The BeGraft Balloon Expandable Covered Stent as a Proximal Extension to an Iliac Branch Device for Endovascular Repair of Isolated Common Iliac Artery Aneurysms

Treatment for aortoiliac bifurcation disease by balloon-expandable covered stent; "Double-D" molding technique

Appropriate endovascular treatment for aortic bifurcation lesions remains unclear. Incomplete apposition and radial mismatch have not been resolved to date. We treated two cases of aortic bifurcation lesions including common iliac aneurysms with balloon-expandable covered stents with "Double-D molding technique (DDMT)." This is the method. First, standard kissing stent technique with two balloon-expandable covered stents for aortic bifurcation lesions is performed. Second, either covered stent post-dilated with a larger size percutaneous transluminal angioplasty (PTA) balloon before the other covered stent also post-dilated with the same larger size PTA balloon. Kissing balloon technique was performed with the two previous size PTA balloons. Good double-D shape configuration is observed. This DDMT could improve the radial mismatch of the kissing covered stents to distal aortic wall. 〈Learning objective: The treatment of aortoiliaic bifurcation disease including iliac aneurysms with balloon expandable covered stents using "double D-shape molding technique" is safe and effective.〉.

EVAR with Aortic Placement of a Single JOTEC E-iliac Stent-graft System in a Patient with Poliomyelitis Aortoiliac Deformities

Small-sized vessels can represent a contraindication to standard endovascular aortic repair (EVAR), and more specifically, aortoiliac deformities resulting from poliomyelitis may add an adjunctive challenge for total endovascular repair. Herein we report a case of a 62-year-old man with a 55 mm abdominal aortic aneurysm (AAA) and a history of poliomyelitis. More specifically, a computed tomography angiogram (CTA) showed a very narrow infrarenal aortic neck, measuring 13 mm in maximum diameter, and severely atrophic external iliac and common femoral arteries. A total endovascular repair was planned and realized with a single aortic JOTEC iliac branch and contralateral VBX placement. All prosthetic materials were delivered from the nonatrophic side. At the 1-year CTA, the aneurysm was successfully excluded and both iliofemoral axes were patent.

Secondary Relining With Focal Flaring of Novel-Generation Balloon-Expandable Covered Stents for Endovascular Treatment of Significant Diameter Mismatch in the Aorto-Iliac Territory

OBJECTIVES

The aim of this study was to report on the safety and feasibility of secondary relining with focal flaring of novel-generation balloon-expandable covered stents for endovascular treatment of significant diameter mismatch in the aorto-iliac territory. Significant diameter mismatch was defined as >20% difference in the nominal diameter between the intended proximal and distal landing zones.

METHODS

Patient A was an 84-year-old man with prior abdominal aortic aneurysm open repair with a straight 20 mm Dacron tube. He presented with a right common iliac artery aneurysm (Ø88 mm) with contained rupture. The Gore Viabahn endoprosthesis (9 mm × 5 cm) was inserted proximally about 15 mm above the occluded ostium of the internal iliac artery. Subsequently, the BeGraft Aortic® (16 mm × 48 mm) was inserted proximally up to the common iliac artery origin; its proximal portion was flared to 22 mm. Patient B was a 77-year-old man with prior endovascular abdominal aortic aneurysm repair with a Medtronic Endurant stent-graft. He presented with occlusion of the right limb of the aortic endoprosthesis and thrombosis that extended down to the level of the superficial femoral artery. After mechanical thrombectomy, two Gore Viabahn endoprosthesis (first one, 8 mm × 10 cm; second one, 10 mm × 15 cm) were inserted into the right iliac limb. Subsequently, the BeGraft Aortic® (12mm × 39mm) was inserted proximally up to the gate of the aortic stent-graft; its proximal portion was flared to 16 mm.

RESULTS

Technical success and clinical success were achieved in both patients. Imaging follow-up (6 months for Patient A, 12 months for Patient B) showed correct placement of all stent-grafts without any graft-related adverse event. The patients remained free from new reinterventions or recurrent symptoms. Patient A died 8 months after the index procedure from acute respiratory failure after community acquired pneumonia.

CONCLUSION

Secondary relining with focal flaring of novel-generation balloon-expandable covered stents for endovascular treatment of significant diameter mismatch in the aorto-iliac territory is safe and feasible. Although mid-term results seem to be effective, longer follow-up is warranted to establish durability of the technique.

Outcomes after Standalone Use of Gore Excluder Iliac Branch Endoprosthesis for Endovascular Repair of Isolated Iliac Artery Aneurysms

BACKGROUND

The aim of our study was to describe outcomes of stand-alone use (i.e., without concomitant implantation of an aortic stent graft) of the Gore Excluder iliac branch endoprosthesis (IBE) for elective endovascular repair of isolated iliac artery aneurysms.

METHODS

We evaluated all consecutive patients electively treated for isolated iliac artery aneurysms using standalone Gore Excluder IBE (January 2014-December 2018). Early (i.e., 30-day) endpoints were technical success, mortality, major adverse events (MAEs), and major access-site complications. Late endpoints were survival, freedom from aortic-related mortality (ARM), internal iliac artery (IIA) primary patency, IIA branch instability, graft-related adverse events (GRAEs), secondary interventions, endoleaks (ELs), aneurysm sac behavior, and new-onset buttock claudication (BC).

RESULTS

A total of 11 consecutive patients (10 men; median age 75 years) were included. The technical success rate was 100%. At 30 days, mortality, MAEs, and major access-site complications were all 0%. Survival and freedom from ARM were 91% and 100%, respectively; only one nonaortic related death was recorded during follow-up. At a median follow-up of 14 months, IIA primary patency, IIA branch instability, and GRAEs were 100%, 0%, and 0%, respectively. No instances of graft migration ≥10 mm were detected. No graft-related secondary interventions were recorded, and 2 patients required a procedure-related secondary intervention 3 months after the index procedure (1 common femoral artery endarterectomy and 1 external iliac artery stenting). Although new-onset type 1 or type 3 ELs were never noted, one patient developed a new-onset type 2 EL. Aneurysm sac regression ≥5 mm was noted in 6 patients (55%), whereas in the remaining ones, the sac size was stable. No instances of new-onset BC were noted.

CONCLUSIONS

Use of standalone Gore Excluder IBE for elective endovascular repair of isolated iliac artery aneurysms is a safe, feasible, and effective treatment option. These results may support use of the technique as an effective means of endovascular reconstruction in patients with suitable anatomy.

One-year outcomes of the BeGraft stent graft used as chimney graft in conjunction with the Endurant device for the treatment of complex abdominal diseases

Aim

To evaluate the performance of two different flexible devices, the balloon-expandable BeGraft stent as on-label chEVAR use with the Endurant (Medtronic, Santa Rosa, USA) stent graft compared to the self-expandable off-label employment of Viabahn (Gore Flagstaff, Arizona, USA).

Methods

All patients treated for pararenal aortic pathologies between 2008 and 2017 using Endurant II (Medtronic, Santa Rosa, CA, USA) abdominal endograft in combination with Viabahn (Gore, Flagstaff, AZ, USA) or BeGraft (Bentley, Hechingen, Germany) at our institution were retrospectively analyzed. Patients were divided into two groups according to the employed chimney graft, namely Viabahn (group A) and BeGraft (group B). The primary endpoint was the incidence of type IA endoleak at one month and last follow-up. Secondary endpoints included reintervention rates, primary patency of the chimney graft, and need for additional placement of bare metal stents also known as relining.

Results

A total of 27 patients (mean age: 76 years) were treated with overall 47 chimney grafts. In particular, 11 patients received 21 Viabahn and 16 patients underwent placement of 26 BeGraft stents. Mean follow-up was 14.3 ± 9.0 months for group A and 13.0 ± 13.7 for group B, p = .451. The mean chimney graft length was 85.1 ± 38.9 mm for group A and 34.9 ± 9.8mm for group B ( p < .001). The oversizing rate at the proximal sealing zone was significantly higher in group B (Group A: 23.1 ± 16.5% vs. Group B: 33.6 ± 7.6%, p = .007). The primary patency rates were similar between groups ( p = .250). The subgroup analysis showed a significantly higher early (9–42.9% vs. 2–7.7%, p = .005) and at last CT follow-up (5–23.8% vs. 0–0.0%, p = .011) type IA endoleak, higher primary relining (14–66.7% vs. 5–19.2%, p = .001) and reintervention rates (5–23.8% vs. 0–0.0%; p = .011) for group A chimney stent grafts.

Conclusions

Both chEVAR combinations displayed similar patency rate, showing the BeGraft-Endurant composition less need for relining and fewer one-year type IA endoleak and reintervention rates in the subgroup analysis.