A clinical review of early outcomes from contemporary flow modulation versus open, fenestrated and branch technologies in the management of thoracoabdominal aortic aneurysm

Abstract

Traditional therapeutic options for complex thoracoabdominal aneurysm include open repair, hybrid repair or endovascular repair (involving fenestrated or branched endografts). The Streamliner Multilayer Flow Modulator has been available for treatment of thoracoabdominal aneurysms since 2010. Its design permits blood flow to perfuse through the mesh in a modus that preserves collateral branch patency, while modulating turbulent to laminar flow within the device. The flow then stagnates over time within the surrounding aneurysm sac. Significant complications, including paraplegia, renal failure and cerebrovascular accident, are much lower with Streamliner Multilayer Flow Modulator treatment. Application of the Streamliner Multilayer Flow Modulator to complex aortic pathologies presents a novel solution to an, as of yet, unmet clinical need, and has resulted in promising clinical outcomes when compared to existing solutions. The Streamliner Multilayer Flow Modulator offers potential for treatment of thoracoabdominal aortic pathologies in patients and is not just confined to those with complexity that dictates no other management options. While current literature illustrates that there is a decreased risk of mortality and associated complications when this new disruptive technology is utilised, there is still a need for prospective, long-term clinical trials, as well as comparative trials to accurately assess outcomes of Streamliner Multilayer Flow Modulator treatment that are both precise and reproducible. This article is a review of current clinical literature regarding contemporary flow modulating technology compared with open, branched and fenestrated managements, presenting early outcomes.

2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines

“…Modified approaches have been described that eliminate the need for open repair whereby the ascending aorta is replaced first with a trifurcated side-branch for debranching of the arch in a sequential manner to a level that is accessible for clamping; however, no studies have yet shown the benefit of such an approach. Although it does add to the cardiopulmonary bypass time and blood loss, 4,5 the addition of a hemiarch has been shown not to increase the risk of the procedure. However, this noninferiority is lost when the proximal arch is disease free, with exception of an underlying aortopathy in which the normal-sized arch will predictively enlarge or dissect at a later time; in this setting, a hemiarch is justified.…”

Effects of two different surgical methods for endovascular repair of the thoracic aorta on the hemodynamics of the left subclavian artery

“…Concerning the application of MFM in aortic Z2 lesions, some clinicians have made bold attempts and achieved good short-term results. This technology not only seals the aortic intima groove with a traditional endograft, but also guides the blood ow into the branches, without blocking the main branches of the supraarch artery [41]. In this study, compared with the stent-free model, it is considered that the MFM has little effect on the blood ow of the subclavian artery branch.…”

Aneurysm Sac Pressure during Branched Endovascular Aneurysm Repair versus Multilayer Flow Modulator Implantation in Patients with Thoracoabdominal Aortic Aneurysm

“…A case report was published that described the emergency use of MFM for the treatment of aortic dissection, outside the indications for use [ 15 ]. The most extensive experience with the MFM technique was reported by Sultan et al [ 12 , 16 , 17 ]. Several published papers describe findings from in-vitro [ 16 ], animal [ 17 ], and early clinical studies [ 12 ].…”

“…The most extensive experience with the MFM technique was reported by Sultan et al [ 12 , 16 , 17 ]. Several published papers describe findings from in-vitro [ 16 ], animal [ 17 ], and early clinical studies [ 12 ].…”