T Branch Repair of Ruptured a Type IV Thoracoabdominal Aortic Aneurysm Complicated by Renal Branch Occlusion

2021 ◽  
pp. 153857442198985
Author(s):  
Stevo Duvnjak ◽  
Stephan Bach-Frommer ◽  
Timothy Andrew Resch
Keyword(s):  
Renal Function ◽  
Aortic Aneurysm ◽  
Stent Graft ◽  
Thoracoabdominal Aortic Aneurysm ◽  
Bare Metal Stent ◽  
Aneurysm Rupture ◽  
Bare Metal ◽  
Metal Stent ◽  
Type Iv ◽  
Cook Medical

A 60-year male patient presented with a thoracoabdominal aortic aneurysm rupture, which was treated emergently with a modified off-the-shelf t-Branch stent-graft (COOK Medical Inc). The sole renal branch occluded 1 month after TEVAR due to branch compression, and the patient became anuric and temporarily dialysis-dependent. Despite the prolonged renal ischemia time, the occluded renal branch was successfully opened with thrombolysis and reinforced with a bare-metal stent. The patient recovered his renal function and came off dialysis.

scholarly journals Clinical consequence of bare metal stent and stent graft failure in femoropopliteal occlusive disease

2013 ◽  
Vol 58 (6) ◽  
pp. 1525-1531 ◽  
Author(s):  
Shant M. Vartanian ◽  
Paul C. Johnston ◽  
Joy P. Walker ◽  
Sara J. Runge ◽  
Charles M. Eichler ◽  
...  
Keyword(s):  
Stent Graft ◽  
Graft Failure ◽  
Bare Metal Stent ◽  
Occlusive Disease ◽  
Clinical Consequence ◽  
Bare Metal ◽  
Metal Stent

scholarly journals Clinical Consequence of Bare-Metal Stent and Stent Graft Failure in Femoropopliteal Occlusive Disease

2012 ◽  
Vol 56 (2) ◽  
pp. 582
Author(s):  
Shant M. Vartanian ◽  
Paul J. Johnston ◽  
Joy P. Walker ◽  
Sara J. Runge ◽  
Charles M. Eichler ◽  
...  
Keyword(s):  
Stent Graft ◽  
Graft Failure ◽  
Bare Metal Stent ◽  
Occlusive Disease ◽  
Clinical Consequence ◽  
Bare Metal ◽  
Metal Stent

scholarly journals Grade III Coronary Artery Perforation Following PCI and Unusual Stent Graft Delivery System

2014 ◽  
Vol 15 (2) ◽  
pp. 101-103
Author(s):  
Miodrag Sreckovic ◽  
Nikola Jagic ◽  
Vladimir Miloradovic ◽  
Mladen Tasic ◽  
Dusan Nikolic
Keyword(s):  
Coronary Artery ◽  
Stent Graft ◽  
Bare Metal Stent ◽  
Covered Stent ◽  
Severe Form ◽  
Bare Metal ◽  
Metal Stent ◽  
High Profile ◽  
Coronary Artery Perforation ◽  
Grade Iii

ABSTRACT Coronary perforations are rare but vicious complications of PCI procedures. Ellis type III coronary artery perforation represents the most severe form and demands an urgent solution. It is often necessary to perform pericardiocentesis and utilizise multiple interventional techniques to seal the perforation. Polytetrafluoroethylene (PTFE)-covered stent implantation has become one of the most frequently used percutaneous solutions, but disadvantages of this intervention are its high profile and low device flexibility. In our case, we attempted to improve the deliverability of the PTFE stent graft alone by mounting it on a bare metal stent used as a stent graft carrier.

Repair of Junctional Stent-Graft Leaks with Use of a Bare Metal Stent

1999 ◽  
Vol 10 (3) ◽  
pp. 275-280 ◽  
Author(s):  
Jacob Cynamon ◽  
Adam S. Federman ◽  
Frank J. Veith
Keyword(s):  
Stent Graft ◽  
Bare Metal Stent ◽  
Bare Metal ◽  
Metal Stent

Endovascular Repair Using a 7-Branch Stent-Graft for a Thoracoabdominal Aortic Aneurysm With Variant Renovisceral Artery Anatomy

2019 ◽  
Vol 27 (2) ◽  
pp. 231-236 ◽  
Author(s):  
Ahmed Eleshra ◽  
Konstantinos Spanos ◽  
Giuseppe Panuccio ◽  
Catharina Gronert ◽  
Fiona Rohlffs ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Stent Graft ◽  
Endovascular Repair ◽  
Thoracoabdominal Aortic Aneurysm ◽  
Covered Stent ◽  
Covered Stents ◽  
Femoral Access ◽  
Type Iv ◽  
Custom Made ◽  
Artery Disease

Purpose: To present a case of endovascular repair using a custom-made 7-branch stent-graft for a thoracoabdominal aortic aneurysm (TAAA) in a patient with variations in the renovisceral artery anatomy. Case Report: A 70-year-old asymptomatic man presented with a 60-mm-diameter type IV TAAA. Due to severe coronary artery disease, an endovascular approach was elected. In the preoperative computed tomography angiography (CTA) scans, variations in the renovisceral artery anatomy included the common hepatic and splenic arteries deriving separately from the aorta and bilateral double renal arteries (RAs). A custom-made 7-branch stent-graft was manufactured to preserve all renovisceral arteries. The 7 branches were catheterized and connected with a steerable sheath from a femoral access. All branches were bridged to the target vessel (TV) with a self-expanding covered stent; 4 TVs also had balloon-expandable covered stents implanted. Final angiography and predischarge CTA showed patency of all 7 target vessels and corresponding visceral organs, with no endoleak. The patient was discharged on postoperative day 8 without complications. Six-month follow-up CTA demonstrated exclusion of the TAAA and patency of all 7 target vessels. Conclusion: Successful treatment of a TAAA in a patient with multiple variant renovisceral arteries was feasible with a custom-made 7-branch stent-graft, achieving a good early outcome.

scholarly journals Early Outcomes of the t-Branch Off-the-Shelf Multibranched Stent-Graft in Urgent Thoracoabdominal Aortic Aneurysm Repair

2017 ◽  
Vol 25 (1) ◽  
pp. 31-39 ◽  
Author(s):  
Konstantinos Spanos ◽  
Tilo Kölbel ◽  
Myrto Theodorakopoulou ◽  
Franziska Heidemann ◽  
Fiona Rohlffs ◽  
...  
Keyword(s):  
Renal Function ◽  
Aortic Aneurysm ◽  
Stent Graft ◽  
Thoracoabdominal Aortic Aneurysm ◽  
Type I ◽  
Target Vessel ◽  
Procedure Time ◽  
Renal Function Impairment ◽  
Function Impairment ◽  
The Impact

Purpose: To assess the short-term outcomes of the multibranched off-the-shelf t-Branch stent-graft for urgent thoracoabdominal aortic aneurysm (TAAA) repair and to evaluate the impact on outcomes of the learning curve and adherence to the instruction for use (IFU). Methods: Between 2014 and 2017, 42 patients (mean age 73.3±7 years; 26 men) underwent urgent TAAA treatment using the t-Branch stent-graft [18 in the early (2014–2015) period and 24 in the late (2016–2017) period]. Nearly half the patients were symptomatic (n=18) and 12 had contained rupture. Aneurysm diameter >80 mm was present in 12 (mean diameter 77.7±13.2 mm). Nineteen patients did not meet the IFU for the t-Branch due to target vessel anatomy. The primary endpoints were spinal cord ischemia (SCI), renal function impairment, and 30-day mortality. Target vessel patency and endoleak incidence were assessed at 30 days. Multivariate analyses examined associations between perioperative variables and outcomes; the results are presented as the odds ratio (OR) and 95% confidence interval (CI). Results: The technical success rate was 93% (39/42). Successful catheterization was achieved in 150/155 target vessels (97%). The postoperative SCI rate was 21% (5 paraplegia/4 transient paraparesis) and was correlated with age (OR 1.26, 95% CI 1.01 to 1.56, p=0.04). The renal function impairment rate was 23% (10/42; 2 temporary, 2 permanent dialysis) and was correlated with early experience (OR 7.74, 95% CI 1.3 to 43.9, p=0.019). The 30-day mortality was 14% (no intraoperative deaths); no factor was associated with mortality. During the first month, the incidences of type I, II, and III endoleaks were 0%, 43%, and 0%, respectively; branch patency was 99% (150/151). Procedure time decreased in the later experience (479±333 vs 407±25 minutes, p=0.09), though it was increased in cases outside the IFU (497±135 vs 389±118 minutes, p=0.009), along with fluoroscopy time (121±48 vs 92±33 minutes, p=0.036). Conclusion: Endovascular repair of urgent TAAA using the t-Branch is a feasible treatment option with acceptable 30-day mortality and morbidity in terms of SCI and renal function impairment. Adherence to the IFU prolonged procedure time but had no effect on outcomes. Increased experience of such cases over time may improve outcomes.

Technique for Fenestrated Stent-Graft Implantation as a Proximal Extension to a Previous Fenestrated Endovascular Repair for Abdominal Aortic Aneurysm

2017 ◽  
Vol 25 (1) ◽  
pp. 16-20 ◽  
Author(s):  
Konstantinos Spanos ◽  
Nikolaos Tsilimparis ◽  
Franziska Heidemann ◽  
Fiona Rohlffs ◽  
Christian-Alexander Behrendt ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Stent Graft ◽  
Endovascular Repair ◽  
Endovascular Aneurysm Repair ◽  
Thoracoabdominal Aortic Aneurysm ◽  
Efficient Treatment ◽  
Type Iv ◽  
Abdominal Aortic ◽  
Custom Made

Purpose: To describe planning and a technique for fenestrated endovascular repair of a large Crawford type IV thoracoabdominal aortic aneurysm after previous 2-fenestration endovascular aneurysm repair (FEVAR). Technique: The first FEVAR procedure performed at another center implanted a standard Zenith device with 2 fenestrations and 1 scallop for a juxtarenal abdominal aortic aneurysm. The diameter of the Crawford type IV thoracoabdominal aortic aneurysm had progressed from 68 to 75 mm within a year after the FEVAR. Since the celiac trunk was already occluded, a 3-fenestration 22-×172-mm stent-graft was chosen to extend the existing stent-graft further proximally. A tapered 38/22-×179-mm Zenith custom-made device was designed for the thoracic component. The technique addresses several issues that arise during a FEVAR-in-FEVAR case, such as the orientation of the new stent-graft and its fenestrations, the absence of space between the 2 devices for maneuvers, and the difficulty in catheterizing target vessels with existing bridging stents, for which a bailout “snare-ride” maneuver is described. Conclusion: FEVAR after previous FEVAR is a feasible and efficient treatment option. The modified “snare-ride” technique can be used to catheterize target vessels in the absence of an Indy snare.

scholarly journals POSSIBILITIES OF APPLYING MATHEMATICAL ANALYSIS OF BLOOD FLOW CHARACTERISTICS IN ENDOVASCULAR TREATMENT OF AORTIC DISEASES USING HOLOMETALLIC STENTS

2019 ◽  
Vol 6 (1) ◽  
pp. 99-105
Author(s):  
M. A. Chernyavskiy ◽  
B. S. Artyushin ◽  
A. V. Chernov ◽  
D. V. Chernova ◽  
N. N. Zherdev ◽  
...  
Keyword(s):  
Blood Flow ◽  
Aortic Aneurysm ◽  
Abdominal Aorta ◽  
Flow Characteristics ◽  
Bare Metal Stent ◽  
Bare Metal ◽  
Metal Stent ◽  
Aortic Diseases ◽  
Aneurysm Wall ◽  
Before And After

Purpose. The purpose of the article is to access possibilities of blood flow mathematical analysis in aortic aneurysm before and after bare metal stent implantation.Materials and methods. Mathematical models of aortic blood flow were based on data received at studying 15 CT-scans of patients with abdominal aorta aneurysms (12) and dissections (3) and their duplex ultra-sound hemodynamic data. At constructing mathematical model the program SolidWorks was used. Working with the program consisted of two stages: establishment of conditions for geometric objects; forming of abdominal aorta model from these objects. In the study hemodinamic aneurysm indexes was evaluated on rectilinear and curvilinear segments. Some of characteristics were variable: diameter, aneurysm wall thickness, its length, elasticity.Results. Correlation of extreme tension into aneurysm wall on rectilinear and curvilinear segments according to aneu­rysm wall thickness was assessed. Possibilities of pathological blood flow changes correction at bare metal stent im­plantation into aortic aneurysm were estimated: if presence of bare metal stent were introduced into mathematical parameters blood flow characteristics became almost as standard characteristics. Received data can enhance successful endovascular treatment of aortic diseases with using of bare metal stents.Conclusion. Mathematical models of aortic and vascular aneurysms before and after surgery can be an effective tool in bettering quality of medical help for vascular patients.

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