Spot Stenting Combined With False Lumen Endovascular Occlusive Repair for Post-dissection Abdominal Aortic Aneurysm

Purpose: To introduce a new spot stenting, combined with a false lumen endovascular occlusive repair (SS-FLEVOR) technique for treating post-dissection abdominal aortic aneurysms. Technique: This technique is demonstrated in a 74-year-old man who received an initial thoracic endovascular aortic repair 7 years ago and suffered from distal aortic expansion during the follow-up session. All the tears located more than 15 mm away from the orifice of visceral arteries were excluded by spot stenting in the aortic true lumen. Then, a compliant stent-graft was implanted in the false lumen to seal the tears near the visceral arteries orifice from the outside. In addition, coils were deployed to block the potential backflow from the intercostal arteries and to induce false lumen thrombosis. Moreover, visceral arteries originated from false lumen were repaired by covered-stents implanted from the true lumen. The distal iliac arteries were sealed either with iliac extensions or cover-stents. This new technique has been applied in 5 patients, resulting in 100% technical success and encouraging intermediate outcomes. Conclusion: SS-FLEVOR is a feasible and safe technique to promote false lumen thrombosis in selected cases.

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Outcomes of Advanta V12 Covered Stents After Fenestrated Endovascular Aneurysm Repair

Journal of Endovascular Therapy ◽

10.1177/15266028211016423 ◽

2021 ◽

pp. 152660282110164

Author(s):

Claire van der Riet ◽

Richte C. L. Schuurmann ◽

Eric L. G. Verhoeven ◽

Clark J. Zeebregts ◽

Ignace F. J. Tielliu ◽

...

Keyword(s):

Endovascular Aneurysm Repair ◽

Aortic Aneurysms ◽

Stent Fracture ◽

Covered Stents ◽

Significant Stenosis ◽

Primary Endpoints ◽

Visceral Arteries ◽

Aneurysm Repair ◽

Type 3

Purpose: Fenestrated endovascular aneurysm repair (FEVAR) is a well-established endovascular treatment option for pararenal abdominal aortic aneurysms in which balloon-expandable covered stents (BECS) are used to bridge the fenestration to the target vessels. This study presents midterm clinical outcomes and patency rates of the Advanta V12 BECS used as a bridging stent. Methods: All patients treated with FEVAR with at least 1 Advanta V12 BECS were included from 2 large-volume vascular centers between January 2012 and December 2015. Primary endpoints were freedom from all-cause reintervention, and freedom from BECS-associated complications and reintervention. BECS-associated complications included significant stenosis, occlusion, type 3 endoleak, or stent fracture. Secondary endpoints included all-cause mortality in-hospital and during follow-up. Results: This retrospective study included 194 FEVAR patients with a mean age of 72.2±8.0 years. A total of 457 visceral arteries were stented with an Advanta V12 BECS. Median (interquartile range) follow-up time was 24.6 (1.6, 49.9) months. The FEVAR procedure was technically successful in 93% of the patients. Five patients (3%) died in-hospital. Patient survival was 77% (95% CI 69% to 84%) at 3 years. Freedom from all-cause reintervention was 70% (95% CI 61% to 78%) at 3 years, and 33% of all-cause reinterventions were BECS associated. Complications were seen in 24 of 457 Advanta V12 BECSs: type 3 endoleak in 8 BECSs, significant stenosis in 4 BECSs, occlusion in 6 BECSs, and stent fractures in 3 BECSs. A combination of complications occurred in 3 BECSs: type 3 endoleak and stenosis, stent fracture and stenosis, and stent fracture and occlusion. The freedom from BECS-associated complications for Advanta V12 BECSs was 98% (95% CI 96% to 99%) at 1 year and 92% (95% CI 88% to 95%) at 3 years. The freedom from BECS-associated reinterventions was 98% (95% CI 95% to 100%) at 1 year and 94% (95% CI 91% to 97%) at 3 years. Conclusion: The Advanta V12 BECS used as bridging stent in FEVAR showed low complication and reintervention rates at 3 years. A substantial number of FEVAR patients required a reintervention, but most were not BECS related.

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The Italian Trial of Endovascular AAA Exclusion Using the Parodi Endograft

Journal of Endovascular Therapy ◽

10.1177/152660289700400312 ◽

1997 ◽

Vol 4 (3) ◽

pp. 299-306 ◽

Cited By ~ 3

Author(s):

Gioacchino Coppi ◽

Roberto Moratto ◽

Roberto Silingardi ◽

Nicola Tusini ◽

Roberto Vecchioni ◽

...

Keyword(s):

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Covered Stents ◽

The Third ◽

Abdominal Aortic ◽

The Mean ◽

Distal Fixation

Purpose: To report the outcome of the prospective 11-center Italian Parodi Trial using straight and tapered endografts for the endovascular exclusion of abdominal aortic aneurysms (AAA). Methods: From April 1994 to July 1995, 27 patients were evaluated and selected for endovascular AAA exclusion. The Parodi devices were delivered through femoral arteriotomies using 18 to 22F introducers and deployed by balloon expansion of the terminal stents. Results: Of 27 cases attempted, 24 endografts (15 tube, 9 aortomonoiliac) were implanted (1 deployment and 2 access failures [11.1%] were converted). Three endoleaks (12.5%) were treated intraoperatively with covered stents, two successfully, and the third sealed within 30 days. Three (12.5%) of the 24 treated patients died in-hospital of device- (n = 2) and procedure-related (n = 1) causes; the remaining 21 patients were discharged within 8 days. Of the 8 aortomonoiliac grafts in follow-up, only 1 (12.5%) failed in the mean 23-month (range 18 to 30) follow-up; however, 4 (31%) of 13 tube graft patients were converted to surgery within 18 months. Of the 16 (66.7%) surviving endografts at 2 years, 6 (38%) showed no change in the AAA diameter, while 10 (62%) had shrunk. Conclusions: The tube graft was applicable in only about 5% of cases, and accurate endograft sizing and distal fixation were problematic. The aortomonoiliac design was not appealing to surgeons but fared better in the long term. Given the advent of newer endograft models, the Italian Parodi Trial has been terminated.

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The Nellix™ EndoVascular sealing system in patients with abdominal aortic aneurysms in conjunction with iliac artery occlusive disease

Vascular ◽

10.1177/1708538116666690 ◽

2016 ◽

Vol 25 (2) ◽

pp. 190-195 ◽

Cited By ~ 1

Author(s):

Steven MM van Sterkenburg ◽

Leo H van den Ham ◽

Luuk Smeets ◽

Jan-Willem Lardenoije ◽

Michel MPJ Reijnen

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Iliac Artery ◽

Occlusive Disease ◽

Aortic Aneurysms ◽

Covered Stents ◽

Single Center ◽

Technical Success ◽

Abdominal Aortic

Introduction Concomitant abdominal aortic aneurysm formation and aortoiliac occlusive disease is a challenging combination, often requiring open reconstructive surgery. In this study, we have assessed a single center experience of the Nellix EndoVascular Aneurysm Sealing System in the treatment of an abdominal aortic aneurysm in conjunction with iliac artery occlusive disease. Methods Retrospectively case files of patients treated with Nellix EndoVascular Aneurysm Sealing System in a single center were reviewed. The primary endpoints of the study were the technical success of Nellix EndoVascular Aneurysm Sealing System in patients with coincidental iliac artery occlusive disease and the successful exclusion of the aneurysm during follow-up. Results Of the 96 patients that were treated with Nellix EndoVascular Aneurysm Sealing System, five were identified that had an abdominal aortic aneurysm in conjunction with iliac artery occlusive disease. Treated patients had either unilateral (n = 4) or bilateral (n = 1) common iliac artery occlusive disease varying from 70% stenosis to complete occlusions. The lesion length varied from 5 to 50 mm and in two cases it involved an occluded bare metal stent. The indication for surgery was the abdominal aortic aneurysm in all patients, including three also suffering from claudication. In all patients the iliac artery occlusive disease was pretreated with balloon-expandable covered stents. Technical success was achieved in all five patients. After a median follow-up of nine months all stents were patent with no signs of endoleak and stable aneurysm diameters. All patients were free of intermittent claudication or ischemic wounds. Conclusion Nellix EndoVascular Aneurysm Sealing System seems feasible and safe in patients with a combination of abdominal aortic aneurysm and iliac artery occlusive disease.

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Description of a new technique for repairing chronic type B dissections that involve visceral branches being fed by both true and false lumen by using both lumens as conduits

Vascular ◽

10.1177/1708538115586913 ◽

2015 ◽

Vol 24 (1) ◽

pp. 103-105 ◽

Cited By ~ 2

Author(s):

Joe Anderson ◽

Tyler Remund ◽

Katie Pohlson ◽

Patrick Kelly

Keyword(s):

False Lumen ◽

Aortic Aneurysms ◽

Type B ◽

Stent Grafts ◽

True Lumen ◽

Chronic Type ◽

Novel Technique ◽

A New Technique

Here we present three cases performed using a novel technique where aortic flow is compartmentalized proximal to the target vessels through a physician-modified endograft. The visceral segment is then further compartmentalized by the use of another physician modified endograft. By compartmentalizing the flow proximal to the visceral segment, both the true lumen and false lumen can be used as conduits for coextensive bridging stent grafts. Overall, patients have tolerated this procedure extremely well, and while further study and follow-up must be conducted, this procedure could offer a reasonable long-term solution to thoracoabdominal aortic aneurysms complicated by dissection.

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Unusual abdominal aneurysms in a patient after kidney transplantation treated by endovascular technique

VASA ◽

10.1024/0301-1526/a000165 ◽

2012 ◽

Vol 41 (1) ◽

pp. 63-66

Author(s):

Synowiec ◽

Checinski ◽

Micker ◽

Samolewski ◽

Glyda ◽

...

Keyword(s):

Abdominal Aortic Aneurysm ◽

Abdominal Aortic Aneurysms ◽

Renal Arteries ◽

Aortic Aneurysms ◽

Vascular Pathology ◽

Endovascular Technique ◽

Iliac Arteries ◽

Abdominal Aortic ◽

Common Iliac Arteries

While abdominal aortic aneurysms are quite common, visceral aneurysms are a seldomly diagnosed vascular pathology. Aneurysms of renal arteries, abdominal aorta and iliac arteries seem to be very rare. We present a patient after renal transplantation with aneurysms of both stumps of the renal arteries, abdominal aortic aneurysm and aneurysms of common iliac arteries. Because of the symptomatic course, the patient required urgent treatment. A successful endovascular procedure was performed. Follow-up imaging did not reveal any complications.

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Dynamic Remeshing for Fluid Structure Interaction: Application to Modelling Aortic Dissection

ASME 2007 Summer Bioengineering Conference ◽

10.1115/sbc2007-175989 ◽

2007 ◽

Author(s):

Keri R. Moyle ◽

Yiannis Ventikos

Keyword(s):

Aortic Dissection ◽

Rate Increase ◽

False Lumen ◽

Aortic Aneurysms ◽

True Lumen ◽

Structure Interaction ◽

Abdominal Aortic ◽

Branch Vessel ◽

Ruptured Abdominal Aortic Aneurysms ◽

Acute Condition

Aortic dissection is an acute condition occurring more frequently than ruptured abdominal aortic aneurysms, with a mortality rate increase of 1% per hour if left untreated [1]. Dissection occurs following creation of an entrance tear, through which blood can force its way into the wall, forming a pocket that propagates longitudinally. The membrane of the dissection flap separates the true lumen (through which the organs are supplied with blood), from a false lumen (the pocket created by the dissection). The total obstruction of the true lumen by the motion of the vessel flap, or organ starvation due to branch vessel compression by the false lumen, can be fatal. Figure 1 shows an idealised representation of an aortic dissection model.

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Dilatation of Aortic Neck and Common Iliac Arteries after Open Repair of Abdominal Aortic Aneurysms: Long-Term Follow-Up According to Aortic Reconstruction Configuration

Annals of Vascular Surgery ◽

10.1016/j.avsg.2020.05.051 ◽

2020 ◽

Vol 69 ◽

pp. 345-351

Author(s):

Bruno Pagnin Schmid ◽

Laura Lane Menezes Polsin ◽

Fábio Hüsemann Menezes

Keyword(s):

Open Repair ◽

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Iliac Arteries ◽

Aortic Neck ◽

Abdominal Aortic ◽

Long Term Follow Up ◽

Common Iliac Arteries

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Treatment of Abdominal Aortic Aneurysms with Accompanied Iliac Artery Aneurysms Using New Sack Sealing Device

Acta Chirurgica Latviensis ◽

10.2478/chilat-2013-0005 ◽

2013 ◽

Vol 13 (1) ◽

pp. 22-27

Author(s):

Kaspars Kisis ◽

Janis Savlovskis ◽

Polina Dombure ◽

Marcis Gedins ◽

Natalija Ezite ◽

...

Keyword(s):

Treatment Group ◽

Iliac Artery ◽

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Iliac Arteries ◽

Pelvic Organs ◽

Abdominal Aortic ◽

Internal Iliac ◽

New Generation

Summary Introduction. 20-30% of abdominal aortic aneurysms (AAA) occur simultaneously with unilateral or bilateral common iliac artery aneurysms (CIAA). Endovascular aneurysm repair (EVAR) is known to be an effective AAA treatment method used by many centres in over 80% of cases. Presence of AAA accompanied by CIAA significantly increases the complexity of EVAR with currently available endografts, internal iliac artery (IIA) often requiring coil embolisation resulting in serious post-procedural complications such as ischaemia of pelvic organs, gluteal claudication and erectile dysfunction. Aim of the study. Demonstrate successful endovascular AAA and CIAA treatment with new generation sac-sealing endograft device. Materials and methods. From 2008 Pauls Stradins Clinical University Hospital is participating in the prospective clinical trial assessing the efficacy and stability of the new generation sac-sealing endograft device (Nellix®, Endologix, USA). Until now this trial had 40 enrolled patients with suitable for endovascular treatment aneurysmal morphology. The treatment group has included 16 patients with AAA extending to either one or both common iliac arteries (CIA). The control group consisted of 24 patients with isolated AAA. AAA diameter was 5.6±0.76 cm (min - 4.3, max - 6.98) and 5.16± 0.91 cm (min-3.78, max-7.24) in the treatment and control groups respectively. Seven patients had unilateral and nine patients had bilateral CIAA. The diameter of CIAA was 2.61±0.57 cm (min - 2.04, max - 4.44). Post-procedural follow-up was done at one, six and twelve months and on annual basis thereafter. During follow-up the general health condition of the patients was assessed as well as computer tomography angiography (CTA) and duplex ultrasonography (DUS) imaging was performed in order to examine the status of the aneurysm, endograft condition and patency of IIA. Statistical analysis of data was performed using v19.0 SPSS software (IBM). Results. All patients successfully treated with new generation sac-sealing endograft excluding AAA and CIAA from blood circulation. Average follow-up period was 18 months. Upon follow-up in both groups endograft was stable and fixated in aneurysms with no endoleaks detected. In the treatment group all treated IIAs had remained patent with no pelvic organs ischaemia or gluteal claudication symptoms. Conclusion. New generation sac-sealing endograft is effective and simple in employment for the treatment of concomitant AAA and CIAA allowing the treatment of aneurysms with complex morphology and preserving the blood flow to internal iliac arteries. Further studies are required for long-term assessment of this endograft efficacy.

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