scholarly journals Endovascular Aneurysm Repair Using Anaconda Repositionable Aortic Stent Graft Assisted Exclusively by Intravascular Ultrasound Imaging

2019 ◽  
Vol 2 (1) ◽  
pp. 32-37
Author(s):  
Gaetano La Barbera ◽  
Giuliana La Rosa ◽  
Fabrizio Valentino ◽  
Gabriele Ferro ◽  
Dario Parsaei ◽  
...  
Keyword(s):  
Intravascular Ultrasound ◽  
Stent Graft ◽  
Clinical Success ◽  
Endovascular Aneurysm Repair ◽  
Diagnostic Technique ◽  
Primary Objective ◽  
Aortic Aneurysms ◽  
Aortic Stent Graft ◽  
Aneurysm Repair

Arteriography with contrast medium (CM) injection is normally employed to visualise the lowest renal artery during endovascular aneurysm repair (EVAR). Intravascular ultrasound (IVUS) has been proposed as an alternative, real-time imaging diagnostic technique to arteriography. In this study, we evaluated the feasibility of EVAR using Anaconda repositionable aortic stent graft (Vascutek) assisted by IVUS (Volcano Visions, Philips) during intraluminal navigation without CM. From January 2016 to December 2017, 25 patients with infrarenal abdominal aortic aneurysms, identified through anatomical inclusion criteria, underwent EVAR. All of the patients had an arteriogram at the end of the EVAR procedure to confirm aortic stent graft patency and to exclude type 1 endoleaks. The primary objective was the technical and clinical success of this CM-free aortic stent graft delivery procedure. At the end of the period, 150 target vessels were evaluated. IVUS versus angio-CT sensitivity and specificity rate were 97.3% and 100%, respectively. The primary technical success was obtained in 88% of the cases. Three patients (12%) needed CM injection to complete the procedure and there were no cases of type 1 endoleak. Primary clinical success was 100%. During follow-up at a mean of 20 months, none of the patients died or had complications. We conclude that a full EVAR procedure is feasible using only IVUS navigation and repositionable aortic stent graft without CM injection in anatomically selected cases.

The TREO abdominal aortic stent-graft system

2020 ◽  
Author(s):  
Laura Boitano ◽  
Matthew J Eagleton
Keyword(s):  
Stent Graft ◽  
Endovascular Aneurysm Repair ◽  
Primary Treatment ◽  
Aortic Aneurysms ◽  
Aortic Stent Graft ◽  
Primary Treatment Modality ◽  
Abdominal Aortic ◽  
The Us ◽  
Aneurysm Repair

Endovascular aneurysm repair has become a primary treatment modality for patients with abdominal aortic aneurysms due to its less invasive nature and improved peri-operative mortality rates compared with conventional open surgery. Long-term, endovascular aneurysm repair is hindered by the need for reintervention due to a variety of reasons. Device improvements are directed toward improving these long-term outcomes. The current manuscript highlights some of the details of the Terumo Aortic TREO abdominal aortic stent-graft, which was approved in 2020 for clinical use by the US FDA. A brief review of the available clinical outcomes from the US trial, as well as experience in the rest of the world, are provided demonstrating its excellent performance.

scholarly journals Global Post-Market Clinical Follow-up of the Treovance Stent-Graft for Endovascular Aneurysm Repair: One-Year Results From the RATIONALE Registry

2018 ◽  
Vol 25 (6) ◽  
pp. 726-734 ◽  
Author(s):  
Raman Uberoi ◽  
Carlo Setacci ◽  
Mario Lescan ◽  
Antonio Lorido ◽  
David Murray ◽  
...  
Keyword(s):  
Stent Graft ◽  
Clinical Performance ◽  
Clinical Success ◽  
Endovascular Aneurysm Repair ◽  
Aortic Aneurysms ◽  
Type I ◽  
Technical Success ◽  
Major Morbidity ◽  
Aneurysm Repair

Purpose: To evaluate the safety and performance of the Treovance stent-graft. Methods: The global, multicenter RATIONALE registry ( ClinicalTrials.gov; identifier NCT03449875) prospectively enrolled 202 patients (mean age 73.0±7.8 years; 187 men) with abdominal aortic aneurysms (AAA) suitable for endovascular aneurysm repair (EVAR) using the Treovance. The composite primary safety endpoint was site-reported all-cause mortality and major morbidity. The primary efficacy outcome was clinical success. Further outcomes evaluated included technical success; stent-graft migration, patency, and integrity; endoleak; and aneurysm size changes. Results: Technical success was 96% (194/202); 8 patients had unresolved type I endoleaks at the end of the procedure. There was no 30-day mortality and 1% major morbidity (1 myocardial infarction and 1 bowel ischemia). Clinical success at 1 year was confirmed in 194 (96%) patients; 6 of 8 patients had new/persistent endoleaks and 2 had aneurysm expansion without identified endoleak. A total of 8 (4%) reinterventions were required during the mean 13.7±3.1 months of follow-up (median 12.8). At 1 year, the Kaplan-Meier estimate for freedom from reintervention was 95.6% (95% CI 91.4% to 97.8%). Other estimates were 95.5% (95% CI 91.7% to 97.6%) for freedom from endoleak type I/III and 97.4% (95% CI 94.2% to 98.9%) for freedom from aneurysm expansion. Thirteen (6.4%) patients died; no death was aneurysm related. Conclusion: The RATIONALE registry showed favorable safety and clinical performance of the Treovance stent-graft for the treatment of infrarenal AAAs in a real-world setting.

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.

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 Short and Intermediate Outcome of Endovascular Aortic Aneurysmal Repair, A multicenteric Study

2021 ◽  
Vol 9 (B) ◽  
pp. 1494-1498
Author(s):  
Mohamed Hosny Sayed ◽  
Mohammed Ali Hassan ◽  
Ahmed Samir Hosny ◽  
Hisham Rashid ◽  
Mohamed Hosni El Dessoki
Keyword(s):  
Stent Graft ◽  
Survival Curve ◽  
Rapid Evolution ◽  
Endovascular Aneurysm Repair ◽  
Aortic Aneurysms ◽  
Stent Grafts ◽  
College Hospital ◽  
Aneurysm Morphology ◽  
Multicenter Prospective Study ◽  
Aneurysm Repair

BACKGROUND: The availability of aortic stent-grafts has permitted an obvious change in the management of abdominal aortic aneurysms (AAA). For elective cases open surgical repair has been widely superseded by the use of stent-graft. With the rapid evolution of the endovascular technology, a significant development in stent-graft techniques was achieved in conjunction with a better understanding of how to utilize stent-grafts. METHODS: A multicenter prospective study in which 49 patients were enrolled, they underwent an elective endovascular aneurysm repair (EVAR) procedure for infrarenal AAA in two different institutions, Kasr Al-ainy School of Medicine, Cairo University and King’s College Hospital in London, the selected patients were followed up for 6 months after the procedure. Data relating to demographics and pre-operative comorbidities were recorded. Aneurysm morphology was reviewed by computed tomography angiography scans. Clinical data was collected through operative records and afterward through outpatient clinic follow-up sessions. RESULTS: Overall survival was 94% over a period of 6 months calculated using KaplanMeier Survival Curve. CONCLUSIONS: Endovascular repair resulted in fewer perioperative deaths. This study provides insight into clinical parameters that can be used to stratify patients’ post-EVAR surveillance and need for re-intervention and it came to the conclusion that EVAR could be considered as the standard repair for uncomplicated infrarenal AAA.

Feasibility and Safety of Sac Embolization Using N-Butyl Cyanoacrylate in Emergency Endovascular Aneurysm Repair for Ruptured Abdominal Aortic Aneurysms or Isolated Iliac Artery Aneurysms

2020 ◽  
Vol 27 (5) ◽  
pp. 828-835
Author(s):  
Shota Ohba ◽  
Masashi Shimohira ◽  
Takuya Hashizume ◽  
Masahiro Muto ◽  
Kengo Ohta ◽  
...  
Keyword(s):  
Iliac Artery ◽  
Clinical Success ◽  
Endovascular Aneurysm Repair ◽  
Artery Aneurysm ◽  
Aortic Aneurysms ◽  
Control Group ◽  
Success Rates ◽  
Iliac Artery Aneurysm ◽  
Abdominal Aortic ◽  
Aneurysm Repair

Purpose: To evaluate the feasibility and safety of sac embolization with N-butyl cyanoacrylate (NBCA) in emergency endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysm (AAA) and iliac artery aneurysm (IAA) in comparison to EVAR without sac embolization. Materials and Methods: Between February 2012 and December 2019, among 44 consecutive patients with ruptured AAA or IAA, 29 underwent EVAR. Of these, 22 patients (median age 77.5 years; 18 men) had concomitant sac embolization using NBCA; the remaining 7 patients (median age 88 years; 6 men) underwent EVAR without sac embolization and form the control group. The technical success, clinical success (hemodynamic stabilization), procedure-related complications, and mortality were compared between the groups. Results: All EVAR procedures and embolizations were successful. The clinical success rates in the NBCA and control groups were 95% (21/22) and 71% (5/7), respectively (p=0.14). There was no complication related to the procedure. Type II endoleak occurred in 4 of 21 patients (19%) in the NBCA group vs none of the control patients. One patient (5%) died in the NBCA group vs 3 (43%) in the controls (p=0.034). Conclusion: Sac embolization using NBCA in emergency EVAR appears to be feasible and safe for ruptured AAA and IAA.

Abdominal Aortic Stent Graft Mechanics: Sizing Them Up

2013 ◽  
Author(s):  
S. De Bock ◽  
F. Iannaccone ◽  
M. De Beule ◽  
F. Vermassen ◽  
P. Segers ◽  
...  
Keyword(s):  
Stent Graft ◽  
Structural Integrity ◽  
Endovascular Aneurysm Repair ◽  
Preventive Treatment ◽  
Metallic Stent ◽  
Aortic Stent Graft ◽  
Abdominal Aortic ◽  
Downward Displacement ◽  
Aneurysm Repair

An abdominal aortic aneurysm (AAA) of the aorta is a local widening of the aorta in a region between the renal arteries and the aortic bifurcation. The disease impacts the structural integrity of the AAA wall, weakening the tissue and predisposing it to rupture. Preventive treatment of the disease is often performed minimally invasive with endovascular repair by stent graft deployment, as an alternative to open surgical repair. During endovascular aneurysm repair, a metallic stent, covered with a polymer membrane is first crimped and mounted onto the delivery system and inserted through the iliac artery. It is advanced to the AAA region, and expanded to cover the weakened, ballooning aorta. The technique has excellent clinical outcome, yet it is still associated with long term problems such as migration, a downward displacement of the device, and endoleakage, with blood reentering and pressurizing the aneurismal sack.

scholarly journals Patients With Familial Abdominal Aortic Aneurysms Are at Increased Risk for Type 1 Endoleak Following Elective Endovascular Aneurysm Repair

2015 ◽  
Vol 61 (2) ◽  
pp. 584-585
Author(s):  
Biju K. Thomas ◽  
Evan J. Ryer ◽  
Robert P. Garvin ◽  
Helena Kuivaniemi ◽  
David P. Franklin ◽  
...  
Keyword(s):  
Endovascular Aneurysm Repair ◽  
Abdominal Aortic Aneurysms ◽  
Aortic Aneurysms ◽  
Abdominal Aortic ◽  
Increased Risk ◽  
Aneurysm Repair

Early Elective Conversion for Failing Evar

2005 ◽  
Vol 94 (3) ◽  
pp. 221-226 ◽  
Author(s):  
P.-S. Aho ◽  
W. D. Roth ◽  
P. Keto ◽  
M. Lepäntalo
Keyword(s):  
Stent Graft ◽  
First Generation ◽  
Endovascular Aneurysm Repair ◽  
Treatment Method ◽  
Aortic Aneurysms ◽  
Long Term Results ◽  
Conversion To Open Surgery ◽  
Abdominal Aortic ◽  
Secondary Procedures ◽  
Aneurysm Repair

Background: The aim of the study was to assess the long term results of endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms at the Helsinki University Central Hospital 1996–2004 with a special emphasis on elective conversion procedures and their outcome. Methods: Treatment results and follow-up data of all 110 elective EVAR procedures performed in our institution were gathered prospectively and evaluated. Results: Conversion to open surgery was performed in 23 (21%) of 110 EVAR patients. 30-day mortality after elective stent-graft deployment was 0% as it was also on elective conversions (n = 20). Secondary elective conversions were performed due to infection in two and after failing stent-graft treatment in 12 patients. Six of the conversions were performed primarily. Three urgent conversions (3% overall) were performed: two of these patients died, corresponding to an overall mortality of 9% (2/23) in all conversions. Five-year aneurysm-related mortality after EVAR among patients with elective conversion was 0% and 19% in patients with secondary procedures other than elective conversions. Conclusions: As conversions seem to be hazardous only when performed in urgent situations, elective conversion could be an alternative treatment method in complex failing first-generation stent-grafts as it may reduce mortality associated with urgent conversions or repeated attempts to maintain graft integrity with endovascular procedures.

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