An update on the ovation abdominal stent graft for the treatment of abdominal aortic aneurysms: current evidence and future perspectives

Georgakarakos, Efstratios; Papatheodorou, Nikolaos; Argyriou, Christos; Tasopoulou, Kalliopi-Maria; Doukas, Damianos; Georgiadis, George S.

doi:10.1080/17434440.2020.1848539

Cited by 9 publications

(5 citation statements)

References 39 publications

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“…The design of these endografts can be grouped into three broad categories. The first and most common is where a short main body around 5 cm long splits to two iliac limbs [36]. The second uses an anatomical fixation of the main body into the native aortic bifurcation, where the main body has the length of the native infra-renal aorta [37].…”

Section: Discussionmentioning

confidence: 99%

Selection of Bifurcated Grafts’ Dimensions during Aorto-Iliac Vascular Reconstruction Based on Their Hemodynamic Performance

et al. 2023

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During the vascular surgical reconstruction of aorto-iliac occlusive/aneurysmal disease, bifurcated grafts are used where vascular surgeons intra-operatively select the size and the relative lengths of the parent and daughter portions of the graft. Currently, clinical practice regarding the selection of the most favorable geometric configuration of the graft is an understudied research subject: decisions are solely based on the clinical experience of the operating surgeon. This manuscript aims to evaluate the hemodynamic performance of various diameters, D, of bifurcated aortic grafts and relate those with proximal/distal part length ratios (the angle φ between the limbs is used as a surrogate marker of the main body-to-limb length ratio) in order to provide insights regarding the effects of different geometries on the hemodynamic environment. To this end, a computationally intensive set of simulations is conducted, and the resulting data are analyzed with modern statistical regression tools. A negative curvilinear relationship of TAWSS with both φ and D is recorded. It is shown that the angle between limbs is a more important predictor for the variability of TAWSS, while the graft’s diameter is an important determinant for the variability of OSI. Large percentages of the total graft area with TAWSS < 0.4 Pa, which correspond to thrombogenic stimulating environments, are only observed for large values of φ and D > 20 mm. This variable ranges from 10% (for the smallest values of φ and D) to 55% (for the largest φ and D values). Our findings suggest that grafts with the smallest possible angle between the limbs (i.e., smallest parent-to-daughter length ratio) present the most favorable hemodynamic performance, yielding the smallest percentage of total graft area under thrombogenic simulating environments. Similarly, grafts with the smallest acceptable diameter should be preferred for the same reason. Especially, grafts with diameters greater than 20 mm should be avoided, given the abrupt increase in estimated thrombogenic areas.

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Section: Discussionmentioning

confidence: 99%

Selection of Bifurcated Grafts’ Dimensions during Aorto-Iliac Vascular Reconstruction Based on Their Hemodynamic Performance

et al. 2023

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“…Gregory et al [11] stated that although existing published data on the ALTO device are limited, if more published data show short-to long-term results comparable to those obtained using the Ovation iX [12][13][14][15][16][17][18][19], then the ALTO device can be used more widely. However, whether ALTO devices can be successfully used in patients with more hostile aortic anatomies remains to be seen, considering the satisfac-tory results of Ovation iX use reported by Sirignano et al [17] and Morgan-Bates and Chaudhuri [19].…”

Section: Discussionmentioning

confidence: 99%

Endovascular Juxtarenal Aortic Aneurysm Repair Using the ALTO Abdominal Stent Graft System: The First Case Series

Efthymiou

Tsimpoukis

Papatsirou

et al. 2022

Vasc Specialist Int

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The ALTO abdominal stent graft system (Endologix Inc., Irvine, CA, USA) is a latest-generation polymer-based device used to treat patients with abdominal aortic aneurysms. The present study describes the first case series of patients with abdominal aortic aneurysms, including two patients with juxtarenal aneurysms, treated using the ALTO stent graft system. Six males were treated using the ALTO device at a single public center. All procedures were uneventful, and the dosimetric results recorded in terms of kerma-area product and fluoroscopy time were similar to those reported in previous studies. At the 1-month follow-up, computed tomography angiography showed no evidence of endoleak, device migration, thrombosis, or structural graft failure. This clinical series demonstrates that the use of the ALTO stent graft system is associated with promising patient outcomes. Lifelong postoperative imaging surveillance may highlight possible late failures and suggest potential graft improvements.

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“…This assumption comes with a benefit in reducing aortic neck dilatation and consecutive endograft migration, a typical complication of SESGs. All these features define the revolutionary concept of “Custom Seal” as a tailored adaptation of polymer rings to the aortic wall, including wall calcification, wall thrombosis, and aortic tortuosity [ 75 , 76 , 77 ].…”

Section: Polymer and Endovascular Aneurysm Repairmentioning

confidence: 99%

The Polymer-Based Technology in the Endovascular Treatment of Abdominal Aortic Aneurysms

et al. 2021

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An abdominal aortic aneurysm (AAA) is a dilatation of the abdominal aorta that progressively grows until it ruptures. Treatment is typically recommended when the diameter is more than 5 cm. The EVAR (Endovascular aneurysm repair) is a minimally invasive procedure that involves the placement of an expandable stent graft within the aorta to treat aortic disease without operating directly on the aorta. For years, stent grafts’ essential design was based on metallic stent frames to support the fabric. More recently, a polymer-based technology has been proposed as an alternative method to seal AAA. This review underlines the two platforms that are based on a polymer technology: (1) the polymer-filled endobags, also known as Endovascular Aneurysm Sealing (EVAS) with Nellix stent graft; and (2) the O-ring EVAR polymer-based proximal neck sealing device, also known as an Ovation stent graft. Polymer characteristics for this particular aim, clinical applications, and durability results are hereby summarized and commented critically. The technique of inflating endobags filled with polymer to exclude the aneurysmal sac was not successful due to the lack of an adequate proximal fixation. The platform that used polymer to create a circumferential sealing of the aneurysmal neck has proven safe and effective.

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An update on the ovation abdominal stent graft for the treatment of abdominal aortic aneurysms: current evidence and future perspectives

Cited by 9 publications

References 39 publications

Selection of Bifurcated Grafts’ Dimensions during Aorto-Iliac Vascular Reconstruction Based on Their Hemodynamic Performance

Selection of Bifurcated Grafts’ Dimensions during Aorto-Iliac Vascular Reconstruction Based on Their Hemodynamic Performance

Endovascular Juxtarenal Aortic Aneurysm Repair Using the ALTO Abdominal Stent Graft System: The First Case Series

The Polymer-Based Technology in the Endovascular Treatment of Abdominal Aortic Aneurysms

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