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Simmering JA, Koenrades MA, Slump CH, Groot Jebbink E, Zeebregts CJ, Reijnen MMPJ, Geelkerken RH. Renal and Visceral Artery Configuration During the First Year of Follow-Up After Fenestrated Aortic Aneurysm Repair Using the Anaconda Stent-graft: A Prospective Longitudinal Multicenter Study With ECG-Gated CTA Scans. J Endovasc Ther 2023:15266028231209929. [PMID: 37933525 DOI: 10.1177/15266028231209929] [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: 11/08/2023]
Abstract
OBJECTIVE The performance of fenestrated endovascular aortic aneurysm repair (FEVAR) may be compromised by complications related to the dynamic vascular environment. The aim of this study was to analyze the behavior of FEVAR bridging stent configurations during the cardiac cycle and during follow-up to improve our understanding on treatment durability. DESIGN Twenty-one patients presenting with complex abdominal aortic aneurysms (AAAs; 9 juxtarenal/6 pararenal/3 paravisceral/1 thoracoabdominal aortic aneurysm type IV), treated with a fenestrated Anaconda (Terumo Aortic, Inchinnan, Scotland, UK) with Advanta V12 bridging stents (Getinge, Merrimack, NH, USA), were prospectively enrolled in a multicenter observational cohort study and underwent electrocardiogram (ECG)-gated computed tomographic angiography (CTA) preoperatively, at discharge, 7-week, and 12-month follow-ups. METHODS Fenestrated endovascular aortic aneurysm repair stability was assessed considering the following variables: branch angle as the angle between the aorta and the target artery, end-stent angle as the angle between the end of the bridging stent and the native artery downstream from it, curvature and tortuosity index (TI) to describe the bending of the target artery. Body-bridging stent stability was assessed considering bridging stent flare lengths, the distances between the proximal sealing stent-ring and fenestrations and the distance between the fenestration and first apposition in the target artery. RESULTS Renal branch angles significantly increased after FEVAR toward a perpendicular position (right renal artery from median 60.9°, inter quartile range [IQR]=44.2-84.9° preoperatively to 94.4°, IQR=72.6-99.8°, p=0.001 at 12-month follow-up; left renal artery [LRA], from 63.7°, IQR=55.0-73.0° to 94.3°, IQR=68.2-105.6°, p<0.001), while visceral branch angles did not. The mean dynamic curvature only decreased for the LRA from preoperative (3.0, IQR=2.2-3.8 m-1) to 12-month follow-up (1.9, IQR=1.4-2.6 m-1, p=0.027). The remaining investigated variables did not seem to show any changes over time in this cohort. CONCLUSIONS Fenestrated endovascular aortic aneurysm repair for complex AAAs using the Anaconda fenestrated stent-graft and balloon-expandable Advanta V12 bridging stents demonstrated stable configurations up to 12-month follow-up, except for increasing renal branch angles toward perpendicular orientation to the aorta, yet without apparent clinical consequences in this cohort. CLINICAL IMPACT This study provides detailed information on the cardiac-pulsatility-induced (dynamic) and longitudinal geometry deformations of the target arteries and bridging stents after fenestrated endovascular aortic aneurysm repair (FEVAR) up to 12-month follow-up. The configuration demonstrated limited dynamic and longitudinal deformations in terms of branch angle, end-stent angle, curvature, and tortuosity index (TI), except for the increasing renal branch angles that go toward a perpendicular orientation to the aorta. Overall, the results suggest that the investigated FEVAR configurations are stable and durable, though careful consideration of increasing renal branch angles and significant geometry alterations is advised.
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Affiliation(s)
- Jaimy A Simmering
- Department of Surgery (Division of Vascular Surgery), Medisch Spectrum Twente, Enschede, the Netherlands
- Multi-modality Medical Imaging (M3i) Group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Maaike A Koenrades
- Department of Surgery (Division of Vascular Surgery), Medisch Spectrum Twente, Enschede, the Netherlands
- Multi-modality Medical Imaging (M3i) Group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, the Netherlands
- Medical 3D Lab, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Cornelis H Slump
- Robotics and Mechatronics (RaM) Group, Faculty of Electrical Engineering, Mathematics and Computer Science, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Erik Groot Jebbink
- Multi-modality Medical Imaging (M3i) Group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, the Netherlands
- Department of Surgery, Rijnstate, Arnhem, the Netherlands
| | - Clark J Zeebregts
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Michel M P J Reijnen
- Multi-modality Medical Imaging (M3i) Group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, the Netherlands
- Department of Surgery, Rijnstate, Arnhem, the Netherlands
| | - Robert H Geelkerken
- Department of Surgery (Division of Vascular Surgery), Medisch Spectrum Twente, Enschede, the Netherlands
- Multi-modality Medical Imaging (M3i) Group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, the Netherlands
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El-Sayed T, Zahed A, McCaslin J, Bungay P, Williams R, Nandhra S. Incidentally Discovered Fractured Proximal Nitinol Ring in Fenestrated Anaconda Stent Graft Device: an Important Radiographic Finding. Eur J Vasc Endovasc Surg 2023; 66:601-602. [PMID: 37516381 DOI: 10.1016/j.ejvs.2023.07.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 07/03/2023] [Accepted: 07/21/2023] [Indexed: 07/31/2023]
Affiliation(s)
- Tamer El-Sayed
- The Northern Vascular Centre, Freeman Hospital, Newcastle upon Tyne, UK
| | - Asef Zahed
- The Northern Vascular Centre, Freeman Hospital, Newcastle upon Tyne, UK
| | - James McCaslin
- The Northern Vascular Centre, Freeman Hospital, Newcastle upon Tyne, UK
| | - Peter Bungay
- Department of Radiology, Royal Derby Hospital, Derby, UK
| | - Robin Williams
- The Northern Vascular Centre, Freeman Hospital, Newcastle upon Tyne, UK
| | - Sandip Nandhra
- The Northern Vascular Centre, Freeman Hospital, Newcastle upon Tyne, UK.
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Jubouri M, Surkhi AO, Tan SZCP, Bailey DM, Williams IM. Patient longevity and survival with custom-made endovascular solutions: The Fenestrated Anaconda TM approach. Asian Cardiovasc Thorac Ann 2023; 31:615-623. [PMID: 36803010 DOI: 10.1177/02184923231158579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
BACKGROUND Endovascular aortic repair (EVAR) has become the mainstay treatment for abdominal aortic aneurysms and is associated with excellent clinical outcomes. However, there remains a risk of complications requiring reintervention. Several EVAR devices exist commercially, yet, the Terumo Aortic Fenestrated Anaconda™ has demonstrated outstanding results. The main scope of this study is to evaluate survival/longevity, target vessel patency (TVP), endograft migration and reintervention following Fenestrated Anaconda™ implantation and discuss relevant literature. METHODS The current study represents a 9-year cross-sectional international analysis of custom-made Fenestrated Anaconda™ device. For the statistical analysis, SPSS 28 for Windows and R was utilised. Pearson Chi-Square analysis was used to assess differences in cumulative distribution frequencies between variables. Statistical significance for all two-tailed tests was set at p < 0.05. RESULTS A total of 5058 patients received the Fenestrated Anaconda™ endograft. The Fenestrated Anaconda™ was indicated either due to complex anatomy for competitor devices (n = 3891, 76.9%) or based on surgeon preference (n = 1167, 23.1%). Both survival and TVP were 100% during the first 6 postoperative years but dropped to 77.1% and 81% thereafter. In the complex anatomy indication group, cumulative survival and TVP were both 100% until year 7 post-EVAR when they decreased to 82.8% and 75.7%. In the other indication group, survival and TVP were also 100% during the first 6 years but plateaued at 58.1% and 98.8% in years 7-9 of follow-up. No cases of endograft migration and reintervention were recorded. CONCLUSION The Fenestrated Anaconda™ has been proven across the literature to be a highly effective EVAR endograft, as it has demonstrated excellent survival/longevity and TVP as well as minimal endograft migration and reintervention.
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Affiliation(s)
- Matti Jubouri
- Hull York Medical School, University of York, York, UK
| | | | - Sven Z C P Tan
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Damian M Bailey
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Cardiff, UK
| | - Ian M Williams
- Department of Vascular Surgery, University Hospital of Wales, Cardiff, UK
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Jubouri M, Surkhi AO, Tan SZ, Bailey DM, Williams IM, Bashir M. Correlative effect between sac regression and patient longevity following endovascular solution for abdominal aortic aneurysms: an international analysis. Asian Cardiovasc Thorac Ann 2023; 31:557-564. [PMID: 36168205 DOI: 10.1177/02184923221129983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Since the introduction of endovascular aortic repair (EVAR) it has become the mainstay treatment for abdominal aortic aneurysms. Several EVAR devices exist commercially, yet, the Terumo Aortic Fenestrated Anaconda™ endograft has demonstrated outstanding results. Evidence in the literature suggests that sac regression could be linked to patient survival and longevity. The main scope of this study is to evaluate sac regression and survival achieved using the Fenestrated Anaconda™ endograft and to discuss relevant literature. MATERIALS AND METHODS The current study represents a nine-year cross-sectional international analysis of custom-made Fenestrated Anaconda™ device. For the statistical analysis, SPSS 28 for Windows and R were utilised. Pearson chi-square analysis was used to assess differences in cumulative distribution frequencies between select variables. Statistical significance for all two-tailed tests was set at p < 0.05. RESULTS A total of 5,058 patients received the Fenestrated Anaconda™ in this study, either due to unsuitable/complex anatomy for competitor devices (n = 3,891) or based on surgeon preference (n = 1,167). A sac regression of 0-30% was observed in 4,772 (94.3%) over the first four years post-EVAR. Here, 99.6% of patients receiving the Fenestrated Anaconda™ due to unsuitable/complex anatomy for competitor devices and 76.8% based on surgeon preference had 0-30% sac regression. During years 5-9 of follow-up, all patients had 20-45% sac regression. Patient survival during the first six years post-EVAR was 100% but dropped to 77.1% in years 7-9. Survival differed between categorical patient subsets based on the indication. DISCUSSION The Fenestrated Anaconda™ has been proven to be a highly effective EVAR endograft. Evidence in the literature clearly demonstrates that sac regression is an accurate prognostic factor for patient survival and longevity.
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Affiliation(s)
- Matti Jubouri
- Hull York Medical School, University of York, York, UK
| | | | - Sven Zcp Tan
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Damian M Bailey
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Wales, UK
| | - Ian M Williams
- Department of Vascular Surgery, University Hospital of Wales, Cardiff, UK
| | - Mohamad Bashir
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Wales, UK
- Vascular and Endovascular Surgery, Velindre University NHS Trust, Health Education and Improvement Wales (HEIW), Cardiff, UK
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Jubouri M, Hussain K, Saha P, Alkhadire ZM, Tan SZ, Bailey DM, Williams IM, Bashir M. Endovascular solutions for abdominal aortic aneurysms: A comparative review of clinical outcomes with custom-made endografts. Asian Cardiovasc Thorac Ann 2023; 31:565-576. [PMID: 36299237 DOI: 10.1177/02184923221133956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND The introduction of endovascular aortic repair has revolutionised the treatment of abdominal aortic aneurysms, replacing open surgical repair for the majority of elective cases due to its optimal morbidity and mortality. Several endovascular aortic repair stent grafts exist commercially, one of which is the Fenestrated Anaconda™ by Terumo Aortic which benefits from a very innovative design, unique custom-made approach and highly favourable results. AIMS The main scope of this narrative review is to provide a comprehensive overview of endovascular aortic repair clinical outcomes using the Fenestrated Anaconda™ stent-graft and comparing these with its market competitor, Zenith. This review will also examine the evidence in the literature on the Anaconda™'s custom-made approach. METHODS A comprehensive literature was conducted on several search engines including PubMed, Google Scholar, Ovid, Scopus and Embase to collate the evidence in the literature on clinical outcomes achieved with the Fenestrated Anaconda™ and Zenith including, but not limited to, survival, technical success, target vessel patency, endoleak, reintervention and aneurysm sac regression. RESULTS The Fenestrated Anaconda™ is associated with excellent results, including highly favourable survival, technical and clinical success and target vessel patency rates, very low need for reintervention or conversion, and minimal incidence of complications such as endoleak and endograft migration. The Fenestrated Anaconda™ also drives significant sac regression and aortic remodelling. In addition, its unique custom-made approach enables it to treat highly complex aortic anatomy as well as to 'rescue' failed competitor grafts. CONCLUSION The Fenestrated Anaconda™ has proven that it is a very safe, highly applicable and extremely effective device used for complex aortic and/or iliac pathology based on its novel design and outstanding track record of clinical outcomes.
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Affiliation(s)
- Matti Jubouri
- Hull York Medical School, University of York, York, UK
| | - Kamran Hussain
- East Lancashire Teaching Hospitals NHS Trust, Blackburn, UK
| | - Priyanshu Saha
- School of Medicine, St George's University of London, London, UK
| | | | - Sven Zcp Tan
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Damian M Bailey
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - Ian M Williams
- Department of Vascular Surgery, University Hospital of Wales, Cardiff, UK
| | - Mohamad Bashir
- Vascular & Endovascular Surgery, Velindre University NHS Trust, Health Education & Improvement Wales (HEIW), Cardiff, UK
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Taher F, Plimon M, Walter C, Weiss G, Kliewer M, Assadian A, Falkensammer J. Fenestrated Endovascular Aortic Repair After Failed Endovascular Aortic Repair. J Endovasc Ther 2023:15266028231174113. [PMID: 37154408 DOI: 10.1177/15266028231174113] [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: 05/10/2023]
Abstract
PURPOSE Fenestrated endovascular aortic repair (FEVAR) is technically more challenging when performed after a failing EVAR procedure (FEVAR after EVAR). This study aims to assess the technical outcome of FEVAR after EVAR and to identify factors that may influence complication rates. METHODS A retrospective observational study was conducted at a single department of vascular and endovascular surgery. The rate of FEVAR after EVAR compared to primary FEVAR is reported. Complication and primary unconnected fenestration (PUF) rates as well as survival were assessed for the FEVAR after EVAR cohort. PUF rates and operating time were also compared to all primary FEVAR patients. Patient characteristics and technical factors such as number of fenestrations or use of a steerable sheath were assessed as possible influencers on technical success when performing FEVAR after EVAR. RESULTS Two hundred and nine fenestrated devices were implanted during the study period (2013 to April 2020). Thirty-five patients (16.7% of all FEVAR patients) had undergone FEVAR after EVAR and were included in the study. Overall survival at last follow-up (20.2±19.1 months) was 82.9% in FEVAR after EVAR patients. Rates of technical failure dropped significantly after 14 procedures (42.9% vs. 9.5%; p=0.03). Primary unconnected fenestrations were seen in 3 cases of FEVAR after EVAR (8.6%) and 14 of 174 primary FEVAR cases (8.0%; p>0.99). Operating time for FEVAR after EVAR was significantly higher than for primary FEVAR (301.1±110.5 minutes vs. 253.9±103.4 minutes; p=0.02). The availability of a steerable sheath was a significant predictor of reduced risk of PUFs, whereas age and gender, number of fenestrations or suprarenal fixation of the failed EVAR did not significantly influence PUF rates. CONCLUSION Fewer technical complications were seen over the study period in FEVAR after EVAR patients. While rates of PUFs were not different from primary FEVAR, operating time was significantly longer in patients undergoing FEVAR for failed EVAR. Fenestrated EVAR can be a valuable and safe tool to treat patients with progression of aortic disease or type Ia endoleak after EVAR but may be more complex to achieve than primary FEVAR. CLINICAL IMPACT This retrospective study assesses the technical outcome of fenestrated endovascular aortic repair (fenestrated EVAR; FEVAR) after prior EVAR. While rates of primary unconnected fenestrations were not different from primary FEVAR, operating time was significantly longer in patients undergoing FEVAR for failed EVAR. Fenestrated EVAR after prior EVAR may be technically more challenging than primary FEVAR procedures, but could be performed with equally good results in this patient cohort. FEVAR offers a feasible treatment option for patients with progression of aortic disease or type Ia endoleak after EVAR.
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Affiliation(s)
- Fadi Taher
- Department of Vascular and Endovascular Surgery, Klinik Ottakring, Vienna, Austria
| | - Markus Plimon
- Department of Vascular and Endovascular Surgery, Klinik Ottakring, Vienna, Austria
| | - Corinna Walter
- Department of Vascular and Endovascular Surgery, Klinik Ottakring, Vienna, Austria
| | - Gabriel Weiss
- Department of Cardiovascular Surgery, Klinik Floridsdorf, Vienna, Austria
| | - Miriam Kliewer
- Department of Vascular and Endovascular Surgery, Klinik Ottakring, Vienna, Austria
| | - Afshin Assadian
- Department of Vascular and Endovascular Surgery, Klinik Ottakring, Vienna, Austria
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Kapahnke S, Bürger M, Torsello GF, Omran S, Hinterseher I, Greiner A, Frese JP. Cannulation of visceral vessels using a steerable sheathin fenestrated and branched aortic endografts. Ann Vasc Surg 2022; 85:305-313. [PMID: 35271960 DOI: 10.1016/j.avsg.2022.02.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/18/2022] [Accepted: 02/19/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION A critical step in the endovascular treatment of complex aortic aneurysm is the cannulation and stenting of renovisceral vessels, especially in cases with a complex anatomy or atherosclerotic lesions. This study aimed to demonstrate the results of renovisceral vessel cannulation using a steerable sheath in fenestrated or branched endovascular aortic procedures (FB-EVAR). METHODS Patients undergoing elective FB-EVAR for asymptomatic thoracoabdominal or juxtarenal aneurysm at a single tertiary referral center from 2016 to 2019 were included in this study. Underlying pathologies, renovisceral target vessels (TV), technical success (TS), freedom from reintervention (FFR), and TV patency were assessed. Target vessels were categorized as challenging or non-challenging TV. RESULTS Fifty-three patients (median age 73 (Q1, Q3 (68 - 80)); 43 male (81%)) who underwent elective FB-EVAR were included. Indications comprised thoracoabdominal aneurysms (Crawford I-IV) (n = 26; 49%), juxtarenal aneurysms (n = 23; 43.5%) and penetrating aortic ulcers (PAU) (n = 4; 7.5%). Two patients (4%) had prior open aortic surgery, and three patients (6%) had undergone a failed standard EVAR before. Of the 196 treated TV, 131 (67%) were categorized as challenging. Cannulation was successful in 194 of 196 vessels (99%). A total of three TV (1.5%) showed periprocedural complications. No significant difference was found in the rate of intraoperative complications between challenging versus non-challenging TV (p = 0.457). One patient died within 30 days of the procedure (1.9%). No stroke or intestinal ischemia occurred. After 12, 24, and 36 months, the survival rate was 87%, 87%, and 81%, respectively Primary patency after 12 months was 98.6%, and 97.9% of vessels remained FFR during follow-up. CONCLUSION Transfemoral, retrograde cannulation of renovisceral vessels using a steerable sheath is feasible and safe and provides good mid-term results, especially in cases with challenging renovisceral vessels. The potential complications of antegrade vascular access can be avoided.
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Affiliation(s)
- Sebastian Kapahnke
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Vascular Surgery, Hindenburgdamm 30, 12203 Berlin, Germany.
| | - Matthias Bürger
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Vascular Surgery, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Giovanni Federico Torsello
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Safwan Omran
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Vascular Surgery, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Irene Hinterseher
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Vascular Surgery, Hindenburgdamm 30, 12203 Berlin, Germany; Medizinische Hochschule Brandenburg Theodor Fontane - Campus Neuruppin, Vascular Surgery; Fehrbelliner Str. 38, 16816 Neuruppin, Germany
| | - Andreas Greiner
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Vascular Surgery, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Jan Paul Frese
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Vascular Surgery, Hindenburgdamm 30, 12203 Berlin, Germany
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Creating Interactive Three-Dimensional Applications to Visualise Novel Stent Grafts That Aid in the Treatment of Aortic Aneurysms. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1356:1-29. [PMID: 35146615 DOI: 10.1007/978-3-030-87779-8_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Three-Dimensional (3D) medical animations incorporated into applications are highly beneficial for clinical outreach and medical communication purposes that work towards educating the clinician and patient. Aortic aneurysms are a clinically important area to communicate with multiple audiences about various treatment options; both abdominal and thoracic aortic aneurysms were selected to create 3D animations and applications to educate medical professionals and patients regarding treatment options. Fenestrated endovascular aortic repair (FEVAR) and thoracic endovascular aortic repair (TEVAR) are both tried and tested minimally invasive surgical methods for treating thoracic aortic aneurysms respectively. The Terumo Aortic Custom Relay Proximal Scalloped stent graft and Fenestrated Anaconda stent graft were both designed specifically for these procedures; however, it can be difficult to visually communicate to clinicians and patients in a straightforward way how these devices work. Therefore, we have developed two interactive applications that use 3D visualisation techniques to demonstrate how these aortic devices function and are implemented. The objective of these applications is to engage both clinicians and patients, therefore demonstrating that the addition of anatomically accurate 3D visualisations within an interactive interface would have a positive impact on public engagement while also ensuring that clinicians will have the best possible understanding of the potential uses of both devices, enabling them to exploit their key features to effectively broaden the treatable patient population.Detailed anatomical modelling and animation was used to generate realistic and accurate rendered videos showcasing both products. These videos were integrated into an interactive application within a modern, professional graphic interface that allowed the user to explore all aspects of the stent device. The resulting applications were broken down into three modules: deployment, clinical performance and features. Following application development, these applications were evaluated by professionals in the field. Overall, positive feedback was received regarding the user-friendly nature of the applications and highly effective animations to showcase the products. The clinical applications and feature modules were particularly successful, while the deployment modules had a neutral response. Biomedical applications such as these show great potential for communicating the key features of medical devices and promoting discussion between clinicians and patients; further testing would need to be conducted on a larger group of participants in order to validate the learning effectiveness of the applications.
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Leeuwerke SJG, de Niet A, Geelkerken RH, Reijnen MMPJ, Zeebregts CJ. Incidence and predictive factors for endograft limb patency of the Fenestrated Anaconda™ endograft used for complex endovascular aneurysm repair. J Vasc Surg 2021; 75:1512-1520.e1. [PMID: 34921964 DOI: 10.1016/j.jvs.2021.11.066] [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: 06/12/2021] [Accepted: 11/12/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe the incidence, risk factors and outcomes of treatment for limb occlusion in patients treated for complex (thoraco-)abdominal aortic aneurysms (AAA) with the Fenestrated Anaconda™. METHODS Between June 2010 and May 2018, 335 patients underwent elective fenestrated aortic aneurysm repair in 11 participating centers using the Fenestrated Anaconda™ with a median follow-up of 14.3 months (IQR 27.4). The primary outcome measure was freedom-from-limb-occlusion. Secondary outcome measures were freedom-from-limb-related-reintervention, secondary patency, and risk factors associated with limb occlusion. RESULTS Thirty (9.0%) patients presented with limb occlusion during follow-up with freedom-from-limb-occlusion of 98.5%, 91.2%, and 81.7% at 30-days, 1 and 5 years, respectively. In 87% of cases, no obvious cause for limb occlusion was documented. Primary occlusion occurred within 30-days in 36.7% and within 1 year in 80.0%. Twenty-three (6.9%) patients underwent an occlusion-related reintervention; seven (23.3%) patients were treated conservatively. Freedom-from-limb-occlusion-related-reintervention at 30-days, one and five years was 97.8%, 93.2% and 88.6%, respectively. Secondary patency was 91.3% after 1-month and 86.2% after 1 and 5 years, respectively. Female sex (OR 3.27 - 95% CI 1.28 to 8.34, P = .01) was a statistically significant predictor for limb occlusion. A higher percentage of thrombus in the aneurysm sac appeared to be protective for limb occlusion (0% compared to <25%: OR 0.22 - 95% CI 0.07 to 0.63, P = .01; 0% compared to 25-50%: OR 0.20 - 95% CI 0.07 to 0.57, P = .00 and 0% compared to >50%: OR 0.08 - 95% CI 0.02 to 0.38, P = .00), as did iliac angulation (OR 0.99 - 95% CI 0.98 to 1.00, P = .04). CONCLUSION Limb occlusion remains a significant impediment of endograft durability in patients treated with the Fenestrated Anaconda™, especially in female patients. Controversially, a high aneurysmal thrombus load and a high degree of iliac angulation appeared to be protective for limb occlusion, for which no obvious cause could be identified.
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Affiliation(s)
- S J G Leeuwerke
- Department of Surgery (Division of Vascular Surgery), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
| | - A de Niet
- Department of Surgery (Division of Vascular Surgery), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - R H Geelkerken
- Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, the Netherlands; Department of Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
| | - M M P J Reijnen
- Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, the Netherlands; Department of Surgery, Rijnstate, Arnhem, the Netherlands
| | - C J Zeebregts
- Department of Surgery (Division of Vascular Surgery), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Pini R, Giordano J, Ferri M, Palmieri B, Solcia M, Michelagnoli S, Chisci E, Fadda Gian F, Cappiello P, Talarico F, Licata S, Frigatti P, Ronchey S, Mangialardi N, Pratesi C, Salvini M, Milite D, Pilon F, Perkmann R, Stringari C, Pulli R, Faggioli G, Gargiulo M. The Italian Multicentre Registry of Fenestrated Anaconda™ Endografts for Complex Abdominal Aortic Aneurysms Repair. Eur J Vasc Endovasc Surg 2020; 60:181-191. [PMID: 32709467 DOI: 10.1016/j.ejvs.2020.04.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 03/17/2020] [Accepted: 04/22/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim was to describe the outcomes of the Anaconda™ Fenestrated endograft Italian Registry for complex aortic aneurysms (AAAs), unsuitable for standard endovascular aneurysm repair (EVAR). METHODS Between 2012 and 2018 patients with a proximal neck unsuitable for standard EVAR, treated with the fenestrated Anaconda™ endograft, were prospectively enrolled in a dedicated database. Endpoints were peri-operative technical success (TS) and evaluation of type Ia/b or 3 endoleaks (T1/3 EL), target visceral vessel (TVV) occlusion, re-interventions, and AAA related mortality at 30 days, six months, and later follow up. RESULTS One hundred twenty seven patients (74 ± 7 years, American Society Anesthesiology (ASA) II/III/IV: 12/85/30) were included in the study in 49 Italian Vascular Surgery Units (83 juxta/para-renal AAA, 13 type IV thoraco-abdominal AAA, 16 T1aEL post EVAR, and 15 short neck AAA). Configurations with one, two, three, and four fenestrations were used in 5, 56, 39, and 27 cases, respectively, for a total of 342 visceral vessels. One hundred and eight (85%) bifurcated and 19 (15%) tube endografts were implanted. In 35% (44/127) of cases the endograft was repositioned during the procedure, and 37% (128/342) of TVV were cannulated from brachial access. TS was 87% (111/127): five T1EL, six T3EL (between fenestration and vessel stent), and six loss of visceral vessels (one patient with a Type Ia EL had also a TVV loss) occurred. Thirty day mortality was 4% (5/127). Two of the five T1EL resolved spontaneously at 30 days. The overall median follow up was 21 ± 16 months; one T1EL (5%) occurred at six months and one T3EL (4%) at the three year follow up. Another two (3%) TVV occlusions occurred at six months and five (3%) at three years. The re-intervention rate at the 30 days, six months, and three year follow up was 5%, 7%, and 18 ± 5%, respectively. CONCLUSION The fenestrated Anaconda™ endograft is effective in the treatment of complex AAA. Some structure properties, such as the re-positionability and the possibility of cannulation from above, are specific characteristics helpful for the treatment of some complex anatomies.
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Affiliation(s)
- Rodolfo Pini
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Policlinico Sant'Orsola-Malpighi, Bologna, Italy.
| | - Jacopo Giordano
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | | | - Bruno Palmieri
- Dipartimento Cardiotoracovascolare, Ospedale Niguarda, Milan, Italy
| | - Marco Solcia
- Dipartimento Cardiotoracovascolare, Ospedale Niguarda, Milan, Italy
| | | | - Emiliano Chisci
- Dipartimento Chirurgico, Ospedale San Giovanni di Dio, Florence, Italy
| | | | | | | | - Silvio Licata
- Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - Paolo Frigatti
- Dipartimento di Chirurgia Generale, Ospedale Santa Maria della Misericordia, Udine, Italy
| | - Sonia Ronchey
- Dipartimento delle Specialità Chirurgiche, Azienda Ospedaliera San Filippo Neri, Rome, Italy
| | - Nicola Mangialardi
- Dipartimento delle Specialità Chirurgiche, Azienda Ospedaliera San Filippo Neri, Rome, Italy
| | - Carlo Pratesi
- Dipartimento di Medicina Sperimentale e Clinica, Ospedale Careggi, Florence, Italy
| | - Mauro Salvini
- Dipartimento Chirurgico, Ospedale Civile, Alessandria, Italy
| | - Domenico Milite
- Dipartimento Strutturale Area Chirurgia Maggiore, Ospedale San Bortolo, Vicenza, Italy
| | - Fabio Pilon
- Dipartimento Strutturale Area Chirurgia Maggiore, Ospedale San Bortolo, Vicenza, Italy
| | | | | | - Raffaele Pulli
- Dipartimento dell'Emergenza e dei Trapianti di Organi, Policlinico di Bari, Bari, Italy
| | - Gianluca Faggioli
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Mauro Gargiulo
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Policlinico Sant'Orsola-Malpighi, Bologna, Italy
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Falkensammer J, Taher F, Plimon M, Kliewer M, Walter C, Pelanek E, Assadian A. Assessment of Pull-out Forces in TEVAR and ANACONDA FEVAR Combination and Early Clinical Results: Creation of a Proximal Landing Zone for FEVAR in Patients with Extent I and Extent IV TAAAs. Ann Vasc Surg 2020; 66:160-170. [PMID: 31978487 DOI: 10.1016/j.avsg.2020.01.075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/07/2020] [Accepted: 01/12/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although recent data on the treatment of thoracoabdominal aortic aneurysms (TAAAs) are promising, in some cases, the paravisceral segment of the aorta may not be suitable for a branched endograft due to space restrictions. A combination of a fenestrated aneurysm repair (FEVAR) with a thoracic aneurysm repair (TEVAR) may represent a feasible treatment option. The current investigation was performed to assess the stability of a fenestrated Anaconda device implanted into a set of thoracic endografts from different manufacturers. We then assessed our clinical results with the FEVAR/TEVAR combination. METHODS Pull-out forces were measured in vitro after docking a fenestrated Anaconda graft within the distal end of different TEVAR devices. Anaconda devices were implanted in 28- or 30-mm thoracic tube grafts (oversizing of at least 2 mm: 13.3-21.4; minimum overlap of 15 mm). Continuously increasing longitudinal pull forces of up to 100 N were applied on an Instron Tensile Tester. Initial break point and damage to the endografts were documented. Clinical results of patients treated with such an FEVAR/TEVAR combination at our institution are presented as a second part of this study. RESULTS Median pull-out forces ranged from 2.38 N to 55.0 N. The highest stability was achieved with 34-mm Anaconda devices in 28-mm thoracic tube grafts. Grafts with either thinner Dacron material or those featuring a polytetrafluorethylene membrane seemed especially vulnerable to punctures and tears caused by the downward-looking hooks of the Anaconda device. Between April 1, 2013 and December 31, 2018, in 28 of 172 patients treated with a fenestrated Anaconda device, prior implantation of a thoracic tube graft was necessary to create a sufficient proximal landing zone. In 25 cases (89.3%), the aneurysm was successfully treated. Although the 30-day reintervention rate in this subgroup was relatively high at 28.6%, none of these was due to a failure of the FEVAR/TEVAR combination. Upon an average follow-up of 15 months, no failure of the graft connection and no type III endoleak due to membrane damage were observed. CONCLUSIONS The combination of a thoracic tube graft and a fenestrated Anaconda device is a viable option for the treatment of patients with Extent I or IV TAAAs with no adequate landing zone above the celiac trunk. Although pull-out testing has shown good stability with most assessed grafts, the thoracic devices with thicker Dacron membranes seemed to be especially suitable.
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Affiliation(s)
- Jürgen Falkensammer
- Department of Vascular and Endovascular Surgery, Wilhelminenhospital, Vienna, Austria; Sigmund Freud Private University, Medical School, Vienna, Austria.
| | - Fadi Taher
- Department of Vascular and Endovascular Surgery, Wilhelminenhospital, Vienna, Austria
| | - Markus Plimon
- Department of Vascular and Endovascular Surgery, Wilhelminenhospital, Vienna, Austria
| | - Miriam Kliewer
- Department of Vascular and Endovascular Surgery, Wilhelminenhospital, Vienna, Austria
| | - Corinna Walter
- Department of Vascular and Endovascular Surgery, Wilhelminenhospital, Vienna, Austria
| | - Elisabeth Pelanek
- Department of Vascular and Endovascular Surgery, Wilhelminenhospital, Vienna, Austria
| | - Afshin Assadian
- Department of Vascular and Endovascular Surgery, Wilhelminenhospital, Vienna, Austria
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de Niet A, Zeebregts CJ, Reijnen MMPJ. Outcomes after treatment of complex aortic abdominal aneurysms with the fenestrated Anaconda endograft. J Vasc Surg 2019; 72:25-35.e1. [PMID: 31831315 DOI: 10.1016/j.jvs.2019.08.283] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 08/22/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To date, information on the fenestrated Anaconda endograft is limited to case series with a small sample size. This study was performed to assess the technical and clinical outcome of this device in a large international case series. METHODS All worldwide centers having treated more than 15 complex abdominal aortic aneurysms (AAA) or type IV thoracoabdominal aortic aneurysm patients with the fenestrated Anaconda endograft were approached. Main outcome parameters were procedural technical success, postoperative and follow-up clinical outcome for endoleaks, target vessel patency, reintervention rate, and patient survival. RESULTS Three hundred thirty-five consecutive cases treated between June 2010 and May 2018 in 11 sites were included. Patients were treated for a short neck infrarenal (n = 98), juxtarenal (n = 191), suprarenal AAA (n = 27), or type IV thoracoabdominal aortic aneurysm (n = 19). Mean age was 73.6 ± 4.6 years (292 male). Endografts contained a total of 920 fenestrations, with a mean of 2.7 ± 0.8 fenestrations per case. Technical success was 88.4% (primary, 82.7%; assisted primary 5.7%). In 6.9% of cases, a procedural type IA endoleak was observed, spontaneously disappearing in 82.6% during early follow-up. The development of a type IA endoleak was associated with greater neck angulation (odds ratio [OR], 0.94; P = .01), three fenestrations (OR, 42.7; P = .01) and the presence of augmented proximal rings (OR, 0.17; P = .03). Median follow-up was 1.2 years (interquartile range, 0.4-2.6). The mean estimated glomerular filtration rate deteriorated from 67.6 ± 19.3 mL/min/1.73 m2 preoperatively to 59.3 ± 22.7 mL/min/1.73 m2 at latest follow-up (P = .00). The freedom from AAA growth were 97.9 ± 0.9% (n = 190) and 86.4 ± 3.0% (n = 68), with a freedom from AAA rupture of 99.7 ± 0.3% (n = 191) and 99.1 ± 0.7% (n = 68), at 1 and 3 years, respectively. The endoleak-free survival, excluding spontaneously resolved procedural endoleaks, at 1 and 3 years was 73.4 ± 2.6 (n = 143) and 65.6 ± 3.4% (n = 45), respectively. The target vessel patency at one and three years were 96.4 ± 0.7% (n = 493) and 92.7 ± 1.4% (n = 156), respectively. A total of 75 reinterventions were done in 64 cases (19.1%), of which 25 cases for an endoleak. The reintervention-free survival at 1 and 3 years were 83.6 ± 2.2% (n = 190) and 71.0 ± 3.7% (n = 68), respectively. No deaths during procedure, extending within 24 hours postoperatively, were observed. Within 30 days 14 patients (4.2%) died and during follow-up another 39 patients (11.6%) died. Three deaths were considered AAA related (one rupture, one endograft infection, and one bilateral renal artery occlusion). The estimated cumulative survival at 1 and 3 years were 89.8 ± 1.8% (n = 191) and 79.2 ± 3.0% (n = 68), respectively. CONCLUSIONS The custom-made fenestrated Anaconda endograft is a valuable option for the treatment of a complex AAA. A procedural type IA endoleak is seen relatively frequently, but spontaneously resolves in most cases.
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Affiliation(s)
- Arne de Niet
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Clark J Zeebregts
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Michel M P J Reijnen
- Department of Surgery, Rijnstate, Arnhem, The Netherlands; Multimodality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, The Netherlands.
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Kalder J, Gombert A, Kotelis D, Jacobs MJ. Feasibility and Twelve-month Patency of a Six-fold Fenestrated Stent Graft for Type IV Thoracoabdominal Aneurysm Repair. Ann Vasc Surg 2019; 60:478.e1-478.e5. [DOI: 10.1016/j.avsg.2019.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 02/28/2019] [Accepted: 03/01/2019] [Indexed: 12/22/2022]
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de Niet A, Reijnen MMPJ, Zeebregts CJ. Early results with the custom-made Fenestrated Anaconda aortic cuff in the treatment of complex abdominal aortic aneurysm. J Vasc Surg 2018; 69:348-356. [PMID: 30104097 DOI: 10.1016/j.jvs.2018.05.218] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 05/18/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objective of this study was to investigate the feasibility of a specific custom-made fenestrated aortic cuff in the treatment of complex abdominal aortic aneurysms (AAAs). METHODS Between 2013 and 2016, a total of 57 custom-made Fenestrated Anaconda (Vascutek, Inchinnan, Scotland, UK) aortic cuffs were placed in 38 centers worldwide. All centers were invited to participate in this retrospective analysis. Postoperative and follow-up data included the presence of adverse events, necessity for reintervention, and renal function. RESULTS Fifteen clinics participated, leading to 29 cases. Median age at operation was 74 years (interquartile range [IQR], 71-78 years); five patients were female. Two patients were treated for a para-anastomotic AAA after open AAA repair, 19 patients were treated because of a complicated course after primary endovascular AAA repair, and 8 cases were primary procedures for AAA. A total of 76 fenestrations (mean, 2.6 per case) were used. Four patients needed seven adjunctive procedures. Two patients underwent conversion, one because of a dissection of the superior mesenteric artery and one because of perforation of a renal artery. Median operation time was 225 minutes (IQR, 150-260 minutes); median blood loss, 200 mL (IQR, 100-500 mL); and median contrast volume, 150 mL (IQR, 92-260 mL). Primary technical success was achieved in 86% and secondary technical success in 93%. The 30-day morbidity was 7 of 29 with a mortality rate of 4 of 29. Estimated glomerular filtration rate remained unchanged before and after surgery (76 to 77 mL/min/m2). Between preoperative and median follow-up of 11 months, estimated glomerular filtration rate was reduced statistically significantly (76 to 63 mL/min/m2). During follow-up, 9 cases had an increase in aneurysm sac diameter (5 cases >5 mm); 14 cases had a stable or decreased aneurysm sac diameter; and in 2 cases, no aneurysm size was reported. No type I endoleak was reported, and two cases with a type III endoleak were treated by endovascular means during follow-up. Survival, reintervention-free survival, and target vessel patency at 1 year were 81% ± 8%, 75% ± 9%, and 99% ± 1%, respectively. After 2 years, these numbers were 81% ± 8%, 67% ± 11%, and 88% ± 6%, respectively. During follow-up, the two patients with a type III endoleak needed endograft-related reinterventions. CONCLUSIONS Treatment with this specific custom-made fenestrated aortic cuff is feasible after complicated previous (endovascular) aortic repair or in complex AAAs. The complexity of certain AAA cases is underlined in this study, and the Fenestrated Anaconda aortic cuff is a valid option in selected cases in which few treatment options are left.
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Affiliation(s)
- Arne de Niet
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, 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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Ciani O, Epstein D, Rothery C, Taylor RS, Sculpher M. Decision uncertainty and value of further research: a case-study in fenestrated endovascular aneurysm repair for complex abdominal aortic aneurysms. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2018; 16:15. [PMID: 29686541 PMCID: PMC5902886 DOI: 10.1186/s12962-018-0098-7] [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: 07/21/2017] [Accepted: 04/07/2018] [Indexed: 11/19/2022] Open
Abstract
Background Fenestrated endovascular aneurysm repair (fEVAR) is a new approach for complex abdominal aortic aneurysms, limited to a few specialist centers, with limited evidence base. We developed a cost-effectiveness decision model of fEVAR compared to open surgical repair (OSR) to investigate the likely direction of costs and benefits and inform further research projects on this technology. Methods A systematic review with meta-analysis and a four-state Markov model were used to estimate the cost-effectiveness of fEVAR versus OSR. We used a recent coverage with evidence development framework to characterize the main sources of uncertainty and inform decisions about the type of further research that would be most worthwhile and feasible. Results Seven observational comparative studies were identified, of which four presented odds ratios adjusted for confounders. The odds ratios for operative mortality varied widely between studies. Assuming a central estimate of the odds ratio of 0.54 (95% CI 0.05–6.24), the decision model estimated that the incremental cost per quality adjusted life year (QALY) was £74,580/QALY with a probability of 9 and 16% of being cost-effective at standard cost-effectiveness thresholds of £20,000/QALY and £30,000/QALY, respectively. The Expected Value of Perfect Information over 10 years at a threshold of £20,000/QALY was £11.2 million. Operative mortality contributed to most of the uncertainty in the decision model. Conclusions In the case of “maturing technologies”, decision modelling indicates the likely direction of costs and benefits and guides the development of further research projects. In our analysis of fEVAR versus OSR, decision uncertainty, particularly around operative mortality, might be effectively resolved by a short-term RCT, or possibly a well-conducted comparative observational study. Decision makers may consider that a conditional coverage decision is warranted with assessments required to make this type of recommendation depending on local priorities and circumstances. Electronic supplementary material The online version of this article (10.1186/s12962-018-0098-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Oriana Ciani
- 1Evidence Synthesis and Modeling for Health Improvement, Institute of Health Research, University of Exeter Medical School, South Cloisters, St Luke's Campus, Exeter, EX1 2LU UK.,2Center for Research on Health and Social Care Management, SDA Bocconi University, via Roentgen 1, 20136 Milan, Italy
| | - David Epstein
- 3Centre for Health Economics, University of York, Heslington, Alcuin 'A' Block, York, YO10 5DD UK.,4Department of Applied Economics, University of Granada, Campus Universitario de Cartuja, 18071 Granada, Spain
| | - Claire Rothery
- 3Centre for Health Economics, University of York, Heslington, Alcuin 'A' Block, York, YO10 5DD UK
| | - Rod S Taylor
- 1Evidence Synthesis and Modeling for Health Improvement, Institute of Health Research, University of Exeter Medical School, South Cloisters, St Luke's Campus, Exeter, EX1 2LU UK
| | - Mark Sculpher
- 3Centre for Health Economics, University of York, Heslington, Alcuin 'A' Block, York, YO10 5DD UK
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Falkensammer J, Taher F, Uhlmann M, Hirsch K, Strassegger J, Assadian A. Rescue of failed endovascular aortic aneurysm repair using the fenestrated Anaconda device. J Vasc Surg 2017; 66:1334-1339. [DOI: 10.1016/j.jvs.2017.02.048] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 02/27/2017] [Indexed: 10/19/2022]
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Taher F, Falkensammer J, McCarte J, Strassegger J, Uhlmann M, Schuch P, Assadian A. The influence of prototype testing in three-dimensional aortic models on fenestrated endograft design. J Vasc Surg 2017; 65:1591-1597. [DOI: 10.1016/j.jvs.2016.10.108] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 10/24/2016] [Indexed: 11/16/2022]
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Fadda GF, Marino M, Kasemi H, Di Angelo CL, Dionisi CP, Cammalleri V, Setacci C. Aortic aneurysm endovascular treatment with the parallel graft technique from the aortic arch to the iliac axis. THE JOURNAL OF CARDIOVASCULAR SURGERY 2017; 60:589-598. [PMID: 28548474 DOI: 10.23736/s0021-9509.17.09899-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The chimney technique has been developed for the treatment of complex aortic aneurysms. We analyzed the midterm to long-term outcomes of this approach from a single-center experience. METHODS From October 2008 to July 2016, 58 patients underwent endovascular aortic aneurysm repair using the chimney technique. Indications for treatment were thoracic aortic aneurysm (TAA) (N.=11), thoracoabdominal aortic aneurysm (TAAA) (N.=2), pararenal aortic aneurysm (PAAA) (N.=15), aortoiliac/isolated hypogastric artery aneurysm (N.=25), type I endoleak after previous TEVAR/EVAR (N.=4), proximal pseudoaneurysm after AAA open repair (N.=1). Elective (82.8%) and emergent (17.2%) procedures were included. RESULTS The immediate technical success was 100%. Single, double and triple chimneys were performed in 46, 10, and two patients, respectively. Overall, 61 target vessels (three left common carotid arteries, eight left subclavian arteries, three celiac trunks, three superior mesenteric arteries, 19 renal arteries and 25 hypogastric arteries) were involved. Postoperative mortality was 0. No neurologic complications were registered. Primary patency rate of the chimney stent/stent graft was 98.3%. Low-flow type I endoleak was observed in four patients (6.9%). Postoperative chimney graft re-intervention rate was 1.7%. The median follow-up was 32±20 months (range 3-96 months). Overall estimated survival at 12, 50, and 80 months was 100%, 89% and 44%, respectively. Estimated freedom from endoleak at 1, 12, 24, and 36 months was 96.5%, 95%, 95%, and 93%, respectively. One hypogastric artery stent-graft occluded at the 3rd month of follow-up. No reintervention was performed. CONCLUSIONS Our experience with the chimney technique for aortic aneurysms from the aortic arch to the iliac axis shows promising and durable mid- and long-term results. Endograft oversizing, associated with the chimney graft diameter and length choice remain fundamental to reduce the risk of the most frequent procedure complications: type I endoleak and CG occlusion. The wider use of this technique should be justified in patients considered at high risk for open repair and/or not suitable for the custom-made branched/fenestrated endografts.
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Affiliation(s)
- Gian Franco Fadda
- Unit of Vascular and Endovascular Surgery, Department of Surgery, San Francesco Hospital, Nuoro, Italy
| | - Mario Marino
- Unit of Vascular and Endovascular Surgery, Department of Surgery, San Francesco Hospital, Nuoro, Italy
| | - Holta Kasemi
- Unit of Vascular and Endovascular Surgery, Department of Surgery, San Francesco Hospital, Nuoro, Italy -
| | - Costantino L Di Angelo
- Unit of Vascular and Endovascular Surgery, Department of Surgery, San Francesco Hospital, Nuoro, Italy
| | - Carlo P Dionisi
- Unit of Vascular Surgery, Department of Surgery, Cardinal Panico Hospital, Tricase, Lecce, Italy
| | - Valeria Cammalleri
- Unit of Cardiology, Department of Cardiovascular Disease, Tor Vergata University, Rome, Italy
| | - Carlo Setacci
- Unit of Vascular and Endovascular Surgery, Department of Medicine, Surgery and Neurological Sciences, University of Siena, Siena, Italy
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Results of the French Multicentric Study of ANACONDA™ Fenestrated Endografts in the Treatment of Complex Aortic Pathologies (EFEFA Registry). Ann Vasc Surg 2017; 43:151-165. [PMID: 28495540 DOI: 10.1016/j.avsg.2017.03.171] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 03/28/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Most of the experience on fenestrated endovascular aneurysm repair involves the custom-made Zenith® endograft (Cook). The fenestrated Anaconda® endograft (Vascutek) was introduced with the potential advantages of complete repositioning and lack of stent material on the main aortic body for more versatility. However, few data are available. Our objective was to assess its mid-term results in the treatment of complex aortic aneurysms. METHODS Consecutive patients treated with the custom-made fenestrated Anaconda endograft in France and the Principality of Monaco, from December 2010 to October 2015, were included. RESULTS Eighty-six patients were included over 16 centers (82 men, mean age 73.4 ± 8.1 years, 16 (18.6%) symptomatic aneurysms). The repositioning system was used in 68 cases (79.1%). Two hundred ninety-two visceral/renal vessels were targeted, with a mean number of 3.4 ± 0.6 target vessels/patient and a successful reconstruction in 99.3% of the cases (290/292 vessels). Perioperative technical success was achieved in 86.0% (74/86 patients). In-hospital and 30-day mortality rates were 3.5% (3 patients) and 7.0% (6 patients), respectively. At 12 and 24 months, estimated overall survival rate was 88.3% and 85.2%, target vessel's patency rate was 97.2% and 96.3%, and freedom from aneurysm-related reintervention rate was 96.3% and 88.0%, respectively. At 24 months, there were 7 type II endoleaks (12.7%) and a significant reduction in aneurysm maximum transverse diameter in 70.4%. Five limb occlusions occurred at 1-year and 1 at 2-year follow-up (7.0%). CONCLUSIONS The fenestrated Anaconda stent-graft system offers acceptable technical success rates, mid-term efficacy, and durability with respect to aneurysm sac regression, target vessel patency, overall mortality, and reintervention rates. Long-term results are still awaited, until then, the rate of graft limb occlusion is of concern and should be further investigated, especially in case of particularly complex aortic anatomies.
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Maeda K, Ohki T, Kanaoka Y, Baba T, Kaneko K, Shukuzawa K. Comparison between Open and Endovascular Repair for the Treatment of Juxtarenal Abdominal Aortic Aneurysms: A Single-Center Experience with Midterm Results. Ann Vasc Surg 2017; 41:96-104. [DOI: 10.1016/j.avsg.2016.08.045] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 07/07/2016] [Accepted: 08/16/2016] [Indexed: 12/20/2022]
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Blankensteijn LL, Dijkstra ML, Tielliu IF, Reijnen MM, Zeebregts CJ, Zeebregts CJ, Tielliu IF, Geelkerken RH, Meerwaldt R, Pierie ME, van Brussel JP, van den Haak RF, Schurink GWH, van Herwaarden JA, Lardenoije JW, Reijnen MM, Jahrome AK, Balm R, Klemm PL, Witte ME, Waasdorp EJ, Schlejen PM, van Rijn MJ, Verhagen HJ. Midterm results of the fenestrated Anaconda endograft for short-neck infrarenal and juxtarenal abdominal aortic aneurysm repair. J Vasc Surg 2017; 65:303-310. [DOI: 10.1016/j.jvs.2016.08.092] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 08/26/2016] [Indexed: 10/20/2022]
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Schoretsanitis N, Georgakarakos E, Argyriou C, Ktenidis K, Georgiadis GS. A critical appraisal of endovascular stent-grafts in the management of abdominal aortic aneurysms. Radiol Med 2017; 122:309-318. [DOI: 10.1007/s11547-017-0724-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 01/03/2017] [Indexed: 11/30/2022]
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23
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Smeds MR, Charlton-Ouw KM. Infrarenal endovascular aneurysm repair: New developments and decision making in 2016. Semin Vasc Surg 2016; 29:27-34. [PMID: 27823586 DOI: 10.1053/j.semvascsurg.2016.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
New developments in infrarenal abdominal aortic aneurysm stent-graft devices have made more patients eligible for endovascular aneurysm repair (EVAR). Recent US Food and Drug Administration approval for fenestrated endograft repair and impending approval for iliac branch devices extend the proximal and distal landing zones. Better deployment systems allow for partial deployment of endografts to facilitate repositioning, and more flexible designs allow for treatment of angulated infrarenal aneurysm necks and tortuous iliac arteries. New iterations of endografts have smaller delivery catheter diameters, which facilitate traversal of smaller access vessels. Long-term outcomes data are still accumulating and it remains to be seen whether EVAR for this expanded-indication abdominal aortic aneurysms anatomy has the same durability as standard EVAR. More options for repair also mean vascular surgeons must select the best EVAR device based on each patient's abdominal aortic aneurysm anatomy.
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Affiliation(s)
- Matthew R Smeds
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Arkansas for Medical Sciences, 4301 West Markham Street #520-2, Little Rock, AR 72205-7199.
| | - Kristofer M Charlton-Ouw
- Division of Vascular and Endovascular Surgery, Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), TX
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24
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Single Centre Results of Total Endovascular Repair of Complex Aortic Aneurysms with Custom Made Anaconda Fenestrated Stent Grafts. Eur J Vasc Endovasc Surg 2016; 52:500-508. [DOI: 10.1016/j.ejvs.2016.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 07/04/2016] [Indexed: 11/23/2022]
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25
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Kotelis D, Schleimer K, Foldenauer C, Jalaie H, Grommes J, Jacobs MJ, Kalder J. Operative and Midterm Outcomes of the Fenestrated Anaconda Stent-Graft in the Endovascular Treatment of Juxtarenal, Suprarenal, and Type IV Thoracoabdominal Aortic Aneurysms. J Endovasc Ther 2016; 23:930-935. [DOI: 10.1177/1526602816667281] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To report operative and midterm outcomes of fenestrated endovascular aneurysm repair (FEVAR) with the Anaconda device. Methods: A retrospective analysis was conducted of 39 consecutive patients (median age 74 years; 36 men) treated with the fenestrated Anaconda stent-graft between July 2011 and December 2015 at a single center. Indications for FEVAR were abdominal aortic aneurysms (AAAs) with neck anatomy unsuitable for a standard stent-graft. Median infrarenal neck length was 4 mm (range 0–9). Four (10%) patients presented with type IV thoracoabdominal aortic aneurysm (TAAA), 12 (31%) with suprarenal aneurysms, and 23 (59%) with juxtarenal aneurysms. Four (10%) patients had previous infrarenal aortic repair. Five (13%) patients had an infrarenal neck angulation >60°. A total of 106 fenestrations were incorporated into the stent-grafts (73 renal arteries, 25 superior mesenteric arteries, and 8 celiac trunks). Technical success, perioperative and midterm mortality and morbidity, target vessel patency, endoleaks, and reinterventions were documented. Results: Technical success was 95% (37/39). Three (8%) patients died in-hospital from mesenteric embolism in 2 and renal artery rupture with consequent multiorgan failure in 1. Two (5%) patients suffered an intraoperative embolic stroke. During a median follow-up of 33 months (range 4–55), adjunctive maneuvers were performed in 9 (23%) patients, including reintervention for type II endoleak with enlarged aneurysm sac in 2 (5%). Four additional patients died of causes unrelated to the aortic pathology (overall mortality 18%). In 34 (94%) of the 36 patients seen in follow-up, aneurysm sac size was stable or decreased. Target vessel stent patency was 99% (95/96). Conclusion: FEVAR with the Anaconda device delivers satisfactory short-term technical and clinical success rates in patients with juxtarenal, suprarenal, and type IV TAAA. Midterm efficacy and durability with respect to aneurysm sac regression and target vessel patency appear very good. Overall mortality and the need for reintervention were significant in this patient cohort.
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Affiliation(s)
- Drosos Kotelis
- European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Karina Schleimer
- European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Christina Foldenauer
- European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Houman Jalaie
- European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Jochen Grommes
- European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Michael J. Jacobs
- European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, RWTH Aachen University Hospital, Aachen, Germany
- European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Johannes Kalder
- European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, RWTH Aachen University Hospital, Aachen, Germany
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26
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Yaoguo Y, Zhong C, Lei K, Yaowen X. Treatment of complex aortic aneurysms with fenestrated endografts and chimney stent repair: Systematic review and meta-analysis. Vascular 2016; 25:92-100. [PMID: 26846442 DOI: 10.1177/1708538115627718] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective We reviewed data pertaining to fenestrated endograft technique and chimney stent repair of complex aortic aneurysm for comparative analysis of the outcomes. Methods A comprehensive search of relevant databases was conducted to identify articles in English, related to the treatment of complex aortic aneurysm with fenestrated endovascular aneurysm repair and chimney stent repair, published until January 2015. Results A total of 42 relevant studies and 2264 patients with aortic aneurysm undergoing fenestrated endovascular aneurysm repair and chimney stent repair were included in our review. A total of 4413 vessels were involved in these processes. The cumulative 30-day mortality was 2.4% and 3.2% ( p = 0.459). The follow-up aneurysm-related mortality was 1.4% and 3.2% ( p = 0.018), and target organ dysfunction was 5.0% and 4.0% in fenestrated endovascular aneurysm repair and chimney stent repair, respectively ( p = 0.27). A total of 156 vessels showed restenosis or occlusion after primary intervention (3.6% and 3.4% in fenestrated endovascular aneurysm repair and chimney stent repair, respectively, p = 0.792). The cumulative type I endoleak was 2.0% (38/1884) after fenestrated endovascular aneurysm repair compared with 3.4% (13/380) after chimney stent repair ( p = 0.092), and the type II endoleak was 5.4% (102/1884) and 5.3% (20/380), respectively ( p = 0.905). Approximately, 1.1% and 1.6% increase in aneurysm was observed following fenestrated endovascular aneurysm repair and chimney stent repair, respectively ( p = 0.437). The re-intervention frequency was 205 and 19 cases after fenestrated endovascular aneurysm repair and chimney stent repair, respectively (11.7%, 5.6%, p = 0.001). Conclusions Fenestrated endovascular aneurysm repair and chimney stent repair are safe and effective in treating patients with complex aortic aneurysm. A higher aneurysm-related mortality was observed in chimney stent repair while fenestrated endovascular aneurysm repair was associated with a higher re-intervention rate.
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Affiliation(s)
- Yang Yaoguo
- Department of Vascular Surgery, The Capital Medical University Affiliated Beijing Anzhen Hospital, Beijing, China
- Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Chen Zhong
- Department of Vascular Surgery, The Capital Medical University Affiliated Beijing Anzhen Hospital, Beijing, China
- Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Kou Lei
- Department of Vascular Surgery, The Capital Medical University Affiliated Beijing Anzhen Hospital, Beijing, China
- Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Xiao Yaowen
- Department of Vascular Surgery, The Capital Medical University Affiliated Beijing Anzhen Hospital, Beijing, China
- Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
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27
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Georgiadis GS, van Herwaarden JA, Antoniou GA, Giannoukas AD, Lazarides MK, Moll FL. Fenestrated stent grafts for the treatment of complex aortic aneurysm disease: A mature treatment paradigm. Vasc Med 2016; 21:223-38. [DOI: 10.1177/1358863x16631841] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The introduction of fenestrated stent grafts (SGs) to treat abdominal aortic aneurysms (AAAs) with short proximal necks began in 1999. Nowadays, the whole visceral aorta can be treated totally by endovascular means. The established use of fenestrated devices to treat complex AAAs as a first-line management option has been previously reported. An up-to-date evaluation of the literature was performed including all types of publications regarding the use of fenestrated technology to repair complex AAAs. Fenestrated repair is now an established alternative to hybrid/chimney/snorkel repairs. However, specific criteria and prerequisites are required for the use and improvement of this method. Multiple device morphologies have been used incorporating the visceral arteries in various combinations. This modular strategy connects different devices (bridging covered stents and bifurcated SGs) with the aortic main body, thus excluding the aneurysm from the circulation. Precise deployment of the fenestrated SG is mandatory for successful visceral vessel revascularization. Accurate SG sizing and customization, a high level of technical skill, and facilities with modern imaging techniques including 3D road mapping and dedicated hybrid rooms are required. Most experience has been with the custom-made Zenith Cook platform, although off-the-shelf devices have been recently implanted. More complex repairs have been performed over the last few years, but device complexity has also increased. Perioperative, mid-term, and a few recently reported long-term results are encouraging. Secondary interventions remain the main problem, similar to that observed after traditional endovascular abdominal aortic aneurysm repair (EVAR).
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Affiliation(s)
- George S Georgiadis
- Department of Vascular Surgery, University Medical Center, Utrecht, The Netherlands
- Department of Vascular Surgery, ‘Demokritus’ University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | | | - George A Antoniou
- Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, UK
| | | | - Miltos K Lazarides
- Department of Vascular Surgery, ‘Demokritus’ University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Frans L Moll
- Department of Vascular Surgery, University Medical Center, Utrecht, The Netherlands
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Li Y, Hu Z, Bai C, Liu J, Zhang T, Ge Y, Luan S, Guo W. Fenestrated and Chimney Technique for Juxtarenal Aortic Aneurysm: A Systematic Review and Pooled Data Analysis. Sci Rep 2016; 6:20497. [PMID: 26869488 PMCID: PMC4751537 DOI: 10.1038/srep20497] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 01/05/2016] [Indexed: 12/02/2022] Open
Abstract
Juxtarenal aortic aneurysms (JAA) account for approximately 15% of abdominal aortic aneurysms. Fenestrated endovascular aneurysm repair (FEVAR) and chimney endovascular aneurysm repair (CH-EVAR) are both effective methods to treat JAAs, but the comparative effectiveness of these treatment modalities is unclear. We searched the PubMed, Medline, Embase, and Cochrane databases to identify English language articles published between January 2005 and September 2013 on management of JAA with fenestrated and chimney techniques to conduct a systematic review to compare outcomes of patients with juxtarenal aortic aneurysm (JAA) treated with the two techniques. We compared nine F-EVAR cohort studies including 542 JAA patients and 8 CH-EVAR cohorts with 158 JAA patients regarding techniques success rates, 30-day mortality, late mortality, endoleak events and secondary intervention rates. The results of this systematic review indicate that both fenestrated and chimney techniques are attractive options for JAAs treatment with encouraging early and mid-term outcomes.
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Affiliation(s)
- Yue Li
- Department of Vascular Surgery, General Hospital of People's Liberation Army, Beijing 100853, China
| | - Zhongzhou Hu
- Medical Center Tsinghua University, Beijing, China
| | - Chujie Bai
- Department of Orthopaedic Oncology, Peking University Caner Hospital, Beijing, China
| | - Jie Liu
- Department of Vascular Surgery, General Hospital of People's Liberation Army, Beijing 100853, China
| | - Tao Zhang
- Department of Vascular Surgery, Peking University People's Hospital, Beijing, China
| | - Yangyang Ge
- Department of Vascular Surgery, General Hospital of People's Liberation Army, Beijing 100853, China
| | - Shaoliang Luan
- Department of Vascular Surgery, General Hospital of People's Liberation Army, Beijing 100853, China
| | - Wei Guo
- Department of Vascular Surgery, General Hospital of People's Liberation Army, Beijing 100853, China
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29
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Kasemi H, Marino M, Di Angelo CL, Fadda GF. Complicated Fenestrated Endovascular Repair of a Pararenal Aortic Aneurysm. Ann Vasc Surg 2016; 32:133.e7-10. [PMID: 26806232 DOI: 10.1016/j.avsg.2015.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 10/25/2015] [Accepted: 11/08/2015] [Indexed: 11/24/2022]
Abstract
We report the case of a 77-year-old man treated with a custom-made fenestrated endograft for pararenal aortic aneurysm repair. Fenestrations for the superior mesenteric and both the renal arteries and augmented anterior valley and/or scallop for the celiac trunk were performed. The procedure was complicated by the superior mesenteric artery stent-graft entrapment from the endograft delivery system release wires and total dislodgement into the endograft main body. Superior mesenteric artery restenting and displaced stent-graft removal completed the intervention. Fenestrated-endograft deployment should be performed by a team familiar with the device, deployment system, and bail out solutions.
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Affiliation(s)
- Holta Kasemi
- Vascular Surgery Unit, Department of Surgery, "San Francesco" Hospital, Nuoro, Italy; Vascular Surgery Unit, Department "Paride Stefanini", Sapienza University of Rome, Policlinico Umberto I, Rome, Italy.
| | - Mario Marino
- Vascular Surgery Unit, Department of Surgery, "San Francesco" Hospital, Nuoro, Italy; Vascular Surgery Unit, Department "Paride Stefanini", Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | | | - Gian Franco Fadda
- Vascular Surgery Unit, Department of Surgery, "San Francesco" Hospital, Nuoro, Italy
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30
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A Systematic Review of Fenestrated Endovascular Repair for Juxtarenal and Short-Neck Aortic Aneurysm: Evidence So Far. Ann Vasc Surg 2015; 29:1680-8. [DOI: 10.1016/j.avsg.2015.06.074] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 05/15/2015] [Accepted: 06/04/2015] [Indexed: 11/21/2022]
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31
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Graves HL, Jackson BM. The Current State of Fenestrated and Branched Devices for Abdominal Aortic Aneurysm Repair. Semin Intervent Radiol 2015; 32:304-10. [PMID: 26327749 DOI: 10.1055/s-0035-1558707] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Endovascular abdominal aortic aneurysm repair (EVAR) provides an attractive alternative to traditional open techniques. Endovascular repair is frequently limited by aortic aneurysm neck angulation, the absence of an adequate infrarenal neck, and the need for internal iliac preservation. Several devices have been created to incorporate visceral artery segments as well as preserve the internal iliac artery, thus broadening the patient population suited for endovascular repair. This article will provide a review of the current literature regarding fenestrated devices, branch devices, off-the-shelf devices, and physician-modified devices. It will also highlight the iliac branch stent grafts currently on trial for internal iliac artery preservation. Data thus far have suggested that these devices will be both a safe and effective option for anatomically challenging abdominal aortic aneurysms.
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Affiliation(s)
- Holly L Graves
- Division of Vascular Surgery and Endovascular Therapy, Department of General Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Benjamin M Jackson
- Division of Vascular Surgery and Endovascular Therapy, Department of General Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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32
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Panuccio G, Bisdas T, Berekoven B, Torsello G, Austermann M. Performance of Bridging Stent Grafts in Fenestrated and Branched Aortic Endografting. Eur J Vasc Endovasc Surg 2015; 50:60-70. [DOI: 10.1016/j.ejvs.2015.03.023] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 03/09/2015] [Indexed: 11/24/2022]
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