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.

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.

Up-and-Over Technique for Implantation of Iliac Branch Devices After Prior Aortic Endograft Repair

2018 ◽  
Vol 25 (1) ◽  
pp. 21-27 ◽  
Author(s):  
David L. Dawson ◽  
Giuliano de Almeida Sandri ◽  
Emanuel Tenorio ◽  
Gustavo S. Oderich
Keyword(s):  
Stent Graft ◽  
Iliac Artery ◽  
Endovascular Aneurysm Repair ◽  
Covered Stent ◽  
Femoral Access ◽  
Aortic Stent Graft ◽  
Flow Divider ◽  
Device Placement ◽  
Internal Iliac ◽  
Aneurysm Repair

Purpose: To describe a modified up-and-over access technique for treatment of iliac artery aneurysms in patients with prior bifurcated stent-grafts for endovascular aneurysm repair (EVAR). Technique: This technique uses a coaxial 12-F flexible sheath that is docked with a through-and-through wire into a 7-F sheath advanced from the contralateral femoral approach. This maneuver allows both sheaths to be moved as a unit while maintaining position of the apex of the system as it loops over the flow divider, avoiding damage to or displacing the extant endograft. Once the 12-F sheath is positioned in the iliac limb of the aortic stent-graft and secured in place with the through-and-through wire, the repair is extended into the internal iliac artery using a bridging stent-graft or covered stent introduced via a coaxial sheath. Conclusion: The up-and-over technique with a flexible 12-F sheath mated with a 7-F sheath from the opposite side allows bilateral femoral access to be used for iliac branch device placement after prior aortic endograft procedures that create a higher, acutely angled bifurcation. Use of a through-and-through wire and a coaxial sheath for stent delivery creates a very stable platform for intervention.

scholarly journals Endovascular Treatment of Spontaneous and Isolated Infrarenal Acute Aortic Syndrome with Unibody Aortic Stent-Grafts

2020 ◽  
Vol 44 (12) ◽  
pp. 4267-4274
Author(s):  
Felice Pecoraro ◽  
Ettore Dinoto ◽  
Domenico Mirabella ◽  
Francesca Ferlito ◽  
Arduino Farina ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Stent Graft ◽  
Abdominal Aorta ◽  
Infrarenal Aorta ◽  
Acute Aortic Syndrome ◽  
Technical Success ◽  
Stent Grafts ◽  
Femoral Access ◽  
Persistent Symptoms

Abstract Introduction Spontaneous acute aortic syndrome (IAAS) is rarely localized in the infrarenal aorta. The endovascular approach is preferred over conventional open surgery with fewer complications. However, dedicated endovascular devices for IAAS treatment are unavailable. The aim was to report a large single-center experience using unibody stent-grafts to address IAAS. Methods From April 2016 to March 2019, a retrospective analysis of patients presenting spontaneous and isolated IAAS was performed. Patients addressed with the unibody stent-graft (AFX endovascular AAA system; Endologix Inc., Irvine, CA) were included in the study. Indications to IAAS treatment were persistent symptoms and/or dilated abdominal aorta (>3 cm). The measured outcomes were technical success; early outcomes (<30 days) including mortality, morbidity, symptoms recurrence, and endoleak occurrence; and late outcomes (>30 days) including mortality, symptoms recurrence, endoleak occurrence, stent-graft patency, and survival. Median follow-up was 23.77 ± 10 months. Results Twenty-one patients with IAAS were included. Indications to treatment were symptoms in 14 (67%) patients and dilated abdominal aorta in 7 (33%). Technical success was achieved in all cases. No perioperative mortality and 1 (4.8%) early femoral access complication was encountered. During the follow-up were registered 1 (4.8%) aortic unrelated death and 1 (4.8%) stent-graft limb stenosis. The 36 months estimated survival and freedom from reintervention were 92% (CI: 37–43; SE: 1.7) and 94% (CI: 37–44; SE: 1.7), respectively. Conclusions The endovascular treatment of IAAS with unibody stent-graft (AFX endovascular AAA system; Endologix Inc.) is safe and effective with promising mid-term outcomes. The use of unibody stent-grafts expands the endovascular indication, despite the usual anatomic IAAS features. Larger studies with longer follow-up are required to validate the outcomes of the reported technique.

Use of a Steerable Sheath for Retrograde Access to Antegrade Branches in Branched Stent-Graft Repair of Complex Aortic Aneurysms

2018 ◽  
Vol 25 (5) ◽  
pp. 566-570 ◽  
Author(s):  
Vladimir Makaloski ◽  
Nikolaos Tsilimparis ◽  
Fiona Rohlffs ◽  
Konstantinos Spanos ◽  
E. Sebastian Debus ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Stent Graft ◽  
Femoral Artery ◽  
Common Femoral Artery ◽  
Aortic Aneurysms ◽  
Femoral Access ◽  
Aortic Stent Graft ◽  
Stent Graft Repair ◽  
The Common ◽  
Steerable Sheath

Purpose: To describe how to use a steerable sheath from a femoral access to catheterize antegrade branches in a branched aortic stent-graft. Technique: Following femoral cutdown, a stent-graft with antegrade branches destined for renovisceral target vessels was deployed in the desired position. A steerable sheath with a tip that rotates up to 180° was introduced from the common femoral artery and navigated to the antegrade branches for consecutive catheterization of the target vessels and deployment of one or more bridging stents per branch. The technique is demonstrated in 4 patients who underwent successful complex abdominal and thoracoabdominal branched endovascular repairs with 1, 2, and 4 antegrade branches. Conclusion: Retrograde access for complex aortic endografts with antegrade branches using a steerable sheath appears feasible and effective and may serve as an alternative to upper extremity access.

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.

Early stent fracture and collapse of a Zenith TX2 thoracic stent graft used for traumatic aortic rupture

Vascular ◽  
2011 ◽  
Vol 19 (5) ◽  
pp. 287-290 ◽  
Author(s):  
Mårten Falkenberg ◽  
Jonas Cronqvist ◽  
Martin Malina
Keyword(s):  
Stent Graft ◽  
Aortic Rupture ◽  
Stent Fracture ◽  
X Rays ◽  
Structural Failure ◽  
Stent Grafts ◽  
Lethal Outcome ◽  
Retrospective Assessment ◽  
Aortic Transection

Structural failure and collapse of thoracic stent grafts may cause fatal complications that are easily overlooked on follow-up imaging. A young man with multiple injuries from a motorcycle crash was treated with endografting for an aortic transection. The clinical course was initially satisfactory but deteriorated one week after the injury and the patient died two weeks later. Autopsy and retrospective assessment of chest X-rays revealed early fractures and collapse of the stent graft that had been overlooked and may have contributed to the lethal outcome. The design of thoracic stent grafts needs to be improved for treatment of traumatic aortic transection. Careful follow-up of these patients is warranted.

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.

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

Fatigue Resistance of the Advanta V12/iCast and Viabahn Balloon-Expandable Stent-Graft as Bridging Stents in Experimental Fenestrated Endografting

2021 ◽  
pp. 152660282199672
Author(s):  
Giovanni Torsello ◽  
Marcus Müller ◽  
Sarah Litterscheid ◽  
Bärbel Berekoven ◽  
Martin Austermann ◽  
...  
Keyword(s):  
Stent Graft ◽  
Fatigue Resistance ◽  
Transluminal Angioplasty ◽  
Fatigue Tests ◽  
Stent Fracture ◽  
Stent Grafts ◽  
Radiographic Images ◽  
Significant Difference ◽  
Prolonged Stress ◽  
Layer Defect

Purpose: Bridging stents undergo millions of cycles during respiratory movements of the kidneys throughout the patient’s life. Thus, understanding the response of fabric and endoskeleton of the stent to cyclic loading over the time is crucial. In this study, we compare the fatigue resistance of the Viabahn Balloon-Expandable stent-graft (VBX) with the widely used Advanta V12/iCast under prolonged stress induction. Materials and Methods: A polyester test sheet with 10 fenestrations was used simulating a fenestrated endograft. Five 6×59 mm VBX stent-grafts and five 6×58 mm Advanta stent-grafts were implanted into 6×6 mm fenestrations. The stents were flared with a 10×20 mm PTA (percutaneous transluminal angioplasty) catheter and connected with a fatigue stress machine. All stent-grafts were evaluated by microscopy and radiography at baseline and after regular intervals until 50,000,000 cycles were applied, simulating a life span of approximately 75 months. Freedom from fracture (FF), freedom from initial polytertafluoroethylene (PTFE) changes (FIC), and from PTFE breakpoint (FBP, all-layer defect) were calculated. Results: Digital radiographic images did not show any stent fracture in both groups after 50,000,000 cycles. The VBX stent-graft was free from any all-layer defects at the conclusion of 50,000,00 cycles resulting in a significant higher FBP compared with Advanta V12 (50,000,000 vs 33,400,000; p<0.01). All-layer defects were observed only in the Advanta group. Two of 5 Advanta stents showed early penetration of the nitinol ring causing a defect of PTFE. Regarding FIC, there was no significant difference between the stents (3,400,000 in VBX vs 3,200,000 in Advanta). Conclusions: In fatigue tests simulating respiration movements, VBX and Advanta V12 performed equally well in terms of fracture resistance and freedom from initial PTFE changes. VBX maintained freedom from PTFE breakpoint throughout the full 50,000,000 cycles. All-layers defects were detected only in Advanta and were mainly caused by penetration of the nitinol ring through the PTFE.

Endovascular resuscitation for ruptured abdominal aortic aneurysms with main stent-graft and REBOA via single-sided access

2018 ◽  
Vol 2 (3) ◽  
Author(s):  
David T McGreevy ◽  
Tal M Hörer ◽  
Artai Pirouzram
Keyword(s):  
Stent Graft ◽  
Vascular Access ◽  
Abdominal Aortic Aneurysms ◽  
Balloon Occlusion ◽  
Aortic Aneurysms ◽  
Team Approach ◽  
Femoral Access ◽  
Aortic Stent Graft ◽  
Abdominal Aortic ◽  
Ruptured Abdominal Aortic Aneurysms

Background Aortic Balloon Occlusion or Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for hemorrhage control during endovascular aortic repair (EVAR) is a technique that has been used for decades for ruptured abdominal aortic aneurysms (rAAA). This usually requires bilateral femoral access, however, when only single-sided vascular access can be obtained this complicates the procedure if these techniques are to be used. We present two cases of single-sided vascular access, recently performed at our institution, using simultaneous REBOA and aortic stent-graft placement during EVAR in rAAA.   Methods and Results This is a description of two clinical cases where REBOA and EVAR were performed through single-sided vascular access for the treatment of rAAA at Örebro University Hospital between March 2018 and June 2018.   Conclusion This case report demonstrates that despite the limitation of single-sided access, an aortic stent-graft can be placed for treatment of a rAAA during continuous aortic occlusion with REBOA, facilitated by using a multidisciplinary EVTM team approach.

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