Fenestrated and Branched Grafts for Para-Anastomotic Aortic Aneurysm Repair

2007 ◽  
Vol 14 (4) ◽  
pp. 513-519 ◽  
Author(s):  
Peter Ziegler ◽  
Theodossios P. Perdikides ◽  
Efthimios D. Avgerinos ◽  
Thomas Umscheid ◽  
Wolf J. Stelter
Keyword(s):  
Stent Graft ◽  
Standard Procedure ◽  
Operating Time ◽  
Side Branch ◽  
Promising Alternative ◽  
Stent Graft Repair ◽  
The Mean ◽  
Aneurysm Repair ◽  
Aortic Aneurysm Repair

Purpose: To investigate the use of fenestration and branch artery stenting during endovascular stent-graft repair of para-anastomotic aneurysms (PAA). Methods: A retrospective review was conducted of 9 patients (all men; mean age 71 years, range 60–80) who received custom-designed fenestrated endoprostheses for PAA repair. Eight tubular fenestrated devices and 1 composite device (fenestrated tube plus modular bifurcated body) with a total of 31 fenestrations were used. Results: The mean operating time was 318±93 minutes (range 220–485); the mean fluoroscopy time was 77±38 minutes (range 39–158), during which a mean 121±81 mL (range 33–300) of contrast was used. Technical success was achieved in all cases. Over a mean follow-up of 12±5.5 months (range 6–24), 1 secondary intervention was carried out due to a break in a side branch stent-graft; 2 transient renal impairments and 1 permanent renal insufficiency unrelated to renal artery patency were observed. So far, no vessel loss has emerged. Conclusion: Conventional repair of PAA has been a standard procedure for many years, though it carries high surgical risk as well as perioperative mortality. Fenestrated endografts may be a promising alternative in selected patients.

Stent Graft Repair of Paraanastomotic Aneurysms After Open Descending Thoracic and Thoracoabdominal Aortic Aneurysm Repair

2013 ◽  
Vol 27 (6) ◽  
pp. 693-698 ◽  
Author(s):  
David J. O'Connor ◽  
Ageliki Vouyouka ◽  
Sharif H. Ellozy ◽  
Scott A. Sundick ◽  
Patrick LeMasters ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Stent Graft ◽  
Thoracoabdominal Aortic Aneurysm ◽  
Stent Graft Repair ◽  
Thoracoabdominal Aortic Aneurysm Repair ◽  
Aneurysm Repair ◽  
Aortic Aneurysm Repair

Migration versus Apparent Migration: Importance of Errors Due to Positioning Variation in Plain Radiographic Follow-up of Aortic Stent-Grafts

2003 ◽  
Vol 10 (5) ◽  
pp. 902-910 ◽  
Author(s):  
Richard Hodgson ◽  
Richard G. McWilliams ◽  
Alistair Simpson ◽  
Derek A. Gould ◽  
John A. Brennan ◽  
...  
Keyword(s):  
Stent Graft ◽  
Abdominal Aortic Aneurysm Repair ◽  
Geometric Distortion ◽  
Aortic Stent Graft ◽  
Abdominal Aortic ◽  
Clinically Significant ◽  
Aneurysm Repair ◽  
Graft Migration ◽  
Aortic Aneurysm Repair

Purpose: To demonstrate the influence of radiographic positioning on the assessment of stent-graft migration using plain radiographs following endovascular abdominal aortic aneurysm repair. Methods: Equations were derived to correct for artifactual stent-graft migration introduced by geometric distortion due to variations in positioning between radiographs acquired at different times. A phantom system was used to validate the equations. Results: Errors in stent position increase with (1) the distance of the aortic stent-graft from the midline and (2) differences in radiographic centering points in the craniocaudal direction; other variables have little effect. For typical stent positions, errors are small if the centering changes by <8 cm. Consistent radiographic positioning to within 4 cm on successive imaging studies limits errors to 1.5 mm. Even if artifactual migration is large, the true migration can be reliably calculated to within 2 mm. Conclusions: Artifactual migration due to variation in radiographic centering is not usually clinically significant if care is taken to center radiographs consistently. Radiographs in which artifactual migration may be important are readily identified, and mathematical correction is straightforward.

Impact of aortic stent-graft oversizing on outcomes of the chimney endovascular technique based on a new analysis of the PERICLES Registry

Vascular ◽  
2018 ◽  
Vol 27 (2) ◽  
pp. 175-180 ◽  
Author(s):  
Konstantinos P Donas ◽  
Marco V Usai ◽  
Gergana T Taneva ◽  
Frank J Criado ◽  
Giovanni B Torsello ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Stent Graft ◽  
Endovascular Aortic Aneurysm Repair ◽  
Aortic Stent Graft ◽  
Type Ia ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Aneurysm Repair ◽  
Aortic Aneurysm Repair

Objective Chimney endovascular aortic aneurysm repair is gaining ever greater acceptance. However, persistent gutters leading to type IA endoleaks represent an unsolved issue. The aim of the current study was to analyze the impact of abdominal endograft oversizing to the occurrence of this phenomenon. Methods The PERformance of the snorkel/chImney endovascular teChnique in the treatment of compLex aortic PathologiesES registry includes the largest experience with chimney endovascular aortic aneurysm repair from 13 vascular centers in Europe and the U.S. Prospectively collected data from centers with standard use of the Endurant stent-graft and balloon-expandable covered stents as chimney grafts only were included in the present analysis. The parameter which varied was the degree of oversizing of the aortic stent-graft classifying the cohort in two groups, group A (20% and less oversizing) and group B (>20% of oversizing). The primary endpoint was the incidence of persistent type IA endoleak needed reintervention. Secondary endpoints were all-cause mortality and freedom from reintervention. Results Group A included 21 patients while group B 144. The mean preoperative pathology’s neck length and diameter was 5.8 mm (±4.4) versus 4.9 mm (±3.8) and 27.6 mm (±4.7) versus 24.9 mm (±3.7) for group A and group B, respectively. The mean length of the new sealing zone after chimney graft placement was similar for both groups (group A versus group B; 17.9 mm versus 18.3 mm, respectively, P = .21). The percentage of oversizing of the aortic stent-graft ranged between 13.8 and 20% versus 22.2 and 30%, for group A and group B, respectively. Patients of group A had more type 1A endoleaks, (14.3%) versus patients of group B (2.1%) based on the first follow-up imaging, P = .02. The incidence of persistent type IA endoleaks needing a reintervention was 14.3 and 1.4% for the group A and group B, respectively, P = .01. The mean volume of contrast medium used was greater in group A versus group B with 239 ml versus150 ml, P = .05. Additionally, 14.3% of patients of group A experienced acute renal failure compared to those in group B which was 1.0%, P = .01. Conclusions Oversizing of ideally 30% of the Endurant stent-graft is associated with significant lower incidence of type IA endoleaks requiring reintervention for patients treated by chimney endovascular aortic aneurysm repair.

Fenestrated Endografting for Aortic Aneurysm Repair: A 7-Year Experience

2007 ◽  
Vol 14 (5) ◽  
pp. 609-618 ◽  
Author(s):  
Peter Ziegler ◽  
Efthimios D. Avgerinos ◽  
Thomas Umscheid ◽  
Theodosios Perdikides ◽  
Wolf J. Stelter
Keyword(s):  
Treatment Success ◽  
Type I ◽  
Technical Success ◽  
Type Iii ◽  
Type Ia ◽  
The Mean ◽  
Aneurysm Repair ◽  
Aortic Aneurysm Repair ◽  
Related Mortality

Purpose: To present a 7-year single-center clinical experience with fenestrated endografts and side branches. Methods: Between April 1999 and August 2006, 63 patients (57 men; mean age 70.5611.6 years, range 25–89) received custom-designed Zenith fenestrated endoprostheses for a variety of aneurysms (59 abdominal, 1 thoracoabdominal, and 3 thoracic). They were all unsuitable for standard EVAR owing to short aortic necks and high risk for open surgery. Results: Nineteen tube grafts and 44 composite bifurcated grafts with a total of 122 fenestrations and 58 side branches were used. Technical success was achieved in 55 (87.3%) patients and in 118 (96.7%) vessels. Treatment success was 93.7%. The mean follow-up was 23±18 months (median 14, range 6–77). Overall, 9 (7.4%) visceral branches were lost: 4 intraoperative, 2 perioperative, and 3 late. There were 12 (19.0%) endoleaks identified: 5 (7.9%: 4 type Ia and 1 fenestration-related type III) primary and 7 (11.1%: 4 type II, 1 type I, and 2 type III) secondary endoleaks; 4 resolved, 4 were treated, and 4 are under observation. At 77 months, 75.3% of patients were free of a reintervention. All reinterventions were performed within the first 14 months. Fourteen cases of renal impairment were seen [6 permanent (only 1 on dialysis) and 8 transient]. One (1.6%) conversion and 1 (1.6%) rupture were recorded; aneurysm-related mortality was 4.8% (3/63). Conclusion: The favorable outcomes in this study, which encompasses the team's learning curve with fenestrated endografts and side branches, support the use of these devices in selected patients.

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