Assessment of Bridging Stent Grafts in Branched Endovascular Aortic Repair (EVAR) Procedures Using Intravascular Ultrasound (IVUS).
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ABSTRACT:
SUBMITTER: Usai MV
PROVIDER: S-EPMC8077033 | biostudies-literature | 2020
REPOSITORIES: biostudies-literature
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Assessment of Bridging Stent Grafts in Branched Endovascular Aortic Repair (EVAR) Procedures Using Intravascular Ultrasound (IVUS).
Usai Marco V MV Oberhuber Alexander A Asciutto Giuseppe G
EJVES vascular forum 20200423
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Project description:ObjectivesThis study aims to improve fenestrated/branched endovascular aortic repair (F/B EVAR) through fabricating physician-modified stent grafts (PMSG) with short bridging stent to treat complex aortic dissection.MethodsFrom November 2018 to January 2024, a total of 82 aortic dissection patients were treated by F/B EVAR combined with short bridging stents, including 19 aortic arch dissection patients and 63 thoracoabdominal aortic dissection patients. Inner or outer short bridging stents were applied to fabricate PMSG with the help of 3D-printing models intraoperatively. All patients underwent postoperative evaluation by enhanced computed tomography in follow-up.ResultsAll aortic dissections were successfully repaired. In aortic arch group, the average operative time was 289.2 ± 88.8 min. The perioperative mortality rate was 5.3%. The total reintervention rate was 5.3%. The average follow-up duration of 36.2 ± 9.5 months. The total incidence of endoleak after surgery was 15.8%. In thoracoabdominal aorta group, the average operative time was 345.5 ± 112.0 min. The perioperative mortality rate was 1.6%. The total reintervention rate was 1.6%. The average follow-up duration of 32.4 ± 19.2 months. The total incidence of endoleak after surgery was 11.1%.DiscussionThe application of short bridging stents has shown promising results in reducing endoleak rates after F/B EVAR. 3D-printing is a feasible way to assist the precise fenestration and design of short bridging stents. However, the safety and reliability of this method need to be further validated.
| S-EPMC11578960 | biostudies-literature
Project description:BackgroundThe treatment of residual pathology of the aortic arch after surgical repair for type A acute dissection (AAD) represents a therapeutic challenge. Recently, new branched endovascular devices have expanded the possibility of aortic arch stent-grafting (ASG) with proximal landing in zone 0. The aim of this retrospective, single-center study was to evaluate outcomes of patients with a history of surgical repair for AAD undergoing ASG with branched devices.MethodsWe analyzed patients undergoing ASG after treatment for type AAD with 2 different branched devices: Nexus (dual-module, single branch, off-the-shelf) and RelayBranch (single-module, dual branch, custom-made). Before ASG, surgical bypass of supra-aortic vessels was performed according to patient's anatomy and to the selected device. All patients underwent clinical and computed tomography scan evaluation before hospital discharge, at 6 months, and on a yearly basis thereafter.ResultsFrom March 2017 to April 2019, 4 consecutive patients underwent ASG after surgery for AAD at our institution. Mean time from surgery for AAD to ASG was 20 months. Mean age at the time of ASG was 72 years. Nexus and Relay were implanted in 2 patients each. All patients survived and were successfully discharged. Mean intensive care unit stay and hospital stay were 3 and 19 days, respectively. We did not observe any major adverse events. At a mean follow-up of 28 months, all patients are alive and computed tomography scans showed good anatomic results with no endoleaks.ConclusionsThis preliminary experience shows that ASG after surgery for AAD is feasible and provides encouraging clinical and anatomic early results.
| S-EPMC8302916 | biostudies-literature
Project description:A traumatic thoracic aortic injury is fatal in the majority of cases. Surviving the aortic injury in addition to the myriad of associated trauma requires comprehensive medical management from many medical services. Balancing these services and coordinating the medical care requires free and open communication between services. Although one might assume a thoracic aortic injury takes precedence over other injuries, an organized plan of care in which the morbidity of the injury as well as the consequences of treatment of each injury helps provide an appropriate "rank order" in the treatment process. A patient with a thoracic aortic injury can be observed for several days while additional injuries are treated, as long as appropriate blood pressure controls are observed. The treatment order for multiple injuries must be reevaluated on a regular basis to adjust for changes in the overall clinical condition. This rank order to treatment and scheduled treatment plan allows for appropriate imaging, evaluation, and coordination of services in preparation for the placement of a thoracic aortic stent graft. The goal of treatment is to reduce the risk of aortic rupture and subsequent fatal hemorrhage. Choosing an open surgical repair versus an endovascular stent graft depends upon physician expertise and clinical status of the patient. In the appropriate clinical setting, endovascular repair of the thoracic aortic injury has become the treatment of choice at the authors' institution in patients with significant operative risks and extensive comorbid injuries. Specific characteristics of the injured aorta also dictate the type of endovascular device required for repair. Case reviews of a patient with blunt trauma and a patient with penetrating trauma used to demonstrate clinical parameters, imaging options, and details of stent graft choice and placement, are presented followed by a review of the literature.
| S-EPMC3140249 | biostudies-other
Project description: Not available
| S-EPMC11689523 | biostudies-literature
Project description:ObjectivesTo evaluate outcomes after thoracic endovascular aortic repair in young patients sustaining traumatic blunt aortic injury (BAI) using iliac extension stent-grafts because of small aortic diameters measuring <24 mm.MethodsRetrospective analysis regarding clinical presentation, trauma management, endovascular techniques and outcome of patients with a small descending aorta involving an iliac extension stent-graft to treat traumatic BAI.ResultsAmong 48 patients who suffered a BAI and underwent thoracic endovascular aortic repair, 7 received iliac extension stent-grafts. They were 27.4/[standard deviation (SD): -13.1] years old and 6 out of 7 were male. The iliac extension stent-graft was used as distal stent-graft, and a thoracic stent-graft was used in most patients as proximal extension. We achieved overall technical success in all patients during a procedure lasting 92.6 (SD: 54.9) min. One patient died 2 days after the endovascular procedure of hypoxic brain injury, and another died after 17 days of liver failure. That patient had also suffered a spinal cord injury following the procedure, as the stent-graft had been deployed in Ishimaru Zone 2, and the carotid to subclavian bypass had to be omitted because of his critical condition. Control computed tomographic angiographs was available in 6 patients after 7.7 (SD: 5.1) days and showed no endoleak. The surviving patients were discharged after 18.4 (SD: 13.4) days.ConclusionsTreating traumatic BAI using iliac extension stent-grafts in young patients with small aortic diameters is feasible. We observed no mortality caused by the BAI or related to endovascular therapy within this small patient cohort.
| S-EPMC9153381 | biostudies-literature
Project description:Background: This study examines the impact of the use of the combination of BeGraft and Solaris stent grafts on the outcomes during the covered endovascular reconstruction of aortic bifurcation (BS-CERAB) technique and extension to the iliac arteries. Methods: Consecutive patients with aortoiliac occlusive disease who underwent endovascular treatment using BS-CERAB between January 2020 and December 2023 were included. Patient demographics, symptoms, lesion characteristics, and procedural and follow-up details were collected and analyzed. Perioperative complications and reinterventions were also identified. Results: A total of 42 patients met the inclusion criteria (32 men, 76.2%, median age 72 years, range 59-85). Indications for treatment were intermittent claudication (42.9%) and critical limb ischemia (57.1%). Procedure success was achieved in all cases. The median patient follow-up time was 14 months (1-36). One patient died at a 10-month follow-up due to lung cancer. The mean pre-operative ABI increased from 0.37 ± 0.19 before intervention to 0.71 ± 1.23 post-operatively at 12 months (p = 0.037). The estimated primary patency rates at 3, 6, and 12 months were 90.5%, 85.7%, and 81.0% and primary assisted patency rates were 90.5%, 90.5%, and 85.7%, respectively. Secondary patency was 95.2% at 3 and 6 months and 90.5% at a 12-month follow-up. Active cancer (p = 0.023, OR 2.12 95%CI 1.14-3.25) was a risk factor for restenosis. Conclusions: This mid-term experience shows that the CERAB technique using the combination of BeGraft and Solaris stents grafts, for the endovascular treatment of severe aortoiliac atherosclerotic disease, may allow an effective reconstruction of the aortic bifurcation and iliac arteries related to high-patency and lower-reintervention rates.
| S-EPMC11012459 | biostudies-literature
Project description:BackgroundThoracic endovascular aortic repair (TEVAR) with fenestrated surgeon-modified stent-grafts (f-SMSGs) is becoming an option for treating type B aortic dissection (TBAD) involving the aortic arch. This study aimed to evaluate the outcomes of this technique.MethodsA retrospective multicenter study was conducted, involving consecutive patients from three medical centers in China who underwent TEVAR with f-SMSG for TBAD. A new technique called "Lu's direction-turnover technique" was employed to align the fenestrations with supra-aortic vessels.ResultsFrom March 2016 to January 2020, 117 patients diagnosed with TBAD were deemed eligible for inclusion. The technical success rate was 94% (n=110). The estimated 30-day survival rate was 97.4% [95% confidence interval (CI): 94.5% to 100.0%], with freedom from re-intervention estimated at 95.7% (95% CI: 92.0% to 99.4%). The median follow-up period was 27 months (interquartile range, 19 to 35 months). The estimated survival rate at 27 months was 94.9% (95% CI: 90.8% to 98.9%) and the rate of freedom from re-intervention was 91.5% (95% CI: 86.3% to 96.6%). Cases of retrograde type A aortic dissection, stroke and endoleaks were documented. Five cases of retrograde type A aortic dissection were documented, with three occurring within 30 days and one during the follow-up. Four cases of stroke were recorded, with one occurring within 30 days and three during the follow-up. Furthermore, eleven cases of endoleaks were recorded, with one occurring within 30 days and ten during the follow-up.ConclusionsClinically acceptable technical success and prognosis were observed in a cohort with TEVAR with f-SMSG for the treatment of TBAD involving the aortic arch, which necessitated revascularization of the supra-aortic vessels. Further comparative studies are required to validate the benefits of this approach.
| S-EPMC11494561 | biostudies-literature
Project description:Abdominal aortic aneurysm (AAA) is a frequent aortic disease. If the diameter of the aorta is larger than 5 cm, an open surgical repair (OSR) or an endovascular aortic repair (EVAR) are recommended. To prevent possible complications (i.e., endoleaks), EVAR-treated patients need to be monitored for 5 years following the intervention, using computed tomography angiography (CTA). However, this radiological method involves high radiation exposure in terms of CTA/year. In such a context, the study of peripheral-blood-circulating extracellular vesicles (pbcEVs) has great potential to identify biomarkers for EVAR complications. We analyzed several phenotypes of pbcEVs using polychromatic flow cytometry in 22 patients with AAA eligible for EVAR. From each enrolled patient, peripheral blood samples were collected at AAA diagnosis, and after 1, 6, and 12 months following EVAR implantation, i.e. during the diagnostic follow-up protocol. Patients developing an endoleak displayed a significant decrease in activated-platelet-derived EVs between the baseline condition and 6 months after EVAR intervention. Furthermore, we also observed, that 1 month after EVAR implantation, patients developing an endoleak showed higher concentrations of activated-endothelial-derived EVs than patients who did not develop one, suggesting their great potential as a noninvasive and specific biomarker for early identification of EVAR complications.
| S-EPMC9782915 | biostudies-literature
Project description:ObjectiveTotal endovascular repair of aortic arch aneurysms is feasible in select patients. This study aims to evaluate the feasibility and early outcomes of total endovascular arch repair using 3-vessel company-manufactured devices (CMDs) and physician-modified endo grafts (PMEGs).MethodsPatients unfit for open repair who underwent 3-vessel total arch repair at a single institution from 2018 to 2021 were reviewed. Patients received either 3-vessel inner-branch CMDs or PMEGs. Three-vessel designs were used to incorporate the innominate, left common carotid, and left subclavian arteries. The antegrade inner branches in both devices were accessed via right brachial or carotid approach. The left carotid was accessed via carotid cutdown or femoral approach. The left subclavian artery was accessed via transfemoral approach. The study endpoints included procedural technical success, patient survival, neurologic events, cardiac complications, reinterventions, and target artery patency.ResultsNine patients underwent treatment. Four patients were treated with PMEGs, and 5 with CMDs. Procedural technical success was 100%. There were no in-hospital deaths. There were no strokes, transient ischemic attacks, myocardial infarction, or spinal ischemia in the perioperative period. Major adverse events occurred in 3 patients (33%). Two (22%) vascular access complications and one (11%) acute kidney injury occurred. One (11%) patient required early reintervention for an access complication. The median follow-up period was 358 days (CMD, 392 days; PMEG, 198 days). There was a late reintervention and conversion to open repair at 142 days of follow-up in a patient with a PMEG that developed an aortic infection, leading to death on postoperative day 239. The mean length of stay was 7±4 days. Computed tomography imaging obtained during the immediate postoperative period revealed endoleak in 6 (66%) patients, out of which 5 resolved spontaneously and 1 required reintervention via left subclavian artery stenting. Target artery patency was 100% at the end of the follow-up period.ConclusionsThree-vessel total endovascular aortic arch repair using a CMD or PMEG is feasible with optimal early outcomes. Physician-modified stent-grafts are a feasible option for patients who do not meet anatomic criteria for CMDs.Clinical impactManagement of aortic arch disease remains a significant challenge in vascular surgery. This study showcases the feasibility and safety of using a total endovascular approach to repair the aortic arch, which could potentially reduce morbidity and mortality associated with traditional surgical approaches. The results suggest that this minimally invasive technique could be an alternative treatment option for high-risk patients and could significantly improve outcomes for those requiring aortic arch repair. Overall, this study represents a promising development in the field of endovascular surgery and highlights the potential to improve patient outcomes.
| S-EPMC11552197 | biostudies-literature
Project description:Retrograde type B aortic dissection after perivisceral aortic endograft placement is a rare occurrence, not well described in literature. A handful of case reports describe this complication after infrarenal endovascular aortic aneurysm repair (EVAR). We have identified retrograde type B aortic dissection after fenestrated-branched EVAR (F/BEVAR) as a rare, but real complication. We describe diagnosis and management of 4 such occurrences in the context of 344 F/BEVARs.
| S-EPMC11868759 | biostudies-literature