Endovascular Covered Stent Repair of an Intercostal Artery Patch Dehiscence from a Descending Thoracic Aortic Aneurysm Graft

Purpose: To describe the use of endovascular techniques to repair a descending thoracic aortic pseudoaneurysm at a site of patch dehiscence. Methods and Results: A 63-year-old hypertensive, diabetic female with a 4-cm aneurysm in the descending thoracic aorta underwent surgical repair with a 35-mm Dacron graft. Dehiscence of the intercostal arterial patch produced a large, 6-cm-diameter pseudoaneurysm that extended into the left thoracic cavity. An endovascular repair was planned using a Dacron stent-graft. Despite induced hypotension and an exteriorized, stiff exchange wire to enhance control of the delivery balloon catheter, the initial attempt failed to close the suture line defect. A customized polytetrafluoroethylene-covered, balloon-expandable stent was successfully deployed using the original stent-graft as a landmark. At 6 months, the contrast-enhanced spiral computed tomographic scan showed patency of the stent-graft and resorption of the pseudoaneurysm. Conclusions: This communication describes the management of a surgical complication using balloon-expandable covered stents in contrast to either conventional surgery or self-expanding stent-grafts. Transesophageal ultrasound monitoring delineated the suture line leak, identified the position of the stent-grafts, and accurately demonstrated closure of the defect.

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Aortic Debranching for Descending Thoracic Aortic Aneurysm Repair by Stent Grafts

The American Surgeon ◽

10.1177/000313480707300108 ◽

2007 ◽

Vol 73 (1) ◽

pp. 32-36

Author(s):

Chandra Cherukupalli ◽

Amit J. Dwivedi ◽

Rajeev Dayal ◽

Khambapatty V. Krishnasastry

Keyword(s):

Aortic Aneurysm ◽

Stent Graft ◽

Subclavian Artery ◽

Thoracic Aortic Aneurysm ◽

Left Subclavian Artery ◽

Artery Bypass ◽

Celiac Artery ◽

Stent Grafts ◽

Descending Thoracic Aortic Aneurysm ◽

Aneurysm Repair

Endovascular repair of a descending thoracic aortic aneurysm may result in covering the ostia of the left carotid or left subclavian artery for proper proximal landing zones, and the celiac artery or superior mesenteric artery ostia in the abdomen for distal landing zones. To prevent possible complications of occluding the ostia of these vessels, the authors performed an innominate to left common carotid and left subclavian artery bypass as the first procedure in one patient. In the second patient they performed an aortoceliac and aortomesenteric bypass before stent graft placement. The stent graft repair of the descending thoracic aortic aneurysm was performed subsequently in both patients. This aortic debranching provides subsequent proper placement of thoracic stent grafts.

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Endovascular treatment of distal thoracic aortic transection associated with severe thoracolumbar spinal fracture

Vascular ◽

10.1177/1708538114560458 ◽

2014 ◽

Vol 23 (5) ◽

pp. 550-552 ◽

Cited By ~ 6

Author(s):

Megan M Chock ◽

Johnathon Aho ◽

Nimesh Naik ◽

Michelle Clarke ◽

Stephanie Heller ◽

...

Keyword(s):

Stent Graft ◽

Endovascular Repair ◽

Operative Procedure ◽

Spinal Fracture ◽

Aortic Injury ◽

Common Mechanism ◽

Percutaneous Technique ◽

Stent Grafts ◽

Aortic Pseudoaneurysm ◽

Aortic Transection

Endovascular repair has become the first line of treatment in most patients with blunt aortic injury. The most common mechanism is deceleration injury affecting the aortic isthmus distal to the origin of the left subclavian artery. Injuries of the distal thoracic aorta are uncommon. We report the case of a 25-year-old male patient who presented with paraplegia and distal thoracic aortic pseudoaneurysm associated with severe thoracolumbar vertebral fracture and displacement after a motocross accident. Endovascular repair was performed using total percutaneous technique and conformable C-TAG thoracic stent-graft (WL Gore, Flagstaff, AZ). Following stent-graft placement and angiographic confirmation of absence of endoleak, thoracolumbar spinal fixation was performed in the same operative procedure. This case illustrates a multispecialty approach to complex aortic and vertebral injury and the high conformability of newer thoracic stent-grafts to adapt to tortuous anatomy.

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Use of 3D Printing to Guide Creation of Fenestrations in Physician-Modified Stent-Grafts for Treatment of Thoracoabdominal Aortic Disease

Journal of Endovascular Therapy ◽

10.1177/1526602820917960 ◽

2020 ◽

Vol 27 (3) ◽

pp. 385-393 ◽

Cited By ~ 1

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.

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“Paving and Cracking”: An Endovascular Technique to Facilitate the Introduction of Aortic Stent-Grafts through Stenosed Iliac Arteries

Journal of Endovascular Therapy ◽

10.1177/152660280701400505 ◽

2007 ◽

Vol 14 (5) ◽

pp. 630-633 ◽

Cited By ~ 46

Author(s):

Robert J. Hinchliffe ◽

Krassi Ivancev ◽

Björn Sonesson ◽

Martin Malina

Keyword(s):

Stent Graft ◽

Covered Stents ◽

Stent Grafts ◽

Endovascular Technique ◽

Iliac Arteries ◽

Aortic Stent Graft

Purpose: To describe a technique that facilitates the safe introduction of aortic stent-grafts through diseased iliac arteries. Technique: The technique involves relining and dilating (“paving and cracking”) stenosed iliac arteries with covered stents prior to the introduction of the main aortic stent-graft. It has been successfully used to introduce aortic stent-grafts in patients where other transfemoral endovascular measures have failed. Conclusion: This technique increases the applicability of transfemoral EVAR and prevents serious complications as a result of access-related damage to the iliac arteries.

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Performance of BeGraft and BeGraft+ Stent-Grafts as Bridging Devices for Fenestrated Endovascular Aneurysm Repair: An In Vitro Study

Journal of Endovascular Therapy ◽

10.1177/1526602819866435 ◽

2019 ◽

Vol 26 (6) ◽

pp. 787-794 ◽

Cited By ~ 5

Author(s):

Giovanni Federico Torsello ◽

Monika Herten ◽

André Frank ◽

Markus Müller ◽

Susanne Jung ◽

...

Keyword(s):

Shear Stress ◽

Stent Graft ◽

Stress Test ◽

Endovascular Aneurysm Repair ◽

Covered Stents ◽

Cobalt Chromium ◽

Stent Grafts ◽

Stent Geometry ◽

Stent Diameter

Purpose: To investigate 2 generations of balloon-expandable covered stents as potential bridging devices using an in vitro model of stent-graft fenestrations. Materials and Methods: Twenty BeGraft and 20 BeGraft+ cobalt-chromium stents covered in expanded polytetrafluoroethylene (ePTFE) in 6- and 8-mm diameters were tested in sheets mimicking stent-graft fenestrations. Microscopy and radiography were employed to evaluate stent morphology after flaring. In vitro bench tests measured maximum pullout (perpendicular displacement) and the shear stress (axial displacement) forces needed to dislocate the stents. Results: No alteration of ePTFE coverage was detected in the flared stents. Digital radiography and computed tomography showed marked alteration of the stent geometry, which was more pronounced in the BeGraft group. No fractures were detected. Median (minimum–maximum) pullout forces for the 6-mm stent-grafts were 17.1 N (15.8–19.6) for the BeGraft device and 30.4 N (20.2–31.9) for the BeGraft+ device (p=0.006). Median (minimum–maximum) pullout forces for the 8-mm stent-grafts were 11.3 N (11–12.1) for the BeGraft device and 21.8 N (18.2–25.5) for the BeGraft+ device (p<0.001). The shear stress test showed median forces of 10.5 vs 15.28 N at 150% of the stent diameter for the 6-mm BeGraft and BeGraft+ stent-grafts, respectively, and 15.23 vs 20.72 N at 150% stent diameter for the 8-mm models (p=0.016 and 0.017, respectively). Conclusion: Flaring changed the stent geometry but did not provoke stent fractures. The BeGraft+ is superior to the BeGraft in terms of pullout and shear stress forces, demonstrating greater resilience.

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Modifying the “Eye of the Tiger” Technique: Preserving Gluteal Artery Perfusion in the Treatment of an Aneurysm of the Hypogastric Artery

Vascular and Endovascular Surgery ◽

10.1177/1538574420966109 ◽

2020 ◽

pp. 153857442096610

Author(s):

Shinichi Iwakoshi ◽

Masahiro Inagaki ◽

Yutaka Yoshiyama ◽

Yuichi Shimohara ◽

Masanori Yamashita ◽

...

Keyword(s):

Case Report ◽

Endovascular Treatment ◽

Stent Graft ◽

Balloon Catheter ◽

Balloon Dilation ◽

Artery Aneurysm ◽

Hypogastric Artery ◽

Stent Grafts ◽

Distal Branch ◽

Hypogastric Artery Aneurysm

Purpose: In endovascular aneurysm repair, parallel stent graft deployment is sometimes utilized to preserve the distal branch perfusion. However, there will be some gutter space around 2 stent grafts, which may cause endoleak. The “eye of the tiger” technique was invented to minimize this leak when deploying a small side-branch stent graft in conjunction with a large aortic endograft. The purpose of this case report is to describe our modified technique for 2 small endografts deployed in double D-shape in order to prevent gutter leak, which we applied in endovascular treatment for a hypogastric artery aneurysm. Case Report: A 79-year-old male patient presented with a right hypogastric artery aneurysm measuring 44 mm. The patient refused the open surgical repair option and hoped for an endovascular treatment. Therefore, endovascular treatment to exclude the hypogastric artery aneurysm as well as preserve the gluteal arteries was planned. An Internal Iliac Component (IIC)(W. L. Gore & Associates, Flagstaff, AZ, USA) was utilized for the proximal sealing and 2 Viabahn stent grafts (W. L. Gore & Associates) were deployed in the superior and inferior gluteal arteries for distal sealing. Then, 2 VBX stent grafts (W. L. Gore & Associates) were added in the IIC as bridging stents to connect the IIC and both Viabahn stent grafts. Next, over-dilatation of VBX stent grafts was performed alternately with an 8 mm balloon catheter and subsequent kissing balloon dilation with 5 mm balloon catheters, which allowed the VBX stents to be set in double D-shape. A follow-up CT scan performed 1 week after the procedure revealed no endoleak and a favorable shape to the VBX stent grafts. Conclusion: The modified method of dilating the VBX stent grafts allowed the double D-shape deployment, minimizing the risk of gutter leak and preserving distal branch perfusion.

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Elective placement of covered stents in native coronary arteries

Acta Radiologica ◽

10.1080/j.1600-0455.2003.00059.x ◽

2003 ◽

Vol 44 (3) ◽

pp. 294-301 ◽

Cited By ~ 4

Author(s):

E. Søvik ◽

N-E. Kløw ◽

M. Brekke ◽

S. Stavnes

Keyword(s):

Stent Graft ◽

Coronary Arteries ◽

Nyha Class ◽

Covered Stent ◽

Covered Stents ◽

Restenosis Rate ◽

Stent Grafts ◽

Target Vessel Revascularization ◽

Q Wave

Purpose: To study the feasibility of placing a polytetrafluoroethylene (PTFE)-covered stent graft into native coronary arteries and assess the complications and the restenosis rate. Material and Methods: Fifty consecutive patients with stable angina pectoris were included and the stent graft was placed into native coronary arteries. Clinical and angiographic follow-up were performed after 6 months. Results: The stent grafts were successfully placed in all patients. The mean reference diameter was 3.3 ± 0.6 mm. During follow-up the stent grafts occluded in patients after 1, 2 and 2.5 months and one more was occluded at 6 months. Three patients experienced myocardial infarction, 2 Q wave and one non-Q wave. After 6 months 42 (84%) patients had angina NYHA class 0 or 1. Target vessel revascularization was done in 11 cases for restenosis in the graft (n = 4), outside the graft (n = 3) and both (n = 4), giving a restenosis rate of 24%. The total major adverse coronary events at 6 months was 24%. Conclusion: The stent graft was deployed with a high success rate. The restenosis rate was not higher than expected for bare stents. However, this study showed that subacute occlusion may occur more frequently and we therefore recommend that ticlopidine or clopidogrel treatment should be prolonged to at least 3 months.

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Endovascular stent-graft treatment for graft-vein anastomotic stenosis in haemodialysis patients with arteriovenous grafts

VASA ◽

10.1024/0301-1526/a000470 ◽

2015 ◽

Vol 44 (6) ◽

pp. 466-472 ◽

Cited By ~ 1

Author(s):

Chia-Hsun Lin ◽

Yen-Yang Chen ◽

Chai-Hock Chua ◽

Ming-Jen Lu

Keyword(s):

Risk Factors ◽

Stent Graft ◽

Target Lesion ◽

Primary Patency ◽

Anastomotic Stenosis ◽

Secondary Patency ◽

Endovascular Stent ◽

Stent Grafts ◽

Venous Anastomosis ◽

Arteriovenous Grafts

Abstract. Background: In this study, we investigated the patency of endovascular stent grafts in haemodialysis patients with arteriovenous grafts, the modes of patency loss, and the risk factors for re-intervention. Patients and methods: Haemodialysis patients with graft-vein anastomotic stenosis of their arteriovenous grafts who were treated with endovascular stent-grafts between 2008 and 2013 were entered into this retrospective study. Primary and secondary patency, modes of patency loss, and risk factors for intervention were recorded. Results: Cumulative circuit primary patency rates decreased from 40.0 % at 6 months to 7.3 % at 24 months. Cumulative target lesion primary patency rates decreased from 72.1 % at 6 months to 22.0 % at 24 months. Cumulative secondary patency rates decreased from 81.3 % at 12 months to 31.6 % at 36 months. Patients with a history of cerebrovascular accident had a significantly higher risk of secondary patency loss, and graft puncture site stenosis jeopardised the results of stent-graft treatment. Conclusions: Our data can help to improve outcomes in haemodialysis patients treated with stent-grafts for venous anastomosis of an arteriovenous graft.

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The first commercial use of the Valiant Navion stent graft system for endovascular repair of a descending thoracic aortic aneurysm

Vascular ◽

10.1177/1708538120981127 ◽

2020 ◽

pp. 170853812098112

Author(s):

Cassra N Arbabi ◽

Navyash Gupta ◽

Ali Azizzadeh

Keyword(s):

Stent Graft ◽

Standard Of Care ◽

Aortic Aneurysms ◽

Descending Thoracic Aortic Aneurysm ◽

Thoracic Aortic Aneurysms ◽

Commercial Use ◽

Early Results ◽

Multiple Configuration ◽

One Year

Objectives Thoracic endovascular aortic repair (TEVAR) is the standard of care for descending thoracic aortic aneurysms (DTAA), and newer generation stent grafts have significant design improvements compared to earlier generation devices. Methods We report the first commercial use of the Medtronic Valiant Navion stent graft for treatment of an 85-year-old woman with a 5.8 cm DTAA and a highly tortuous thoracic aorta. Results A percutaneous TEVAR was performed using a two-piece combination of the Valiant Navion FreeFlo and CoveredSeal stent graft configurations for zones 2–5 coverage. The devices were successfully delievered through highly tortuous anatomy and deployed, excluding the entire length of the aneurysm with precise landing, excellent apposition and no evidence of endoleak. The patient tolerated the procedure well and has had no stent graft-related complications through one-year follow-up. Conclusions Design enhancements such as a lower profile delivery system, better conformability, and a shorter tapered tip are some of the improvements to this third-generation TEVAR device. Coupled with the multiple configuration options available, this gives physicians a better tool to treat thoracic aortic pathologies in patients with challenging anatomy. The early results are encouraging, and evaluation of long-term outcomes will continue.

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Acute Type A Aortic Dissection Treated Using a Tubular Stent-Graft in the Ascending Aorta and a Multibranched Stent-Graft in the Aortic Arch

Journal of Endovascular Therapy ◽

10.1177/1526602816680089 ◽

2016 ◽

Vol 24 (1) ◽

pp. 75-80 ◽

Cited By ~ 17

Author(s):

Tilo Kölbel ◽

Christian Detter ◽

Sebastian W. Carpenter ◽

Fiona Rohlffs ◽

Yskert von Kodolitsch ◽

...

Keyword(s):

Aortic Dissection ◽

Stent Graft ◽

Open Surgery ◽

Type A ◽

Ascending Aorta ◽

Type I ◽

Acute Type ◽

Stent Grafts ◽

Type A Aortic Dissection ◽

Custom Made

Purpose: To describe the combined use of a tubular stent-graft for the ascending aorta and an inner-branched arch stent-graft for patients with acute type A aortic dissection. Technique: The technique to deploy these modular, custom-made stent-grafts is demonstrated in 2 patients with acute DeBakey type I aortic dissections and significant comorbidities precluding open surgery. Both emergent procedures were made possible by the availability of suitable devices manufactured for elective repair in other patients. After preliminary carotid-subclavian bypass, a long Lunderquist guidewire was introduced from the right femoral artery to the left ventricle for delivery of the Zenith Ascend and Zenith Branched Arch Endovascular Grafts under inflow occlusion. Bridging stent-grafts were delivered to the innominate and left common carotid arteries to connect to the 2 inner branches; the left subclavian artery was occluded. Both cases were technically successful and resulted in exclusion of the false lumen in the ascending aorta. The operating and fluoroscopy times did not exceed those of comparable elective procedures. The patients were rapidly extubated shortly after the procedure and without serious immediate complications. One patient survived 11 months with a satisfactory repair; the other succumbed to complications of recurrent pneumonia after 23 days. Conclusion: Endovascular treatment of patients with acute type A aortic dissection using a combination of tubular and branched stent-grafts in the ascending aorta is feasible and offers an alternative strategy to open surgery.

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