Transluminal Stent-Graft Repair for Pseudoaneurysm of PTFE Hemodialysis Grafts

1998 ◽  
Vol 5 (2) ◽  
pp. 138-141
Author(s):  
Prem Rabindranauth ◽  
Larry Shindelman
Keyword(s):  
Endovascular Repair ◽  
False Aneurysm ◽  
Ptfe Graft ◽  
Normal Flow ◽  
Endovascular Techniques ◽  
Stent Grafts ◽  
Stented Graft ◽  
Stent Graft Repair ◽  
Flow Through

Purpose: To report the use of endovascular techniques to treat two cases of nonanastomotic pseudoaneurysm of a bridge graft fistula (BGF). Methods and Results: Two men with fully functional polytetrafluoroethylene (PTFE) BGFs both presented with an enlarging mass adjacent to their arteriovenous shunt. The false aneurysm in both instances was located by ultrasound and confirmed by shunt angiography at the time of surgery. Both fistulas were repaired by transluminally introducing a stented graft composed of a balloon-expandable Palmaz stent covered with a PTFE graft. Completion arteriography confirmed normal flow through the graft with no communication between the lumen and the aneurysmal cavity. Both patients recovered without complications and were discharged on the day of the procedure. Follow-up data reveal that both fistulas remain fully functional up to 5 and 6 months, respectively. Conclusions: Endovascular repair using stent-grafts can be a safe and effective method of excluding pseudoaneurysms associated with PTFE BGFs.

Total Endovascular Repair With Parallel Stent-Grafts for Postdissection Thoracoabdominal Aneurysm After Prior Proximal Repair

2019 ◽  
Vol 26 (5) ◽  
pp. 668-675 ◽  
Author(s):  
Junjun Liu ◽  
Zhenjiang Li ◽  
Jiaxuan Feng ◽  
Jian Zhou ◽  
Zhiqing Zhao ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Endovascular Therapy ◽  
Endovascular Repair ◽  
Spinal Cord Ischemia ◽  
Thoracoabdominal Aortic Aneurysm ◽  
Type I ◽  
Type Ii ◽  
Technical Success ◽  
Stent Grafts

Purpose: To evaluate the safety and efficacy of total endovascular repair with parallel stent-grafts for postoperative residual dissection thoracoabdominal aortic aneurysm (TAAA). Materials and Methods: A retrospective study was undertaken of 21 patients (mean age 64.0±12.5 years; 17 men) undergoing total endovascular therapy with parallel stent-grafts for postdissection TAAA after prior proximal repair between 2014 and 2016. The preoperative minimum true lumen diameter was 12.3±4.8 mm and the mean extent of dissection was 248.1±48.2 mm. Pre-, intra-, and postoperative medical records were reviewed to assess technical success, spinal cord ischemia, patency of target branch arteries, endoleak, and short-term outcomes of this approach. Results: Technical success was achieved in 17 of 21 patients owing to 4 type I endoleaks at the end of the procedures. A total of 70 branch arteries were revascularized and 14 celiac trunks were covered intentionally without reconstruction. Of 7 intraoperative endoleaks, 2 were managed intraoperatively and 5 (4 type I and 1 type II) disappeared spontaneously within 1 month. No spinal cord or abdominal organ or limb ischemia was observed. Mean follow-up was 16.2±6.1 months. No death or type I or III endoleak occurred during the follow-up; 2 type II endoleaks were observed. Nineteen of the 21 false lumens thrombosed, and the total aortic diameter decreased (57.3±8.4 to 55.3±7.4 mm, p<0.01). Three (4.3%) of 70 target branch arteries occluded during follow-up. The cumulative patency of retrogradely and antegradely revascularized branch arteries was 97.3% vs 100% at 12 months and 91.2% vs 100% at 18 months. Conclusion: Total endovascular therapy with parallel stent-grafts could be an effective alternative in treating postdissection TAAA. Further studies with long-term follow-up and larger sample size are recommended to evaluate the technique.

scholarly journals Three-year follow-up of composite stent grafts used in the repair of Crawford Type III thoracoabdominal aortic aneurysms; A case report

2019 ◽  
Vol 48 (1) ◽  
pp. 030006051984862
Author(s):  
Yuan-hao Tong ◽  
Tong Yu ◽  
Min Zhou ◽  
Chen Liu ◽  
Xiao-qiang Li ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Endovascular Repair ◽  
Mesenteric Artery ◽  
Aortic Aneurysms ◽  
Stent Grafts ◽  
Management Options ◽  
Off Label ◽  
Visceral Arteries

Complex aortic aneurysms are difficult to treat endovascularly and so techniques have been developed to broaden the management options. We report a case of 51-year-old man with several thoracoabdominal aortic aneurysms (TAAAs) who underwent endovascular repair with “off-label” stent grafts. Three aortic stent grafts and four branched stent grafts were used in the procedure using chimney and periscope techniques. The patient was followed for three years with regular computed tomography angiography (CTA). Scans at 3 and 12 months showed that the TAAAs were repaired and all visceral arteries were patent. Although, scans at the two- and three-year follow-ups showed that the stent graft in the superior mesenteric artery was occluded, the patient did not have any complications probably as a result of coeliac artery compensation.

Superficial Femoral Endarterectomy with Intraarterial PTFE Grafting

1995 ◽  
Vol 2 (3) ◽  
pp. 297-301 ◽  
Author(s):  
Alan E. Bray
Keyword(s):  
Surgical Repair ◽  
Early Experience ◽  
Normal Flow ◽  
Endovascular Techniques ◽  
Endovascular Approach ◽  
Flow Through ◽  
Thin Walled ◽  
Distal Fixation ◽  
Percutaneous Recanalization ◽  
Small Perforation

Purpose: To report early experience with a new endovascular approach to treating occluded Wallstents™ in the superficial femoral artery (SFA). Methods and Results: A symptomatic female patient with a 20-cm SFA occlusion involving a 10-cm Wallstent placed 2 years previously was offered an endovascular intervention. However, when percutaneous recanalization techniques failed, a semiclosed endarterectomy was undertaken using a conventional ring stripper. Although the atherosclerotic core and stent were removed smoothly, a small perforation was seen in the distal SFA. To avoid surgical repair, the endarterectomized segment was lined endoluminally using a 3-mm diameter, thin-walled polytetrafluoroethylene graft. A 15-mm Palmaz stent was used for distal fixation, with a plasty procedure performed at the proximal arteriotomy. There were no postoperative complications, and the patient, who was discharged on the second day, remains asymptomatic with normal flow through the graft at 3 months. Conclusion: Newer endovascular techniques may be applied in concert with conventional semiclosed endarterectomy to successfully treat lengthy SFA occlusions, particularly those involving stents.

Adherence to instruction for use after endovascular repair of popliteal artery aneurysm

Vascular ◽  
2021 ◽  
pp. 170853812110073
Author(s):  
Axel Wrede ◽  
Leena Lehti ◽  
Jonas Peter Eiberg ◽  
Stefan Acosta
Keyword(s):  
Stent Graft ◽  
Endovascular Repair ◽  
Popliteal Artery ◽  
Artery Aneurysm ◽  
Primary Patency ◽  
Size Difference ◽  
Stent Grafts ◽  
Popliteal Artery Aneurysm ◽  
One Year

Objectives Endovascular repair (ER) of popliteal artery aneurysm (PAA) is an alternative to open repair. However, there is no standardized protocol for when to opt for ER and the decision is therefore at the discretion of the clinician. This study aims to evaluate the adherence to the Instruction For Use (IFU) in patients undergoing ER for PAA and factors associated with stent graft patency at one year. Methods The adherence to IFU provided by the manufacturer in 55 patients treated with Gore Viabahn® Endoprosthesis with Heparin Bioactive Surface for PAA between 2009 and 2019 were retrospectively analyzed. Duplex follow-up was performed at 30 days and one year. Results The two groups of patients treated within ( n = 10) and not within ( n = 45) IFU did not differ in patient demographics, diagnostic assessment, treatment or outcome. Forty-five patients (81.8%) received stent graft placement with at least one deviation according to IFU. Distal oversizing >20% was the most frequent deviation against IFU ( n = 22, 40.0%). Primary patency at one year was 72%. Diameter size difference >1 mm between overlapping stent grafts (6/14 [43%], p = 0.013) and renal insufficiency (5/12 [42%], p = 0.0086) were associated with lower primary patency at one year. Age-adjusted analysis of tortuosity index (HR 1.78/SD, 95% CI 1.17–2.71; p = 0.0071) and maximal PAA angle (HR 1.73/SD, 95% CI 1.018–2.95; p = 0.043) were associated with major amputation/mortality at end of follow-up. Conclusion The majority of patients undergoing ER for PAA were not treated within IFU. Diameter size difference >1 mm between overlapping stent grafts was associated with a higher loss of primary patency at one year. Multi-center studies with larger sample size and long-term follow up of patency are warranted.

The use of thoracic stent grafts for endovascular repair of abdominal aortic aneurysms

Vascular ◽  
2017 ◽  
Vol 26 (3) ◽  
pp. 278-284 ◽  
Author(s):  
VP Bastiaenen ◽  
MGJ Snoeijs ◽  
JGAM Blomjous ◽  
J Bosma ◽  
VJ Leijdekkers ◽  
...  
Keyword(s):  
Endovascular Repair ◽  
Endovascular Aneurysm Repair ◽  
Aortic Aneurysms ◽  
Type I ◽  
Stent Grafts ◽  
Aortic Neck ◽  
Abdominal Aortic ◽  
Median Diameter ◽  
Aneurysm Repair

Objectives Stent grafts for endovascular repair of infrarenal aneurysms are commercially available for aortic necks up to 32 mm in diameter. The aim of this study was to evaluate the feasibility of endovascular repair with large thoracic stent grafts in the infrarenal position to obtain adequate proximal seal in wider necks. Methods All patients who underwent endovascular aneurysm repair using thoracic stent grafts with diameters greater than 36 mm between 2012 and 2016 were included. Follow-up consisted of CT angiography after six weeks and annual duplex thereafter. Results Eleven patients with wide infrarenal aortic necks received endovascular repair with thoracic stent grafts. The median diameter of the aneurysms was 60 mm (range 52–78 mm) and the median aortic neck diameter was 37 mm (range 28–43 mm). Thoracic stent grafts were oversized by a median of 14% (range 2–43%). On completion angiography, one type I and two type II endoleaks were observed but did not require reintervention. One patient experienced graft migration with aneurysm sac expansion and needed conversion to open repair. Median follow-up time was 14 months (range 2–53 months), during which three patients died, including one aneurysm-related death. Conclusions Endovascular repair using thoracic stent grafts for patients with wide aortic necks is feasible. In these patients, the technique may be a reasonable alternative to complex endovascular repair with fenestrated, branched, or chimney grafts. However, more experience and longer follow-up are required to determine its position within the endovascular armamentarium.

Homemade Fenestrated Stent-Grafts for Complete Endovascular Repair of Aortic Arch Dissections

2019 ◽  
Vol 26 (5) ◽  
pp. 645-651 ◽  
Author(s):  
Ludovic Canaud ◽  
Baris Ata Ozdemir ◽  
Lucien Chassin-Trubert ◽  
Julien Sfeir ◽  
Pierre Alric ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Stent Graft ◽  
Endovascular Repair ◽  
Covered Stent ◽  
Type I ◽  
Type Ii ◽  
Stent Grafts ◽  
Fenestrated Stent Graft ◽  
Type I Endoleak

Purpose: To evaluate outcomes of homemade fenestrated stent-grafts for complete endovascular aortic repair of aortic arch dissections. Materials and Methods: From July 2014 through September 2018, 35 patients (mean age 66±11 years; 25 men) underwent homemade fenestrated stent-graft repair of acute (n=16) or chronic (n=10) complicated type B aortic dissections (n=16) and dissecting aortic arch aneurysms subsequent to surgical treatment of acute type A dissections (n=9). Nineteen (54%) procedures were emergent. Results: Zone 2 single-fenestrated stent-grafts were used in 25 cases; the remaining 10 were double-fenestrated stent-grafts deployed in zone 0. Median time for stent-graft modification was 18 minutes (range 16–20). Technical success was achieved in all cases. An immediate distal type I endoleak was treated intraoperatively. Among the double-fenestrated stent-graft cases, the left subclavian artery fenestration could not be cannulated in 2 patients and revascularization was required. Partial coverage of the left common carotid artery necessitated placement of a covered stent in 3 cases. One (3%) patient had a stroke without permanent sequelae. Two type II endoleaks required additional covered stent placement at 5 and 7 days postoperatively, respectively. The 30-day mortality was 6% (2 patients with ruptured aortic arch aneurysm). During a mean follow-up of 17.6±13 months, there was no aortic rupture or retrograde dissection. One late type I endoleak was treated with additional proximal fenestrated stent-graft placement. One type II endoleak is currently under observation. One additional patient died (unrelated to the aorta); overall mortality was 9%. All supra-aortic trunks were patent. Conclusion: The use of homemade fenestrated stent-grafts for endovascular repair of aortic arch dissections is feasible and effective for total endovascular aortic arch repair. Durability concerns will need to be assessed in additional studies with long-term follow-up.

Treatment of Popliteal Artery Aneurysms with the Hemobahn Stent-Graft

2003 ◽  
Vol 10 (1) ◽  
pp. 111-116 ◽  
Author(s):  
Ignace F.J. Tielliu ◽  
Eric L.G. Verhoeven ◽  
Ted R. Prins ◽  
Wendy J. Post ◽  
Robin G. Hulsebos ◽  
...  
Keyword(s):  
Stent Graft ◽  
Popliteal Artery ◽  
Ankle Brachial Index ◽  
Radiographic Examination ◽  
Stent Grafts ◽  
Vascular Intervention ◽  
Popliteal Aneurysm ◽  
Stent Graft Repair ◽  
A Prospective Study

Purpose: To report a prospective study to ascertain the results of popliteal aneurysm treatment with a self-expanding stent-graft. Methods: In a recent 3-year period, 21 patients (18 men; median age 67 years, range 52–82) with 23 popliteal aneurysms were treated with Hemobahn stent-grafts. Follow-up evaluation included duplex scanning, ankle-brachial index (ABI) measurements, and radiographic examination of the knee. Outcome measures were occlusion of the stent-graft and limb loss. Results: Technical success in placing the stent-graft and excluding the aneurysm was 100%. An additional vascular intervention was performed in the same session in 5 (24%) cases. In the other 16 patients, local anesthesia was used in 10 (63%). During a median follow-up of 15 months (range 2–37), 5 (22%) of 23 stent-grafts occluded, resulting in a cumulative patency of 74%. All occlusions occurred within 6 months after the intervention; 2 were successfully recanalized, and none of the 3 patients with persisting occlusion required an amputation. Conclusions: The results of this study suggest that endovascular stent-graft repair of popliteal artery aneurysms is feasible. Midterm patency rates are lower compared to traditional surgical repair.

Long-Term Outcomes of Thoracic Endovascular Repair for Aortic Arch Dissection Using Customized Single-Branched Fenestrated Stent-Graft

2021 ◽  
pp. 153857442110104
Author(s):  
Xiaoye Li ◽  
Lei Zhang ◽  
Chao Song ◽  
Hao Zhang ◽  
Shibo Xia ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Stent Graft ◽  
Endovascular Repair ◽  
Artery Occlusion ◽  
Stent Grafts ◽  
Technical Success Rate ◽  
Thoracic Endovascular Repair ◽  
Subclavian Artery Occlusion ◽  
Fenestrated Stent Graft

Objectives: To report outcomes of thoracic endovascular repair using customized single-branched fenestrated stent-grafts in treatment of aortic arch dissections. Materials and Methods: Between November 2009 and November 2011, 16 patients with aortic arch dissections underwent thoracic endovascular aortic repair utilizing customized unibody single-branched fenestrated stent-graft (UBFSG) in our institution. Results: All 16 patients were male with mean age of 54.50 ± 11.33. The technical success rate was 100%. 30-day mortality rate was 6.25% (n = 1). The median follow-up period was 98 months (range, 0-119). During follow-up, 4 nonaorta-related deaths were recorded. Two (2) cases of left subclavian artery occlusion were observed 12 and 14 months after the operation. Two (2) patients had another successful endovascular repair in time, including one case of type Ib endoleak occurred 100 months after the operation and one case of stent-graft induced new entry tear 38 months after the operation. No stroke and migration of stent-grafts were observed. Conclusions: The branched fenestrated stent-graft may be an effective alternative treatment for aortic arch dissections unfit for open surgery.

Endovascular Repair of Acute AAAs under Local Anesthesia with Bifurcated Endografts: A Feasibility Study

2002 ◽  
Vol 9 (6) ◽  
pp. 729-735 ◽  
Author(s):  
Eric L.G. Verhoeven ◽  
Ted R. Prins ◽  
Jan J.A.M. van den Dungen ◽  
Ignace F.J. Tielliu ◽  
Robin G. Hulsebos ◽  
...  
Keyword(s):  
Local Anesthesia ◽  
Stent Graft ◽  
Endovascular Repair ◽  
Aortic Aneurysms ◽  
Acute Setting ◽  
Abdominal Aortic ◽  
Stent Graft Repair ◽  
Groin Hematoma ◽  
Median Blood Loss

Purpose: To evaluate endovascular repair of abdominal aortic aneurysms (AAA) under local anesthesia in the acute setting. Methods: Between 1998 and 2001, 47 patients with an acute AAA were evaluated for endovascular repair after informed consent, provided they were in a stable, albeit hypotensive condition. The patients underwent urgent computed tomography to assess suitability for endovascular repair; 16 were eligible for stent-graft repair: 9 were frank ruptures and 7 were symptomatic aneurysms. Complications and outcome of endovascular repair were evaluated; mortality was compared to a contemporaneous surgical cohort. Results: Seven (23%) of 31 patients having a standard surgical procedure died in the study period compared to 1 (6%) of 16 patients undergoing endovascular repair (following conversion to surgery because of calcified access vessels). Twelve (75%) of the endovascular repairs were performed under local anesthesia; no complications with this mode of anesthesia were encountered. The median duration of the endovascular procedures was 110 minutes (range 75–240); median blood loss was 250 mL (range 100–2800 mL). Only 4 patients required blood transfusion, and only 8 patients required admission to the intensive care unit. There were 3 postoperative complications (1 ischemic colitis, 1 renal failure, 1 groin hematoma). During follow-up, 3 endograft patients received stent-graft extensions in uneventful procedures. Two patients died at 9 and 16 months from cardiac causes. Conclusions: This study demonstrates the feasibility and possible advantages of endovascular repair under local anesthesia in selected acute AAA patients. Further studies are needed to prove the advantages over open repair.

Percutaneous Endovascular Stent-Graft Repair of Iliac Artery Aneurysms

1997 ◽  
Vol 4 (4) ◽  
pp. 370-375 ◽  
Author(s):  
Gerald Dorros ◽  
Joel M. Cohn ◽  
Michael R. Jaff
Keyword(s):  
Iliac Artery ◽  
Balloon Dilation ◽  
Percutaneous Technique ◽  
Stent Grafts ◽  
Baseline Serum ◽  
Average Hospital ◽  
Stent Graft Repair ◽  
Endovascular Stent Graft Repair ◽  
Isolated Iliac Artery Aneurysms

Purpose: To report a percutaneous technique for endovascular repair of iliac artery aneurysms using commercially available materials. Methods: Ten patients (9 males; mean age 65 ± 11 years) presented with 11 isolated iliac artery aneurysms; 3 patients were asymptomatic. Stent-grafts were customized for each patient from polytetrafluoroethylene grafts with Palmaz stents sutured at either end of the tube. The devices were delivered percutaneously through standard 14F sheaths and deployed by balloon dilation. Results: All iliac aneurysms were excluded without procedural incident. One patient with chronic renal insufficiency (baseline serum creatinine 1.9 mg/dL) experienced transient contrast-induced renal failure inhospital. The average hospital stay was 2.5 days (range 1 to 7). One vessel thrombosed 2 weeks following the procedure; the culprit stenosis at the site of arterial cannulation was dilated. One patient died of myocardial infarction at 6 weeks. The remaining eight grafts are patent and free of endoleak at a mean 14-month follow-up. Conclusions: This percutaneous technique appears to be an acceptable alternative to open surgical repair.

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