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Becker D, Ali A, Prendes C, Stavroulakis K, Stana J, Tsilimparis N. Physician Modification of a Custom-Made Fenestrated Endograft By Closure of a Fenestration With Bovine Patch. J Endovasc Ther 2023:15266028231187749. [PMID: 37464749 DOI: 10.1177/15266028231187749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
PURPOSE Ruptured mycotic pararenal aortic aneurysms are rare and serious condition that requires prompt treatment. Open surgery with aortic resection and in-situ or extra-anatomic reconstruction is the standard treatment. The aim of this technical note is to report urgent endovascular treatment using a readily available custom-made device (created for another patient), with a back-table modification using pericardium patch and a new fenestration. TECHNIQUE In preoperative measurements on centerline-based workstation, aortic diameter in proximal and distal landing zone and target vessel position matched the measurements of graft plan of custom-made device (CMD) besides left renal artery. To address current patient`s anatomy, closure of the nonsuitable fenestration with pericardial patch and creation of new fenestration (1 cm above and 1:15 hours posterior to original fenestration) for the respective target vessel have been performed. Postoperative computed tomography angiography (CTA) scan showed complete exclusion of aneurysm, perfused target vessels, and no endoleak. Under resistance-based antibiotic therapy, the patient was asymptomatic and showed normal infection parameters in blood samples postoperatively. CONCLUSION In the hands of an experienced endovascular aortic surgeon modification of a custom-made device is a quick and feasible technique in this emergency situation. Long-term follow-up must confirm the durability and reliability of this new technique. CLINICAL IMPACT The described technique of modification of a custom-made endograft can provide an alternative endovascular treatment option for urgent complex abdominal aortic pathologies. Compared to the current available treatment modalities, like physician modified endografts, off-the-shelf branched devices, parallel grafts and in-situ fenestration, it can save considerable time and provides reasonable sealing in ruptured cases. The technique offers a valuable add-on to the armamentarium of experienced endovascular physicians.
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Affiliation(s)
- D Becker
- Department of Vascular Surgery-Vascular and Endovascular Surgery, University Hospital, Ludwig Maximillian University Munich, Munich, Germany
| | - A Ali
- Department of Vascular Surgery-Vascular and Endovascular Surgery, University Hospital, Ludwig Maximillian University Munich, Munich, Germany
| | - C Prendes
- Department of Vascular Surgery-Vascular and Endovascular Surgery, University Hospital, Ludwig Maximillian University Munich, Munich, Germany
| | - K Stavroulakis
- Department of Vascular Surgery-Vascular and Endovascular Surgery, University Hospital, Ludwig Maximillian University Munich, Munich, Germany
| | - J Stana
- Department of Vascular Surgery-Vascular and Endovascular Surgery, University Hospital, Ludwig Maximillian University Munich, Munich, Germany
| | - N Tsilimparis
- Department of Vascular Surgery-Vascular and Endovascular Surgery, University Hospital, Ludwig Maximillian University Munich, Munich, Germany
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Krammer J, Pichlmaier M, Stana J, Heinisch PP, Hagl C, Grefen L, Grab M. Biomimetic Multilayered Aortic Grafts: Combining 3D-Printing and Electrospinning to Improve Prosthesis Performance. Thorac Cardiovasc Surg 2023. [DOI: 10.1055/s-0043-1761798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Affiliation(s)
- J. Krammer
- Department of Cardiac Surgery, Ludwig Maximilian University of Munich, München, Deutschland
| | - M. Pichlmaier
- Department of Cardiac Surgery, Ludwig Maximilian University of Munich, München, Deutschland
| | - J. Stana
- Department of Vascular Surgery, Ludwig Maximilian University of Munich, München, Deutschland
| | - P. P. Heinisch
- Department of Pediatric and Congenital Heart Surgery, German Heart Center Munich, München, Deutschland
| | - C. Hagl
- Department of Cardiac Surgery, Ludwig Maximilian University of Munich, München, Deutschland
| | - L. Grefen
- Department of Cardiac Surgery, Ludwig Maximilian University of Munich, München, Deutschland
| | - M. Grab
- Department of Cardiac Surgery, Ludwig Maximilian University of Munich, München, Deutschland
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Stana J, Grab M, Kargl R, Tsilimparis N. 3D printing in the planning and teaching of endovascular procedures. Radiologie (Heidelb) 2022; 62:28-33. [PMID: 36112173 DOI: 10.1007/s00117-022-01047-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/05/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The introduction of 3D printing in the medical field led to new possibilities in the planning of complex procedures, as well as new ways of training junior physicians. Especially in the field of vascular interventions, 3D printing has a wide range of applications. METHODOLOGICAL INNOVATIONS 3D-printed models of aortic aneurysms can be used for procedural training of endovascular aortic repair (EVAR), which can help boost the physician's confidence in the procedure, leading to a better outcome for the patient. Furthermore, it allows for a better understanding of complex anatomies and pathologies. In addition to teaching applications, the field of pre-interventional planning benefits greatly from the addition of 3D printing. Especially in the preparation for a complex endovascular aortic repair, prior orientation and test implantation of the stent grafts can further improve outcomes and reduce complications. For both teaching and planning applications, high-quality imaging datasets are required that can be transferred into a digital 3D model and subsequently printed in 3D. Thick slice thickness or suboptimal contrast agent phase can reduce the overall detail of the digital model, possibly concealing crucial anatomical details. CONCLUSION Based on the digital 3D model created for 3D printing, another new visualization technique might see future applications in the field of vascular interventions: virtual reality (VR). It enables the physician to quickly visualize a digital 3D model of the patient's anatomy in order to assess possible complications during endovascular repair. Due to the short transfer time from the radiological dataset into the VR, this technique might see use in emergency situations, where there is no time to wait for a printed model.
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Affiliation(s)
- J Stana
- Department of Vascular Surgery, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany.
| | - M Grab
- Department of Cardiac Surgery, Ludwig Maximilians University, Munich, Germany
- Chair of Medical Materials and Implants, Technical University Munich, Munich, Germany
| | - R Kargl
- Institute for Chemistry and Technology of Biobased System, (IBioSys), Graz University of Technology, Graz, Switzerland
| | - N Tsilimparis
- Department of Vascular Surgery, LMU University Hospital, Marchioninistr. 15, 81377, Munich, Germany
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Stana J, Prendes C, e Melo R, Pichlmaier M, Ginthoer B, Stavroulakis K, Abicht JM, Tsilimparis N. First Experience with the Munich Valsalva Implantation Technique (MuVIT) for Cardiac Output Reduction During Standard and Complex Thoracic Endovascular Aortic Repair. J Vasc Surg 2022. [DOI: 10.1016/j.jvs.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Argyriou A, Rantner B, Stana J, Tsilimparis N, Sensebat Ö, Torsello G, Stavroulakis K. Moderne endovaskuläre Therapieoptionen bei diabetischem Fußsyndrom. Diabetologe 2022. [DOI: 10.1007/s11428-022-00869-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Prendes C, Dayama A, Panneton J, Stana J, Rantner B, Marcos F. Endovascular Aortic Repair in Nonagenarian Patients. J Vasc Surg 2021. [DOI: 10.1016/j.jvs.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Fasl H, Stana J, Stropnik D, Strnad S, Stana-Kleinschek K, Ribitsch V. Improvement of the Hemocompatibility of PET Surfaces Using Different Sulphated Polysaccharides as Coating Materials. Biomacromolecules 2010; 11:377-81. [DOI: 10.1021/bm9010084] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- H. Fasl
- Institute for Chemistry (IfC), Rheology and Colloid Science, Karl-Franzens-University Graz, Heinrichstrasse 28, 8010 Graz, Austria, Laboratory for Characterization and Processing of Polymers, Faculty of Mechanical Engineering, University of Maribor, Maribor, Slovenia, and Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - J. Stana
- Institute for Chemistry (IfC), Rheology and Colloid Science, Karl-Franzens-University Graz, Heinrichstrasse 28, 8010 Graz, Austria, Laboratory for Characterization and Processing of Polymers, Faculty of Mechanical Engineering, University of Maribor, Maribor, Slovenia, and Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - D. Stropnik
- Institute for Chemistry (IfC), Rheology and Colloid Science, Karl-Franzens-University Graz, Heinrichstrasse 28, 8010 Graz, Austria, Laboratory for Characterization and Processing of Polymers, Faculty of Mechanical Engineering, University of Maribor, Maribor, Slovenia, and Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - S. Strnad
- Institute for Chemistry (IfC), Rheology and Colloid Science, Karl-Franzens-University Graz, Heinrichstrasse 28, 8010 Graz, Austria, Laboratory for Characterization and Processing of Polymers, Faculty of Mechanical Engineering, University of Maribor, Maribor, Slovenia, and Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - K. Stana-Kleinschek
- Institute for Chemistry (IfC), Rheology and Colloid Science, Karl-Franzens-University Graz, Heinrichstrasse 28, 8010 Graz, Austria, Laboratory for Characterization and Processing of Polymers, Faculty of Mechanical Engineering, University of Maribor, Maribor, Slovenia, and Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - V. Ribitsch
- Institute for Chemistry (IfC), Rheology and Colloid Science, Karl-Franzens-University Graz, Heinrichstrasse 28, 8010 Graz, Austria, Laboratory for Characterization and Processing of Polymers, Faculty of Mechanical Engineering, University of Maribor, Maribor, Slovenia, and Faculty of Medicine, University of Maribor, Maribor, Slovenia
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