scholarly journals E-nside Off-the-Shelf Inner Branch Stent Graft: Technical Aspects of Planning and Implantation

2021 ◽  
pp. 152660282110479
Author(s):  
Alexander Zimmermann ◽  
Anna-Leonie Menges ◽  
Zoran Rancic ◽  
Lorenz Meuli ◽  
Philip Dueppers ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Stent Graft ◽  
Patient Selection ◽  
Endovascular Therapy ◽  
Aortic Aneurysms ◽  
Implantation Technique ◽  
Stent Grafts ◽  
Middle Segment ◽  
Technical Aspects ◽  
Fenestrated Stent Graft

Purpose This article aims to present all aspects regarding patient selection, planning, and implantation technique for a new off-the-shelf pre-cannulated multi-inner branch stent graft. The stent graft comes in 4 different versions with proximal diameters of 33 and 38 mm and distal diameters of 26 and 30 mm. The 4 inner branches are located in the middle segment, which has a diameter of 24 mm. Technique With inner branch technology, the field of application for the treatment of thoracoabdominal aortic aneurysms (TAAA) has been further extended. In addition to routine use in elective cases the pre-cannulation of the inner branches predisposes especially for emergencies. Pre-cannulation is intended to reduce the time to cannulation and the radiation dose. All steps of planning, stent-graft deployment, and cannulation of the inner branches are described in detail. Conclusion The E-nside stent graft represents a promising new endovascular therapy in the treatment of acute and elective TAAA. By using inner branch technology, this endograft combines the advantages of fenestrated and branched stent grafts. Indication, planning, and implantation require experience in branched and fenestrated stent graft technology.

Thoracic Aortic Aneurysm Repair with Endovascular Stent-Grafts

1997 ◽  
Vol 2 (2) ◽  
pp. 98-103 ◽  
Author(s):  
Charles P Semba ◽  
R Scott Mitchell ◽  
D Craig Miller ◽  
Noriyuki Kato ◽  
Stephen T Kee ◽  
...  
Keyword(s):  
High Risk ◽  
Aortic Aneurysm ◽  
Stent Graft ◽  
Aortic Aneurysms ◽  
Stent Grafts ◽  
Thoracic Aortic Aneurysms ◽  
Risk Patients ◽  
Aneurysm Repair ◽  
Aortic Aneurysm Repair ◽  
Endoluminal Stent

The purpose of the study was to describe the clinical experience in using endoluminal stent-grafts for the treatment of thoracic aortic aneurysms in high-risk patients. Patients with aneurysms of the descending thoracic aorta who were considered high surgical risks underwent evaluation for endoluminal repair. The prosthesis was constructed from Z stents covered with polyester fabric using dimensions based upon preprocedural computed tomography scans and angiography. Through a femoral arteriotomy or left retroperitoneal flank incision, a 22–24 Fr delivery catheter was inserted and advanced through the aorta to the target site under fluoroscopic guidance in the operating suite. The stent-graft prosthesis was deployed at the site of the aneurysm. 44 patients (36 male, 8 female; mean age 36 years) underwent stent-graft repair for thoracic aneurysms (mean diameter 6.3 cm). The deployment was technically successful in all cases, with complete aneurysm thrombosis in 88%. The 30-day perioperative mortality rate was 6.8% and 35-month actuarial survival was 82%. There were no cases of stent migration, surgical conversion or intraprocedural death. Paraplegia occurred in two patients who underwent simultaneous surgical infrarenal aortic aneurysm repair immediately followed by stent-graft placement for a coexisting thoracic aneurysm. The conclusion was that placement of endoluminal stent-grafts for repair of thoracic aortic aneurysms is technically feasible in high-risk patients in whom conventional surgery is contraindicated. Long-term studies are needed to determine protection against aneurysm rupture and patient survival.

scholarly journals Endovascular repair of aortic aneurysm: Preliminary results

2009 ◽  
Vol 137 (1-2) ◽  
pp. 10-17 ◽  
Author(s):  
Lazar Davidovic ◽  
Momcilo Colic ◽  
Igor Koncar ◽  
Dejan Markovic ◽  
Dusan Kostic ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Stent Graft ◽  
Endovascular Aneurysm Repair ◽  
Aortic Aneurysms ◽  
Endovascular Stent ◽  
Stent Grafts ◽  
Graft Thrombosis ◽  
Abdominal Aortic

Introduction. Endovascular aneurysm repair (EVAR) has been introduced into clinical practice at the beginning of the 90's of the last century. Because of economic, political and social problems during the last 25 years, the introduction of this procedure in Serbia was not possible. Objective. The aim of this study was to present preliminary experiences and results of the Clinic for Vascular Surgery of the Serbian Clinical Centre in Belgrade in endovascular treatment of thoracic and abdominal aortic aneurysms. Methods. The procedure was performed in 33 patients (3 female and 30 male), aged from 42 to 83 years. Ten patients had a descending thoracic aorta aneurysm (three atherosclerotic, four traumatic - three chronic and one acute as a part of polytrauma, one dissected, two penetrated atherosclerotic ulcers), while 23 patients had the abdominal aortic aneurysm, one ruptured and two isolated iliac artery aneurysms. The indications for EVAR were isthmic aneurismal localisation, aged over 80 years and associated comorbidity (cardiac, pulmonary and cerebrovasular diseases, previous thoracotomy or multiple laparotomies associated with abdominal infection, idiopatic thrombocitopaenia). All of these patients had three or more risk factors. The diagnosis was established using duplex ultrasonography, angiography and MSCT. In the case of thoracic aneurysm, a Medtronic-Valiant? endovascular stent graft was implanted, while for the abdominal aortic aneurysm Medtronic-Talent? endovascular stent grafts with delivery systems were used. In three patients, following EVAR a surgical repair of the femoral artery aneurysm was performed, and in another three patients femoro-femoral cross over bypass followed implantation of aortouniiliac stent graft. Results. During procedure and follow-up period (mean 1.6 years), there were: one death, one conversion, one endoleak type 1, six patients with endoleak type 2 that disappeared during the follow-up period, one early graft thrombosis. No other complications, including aneurysm expansion, collapse, deformity and migration of the endovascular stent grafts, were registered. Conclusion. According to all medical and economic aspects, we recommend EVAR to treat acute traumatic thoracic aortic aneurysm, as well as in elderly and high-risk patients with abdominal or thoracic aneurysms, when open surgery is related to a significantly higher mortality and morbidity.

scholarly journals Evolution of Fenestrated Stent-Graft Design in Early Versus Late Experience with Fenestrated Stent-grafts

2019 ◽  
Vol 58 (6) ◽  
pp. e687
Author(s):  
Pablo Marques de Marino ◽  
Athanasios Katsargyris ◽  
Sebastian Nagel ◽  
Eric Verhoeven
Keyword(s):  
Stent Graft ◽  
Stent Grafts ◽  
Fenestrated Stent Graft

Development of an In Vitro Porcine Aorta Model to Study the Stability of Stent Grafts in Motor Vehicle Accidents

2009 ◽  
Vol 131 (4) ◽  
Author(s):  
Kurosh Darvish ◽  
Mehdi Shafieian ◽  
Vasily Romanov ◽  
Vittorio Rotella ◽  
Michael D. Salvatore ◽  
...  
Keyword(s):  
Stent Graft ◽  
Motor Vehicle ◽  
Motor Vehicle Accidents ◽  
Aortic Aneurysms ◽  
Endovascular Stent ◽  
Stent Grafts ◽  
Vehicle Accidents ◽  
Impact System ◽  
The Stability

Endovascular stent grafts for the treatment of thoracic aortic aneurysms have become increasingly utilized and yet their locational stability in moderate chest trauma is unknown. A high speed impact system was developed to study the stability of aortic endovascular stent grafts in vitro. A straight segment of porcine descending aorta with stent graft was constrained in a custom-made transparent urethane casing. The specimen was tested in a novel impact system at an anterior inclination of 45deg and an average deceleration of 55G, which represented a frontal automobile crash. Due to the shock of the impact, which was shown to be below the threshold of aortic injury, the stent graft moved 0.6mm longitudinally. This result was repeatable. The presented experimental model may be helpful in developing future grafts to withstand moderate shocks experienced in motor vehicle accidents or other dynamic loadings of the chest.

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.

scholarly journals Short and Intermediate Outcome of Endovascular Aortic Aneurysmal Repair, A multicenteric Study

2021 ◽  
Vol 9 (B) ◽  
pp. 1494-1498
Author(s):  
Mohamed Hosny Sayed ◽  
Mohammed Ali Hassan ◽  
Ahmed Samir Hosny ◽  
Hisham Rashid ◽  
Mohamed Hosni El Dessoki
Keyword(s):  
Stent Graft ◽  
Survival Curve ◽  
Rapid Evolution ◽  
Endovascular Aneurysm Repair ◽  
Aortic Aneurysms ◽  
Stent Grafts ◽  
College Hospital ◽  
Aneurysm Morphology ◽  
Multicenter Prospective Study ◽  
Aneurysm Repair

BACKGROUND: The availability of aortic stent-grafts has permitted an obvious change in the management of abdominal aortic aneurysms (AAA). For elective cases open surgical repair has been widely superseded by the use of stent-graft. With the rapid evolution of the endovascular technology, a significant development in stent-graft techniques was achieved in conjunction with a better understanding of how to utilize stent-grafts. METHODS: A multicenter prospective study in which 49 patients were enrolled, they underwent an elective endovascular aneurysm repair (EVAR) procedure for infrarenal AAA in two different institutions, Kasr Al-ainy School of Medicine, Cairo University and King’s College Hospital in London, the selected patients were followed up for 6 months after the procedure. Data relating to demographics and pre-operative comorbidities were recorded. Aneurysm morphology was reviewed by computed tomography angiography scans. Clinical data was collected through operative records and afterward through outpatient clinic follow-up sessions. RESULTS: Overall survival was 94% over a period of 6 months calculated using KaplanMeier Survival Curve. CONCLUSIONS: Endovascular repair resulted in fewer perioperative deaths. This study provides insight into clinical parameters that can be used to stratify patients’ post-EVAR surveillance and need for re-intervention and it came to the conclusion that EVAR could be considered as the standard repair for uncomplicated infrarenal AAA.

Outcomes of Total Endovascular Aortic Arch Repair with Surgeon-Modified Fenestrated Stent-Grafts on Zone 0 Landing for Aortic Arch Pathologies

2021 ◽  
pp. 152660282110364
Author(s):  
Xiaoye Li ◽  
Lei Zhang ◽  
Chao Song ◽  
Hao Zhang ◽  
Shibo Xia ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Stent Graft ◽  
Artery Occlusion ◽  
Technical Success ◽  
Stent Grafts ◽  
Landing Zone ◽  
Subclavian Artery Occlusion ◽  
Fenestrated Stent Graft ◽  
Aortic Arch Repair

Objectives This study evaluated the feasibility and safety of total endovascular aortic arch repair with surgeon-modified fenestrated stent-graft on zone 0 landing for aortic arch pathologies. Methods Between June 2016 and October 2019, 37 consecutive patients underwent total endovascular arch repair with surgeon-modified fenestrated stent-grafts on zone 0 landing. Outcomes included technical success, perioperative and follow-up morbidity and mortality, and branch artery patency. Results During the study period, 37 patients were treated with total endovascular aortic arch repair with surgeon-modified fenestrated stent-graft. Twenty-one (56.8%) patients were diagnosed with aortic dissections, 15 (40.5%) patients with aneurysms, and 1 (2.7%) patient required reintervention due to endoleak and sac expansion from previous thoracic endovascular aortic repair for thoracoabdominal aneurysm. The proximal landing zone for all patients were in zone 0, and all branch arteries of aortic arch were reconstructed. Technical success was achieved in 34 cases (91.9%). Three (8.1%) patients had fenestrations misaligned with target arteries, and the chimney technique was applied as a complementary measure. Thirty-day mortality rate was 5.4% (n=2). Thirty-day stroke rate was 5.4% (n=2). Thirty-day reintervention rate was 2.7% (n=1). At a median follow-up of 20 months (range, 3–49 months), 5 (13.5%) patients died, including 2 aortic-related deaths, 1 nonaortic-related death, and 2 deaths of unknown reason. One (2.7%) patient had stroke. Four patients (10.8%) had reintervention during the follow-up, including 2 cases of left subclavian artery occlusion and 2 cases of type II endoleak. The estimated survival (±SE) at 2 years was 72.4%±9.7% (95% CI 53.4%–91.4%). The estimated freedom from reintervention (±SE) at 2 years was 87.4%±5.9% (95% CI 75.84%–98.96%). Conclusions Total endovascular aortic arch repair with surgeon-modified fenestrated stent-grafts on zone 0 landing is an alternate option for the treatment of aortic arch pathologies in experienced centers.

scholarly journals Endovascular stent-grafting for traumatic aortic aneurysms with the use of a fenestrated stent-graft

2001 ◽  
Vol 122 (1) ◽  
pp. 144-146 ◽  
Author(s):  
Taijiro Sueda ◽  
Kazumasa Orihashi ◽  
Masanabu Watari ◽  
Kenji Okada ◽  
Osamu Ishii ◽  
...  
Keyword(s):  
Stent Graft ◽  
Aortic Aneurysms ◽  
Endovascular Stent ◽  
Stent Grafting ◽  
Endovascular Stent Grafting ◽  
Fenestrated Stent Graft
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