Completion of Target Vessel Stenting After FEVAR via Snare Technique in a Patient with Tortuous Right Renal Artery

2021 ◽  
pp. 155698452110426
Author(s):  
Alexander Tschischka ◽  
Peter Schott ◽  
Patrick Freyhardt ◽  
Apostolos Mamopoulos ◽  
Gabor Gäbel ◽  
...  
Keyword(s):  
Renal Artery ◽  
Endovascular Aneurysm Repair ◽  
Stable Condition ◽  
Aortic Aneurysms ◽  
Target Vessel ◽  
The Right ◽  
Aneurysm Repair ◽  
Juxtarenal Aneurysm ◽  
Established Technique ◽  
Control Angiography

Target vessel catheterization remains challenging in patients with complex anatomies. Fenestrated endovascular aneurysm repair (FEVAR) is an established technique to treat aortic aneurysms. In this case report, we treated a juxtarenal aneurysm using FEVAR. Initial attempts to complete the target vessel stenting were unsuccessful because of an unfavorable orifice and tortuosity of the right renal artery. The completion of FEVAR was achieved with a bifemoral approach using a snare system, which aligned the tip of a steerable sheath at the level of the fenestration for the right renal artery to create a stable condition. Control angiography and computed tomography confirmed a successful stenting of the target vessel and the sealing of the fenestration without an endoleak.

Cardiac Pulsatility– and Respiratory-Induced Deformations of the Renal Arteries and Snorkel Stents After Snorkel Endovascular Aneurysm Sealing

2019 ◽  
Vol 26 (4) ◽  
pp. 556-564
Author(s):  
Christopher P. Cheng ◽  
Ga-Young Suh ◽  
John J. Kim ◽  
Andrew Holden
Keyword(s):  
Renal Artery ◽  
Endovascular Aneurysm Repair ◽  
Renal Arteries ◽  
Aortic Aneurysms ◽  
Left Renal Artery ◽  
3 Dimensional ◽  
Maximum Curvature ◽  
Mechanical Durability ◽  
The Right ◽  
Aneurysm Repair

Purpose: To quantify deformations of renal arteries and snorkel stents after snorkel endovascular aneurysm sealing (Sn-EVAS) resulting from cardiac pulsatility and respiration and compare these deformations to patients with untreated abdominal aortic aneurysms (AAA) and snorkel endovascular aneurysm repair (Sn-EVAR). Materials and Methods: Ten Sn-EVAS patients (mean age 75±6 years; 8 men) were scanned with cardiac-gated, respiration-resolved computed tomography angiography. From 3-dimensional geometric models, changes in renal artery and stent angulation and curvature due to cardiac pulsatility and respiration were quantified. Respiration-induced motions were compared with those of 16 previously reported untreated AAA patients and 11 Sn-EVAR patients. Results: Renal artery bending at the stent end was greater for respiratory vs cardiac influences (6°±7° vs −1°±2°, p<0.025). Respiration caused a 3-fold greater deformation on the left renal artery as compared with the right side. Maximum curvature change was higher for respiratory vs cardiac influences (0.49±0.29 vs 0.24±0.17 cm−1, p<0.025), and snorkel renal stents experienced similar maximum curvature change due to cardiac pulsatility and respiration (0.14±0.10 vs 0.19±0.09 cm−1, p=0.142). When comparing the 3 patient cohorts for respiratory-induced deformation, there was significant renal branch angulation in untreated AAAs, but not in Sn-EVAR or Sn-EVAS, and there was significant bending at the stent end in Sn-EVAR and Sn-EVAS. Maximum curvature change due to respiration was ~10-fold greater in Sn-EVAR and Sn-EVAS compared to untreated AAAs. Conclusion: The findings suggest that cardiac and respiratory influences may challenge the mechanical durability of snorkel stents of Sn-EVAS; similarly, however, respiration may be the primary culprit for tissue irritation, increasing the risk for stent-end thrombosis, especially in the left renal artery. The bending stiffness of snorkel stents in both the Sn-EVAR and Sn-EVAS cohorts damped renal branch angulation while it intensified bending of the artery distal to the snorkel stent. Understanding these device-to-artery interactions is critical as they may affect mechanical durability of branch stents and quality and durability of treatment.

scholarly journals Endograft Conformability in Fenestrated Endovascular Aneurysm Repair for Complex Abdominal Aortic Aneurysms

2020 ◽  
Vol 27 (5) ◽  
pp. 848-856
Author(s):  
Arne de Niet ◽  
Esmé J. Donselaar ◽  
Suzanne Holewijn ◽  
Ignace F. J. Tielliu ◽  
Jan Willem H. P. Lardenoije ◽  
...  
Keyword(s):  
Renal Artery ◽  
Endovascular Aneurysm Repair ◽  
Aortic Aneurysms ◽  
Left Renal Artery ◽  
Slice Thickness ◽  
Target Vessel ◽  
Abdominal Aortic ◽  
Custom Made ◽  
Aneurysm Repair ◽  
The Impact

Purpose: To compare the impact of 2 commercially available custom-made fenestrated endografts on patient anatomy. Materials and Methods: The records of 234 patients who underwent fenestrated endovascular aneurysm repair for abdominal aortic aneurysm from March 2002 to July 2016 in 2 hospitals were screened to identify those who had pre- and postoperative computed tomography angiography assessments with a slice thickness of ≤2 mm. The search identified 145 patients for further analysis: 110 patients (mean age 72.4±7.1 years; 94 men) who had been treated with the Zenith Fenestrated (ZF) endograft and 35 patients (mean age 72.3±7.3 years; 30 men) treated with the Fenestrated Anaconda (FA) endograft. Measurements included aortic diameters at the level of the superior mesenteric artery (SMA) and renal arteries, target vessel angles, target vessel clock positions, and the target vessel tortuosity index. Variables were tested for inter- and intraobserver agreement. Results: There was a good agreement between observers in all tested variables. The native anatomy changed in both groups after endograft implantation. In the ZF group, changes were seen in the angles of the celiac artery (p=0.012), SMA (p=0.022), left renal artery (LRA) (p<0.001), and the right renal artery (RRA) (p<0.001); the aortic diameter at the SMA level (p<0.001); and the LRA (p<0.001) and RRA (p<0.001) clock positions. In the FA group, changes were seen in the angles of the LRA (p=0.001) and RRA (p<0.001) and in the SMA tortuosity index (p=0.044). Between group differences in changes were seen for the aortic diameters at the SMA and renal artery levels (p<0.001 for both) and the LRA clock position (p=0.019). Conclusion: Both custom-made fenestrated endografts altered vascular anatomy. The data suggest a higher conformability of the Fenestrated Anaconda endograft compared with the Zenith Fenestrated.

Spiral CT Angiography versus Aortography in the Assessment of Aortoiliac Length in Patients Undergoing Endovascular Abdominal Aortic Aneurysm Repair

1998 ◽  
Vol 5 (3) ◽  
pp. 222-227 ◽  
Author(s):  
Matthew P. Armon ◽  
Simon C. Whitaker ◽  
Roger H.S. Gregson ◽  
Peter W. Wenham ◽  
Brian R. Hopkinson
Keyword(s):  
Renal Artery ◽  
Large Diameter ◽  
Endovascular Aneurysm Repair ◽  
Spiral Ct ◽  
Abdominal Aortic Aneurysm Repair ◽  
Aortic Aneurysms ◽  
Aortic Bifurcation ◽  
Abdominal Aortic ◽  
Aneurysm Repair ◽  
Level Of Agreement

Purpose: To compare measurements of aortoiliac length obtained with spiral computed tomographic angiography (CTA) and aortography in patients undergoing endovascular aneurysm repair. Methods: The distances from the lower-most renal artery to the aortic bifurcation and from the aortic bifurcation to the common iliac artery (CIA) bifurcation were measured using both CTA and aortography in 108 patients with abdominal aortic aneurysms. Results: The level of agreement between CTA and aortography was high, with 69% of aortic and 76% of iliac measurements within 1 cm and > 90% within 2 cm of each other. Mean differences were −0.35 ± 1.20 cm and 0.25 ± 1.10 cm, respectively, for aortic and iliac lengths. Aortography overestimated renal artery to aortic bifurcation length in comparison to CTA (p = 0.003), particularly in patients with large aneurysms (> 6.5 cm) and lumen diameters > 4.5 cm (p < 0.0001). Measurements of CIA length were shorter by aortography than CTA (p = 0.02). Conclusions: There is a high level of agreement between CTA and aortography in the measurement of aortoiliac length, but aortography overestimates renal artery to aortic bifurcation length in patients with large-diameter aneurysms and wide aneurysm lumens. CTA is sufficiently accurate in the majority of cases to be used as the sole basis for the construction of endovascular grafts.

Double D Technique: An Innovative Modified Bifurcated Stent Graft Deployment Strategy for an Isolated Common Iliac Artery Aneurysm With a Challenging Renal Artery Anatomy

2019 ◽  
Vol 53 (7) ◽  
pp. 613-616 ◽  
Author(s):  
Yusuke Date ◽  
Tamaki Takano ◽  
Taishi Fujii ◽  
Takamitsu Terasaki ◽  
Masayuk Sakaguchi
Keyword(s):  
Renal Artery ◽  
Iliac Artery ◽  
Common Iliac Artery ◽  
Endovascular Aneurysm Repair ◽  
Artery Aneurysm ◽  
Aortic Bifurcation ◽  
Iliac Artery Aneurysm ◽  
Common Iliac Artery Aneurysm ◽  
The Right ◽  
Aneurysm Repair

Purpose: Endovascular aneurysm repair (EVAR) for an isolated common iliac artery aneurysm (iCIAA) sometimes requires a bifurcated stent graft (SG). In EVAR, it is essential to preserve the renal artery (RA). However, this is challenging in cases of anatomical variation. The double D technique (DDT) can be used in anatomically inadequate cases with a commercially approved bifurcated SG. Here, we report the repair of iCIAA in the presence of a challenging RA anatomy, through EVAR using the DDT. Case Report: An 84-year-old woman was diagnosed with a maximal 35-mm diameter left iCIAA and a nonaneurysmal aorta by computed tomography (CT), which also showed that the right RA arose 50-mm above the aortic bifurcation. The DDT was chosen because commercially approved bifurcated SGs typically require a distance of >70 mm from the proximal position to the aortic bifurcation. Postoperative CT showed excellent results with no endoleaks or SG kinking and occlusion, as well as preservation of robust blood flow to the right RA. Conclusion: Endovascular aneurysm repair using the DDT can be an alternative option for treatment of iCIAA with a challenging RA anatomy.

Imaging Obtained Up To 12 Months Preoperatively Is Adequate for Planning Fenestrated/Branched Endovascular Aortic Aneurysm Repair

2019 ◽  
Vol 53 (7) ◽  
pp. 563-571 ◽  
Author(s):  
Tammy T. Nguyen ◽  
Jessica P. Simons ◽  
Sourav Podder ◽  
Allison S. Crawford ◽  
Dejah R. Judelson ◽  
...  
Keyword(s):  
Renal Artery ◽  
Separation Distance ◽  
Celiac Artery ◽  
Left Renal Artery ◽  
Time Interval ◽  
Target Vessel ◽  
Significant Difference ◽  
Clinically Significant ◽  
The Right ◽  
Aneurysm Repair

Objectives: Patients referred for fenestrated/branched endovascular aortic repair (F/BEVAR) often present with a previous computed tomography angiogram (CTA), but it is unknown how recent the CTA must be to ensure accurate F/BEVAR planning. We sought to determine whether anatomic planning parameters change significantly between a CTA used for F/BEVAR planning and a CTA obtained 6 to 12 months prior. Methods: Two blinded observers reviewed preoperative CTAs from 21 patients who underwent F/BEVAR. Each patient had a “recent” scan obtained 0 to 6 months before F/BEVAR planning and a “prior” scan obtained 6 to 12 months before the “recent” CTA. Standard measurements included (1) target vessel separation distances, (2) target vessel origin clock position, and (3) proximal F/BEVAR device diameter. Clinically significant differences for target vessel separation distance, target vessel origin clock position, and proximal F/BEVAR device diameter were predefined as >5 mm, >30 minutes, and >4 mm, respectively. Differences between “recent”/“prior” CTA scans were examined by paired t test. Results: Mean time interval between paired “recent”/“prior” CTAs was 8.0 months (standard deviation: ±1.7). Mean difference in paired “recent”/“prior” target vessel distance (relative to celiac artery [CA]) was 2.6 mm for the superior mesenteric artery (SMA), 2.5 mm for the right renal artery (RRA), and 3.3 mm for the left renal artery (LRA). Of the 21 paired “recent”/“prior” CTAs, clinically significant differences were observed in 2, 4, and 2 patients for SMA, RRA, and LRA target vessel distance, respectively. Target vessel clock position (SMA reference at 12:00) varied by 12 minutes for the CA, 13 minutes for the RRA, and 15 minutes for the LRA. One paired “recent”/“prior” CTA was found to have a clinically significant difference for the LRA. No clinically significant differences were observed for proximal device diameter. Conclusions: In patients who underwent successful F/BEVAR, measurement comparisons between CTAs obtained up to 1 year prior were minor and unlikely to yield clinically significant changes to F/BEVAR design.

In Vivo Fenestration During Endovascular Aneurysm Repair

2018 ◽  
Author(s):  
Abdulrahman Masrani ◽  
Bulent Arslan
Keyword(s):  
Renal Artery ◽  
Endovascular Aneurysm Repair ◽  
Aortic Aneurysms ◽  
Stent Grafting ◽  
Landing Zone ◽  
Aortic Neck ◽  
Abdominal Aortic ◽  
Custom Made ◽  
Aneurysm Repair

Abdominal aortic aneurysms have been managed endovascularly during the past 10–15 years. The main limitations in the ability to treat patients endovascularly are anatomical constraints. The most important factors are aortic neck and iliofemoral access anatomy. This chapter describes a technique to overcome a short neck with a renal artery originating from the aneurysm that does not allow enough proximal landing zone for stent grafting. Several techniques have been developed to overcome this obstacle, including custom-made grafts with fenestrations, back table fenestration, and parallel graft placement. This chapter discusses the in vivo graft fenestration technique to preserve the renal artery lumen during the endovascular repair of an abdominal aortic aneurysm.

Comparison of Cerebral Embolic Events Between Right and Left Upper Extremity Access During Fenestrated/Branched Endovascular Aortic Repair

2020 ◽  
pp. 152660282095351
Author(s):  
Aleem K. Mirza ◽  
Emanuel R. Tenorio ◽  
Giulianna B. Marcondes ◽  
Guilherme B. B. Lima ◽  
Thanila A. Macedo ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Endovascular Aneurysm Repair ◽  
Aortic Aneurysms ◽  
Technical Success ◽  
Contrast Volume ◽  
Significant Difference ◽  
Stent Graft Repair ◽  
Ischemic Attack ◽  
The Right ◽  
Aneurysm Repair

Purpose: To evaluate the incidence and outcomes of cerebral embolic events when using right (RUE) vs left upper extremity (LUE) access for fenestrated/branched endovascular aneurysm repair (f/bEVAR). Materials and Methods: A retrospective review was conducted of 290 consecutive patients enrolled in a physician-sponsored Investigational Device Exemption study to evaluate f/bEVAR between 2013 and 2018. Of these, 270 patients (93%) had an upper extremity access with 12-F sheaths, including 205 patients (mean age 75±8 years; 147 men) with LUE and 65 patients (mean age 73±8 years; 42 men) with RUE access. Outcome measures were technical success, procedural metrics, major adverse events (MAEs), any stroke or transient ischemic attack (TIA), and mortality. Results: Technical success was higher (p=0.04) for LUE (99.6%) vs RUE access (98.4%). Patients treated via RUE access more often had extent I-III thoracoabdominal aortic aneurysms (57% vs 39%, p=0.03). Procedural metrics were similar for LUE vs RUE sides, including endovascular time (255±80 vs 246±83 minutes, respectively; p=0.23), fluoroscopy time (84±32 vs 90±35 minutes, respectively; p=0.80), and contrast volume (156±57 vs 153±56 mL, respectively; p=0.82). Total radiation exposure was significantly higher for LUE vs RUE access (2463±1912 vs 1757±1494 mGy, respectively; p=0.02). There were 2 deaths (1%) at 30 days or during hospital admission, both unrelated to access site complications. MAEs occurred in 32% of patients who had LUE and 26% of those who had RUE access (p=0.44). Five patients (2%) had embolic stroke and none had TIA. Embolic strokes were ipsilateral to the access side in 4 patients and affected the posterior circulation in 3. Two patients (1%) had hemorrhagic strokes. The incidence of stroke was 3% for LUE and 2% for RUE access (p>0.99). Conclusion: Fenestrated/branched stent-graft repair was associated with low rates of cerebral embolic events and no significant difference between the right vs left upper extremity approach.

The Clinical Utility and Assessment of Renal Biomarkers in Acute Kidney Injury After Abdominal Endovascular Aneurysm Repair. A Systematic Review

2020 ◽  
Vol 25 (44) ◽  
pp. 4695-4701 ◽  
Author(s):  
Georgios Karaolanis ◽  
Zachary F. Williams ◽  
Chris Bakoyiannis ◽  
Dimitrios Hadjis ◽  
Mitchell W. Cox ◽  
...  
Keyword(s):  
Systematic Review ◽  
Acute Kidney Injury ◽  
Systematic Reviews ◽  
Clinical Utility ◽  
Binding Protein ◽  
Endovascular Aneurysm Repair ◽  
Kidney Injury ◽  
Aortic Aneurysms ◽  
Renal Biomarkers ◽  
Aneurysm Repair

: The widespread adoption of endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAA) is due to the obvious advantages of the procedure compared to the traditional open repair. However, these advantages have to be weighed against the increased risk of renal dysfunction with EVAR. The evaluation of the perioperative renal function after EVAR has been hampered by the lack of sensitive and specific biochemical markers of acute kidney injury (AKI). The purpose of this study was to summarize all novel renal biomarkers and to evaluate their clinical utility for the assessment of the kidney function after EVAR. A systematic review of the current literature, as the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines, was performed to identify relevant studies with novel renal biomarkers and EVAR. Pubmed and Scopus databases were systemically searched. Studies reporting on thoracic endovascular aortic repair (TEVAR), case reports, case series, letters to the editor, and systematic reviews were excluded. Neutrophil-Gelatinase-Associated Lipocalin, Cystatin C, Liver-type fatty-acid-binding protein were the most common among the eligible studies while Interleukin-18, Retinol binding protein, N-acetyle-b-D-glucosaminidase and microalbumin have a sparse appearance in the literature. These biomarkers have been assessed in plasma as well as urine samples with each sample material having its own advantages and drawbacks. Which of these biomarkers has the most potential for assessing postoperative renal failure after EVAR, remains to be proved. The few studies presented in the literature show the potential clinical utility of these biomarkers, but larger studies with longer follow-up are required to determine the precise relationship between these biomarkers and postoperative acute kidney injury.

scholarly journals Outcomes of Advanta V12 Covered Stents After Fenestrated Endovascular Aneurysm Repair

2021 ◽  
pp. 152660282110164
Author(s):  
Claire van der Riet ◽  
Richte C. L. Schuurmann ◽  
Eric L. G. Verhoeven ◽  
Clark J. Zeebregts ◽  
Ignace F. J. Tielliu ◽  
...  
Keyword(s):  
Endovascular Aneurysm Repair ◽  
Aortic Aneurysms ◽  
Stent Fracture ◽  
Covered Stents ◽  
Significant Stenosis ◽  
Primary Endpoints ◽  
Visceral Arteries ◽  
Aneurysm Repair ◽  
Type 3

Purpose: Fenestrated endovascular aneurysm repair (FEVAR) is a well-established endovascular treatment option for pararenal abdominal aortic aneurysms in which balloon-expandable covered stents (BECS) are used to bridge the fenestration to the target vessels. This study presents midterm clinical outcomes and patency rates of the Advanta V12 BECS used as a bridging stent. Methods: All patients treated with FEVAR with at least 1 Advanta V12 BECS were included from 2 large-volume vascular centers between January 2012 and December 2015. Primary endpoints were freedom from all-cause reintervention, and freedom from BECS-associated complications and reintervention. BECS-associated complications included significant stenosis, occlusion, type 3 endoleak, or stent fracture. Secondary endpoints included all-cause mortality in-hospital and during follow-up. Results: This retrospective study included 194 FEVAR patients with a mean age of 72.2±8.0 years. A total of 457 visceral arteries were stented with an Advanta V12 BECS. Median (interquartile range) follow-up time was 24.6 (1.6, 49.9) months. The FEVAR procedure was technically successful in 93% of the patients. Five patients (3%) died in-hospital. Patient survival was 77% (95% CI 69% to 84%) at 3 years. Freedom from all-cause reintervention was 70% (95% CI 61% to 78%) at 3 years, and 33% of all-cause reinterventions were BECS associated. Complications were seen in 24 of 457 Advanta V12 BECSs: type 3 endoleak in 8 BECSs, significant stenosis in 4 BECSs, occlusion in 6 BECSs, and stent fractures in 3 BECSs. A combination of complications occurred in 3 BECSs: type 3 endoleak and stenosis, stent fracture and stenosis, and stent fracture and occlusion. The freedom from BECS-associated complications for Advanta V12 BECSs was 98% (95% CI 96% to 99%) at 1 year and 92% (95% CI 88% to 95%) at 3 years. The freedom from BECS-associated reinterventions was 98% (95% CI 95% to 100%) at 1 year and 94% (95% CI 91% to 97%) at 3 years. Conclusion: The Advanta V12 BECS used as bridging stent in FEVAR showed low complication and reintervention rates at 3 years. A substantial number of FEVAR patients required a reintervention, but most were not BECS related.

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