Fenestrated and Branched Endovascular Aortic Repair of Thoracoabdominal Aortic Aneurysm With More Than 4 Target Visceral Vessels due to Renovisceral Arterial Anatomical Variations: Feasibility and Early Results

2021 ◽  
pp. 152660282110164
Author(s):  
Ahmed Eleshra ◽  
Giuseppe Panuccio ◽  
Konstantinos Spanos ◽  
Fiona Rohlffs ◽  
Nikolaos Tsilimparis ◽  
...  
Keyword(s):  
Anatomical Variations ◽  
Celiac Artery ◽  
Renal Arteries ◽  
Aortic Aneurysms ◽  
Endovascular Aortic Repair ◽  
Technical Success ◽  
Early Results ◽  
The Mean ◽  
Accessory Renal Arteries

Purpose: This study describes technical success, feasibility, and early results of fenestrated and branched endovascular aortic repair (F/B-EVAR) for treatment of thoracoabdominal aortic aneurysms (TAAAs) or pararenal aneurysms with more than 4 target visceral vessels (TVs) due to renovisceral arterial anatomical variations. Materials and Methods: Patients with TAAAs or pararenal aortic aneurysms who had more than 4 TVs due to renovisceral arterial anatomical variations of renal, celiac, and/or superior mesenteric arteries and received F/B-EVAR between January 2017 and September 2019 at a single aortic center were included in this study. We analyzed technical success, feasibility, and early outcomes. Results: Twelve patients (mean age 70±10 years, 9 males) were included. The anatomical variations included 6 right accessory renal arteries, 8 left accessory renal arteries, and 1 celiac artery variant. Stent-grafts were fenestrated, branched or combined in 6, 5, or 1 patients, respectively. The mean operating time was 346±120 minutes, the mean fluoroscopy time was 80±29 minutes, and the mean radiation dose area product was 430±219 Gy·cm2. The mean contrast volume was 129±45 mL. The total number of TVs was 64; 5 TVs in 9 patients, 6 in 2 patients, and 7 in 1 patient. Technical success was achieved in all cases. The mean intensive care unit stay was 6±5 days, and the mean total hospital stay was 14±10 days. One patient died early (30-day). Early morbidities included respiratory complication in 1 patient, renal insufficiency in 1 patient, and wound infection in 2 patients. No spinal cord ischemia, stroke, or bowel ischemia occurred. Early computed tomography angiography showed 100% patency of the bridging covered stents and TVs. The mean follow-up was 13±4.3 months. No mortality or adverse major event occurred during the follow-up. Two patients with developed type Ic endoleak related to 1 right renal artery and 1 celiac artery covered stent. Patency of the TVs during follow-up was 100%. Conclusion: The use of F/B-EVAR for the treatment of TAAA with more than 4 TVs due to renovisceral arterial anatomical variations in our own experience is feasible and not related to increased morbidity and mortality.

Hybrid Endovascular Repair of Thoracoabdominal Aorta: Early Results

2014 ◽  
Vol 17 (3) ◽  
pp. 146
Author(s):  
Osman Tansel Darcin ◽  
Mehmet Kalender ◽  
Ayse Gul Kunt ◽  
Okay Guven Karaca ◽  
Ata Niyazi Ecevit ◽  
...  
Keyword(s):  
Endovascular Repair ◽  
Therapeutic Option ◽  
Complete Recovery ◽  
Aortic Aneurysms ◽  
Thoracoabdominal Aorta ◽  
Mortality And Morbidity ◽  
Early Results ◽  
The Mean ◽  
Procedural Success

<p><b>Background:</b> Thoracoabdominal aortic aneurysms (TAAA) present a significant clinical challenge, as they are complex and require invasive surgery. In an attempt to prevent considerably high mortality and morbidity in open repair, hybrid endovascular repair has been developed by many authors. In this study, we evaluated the early-term results obtained from this procedure.</p><p><b>Methods:</b> From November 2010 to February 2013, we performed thoracoabdominal hybrid aortic repair in 18 patients. The mean age was 68 years (12 men, 6 women). All of the patients had significant comorbidities. Follow-up computed tomography (CT) scans were performed at 1 week, 3 months, 6 months, and annually thereafter.</p><p><b>Results:</b> All patients were operated on in a staged procedure and stent graft deployment was achieved. Procedural success was achieved in all cases. All patients were discharged with complete recovery. No endoleaks weres detected in further CT examination.</p><p><b>Conclusion:</b> Our results suggests that hybrid debranching and endovascular repair of extensive thoracoabdominal aneurysms represents a suitable therapeutic option to reduce the morbidity and mortality of TAAA repair, particularly in those typically considered at high risk for standard repair.</p>

Preliminary Outcomes of Viabahn Balloon-Expandable Endoprosthesis as Bridging Stent in Renal Arteries During Fenestrated Endovascular Aortic Repair

2021 ◽  
pp. 152660282110124
Author(s):  
Luca Mezzetto ◽  
Davide Mastrorilli ◽  
Nicola Leone ◽  
Stefano Gennai ◽  
Roberto Silingardi ◽  
...  
Keyword(s):  
Renal Artery ◽  
Endovascular Aneurysm Repair ◽  
Renal Arteries ◽  
Endovascular Aortic Repair ◽  
Type I ◽  
Target Vessel ◽  
Technical Success ◽  
Transverse Axis ◽  
Aortic Repair

Purpose: To report preliminary outcomes of Viabahn Balloon-Expandable Endoprosthesis (VBX) stent-graft as bridging stent for renal arteries in fenestrated endovascular aneurysm repair (FEVAR). Materials and Methods: Between 2018 and 2019, patients undergoing FEVAR at 3 referral Italian university hospitals were prospectively collected. During the study period, VBX was the first-line choice as bridging stent for renal arteries. Procedural and anatomical data were analyzed, including renal artery (RA) configuration. A dedicated software (3Mensio, Vascular Imaging, Bilthoeven, The Netherlands) was used and RA anatomy classified as follow: upward-oriented in case of any angle >30° above the horizontal or transverse axis perpendicular to the aortic axis, downward-oriented if there was an angle >30° measured below the transverse axis and downward + upward in case of an angle <30° associated with a renal artery angulation >90°. Primary endpoints were technical success, defined as complete deployment of the fenestrated endograft without target vessel (TV) loss, limb stenosis or occlusion and type I or III endoleak, and freedom from target artery instability (TAI), defined by target vessel-related death, occlusion, rupture or reintervention for stenosis, endoleak or disconnection. Secondary endpoints were target artery patency rate and freedom from reinterventions. Results: A total of 26 elective FEVAR for juxta/pararenal aneurysm (20), thoracoabdominal type II (3) and type IV (3) were included. Fifty-one RA were planned for revascularization. Of these, 32 were downward, 10 horizontal, 6 upward, 4 were downward + upward. Technical success was achieved in 88.5% (23/26) of patients and 94.2% (48/51) of the TVs. One occlusion (2.1%) occurred within 30 days in a patient with previous endovascular aortic repair and suprarenal fixation. During follow-up (median 10 months), there was 1 type IC endoleak after 6 months (2.1%) in a patient with upward plus downward arterial orientation. Freedom from TAI was 96.1% (CI = 0.89 to 1.04) at first month and 92.3% (CI = 0.82 to 1.03) at 6 months. No aneurysm-related mortality and renal insufficiency occurred during follow-up. Conclusion: The use of VBX as bridging stent of RA in FEVAR is safe and feasible. Previous EVAR and tortuosity of RA may be a challenging on target vessel fate.

scholarly journals In-hospital and mid-term outcome after complex endovascular aortic repair with fenestrated and branched stent-grafts

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
V Makaloski ◽  
D Broger ◽  
S Weiss ◽  
S Jungi ◽  
D Becker ◽  
...  
Keyword(s):  
Stent Graft ◽  
Renal Arteries ◽  
Aortic Aneurysms ◽  
Endovascular Aortic Repair ◽  
Mesenteric Arteries ◽  
Hospital Death ◽  
Stent Grafts ◽  
Term Outcome ◽  
Aortic Repair

Abstract Objective The aim of the study is to evaluate in-hospital and mid-term outcome after complex endovascular aortic repair with fenestrated and branched stent-grafts (fEVAR / bEVAR). Methods This is a single-center retrospective analysis from a prospectively collected database of all patients treated electively with fEVAR or bEVAR for para/suprarenal (PAA) and thoraco-abdominal aortic aneurysm (TAAA) between September 2010 and June 2019. In-hospital and mid-term mortality, major adverse events and re-interventions were assessed. Results Fifty-one patient (84% male) with a mean age of 74±7 years were analysed. Eighteen patients (35%) had TAAA, four patients (8%) suprarenal, and 29 patients (57%) pararenal aortic aneurysms. Mean aneurysm diameter was 64±8 mm. Thirty-eight patients (75%) underwent fEVAR and 13 patients (25%) bEVAR. A total of 157 target vessels were incorporated: 22 celiac trunks (CT), 40 superior mesenteric arteries (SMA), 92 renal arteries (RA), two separate hepatic arteries and one splenic artery. No in-hospital death or stroke was recorded. One patient suffered from early postoperative paraplegia and did not recover and one had paraparesis after 38 days and recovered completely. Six patients (12%) with patent renal arteries experienced acute postoperative kidney injury; one required temporary dialysis. Five in-hospital re-interventions were stent-graft related (four bridging stents angioplasty and one iliac leg extension) and seven re-interventions were not stent-graft related. Mean follow-up was 19±17 months. Eleven patients (22%) died during follow-up: nine were not aortic-related and two were unknown. The Kaplan-Meier estimated survival rates at 1 and 2 years were 81% and 77%, respectively. Five renal stents (5%, 5/92) occluded during follow-up: three were successfully recanalized and two remained occluded. Ten stents (three CT, five SMA, and two RA stents required relining after 13±16 months postoperatively, resulting with estimated primary assisted patency at 2 years of 100%, 100%, 93%, and 95% for the CT, SMA, right RA and left RA, respectively. Conclusion Complex endovascular aortic repair with fEVAR / bEVAR for PAA and TAAA is safe with very low early mortality and morbidity. In-stent stenosis/occlusions occurred within the first two years. However, primary assisted patency was high. A surveillance program to detect potential stent-graft related complications is mandatory.

Systematic review with pooled data analysis reveals the need for a standardized reporting protocol including the visceral vessels during fenestrated endovascular aortic repair (FEVAR)

Vascular ◽  
2021 ◽  
pp. 170853812110191
Author(s):  
Georgios I Karaolanis ◽  
Constantine N Antonopoulos ◽  
Salvatore Scali ◽  
Stylianos G Koutsias ◽  
Drosos Kotelis ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Aortic Aneurysms ◽  
Endovascular Aortic Repair ◽  
Type I ◽  
Complication Rates ◽  
Technical Success ◽  
Aortic Repair ◽  
Standardized Reporting ◽  
Related Mortality

Objectives To collect and analyse the available evidence in the outcomes of patients treated with fenestrated endovascular aortic repair (f-EVAR) technique focusing specifically on visceral vessel outcomes. Methods The current meta-analysis was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All the studies reporting the f-EVAR technique for the management of degenerative pararenal and/or type IV thoracoabdominal aortic aneurysms (TAAA) were considered eligible for inclusion in the study. The main study outcomes (technical success, type I endoleaks, fracture or occlusion of the bridging stents, overall aneurysm-related mortality, and the reintervention rate) were subsequently expressed as proportions and 95% confidence intervals. Results Fourteen studies with a total of 1804 patients were included in a pooled analysis. The technical success of the procedure was 95.97% (95%CI = 92.35–98.60). Intraoperatively, the pooled proportion of reported type I endoleak was 7.6% (95%CI = 2.52–14.60) while during a median follow-up of 41 months (range 11–96) follow-up period the pooled rate of fracture and occlusion of the bridging stents was 2.79% (95%CI = 0.00–8.52) and 4.46% (95%CI = 1.93–7.77), respectively. The overall aneurysm-related mortality was detected to be 0.63% (95%CI = 0.04–1.63), and the pooled estimate for re-intervention rate was 15.69%. Conclusions Fenestrated endovascular repair for p-AAA is an effective and safe treatment. Target vessel complications and endoleaks remain the two most important concerns for fenestrated endovascular procedures, contributing to most of the secondary interventions. The lack of computed tomography angiography follow-up evaluation does not allow us to draw robust conclusions about the complication rates for the superior mesenteric artery during f-EVAR. Due to the potential implications of SMA complications on aneurysm-related mortality, standardized reporting of short- and long-term target visceral vessel outcomes is required.

scholarly journals Multicenter observational study of the gore excluder conformable endograft for endovascular abdominal aortic repair: Initial results

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
A Roesti ◽  
A Isaak ◽  
G Gemayel ◽  
E Mujagic ◽  
L Briner ◽  
...  
Keyword(s):  
Operation Time ◽  
Aortic Aneurysms ◽  
Technical Success ◽  
New Device ◽  
Abdominal Aortic ◽  
Mean Diameter ◽  
Type Ia ◽  
The Mean ◽  
Initial Results

Abstract Objective Endovascular repair (EVAR) has become the standard of care for treatment of abdominal aortic aneurysms. However, a significant number of EVAR remains outside the IFU, especially in cases of severe proximal angulation (&gt;60 degrees), resulting in failure. The new device GORE EXCLUDER Conformable AAA Endoprosthesis (W. L. Gore & Associates, Flagstaff, Ariz) has been designed to accommodate neck angulation, due to conformability and angulation control. The aim of this multicenter study is to report the initial results of this device. Methods From March 2019 to January 2021, the data of all consecutive patients with AAA treated with the Gore Excluder Conformable endograft at 4 vascular centers were reviewed. Patients were followed using a standardized protocol, with CT-scan at 1, 6 and 12 months, and then yearly. The primary endpoint was technical success and secondary outcomes were postoperative morbidity, rate of endoleak (EL) and any aneurysm-related re-interventions during follow-up. Results Among the 32 patients included, most were men with a mean age of 77 years old (range 60-92). Half of patients were smokers and 72% had hypertension. The mean diameter of AAA was 62 mm (47-90). The mean length of aortic neck was 26 mm (10-69), the mean diameter 23 mm (16-31) and the median neck angulation was 81 degrees (range 40-110). The mean procedural duration was 102 min (54-153) with a mean time of scopy of 24 min (8-47) and a total volume of contrast of 101 ml (40-165). Thirteen iliac branch device have been used in 7 patients. The technical success was 97% with 1 type Ia EL (3%). In the post-operative period, 4 medical and 3 surgical complications were observed. Two reinterventions were needed with an iliac stenting for a stenosis and a correction of a femoral false aneurysm. During the mean follow-up of 7 months, 2 type Ia ELs were observed. One spontaneously resolved and the other one was followed. One distal limb extension was succesfully implanted at 3 months for a type Ib EL for a total rate of reintervention of 9%. No migration was observed. No death occured. Conclusion The use of the Gore Excluder Conformable endograft seems to be safe and effective in difficult anatomies and especially high angulation. It allows for precise deployment without the need for additional contrast or operation time. Longer follow-up and more patients are required to confirm these excellent initials results.

Early Clinical Outcomes of the Active Seal Technology of the AFX Endovascular Aortic Aneurysm System With the VELA Cuff for Patients With a Conical Proximal Neck

2022 ◽  
pp. 152660282110709
Author(s):  
Naoki Fujimura ◽  
Hideaki Obara ◽  
Takaaki Nagano ◽  
Yukihisa Ogawa ◽  
Taira Kobayashi ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Endovascular Aneurysm Repair ◽  
Aortic Aneurysms ◽  
Proximal Neck ◽  
Landing Zone ◽  
The Core ◽  
The Mean ◽  
Instructions For Use ◽  
Lost To Follow Up

Purpose: To evaluate the efficacy of the Active Seal technology employed in the AFX endovascular aortic aneurysm system (AFX), during endovascular aneurysm repair (EVAR) in patients with abdominal aortic aneurysms (AAAs) having a conical proximal neck. Materials and Methods: A retrospective analysis of the EVAR for AAA with a conical proximal neck using the AFX was performed at 17 Japanese hospitals between January 2016 and August 2020. The conical proximal neck was defined as a cone-shaped proximal neck, with more than 10% diameter increase within a 15 mm length at the proximal landing zone. All anatomical analyses were performed in the core laboratory, and cases with parallel walls within the proximal neck adequate for the landing zone were excluded from the study. Results: This study included 53 patients, but only 39 patients (mean age, 76.6 ± 6.7 years; 87.0% males; mean aneurysm diameter, 52.0 ± 8.0 mm) were analyzed after being characterized as having a pure conical neck by the core laboratory. The mean proximal neck diameters at the lower renal artery and proximal edge of the aneurysm were 20.0 ± 2.9 mm and 27.5 ± 4.9 mm, respectively. The mean proximal neck length was 21.5 ± 6.0 mm. Instructions for use violations other than the conical neck were observed in 15 patients (38.5%). The VELA cuff was used in all cases; however, additional proximal cuff was required in 9 more cases (23.1%). The Active Seal technology was able to significantly extend the proximal sealing zone from 21.5 ± 6.0 to 26.0 ± 12.2 mm ( p = .047). Thirty-six patients completed the 12-month follow-up (one patient was lost to follow-up, and 2 patients died from causes unrelated to the aneurysm), and there were no type-1a and 3 endoleaks with only one reintervention (2.6%) related to type 1b endoleak in the 12-month period. Furthermore, there was no significant enlargement of the proximal neck diameter at 12 months (at 1 month: 20.6 ± 3.4 mm and at 12 months: 21.3 ± 3.8 mm; p = .420). Conclusion: The Active Seal technology of the AFX significantly extended the proximal seal zone and no type-1a endoleak and proximal neck dilation was observed in patients with conical proximal neck at 12 months.

scholarly journals Ultrasound Surveillance of Ectatic Abdominal Aortas

2008 ◽  
Vol 90 (6) ◽  
pp. 477-482 ◽  
Author(s):  
S Devaraj ◽  
SR Dodds
Keyword(s):  
Growth Rate ◽  
Growth Rates ◽  
Screening Programme ◽  
T Test ◽  
Aortic Aneurysms ◽  
Aortic Diameter ◽  
Ultrasound Screening ◽  
The Mean ◽  
Clinically Significant

INTRODUCTION Some studies have considered abdominal aortas of 2.6–2.9 cm diameter (ectatic aortas) at age 65 years as being abnormal and have recommended surveillance, whereas others have considered these normal and surveillance unnecessary. It is, therefore, not clear how to manage patients with an initial aortic diameter between 2.6–2.9 cm detected at screening. The aim of this study was to evaluate growth rates of ectatic aortas detected on initial ultrasound screening to determine if any developed into clinically significant abdominal aortic aneurysms (AAAs; > 5.0 cm) and clarify the appropriate surveillance intervals for these patients. PATIENTS AND METHODS Data were obtained from a prospective AAA screening programme which commenced in 1992. The group of patients with initial aortic diameters of 2.6–2.9 cm with a minimum of 1-year follow-up were included in this study (Group 2). This was further divided into two subgroups (Groups 3a and 3b) based on a minimum follow-up interval obtained from outcome analysis. Mean growth rate was calculated as change in aortic diameter with time. The comparison of growth rates in Groups 3a and 3b was performed using the t-test. The number and proportion of AAAs that expanded to ≥ 3.0 cm and ≥ 5.0 cm in diameter were also calculated. RESULTS Out of 999 patients with AAA ≥ 2.6 cm with minimum 1-year follow-up, 358 (36%) were classified as ectatic aortas (2.6–2.9 cm) at initial ultrasound screening with the mean growth rate of 1.69 mm/year (95% CI, 1.56–1.82 mm/year) with a mean follow-up of 5.4 years. Of these 358 ectatic aortas, 314 (88%) expanded into ≥ 3.0 cm, 45 (13%) expanded to ≥ 5.0 cm and only 8 (2%) expanded to ≥ 5.5 cm over a mean follow-up of 5.4 years (range, 1–14 years). No ectatic aortas expanded to ≥ 5.0 cm within the first 4 years of surveillance. Therefore, the minimum follow-up interval was set at 4 years and this threshold was then used for further analysis. The mean growth rate in Group 3a (< 5.0 cm at last scan) was 1.33 mm/year (95% CI, 1.23–1.44 mm/year) with a mean follow-up of 7 years compared to Group 3b (≥ 5.0 cm at last scan) with the mean growth rate of 3.33 mm/year (95% CI 3.05–3.61 mm/year) and a mean follow-up of 8 years. The comparison of mean growth rates between Groups 3a and 3b is statistically significant (t-test; T = 13.00; P < 0.001). CONCLUSIONS One-third of patients undergoing AAA screening will have ectatic aortas (2.6–2.9 cm) and at least 13% of these will expand to a size of ≥ 5.0 cm over a follow-up of 4–14 years. A threshold diameter of 2.6 cm for defining AAAs in a screening programme is recommended and ectatic aortas detected at age 65 years can be re-screened at 4 years after the initial scan. A statistically significant difference was found in the growth rates of ectatic aortas with minimum 4 years follow-up, expanding to ≥ 5.0 cm compared to those less than 5.0 cm at last surveillance scan. Further studies are required to test the hypothesis of whether growth rate over the first 4 years of surveillance will identify those who are most likely to expand to a clinically significant size (> 5.0 cm).

Endovascular Aneurysm Sealing (EVAS) and Chimney EVAS in the Treatment of Failed Endovascular Aneurysm Repairs

2016 ◽  
Vol 24 (1) ◽  
pp. 115-120 ◽  
Author(s):  
Marwan Youssef ◽  
Sebastian Zerwes ◽  
Rudolf Jakob ◽  
Oroa Salem ◽  
Fritz Dünschede ◽  
...  
Keyword(s):  
Endovascular Aneurysm Repair ◽  
Multiple Organ ◽  
Aortic Aneurysms ◽  
Technical Success ◽  
Graft Thrombosis ◽  
Type Ia ◽  
Aneurysm Repair ◽  
Chimney Graft ◽  
Bifurcated Graft

Purpose: To assess the technical success and clinical outcome of reinterventions using the Nellix Endovascular Aneurysm Sealing (EVAS) System to treat complications after endovascular aneurysm repair (EVAR). Methods: Fifteen consecutive patients (mean age 79 years; 14 men) with prior EVAR were treated with EVAS between March 2014 and December 2015 at 2 institutions. The failed prior EVARs included 13 bifurcated endografts, 1 bifurcated graft plus fenestrated cuff, and 1 tube endograft. Endoleaks were the predominant indications: type Ia in 10 and type III in 5 (3 type IIIa and 2 type IIIb). All patients presented with progressive aortic aneurysms (median 7.85-cm diameter; range 6.5–11). Eight patients were treated on an urgent or emergency basis (6 symptomatic aneurysms and 2 contained ruptures). All patients underwent Nellix relining of the failed stent-graft; 10 had chimney (Ch) procedures in combination with EVAS (chEVAS) because the proximal landing zones were inadequate. Results: Technical success was 100%. All endoleaks were successfully sealed, and no additional intervention was required. No further endoleak after EVAS or chEVAS was recorded. Endobag protrusion occurred in 1 case without sequelae. One elderly patient with ruptured aneurysm died from multiple organ failure 2 months postoperatively. One renal artery guidewire injury led to nephrectomy because of active bleeding. No reinterventions, aneurysm-related mortalities, graft thrombosis, endoleaks, or chimney graft occlusions were observed during a median follow-up of 8 months (range 3–24). Conclusion: The present preliminary experience demonstrates that the use of EVAS/chEVAS is feasible for treatment of failed EVAR. This technique may be used as bailout or an alternative treatment when other established methods are infeasible or not available.

Candy-Plug Generation II for False Lumen Occlusion in Chronic Aortic Dissection: Feasibility and Early Results

2019 ◽  
Vol 26 (6) ◽  
pp. 782-786 ◽  
Author(s):  
Ahmed Eleshra ◽  
Tilo Kölbel ◽  
Nikolaos Tsilimparis ◽  
Giuseppe Panuccio ◽  
Martin Scheerbaum ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Clinical Success ◽  
False Lumen ◽  
The Other ◽  
Type I ◽  
Technical Success ◽  
Chronic Aortic Dissection ◽  
Early Results ◽  
Aortic Remodeling

Purpose: To present the early results of false lumen (FL) occlusion in chronic aortic dissection using the Candy-Plug generation II (CP II), which has a self-closing fabric channel that obviates the need for separate occlusion of its center. Materials and Methods: Fourteen consecutive patients (mean age 60±11 years; 10 men) with persistent FL backflow and aneurysm formation at the thoracic segment in chronic aortic dissection underwent thoracic endovascular aortic repair (TEVAR) with FL occlusion using the refined CP II. Primary endpoints were technical success (successful deployment) and clinical success (no FL backflow at the CP II level). Secondary endpoints included 30-day mortality and morbidity and aortic remodeling during follow-up. Results: Technical success was 100%. One patient required additional intraprocedural FL embolization at the CP II level due to persistent FL backflow on final angiography (clinical success 93%), though there was no flow through the CP II center. There were no intraprocedural complications. Immediate complete FL occlusion was achieved in 12 patients; the other 2 required reintervention. One had contrast enhancement in the distal FL proximal to the CP II and was treated with coil embolization. The other patient had persistent type I endoleak at the level of the left subclavian artery (LSA) and underwent left carotid–LSA bypass and proximal stent-graft extension. One patient died due to retrograde type A aortic dissection that was not related to CP II placement. Over a mean 8-month follow-up (range 3–12), 9 patients had computed tomography angiography; 8 patients had evidence of aortic remodeling, while 1 aneurysm sac was stable. Conclusion: The CP II reduces the number of procedural steps and offers good seal, with minimal morbidity and mortality and a high rate of aortic remodeling.

scholarly journals Early results and medico-economic evaluation of a short daily home hemodialysis program in a Private hemodialysis center

2021 ◽  
Vol 4 (2) ◽  
pp. 105-119
Author(s):  
Hadia Hebibi ◽  
Magali Ciroldi ◽  
Laure Cornillac ◽  
Samah Saibi ◽  
Fatia El Boundri ◽  
...  
Keyword(s):  
Professional Activity ◽  
Average Volume ◽  
Training Time ◽  
Professional Integration ◽  
Daily Hemodialysis ◽  
Early Results ◽  
Average Residual ◽  
The Mean ◽  
Medico Economic

Abstract: Between 2015 and 2017 there was a 40% increase in daily hemodialysis, according to the REIN database. This increase concerns 1% of patients and the private sector remains under-represented. Our retrospective study aims to describe the clinical features, the organizational and medico-economic specificities of this technique in a private hemodialysis center. Methods: We included 12 dialyzed patients trained on Nx Stage® machine from February 2020 to April 2021. Data were retrospectively obtained through review of our electronic medical records (EUCLID®). Results: Of the 12 patients trained, 11 dialyzed from home, with an average follow-up of 9 months (1-14). The average age was 45 with a sex ratio of 4/8 (M/W), and a median Charlson score of 3 (2-4). The average residual urinary output was 700 mL/24h, and 50% of patients were anuric. 100% of patients had an arteriovenous fistula and were cannulated using the buttonhole technique. 9 patients are on a transplant list. One patient needed anticoagulants. The mean training time was 35 days (28-35). 83% of patients were dialyzed 6 days a week with an average duration of 210 minutes (130-150) per session. The average volume of dialysate was 24.85 liters. One patient developed an allergy to the PUREMA® membrane. Pre-dialytic hemoglobin, serum creatinine, urea, phosphoremia and B2-microglobuline are stable at 9 months with improvement in metabolic acidosis. Conclusion: DHHD allowed a better socio-professional integration. One patient received a transplant and 3 patients resumed professional activity.

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