Placement of an aortomonoiliac stent graft without femorofemoral revascularization in endovascular aneurysm repair: a case report

Endoleaks are the most common complications following endovascular aneurysm repair. Depending upon their origin, there are five types of endoleaks, types I-V, which can also be classified as direct and indirect endoleaks. Direct endoleaks type 1 and III have higher risk of aneurysm rupture due to rapid sac expansion, and require immediate correction. Indirect endoleaks types II, IV and V have a relatively benign course compared to direct endoleaks. Most of them resolve with time and very few of them need interventions upon sac enlargement. Type V endotension is a special situation where there is sac enlargement despite no demonstrable endoleak. Proper planning and appropriate selection of stent-graft can prevent most of these endoleaks. With improvement in stent-graft technology, the incidence of endoleaks has been reduced. The current narrative review was planned to describe the pathophysiology, risk factors and treatment options for each type of endoleak. Continuous...

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Endovascular Aneurysm Sealing of a Collapsed and Thrombosed Aortic Stent-Graft With Renovisceral Chimney Stent-Grafts

Journal of Endovascular Therapy ◽

10.1177/1526602818811915 ◽

2018 ◽

Vol 26 (1) ◽

pp. 72-75

Author(s):

Fabien Lareyre ◽

Claude Mialhe ◽

Carine Dommerc ◽

Juliette Raffort

Keyword(s):

Stent Graft ◽

Mesenteric Artery ◽

Endovascular Aneurysm Repair ◽

Stent Grafts ◽

Aortic Thrombosis ◽

Aortic Stent Graft ◽

Aneurysm Repair ◽

Stent Graft Implantation ◽

Graft Implantation

Purpose: To report the use of the Nellix endovascular aneurysm sealing (EVAS) system in the management of proximal stent-graft collapse associated with thrombosis following endovascular aneurysm repair (EVAR). Case Report: A 76-year-old man was admitted for proximal collapse of an aortic extension following bifurcated AFX stent-graft implantation associated with chimney grafts in both renal arteries and the superior mesenteric artery 1 month prior. Imaging identified thrombosis of the aortic stent-graft and the iliac limbs. A Nellix EVAS was placed into the AFX stent-graft to recanalize the aneurysm lumen and address the aortic thrombosis. There was no endoleak, and the renovisceral chimney stent-grafts remained patent over a follow-up of 25 months. Conclusion: While further studies are required to generalize its use, EVAS appears to be feasible in the management of aortic stent-graft collapse.

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Vascular Rupture Caused by a Molding Balloon during Endovascular Aneurysm Repair: Case Report

Journal of the Korean Society of Radiology ◽

10.3348/jksr.2011.65.2.127 ◽

2011 ◽

Vol 65 (2) ◽

pp. 127 ◽

Cited By ~ 1

Author(s):

Hee Young Lee ◽

Young Soo Do ◽

Young Wook Kim ◽

Hong Suk Park ◽

Kwang Bo Park ◽

...

Keyword(s):

Case Report ◽

Endovascular Aneurysm Repair ◽

Aneurysm Repair

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Review of postoperative CT and ultrasound for endovascular aneurysm repair using Talent stent graft: can we simplify the surveillance protocol and reduce the number of CT scans?

Acta Radiologica ◽

10.1177/0284185113489826 ◽

2013 ◽

Vol 54 (6) ◽

pp. 662-662

Author(s):

Stephen Wolstenhulme ◽

Jordan Froggett ◽

Marcus J Nichols

Keyword(s):

Stent Graft ◽

Endovascular Aneurysm Repair ◽

Ct Scans ◽

Surveillance Protocol ◽

Aneurysm Repair

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Incomplete Expansion of Chimney Stent Graft during Chimney-Thoracic Endovascular Aneurysm Repair

Annals of Vascular Surgery ◽

10.1016/j.avsg.2016.08.035 ◽

2017 ◽

Vol 39 ◽

pp. 293.e1-293.e5 ◽

Cited By ~ 1

Author(s):

Athanasios Katsargyris ◽

Domenico Spinelli ◽

Kyriakos Oikonomou ◽

Hozan Mufty ◽

Eric LG. Verhoeven

Keyword(s):

Stent Graft ◽

Endovascular Aneurysm Repair ◽

Thoracic Endovascular Aneurysm Repair ◽

Aneurysm Repair

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Review of postoperative CT and ultrasound for endovascular aneurysm repair using Talent stent graft: Can we simplify the surveillance protocol and reduce the number of CT scans?

Acta Radiologica ◽

10.1258/ar.2012.110291 ◽

2013 ◽

Vol 54 (1) ◽

pp. 54-58 ◽

Cited By ~ 11

Author(s):

Thomas Nyheim ◽

Lars Erik Staxrud ◽

L Rosen ◽

Carl Erik Slagsvold ◽

Gunnar Sandbæk ◽

...

Keyword(s):

Stent Graft ◽

Mixed Model ◽

Endovascular Aneurysm Repair ◽

Plain Film ◽

Ct Scans ◽

X Rays ◽

Time Sensitivity ◽

Surveillance Protocol ◽

Aneurysm Repair

Background Simplifying a postoperative surveillance protocol for endovascular aneurysm repair (EVAR) requires quality control comparing computerized tomography (CT) and ultrasound (US) results of abdominal aortic aneurysm (AAA) diameter measurements and endoleaks. Purpose To test if US is comparable to CT, then assess a simplified follow-up with our conventional surveillance to assess patient safety. Material and Methods During 2001-2006, data on 56 patients treated with Talent stent graft were prospectively registered. Median follow-up was 41.5 months (range, 2-94 months), with CT, US, and plain film abdomen X-rays (PFA) at 1, 6, and 12 months, then yearly. Bland-Altman plot was used to assess the agreement between CT and US measuring the AAA diameters and mixed model by the time effect to assess the difference in diameter over time. Sensitivity and specificity for detection of endoleaks by US, with CT as ‘gold standard’ were calculated. A simplified surveillance protocol with US/PFA at 6 and 8 weeks, CT/US/PFA at 1 year, and yearly US/PFA thereafter, was evaluated. CT was carried out when poor visibility, endoleak detected, AAA diameter increase (≥5 mm) on US or migration (≥10 mm) on PFA. This regime was compared with our conventional follow-up protocol. Results Diameter measurements on US appear comparable to CT with 91% specificity and 85% sensitivity for endoleaks detected by US. Using the simplified surveillance protocol no endoleaks, migrations, or endotension requiring treatment were overlooked. The simplified protocol generated 53 selective CT scans, avoiding approximately 144 CT scans. If further simplified by omitting the 1-year CT scan, one type II endoleak would be missed with a 1-year delay, eliminating a further 45 CT scans. Conclusion US appears comparable to CT in the follow-up of Talent stent grafts in our institution. The proposed simplified surveillance protocol seems safe and can lead to a significant reduction in the number of CT scans.

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Up-and-Over Technique for Implantation of Iliac Branch Devices After Prior Aortic Endograft Repair

Journal of Endovascular Therapy ◽

10.1177/1526602817747283 ◽

2018 ◽

Vol 25 (1) ◽

pp. 21-27 ◽

Cited By ~ 9

Author(s):

David L. Dawson ◽

Giuliano de Almeida Sandri ◽

Emanuel Tenorio ◽

Gustavo S. Oderich

Keyword(s):

Stent Graft ◽

Iliac Artery ◽

Endovascular Aneurysm Repair ◽

Covered Stent ◽

Femoral Access ◽

Aortic Stent Graft ◽

Flow Divider ◽

Device Placement ◽

Internal Iliac ◽

Aneurysm Repair

Purpose: To describe a modified up-and-over access technique for treatment of iliac artery aneurysms in patients with prior bifurcated stent-grafts for endovascular aneurysm repair (EVAR). Technique: This technique uses a coaxial 12-F flexible sheath that is docked with a through-and-through wire into a 7-F sheath advanced from the contralateral femoral approach. This maneuver allows both sheaths to be moved as a unit while maintaining position of the apex of the system as it loops over the flow divider, avoiding damage to or displacing the extant endograft. Once the 12-F sheath is positioned in the iliac limb of the aortic stent-graft and secured in place with the through-and-through wire, the repair is extended into the internal iliac artery using a bridging stent-graft or covered stent introduced via a coaxial sheath. Conclusion: The up-and-over technique with a flexible 12-F sheath mated with a 7-F sheath from the opposite side allows bilateral femoral access to be used for iliac branch device placement after prior aortic endograft procedures that create a higher, acutely angled bifurcation. Use of a through-and-through wire and a coaxial sheath for stent delivery creates a very stable platform for intervention.

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