Successful Long-term Patency of a Complicated Coronary Aneurysm at a Prior Coronary Branch Stent Treated with a Stent Graft and Dedicated Bifurcation Stent

The aim of this paper is to share our experience in managing a patient with Klebsiella pneumoniae mycotic abdominal aortic aneurysm who was also infected with COVID-19. A 69-year-old male was transferred to our hospital for the management of an infra-renal mycotic abdominal aortic aneurysm. During his hospital course, the patient contracted severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). He was intubated due to respiratory distress. Over a short period, his mycotic aneurysm increased in size from 2.5 cm to 3.9 cm. An emergency repair of his expanding aneurysm was achieved using our previously described protocol of coating endovascular stents with rifampin. The patient was managed with a rifampin-coated endovascular stent graft without any major complications. Postoperatively, the patient did not demonstrate any neurological deficits nor any vascular compromise. He remained afebrile during his postoperative course and was extubated sometime thereafter. He was then transferred to the ward for additional monitoring prior to his discharge to a rehab hospital while being on long-term antibiotics. During his hospital stay, he was monitored with serial ultrasounds to ensure the absence of abscess formation, aortic aneurysm growth or graft endoleak. At 6 weeks after stent graft placement, he underwent a CT scan, which showed a patent stent graft, with a residual sac size of 2.5 cm without any evidence of abscess or endoleak. Over a follow-up period of 180 days, the patient remained asymptomatic while remaining on long-term antibiotics. Thus, in patients whose surgical risk is prohibitive, endovascular stent grafts can be used as a bridge to definitive surgical management.

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The first commercial use of the Valiant Navion stent graft system for endovascular repair of a descending thoracic aortic aneurysm

Vascular ◽

10.1177/1708538120981127 ◽

2020 ◽

pp. 170853812098112

Author(s):

Cassra N Arbabi ◽

Navyash Gupta ◽

Ali Azizzadeh

Keyword(s):

Stent Graft ◽

Standard Of Care ◽

Aortic Aneurysms ◽

Descending Thoracic Aortic Aneurysm ◽

Thoracic Aortic Aneurysms ◽

Commercial Use ◽

Early Results ◽

Multiple Configuration ◽

One Year

Objectives Thoracic endovascular aortic repair (TEVAR) is the standard of care for descending thoracic aortic aneurysms (DTAA), and newer generation stent grafts have significant design improvements compared to earlier generation devices. Methods We report the first commercial use of the Medtronic Valiant Navion stent graft for treatment of an 85-year-old woman with a 5.8 cm DTAA and a highly tortuous thoracic aorta. Results A percutaneous TEVAR was performed using a two-piece combination of the Valiant Navion FreeFlo and CoveredSeal stent graft configurations for zones 2–5 coverage. The devices were successfully delievered through highly tortuous anatomy and deployed, excluding the entire length of the aneurysm with precise landing, excellent apposition and no evidence of endoleak. The patient tolerated the procedure well and has had no stent graft-related complications through one-year follow-up. Conclusions Design enhancements such as a lower profile delivery system, better conformability, and a shorter tapered tip are some of the improvements to this third-generation TEVAR device. Coupled with the multiple configuration options available, this gives physicians a better tool to treat thoracic aortic pathologies in patients with challenging anatomy. The early results are encouraging, and evaluation of long-term outcomes will continue.

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Lessons learned from the long-term follow-up of a first-generation aortic stent graft

Journal of Vascular Surgery ◽

10.1067/mva.2003.75 ◽

2003 ◽

Vol 37 (2) ◽

pp. 367-373 ◽

Cited By ~ 51

Author(s):

Pierre Alric ◽

Robert J. Hinchliffe ◽

Peter W. Wenham ◽

Simon C. Whitaker ◽

Timothy A.M. Chuter ◽

...

Keyword(s):

Stent Graft ◽

First Generation ◽

Lessons Learned ◽

Aortic Stent Graft ◽

Long Term Follow Up

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Abstract 219: Long - Term Prognosis Of Patients With Kawasaki Disease Complicated By Significant Coronary Aneurysm (diameter ≥ 6 mm)

Circulation ◽

10.1161/circ.131.suppl_2.219 ◽

2015 ◽

Vol 131 (suppl_2) ◽

Author(s):

Ji Seok Bang ◽

Gi Beom Kim ◽

Bo Sang Kwon ◽

Eun Jung Bae ◽

Chung Il Noh ◽

...

Keyword(s):

Coronary Artery ◽

Kawasaki Disease ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Coronary Aneurysm ◽

Coronary Intervention ◽

Surgical Interventions ◽

Coronary Aneurysms ◽

The Mean

Background: Some patients with Kawasaki disease (KD) develop large coronary aneurysms (diameter ≥ 6mm) and coronary stenosis, leading to ischemic heart disease. This study determined the long-term outcome for patients with Kawasaki disease complicated by significant coronary aneurysm. Methods and Results: From the database in Seoul National University Children’s Hospital between December 1986 and December 2013, medical records of 83 patients (61 men and 22 women) with large coronary aneurysms (diameter ≥ 6mm) were retrospectively reviewed. Information on patient demographics, catheter or surgical interventions, and most recent status was collected. From these data, we calculated the survival rate, cumulative coronary intervention rate, coronary artery bypass graft surgery rate. The mean age at onset was 4.28 ± 2.62 years, and the mean observational period was 13.2 ± 6.5 years. The maximum coronary artery internal diameter ranged from 6.1 to 25mm (median 9mm). Giant coronary aneurysm was 57 patients (68.7%) and large coronary aneurysm (6-8mm) was 26 patients (31.3%). Coronary aneurysms had progressed to coronary artery stenosis and/or complete occlusion in 42 patients (50.6%). The overall freedom from coronary intervention, coronary artery bypass surgery, or coronary thrombi was respectively 85.5%, 85.5%, and 90.3%. Catheter and surgical coronary interventions (median 1 intervention; range 1 to 5 interventions) were performed in 20 patients (24.1%) at 9 month to 18 years after onset, resulting in 33.7% cumulative coronary intervention rates at 20 years after onset. There were no differences in cumulative coronary intervention rates between two coronary aneurysm groups (6-8mm vs ≥8mm). Myocardial infarction occurred in 8 (8.98 %) patients. During this study period, 1 patient died and 98% survival rates was seen in our patients group. Conclusion: The long-term survival of patients with Kawasaki disease complicated by large coronary aneurysm is good even though a fourth of patients underwent multiple catheter or surgical interventions. Further research should focus on the indications for and effectiveness of percutaneous and surgical coronary interventions in large coronary aneurysm (≥ 6mm).

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Long-term outcome of Kawasaki disease complicated by a large coronary aneurysm

Pediatrics & Therapeutics ◽

10.4172/2161-0665-c10-079 ◽

2018 ◽

Vol 08 ◽

Author(s):

Jo Won Jung

Keyword(s):

Kawasaki Disease ◽

Coronary Aneurysm ◽

Term Outcome ◽

Long Term Outcome

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Abstract No. 637 Stent-graft placement to treat central venous stenosis in hemodialysis patients: long-term results

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2018.01.682 ◽

2018 ◽

Vol 29 (4) ◽

pp. S264

Author(s):

W. Yang ◽

D. Gwon ◽

S. Noh ◽

H. Chu ◽

J. Kim ◽

...

Keyword(s):

Stent Graft ◽

Hemodialysis Patients ◽

Long Term Results ◽

Central Venous ◽

Graft Placement ◽

Central Venous Stenosis ◽

Venous Stenosis

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High Long Term Re-Intervention Rates for a Third Generation Stent Graft

European Journal of Vascular and Endovascular Surgery ◽

10.1016/j.ejvs.2020.02.025 ◽

2020 ◽

Vol 60 (1) ◽

pp. 26

Author(s):

Jonathan R. Boyle

Keyword(s):

Stent Graft ◽

Third Generation

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The Evaluation of Aortic Diameter Changes During Long-Term Follow-Up After Endovascular Treatment of Acute Blunt Traumatic Thoracic Aortic Injuries

Vascular and Endovascular Surgery ◽

10.1177/1538574418765385 ◽

2018 ◽

Vol 52 (5) ◽

pp. 335-343 ◽

Cited By ~ 6

Author(s):

Federico Fontana ◽

Edoardo Macchi ◽

Filippo Piacentino ◽

Larissa Nocchi Cardim ◽

Giuseppe De Marchi ◽

...

Keyword(s):

Endovascular Treatment ◽

Stent Graft ◽

Mean Value ◽

Aortic Diameter ◽

Long Term Results ◽

Technical Success ◽

Long Term Follow Up ◽

Aortic Injuries

Purpose: To evaluate the variations in aortic diameters and long-term results in patients who underwent thoracic endovascular aortic repair (TEVAR) for acute blunt traumatic thoracic aortic injuries (BTTAIs). Materials and Methods: We retrospectively evaluated 23 patients with a mean age of 39 years (range: 17-74 years) who underwent TEVAR for BTTAI between October 2000 and November 2014. All of the patients underwent computed tomography angiography (CTA) before hospital discharge as a baseline imaging for the subsequent follow-up examinations. The technical success, overall survival, and complications were evaluated. Furthermore, the aortic diameters outside of the stent-graft (1 cm proximal and 1 cm distal to the stent-graft) and the aortic diameters within the stent-graft (2 cm distal to the proximal end and 2 cm proximal to the distal end) were assessed. The diameters at baseline on CTA were compared with those of the latest available follow-up examination. Results: Technical success was 100% with a mean follow-up of 65.4 months (range: 12-171 months). No death was registered, and 2 (8.7%) of 23 endograft-related complications (1 stent-graft distal infolding and 1 endoleak 2 and 4 months after the procedure, respectively) were observed. An increase in aortic diameter either proximal or distal to the stent-graft (mean value 0.7 and 0.5 mm, respectively) or within the stent-graft (mean value of 0.5 mm for both proximal and distal diameters) was registered (mean follow-up at 65.4 months, range: 12-171 months). Conclusion: Aortic dilatation following TEVAR for BTTAI is minimal during long-term follow-up. Endovascular treatment represents a durable and safe option in acute BTTAIs.

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Long-term Patency and Clinical Outcome of the Viabahn Stent-Graft for Femoropopliteal Artery Obstructions

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2007.07.011 ◽

2007 ◽

Vol 18 (11) ◽

pp. 1341-1349 ◽

Cited By ~ 73

Author(s):

Richard R. Saxon ◽

Jeanine M. Coffman ◽

Justin M. Gooding ◽

Donald J. Ponec

Keyword(s):

Clinical Outcome ◽

Stent Graft ◽

Femoropopliteal Artery

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Functional Endoluminal Paving (FELP): Thermoforming, Biodegradation, and Mechanical Properties of a Novel Polymer Graft for Abdominal Aortic Aneurysms

ASME 2010 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2010-19463 ◽

2010 ◽

Cited By ~ 1

Author(s):

John H. Ashton ◽

James A. M. Mertz ◽

Megan J. Alexander ◽

Marvin J. Slepian ◽

Joseph L. Mills ◽

...

Keyword(s):

Mechanical Properties ◽

Stent Graft ◽

Endovascular Repair ◽

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Complex Anatomy ◽

Abdominal Aortic ◽

Drug Treatments

The preferred method to treat abdominal aortic aneurysms (AAAs) is endovascular repair with a stent-graft (EVAR). Although EVAR is fairly successful, there are several challenges to address, which include patient ineligibility due to complex anatomy and long-term failure due to migration and endoleak. Drug treatments that reduce or halt AAA growth are also currently under investigation [1].

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