Stent grafts implantation in patients with life-threatening aortic conditions – first experience in Kyrgyz Republic

Objective: Aortic diseases remain an acute and debatable problem. Among all the aortic pathologies, the most dangerous are dynamic aneurysmal expansion, traumatic dissections and / or aneurysms, pure aortic intima dissections. Contemporary and less invasive treatment method is the stent graft implantation into aorta. This report describes the first experience of thoracic endovascular aortic repair (TEVAR) and endovascular aneurysm repair (EVAR) in the Kyrgyz Republic in consecutive patients with life-threatening aortic conditions. Methods: Nine patients, who underwent TEVAR and EVAR, were presented after all clinical examinations, echocardiography and computed tomography angiography with various life-threatening aortic diseases. Among the pathologies there were 2 (22.2%) dissections only, traumatic aneurysm 1 (11.1%), aneurysm without dissection 1 (11.1%), aneurysm with intimal dissection 5 (55.6%). Seven patients with dissection had type B (The Stanford classification). Results: TEVAR was performed in eight cases EVAR just in one. All patients reached the 6-month endpoint. None of the following, such as aneurysm expansion, aneurysm thrombosis or a functioning of false lumen at the sites of the stent graft implantation have been recorded. In addition, no further progression of the false lumen below the implantation zones was visualized. Mean diameter of stent grafts was 31.4 ± 4.8 mm and 188.9 ± 34.6 mm in length. Conclusion: This modest observation showed the effectiveness of stent grafts implantation procedures in various aortic life-threatening conditions, such as aneurysm and / or aortic intima dissection.

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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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Treatment of Thoracic Aortic Dissection with Stent-Grafts: Midterm Results

Journal of Endovascular Therapy ◽

10.1177/152660280200900615 ◽

2002 ◽

Vol 9 (6) ◽

pp. 817-821 ◽

Cited By ~ 16

Author(s):

Won-Heum Shim ◽

Bon-Kwon Koo ◽

Young-Sup Yoon ◽

Donghoon Choi ◽

Yangsoo Jang ◽

...

Keyword(s):

Aortic Dissection ◽

Stent Graft ◽

False Lumen ◽

Endovascular Stent ◽

Stent Grafts ◽

Endovascular Stent Graft ◽

Thoracic Aortic Dissection ◽

Stent Graft Implantation ◽

Graft Implantation

Purpose: To evaluate the early and midterm outcomes after stent-graft implantation for dissection in the descending thoracic aorta. Methods: Sixteen custom-made endovascular stent-grafts were implanted in 15 patients (10 men; mean age 55.9 ± 13.7 years, range 32–82) with descending thoracic aortic dissection. Indications for stent-graft implantation were persistent symptoms unresponsive to medical treatment or progressive enlargement of the false lumen. Clinical and imaging surveillance with computed tomography was performed within 1 month of the procedure and at 3 to 6-month intervals in follow-up. Results: Endovascular stent-graft implantation at the target site was successful in 14 (93%) patients; 1 device migrated, leaving the false lumen open to flow in the failed case. One (7%) patient who was treated emergently for rupture died suddenly 2 days after the procedure. Over an average follow-up of 31.5 ± 23.8 months, 1 (7%) patient died and 2 (14%) patients underwent surgical treatment due to recurrent dissection. The remaining 10 patients showed complete thrombosis of the false lumen; in 3, the false lumen completely resolved. Conclusions: Endovascular stent-graft implantation in descending thoracic aortic dissection is a feasible, safe, and effective treatment modality. However, further studies are necessary in a greater number of patients to determine if wider application of this minimally invasive procedure is justified.

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How to Exclude the Dilated False Lumen in Patients after a Type B Aortic Dissection? The Cork in the Bottleneck

Journal of Endovascular Therapy ◽

10.1177/152660280301000213 ◽

2003 ◽

Vol 10 (2) ◽

pp. 244-248 ◽

Cited By ~ 16

Author(s):

Maartje C. Loubert ◽

Victor P.M. van der Hulst ◽

Cees De Vries ◽

Kees Bloemendaal ◽

Anco C. Vahl

Keyword(s):

Aortic Dissection ◽

Stent Graft ◽

Case Reports ◽

False Lumen ◽

Type B ◽

Type B Aortic Dissection ◽

Type B Dissection ◽

Occluder Device ◽

Stent Graft Implantation ◽

Graft Implantation

Purpose: To report techniques for excluding the dilated false lumen associated with chronic type B aortic dissection following placement of a stent-graft in the true lumen. Case Reports: Two patients underwent stent-graft implantation for a dilated false lumen after chronic aortic dissection, but the false lumen was not excluded from the circulation by this procedure. The false lumen was obliterated in one case with Greenfield filters and detachable balloons placed above a renal artery orifice that was perfused via the false lumen. This acted like “a cork in the bottleneck” to block retrograde flow into the thoracic portion of the false lumen above the blockade. In the other patient, an occluder device was used as the “cork.” In both cases, a good result was obtained. The occluder device is preferred because deployment is more controllable. Conclusions: An occluder device may be used like a cork in a bottle to exclude the dilated false lumen in the thoracic aorta after a type B dissection.

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Partially Covered Stent-Graft Implantation in Rabbit Aorta: A New Model to Investigate Bioactive Stent-Grafts in Small Animals

Journal of Endovascular Therapy ◽

10.1583/08-2617.1 ◽

2009 ◽

Vol 16 (2) ◽

pp. 154-160 ◽

Cited By ~ 5

Author(s):

Hongshan Zhong ◽

Osamu Matsui ◽

Ke Xu ◽

Takahiro Ogi ◽

Miho Okuda ◽

...

Keyword(s):

Stent Graft ◽

Rabbit Aorta ◽

Covered Stent ◽

Small Animals ◽

Stent Grafts ◽

New Model ◽

Covered Stent Graft ◽

Stent Graft Implantation ◽

Graft Implantation ◽

Bioactive Stent

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Hybrid endovascular repair of a dissecting thoracoabdominal aortic aneurysm with stent graft implantation through the false lumen

Journal of Vascular Surgery ◽

10.1016/j.jvs.2013.07.101 ◽

2014 ◽

Vol 59 (1) ◽

pp. 264-267 ◽

Cited By ~ 10

Author(s):

Yoshiki Watanabe ◽

Toru Kuratani ◽

Yukitoshi Shirakawa ◽

Kei Torikai ◽

Kazuo Shimamura ◽

...

Keyword(s):

Aortic Aneurysm ◽

Stent Graft ◽

Endovascular Repair ◽

False Lumen ◽

Thoracoabdominal Aortic Aneurysm ◽

Stent Graft Implantation ◽

Graft Implantation

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Push-Up Technique and Anatomical Deployment With the Endurant Stent-Graft System for Severely Angulated Aneurysm Necks

Journal of Endovascular Therapy ◽

10.1177/1526602817692790 ◽

2017 ◽

Vol 24 (3) ◽

pp. 435-439 ◽

Cited By ~ 5

Author(s):

Shizuyuki Dohi ◽

Yasutaka Yokoyama ◽

Taira Yamamoto ◽

Kenji Kuwaki ◽

Akifusa Hariya ◽

...

Keyword(s):

Blood Flow ◽

Stent Graft ◽

Endovascular Aneurysm Repair ◽

Stent Deployment ◽

Proximal Neck ◽

Aneurysm Repair ◽

Angulated Neck ◽

Stent Graft Implantation ◽

Graft Implantation ◽

Push Up

Purpose: To describe a technique suitable for treating severely angulated (>75°) necks during endovascular aneurysm repair using the Endurant stent-graft. Technique: In the push-up technique, the suprarenal stent is released early to fix the proximal stent-graft in place so that each stent in the neck can be deployed individually without displacing the device upward. It is important to push the delivery system up after each stent deployment to allow the fabric between the stents to fold up circumferentially. By doing so, there is minimal upward force applied to the suprarenal stent. Because the stents expand along the angulated neck while catching blood flow, this anatomical deployment is feasible, with hardly any change to the proximal neck shape after stent-graft implantation. Conclusion: The push-up technique and anatomical deployment with the Endurant stent-graft system are effective and safe methods for treating aneurysms with severely angulated necks.

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How to Guide Stent-Graft Implantation in Type B Aortic Dissection?

Circulation ◽

10.1161/circulationaha.104.525972 ◽

2005 ◽

Vol 112 (9_supplement) ◽

Author(s):

Dietmar H. Koschyk ◽

Christoph A. Nienaber ◽

Malgorzata Knap ◽

Thomas Hofmann ◽

Yskert V. Kodolitsch ◽

...

Keyword(s):

Aortic Dissection ◽

Stent Graft ◽

Guide Wire ◽

False Lumen ◽

Entire Length ◽

Type B ◽

Type B Aortic Dissection ◽

Complex Anatomy ◽

Stent Graft Implantation ◽

Graft Implantation

Background— Despite growing interest in stent-graft implantation for type-B aortic dissection, there are no established recommendations to prepare and perform an implantation procedure. Methods and Results— We directly compared angiography (ANGIO), transesophageal echocardiography (TEE), and intravascular ultrasound (IVUS) intraprocedually before and after placement of 48 stent grafts in 42 consecutive patients (12 women, 61±11 years of age) with acute and chronic type-B aortic dissection for both usefulness and capability to guide aortic stent-graft implantation. Both IVUS and TEE are superior to ANGIO to identify multiple entries (52 and 43 versus 34; P <0.005 each), to diagnose false-lumen slow flow after stent-graft implantation (32 and 31 versus 24; P <0.005 each) and to detect incomplete stent apposition (18 and 16 versus 8; P <0.005 each). In comparison with ANGIO, guide wire position over the entire length of the aorta was documented more frequently by TEE and IVUS (40 and 42 versus 25; P <0.001 each). In 4 patients with abdominal extension of the dissection, only IVUS was able to accurately identify the false lumen over the entire length of the diseased aorta. TEE was superior to IVUS and ANGIO in the detection of endoleaks (5 versus 0 and 1; P <0.05 each). Intraprocedural ANGIO, TEE, and IVUS had been performed without complications in all patients. Conclusions— TEE in conjunction with ANGIO appears to be advantageous and adds incremental information to safely guide stent-graft placement in type-B aortic dissection. Additional use of IVUS was found to be helpful in patients with complex anatomy and abdominal extension of the dissection.

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