Zone 2 landing at different aortic pathologies: Surgeon-modified 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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Therapeutic Strategies for Infectious Multiple Aortic Aneurysms: Thoracoabdominal Aortic Aneurysm Treatment Using a Fenestrated Stent-Graft

Annals of Vascular Diseases ◽

10.3400/avd.cr.20-00032 ◽

2020 ◽

Vol 13 (3) ◽

pp. 326-329

Author(s):

Satoshi Okugi ◽

Takashi Azuma ◽

Yoshihiko Yokoi ◽

Satoru Domoto ◽

Hiroshi Niinami

Keyword(s):

Aortic Aneurysm ◽

Stent Graft ◽

Thoracoabdominal Aortic Aneurysm ◽

Therapeutic Strategies ◽

Aortic Aneurysms ◽

Aneurysm Treatment ◽

Fenestrated Stent Graft

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Evolution of Fenestrated Stent-Graft Design in Early Versus Late Experience with Fenestrated Stent-grafts

European Journal of Vascular and Endovascular Surgery ◽

10.1016/j.ejvs.2019.09.204 ◽

2019 ◽

Vol 58 (6) ◽

pp. e687

Author(s):

Pablo Marques de Marino ◽

Athanasios Katsargyris ◽

Sebastian Nagel ◽

Eric Verhoeven

Keyword(s):

Stent Graft ◽

Stent Grafts ◽

Fenestrated Stent Graft

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Handmade stent graft fenestration to preserve left subclavian artery in thoracic endovascular aortic repair†

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezz049 ◽

2019 ◽

Vol 56 (3) ◽

pp. 587-594 ◽

Cited By ~ 5

Author(s):

Huey-Shiuan Kuo ◽

Jih-Hsin Huang ◽

Jer-Shen Chen

Keyword(s):

Carotid Artery ◽

Stent Graft ◽

Subclavian Artery ◽

Common Carotid Artery ◽

Left Subclavian Artery ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Technical Success ◽

Aortic Stent Graft ◽

Aortic Pathologies

Abstract OBJECTIVES This study aimed to evaluate the efficacy and safety of a handmade fenestrated stent graft over an aortic stent graft for preserving the left subclavian artery (LSA) in thoracic endovascular aortic repair (TEVAR). METHODS From July 2015 to October 2018, a total of 32 consecutive patients with various thoracic aortic pathologies who underwent TEVAR in which handmade fenestration over a thoracic aortic stent graft was used for LSA were included. Outcomes including technical success, procedure-related complications, perioperative mortality and morbidity and graft patency were analysed. RESULTS Twenty-four patients (75.00%) presented with aortic dissection, 5 patients (15.63%) with thoracic aortic aneurysm and 2 patients (6.25%) with penetrating aortic ulcer; 1 patient (3.13%) required re-TEVAR due to endoleak and sac expansion from previous TEVAR for thoraco-abdominal aneurysm. TEVAR was performed in a zone 2 landing with single fenestration for LSA (26 patients, 81.25%), zone 1 landing with double fenestration for both LSA and left common carotid artery (5 patients, 15.63%) or zone 1 landing with single fenestration for LSA and a chimney graft for left common carotid artery (1 patient, 3.13%). The technical success rate, defined as the successful alignment of fenestration to LSA, was 93.75%. At a mean follow-up of 17.3 months, 4 cases of endoleak and 2 cases of stent graft-induced new entry were noted, 3 of which were treated endovascularly. CONCLUSIONS Our preliminary results demonstrate the viability of preserving LSA blood flow in TEVAR using a handmade stent graft fenestration to treat various aortic pathologies in various clinical situations and the technical feasibility and short-term results that may justify the use of this method in emergency cases.

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