Therapeutic Strategies for Infectious Multiple Aortic Aneurysms: Thoracoabdominal Aortic Aneurysm Treatment Using a Fenestrated Stent-Graft

Purpose: To evaluate the immediate postoperative and midterm outcomes of complex thoracoabdominal aortic aneurysm (TAAA) treatment with fenestrated/branched physician-modified endovascular grafts (PMEGs) or open debranching of the visceral aorta with bypass graft revascularization plus endovascular aneurysm exclusion (hybrid repair). Materials and Methods: A retrospective analysis was conducted of 88 patients (mean age 70.0±10.6 years; 73 men) with complex TAAAs who underwent treatment with PMEGs (60, 68%) or a hybrid technique (28, 32%) between 2016 and 2019. The mean aneurysm diameter was 64.5±11.7 mm, and 37 patients (42%) were symptomatic. The Zenith TX2 and Ankura were the main stent-grafts used in the PMEG group. The hybrid technique involved visceral debranching with extra-anatomical bypass graft revascularization and subsequent stent-graft deployment (1- or 2-stage procedure). Results: In the PMEG group, 35 patients received modified stent-grafts with 4 fenestrations, 8 patients had 4 branches per device, and 17 patients had combinations (50 fenestrations and 18 branches) that successfully revascularized 228 of the 240 targets (95%). In the 28 hybrid cases, all 110 target vessels were successfully revascularized with bypass grafts. The overall 30-day mortality was 3.4% (2 PMEG and 1 hybrid), and the early rate of target vessel stenosis/occlusion was 3.3% (5 in PMEG group and 6 in the hybrid repair group). The 30-day morbidity was mainly attributed to pulmonary complications (15%), lower limb ischemia (8%), or spinal cord ischemia with paraplegia (6%). Eleven patients (13%) had deteriorated renal function with a >30% decrease in the glomerular filtration rate. The mean follow-up was 22.3±4.9 months, and mortality was 4.5% (3.3% in the PMEG group vs 7.1% in the hybrid repair group). Conclusion: PMEGs and hybrid techniques seem to be feasible treatment options for aortic aneurysms necessitating visceral vessel revascularization. PMEGs may have a lower morbidity than the hybrid technique, which nonetheless remains an important option available for complex aortic aneurysms.

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Stent Graft Repair of Paraanastomotic Aneurysms After Open Descending Thoracic and Thoracoabdominal Aortic Aneurysm Repair

Annals of Vascular Surgery ◽

10.1016/j.avsg.2012.07.023 ◽

2013 ◽

Vol 27 (6) ◽

pp. 693-698 ◽

Cited By ~ 6

Author(s):

David J. O'Connor ◽

Ageliki Vouyouka ◽

Sharif H. Ellozy ◽

Scott A. Sundick ◽

Patrick LeMasters ◽

...

Keyword(s):

Aortic Aneurysm ◽

Stent Graft ◽

Thoracoabdominal Aortic Aneurysm ◽

Stent Graft Repair ◽

Thoracoabdominal Aortic Aneurysm Repair ◽

Aneurysm Repair ◽

Aortic Aneurysm Repair

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Extensive Aortic Stent Graft Coverage for Thoracoabdominal Aortic Aneurysm is Associated With Hemorrhagic Complications Induced by Disseminated Intravascular Coagulation

Annals of Vascular Surgery ◽

10.1016/j.avsg.2021.06.017 ◽

2021 ◽

Author(s):

Takayuki Kawashima ◽

Kenshi Yoshimura ◽

Takashi Shuto ◽

Tomoyuki Wada ◽

Keitaro Okamoto ◽

...

Keyword(s):

Aortic Aneurysm ◽

Stent Graft ◽

Disseminated Intravascular Coagulation ◽

Thoracoabdominal Aortic Aneurysm ◽

Intravascular Coagulation ◽

Aortic Stent Graft ◽

Hemorrhagic Complications

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Thoracic Aortic Aneurysm Repair with Endovascular Stent-Grafts

Vascular Medicine ◽

10.1177/1358863x9700200205 ◽

1997 ◽

Vol 2 (2) ◽

pp. 98-103 ◽

Cited By ~ 32

Author(s):

Charles P Semba ◽

R Scott Mitchell ◽

D Craig Miller ◽

Noriyuki Kato ◽

Stephen T Kee ◽

...

Keyword(s):

High Risk ◽

Aortic Aneurysm ◽

Stent Graft ◽

Aortic Aneurysms ◽

Stent Grafts ◽

Thoracic Aortic Aneurysms ◽

Risk Patients ◽

Aneurysm Repair ◽

Aortic Aneurysm Repair ◽

Endoluminal Stent

The purpose of the study was to describe the clinical experience in using endoluminal stent-grafts for the treatment of thoracic aortic aneurysms in high-risk patients. Patients with aneurysms of the descending thoracic aorta who were considered high surgical risks underwent evaluation for endoluminal repair. The prosthesis was constructed from Z stents covered with polyester fabric using dimensions based upon preprocedural computed tomography scans and angiography. Through a femoral arteriotomy or left retroperitoneal flank incision, a 22–24 Fr delivery catheter was inserted and advanced through the aorta to the target site under fluoroscopic guidance in the operating suite. The stent-graft prosthesis was deployed at the site of the aneurysm. 44 patients (36 male, 8 female; mean age 36 years) underwent stent-graft repair for thoracic aneurysms (mean diameter 6.3 cm). The deployment was technically successful in all cases, with complete aneurysm thrombosis in 88%. The 30-day perioperative mortality rate was 6.8% and 35-month actuarial survival was 82%. There were no cases of stent migration, surgical conversion or intraprocedural death. Paraplegia occurred in two patients who underwent simultaneous surgical infrarenal aortic aneurysm repair immediately followed by stent-graft placement for a coexisting thoracic aneurysm. The conclusion was that placement of endoluminal stent-grafts for repair of thoracic aortic aneurysms is technically feasible in high-risk patients in whom conventional surgery is contraindicated. Long-term studies are needed to determine protection against aneurysm rupture and patient survival.

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E-nside Off-the-Shelf Inner Branch Stent Graft: Technical Aspects of Planning and Implantation

Journal of Endovascular Therapy ◽

10.1177/15266028211047967 ◽

2021 ◽

pp. 152660282110479

Author(s):

Alexander Zimmermann ◽

Anna-Leonie Menges ◽

Zoran Rancic ◽

Lorenz Meuli ◽

Philip Dueppers ◽

...

Keyword(s):

Radiation Dose ◽

Stent Graft ◽

Patient Selection ◽

Endovascular Therapy ◽

Aortic Aneurysms ◽

Implantation Technique ◽

Stent Grafts ◽

Middle Segment ◽

Technical Aspects ◽

Fenestrated Stent Graft

Purpose This article aims to present all aspects regarding patient selection, planning, and implantation technique for a new off-the-shelf pre-cannulated multi-inner branch stent graft. The stent graft comes in 4 different versions with proximal diameters of 33 and 38 mm and distal diameters of 26 and 30 mm. The 4 inner branches are located in the middle segment, which has a diameter of 24 mm. Technique With inner branch technology, the field of application for the treatment of thoracoabdominal aortic aneurysms (TAAA) has been further extended. In addition to routine use in elective cases the pre-cannulation of the inner branches predisposes especially for emergencies. Pre-cannulation is intended to reduce the time to cannulation and the radiation dose. All steps of planning, stent-graft deployment, and cannulation of the inner branches are described in detail. Conclusion The E-nside stent graft represents a promising new endovascular therapy in the treatment of acute and elective TAAA. By using inner branch technology, this endograft combines the advantages of fenestrated and branched stent grafts. Indication, planning, and implantation require experience in branched and fenestrated stent graft technology.

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Endovascular repair of aortic aneurysm: Preliminary results

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh0902010d ◽

2009 ◽

Vol 137 (1-2) ◽

pp. 10-17 ◽

Cited By ~ 1

Author(s):

Lazar Davidovic ◽

Momcilo Colic ◽

Igor Koncar ◽

Dejan Markovic ◽

Dusan Kostic ◽

...

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Stent Graft ◽

Endovascular Aneurysm Repair ◽

Aortic Aneurysms ◽

Endovascular Stent ◽

Stent Grafts ◽

Graft Thrombosis ◽

Abdominal Aortic

Introduction. Endovascular aneurysm repair (EVAR) has been introduced into clinical practice at the beginning of the 90's of the last century. Because of economic, political and social problems during the last 25 years, the introduction of this procedure in Serbia was not possible. Objective. The aim of this study was to present preliminary experiences and results of the Clinic for Vascular Surgery of the Serbian Clinical Centre in Belgrade in endovascular treatment of thoracic and abdominal aortic aneurysms. Methods. The procedure was performed in 33 patients (3 female and 30 male), aged from 42 to 83 years. Ten patients had a descending thoracic aorta aneurysm (three atherosclerotic, four traumatic - three chronic and one acute as a part of polytrauma, one dissected, two penetrated atherosclerotic ulcers), while 23 patients had the abdominal aortic aneurysm, one ruptured and two isolated iliac artery aneurysms. The indications for EVAR were isthmic aneurismal localisation, aged over 80 years and associated comorbidity (cardiac, pulmonary and cerebrovasular diseases, previous thoracotomy or multiple laparotomies associated with abdominal infection, idiopatic thrombocitopaenia). All of these patients had three or more risk factors. The diagnosis was established using duplex ultrasonography, angiography and MSCT. In the case of thoracic aneurysm, a Medtronic-Valiant? endovascular stent graft was implanted, while for the abdominal aortic aneurysm Medtronic-Talent? endovascular stent grafts with delivery systems were used. In three patients, following EVAR a surgical repair of the femoral artery aneurysm was performed, and in another three patients femoro-femoral cross over bypass followed implantation of aortouniiliac stent graft. Results. During procedure and follow-up period (mean 1.6 years), there were: one death, one conversion, one endoleak type 1, six patients with endoleak type 2 that disappeared during the follow-up period, one early graft thrombosis. No other complications, including aneurysm expansion, collapse, deformity and migration of the endovascular stent grafts, were registered. Conclusion. According to all medical and economic aspects, we recommend EVAR to treat acute traumatic thoracic aortic aneurysm, as well as in elderly and high-risk patients with abdominal or thoracic aneurysms, when open surgery is related to a significantly higher mortality and morbidity.

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Results of a three-year follow-up after endovascular therapy with multilayer flow modulator in complex thoracoabdominal aortic aneurysm: A case report

Vascular ◽

10.1177/1708538120933516 ◽

2020 ◽

pp. 170853812093351

Author(s):

Nazım Kankılıç ◽

Mehmet S Aydın

Keyword(s):

Case Report ◽

Aortic Aneurysm ◽

Renal Artery ◽

Medical Center ◽

Left Kidney ◽

Thoracoabdominal Aortic Aneurysm ◽

Aortic Aneurysms ◽

Left Renal Artery

Objectives Studies on the short-, medium and long-term effects of flow guiding stents are still limited. In this case report, we present three-year follow-up of the multilayer flow modulator stent in a 55-year-old patient with Crawford Type 2 thoracoabdominal aortic aneurysm. Methods A 55-year-old male patient with Crawford Type 2 thoracoabdominal aortic aneurysm had applied to our medical center. The aneurysm involved coeliac truncus and superior mesenteric artery and extended to the renal artery ostia. Multilayer flow modulator stent was successfully placed, and follow-up CT (Computed tomography) angiographic examination images recorded intermittently (36 months). Results After three years, it was observed that the left renal artery was thrombosed and the left kidney went to atrophy. Other major vascular branches were observed to be open. During this time, the aneurysm was completely closed with thrombus, but the diameter of the aneurysm continued to increase. Conclusions Multilayer flow modulator stents are safe in complex aortic aneurysms. The device increases the thrombus load in the aortic aneurysm and maintains the flow of the main vascular branches. But re-interventions, dilatation of the aneurysm sac and visceral branch obstructions are still challenging for multilayer flow modulator stents.

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Endovascular repair of thoracoabdominal aortic aneurysm using the off-the-shelf multibranched t-Branch stent graft

Journal of Vascular Surgery ◽

10.1016/j.jvs.2016.02.021 ◽

2016 ◽

Vol 63 (5) ◽

pp. 1394-1399.e2 ◽

Cited By ~ 18

Author(s):

Bernardo C. Mendes ◽

Gustavo S. Oderich

Keyword(s):

Aortic Aneurysm ◽

Stent Graft ◽

Endovascular Repair ◽

Thoracoabdominal Aortic Aneurysm

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Staged hybrid open and endovascular exclusion of a symptomatic thoracoabdominal aortic aneurysm in a high-risk patient

Vascular ◽

10.1177/1708538113492515 ◽

2013 ◽

Vol 22 (4) ◽

pp. 280-285 ◽

Cited By ~ 1

Author(s):

Christine Chung ◽

Rajesh Malik ◽

Michael Marin ◽

Peter Faries ◽

Sharif Ellozy

Keyword(s):

High Risk ◽

Aortic Aneurysm ◽

Hybrid Approach ◽

High Risk Patient ◽

Thoracoabdominal Aortic Aneurysm ◽

The Elderly ◽

Aortic Aneurysms ◽

Risk Patient ◽

Abdominal Aortic ◽

Thoracic Aneurysms

Thoracoabdominal aortic aneurysms have a higher prevalence in the elderly, who are often poor surgical candidates. These extensive aneurysms may be lethal if left untreated. Conventional open repair has proven to be a major task, involving cardiopulmonary bypass, aortic cross-clamping and expeditious repair of an inaccessible structure involving two body cavities. Endovascular repair has become a viable option to treat isolated descending thoracic aneurysms and infrarenal abdominal aortic aneurysms. However, endovascular techniques alone have been less applicable for treating complex aortic aneurysms, including those involving visceral vessels. Therefore, a hybrid open and endovascular approach with visceral debranching has become an increasingly favorable alternative for patients with these complex conditions. We report a case in which a staged hybrid approach was used for successful exclusion of an extensive thoracoabdominal aortic aneurysm in a symptomatic, high-risk patient who would not have been an appropriate candidate for open surgical repair.

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Complex Endovascular Aortic Repair With a Branched Endograft to Revascularize 5 Renovisceral Vessels and an Intercostal Artery in a Marfan Patient

Journal of Endovascular Therapy ◽

10.1177/1526602819857601 ◽

2019 ◽

Vol 26 (5) ◽

pp. 736-741 ◽

Cited By ~ 1

Author(s):

Ahmed S. Eleshra ◽

Giuseppe Panuccio ◽

Fiona Rohlffs ◽

Martin Scheerbaum ◽

Nikolaos Tsilimparis ◽

...

Keyword(s):

Aortic Aneurysm ◽

Stent Graft ◽

Thoracoabdominal Aortic Aneurysm ◽

Renal Arteries ◽

Endovascular Aortic Repair ◽

Intercostal Artery ◽

Maximum Diameter ◽

Aortic Repair ◽

Custom Made ◽

Marfan Patient

Purpose: To report a case of thoracoabdominal aortic aneurysm (TAAA) repair treated with a multibranched stent-graft including a prophylactic branch for a large intercostal artery in a Marfan patient at risk for spinal cord ischemia (SCI). Case Report: A 43-year-old man with Marfan syndrome presented with a type IV thoracoabdominal aortic aneurysm (TAAA) and history of multiple previous cardiac and aortic operations over the past 28 years. The maximum diameter of the aneurysm was 60 mm. The patient had 2 right renal arteries and 2 reimplanted segmental arteries (1 occluded). With the goal of preserving both right renal arteries and the large intercostal artery, a 6-branch, custom-made stent-graft was planned and manufactured. Bilateral femoral and right brachial artery access was used. The intercostal artery was catheterized and connected to the retrograde branch from a femoral access. Final angiography and predischarge computed tomography angiography (CTA) showed unimpeded flow to all 6 target vessels. The patient was discharged on postoperative day 10 without clinical signs of SCI. Six-month follow-up CTA demonstrated exclusion of the TAAA and patency of all 6 branches. Conclusion: Multibranched endovascular aortic repair with a branch to a large intercostal artery was technically feasible and clinically successful.

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