Uncovered Chimney Stent Graft for Renal Arteries With the Nellix Endovascular Aneurysm Sealing Technique

2017 ◽  
Vol 52 (2) ◽  
pp. 148-153 ◽  
Author(s):  
Luca Garriboli ◽  
Antonio Maria Jannello
Keyword(s):  
Aortic Aneurysms ◽  
Type I ◽  
Abdominal Aortic ◽  
Vessel Patency ◽  
Type I Endoleak ◽  
Procedural Costs ◽  
Endovascular Approach ◽  
Access Complications

Purpose: To describe the application of uncovered chimney stent grafts with the Nellix endovascular aneurysm sealing technique (ChEVAS) for juxtarenal abdominal aortic aneurysms (JAAAs). Case Report: Two patients with JAAA and multiple comorbidities were considered unfit for open surgery and were selected for an endovascular approach. Fenestrated and branched endografts were too expensive, and a chimney endovascular approach was considered inappropriate for the relatively high incidence of proximal type I endoleak and graft migration. ChEVAS was performed successfully with the novel addition of uncovered chimney stents to further reduce costs and possibly improve target vessel patency. JAAA exclusion and visceral vessel patency was confirmed at 18-month follow-up. Conclusion: ChEVAS with bare chimney stents is technically less complex, potentially reduces access complications and procedural costs, and may improve long-term patency compared to alternative techniques. Results at 18 months seem promising, but strict follow-up is necessary as the long-term durability is unknown.

Treatment of a type Ia endoleak following EVAR using a custom-made inner branch device.

Vascular ◽  
2021 ◽  
pp. 170853812110627
Author(s):  
Gino Gemayel GG ◽  
Michel Montessuit MM ◽  
Anouche Gemayel GA
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Open Surgery ◽  
Type I ◽  
Novel Technology ◽  
Abdominal Aortic ◽  
Custom Made ◽  
Type Ia ◽  
Type I Endoleak ◽  
Aortic Cuff

Objectives We represent two cases of late proximal type I endoleak following EVAR with aneurysm expansion that were treated with a custom-made graft with inner branches. Methods Two patients of 87 and 82 years old were operated by EVAR 6 and 8 years ago for abdominal aortic aneurysm. Both had proximal type I endoleak with aneurysm sac expansion. Open surgery had a high risk, and a proximal aortic extension with a simple aortic cuff was not possible neither because previous EVAR grafts were already at the level of the renal arteries. A custom-made endograft with inner branches was planned as a fenestrated graft was not technically possible. Results We successfully treated both patients using a custom-made graft with four inner branches from Jotec (Cryolife, Kennesaw, GA). Three months’ follow-up CT scan did not show any endoleaks. All target vessels were patent with good conformability of the bridging stents. Conclusion The treatment of proximal type I endoleak using inner branches’ endografts is feasible. This novel technology might broaden the indications for complex aortic repair in a group of patients where fenestrated endografts are not possible.

Outcomes after endovascular repair of abdominal aortic aneurysm involving the renovisceral arteries: A multi-center follow-up study

Vascular ◽  
2019 ◽  
Vol 27 (4) ◽  
pp. 397-404
Author(s):  
Otto Stackelberg ◽  
David Lindström ◽  
Kevin Mani ◽  
Göran Lundberg ◽  
Anneli Linné ◽  
...  
Keyword(s):  
Elective Surgery ◽  
Graft Patency ◽  
Aortic Aneurysms ◽  
Swedish Population ◽  
Aneurysm Neck ◽  
Abdominal Aortic ◽  
Vessel Patency ◽  
Sealing Zone ◽  
One Year

Objectives To evaluate outcomes after endovascular treatment of abdominal aortic aneurysms (AAA) involving the renovisceral arteries and to compare outcomes after fenestrated/branched endovascular aortic repair (f/b-EVAR), chimney/periscope EVAR (ch-EVAR), and bailout ch-EVAR. Methods A retrospective multicenter study including all patients with AAA involving the renovisceral segment, treated with f/b-EVAR, ch-EVAR, or bailout ch-EVAR, between 1 January 2005 and 30 June 2015, in three Swedish vascular centers. Patient charts were reviewed for data. Renovisceral stent graft patency was assessed on follow-up CT. Mortality was cross-checked against the Swedish Population Registry. Bailout ch-EVAR was defined as a perioperative decision of renovisceral endografting, as the artery was accidentally covered, or as the aneurysm neck sealing zone was considered inadequate. Results Of the 99 identified patients (76 men; mean age 74 years (range 58–89 years)), 68 underwent f/b-EVAR, 18 ch-EVAR, and 13 bailout ch-EVAR. Follow-up lasted for a median of 3.2 years (Q1, Q3 (2.1, 4.7 years)). Elective surgery comprised 87.9% ( n = 87) of the cases. Six patients died within 30 days, and the 30-day mortality after elective surgery was 4.6% (95% CI, 1.3%–11.4%) overall, 1.6% after f/b-EVAR (95% CI, 0.0%–11.4%), 15.4% after ch-EVAR (95% CI, 1.9%–45.4%), and 10.0% (95% CI, 0.3%–44.5%) after bailout ch-EVAR. During follow-up, there were 16 secondary interventions, of which 75% ( n = 12) were performed within six months after the primary intervention. Compared with f/b-EVAR, ch-EVAR was associated with a higher degree of type 1 endoleaks (1.5% vs. 22.2%, P = 0.001) and re-interventions during follow-up (13.2% vs. 33.3%, P = 0.046). The overall assisted target vessel patency was 96.1% (95% CI, 91.7%–98.6%) at one year and 95.2% (95% CI, 89.2%–98.4%) at two years. Conclusions Results after EVAR involving endografting of renovisceral arteries from three centers in Sweden with medium volumes are consistent with results previously reported from centers with larger volumes.

Endovascular abdominal aortic aneurysm repair in patients with Marfan syndrome

Vascular ◽  
2019 ◽  
Vol 28 (1) ◽  
pp. 48-52
Author(s):  
Allan Marc Conway ◽  
Khalil Qato ◽  
Gautam Anand ◽  
Laurie Mondry ◽  
Gary Giangola ◽  
...  
Keyword(s):  
Marfan Syndrome ◽  
Open Repair ◽  
Aortic Surgery ◽  
Endovascular Aneurysm Repair ◽  
Aortic Aneurysms ◽  
Type I ◽  
Femoral Access ◽  
Abdominal Aortic ◽  
Aneurysm Repair

Objectives Marfan syndrome patients are at risk for aortic degeneration. Repair is traditionally performed with open surgery as this is deemed more durable. Endovascular aneurysm repair remains controversial. We report on the outcomes of Marfan syndrome patients with abdominal aortic aneurysms undergoing endovascular aneurysm repair. Methods The Vascular Quality Initiative registry identified 35,889 patients, including 29 with Marfan syndrome, treated with endovascular aneurysm repair from January 2003 to December 2017. Outcomes were analyzed per the Society for Vascular Surgery reporting standards. Results Median age was 70.0 years (IQR, 57.0–75.0), and 22 (75.9%) were male. Median aneurysm diameter was 5.3 cm (IQR, 4.9–6.3 cm), with an aortic neck length and diameter of 2.0 cm (IQR, 1.6–2.8 cm) and 2.5 cm (IQR, 2.2–2.8 cm), respectively. Twenty-one (72.4%) patients were asymptomatic, seven (24.1%) symptomatic, and one (3.4%) presented with rupture. Ten (34.5%) patients had prior aortic surgery. Six (20.7%) were unfit for open surgical repair. Length of stay was 2.0 days (IQR, 1.0–3.0 days). Percutaneous femoral access was performed in 15 (51.7%) patients with no complications. A type IA endoleak was present in one (3.4%), type IB in one (3.4%), and type II endoleak in two (6.9%) patients. There were no postoperative pulmonary, cardiac, or neurological complications. In-hospital mortality occurred in one (3.4%) patient who presented with a rupture and had been deemed unfit for open repair. A conversion to open repair was required. The patient expired on post-operative day 0. Early clinical success was achieved in 26 (89.7%) patients. Follow-up was available for 15 (51.7%) patients at a median time of 766 days (IQR, 653–937). There were no reinterventions or mortalities. Change in sac diameter was −0.6 cm (IQR, −1.1 to −0.2 cm), with no type I or III endoleaks. Discussion Endovascular aneurysm repair for patients with Marfan syndrome is feasible, and can be performed safely. Mid-term outcomes suggest this technique is durable. More robust long-term follow-up is needed.

The Italian Trial of Endovascular AAA Exclusion Using the Parodi Endograft

1997 ◽  
Vol 4 (3) ◽  
pp. 299-306 ◽  
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.

Abdominal Aortic Aneurysm Wall Stresses After Endovascular Repair

2002 ◽  
Author(s):  
Elena S. Di Martino ◽  
Michel S. Makaroun ◽  
David A. Vorp
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Endovascular Repair ◽  
Careful Consideration ◽  
Aneurysm Wall ◽  
Abdominal Aortic ◽  
Long Term Follow Up ◽  
Endovascular Approach

The early benefits of an endovascular approach to abdominal aortic aneurysm (AAA) treatment has been reported by many authors [1,2]. One of the major advantages is that endovascular repair of AAA (EVAR) as opposed to traditional open surgery, is not a major abdominal surgery. EVAR has been shown to be associated with a death rate comparable to that of surgical repair [3]. In short term follow-up, EVAR is associated with fewer complications and a more rapid recovery [2]. On the contrary very limited data is available on long term follow-up of EVAR patients. Graft-related secondary interventions affect a consistent percentage of the treated cases. The EUROSTAR study [4] recently reported 13% of reintervention in 15.4 months. Our surgical unit reported 20.6% across 48 months in a recent review of 242 cases [3]. The frequence and type of reintervention, whose principal cause is endoleak or perigraft flow, requires careful consideration.

Long-term computed tomography follow-up after open surgical repair of abdominal aortic aneurysms

2006 ◽  
Vol 47 (6) ◽  
pp. 549-553 ◽  
Author(s):  
M. Mantoni ◽  
K. Neergaard ◽  
J. K. Christoffersen ◽  
T. L. Lambine ◽  
N. BÆkgaard
Keyword(s):  
Computed Tomography ◽  
Surgical Repair ◽  
Abdominal Aortic Aneurysms ◽  
Aortic Aneurysms ◽  
Open Surgical Repair ◽  
Abdominal Aortic

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.

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.

Adjunctive Procedures for the Treatment of Proximal Type I Endoleak: The Role of Peri-Aortic Ligatures and Palmaz Stenting

2003 ◽  
Vol 10 (2) ◽  
pp. 233-239 ◽  
Author(s):  
Elias Tzortzis ◽  
Robert J. Hinchliffe ◽  
Brian R. Hopkinson
Keyword(s):  
Endovascular Repair ◽  
Type I ◽  
Long Term Effects ◽  
Single Center Experience ◽  
Abdominal Aortic ◽  
Type I Endoleak ◽  
Secondary Procedures ◽  
Invasive Techniques

Purpose: To investigate the feasibility, efficacy, and long-term effects of peri-aortic ligatures and Palmaz stenting used to treat proximal type I endoleak after endovascular repair (EVR) of abdominal aortic aneurysm (AAA). Methods: An 8-year single-center experience with proximal type I endoleak was reviewed; the records of the 55 identified cases were examined to ascertain the methods of treatment used. Among these, all 22 patients who were treated with peri-aortic ligatures and Palmaz stenting were segregated for analysis. Results: The 22 patients (14 men; mean age 74.6 years, range 66–85) with proximal type I endoleak (18 early, 4 late) selected for analysis underwent 23 secondary procedures: 15 involving peri-aortic ligatures and 8 Palmaz stent implantations. Of the 18 early endoleaks, 11 were treated intraoperatively and 7 were observed. Ten (45%) patients died within 30 days of endoleak treatment: 8 had early endoleaks. Five of the 10 deaths occurred in patients successfully treated with peri-aortic ligatures (3/10) or Palmaz stenting (2/7). The 12 (54%) surviving patients suffered no aneurysm-related deaths or secondary endoleaks over a median follow-up of 20 months (range 4–75) Conclusions: Endoleak is an important mode of failure after endovascular repair. Peri-aortic ligatures and Palmaz stenting are feasible techniques for the treatment of proximal endoleak; however, the perioperative mortality of peri-aortic ligatures was higher when compared with other less invasive techniques. In contrast to other therapeutic options, these methods are more effective in the short and medium term.

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