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

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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Management of Aortic Aneurysms and Dissections with the Zenith TX2 Stent Graft

Vascular ◽

10.2310/6670.2006.00052 ◽

2006 ◽

Vol 14 (5) ◽

pp. 282-289 ◽

Cited By ~ 2

Author(s):

W. Anthony Lee

Keyword(s):

Clinical Trials ◽

Stent Graft ◽

Open Repair ◽

The United States ◽

Aortic Aneurysms ◽

Midterm Results ◽

Thoracic Aortic Aneurysms ◽

Endovascular Device ◽

Related Mortality

Endovascular repair of thoracic aortic aneurysms offers a less invasive alternative to conventional surgery, similar to its counterpart in the abdominal aorta. Although its long-term durability and outcome remain relatively unknown, published midterm results from clinical trials suggest comparable rates of aneurysm-related mortality and significant reductions in early morbidity compared with open repair. The Zenith TX2 stent graft (Cook Endovascular, Bloomington, IN) is an investigational endovascular device that is designed to treat aneurysms and other degenerative pathologies of the thoracic aorta. At the time of this writing, it is nearing completion of its pivotal trial. Clinical experience with this device is limited to countries outside the United States and to sites participating in the clinical trials. The purpose of this article is to provide a description of the Zenith TX2 device and its application in the repair of thoracic aortic aneurysms and dissections.

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Response of plasma matrix metalloproteinases and tissue inhibitor of metalloproteinases to stent-graft surgery for descending thoracic aortic aneurysms

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2007.05.044 ◽

2007 ◽

Vol 134 (4) ◽

pp. 925-931 ◽

Cited By ~ 16

Author(s):

Mario Monaco ◽

Paolo Stassano ◽

Luigi Di Tommaso ◽

Gabriele Iannelli

Keyword(s):

Matrix Metalloproteinases ◽

Stent Graft ◽

Aortic Aneurysms ◽

Tissue Inhibitor Of Metalloproteinases ◽

Tissue Inhibitor ◽

Thoracic Aortic Aneurysms

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Thoracic Aortic Aneurysm Repair with Endovascular Stent-Grafts

Vascular Medicine ◽

10.1177/1358863x9700200205 ◽

1997 ◽

Vol 2 (2) ◽

pp. 98-103 ◽

Cited By ~ 32

Author(s):

Charles P Semba ◽

R Scott Mitchell ◽

D Craig Miller ◽

Noriyuki Kato ◽

Stephen T Kee ◽

...

Keyword(s):

High Risk ◽

Aortic Aneurysm ◽

Stent Graft ◽

Aortic Aneurysms ◽

Stent Grafts ◽

Thoracic Aortic Aneurysms ◽

Risk Patients ◽

Aneurysm Repair ◽

Aortic Aneurysm Repair ◽

Endoluminal Stent

The purpose of the study was to describe the clinical experience in using endoluminal stent-grafts for the treatment of thoracic aortic aneurysms in high-risk patients. Patients with aneurysms of the descending thoracic aorta who were considered high surgical risks underwent evaluation for endoluminal repair. The prosthesis was constructed from Z stents covered with polyester fabric using dimensions based upon preprocedural computed tomography scans and angiography. Through a femoral arteriotomy or left retroperitoneal flank incision, a 22–24 Fr delivery catheter was inserted and advanced through the aorta to the target site under fluoroscopic guidance in the operating suite. The stent-graft prosthesis was deployed at the site of the aneurysm. 44 patients (36 male, 8 female; mean age 36 years) underwent stent-graft repair for thoracic aneurysms (mean diameter 6.3 cm). The deployment was technically successful in all cases, with complete aneurysm thrombosis in 88%. The 30-day perioperative mortality rate was 6.8% and 35-month actuarial survival was 82%. There were no cases of stent migration, surgical conversion or intraprocedural death. Paraplegia occurred in two patients who underwent simultaneous surgical infrarenal aortic aneurysm repair immediately followed by stent-graft placement for a coexisting thoracic aneurysm. The conclusion was that placement of endoluminal stent-grafts for repair of thoracic aortic aneurysms is technically feasible in high-risk patients in whom conventional surgery is contraindicated. Long-term studies are needed to determine protection against aneurysm rupture and patient survival.

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Stent graft types for endovascular repair of thoracic aortic aneurysms

10.1002/14651858.cd008448.pub2 ◽

2013 ◽

Cited By ~ 3

Author(s):

Rachel Rolph ◽

James MN Duffy ◽

Bijan Modarai ◽

Rachel E Clough ◽

Peter Taylor ◽

...

Keyword(s):

Stent Graft ◽

Endovascular Repair ◽

Aortic Aneurysms ◽

Thoracic Aortic Aneurysms

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Clinical Application of a Curved Nitinol Stent-Graft for Thoracic Aortic Aneurysms

Journal of Endovascular Therapy ◽

10.1177/152660280301000106 ◽

2003 ◽

Vol 10 (1) ◽

pp. 20-28 ◽

Cited By ~ 27

Author(s):

Junichiro Sanada ◽

Osamu Matsui ◽

Noboru Terayama ◽

Satoshi Kobayashi ◽

Tetsuya Minami ◽

...

Keyword(s):

Aortic Arch ◽

Stent Graft ◽

Neurological Complications ◽

Polyester Fabric ◽

Aortic Aneurysms ◽

The Other ◽

Neck Length ◽

Nitinol Stent ◽

Proximal Neck ◽

Thoracic Aortic Aneurysms

Purpose: To evaluate the clinical efficacy of a curved nitinol stent-graft for repair of thoracic aortic aneurysms. Methods: The Matsui-Kitamura stent-graft (MKSG), composed of a self-expanding nitinol stent and polyester fabric, was shaped to match the aortic curvature of 11 patients (6 men; mean age 72.6 years, range 33–90) with 6 true and 5 false aneurysms of the distal arch or proximal descending aorta. The delivery system was an 18 or 20-F J-shaped sheath combined with a preloader-type introducer. The original mean proximal neck length was 16.4 mm, but 4 patients received an axilloaxillary bypass to lengthen the neck. Although the mean corrected proximal neck length was 21.9 mm (overall), 5 cases still had proximal necks <15 mm long. Results: All curved MKSGs were successfully deployed in the correct position and fitted to the curvature of the aortic arch, achieving complete aneurysm exclusion in 8 (73%) cases. The other 3 repairs displayed early endoleaks; 1 received an additional MKSG, but the other 2 are being observed. Thirty-day mortality was 0%. One patient developed transient renal failure requiring hemodialysis; no neurological complications were observed. Conclusions: Endovascular repair of thoracic aortic aneurysms using curved MKSGs appears to be feasible and clinically effective. A tighter fit of the device to the curvature of the aortic arch may exclude distal arch aneurysms despite a short proximal neck.

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Endovascular versus open treatment of degenerative aneurysms of the descending thoracic aorta: a single center experience

Vascular ◽

10.1258/vasc.2010.oa0256 ◽

2011 ◽

Vol 19 (1) ◽

pp. 8-14 ◽

Cited By ~ 14

Author(s):

Joachim Andrassy ◽

Rolf Weidenhagen ◽

Georgios Meimarakis ◽

M Rentsch ◽

K-W Jauch ◽

...

Keyword(s):

Endovascular Treatment ◽

Thoracic Aorta ◽

Open Surgery ◽

Aortic Aneurysms ◽

Descending Thoracic Aorta ◽

Entire Cohort ◽

Thoracic Aortic Aneurysms ◽

Asymptomatic Patients ◽

Open Treatment ◽

One Year

Multiple reports could show a reduced risk for thoracic endovascular aortic repair (TEVAR) compared with open treatment. The aim of this study was to evaluate our twelve-year TEVAR experience for thoracic aortic aneurysms and compare these results with open repair. All patients who had received either open or endovascular surgery for a degenerative aortic aneurysm of the descending thoracic aorta in our center were evaluated retrospectively. N = 53 TEVAR patients (1997–2008) were included and their course was compared with an open-surgery group of n = 24 patients (1992–2002). The percentage of symptomatic patients was 43% (TEVAR) and 42% (open surgery). Endovascular treatment resulted in a significantly reduced 30-day (5.7% versus 25% P = 0.02) and one-year mortality (19% versus 42% P = 0.05) in the entire cohort. Symptomatic patients benefited the most from TEVAR (30-day mortality: 9% versus 40%, P = 0.06; one-year mortality: 27% versus 70%, P = 0.049) whereas the survival of our asymptomatic patients was not significantly different (30-day mortality: 3% versus 14%, P = 0.22; one-year mortality: 13% versus 21%, P = 0.65). Lastly, Kaplan–Meier analysis showed a significantly improved survival after TEVAR ( P = 0.05) and in particular for the symptomatic patients ( P = 0.003). In conclusion, endovascular treatment for patients with degenerative thoracic aortic aneurysms has significant advantages over open surgery.

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Long-Term Comparison of Thoracic Endovascular Aortic Repair (TEVAR) to Open Surgery for the Treatment of Thoracic Aortic Aneurysms

Journal of Vascular Surgery ◽

10.1016/j.jvs.2012.11.050 ◽

2013 ◽

Vol 57 (1) ◽

pp. 283

Author(s):

N.D. Desai ◽

K. Burtch ◽

W. Moser

Keyword(s):

Open Surgery ◽

Thoracic Endovascular Aortic Repair ◽

Aortic Aneurysms ◽

Endovascular Aortic Repair ◽

Thoracic Aortic Aneurysms ◽

Aortic Repair

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Functional Endoluminal Paving (FELP): Thermoforming, Biodegradation, and Mechanical Properties of a Novel Polymer Graft for Abdominal Aortic Aneurysms

ASME 2010 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2010-19463 ◽

2010 ◽

Cited By ~ 1

Author(s):

John H. Ashton ◽

James A. M. Mertz ◽

Megan J. Alexander ◽

Marvin J. Slepian ◽

Joseph L. Mills ◽

...

Keyword(s):

Mechanical Properties ◽

Stent Graft ◽

Endovascular Repair ◽

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Complex Anatomy ◽

Abdominal Aortic ◽

Drug Treatments

The preferred method to treat abdominal aortic aneurysms (AAAs) is endovascular repair with a stent-graft (EVAR). Although EVAR is fairly successful, there are several challenges to address, which include patient ineligibility due to complex anatomy and long-term failure due to migration and endoleak. Drug treatments that reduce or halt AAA growth are also currently under investigation [1].

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