scholarly journals 3D Stent Graft Guidance based on Tracking Systems for Endovascular Aneurysm Repair

2021 ◽  
Vol 7 (1) ◽  
pp. 17-20
Author(s):  
Sonja Jäckle ◽  
Tim Eixmann ◽  
Florian Matysiak ◽  
Malte Maria Sieren ◽  
Marco Horn ◽  
...  
Keyword(s):  
Contrast Agent ◽  
Stent Graft ◽  
Endovascular Aneurysm Repair ◽  
Calibration Method ◽  
X Rays ◽  
Tracking Systems ◽  
Clinical Environment ◽  
Landing Zone ◽  
2D Imaging ◽  
Aneurysm Repair

Abstract In endovascular aneurysm repair (EVAR) procedures, the stent graft navigation and implantation is currently performed under a two-dimensional (2D) imaging based guidance requiring X-rays and contrast agent. In this work, a novel 3D stent graft guidance approach based on tracking systems is introduced. A calibration method and the visualization of the stent graft guidance are described. The tracking based stent graft guidance is evaluated by conducting an EVAR procedure on a torso phantom using a stent graft system equipped with an optical fiber and three EM sensors. The physicians were able to navigate the stent graft to the landing zone, and to place and implant it as intended using the introduced guidance. This showed that the application of the stent graft guidance is feasible in a clinical environment and promising for the reduction of radiation and contrast agent.

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?

2013 ◽  
Vol 54 (1) ◽  
pp. 54-58 ◽  
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.

scholarly journals A Study on the Effects of Struts of Z-Shaped Stent-Grafts on Radial Forces

2017 ◽  
Author(s):  
Xuelian Gu ◽  
Kai Yu ◽  
Licheng Lu ◽  
Wenjing Tang
Keyword(s):  
Stent Graft ◽  
Endovascular Aneurysm Repair ◽  
Great Influence ◽  
Radial Force ◽  
Type I ◽  
Stent Grafts ◽  
Element Analysis ◽  
Landing Zone ◽  
Post Surgery ◽  
Aneurysm Repair

Endovascular aneurysm repair (EVAR) techniques have been widely used for the treatment of abdominal aortic aneurysm (AAA). EVAR is associated with lower postoperative morbidity and mortality than traditional surgical procedure to treat AAA [1]. However, during the patient’s follow-up, postoperative complications may occur and secondary interventions are required [2]. Stent-grafts fixation in the vessel affects the success of endovascular aneurysm repair. Researches indicate that insufficient stent-graft radial force is attributed to post-surgery complications, such as prosthesis migration and endoleak type I [3, 4]. Endoleak type I happens when there is not a complete contact between stent graft rings and vessel wall. A great radial force can prevent full obturation in the landing zone. The distal endograft fixation also has a great influence on proximal endograft migration after EVAR [5]. Therefore the radial force of the stent plays a significant role. Single stent-graft ring comprise a series of expandable Z-shaped structural elements (known as “struts”). Currently, there are series of Z-shaped stent-grafts on the market and the struts number ranges from 5 to 12. This work intends to analyze the influence of stent-graft struts number on the radial force. Finite-element analysis (FEA) and experimental method are used.

Endoleaks: current concepts and treatments

2021 ◽  
Author(s):  
Zia Ur Rehman
Keyword(s):  
Stent Graft ◽  
Treatment Options ◽  
Endovascular Aneurysm Repair ◽  
Aneurysm Rupture ◽  
Special Situation ◽  
Type V ◽  
Aneurysm Repair ◽  
Benign Course ◽  
Selection Of

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...

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

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.

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

2017 ◽  
Vol 39 ◽  
pp. 293.e1-293.e5 ◽  
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

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

2018 ◽  
Vol 25 (1) ◽  
pp. 21-27 ◽  
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.

scholarly journals Reverse slider technique using the Endurant stent graft for accurate proximal sealing in hostile neck endovascular aneurysm repair

2019 ◽  
Vol 5 (3) ◽  
pp. 332-337
Author(s):  
Noriyasu Morikage ◽  
Junichi Nishimura ◽  
Takahiro Mizoguchi ◽  
Yuriko Takeuchi ◽  
Takashi Nagase ◽  
...  
Keyword(s):  
Stent Graft ◽  
Endovascular Aneurysm Repair ◽  
Hostile Neck ◽  
Aneurysm Repair

Type IIIb Endoleak After Endovascular Aneurysm Repair Using the Zenith Stent Graft

2019 ◽  
Vol 53 (6) ◽  
pp. 515-519
Author(s):  
Toshiya Nishibe ◽  
Toru Iwahashi ◽  
Kentaro Kamiya ◽  
Masaki Kano ◽  
Keita Maruno ◽  
...  
Keyword(s):  
Stent Graft ◽  
Endovascular Aneurysm Repair ◽  
Aneurysm Rupture ◽  
Type I ◽  
Stent Grafts ◽  
System Type ◽  
Type Iiib ◽  
Type I Endoleak ◽  
Aneurysm Repair

We present 3 cases of type IIIb endoleak after endovascular aneurysm repair (EVAR) using the Zenith stent graft system. Type III endoleak, like type I endoleak, is a high-pressure, high-risk leak that increases sac pressure up to or even above arterial pressure, and is associated with an increased frequency of open conversions or risk of aneurysm rupture. Type IIIb endoleak is rare but there is much concern that the incidence of type IIIb endoleak is likely to increase hereafter; the mechanism of type IIIb endoleak is deterioration of graft fabric in conjunction with stent sutures. Type IIIb endoleak is difficult to diagnose before rupture. The possibility of type IIIb endoleak should be highly suspected when the continued growth of an excluded aneurysm sac without direct radiologic evidence is observed during follow-up. Type IIIb endoleak can be repaired by relining of the stent graft with additional stent grafts.

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