“Paving and Cracking”: An Endovascular Technique to Facilitate the Introduction of Aortic Stent-Grafts through Stenosed Iliac Arteries

2007 ◽  
Vol 14 (5) ◽  
pp. 630-633 ◽  
Author(s):  
Robert J. Hinchliffe ◽  
Krassi Ivancev ◽  
Björn Sonesson ◽  
Martin Malina
Keyword(s):  
Stent Graft ◽  
Covered Stents ◽  
Stent Grafts ◽  
Endovascular Technique ◽  
Iliac Arteries ◽  
Aortic Stent Graft

Purpose: To describe a technique that facilitates the safe introduction of aortic stent-grafts through diseased iliac arteries. Technique: The technique involves relining and dilating (“paving and cracking”) stenosed iliac arteries with covered stents prior to the introduction of the main aortic stent-graft. It has been successfully used to introduce aortic stent-grafts in patients where other transfemoral endovascular measures have failed. Conclusion: This technique increases the applicability of transfemoral EVAR and prevents serious complications as a result of access-related damage to the iliac arteries.

Use of 3D Printing to Guide Creation of Fenestrations in Physician-Modified Stent-Grafts for Treatment of Thoracoabdominal Aortic Disease

2020 ◽  
Vol 27 (3) ◽  
pp. 385-393 ◽  
Author(s):  
Yuan-Hao Tong ◽  
Tong Yu ◽  
Min-Jie Zhou ◽  
Chen Liu ◽  
Min Zhou ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Stent Graft ◽  
Aortic Disease ◽  
Covered Stents ◽  
Stent Grafts ◽  
Aortic Stent Graft ◽  
Computed Tomography Images ◽  
Thoracoabdominal Aortic Disease ◽  
3D Printed

Purpose: To summarize the experience and outcomes of total endovascular repair of thoracoabdominal aortic disease using 3-dimensional (3D) printed models to guide on-site creation of fenestrations in aortic stent-grafts. Materials and Methods: From April 2018 to March 2019, 34 patients (mean age 58±14 years; 24 men) with thoracoabdominal aortic disease were treated in our department. Nineteen patients had thoracoabdominal aortic dissection and 15 had thoracoabdominal aortic aneurysm. Preoperatively, a 3D printed model of the aorta was made according to computed tomography images. In the operating room, the main aortic stent-graft was completely released in the 3D printed model, and the position of each fenestration or branch was marked on the stent-graft. The fenestrations were then made using an electric pen. Wires were sewn to the edge of the fenestrations using nonabsorbable sutures. After customization, the aortic stent-graft was reloaded into the delivery sheath and deployed. Results: The printing process took ~5 hours (1 hour for image reconstruction, 3 hours for printing, and 1 hour for postprocessing). The physician-modified stent-grafts had a total of 107 fenestrations secured by 102 bridging stent-grafts, including 73 covered stents and 29 bare stents. The average procedure time was 5.6±1.2 hours, including a mean 1.3 hours for stent-graft customization. No renal insufficiency or paraplegia occurred. Two branch arteries were lost during the operation. One patient (3%) died 1 week after surgery from a retrograde dissection rupture. One patient developed a minor cerebral infarction postoperatively. The mean follow-up time was 8.5 months. There was 1 endoleak from a fenestration (coil embolized) and 4 distal ruptures of the aortic dissection (3 treated and 1 observed). Conclusion: Three-dimensional printing can be used to guide creation of fenestrated stent-grafts for the treatment of thoracoabdominal aortic diseases involving crucial branches. This technique appears to be more accurate than the traditional measurement method, with short-term follow-up demonstrating the safety and reliability of the method. However, further research and development are needed.

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.

Abdominal Aortic Aneurysms: Experience with the Ivancev-Malmö Endovascular System for Aortomonoiliac Stent-Grafts

1997 ◽  
Vol 4 (3) ◽  
pp. 242-251 ◽  
Author(s):  
Krassi Ivancev ◽  
Martin Malina ◽  
Bengt Lindblad ◽  
Timothy A.M. Chuter ◽  
Jan Brunkwall ◽  
...  
Keyword(s):  
Stent Graft ◽  
Clinical Results ◽  
Aortic Aneurysms ◽  
Stent Grafts ◽  
Iliac Arteries ◽  
Proximal Neck ◽  
Abdominal Aortic ◽  
Median Diameter ◽  
Proximal Extension ◽  
In The Beginning

Purpose: To describe a component-based aortomonoiliac stent-graft system and the first clinical results achieved with this device in endovascular abdominal aortic aneurysm (AAA) repair. Methods: From November 1993 to October 1996, 45 patients aged 60 to 86 years underwent endoluminal exclusion of true AAAs (median diameter 60 mm) involving the common iliac arteries (median diameter 16 mm right and 15 mm left) using unilimb stent-grafts deployed with the Ivancev-Malmö system. Results: Six immediate conversions occurred in the beginning of the series due to endografts that were too short. Complications, including 2 inadvertent renal artery occlusions, 7 kinked grafts, 6 iliac artery dissections, and 3 perioccluder leaks, were prominent features in the first 15 patients. Five patients died in the postoperative period, four of whom were nonsurgical candidates. There were five significant stent-graft migrations: one 3 weeks after surgery due to mechanical injury of the proximal stent and four after 1 year owing to continuous dilation of a wide proximal neck, stent-graft placement in a conical, thrombus-lined proximal neck, and two instances of proximal extension separation from the main graft. Translumbar aneurysm perfusion required embolization in 3 patients. Conclusions: Despite early complications associated with a learning curve, exclusion of large AAAs using unilimb stent-grafts is feasible. Strict inclusion criteria are necessary in order to improve mortality among nonsurgical candidates and minimize the risk for late migration.

Type III Endoleak from a Thoracic Aortic Stent-Graft

2002 ◽  
Vol 9 (4) ◽  
pp. 535-538 ◽  
Author(s):  
Conrad Lange ◽  
Asbjørn Ødegård ◽  
Jan Lundbom ◽  
Staal Hatlinghus ◽  
Hans O. Myhre
Keyword(s):  
Stent Graft ◽  
Late Complication ◽  
Thoracoabdominal Aortic Aneurysm ◽  
Aortic Aneurysms ◽  
Stent Grafts ◽  
Stent Grafting ◽  
Thoracic Aortic Aneurysms ◽  
Type Iii ◽  
Aortic Stent Graft ◽  
Type V

Purpose: To present an as yet unreported late complication of an Excluder thoracic endograft. Case Report: A 78-year-old man underwent surgery for a ruptured type V thoracoabdominal aortic aneurysm in 1996. Four years later, an aneurysm was detected in the proximal thoracic aorta and repaired with 2 Excluder endoprostheses. At 12 months, computed tomography showed an increase in the aneurysm sac diameter and a type III endoleak, which was traced to a hole in the stent-graft fabric on arteriography. No fracture of the metal components was detected in the stent-grafts. Another Excluder device was implanted within the distal endograft. Satisfactory exclusion of the leak has been maintained for 6 months. Conclusions: The risk of type III leaks must be minimized before stent-grafting can be regarded as a routine procedure in the treatment of thoracic aortic aneurysms.

Aortoenteric Fistula Treated With Endovascular Aortic Stent-Graft and Bilateral Chimney Stent-Grafts to Renal Arteries

2012 ◽  
Vol 26 (3) ◽  
pp. 422.e13-422.e16 ◽  
Author(s):  
Glenn Wei Leong Tan ◽  
Daniel Wong ◽  
Sundeep Punamiya ◽  
Bien Peng Tan ◽  
Charles Vu ◽  
...  
Keyword(s):  
Stent Graft ◽  
Renal Arteries ◽  
Aortoenteric Fistula ◽  
Stent Grafts ◽  
Aortic Stent Graft

scholarly journals Multicenter Experience With Large Diameter Balloon-Expandable Stent-Grafts for the Treatment of Infrarenal Penetrating Aortic Ulcers

2021 ◽  
pp. 152660282110282
Author(s):  
Jan Stana ◽  
Carlota Fernandez Prendes ◽  
Lukasz Kruszyna ◽  
Ioannis Thomas Passaloglou ◽  
Maria Antonella Ruffino ◽  
...  
Keyword(s):  
Stent Graft ◽  
Large Diameter ◽  
Small Diameter ◽  
Operation Time ◽  
Stent Fracture ◽  
Stent Grafts ◽  
Femoral Access ◽  
Mortality And Morbidity ◽  
Perioperative Morbidity ◽  
Aortic Stent Graft

Purpose To describe the use of large-diameter balloon-expandable stent-grafts (BeGraft aortic stent-graft, Bentley InnoMed GmbH, Hechingen, Germany) in the treatment of infrarenal penetrating aortic ulcer (iPAU). Materials and Methods Retrospective analysis of patients undergoing endovascular treatment with the BeGraft aortic stent-graft in 8 European centers from January 2017 to October 2020. Demographics, perioperative data, and midterm outcomes were collected. Endpoints of the study were technical feasibility, early mortality, and morbidity. Results A total of 40 patients were included. The mean age was 73.9±7.05 years and 63.2% were male. Indications for treatment included size and morphology (65%), presence of symptoms (29.5%), and contained ruptures (5.5%). Urgent treatment was performed in 5% of cases. Technical success was 97.5%. Median operation time was 58 minutes (19–170 minutes), with 27.5% of patients having additional procedures during the main intervention (1 additional repair with a C-TAG (W.L. Gore & Associates, Inc, Flagstaff, AZ, USA) thoracic endoprosthesis, 5 covered endovascular reconstruction of aortic bifurcation procedures, 3 extensions with proximal cuffs, and 2 percutaneous angioplasties of the common iliac arteries). Percutaneous femoral access was used in 72.5%, while groin cut-down was performed in 27.5%. Repair was successful with only 1 stent in 45% of cases, while 37.5% required 2 stents and nearly 17.5% required 3/4 stent-grafts. The 30-day mortality was 0%, with a 2.5% reintervention rate (1 patient required evacuation of an intra-abdominal hematoma). Median follow-up was 13.9 months (2–39 months), during which no vascular-related reinterventions or deaths were reported. In 4 patients, a type II endoleak was observed. No cases of graft migration, thrombosis, or stent-fracture were observed. Conclusions The treatment of iPAU with the BeGraft aortic stent-graft in a selective patient group is feasible with low rate of perioperative morbidity and mortality. Balloon-expandable stent-grafts offer the option to repair iPAUs with a shorter coverage of the aorta using low-profile sheath, that enables treatment in the presence of calcified access vessels and small diameter aortic bifurcations.

Multicenter Trial of the Jostent Balloon-Expandable Stent-Graft in Renal and Iliac Artery Lesions

2003 ◽  
Vol 10 (2) ◽  
pp. 361-365 ◽  
Author(s):  
Virginia Gaxotte ◽  
Brigitte Laurens ◽  
Stéphan Haulon ◽  
Christophe Lions ◽  
Claire Mounier-Véhier ◽  
...  
Keyword(s):  
Stent Graft ◽  
Iliac Artery ◽  
Ultrasound Examination ◽  
Duplex Ultrasound ◽  
Multicenter Trial ◽  
Stent Grafts ◽  
Iliac Arteries ◽  
Renal Artery Stent ◽  
Color Duplex Ultrasound

Purpose: To report the results of a multicenter feasibility study of the Jostent balloon-expandable stent-graft in the treatment of renal and iliac artery lesions. Methods: Twenty-three patients (17 men; mean age 62 years, range 38–80) with lesions in the renal (n = 12) or iliac arteries (n = 12) were enrolled in 6 centers over a 1-year period. Preprocedural computed tomography (CT) and angiography were performed in all patients. The Jostent device was implanted in the 24 arteries to treat 11 in-stent stenoses, 2 arterial ruptures, 2 aneurysms, 2 dissections, 2 ulcerated stenoses, and 5 chronic occlusions. Follow-up included color duplex ultrasound examination on the day after the procedure and at 6 months; patients with renal artery stent-grafts were also evaluated with CT angiography. Results: Twenty-seven stent-grafts were deployed successfully in the 24 (100%) arteries. Seven (30%) patients required adjunctive procedures to address 1 acute in-stent thrombosis, 2 dissections, and 4 in-stent residual stenoses. At 6-month follow-up, 2 (8.3%) restenoses occurred in the renal arteries; these were treated successfully using balloon angioplasty. Conclusions: These data suggest that a balloon-expandable stent-graft may be safe and useful in patients with selected peripheral indications.

Performance of BeGraft and BeGraft+ Stent-Grafts as Bridging Devices for Fenestrated Endovascular Aneurysm Repair: An In Vitro Study

2019 ◽  
Vol 26 (6) ◽  
pp. 787-794 ◽  
Author(s):  
Giovanni Federico Torsello ◽  
Monika Herten ◽  
André Frank ◽  
Markus Müller ◽  
Susanne Jung ◽  
...  
Keyword(s):  
Shear Stress ◽  
Stent Graft ◽  
Stress Test ◽  
Endovascular Aneurysm Repair ◽  
Covered Stents ◽  
Cobalt Chromium ◽  
Stent Grafts ◽  
Stent Geometry ◽  
Stent Diameter

Purpose: To investigate 2 generations of balloon-expandable covered stents as potential bridging devices using an in vitro model of stent-graft fenestrations. Materials and Methods: Twenty BeGraft and 20 BeGraft+ cobalt-chromium stents covered in expanded polytetrafluoroethylene (ePTFE) in 6- and 8-mm diameters were tested in sheets mimicking stent-graft fenestrations. Microscopy and radiography were employed to evaluate stent morphology after flaring. In vitro bench tests measured maximum pullout (perpendicular displacement) and the shear stress (axial displacement) forces needed to dislocate the stents. Results: No alteration of ePTFE coverage was detected in the flared stents. Digital radiography and computed tomography showed marked alteration of the stent geometry, which was more pronounced in the BeGraft group. No fractures were detected. Median (minimum–maximum) pullout forces for the 6-mm stent-grafts were 17.1 N (15.8–19.6) for the BeGraft device and 30.4 N (20.2–31.9) for the BeGraft+ device (p=0.006). Median (minimum–maximum) pullout forces for the 8-mm stent-grafts were 11.3 N (11–12.1) for the BeGraft device and 21.8 N (18.2–25.5) for the BeGraft+ device (p<0.001). The shear stress test showed median forces of 10.5 vs 15.28 N at 150% of the stent diameter for the 6-mm BeGraft and BeGraft+ stent-grafts, respectively, and 15.23 vs 20.72 N at 150% stent diameter for the 8-mm models (p=0.016 and 0.017, respectively). Conclusion: Flaring changed the stent geometry but did not provoke stent fractures. The BeGraft+ is superior to the BeGraft in terms of pullout and shear stress forces, demonstrating greater resilience.

A Useful Endovascular Technique for Treating Modular Limb Disconnection in a Bifurcated Stent-Graft

2002 ◽  
Vol 9 (1) ◽  
pp. 124-128
Author(s):  
Remi Brouard ◽  
Philippe Otal ◽  
Philippe Soula ◽  
Valérie Chabbert ◽  
Patricia Chemla ◽  
...  
Keyword(s):  
Stent Graft ◽  
Low Pressure ◽  
Covered Stent ◽  
Bleeding Complications ◽  
Endovascular Technique ◽  
Femoral Access ◽  
Type Iii ◽  
Aortic Stent Graft ◽  
Angioplasty Balloon ◽  
Stiff Guidewire

Purpose: To report a technique for treating a type III endoleak owing to disconnection of an iliac graft limb from a modular aortic stent-graft. Technique: A hydrophilic guidewire is introduced via a homolateral femoral access and passed through the thrombosed iliac extension. Once the errant graft limb is recanalized, wire exchange for an extra stiff guidewire facilitates passage of an angioplasty balloon into the stent. Inflated under low pressure, the balloon is used to push the thrombosed limb retrograde into the aneurysm sac. With the aortoiliac axis restored, a new covered stent can be deployed. Conclusions: This approach is one of several that may be used to treat a type III endoleak arising from a disconnected and occluded stent-graft limb. It avoids the bleeding complications of thrombolysis and restores the aortoiliac axis so that another stent-graft may be implanted to re-exclude the aneurysm.

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