scholarly journals Initial Clinical Experience With a New Conformable Abdominal Aortic Endograft: Aortic Neck Coverage and Curvature Analysis in Challenging Aortic Necks

2021 ◽  
pp. 152660282199672
Author(s):  
Alice Finotello ◽  
Richte Schuurmann ◽  
Sara Di Gregorio ◽  
Gian Antonio Boschetti ◽  
Nabil Chakfé ◽  
...  
Keyword(s):  
Aortic Wall ◽  
Surface Coverage ◽  
Infrarenal Aorta ◽  
Technical Success ◽  
Curvature Analysis ◽  
Average Curvature ◽  
Aortic Neck ◽  
Abdominal Aortic ◽  
Shortest Distance ◽  
New Generation

Objectives: Aim of this work was to investigate precision of deployment and conformability of a new generation GORE EXCLUDER Conformable Endoprosthesis with active control system (CEXC Device, W.L. Gore and Associates, Flagstaff, AZ, USA) by analyzing aortic neck coverage and curvature. Methods: All consecutive elective patients affected by abdominal aortic aneurysm or aortoiliac aneurysm treated at our institution between November 2018 and June 2019 with the new CEXC Device were enrolled. Validated software was adopted to determine the available apposition surface area into the aortic neck, apposition of the endograft to the aortic wall, shortest apposition length (SAL), shortest distance between the endograft fabric and the lowest renal arteries (SFD) and between the endograft fabric and the contralateral renal artery (CFD). Pointwise centerline curvature was also computed. Results: Twelve patients (10 men, median age 78 years (71.75, 81.0)) with available pre- and postoperative computed tomography angiography (CTA) were included. Technical success was obtained in all the cases. Preoperative median length of the proximal aortic neck was 16.1 mm (10.7, 21.7) and suprarenal (α) and infrarenal (β) neck angulation were, respectively, 28.9° (15.7°, 47.5°) and 75.0° (66.9°, 81.4°). Postoperative median apposition surface coverage was 79% (69.25%, 90.75%) of the available apposition surface. SFD and CFD were 1.5 mm (0.75, 5.25) and 7 mm (4.5, 21.5), respectively. Average curvature over the infrarenal aorta decreased from 25 m−1 (21.75, 29.0) to 22.5 m−1 (18.75, 24.5) postoperatively (p=0.02). Maximum curvature did not decrease significantly from 64.5 m−1 (54.25, 92.0) to 62 m−1 (41.75, 71.5) (p=0.1). Conclusions: Our early experience showed that deployment of the CEXC Device is safe and effective for patients with challenging proximal aortic necks. Absence of significant changes between pre- and postoperative proximal aortic neck angulations and curvature confirms the high conformability of this endograft.

The Viabahn balloon expandable stent for endovascular reconstruction of the infrarenal aorta and its bifurcation in cases of severe obstructive disease

Vascular ◽  
2020 ◽  
pp. 170853812092784
Author(s):  
Michele Antonello ◽  
Francesco Squizzato ◽  
Michele Piazza
Keyword(s):  
Stent Graft ◽  
Aortic Wall ◽  
Technical Note ◽  
Infrarenal Aorta ◽  
Aortic Bifurcation ◽  
Promising Technique ◽  
Iliac Arteries ◽  
Angio Ct ◽  
New Generation ◽  
Aortic Cuff

Introduction The covered endovascular reconstruction of the aortic bifurcation (CERAB) represents a promising technique for the treatment obstructive lesions involving the aortic bifurcation. The aim of this report is to describe the use of a new generation balloon-expandable stent-graft (Viabahn VBX, W.L. Gore&Associates, AZ, USA), in the CERAB configuration for the treatment of aorto-iliac obstructive lesions involving the infrarenal aorta and bifurcation. Technical note: This technique was adopted in two patients with severe aorto-iliac obstructive lesions. After bilateral iliac recanalization, an 11 mm diameter VBX stent was deployed in the infrarenal aorta; a post-dilatation up to 16 mm with a non-compliant balloon was performed to adapt the proximal edge of the stent to the aortic diameter. Two 8 mm diameter VBX stents were then deployed at the aortic bifurcation in a kissing conformation, overlapping with the previously positioned aortic stent for 15 mm. A post-ballooning with two kissing 12 × 20 mm compliant balloons (Powerflex Pro PTA, Cordis, CA, USA) was performed to adapt the parallel stents to the aortic cuff. A post-operative angio-CT demonstrated optimal conformability of the aortic cuff to the aortic wall, and apposition of the kissing stents to the aortic cuff. Conclusions This preliminary experience shows that the VBX stent may allow an effective reconstruction of the aortic bifurcation; the conformability and flaring capability may allow to overcome the diameter mismatch between the aorta and the iliac arteries.

Rescue EVAR for ruptured AAA: Clinical success does not mean technical success

Vascular ◽  
2013 ◽  
Vol 22 (5) ◽  
pp. 368-370 ◽  
Author(s):  
Francesco Setacci ◽  
Pasqualino Sirignano ◽  
Gianmarco de Donato ◽  
Giuseppe Galzerano ◽  
Carlo Setacci
Keyword(s):  
Emergency Department ◽  
Abdominal Aortic Aneurysm ◽  
Aortic Wall ◽  
Clinical Success ◽  
Type I ◽  
Ruptured Abdominal Aortic Aneurysm ◽  
Technical Success ◽  
Abdominal Aortic ◽  
Good Clinical Condition

We report a clinical evolution of a 85-years old male admitted to our Emergency Department for ruptured abdominal aortic aneurysm (rAAA). One month later a huge type I proximal endoleak was detected and corrected by proximal aortic extension. We decided to fix the stent-graft to the aortic wall using EndoAnchors. However, an asymptomatic type III endoleak due to controlateral limb disconnection was detected at the followed schedulated CT angio and corrected by a relining of the endograft. The patient is now in good clinical condition with no evidence of endoleaks at 1-year follow-up.

Endovascular treatment of complex abdominal aortic aneurysms by combining different types of endoprostheses

Vascular ◽  
2016 ◽  
Vol 24 (4) ◽  
pp. 425-429 ◽  
Author(s):  
Menno T de Bruijn ◽  
Erik Tournoij ◽  
Daniel AF van den Heuvel ◽  
Debbie de Vries-Werson ◽  
Jan Wille ◽  
...  
Keyword(s):  
Large Diameter ◽  
Abdominal Aortic Aneurysms ◽  
Aortic Aneurysms ◽  
Special Focus ◽  
Technical Success ◽  
Aortic Neck ◽  
Abdominal Aortic ◽  
Different Types

Purpose To describe an off-the-shelf method for the treatment of abdominal aortic aneurysms with hostile (large, >30 mm) neck and/or small (<20 mm) aortic bifurcation. Case report We describe five patients with large aortic necks and/or small aortic bifurcations, which were treated by combining an AFX endoprosthesis with a Valiant Captiva endograft, and additional proximal endoanchors when deemed necessary. Initial technical success was 100%. Follow-up ranged from 228 to 875 days. One patient suffered a type 1A and 1B endoleak at 446 days follow-up, which were successfully treated by endovascular means. Conclusion Combining the AFX and Valiant Captiva endografts is an off-the-shelf solution for treatment of large diameter aortic necks and small aortic bifurcations in patients deemed unfit for open repair or declined for fenestrated endografts. Longer follow-up is required to assess the long-term safety with special focus on aortic neck dilation.

Apposition and Positioning of the Nellix EndoVascular Aneurysm Sealing System in the Infrarenal Aortic Neck

2018 ◽  
Vol 25 (4) ◽  
pp. 428-434 ◽  
Author(s):  
Kim van Noort ◽  
Simon P. Overeem ◽  
Ruben van Veen ◽  
Jan M. M. Heyligers ◽  
Michel M. P. J. Reijnen ◽  
...  
Keyword(s):  
Preoperative Planning ◽  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Ct Scans ◽  
Perfect Agreement ◽  
Intraclass Correlation Coefficients ◽  
Current Series ◽  
Aortic Neck ◽  
Abdominal Aortic ◽  
Shortest Distance

Purpose: To investigate the initial proximal position and seal of the Nellix EndoVascular Aneurysm Sealing (EVAS) system in the aortic neck using a novel methodology. Methods: Forty-six consecutive patients who underwent elective EVAS for an abdominal aortic aneurysm were retrospectively selected and dichotomized into an early (n=23) and a late (n=23) group. The aortic neck morphology and aortic neck surface (ANS) were determined on preoperative computed tomography (CT) scans; the endograft position and nonapposition surface (NAS) were determined on the 1-month CT scans. The position of the proximal endobag boundary was measured by 2 experienced observers to analyze the interobserver variability for the EVAS NAS measurements. The shortest distance from the lowest renal artery to the endobag (shortest fabric distance) and the shortest distance from the endobag to the end of the infrarenal neck (shortest sealing distance) were determined. The intraclass correlation coefficients (ICCs) are presented with the 95% confidence interval (CI). Continuous data are presented as the median and interquartile range (IQR: Q3 – Q1). Results: There were no differences between the early and late EVAS groups regarding aortic neck morphology except for the neck calcification circumference [41° (IQR 33°) vs 87° (IQR 60°), respectively; p=0.043]. Perfect agreement was observed for the NAS (ICC 0.897, 95% CI 0.780 to 0.956). The NAS as a percentage of the preoperative ANS was 47% (IQR 43) vs 49% (IQR 49) for the early vs late groups, respectively (p=0.214). The shortest fabric distances were 5 mm (IQR 5) and 4 mm (IQR 7) for the early and late groups, respectively (p=0.604); the shortest sealing distances were 9 mm (IQR 13) and 16 mm (IQR 17), respectively (p=0.066). Conclusion: Accurate positioning of the Nellix EVAS system in the aortic neck may be challenging. Despite considerable experience with the system, still around half of the potential seal in the aortic neck was missed in the current series, without improvement over time. This should be considered during preoperative planning and may be a cause of a higher than expected complication rate. Detailed post-EVAS nonapposition surface can be determined with the described novel methodology that takes into account the sometimes irregularly shaped top of the sealing endobags.

Ruptured Abdominal Aortic Aneurysm and Horseshoe Kidney: Isthmus Sectioning By Endo GIA

2019 ◽  
Vol 53 (7) ◽  
pp. 599-601
Author(s):  
Pagliariccio Gabriele ◽  
Gatta Emanuele ◽  
Carlo Grilli Cicilioni ◽  
Schiavon Sara ◽  
Carbonari Luciano
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Horseshoe Kidney ◽  
Ruptured Abdominal Aortic Aneurysm ◽  
Aortic Graft ◽  
Urinary Leakage ◽  
Aortic Neck ◽  
Abdominal Aortic ◽  
Open Surgical Approach ◽  
Graft Reconstruction

Introduction: A 90-year-old patient was admitted with a hemorrhagic shock from a huge ruptured abdominal aortic aneurysm with an unfavourable infrarenal aortic neck and a horseshoe kidney (HSK). Report: We decided on an open surgical approach: the HSK isthmus was sectioned with an Endo GIA 45 mm, and we performed a suprarenal aortic cross-clamping and an aortic graft reconstruction. Postoperatively, no urinary leakage was detected, and renal function showed no impairment. The patient died on the 10th postoperative day from pneumonia. Conclusion: We believe that the sectioning of the HSK isthmus with Endo GIA is a fast and simple maneouvre.

scholarly journals ASSOCIATION OF ABDOMINAL AORTIC WALL INFLAMMATION, HEPATIC FLUORODEOXYGLUCOSE UPTAKE AND VISCERAL ADIPOSE TISSUE BIOLOGICAL ACTIVITY IN PATIENTS WITH DYSLIPIDEMIAS

2017 ◽  
Vol 69 (11) ◽  
pp. 1436
Author(s):  
Koutagiar Peter Iosif ◽  
Konstantinos Toutouzas ◽  
Georgios Benetos ◽  
Nikoletta Piannou ◽  
Alexios Antonopoulos ◽  
...  
Keyword(s):  
Adipose Tissue ◽  
Biological Activity ◽  
Visceral Adipose Tissue ◽  
Aortic Wall ◽  
Abdominal Aortic ◽  
Visceral Adipose
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