Aortic Aneurysms ◽  
Type I ◽  
Aneurysm Neck ◽  
Custom Made ◽  
Type I Endoleak ◽  
Stent Graft Repair ◽  
Palmaz Stents

Purpose: To study factors that might contribute to intraoperative proximal type I endoleak and to evaluate the placement of giant Palmaz stents as a therapeutic option. Methods: Thirty-three patients (30 men; median age 72 years, range 50–85) with abdominal aortic aneurysms underwent implantation of fully supported Gianturco Z-stent—based endografts (12 custom-made aortomonoiliac and 21 bifurcated Zenith devices). Ten (30%) patients were treated for intraoperative proximal endoleaks. Stent-graft oversizing and neck angulation, length, and shape were compared between patients with and without leaks. Results: In 9 cases, the endoleaks were successfully treated with intraoperative placement of Palmaz stents without complications. In 1 patient, a leak that was resolved intraoperatively with balloon dilation reappeared 1 month later; a Palmaz stent was deployed successfully. Stent-graft oversizing did not differ significantly between patients who developed proximal endoleaks and those who did not (median 4.0 mm in both groups, p = 0.47). Median neck length was 21.0 mm in patients with endoleak and 28.0 mm in those without (p > 0.99). Median neck angulation was 30° in both groups (p = 0.33), and the presence of a conical aneurysm neck was not significantly different (2/10 versus 6/23, p > 0.99). All aneurysms remained excluded at a median follow-up of 13 months (range 6–24). Conclusions: Stent-graft oversizing and neck morphology (length, angulation, and conical shape) do not seem to correlate with the incidence of proximal type I endoleaks. Palmaz stent placement appears to be a feasible and safe treatment option for this complication.

Endovascular Treatment of a Multimorbid Patient with Late AAA Rupture after Stent-Graft Placement: 1-Year Follow-up

2002 ◽  
Vol 9 (6) ◽  
pp. 896-900 ◽  
Author(s):  
Harald Teufelsbauer ◽  
Alexander M. Prusa ◽  
Manfred Prager ◽  
Siegfried Thurnher ◽  
Johannes Lammer ◽  
...  
Keyword(s):  
Stent Graft ◽  
Open Surgery ◽  
Left Kidney ◽  
Abdominal Distension ◽  
Aortic Aneurysms ◽  
Type I ◽  
Stent Grafting ◽  
Aneurysm Neck ◽  
Distal Migration ◽  
Type I Endoleak

Purpose: To report successful endovascular management of a ruptured abdominal aortic aneurysm (AAA) in a multimorbid patient 40 months after primary stent-grafting. Case Report: A 64-year-old man presented with hypotension, severe back pain, and abdominal distension. Immediate computed tomography revealed a proximal type I endoleak due to distal migration of the stent-graft with subsequent rupture of the aneurysm. The patient was hemodynamically unstable, and open surgery was refused because of severe comorbidities that were the indications for initial endovascular repair. The diameter of the proximal aneurysm neck required the use of a thoracic stent-graft that was overly long, which led to occlusion of the contralateral stent-graft limb supplying not only the left leg but also a left kidney transplant. A crossover bypass was implanted to revascularize both. Conclusions: Minimally invasive strategies, even when challenged by complex vascular reconstructions, offer the possibility of managing ruptured aortic aneurysms in patients unsuitable for open surgery.

A standardized aortic aneurysm model for the assessment of endovascular stent-graft technology

Vascular ◽  
2011 ◽  
Vol 19 (2) ◽  
pp. 82-88 ◽  
Author(s):  
J A Macierewicz ◽  
J-N Albertini ◽  
R J Hinchliffe
Keyword(s):  
Stent Graft ◽  
Duplex Ultrasound ◽  
Aortic Aneurysms ◽  
Straight Tube ◽  
Type I ◽  
Infrarenal Aorta ◽  
Endovascular Stent ◽  
Ovine Model ◽  
Endovascular Stent Graft ◽  
Type I Endoleak

Reliable models of aortic aneurysms are required to test endovascular stent-graft technology prior to human use. We describe the creation of a standardized prosthetic aneurysm in an ovine model to assess endovascular technology. In an adult ovine model under general anesthesia, a polyester sphere measuring 6 cm across was sutured onto the infrarenal aorta following aortotomy. Two weeks later an endovascular stent-graft was deployed in the aorta. Exclusion was confirmed on monthly ultrasound duplex and during angiography at three months and under terminal anesthesia at six months. Autopsy along with histology of the specimen were then performed. A total of 10 sheep underwent aneurysm implantation. Nine received a straight tube endovascular stent-graft (Lombard Medical, Abingdon, Oxon, UK) and seven completed the study. Five prosthetic aneurysms shrank during serial imaging with duplex ultrasound and angiography. However, two remained the same size. One of these had a type I endoleak whereas the other had endotension (type I endoleak confirmed at autopsy). This animal model provides a reliable and reproducible method of creating prosthetic aneurysms for assessing endovascular stent-grafts. It was possible to assess aneurysm exclusion non-invasively using duplex ultrasound. Aneurysms effectively excluded from the circulation shrank whereas those with an endoleak did not.

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.

scholarly journals Single Centre Experience with Anaconda Custom-made Fenestrated Stent Graft in the Endovascular Repair of the Juxtarenal Aneurysms

2019 ◽  
Vol 13 (1) ◽  
pp. 31-36
Author(s):  
Milan Lisy ◽  
Guenay Kalender ◽  
Guido Rouhani ◽  
Matthias Schwarzbach ◽  
Wolf Stelter
Keyword(s):  
Stent Graft ◽  
Covered Stent ◽  
Aortic Aneurysms ◽  
Release Mechanism ◽  
Type I ◽  
Aortic Pathology ◽  
Single Centre Experience ◽  
Custom Made ◽  
Fenestrated Stent Graft ◽  
The Mean

Aim: The fenestrated Anaconda custom-made stent graft is one of the recently widely accepted fenestrated devices for managing complex juxta- and pararenal aortic pathology. This study showed its feasibility for treatment of challenging juxtarenal anatomy of the abdominal aorta. Methods: Over the period of 12 months, 9 patients with juxtarenal aortic aneurysm underwent fenestrated stent graft implantation in our institution. The graft fenestrations were customized on the basis of computerized tomography (CT-Angiography; CTA). Selected visceral ostia were protected with covered balloon-expandable stents after partial stent graft deployment. The perioperative and short term data were collected prospectively. Results: The mean aneurysm diameter was 58.4 mm (range 46-73 mm). The mean infrarenal neck length was 3.5 mm (range 0-7 mm), no patient had a severe (>60°) angulation of proximal neck. 18 fenestration for renal arteries, 1 for SMA and 3 for coeliac´s were treated with Advanta V12 covered stent. All the target vessels were cannulated successfully through fenestrations and all the stent grafts were successfully deployed in patients with no technical issue in the release mechanism. All the patients have undergone 6 month follow-up, no aneurysm related or aneurysm-unrelated deaths were reported. On the CTA scan, 3 of the patients had a weak type IIb endoleak; no type I or Type III endoleak was demonstrated. All target vessels were open without an instance of branch-stent stenosis/occlusion. No reintervention was needed. Conclusion: The usage of custom-made Anaconda fenestrated stent graft for endovascular treatment of juxtarenal aortic aneurysms is feasible with acceptable intermediate-term results.

Effects of Major Endoleaks on a Stented Abdominal Aortic Aneurysm

2005 ◽  
Vol 128 (1) ◽  
pp. 59-68 ◽  
Author(s):  
Z. Li ◽  
C. Kleinstreuer
Keyword(s):  
Stent Graft ◽  
Three Dimensional ◽  
Wall Stress ◽  
Aortic Aneurysms ◽  
Type I ◽  
Abdominal Aortic ◽  
Wave Forms ◽  
Type I Endoleak ◽  
Graft Migration ◽  
The Impact

Insertion of a stent-graft into an aneurysm, especially abdominal aortic aneurysms (AAAs), is a very attractive surgical intervention; however, it is not without major postoperative complications, such as endoleaks. An endoleak is the transient accumulation of blood in the AAA cavity, which is formed by the stent-graft and AAA walls. Of the four blood pathways, a type I endoleak constitutes the major one. Thus, focusing on both proximal and distal type I endoleaks, i.e., the minute net influx of blood past the attachment points of a stent-graft into the AAA cavity, the transient three-dimensional interactions between luminal blood flow, stent-graft wall, leakage flow, and AAA wall are computationally simulated. For different type I endoleak scenarios and inlet pressure wave forms, the impact of type I endoleaks on cavity pressure, wall stress, and stent-graft migration force is analyzed. The results indicate that both proximal type I-a and distal type I-b endoleaks may cause cavity pressures close to a patient’s systemic pressure; however, with reduced pulsatility. As a result, the AAA-wall stress is elevated up to the level of a nonstented AAA and, hence, such endoleaks render the implant useless in protecting the AAA from possible rupture. Interestingly enough, the net downward force acting on the implant is significantly reduced; thus, in the presence of endoleaks, the risk of stent-graft migration may be mitigated.

Endovascular Stent-Graft Repair of Ruptured Aortic Aneurysms

2003 ◽  
Vol 10 (3) ◽  
pp. 447-452 ◽  
Author(s):  
Reinhard Scharrer-Pamler ◽  
Thomas Kotsis ◽  
Xaver Kapfer ◽  
Johannes Görich ◽  
Ludger Sunder-Plassmann
Keyword(s):  
Stent Graft ◽  
Open Surgery ◽  
Aortic Aneurysms ◽  
Type I ◽  
Duration Of Treatment ◽  
Actuarial Survival ◽  
Conversion To Open Surgery ◽  
Technical Success Rate ◽  
Actuarial Survival Rate ◽  
Stent Graft Repair

Purpose: To demonstrate the endovascular approach to the management of ruptured abdominal aortic aneurysms (AAA). Methods: From 1995 to 2001, 24 patients (21 men; mean age 69 years, range 26–92) underwent emergency endovascular treatment for ruptured AAA. The average interval between onset of symptoms and admission to the hospital was 8.0 hours; the mean time between admission and the operation was 2.3 hours. No suprarenal occluding catheter was used. The stent-graft configurations were 19 bifurcated, 4 tube, and 1 aortomonoiliac. Results: Stent-graft placement was successful in 23 (96%) cases. Failed limb extension deployment prompted conversion to open surgery in the remaining patient. One case was converted to open surgery. Mean duration of treatment was 122 minutes. Three (12.5%) patients died in-hospital. The median hospital stay was 12 days. The rate of endoleaks (all type I) was 16.7%. The overall technical success rate was 77%. The 3-year actuarial survival rate was 75%. Conclusions: Our experience shows excellent results in emergency patients with ruptured AAAs treated with endovascular surgery. In order to verify these promising results, a broader-scale clinical study must be conducted.

scholarly journals Technical approach and outcomes of failed infrarenal endovascular aneurysm repairs rescued with fenestrated and branched endografts

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Jesse Manunga ◽  
Larissa I. Stanberry ◽  
Peter Alden ◽  
Jason Alexander ◽  
Nedaa Skeik ◽  
...  
Keyword(s):  
Adverse Events ◽  
Stent Graft ◽  
Graft Patency ◽  
Hospital Length ◽  
Aortic Aneurysms ◽  
Hospital Length Of Stay ◽  
Type I ◽  
Technical Success ◽  
Vessel Patency ◽  
Major Adverse Events

Abstract Background Endovascular rescue of failed infrarenal repair (EVAR) has emerged as an attractive option to stent graft explantation. The procedure, however, is underutilized due to limited devices accessibility and the challenges associated with their implantation in this patient population. The purpose of this study was to report our outcomes and discuss our approach to rescuing previously failed infrarenal endovascular aneurysm repairs (EVAR) with fenestrated/branched endografts (f/b-EVAR). Methods A retrospective analysis of prospectively collected data of consecutive patients with failed EVAR rescued with f/b-EVAR at our institution from November 2013 to March 2019 was conducted. The study primary end point was technical success; defined as the implantation of the device with no type I a/b or type III endoleak or conversion to open repair. Secondary endpoints included major adverse events (MAEs), graft patency and reintervention rates. Results During this time, 202 patients with complex aortic aneurysms were treated with f/b-EVAR. Of these, 19 patients (Male: 17, mean age 79 ± 7 years) underwent repair for failed EVAR. The median time from failed repair to f/b-EVAR was 48 (30, 60) months. Treatment failure was attributed to stent graft migration in 9 (47.4%) patients, disease progression in 5 (26.3%), short initial neck in 3 (15.8%) and unable to be determined in 2 (10.5%). Three patients were treated urgently with surgeon modified stent graft. Technical success was achieved in 18 patients (95%), including two who had undergone emergent repair for rupture. Seventy-two targeted vessels (97.3%) were successfully incorporated. Sixteen (84.2%) patients required a thoracoabdominal repair to achieve a durable seal. Major adverse events (MAEs) occurred in 3 patients (15.7%) including paralysis and death in one (5.3%), compartment syndrome and temporary dialysis in another and laparotomy with snorkeling of one renal and bypass of the other in the third patient. Median (IQR) hospital length of stay was 3 (2, 4) days. Late reintervention, primary target vessel patency and primary assisted patency rates were 5.3%, 98.6% and 100%, respectively. Conclusion Implantation of f/b-EVAR in patients with failed previous EVAR is a challenging undertaking that can be performed safely with a high technical success and low reintervention rates.

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.

Modeling Endoleaks and Collateral Reperfusion following Endovascular AAA Exclusion

2003 ◽  
Vol 10 (3) ◽  
pp. 424-432 ◽  
Author(s):  
Chuh K. Chong ◽  
Thien V. How ◽  
Geoffrey L. Gilling-Smith ◽  
Peter L. Harris
Keyword(s):  
Stent Graft ◽  
Aortic Pressure ◽  
Type I ◽  
Type Ii ◽  
Pump System ◽  
Type Ii Endoleak ◽  
Type I Endoleak ◽  
The Impact ◽  
Mean Aortic Pressure

Purpose: To investigate the effect on intrasac pressure of stent-graft deployment within a life-size silicone rubber model of an abdominal aortic aneurysm (AAA) maintained under physiological conditions of pressure and flow. Methods: A commercial bifurcated device with the polyester fabric preclotted with gelatin was deployed in the AAA model. A pump system generated physiological flow. Mean and pulse aortic and intrasac pressures were measured simultaneously using pressure transducers. To simulate a type I endoleak, plastic tubing was placed between the aortic wall and the stent-graft at the proximal anchoring site. Type II endoleak was simulated by means of side branches with set inflow and outflow pressures and perfusion rates. Type IV endoleak was replicated by removal of gelatin from the graft fabric. Results: With no endoleak, the coated graft reduced the mean and pulse sac pressures to negligible values. When a type I endoleak was present, mean sac pressure reached a value similar to mean aortic pressure. When net flow through the sac due to a type II endoleak was present, mean sac pressure was a function of the inlet pressure, while pulse pressure in the sac was dependent on both inlet and outlet pressures. As perfusion rates increased, both mean and pulse sac pressures decreased. When there was no outflow, mean sac pressure was similar to mean aortic pressure. In the presence of both type I and type II endoleaks, mean sac pressure reached mean aortic pressure when the net perfusion rate was low. Conclusions: In vitro studies are useful in gaining an understanding of the impact of different types of endoleaks, in isolation and in combination, on intrasac pressure after aortic stent-graft deployment.

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