Clinical Application of a Curved Nitinol Stent-Graft for Thoracic Aortic Aneurysms

2003 ◽  
Vol 10 (1) ◽  
pp. 20-28 ◽  
Author(s):  
Junichiro Sanada ◽  
Osamu Matsui ◽  
Noboru Terayama ◽  
Satoshi Kobayashi ◽  
Tetsuya Minami ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Stent Graft ◽  
Neurological Complications ◽  
Polyester Fabric ◽  
Aortic Aneurysms ◽  
The Other ◽  
Neck Length ◽  
Nitinol Stent ◽  
Proximal Neck ◽  
Thoracic Aortic Aneurysms

Purpose: To evaluate the clinical efficacy of a curved nitinol stent-graft for repair of thoracic aortic aneurysms. Methods: The Matsui-Kitamura stent-graft (MKSG), composed of a self-expanding nitinol stent and polyester fabric, was shaped to match the aortic curvature of 11 patients (6 men; mean age 72.6 years, range 33–90) with 6 true and 5 false aneurysms of the distal arch or proximal descending aorta. The delivery system was an 18 or 20-F J-shaped sheath combined with a preloader-type introducer. The original mean proximal neck length was 16.4 mm, but 4 patients received an axilloaxillary bypass to lengthen the neck. Although the mean corrected proximal neck length was 21.9 mm (overall), 5 cases still had proximal necks <15 mm long. Results: All curved MKSGs were successfully deployed in the correct position and fitted to the curvature of the aortic arch, achieving complete aneurysm exclusion in 8 (73%) cases. The other 3 repairs displayed early endoleaks; 1 received an additional MKSG, but the other 2 are being observed. Thirty-day mortality was 0%. One patient developed transient renal failure requiring hemodialysis; no neurological complications were observed. Conclusions: Endovascular repair of thoracic aortic aneurysms using curved MKSGs appears to be feasible and clinically effective. A tighter fit of the device to the curvature of the aortic arch may exclude distal arch aneurysms despite a short proximal neck.

Aortic Arch and Descending Thoracic Aortic Aneurysms: Experience with Stent Grafting for Second-Stage “Elephant Trunk” Repair

Vascular ◽  
2005 ◽  
Vol 13 (1) ◽  
pp. 5-10 ◽  
Author(s):  
Alfio Carroccio ◽  
David Spielvogel ◽  
Sharif H. Ellozy ◽  
Robert A. Lookstein ◽  
Iris Y. Chin ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Stent Graft ◽  
Clinical Success ◽  
Perioperative Complications ◽  
Aortic Aneurysms ◽  
Elephant Trunk ◽  
Stent Grafting ◽  
Thoracic Aortic Aneurysms ◽  
Second Stage ◽  
Antegrade Approach

Reconstruction of aortic arch and descending thoracic aortic aneurysms (TAAs) is technically challenging and associated with significant morbidity and mortality. We report our experience with extensive TAAs using a two-stage “elephant trunk” repair, with the second stage completed using an endovascular stent graft (ESG). Over 6 years, 111 patients underwent ESG treatment of TAAs at Mount Sinai Medical Center. Twelve of these patients were referred for ESG placement for the second stage of elephant trunk reconstruction because comorbidities placed them at high risk of open surgical repair. Our database was analyzed for technical and clinical success and perioperative complications. The mean follow-up was 11.8 months (range 1–64 months). Twelve patients (five women and seven men) with a mean age of 69 ± 10 years underwent repair of their distal aortic arch and descending TAAs. These aneurysms included nine atherosclerotic aneurysms, one pseudoaneurysm, and two penetrating atherosclerotic ulcers. Three patients were symptomatic. Stent graft repair was technically successful in 91.7% or 11 of 12 patients. Excessive aortic arch tortuosity resulted in failure to deploy a stent graft in one patient. An antegrade approach through the open elephant trunk was used in two patients with severe iliac occlusive disease. Endoleaks (type 2) were identified in two patients with no aneurysm expansion; however, a 14 mm expansion over 1 year occurred in a patient with no identifiable endoleak. One early mortality occurred in a patient with a ruptured 6 cm infrarenal AAA after successful exclusion of the 8 cm TAA. Second-stage elephant trunk reconstruction of an extensive TAA using an ESG is effective in the short term. Its long-term durability remains to be determined.

Endovascular Repair of Thoracic Aortic Aneurysms: Stent-graft Fixation across the Aortic Arch Vessels

2002 ◽  
Vol 16 (1) ◽  
pp. 24-28 ◽  
Author(s):  
James A. Burks ◽  
Peter L. Faries ◽  
Edwin C. Gravereaux ◽  
Larry H. Hollier ◽  
Michael L. Marin
Keyword(s):  
Aortic Arch ◽  
Stent Graft ◽  
Endovascular Repair ◽  
Aortic Aneurysms ◽  
Graft Fixation ◽  
Thoracic Aortic Aneurysms

Aortic Arch Reconstruction by Transluminally Placed Endovascular Branched Stent Graft

Circulation ◽  
1999 ◽  
Vol 100 (suppl_2) ◽  
Author(s):  
Kanji Inoue ◽  
Hiroaki Hosokawa ◽  
Tomoyuki Iwase ◽  
Mitsuru Sato ◽  
Yuki Yoshida ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Stent Graft ◽  
Aortic Aneurysms ◽  
Therapeutic Modality ◽  
Stent Grafts ◽  
Stent Grafting ◽  
Thoracic Aortic Aneurysms ◽  
Stent Graft Repair ◽  
Aortic Dissections

Background —Recently, thoracic aortic stent grafting has emerged as an alternative therapeutic modality for patients with thoracic aortic aneurysms and aortic dissections. However, its application has been limited to descending thoracic aortic aneurysms distal to the aortic arch. We report our initial clinical experience of endovascular branched stent graft repair for aortic arch aneurysms. Methods and Results —Endovascular grafting with Inoue branched stent grafts was attempted for 15 patients with thoracic aortic aneurysms and aortic dissections under local anesthesia (n=14) or general anesthesia (n=1). Single-branched stent grafts were used in 14 patients, and a triple-branched stent graft in one. The branched stent grafts were delivered through a 22F or a 24F sheath under fluoroscopic guidance and implanted across the aneurysmal aortic arch. In 2 patients, the single-branched stent graft did not pass through the 22F sheath used. Complete thrombosis of the aneurysm was ultimately achieved in 11 patients (73%). Of 4 persistent leaks, 1 minor leak spontaneously thrombosed and 1 major leak was successfully treated by additional straight stent graft placement. In 1 patient, the right external iliac artery ruptured during the withdrawal of the sheath and was successfully repaired by the implantation of a straight stent graft. One patient with severe stenosis of the aortic graft section was successfully managed by additional stent deployment. Peripheral microembolization to a toe occurred in 1 patient, and cerebral infarction occurred in 1 other patient. Two patients who had failed to receive endovascular stent grafts died during an average follow-up of 12.6 months, 1 of pneumonia and the other of rupture of a concomitant abdominal aortic aneurysm. Conclusions —This report demonstrates the technical feasibility of endovascular branched stent graft repair for aneurysms located at the aortic arch. Careful, longer follow-up and further extensive clinical trials are awaited toward establishing this technique as a recommendable alternative to surgical treatment of thoracic aortic aneurysms.

Clinical Application of a Curved Nitinol Stent-Graft for Thoracic Aortic Aneurysms

2003 ◽  
Vol 10 (1) ◽  
pp. 20-28 ◽  
Author(s):  
Junichiro Sanada ◽  
Osamu Matsui ◽  
Noboru Terayama ◽  
Satoshi Kobayashi ◽  
Tetsuya Minami ◽  
...  
Keyword(s):  
Clinical Application ◽  
Stent Graft ◽  
Aortic Aneurysms ◽  
Nitinol Stent ◽  
Thoracic Aortic Aneurysms

Analysis of Risk Factors for Early Type I Endoleaks After Thoracic Endovascular Aneurysm Repair

2016 ◽  
Vol 24 (1) ◽  
pp. 89-96 ◽  
Author(s):  
Yuji Kanaoka ◽  
Takao Ohki ◽  
Koji Maeda ◽  
Takeshi Baba
Keyword(s):  
Risk Factors ◽  
Aortic Arch ◽  
Stent Graft ◽  
Univariate Analysis ◽  
Type I ◽  
Early Type ◽  
Neck Length ◽  
Proximal Neck ◽  
Chimney Technique ◽  
Type I Endoleak

Purpose: To evaluate risk factors for early (<30 days) type I endoleak following thoracic endovascular aortic repair (TEVAR). Methods: A retrospective study was conducted of 439 consecutive patients (mean age 74.0±10.0 years; 333 men) who underwent TEVAR at a single center between June 2006 and June 2013. Pathologies included 237 aortic arch aneurysms and 202 descending thoracic aortic aneurysms (dTAA). Maximum TAA diameter was 63.6±13.7 mm. Among the distal aortic arch aneurysms, 124 required coverage of the left subclavian artery (LSA), while the remaining 113 arch aneurysms had debranching (n=40), the chimney technique (n=52), and a branched stent-graft (n=13). Eight patients with dilatation of the ascending aorta underwent arch replacement with elephant trunk prior to TEVAR. Predictive factors for type I endoleak were explored in univariate analysis and examined for each outcome using logistic regression models; results are given as the odds ratio (OR) and 95% confidence interval (CI). Results: Among 439 TEVAR cases, 37 (8.4%) had type I endoleaks on imaging at 1 month; 31 were in the 237 arch cases (13.1%). Endoleak investigation by site indicated a low incidence (3.0%) for dTAAs and markedly low (1.4%) in zone 4. Significantly more endoleaks were observed in zones 0–2 than in zone 4 (p<0.001). On univariate analysis, significant associations were found between endoleak and LSA coverage (OR 5.8, 95% CI 2.4 to 14.4, p<0.001), operative time ≥240 minutes (OR 3.7, 95% CI 1.5 to 6.2, p=0.002), and ≥270 mL of contrast (OR 2.8, 95% CI 1.4 to 5.8, p=0.004). Among the aortic branch reconstruction procedures, the chimney technique was the only maneuver associated with a significant risk of endoleak (OR 5.3, 95% CI 2.3 to 11.2, p<0.001). Arch state was not correlated with endoleaks, but ≥38-mm proximal neck diameter (OR 3.6, 95% CI 1.2 to 10.8, p=0.023), stent-graft diameter ≥40 mm (OR 9.9, 95% CI 1.4 to 30.5, p=0.015), and excessively oversized (≥14%) stent-grafts (OR 3.5, 95% CI 1.2 to 10.3, p=0.020) were; the proximal neck length was not correlated with endoleaks if a proximal neck length >10 mm can be secured. Conclusion: Risks for early type I endoleaks after TEVAR for aneurysm were landing zone 0–2, LSA coverage, large proximal neck and stent-graft diameters, excessive oversizing, and the use of the chimney technique.

Clinical Application of an Original Flexible MK Stent-Graft for Nonruptured Thoracic Aortic Aneurysms: Early Experience

2006 ◽  
Vol 1 (3) ◽  
pp. 119-122 ◽  
Author(s):  
Hiroshi Ohtake ◽  
Keiichi Kimura ◽  
Go Watanabe ◽  
Junichiro Sanada ◽  
Osamu Matsui
Keyword(s):  
Stent Graft ◽  
Bypass Surgery ◽  
Thrombus Formation ◽  
Perioperative Complications ◽  
Artery Bypass ◽  
Polyester Fabric ◽  
Aortic Aneurysms ◽  
Stent Grafts ◽  
Stent Grafting ◽  
Thoracic Aortic Aneurysms

Objective To obtain early MK stent-grafting results for nonruptured thoracic aortic aneurysms and thoracoabdominal aortic aneurysms. Methods The authors analyzed 47 patients who underwent treatment using MK stent-grafting. All patients (40 men and 7 women; mean age, 70.8 years) underwent elective procedures. Straight, curved, or tapered MK stents were constructed from a nitinol wire and covered with seamless, cylindrical woven polyester fabric grafts. The mean stent-graft diameter was 24 to 48 mm. In cases where the aneurysm had a short proximal neck (under 15 mm), supraaortic arch artery bypass surgery was planned to lengthen the neck. Results Simple stent-grafting without bypass was performed in 26 patients, whereas stent-grafting with supraaortic arch artery bypass was performed in 21 patients. An 18 or 20 F sheath was used as the delivery system in 46 patients (96%). In all 47 patients, the stent-grafts were successfully deployed. Two patients died while in hospital, and another 2 patients suffered a stroke. No other perioperative complications were observed. Postoperative computed tomography after 3 months showed complete thrombus formation in 42 patients (93.3%; 42/45 patients). Conclusions Forty-seven patients with thoracic aortic aneurysm were treated with our original flexible MK stent-graft system. Using a small sheath system, straight or curved M-K stent-grafts could be deployed to adequately fit to the aorta as planned. Furthermore, simultaneous bypass surgery widened the application of stent-grafting. However, careful long-term observation is necessary, and further studies are needed to assess such stent-grafting with bypass surgery.

scholarly journals The first commercial use of the Valiant Navion stent graft system for endovascular repair of a descending thoracic aortic aneurysm

Vascular ◽  
2020 ◽  
pp. 170853812098112
Author(s):  
Cassra N Arbabi ◽  
Navyash Gupta ◽  
Ali Azizzadeh
Keyword(s):  
Stent Graft ◽  
Standard Of Care ◽  
Aortic Aneurysms ◽  
Descending Thoracic Aortic Aneurysm ◽  
Thoracic Aortic Aneurysms ◽  
Commercial Use ◽  
Early Results ◽  
Multiple Configuration ◽  
One Year

Objectives Thoracic endovascular aortic repair (TEVAR) is the standard of care for descending thoracic aortic aneurysms (DTAA), and newer generation stent grafts have significant design improvements compared to earlier generation devices. Methods We report the first commercial use of the Medtronic Valiant Navion stent graft for treatment of an 85-year-old woman with a 5.8 cm DTAA and a highly tortuous thoracic aorta. Results A percutaneous TEVAR was performed using a two-piece combination of the Valiant Navion FreeFlo and CoveredSeal stent graft configurations for zones 2–5 coverage. The devices were successfully delievered through highly tortuous anatomy and deployed, excluding the entire length of the aneurysm with precise landing, excellent apposition and no evidence of endoleak. The patient tolerated the procedure well and has had no stent graft-related complications through one-year follow-up. Conclusions Design enhancements such as a lower profile delivery system, better conformability, and a shorter tapered tip are some of the improvements to this third-generation TEVAR device. Coupled with the multiple configuration options available, this gives physicians a better tool to treat thoracic aortic pathologies in patients with challenging anatomy. The early results are encouraging, and evaluation of long-term outcomes will continue.

Aortic Arch Vessel Geometries and Deformations in Patients with Thoracic Aortic Aneurysms and Dissections

2014 ◽  
Vol 25 (12) ◽  
pp. 1903-1911 ◽  
Author(s):  
Ga-Young Suh ◽  
Ramin E. Beygui ◽  
Dominik Fleischmann ◽  
Christopher P. Cheng
Keyword(s):  
Aortic Arch ◽  
Aortic Aneurysms ◽  
Thoracic Aortic Aneurysms

Thoracic Aortic Aneurysm Repair with Endovascular Stent-Grafts

1997 ◽  
Vol 2 (2) ◽  
pp. 98-103 ◽  
Author(s):  
Charles P Semba ◽  
R Scott Mitchell ◽  
D Craig Miller ◽  
Noriyuki Kato ◽  
Stephen T Kee ◽  
...  
Keyword(s):  
High Risk ◽  
Aortic Aneurysm ◽  
Stent Graft ◽  
Aortic Aneurysms ◽  
Stent Grafts ◽  
Thoracic Aortic Aneurysms ◽  
Risk Patients ◽  
Aneurysm Repair ◽  
Aortic Aneurysm Repair ◽  
Endoluminal Stent

The purpose of the study was to describe the clinical experience in using endoluminal stent-grafts for the treatment of thoracic aortic aneurysms in high-risk patients. Patients with aneurysms of the descending thoracic aorta who were considered high surgical risks underwent evaluation for endoluminal repair. The prosthesis was constructed from Z stents covered with polyester fabric using dimensions based upon preprocedural computed tomography scans and angiography. Through a femoral arteriotomy or left retroperitoneal flank incision, a 22–24 Fr delivery catheter was inserted and advanced through the aorta to the target site under fluoroscopic guidance in the operating suite. The stent-graft prosthesis was deployed at the site of the aneurysm. 44 patients (36 male, 8 female; mean age 36 years) underwent stent-graft repair for thoracic aneurysms (mean diameter 6.3 cm). The deployment was technically successful in all cases, with complete aneurysm thrombosis in 88%. The 30-day perioperative mortality rate was 6.8% and 35-month actuarial survival was 82%. There were no cases of stent migration, surgical conversion or intraprocedural death. Paraplegia occurred in two patients who underwent simultaneous surgical infrarenal aortic aneurysm repair immediately followed by stent-graft placement for a coexisting thoracic aneurysm. The conclusion was that placement of endoluminal stent-grafts for repair of thoracic aortic aneurysms is technically feasible in high-risk patients in whom conventional surgery is contraindicated. Long-term studies are needed to determine protection against aneurysm rupture and patient survival.

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