A Novel Off-the-Shelf Technique for Endovascular Repair of Type III and IV Thoracoabdominal Aortic Aneurysms Using the Gore Excluder and Viabahn Branches

Wooster, Mathew; Tanious, Adam; Jones, R. Wesley; Armstrong, Paul A.; Shames, Murray L.

doi:10.1016/j.avsg.2017.06.155

Cited by 7 publications

(5 citation statements)

References 20 publications

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“…The incidence of major complications was 45.5%, including three deaths, one permanent paraplegia, and one temporary paraplegia. Wooster et al (2018 ) reported using the Octopus technology to treat eight cases of TAAA from January 2015 to January 2017. The incidence of major complications was 37.5%; two cases died during the perioperative period, and one case of temporary paraplegia.…”

Section: Discussionmentioning

confidence: 99%

Clinical effect of endovascular repair of complex aortic lesions using optimized Octopus surgery

Sun

Zhang

Sun

et al. 2023

Front. Bioeng. Biotechnol.

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Objective: Complex aortic lesions, especially those involving branches of the visceral artery, remain a challenge to treat. A single-center study using the Octopus technique to evaluate the safety and short-term effects of endovascular repair of complex aortic lesions was reported and documented.Methods: The data of six cases who underwent optimized Octopus surgery in our center from August 2020 to February 2022 were analyzed retrospectively. The choice of operation scheme, operation time, operation complications, and follow-up data were analyzed among them.Results: The average age of the six patients undergoing optimized Octopus surgery was 55.1 ± 17.2 years. Two cases were diagnosed as pararenal aortic aneurysms; four cases were aortic dissection involving the visceral artery. All cases achieved technical success; all visceral arteries were reconstructed as planned. A total of 17 visceral arteries were planned to be reconstructed; five celiac arteries were embolized. Three cases of gutter endoleak were found during the operation without embolization but with follow-up observation. There were two cases of slight damage to renal function and two cases of perioperative death. Other complications, such as intestinal ischemia and spinal cord ischemia, did not occur. Follow-up ranged from 6 months to 30 months. One patient died of gastrointestinal bleeding 6 months after the operation. At the 6 months follow-up, computed tomographic angiography showed that all internal leaks had disappeared. The patency rate of the visceral artery was 100%, and no complications, such as stent displacement and occlusion, occurred during the follow-up period.Conclusion: With fenestrated and branched stent grafts technology not widely available, and off label use not a viable option, Octopus technology for treating complex aortic lesions should be considered. The Octopus technique is an up-and-coming surgical method, but we should recognize its operation difficulty, operation-related complications, and long-term prognosis. We should pay attention to and continue to optimize Octopus technology.

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Section: Discussionmentioning

confidence: 99%

Clinical effect of endovascular repair of complex aortic lesions using optimized Octopus surgery

Sun

Zhang

Sun

et al. 2023

Front. Bioeng. Biotechnol.

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“…Since then, a few reports have documented promising results by using this attractive technique to treat TAAA and PRAAA. 8–11 Wooster et al 8 reported treatment for 8 TAAA using the “Octopus” technique, describing 2 perioperative deaths (1 died of bowel ischemia due to SMA endograft occlusion) and 1 SCI. Hsu et al 11 reported the “Octopus” technique treatment for 11 TAAA and aortic dissections, demonstrating 89.7% (35/39) technique success rate of target vessels stent placement, 45.5% major complication rate (5/11, including 3 deaths, 1 permanent paraplegia, and 1 temporary paraplegia), and 89.3% (25/28) primary branch patency rate.…”

Section: Discussionmentioning

confidence: 99%

“…Also, the upper edge of SMA endograft should be adjusted slightly higher than the other 2 endografts, to ensure the SMA blood flow, because bowel ischemia was a major cause of in-hospital death. 8,10 In addition, precisely juxtaposing the endografts is high technical demanding, leading to prolonged procedure time and increased blood loss in the classic “Octopus” procedure.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the gutter space has been well studied, 18 gutter leak was common in the “Octopus” procedures, 8,10,11 which might lead to aneurysm growth and threaten the long-term durability of the novel technique, especially in ruptured scenarios. Although better attachment and expansion of the endografts can be achieved by post balloon dilatation, the gutter size can be even worse after post ballooning, because the cylindrical shape of balloons can change the initial shapes of endografts.…”

Section: Discussionmentioning

confidence: 99%

“…Since first reported by Kasirajan K, 7 promising outcomes have been demonstrated by several reports of using this attractive technique to treat complex TAAA. [8][9][10][11] However, the effectiveness and safety of this novel technique in aneurysm ruptured scenarios need to be investigated. In the current study, we present the midterm clinical outcomes of the "Octopus" technique treatment for ruptured or symptomatic TAAAs and PRAAAs.…”

Section: Introductionmentioning

confidence: 99%

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Endovascular Treatment of Ruptured or Symptomatic Thoracoabdominal and Pararenal Aortic Aneurysms Using Octopus Endograft Technique: Mid-Term Clinical Outcomes

et al. 2022

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Objective: To evaluate the effectiveness and safety of using off-the-shelf “Octopus” technique to treat ruptured or symptomatic thoracoabdominal aortic aneurysm (TAAA) and pararenal abdominal aortic aneurysm (PRAAA). Methods and Results: All cases who underwent “Octopus” technique from May 2016 to May 2019 at our center were retrospectively analyzed. A total of 10 cases (8 males) were included. The mean age was 54.5±14.2 years (range: 31–80 years). Eight cases presented as aneurysm rupture or impending rupture accepted emergency repair. Technical success, defined by placement of all endografts as planned, was achieved in all cases. A total of 30 target visceral branches were successfully cannulated, 9 celiac arteries were covered intentionally. Intraoperative endoleak was observed in 6 patients, all of them were gutter leak. During hospital stay, there was no death, no side branch occlusion or spinal cord ischemia. Median follow-up was 30 months (range: 12–50 months). One patient died of lung cancer at 14-month follow-up. There was no secondary endoleak. The primary endoleak were found spontaneously resolved in 3 cases at 7 days, 3-month, and 1-year imaging. One persistent endoleak totally resolved after sealing of gutter spaces at 4-month follow-up. The other 2 persistent endoleak decreased during follow-up, which are still under observation. The branch patency rate was 90.3% (28/31). All the 3 occluded branches were renal arteries. Branch occlusion occurred in 2 cases at 1-month follow-up and 1 case at 2-year follow-up, but renal insufficiency was not observed in these cases. Obvious aneurysm sac shrinkage (≥5 mm) was observed in all cases. The aneurysm size shrunk from 7.6±1.9 to 5.5±1.4 cm. No spinal cord ischemia occurred during follow-up. Conclusion: Treatment of ruptured TAAA and PRAAA with “Octopus” technique is feasible and safe for high surgical risk patients in the absence of fenestrated and branched devices. The long-term clinical outcomes needed to be investigated.

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Early Experience with the Octopus Endovascular Strategy in the Management of Thoracoabdominal Aneurysms

Dua

Lavingia

Deslarzes-Dubuis

et al. 2019

Annals of Vascular Surgery

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A Novel Off-the-Shelf Technique for Endovascular Repair of Type III and IV Thoracoabdominal Aortic Aneurysms Using the Gore Excluder and Viabahn Branches

Cited by 7 publications

References 20 publications

Clinical effect of endovascular repair of complex aortic lesions using optimized Octopus surgery

Clinical effect of endovascular repair of complex aortic lesions using optimized Octopus surgery

Endovascular Treatment of Ruptured or Symptomatic Thoracoabdominal and Pararenal Aortic Aneurysms Using Octopus Endograft Technique: Mid-Term Clinical Outcomes

Early Experience with the Octopus Endovascular Strategy in the Management of Thoracoabdominal Aneurysms

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