Clinical Application and Technical Details of Cook Zenith Devices modification to treat Urgent and Elective Complex Aortic Aneurysms

2021 ◽  
Author(s):  
Jesse Manunga ◽  
Lia Jordan ◽  
Aleem K. Mirza ◽  
Xiaoyi Teng ◽  
Nedaa Skeik ◽  
...  
Keyword(s):  
Stent Graft ◽  
Hospital Length ◽  
Aortic Aneurysms ◽  
Hospital Length Of Stay ◽  
Safe Alternative ◽  
Nitinol Wire ◽  
Estimated Blood Loss ◽  
Contrast Volume ◽  
Custom Made ◽  
Technical Details

Abstract Purpose: To describe technical details of modifying four different Cook Zenith devices to treat complex aortic aneurysms.Material: In the first three cases, the modification process involved complete stent graft deployment on a sterile back table. Fenestrations were created using an ophthalmologic cautery and reinforced with a radiopaque snare using a double-armed 4-0 Ethibond locking suture based on measurements obtained on centerline of flow. In each instance, a nitinol wire was withdrawn and redirected through and through the fabric and used as a constraining wire. In the fourth patient, modification involved partial stent graft deployment and creation of additional two fenestrations to accommodate renal arteries. The devices are resheathed and implanted in the standard fashion.Results: Four patients underwent exclusion of their aneurysms, including thoracoabdominal aneurysms (n=2), a contained ruptured juxtarenal aneurysm (n=1), and a ruptured failed previous endovascular repair (n=1). Fifteen fenestrations were successfully bridged with Atrium iCAST stent grafts. Average graft modification time, operative time, contrast volume, radiation dose, estimated blood loss, and hospital length of stay were 89 minutes, 155.25 minutes, 58.8 mL, 2451 mGy, 175 mL, and 4.3 days, respectively. One patient required a secondary intervention to treat a type Ib endoleak. During an average follow-up of 25 months, aneurysm sacs progressively shrank without additional intervention.Conclusion: Physician-modified fenestrated/branched endografts are a safe alternative to custom made devices, especially in urgent cases and should be part of the armamentarium of any complex aortic program.

scholarly journals Clinical application and technical details of cook zenith devices modification to treat urgent and elective complex aortic aneurysms

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Jesse Manunga ◽  
Lia Jordano ◽  
Aleem K. Mirza ◽  
Xiaoyi Teng ◽  
Nedaa Skeik ◽  
...  
Keyword(s):  
Stent Graft ◽  
Hospital Length ◽  
Aortic Aneurysms ◽  
Hospital Length Of Stay ◽  
Safe Alternative ◽  
Nitinol Wire ◽  
Estimated Blood Loss ◽  
Contrast Volume ◽  
Custom Made ◽  
Technical Details

Abstract Purpose To describe technical details of modifying four different Cook Zenith devices to treat complex aortic aneurysms. Material In the first three cases, the modification process involved complete stent graft deployment on a sterile back table. Fenestrations were created using an ophthalmologic cautery and reinforced with a radiopaque snare using a double-armed 4–0 Ethibond locking suture based on measurements obtained on centerline of flow. In each instance, a nitinol wire was withdrawn and redirected through and through the fabric and used as a constraining wire. In the fourth patient, modification involved partial stent graft deployment and creation of additional two fenestrations to accommodate renal arteries. The devices are resheathed and implanted in the standard fashion. Results Four patients underwent exclusion of their aneurysms, including thoracoabdominal aneurysms (n = 2), a contained ruptured juxtarenal aneurysm (n = 1), and a ruptured failed previous endovascular repair (n = 1). Fifteen fenestrations were successfully bridged with Atrium iCAST stent grafts. Average graft modification time, operative time, contrast volume, radiation dose, estimated blood loss, and hospital length of stay were 89 min, 155.25 min, 58.8 mL, 2451 mGy, 175 mL, and 4.3 days, respectively. One patient required a secondary intervention to treat a type Ib endoleak. During an average follow-up of 25 months, aneurysm sacs progressively shrank without additional intervention. Conclusion Physician-modified fenestrated/branched endografts are a safe alternative to custom made devices, especially in urgent cases and should be part of the armamentarium of any complex aortic program.

scholarly journals Technical approach and outcomes of failed infrarenal endovascular aneurysm repairs rescued with fenestrated and branched endografts

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Jesse Manunga ◽  
Larissa I. Stanberry ◽  
Peter Alden ◽  
Jason Alexander ◽  
Nedaa Skeik ◽  
...  
Keyword(s):  
Adverse Events ◽  
Stent Graft ◽  
Graft Patency ◽  
Hospital Length ◽  
Aortic Aneurysms ◽  
Hospital Length Of Stay ◽  
Type I ◽  
Technical Success ◽  
Vessel Patency ◽  
Major Adverse Events

Abstract Background Endovascular rescue of failed infrarenal repair (EVAR) has emerged as an attractive option to stent graft explantation. The procedure, however, is underutilized due to limited devices accessibility and the challenges associated with their implantation in this patient population. The purpose of this study was to report our outcomes and discuss our approach to rescuing previously failed infrarenal endovascular aneurysm repairs (EVAR) with fenestrated/branched endografts (f/b-EVAR). Methods A retrospective analysis of prospectively collected data of consecutive patients with failed EVAR rescued with f/b-EVAR at our institution from November 2013 to March 2019 was conducted. The study primary end point was technical success; defined as the implantation of the device with no type I a/b or type III endoleak or conversion to open repair. Secondary endpoints included major adverse events (MAEs), graft patency and reintervention rates. Results During this time, 202 patients with complex aortic aneurysms were treated with f/b-EVAR. Of these, 19 patients (Male: 17, mean age 79 ± 7 years) underwent repair for failed EVAR. The median time from failed repair to f/b-EVAR was 48 (30, 60) months. Treatment failure was attributed to stent graft migration in 9 (47.4%) patients, disease progression in 5 (26.3%), short initial neck in 3 (15.8%) and unable to be determined in 2 (10.5%). Three patients were treated urgently with surgeon modified stent graft. Technical success was achieved in 18 patients (95%), including two who had undergone emergent repair for rupture. Seventy-two targeted vessels (97.3%) were successfully incorporated. Sixteen (84.2%) patients required a thoracoabdominal repair to achieve a durable seal. Major adverse events (MAEs) occurred in 3 patients (15.7%) including paralysis and death in one (5.3%), compartment syndrome and temporary dialysis in another and laparotomy with snorkeling of one renal and bypass of the other in the third patient. Median (IQR) hospital length of stay was 3 (2, 4) days. Late reintervention, primary target vessel patency and primary assisted patency rates were 5.3%, 98.6% and 100%, respectively. Conclusion Implantation of f/b-EVAR in patients with failed previous EVAR is a challenging undertaking that can be performed safely with a high technical success and low reintervention rates.

Endovascular Exclusion of Saccular AAAs Using “Stacked” AneuRx Aortic Cuffs

2002 ◽  
Vol 9 (3) ◽  
pp. 295-298 ◽  
Author(s):  
John W. York ◽  
W. Charles Sternbergh ◽  
Michael R. Lepore ◽  
Moises Yoselevitz ◽  
Samuel R. Money
Keyword(s):  
Stent Graft ◽  
Hospital Length ◽  
Aortic Aneurysms ◽  
Hospital Length Of Stay ◽  
Average Hospital ◽  
Major Morbidity ◽  
Abdominal Aortic ◽  
Procedural Time ◽  
Complete Exclusion

Purpose: To show that AneuRx aortic cuffs might be used in a “stacked” configuration to effectively treat saccular abdominal aortic aneurysm (AAA). Methods: In a recent 1-year period, 147 patients underwent endovascular AAA repair. Of these, 5 (4 men; mean age 61.6 years, range 55–69) had saccular AAAs with a mean diameter of 3.7 ± 0.2 cm (range 3.0–4.7). AneuRx aortic cuff prostheses (3.75-cm length) were deployed sequentially in these 5 patients via a right femoral approach; the devices were overlapped ∼1.5 to 2.0 cm until complete exclusion of the aneurysm was achieved. Endograft surveillance was performed using computed tomography at 4 weeks postoperatively and then every 6 months. Results: Successful exclusion of the saccular infrarenal aortic aneurysms was achieved in all 5 patients using 2 or 3 “stacked” stent-graft extensions. Four of the 5 procedures were performed under spinal anesthesia; the average procedural time was 96 ± 41 minutes. The average hospital length of stay was 1.6 days; no major morbidity or mortality was encountered. There were no early or late endoleaks, aneurysm expansion, or device migration over a follow-up that ranged to 12 months. Conclusions: Saccular AAA provides ideal anatomy for endovascular repair with a “tube” endograft. “Stacked” aortic cuffs create a customized stent-graft that is not otherwise commercially available.

Same-Day versus Conventional Different-Day Endoscopic Retrograde Cholangiopancreatography and Laparoscopic Cholecystectomy: A Multi-Center Retrospective Study

2018 ◽  
Vol 84 (10) ◽  
pp. 1679-1683
Author(s):  
Mohammed H. Al-Temimi ◽  
Charles Trujillo ◽  
Mital Shah ◽  
Sriram Rangarajan ◽  
Edwin Kim ◽  
...  
Keyword(s):  
Gastric Bypass ◽  
Success Rate ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Postoperative Morbidity ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Endoscopic Retrograde ◽  
Kaiser Permanente ◽  
Estimated Blood Loss ◽  
Baseline Characteristics

Same-day endoscopic retrograde cholangiopancreatography (ERCP) and cholecystectomy (LC) could potentially reduce hospital length of stay (HLOS). Patients undergoing same-day procedures (N = 164) between 2012 and 2014 were compared with different-day procedures performed in the second half of 2014 (N = 276), in the Kaiser Permanente Southern California database. Both groups had comparable baseline characteristics. ERCP success rate (97.5% vs 93.5%), overall postoperative morbidity (3.66% vs 3.99%), and retained stones (2.5% vs 5.8%) were not different between groups ( P > 0.05); however, HLOS was shorter in the same-day group (2.99 ± 2.34 vs 3.84 ± 2.52 days, P < 0.001). Morbidity, procedure success, and HLOS were not different in the same-day group, whether ERCP was performed before or after LC ( P > 0.05). In the same-day group, those undergoing single anesthesia had higher BMI (40.1 ± 10.8 vs 30.3 ± 6.6) and were more likely to have gastric bypass (30% vs 0%) than those undergoing separate anesthesia sessions ( P < 0.01). Longer HLOS (4.8 ± 3.5 vs 2.9 ± 2.2 days) and higher estimated blood loss (65 ± 90 mL vs 20 ± 29 mL) were also associated with the single-anesthetic session ( P < 0.01). ERCP performed on the same day of LC reduces HLOS without increasing morbidity. This approach does not affect postoperative morbidity and ERCP success rate, whether ERCP was performed before or after LC.

Anatomical Suitability of the T-Branch Stent-Graft in Patients With Thoracoabdominal Aortic Aneurysms Treated Using Custom-Made Multibranched Endografts

2013 ◽  
Vol 20 (5) ◽  
pp. 672-677 ◽  
Author(s):  
Theodosios Bisdas ◽  
Konstantinos P. Donas ◽  
Michel Bosiers ◽  
Giovanni Torsello ◽  
Martin Austermann
Keyword(s):  
Stent Graft ◽  
Aortic Aneurysms ◽  
Custom Made

A Modified Proximal Stent-Graft for Spinal Cord Preconditioning During Staged Endovascular Repair of Thoracoabdominal Aortic Aneurysms

2020 ◽  
Vol 27 (5) ◽  
pp. 764-768
Author(s):  
Enrico Rinaldi ◽  
Niccolò Carta ◽  
Germano Melissano ◽  
Roberto Chiesa ◽  
Luca Bertoglio
Keyword(s):  
Spinal Cord ◽  
Stent Graft ◽  
Endovascular Repair ◽  
Aortic Wall ◽  
Outer Part ◽  
Aortic Aneurysms ◽  
Additional Tool ◽  
Repair Technique ◽  
Custom Made ◽  
Thoracic Stent Graft

Purpose: To describe a new custom-made thoracic device able to seal against the aortic wall and occlude intercostal arteries for spinal cord preconditioning during the first thoracic stage of a thoracoabdominal endovascular repair. Technique: The custom-made device, based on the Zenith Alpha stent-graft, combines different features from 2 previously described devices: the outer part is designed with a bell-bottom configuration similar to the “Embo” stent-graft, while the inner part mimics the “2 in 1” design. The outer stent-graft is designed to span the entire length of the thoracic aorta and cover as many intercostal arteries as possible during the first stage to effectively precondition the spinal cord. The sutured inner component is customizable in diameter and 20 to 40 mm shorter than the outer stent-graft. The technique has been used in 5 patients. Conclusion: The use of this new custom-made thoracic stent-graft might represent an additional tool for effectively preconditioning the spinal cord during fenestrated and branched staged procedures whenever a proximal thoracic proximal component is needed.

Safely Increasing the Efficiency of Thyroidectomy Using a New Bipolar Electrosealing Device (LigaSure™) versus Conventional Clamp-and-Tie Technique

2006 ◽  
Vol 72 (2) ◽  
pp. 132-136 ◽  
Author(s):  
Jan Franko ◽  
Karen J. Kish ◽  
Christopher M. Pezzi ◽  
Ho Pak ◽  
John S. Kukora
Keyword(s):  
Nerve Injury ◽  
Thyroid Surgery ◽  
Operative Time ◽  
Hospital Length ◽  
Conventional Group ◽  
Hospital Length Of Stay ◽  
Recurrent Nerve ◽  
Surgical Resident ◽  
Estimated Blood Loss ◽  
Recurrent Nerve Injury

Operative time in thyroid surgery can be safely reduced through use of a new bipolar electro-sealing device (LigaSure). We evaluated consecutive patients undergoing thyroid surgery from January 2003 through January 2005 (n = 155). During the first half of the study, hemostasis was obtained using silk ties (conventional group, n = 70). During the second half of the study period, hemostasis was obtained with a bipolar electrosealing device (LigaSure group, n = 85). The mean operative time was 130 ± 37 minutes in the conventional group and 110 ± 33 minutes (P < 0.001) in the LigaSure group. EBL in the LigaSure group was statistically significantly less (43 ± 53 vs 33 ± 33 mL; P < 0.05). Postoperative calcium level was statistically significantly higher in the Liga-Sure group (8.2 ± 0.5 vs 8.4 ± 0.6 mg/dL, P < 0.05). Hospital length of stay (LOS) did not differ significantly. One patient in each group developed neck hematoma requiring reoperation. One permanent recurrent nerve injury occurred in the conventional group and one transient bilateral recurrent nerve injury occurred in the LigaSure group. The occurrence of symptomatic hypocalcemia was similar between the two groups. The training level of the surgical resident had no significant impact on the operative time, estimated blood loss (EBL), LOS, or complication rate. LigaSure bipolar electrosealer as the primary means of hemostasis during thyroidectomy significantly reduces mean operative times. Rates of operative complications were unchanged. LigaSure use in thyroid surgery can safely increase efficiency.

scholarly journals Safety and Efficacy of Laparoscopic Caudate Lobectomy: A Systematic Review

2021 ◽  
Vol 10 (21) ◽  
pp. 4907
Author(s):  
Panagiotis Dorovinis ◽  
Nikolaos Machairas ◽  
Stylianos Kykalos ◽  
Paraskevas Stamopoulos ◽  
Spyridon Vernadakis ◽  
...  
Keyword(s):  
Systematic Review ◽  
Malignant Tumors ◽  
Abdominal Cavity ◽  
Major Complication ◽  
High Volume ◽  
Caudate Lobe ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Caudate Lobectomy ◽  
Estimated Blood Loss

Resection of the caudate lobe of the liver is considered a highly challenging type of liver resection due to the region’s intimacy with critical vascular structures and deep anatomic location inside the abdominal cavity. Laparoscopic resection of the caudate lobe is considered one of the most challenging laparoscopic liver procedures. The objective of our systematic review was to evaluate the safety, technical feasibility and main outcomes of laparoscopic caudate lobectomy LCL. A systematic review of the literature was undertaken for studies published until September 2021. A total of 20 studies comprising 221 patients were included. Of these subjects, 36% were women, whereas the vast majority of resections (66%) were performed for malignant tumors. Tumor size varied significantly between 2 and 160 mm in the largest diameter. The mean operative time was 210 min (range 60–740 min), and estimated blood loss was 173.6 mL (range 50–3600 mL). The median hospital length of stay LOS was 6.5 days (range 2–15 days). Seven cases of conversion to open were reported. The vast majority of patients (93.7%) underwent complete resection (R0) of their tumors. Thirty-six out of 221 patients developed postoperative complications, with 5.8% of all patients developing a major complication (Clavien–Dindo classification ≥ III).No perioperative deaths were reported by the included studies. LCL seems to be a safe and feasible alternative to open caudate lobectomy OCL in selected patients when undertaken in high-volume centers by experienced surgeons.

Endoscopic transnasal/transoral odontoid resection in children: results of a combined neurosurgical and otolaryngological protocolized, institutional approach

2021 ◽  
pp. 1-8
Author(s):  
Rajiv R. Iyer ◽  
J. Fredrik Grimmer ◽  
Douglas L. Brockmeyer
Keyword(s):  
Length Of Stay ◽  
Blood Loss ◽  
Pediatric Population ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Endoscopic Endonasal ◽  
Sleep Study ◽  
Average Hospital ◽  
Institutional Approach ◽  
Estimated Blood Loss

OBJECTIVE Odontogenic ventral brainstem compression can be a source of significant morbidity in patients with craniocervical disease. The most common methods for odontoidectomy are the transoral and endoscopic endonasal routes. In this study, the authors investigated the use of an institutional protocol for endoscopic transnasal/transoral odontoidectomy in the pediatric population. METHODS From 2007 to 2017, a multidisciplinary institutional protocol was developed and refined for the evaluation and treatment of pediatric patients requiring odontoidectomy. Preoperative assessment included airway evaluation, a sleep study (if indicated), discussion of possible tonsillectomy/adenoidectomy, and thorough imaging review by the neurosurgery and otolaryngology teams. Further preoperative anesthesia consultation was obtained for difficult airways. Intraoperatively, adenoidectomy was performed at the discretion of otolaryngology. The odontoidectomy was performed as a combined procedure. Primary posterior pharyngeal closure was performed by the otolaryngologist. The postoperative protocol called for immediate extubation, advancement to a soft diet at 24 hours, and no postoperative antibiotics. Outcome variables included time to extubation, operative time, estimated blood loss, hospital length of stay, and postoperative complications. RESULTS A total of 13 patients underwent combined endoscopic transoral/transnasal odontoid resection with at least 3 years of follow-up. All patients had stable to improved neurological function in the postoperative setting. All patients were extubated immediately after the procedure. The average operative length was 201 ± 46 minutes, and the average estimated blood loss was 44.6 ± 40.0 ml. Nine of 13 patients underwent simultaneous tonsillectomy and adenoidectomy. The average hospital length of stay was 6.6 ± 5 days. The first patient in the series required revision surgery for removal of a small residual odontoid. One patient experienced pharyngeal flap dehiscence requiring revision. CONCLUSIONS A protocolized, institutional approach for endoscopic transoral/transnasal odontoidectomy is described. The use of a combined, multidisciplinary approach leads to streamlined patient management and favorable outcomes in this complex patient population.

Intraoperative Proximal Endoleaks during AAA Stent-Graft Repair: Evaluation of Risk Factors and Treatment with Palmaz Stents

2001 ◽  
Vol 8 (3) ◽  
pp. 268-273 ◽  
Author(s):  
Nuno V. Dias ◽  
Timothy Resch ◽  
Martin Malina ◽  
Bengt Lindblad ◽  
Krassi Ivancev
Keyword(s):  
Stent Graft ◽  
Therapeutic Option ◽  
Balloon Dilation ◽  
Aortic Aneurysms ◽  
Type I ◽  
Aneurysm Neck ◽  
Custom Made ◽  
Type I Endoleak ◽  
Stent Graft Repair ◽  
Palmaz Stents

Purpose: To study factors that might contribute to intraoperative proximal type I endoleak and to evaluate the placement of giant Palmaz stents as a therapeutic option. Methods: Thirty-three patients (30 men; median age 72 years, range 50–85) with abdominal aortic aneurysms underwent implantation of fully supported Gianturco Z-stent—based endografts (12 custom-made aortomonoiliac and 21 bifurcated Zenith devices). Ten (30%) patients were treated for intraoperative proximal endoleaks. Stent-graft oversizing and neck angulation, length, and shape were compared between patients with and without leaks. Results: In 9 cases, the endoleaks were successfully treated with intraoperative placement of Palmaz stents without complications. In 1 patient, a leak that was resolved intraoperatively with balloon dilation reappeared 1 month later; a Palmaz stent was deployed successfully. Stent-graft oversizing did not differ significantly between patients who developed proximal endoleaks and those who did not (median 4.0 mm in both groups, p = 0.47). Median neck length was 21.0 mm in patients with endoleak and 28.0 mm in those without (p > 0.99). Median neck angulation was 30° in both groups (p = 0.33), and the presence of a conical aneurysm neck was not significantly different (2/10 versus 6/23, p > 0.99). All aneurysms remained excluded at a median follow-up of 13 months (range 6–24). Conclusions: Stent-graft oversizing and neck morphology (length, angulation, and conical shape) do not seem to correlate with the incidence of proximal type I endoleaks. Palmaz stent placement appears to be a feasible and safe treatment option for this complication.

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