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't Mannetje YW, Reijnen MMPJ, Zeebregts CJ. Upside-Down Gore Excluder as an Endoprosthesis for Aortoiliac Aneurysm Exclusion: A Retrospective Multicenter Study. J Endovasc Ther 2024:15266028231224257. [PMID: 38193446 DOI: 10.1177/15266028231224257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
OBJECTIVE The upside-down configuration of a Gore Excluder contralateral leg endoprosthesis has been used to overcome diameter differences in the endovascular treatment of aortoiliac aneurysms. Our goal was not to describe the technique but to study the applicability and safety. MATERIAL AND METHODS Patients were retrospectively enrolled. The indication and details of the procedure were at the discretion of the treating physicians. A case report form was completed including baseline characteristics, indication for treatment, procedural data, and outcomes during follow-up. RESULTS A total of 31 subjects were enrolled with a range of indications, including 3 patients treated in the emergency setting (9.7%). In 64.5% (n=20), it was a primary intervention for a common iliac aneurysm (n=10), internal iliac aneurysm (n=4), or abdominal aortic aneurysm (n=6). In 11 subjects (35.5%), treatment was performed after previous aortoiliac interventions, including anastomotic iliac artery aneurysm (n=5), type III endoleak (n=3), and endograft thrombus (n=3). Median follow-up was 13 months (range=1-142 months). During follow-up, 2 patients required an upside-down contralateral leg-related secondary intervention, one for an occlusion and another for a type Ia endoleak. There was no type Ib or III endoleak, and no migration, kinking/stenosis, or conversion to open repair was observed. The aneurysm-related mortality was 3.3% (n=1). CONCLUSION An upside-down contralateral leg is a valuable technique that can be used to achieve adequate aneurysm exclusion or resolve complications. It is associated with a limited number of complications. CLINICAL IMPACT This article studies the use of an upside-down iliac endograft. We describe a wide range of indications in which this previously published technique has been applied. In elective and acute settings and as primary and revision intervention an upside-down iliac endograft was performed successfully. Furthermore, follow-up data is presented showing the effectiveness of the technique. Knowledge of this procedure is a valuable addition to the skillset of every interventionalist.
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Affiliation(s)
| | - Michel M P J Reijnen
- Department of Vascular Surgery, Rijnstate Hospital, Arnhem, The Netherlands
- Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - Clark J Zeebregts
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Ashkar S, Charbonneau P, Elkouri S. Inverted Ovation iX Limb to Treat an Isolated Common Iliac Artery Aneurysm. Vasc Specialist Int 2024; 40:1. [PMID: 38186264 PMCID: PMC10772719 DOI: 10.5758/vsi.230086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/26/2023] [Accepted: 11/29/2023] [Indexed: 01/09/2024] Open
Abstract
In recent years, endovascular aneurysm repair has become the predominant method of managing abdominal aortic and common iliac artery aneurysms. Off-label use of different endovascular devices has allowed them to remain a viable option in many cases of atypical anatomy. Some studies have reported the use of iliac devices in an upside-down configuration when the common iliac artery aneurysm has a reverse-tapered morphology. However, the use of the Ovation iX (Endologix) limb in an upside-down configuration has not yet been reported. This limb offers a 14 mm distal end when inverted and offers good patency in the tortuous iliac morphology. This case report describes and illustrates the precise deployment of an inverted Ovation iX limb to treat an isolated common iliac artery aneurysm.
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Affiliation(s)
- Said Ashkar
- Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - Philippe Charbonneau
- Division of Vascular Surgery, Centre Hospitalier de l’Université de Montréal, Québec, Canada
| | - Stephane Elkouri
- Division of Vascular Surgery, Centre Hospitalier de l’Université de Montréal, Québec, Canada
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Québec, Canada
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Stern JR, Tran K, Dossabhoy SS, Sorondo SM, Lee JT. A fenestrated, double-barrel technique for proximal reintervention after open or endovascular abdominal aortic aneurysm repair. J Vasc Surg Cases Innov Tech 2022; 9:101091. [PMID: 36747609 PMCID: PMC9898739 DOI: 10.1016/j.jvscit.2022.101091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
Objective Proximal endovascular reintervention after prior endovascular aortic repair (EVAR) or open abdominal aortic aneurysm repair (OR) can be challenging due to the short distance to the visceral branches. We present a novel solution to allow the use of the commercially available ZFEN device using a double-barrel, kissing-limb technique. Methods Patients who underwent fenestrated repair for proximal failure after EVAR or OR were identified. The ZFEN device is deployed above the prior graft flow divider. Once the visceral branches are secured, kissing limbs are used to connect with the prior graft limbs. The distal diameter of the standard ZFEN is 24 mm, accommodating two 20 mm components according to the formula 2πDLIMB = πDZFEN + 2DZFEN. Results Of 235 patients who underwent repair using ZFEN from 2012 to 2021 at a single institution, 28 were treated for proximal failure of prior repairs, with 13 treated using the double-barrel technique (8 EVAR, 5 OR). The distance from the flow divider to the lowest renal artery was 67 ± 24.4 mm (range, 39-128 mm), and the distance to the superior mesenteric artery (SMA) was 87 ± 30.5 mm (range, 60-164 mm). Technical success was 100%. Seven patients had standard ZFEN builds (2 renal small fenestrations, SMA large fen/scallop). The minimum distance to the lowest renal artery and SMA to accommodate a standard ZFEN build was 56 and 60 mm, respectively. Four patients required adjunctive snorkel grafts and two required laser fenestrations. Two patients had gutter leaks at 1 month that self-resolved; one patient developed a late type 1a endoleak. Freedom from reintervention was 90%, 72%, and 48% at 1, 2, and 3 years, respectively. Conclusions This double-barrel technique allows for distal seal of commercial ZFEN devices into prior open or endovascular repairs with good technical success. Long-term outcomes remain to be quantified.
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Affiliation(s)
- Jordan R. Stern
- Correspondence: Jordan R. Stern, MD, Stanford University School of Medicine, 780 Welch Rd, Ste CJ350, Palo Alto, CA 94304
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Mazzaccaro D, Righini P, Zuccon G, Modafferi A, Malacrida G, Nano G. The reversed bell-bottom technique (ReBel-B) for the endovascular treatment of iliac artery aneurysms. Catheter Cardiovasc Interv 2020; 96:E479-E483. [PMID: 32681707 DOI: 10.1002/ccd.29140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/12/2020] [Accepted: 06/27/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To describe the results of the reversed bell-bottom (ReBel-B) technique for the endovascular treatment of iliac aneurysms (IA) involving the origin of hypogastric artery (HA). METHODS The ReBel-B technique is a strategy for the occlusion of HA in selected patients presenting with IA, in whom the HA cannot be spared or safely occluded with coils or vascular plugs. When employing this technique, an iliac flared ("bell-bottom") extension is deployed in a reverse fashion, through a contralateral crossover femoral access that allows the occlusion of the HA at its origin, by exploiting the flared "bell" part of the reversed endograft. A second limb is then deployed to complete the implant, from the common iliac to the external iliac artery, inside the previous graft. Data of all consecutive patients treated with this technique in our experience were then retrospectively reviewed, and outcomes analyzed. RESULTS The ReBel-B technique was employed in total of six patients who came in an emergent setting for the rupture of a common IA, from January 2014 to December 2018. Endovascular exclusion was performed using a ReBel-B graft plus iliac leg in five out of six cases. In the remaining case, a bifurcated aortic endograft was used to complete the aneurysm exclusion. Technical success was 100%. No complications occurred. CONCLUSIONS In selected cases, the ReBel-B technique can be used for the complete exclusion of IA preventing type II endoleak from the HA, when the embolization with coils or plug or the preservation of the HA is anatomically unfeasible.
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Affiliation(s)
- Daniela Mazzaccaro
- First Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Paolo Righini
- First Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Gianmarco Zuccon
- First Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Alfredo Modafferi
- First Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Giovanni Malacrida
- First Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Giovanni Nano
- First Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Agostinucci A, Data S, Pagliasso E. Late Non-Anastomotic Rupture of a Bifurcated Dacron Aortic Graft Treated Using a Gore Excluder Limb Endoprosthesis. Vasc Specialist Int 2019; 35:241-244. [PMID: 31915670 PMCID: PMC6941776 DOI: 10.5758/vsi.2019.35.4.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/25/2019] [Accepted: 11/26/2019] [Indexed: 11/20/2022] Open
Affiliation(s)
- Andrea Agostinucci
- Division of Vascular and Endovascular Surgery, Ospedale San Giovanni Bosco, Turin, Italy
| | - Stefano Data
- Division of Vascular and Endovascular Surgery, Ospedale San Giovanni Bosco, Turin, Italy
| | - Elisa Pagliasso
- Division of Vascular and Endovascular Surgery, Ospedale San Giovanni Bosco, Turin, Italy
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Hashimoto T, Kato N, Tokui T, Miyake Y, Nasu M, Nakajima K, Higashigawa T, Chino S. Parallel placement of Excluder legs for treatment of type IIIb endoleaks caused by fabric tear after endovascular aneurysm repair. J Vasc Surg 2017; 66:1285-1289. [PMID: 28705593 DOI: 10.1016/j.jvs.2017.06.072] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 06/15/2017] [Indexed: 11/19/2022]
Abstract
A total of 576 patients underwent endovascular aneurysm repair using main body devices for treatment of abdominal aortic aneurysms or iliac artery aneurysms. During follow-up, type IIIb endoleaks caused by fabric tear occurred in six patients (1.0% [6/576]). The device used was Zenith (Cook Medical, Bloomington, Ind) in five cases and Talent (Medtronic, Santa Rosa, Calif) in one case. All endoleaks were close to the flow divider of the main body devices. The distance between the lower renal artery and the top end of the contralateral leg was 53 ± 14 mm. Bell-bottom-shaped Excluder (W. L. Gore & Associates, Flagstaff, Ariz) legs were placed parallel from the top of the main body device through both legs to treat these endoleaks. In two patients, coil embolization was required to treat gutter endoleaks. Postoperative computed tomography showed the obliteration of type IIIb endoleaks in all patients. Our technique may be an acceptable method for treatment of type IIIb endoleaks, especially when they occur near the flow divider.
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Affiliation(s)
| | - Noriyuki Kato
- Department of Radiology, Mie University Hospital, Tsu, Japan
| | - Toshiya Tokui
- Department of Cardiovascular Surgery, Ise Red Cross Hospital, Ise, Japan
| | - Yoichiro Miyake
- Department of Cardiovascular Surgery, Kochi Health Sciences Center, Kochi, Japan
| | - Michihiro Nasu
- Department of Cardiovascular Surgery, Toyooka Public Hospital, Toyooka, Japan
| | - Ken Nakajima
- Department of Radiology, Mie University Hospital, Tsu, Japan
| | | | - Shuji Chino
- Department of Radiology, Mie University Hospital, Tsu, Japan
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Álvarez Marcos F, Couto Mallón D, Vilariño López-Barranco P, Vilariño Rico J, Franco Meijide FJ, Caeiro Quinteiro S. Endograft limb trimming and resheathing can be an alternative for emergent aortic repair without adequate stent graft availability. J Vasc Surg Cases Innov Tech 2016; 2:88-91. [PMID: 38827201 PMCID: PMC11140363 DOI: 10.1016/j.jvscit.2016.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 04/08/2016] [Indexed: 11/24/2022] Open
Abstract
Endograft limb trimming can be an easy customization to perform in some emergent setups and when alternative adequate covered stents are lacking. A man aged 74 years presented with aortoenteric fistula and hemodynamic instability years after an aortobifemoral bypass, and a 56-year-old woman was admitted with acute ischemia due to an aortic ulcer-like lesion. In both cases, tabletop deployment and removal of two stents from an Endurant iliac limb (Medtronic, Fridley, Minn), followed by resheathing and deployment, allowed successful repair as a bridging therapy for open surgery. Both patients are alive and without walking impairment 8 and 6 months later, respectively.
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Kim HK, Song I, Huh S. The Upside-Down Gore Excluder Limb and Double-Barrel Sandwich Technique for Penetrating Aortic Ulcer and Iliac Aneurysm Exclusion. Vasc Specialist Int 2016; 32:17-21. [PMID: 27051656 PMCID: PMC4816021 DOI: 10.5758/vsi.2016.32.1.17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 02/14/2016] [Accepted: 02/22/2016] [Indexed: 11/20/2022] Open
Abstract
Endovascular aneurysm repair has become the first-line treatment for abdominal aortic aneurysms and iliac artery aneurysms in recent years. However, the diameter of the infrarenal aorta is larger than that of the aortic bifurcation, especially with small aortic diameters, for which a reversed tapered device is necessary. We describe the off-label use of the upside-down Gore Excluder limb and double-barrel sandwich technique for the treatment of a penetrating abdominal aortic ulcer with a large common iliac artery aneurysm. These techniques offer an easy endovascular approach for excluding an aneurysm in selected patients. However, this technique is outside the standard instructions for use, therefore careful planning and long-term follow-up are mandatory.
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Affiliation(s)
- Hyung-Kee Kim
- Division of Vascular Surgery, Department of Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Incheol Song
- Division of Vascular Surgery, Department of Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Seung Huh
- Division of Vascular Surgery, Department of Surgery, Kyungpook National University School of Medicine, Daegu, Korea
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