A Modified Proximal Stent-Graft for Spinal Cord Preconditioning During Staged Endovascular Repair of Thoracoabdominal Aortic Aneurysms

2020 ◽  
Vol 27 (5) ◽  
pp. 764-768
Author(s):  
Enrico Rinaldi ◽  
Niccolò Carta ◽  
Germano Melissano ◽  
Roberto Chiesa ◽  
Luca Bertoglio
Keyword(s):  
Spinal Cord ◽  
Stent Graft ◽  
Endovascular Repair ◽  
Aortic Wall ◽  
Outer Part ◽  
Aortic Aneurysms ◽  
Additional Tool ◽  
Repair Technique ◽  
Custom Made ◽  
Thoracic Stent Graft

Purpose: To describe a new custom-made thoracic device able to seal against the aortic wall and occlude intercostal arteries for spinal cord preconditioning during the first thoracic stage of a thoracoabdominal endovascular repair. Technique: The custom-made device, based on the Zenith Alpha stent-graft, combines different features from 2 previously described devices: the outer part is designed with a bell-bottom configuration similar to the “Embo” stent-graft, while the inner part mimics the “2 in 1” design. The outer stent-graft is designed to span the entire length of the thoracic aorta and cover as many intercostal arteries as possible during the first stage to effectively precondition the spinal cord. The sutured inner component is customizable in diameter and 20 to 40 mm shorter than the outer stent-graft. The technique has been used in 5 patients. Conclusion: The use of this new custom-made thoracic stent-graft might represent an additional tool for effectively preconditioning the spinal cord during fenestrated and branched staged procedures whenever a proximal thoracic proximal component is needed.

scholarly journals Temporary Perfusion Branches to Decrease Spinal Cord Ischemia in the Endovascular Treatment of Thoraco-Abdominal Aortic Aneurysms

Aorta ◽  
2015 ◽  
Vol 03 (02) ◽  
pp. 56-60 ◽  
Author(s):  
Parveen Jayia ◽  
Jason Constantinou ◽  
Hamish Hamilton ◽  
Krassi Ivancev
Keyword(s):  
Spinal Cord ◽  
New York ◽  
Endovascular Repair ◽  
Spinal Cord Ischemia ◽  
Abdominal Aortic Aneurysms ◽  
Aortic Aneurysms ◽  
Stent Grafts ◽  
Abdominal Aortic ◽  
Custom Made ◽  
Complete Exclusion

Based on a Presentation at the 2013 VEITH Symposium, November 19–23, 2013 (New York, NY, USA) Background: Spinal cord ischemia (SCI) is one of the most feared complications following the repair of thoraco- abdominal aortic aneurysms (TAAA). Endovascular repair of TAAA is now possible with branched stent grafts, but spinal cord ischaemia rates are still unacceptably high. A number of techniques have been utilized to reduce these levels, however, SCI remains a challenge to endovascular repair of TAAA. The use of sac perfusion branches aims to reduce the incidence of this catastrophic complication. Methods: A retrospective analysis of all patients undergoing branched endovascular aortic repair for all thoraco-abdominal aneurysms (TAAA) using custom made devices during January 2008 to August 2014. We describe a two staged technique in which perfusion of segmental vessels is maintained by a temporary endoleak through an open perfusion branch, incorporated within the branched stent graft, followed by a closure of this branch at a later date to complete exclusion of the aneurysm. Results: Forty-seven patients underwent TAAA repair. Twenty-five (53%) had a two-stage procedure using either a sac perfusion branch or a target vessel to perfuse the sac. Nine patients (19.15%) suffered some form of SCI with eight patients having temporary SCI (lasting less than 72 hours) and one patient having permanent SCI. Of eight patients that had temporary spinal cord ischemia, all had a perfusion strategy. There was one case of permanent SCI (2.13%). Conclusion: Sac perfusion branches provide a safe method for preventing SCI, however this needs to be used in conjunction with controlling MAP and CSF drainage.

scholarly journals Endovascular repair of de novo post-stenotic aortic coarctation aneurysms with complex collateral supply: two cases with long and medium term follow-up

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Omar Abdel-Hadi ◽  
John Thomson ◽  
Simon J. McPherson
Keyword(s):  
Stent Graft ◽  
Endovascular Repair ◽  
Aortic Coarctation ◽  
De Novo ◽  
Aortic Aneurysms ◽  
Medium Term ◽  
First Case ◽  
Case Presentations ◽  
Selective Embolisation

Abstract Purpose To report the technical details and outcomes of the endovascular repair of two cases of de novo post-stenotic aortic coarctation aneurysms complicated by complex collateral supply. Case presentations Two patients with thoracic aortic aneurysms complicated by complex aneurysm sac collaterals distal to a previously untreated thoracic aortic coarctation have been treated at our institution. Open surgical intervention was deemed to carry a high risk of haemorrhage due to the degree and complexity of arterial collateralisation. In the first case, selective embolisation of collateral vasculature was performed prior to successful exclusion of the aneurysm with a thoracic endovascular stent-graft and then balloon-expandable stent dilatation of the coarctation stenosis. In the second case, the additional technique of using a jailed sheath within the aneurysm sac allowed for selective embolisation of previously inconspicuous collaterals after deployment of the stent-graft and stent combination. Results Technical success was achieved in both patients with successful occlusion of the aneurysm, with no recorded complications or aneurysm sac perfusion in the long and medium term follow up periods respectively. Conclusion De novo post stenotic aortic coarctation aneurysms are rare. Endovascular repair is a safe and durable technique that provides a less invasive alternative to open surgical repair. The use of a jailed sheath allows for complete selective embolisation of complex collaterals avoiding a type II aneurysm endoleak.

Regression of a Descending Thoracoabdominal Aortic Dissection following Staged Deployment of Thoracic and Abdominal Aortic Endografts

2002 ◽  
Vol 9 (2_suppl) ◽  
pp. II-92-II-97 ◽  
Author(s):  
Rodney A. White ◽  
Carlos Donayre ◽  
Irwin Walot ◽  
James Lee ◽  
George E. Kopchok
Keyword(s):  
Aortic Dissection ◽  
Stent Graft ◽  
False Lumen ◽  
Acute Chest Pain ◽  
Aortic Aneurysms ◽  
Abdominal Aneurysm ◽  
Entry Site ◽  
Abdominal Aortic ◽  
Thoracic And Abdominal ◽  
Thoracic Stent Graft

Purpose: To describe the successful endovascular repair and regression of an extensive descending thoracoabdominal aortic dissection associated with thoracic and abdominal aortic aneurysms. Case Report: An 83-year-old man presented with acute chest pain and shortness of breath. A descending thoracoabdominal aortic dissection that extended from near the left subclavian artery (LSA) to the right common iliac artery was found on computed tomography. Separate aneurysms in the thoracic and abdominal aorta were also identified. Staged endovascular procedures were undertaken to (1) close the single entry site and exclude the aneurysm in the thoracic aorta with an AneuRx thoracic stent-graft, (2) exclude the abdominal aneurysm and distal re-entry site with a bifurcated AneuRx endograft, and (3) treat a newly dilated thoracic segment between the LSA and first thoracic stent-graft. At 1 year, the false lumen had completely disappeared, the thoracic aneurysm had collapsed onto the endograft, and the abdominal aneurysm had shrunk by 30%. Conclusions: The potential to treat extensive aortic dissections with the hope that they might regress is promising, but repair of highly complex lesions involving one or more aneurysms in addition to the dissection requires meticulous imaging studies both preoperatively and intraprocedurally.

Stent graft types for endovascular repair of thoracic aortic aneurysms

2013 ◽  
Author(s):  
Rachel Rolph ◽  
James MN Duffy ◽  
Bijan Modarai ◽  
Rachel E Clough ◽  
Peter Taylor ◽  
...  
Keyword(s):  
Stent Graft ◽  
Endovascular Repair ◽  
Aortic Aneurysms ◽  
Thoracic Aortic Aneurysms

Anatomical repair for Kommerell diverticulum with deep site in-situ fenestration

2018 ◽  
Vol 26 (6) ◽  
pp. 467-469
Author(s):  
Masami Shingaki ◽  
Yoshihiko Kurimoto ◽  
Kiyofumi Morishita ◽  
Toshio Baba ◽  
Tsuyoshi Shibata ◽  
...  
Keyword(s):  
Stent Graft ◽  
Subclavian Artery ◽  
Endovascular Repair ◽  
Left Subclavian Artery ◽  
The Third ◽  
Deep Site ◽  
Main Component ◽  
Thoracic Stent Graft ◽  
Kommerell Diverticulum

An 83-year-old woman with a Kommerell diverticulum was treated by anatomical endovascular repair with a deep site in-situ fenestration instead of complex debranching techniques. The main component of the thoracic stent-graft was deployed just distal to the third cervical branch to completely exclude the Kommerell diverticulum. A deep site in-situ fenestration was made on the main component using a radiofrequency needle through the left subclavian artery, and a stent-graft was deployed to bridge the main component to the left subclavian artery. Six months postoperatively, the Kommerell diverticulum was completely excluded with excellent left subclavian artery patency.

scholarly journals Paraplegia prevention in aortic aneurysm repair by thoracoabdominal staging with ‘minimally invasive staged segmental artery coil embolisation’ (MIS²ACE): trial protocol for a randomised controlled multicentre trial

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e025488 ◽  
Author(s):  
David Petroff ◽  
Martin Czerny ◽  
Tilo Kölbel ◽  
Germano Melissano ◽  
Lars Lonn ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Minimally Invasive ◽  
Endovascular Repair ◽  
Aortic Aneurysms ◽  
Coil Embolisation ◽  
Segmental Artery ◽  
Generalised Linear Mixed Model ◽  
Cord Injury ◽  
Randomised Controlled ◽  
Aneurysm Repair

IntroductionSpinal cord injury (SCI) including permanent paraplegia constitutes a common complication after repair of thoracoabdominal aortic aneurysms. The staged-repair concept promises to provide protection by inducing arteriogenesis so that the collateral network can provide a robust blood supply to the spinal cord after intervention. Minimally invasive staged segmental artery coil embolisation (MIS2ACE) has been proved recently to be a feasible enhanced approach to staged repair.Methods and analysisThis randomised controlled trial uses a multicentre, multinational, parallel group design, where 500 patients will be randomised in a 1:1 ratio to standard aneurysm repair or to MIS2ACE in 1–3 sessions followed by repair. Before randomisation, physicians document whether open or endovascular repair is planned. The primary endpoint is successful aneurysm repair without substantial SCI 30 days after aneurysm repair. Secondary endpoints include any form of SCI, mortality (up to 1 year), length of stay in the intensive care unit, costs and quality-adjusted life years. A generalised linear mixed model will be used with the logit link function and randomisation arm, mode of repair (open or endovascular repair), the Crawford type and the European System for Cardiac Operative Risk Evaluation (euroSCORE) II as fixed effects and the centre as a random effect. Safety endpoints include kidney failure, respiratory failure and embolic events (also from debris). A qualitative study will explore patient perceptions.Ethics and disseminationThis trial has been approved by the lead Ethics Committee from the University of Leipzig (435/17-ek) and will be reviewed by each of the Ethics Committees at the trial sites. A dedicated project is coordinating communication and dissemination of the trial.Trial registration numberNCT03434314.

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