Commentary: From Bespoke to Off-the-Shelf: The t-Branch Stent-Graft for Total Endovascular TAAA Repair

Chuter, Timothy A.M.

doi:10.1583/13-4428c.1

Cited by 3 publications

(4 citation statements)

References 7 publications

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“…Usually, we do not reinforce stent grafts with self-expanding bare stents unless kinking has been evident or in case of a short landing zone of the target vessel (<20 mm). A similar strategy has been presented by other authors [26,30,31]. We used Lifestent as a relining support for Viabahn stent grafts in one case because of the long distance between the branch and the orifice of the left renal artery.…”

Section: Discussionmentioning

confidence: 97%

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The Colt Device for Treating Thoraco-Abdominal Aneurysms - Concept and Clinical Results

Szopiński¹,

Pleban²,

Iwanowski³

2022

Rev. Cardiovasc. Med.

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Objective: To report results of application a new stent graft design for the treatment of patients with thoraco-abdominal aneurysms (TAAAs), which was co-invented by a vascular surgeon. This is a retrospective observational study. Methods: The Colt is a selfexpanding stent graft, composed of nitinol metal stents creating a special exoskeleton with asymmetric springs covered with polyester material. The Colt device offers some advantages over existing stent graft options. The main body is available in two different diameters on both ends and in three different lengths. It has four branches pointing downward and coming from the main stent graft at two levels. It offers the physician an opportunity to decide which branch to choose for the target vessel. It may be implanted alone or extended proximally and distally. Balloon expandable and/or self-expanding stent grafts are used to create the visceral branches. In complex extensive aneurysms, the procedure is divided into two or three stages to minimize the risks of spinal cord ischemia. Results: Between August 2015 and December 2021, twenty-two Colt stent grafts were implanted in twenty males and two females (aged 56-81) with TAAAs (eight Type II; twelve Type III; two Type IV). The mean aneurysm diameter was 73.4 mm (range 64-83). All patients were asymptomatic. Eighty-five target vessels were reconstructed using either self-expanding or balloon-expandable stent grafts. Fourteen bifurcated, six custom-made tubes and two aortouniiliac (AUI) stent grafts were used as distal extensions to the Colt device. Completion angiography revealed no type I endoleaks. Five patients had Type II endoleaks which were treated conservatively. There were no intraoperative deaths. One patient died on the 7th postoperative day from multiorgan failure. We did not observe any other complications within 30 days after implantation. One patient died from Covid-19 two months after discharge. Follow-up ranged from three to 75 months. There was no migration or dislocation of the docking station or proximal and distal extensions. All Colt device prostheses remained patent, however, two branches leading to the coeliac trunk were found occluded at the time of the 12-month CTA, without any symptoms. In two patients, there were late problems with three renal bridging stent grafts. One of the Type II endoleaks resolved spontaneously after one year, while four others remain under observation. No patient had an increase in sac diameter. Conclusions: Results from the current series are promising. The Colt stent graft can be applied to a large variety of TAAA anatomies, which may facilitate the development of new "off-the-shelf" devices in the future.

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Section: Discussionmentioning

confidence: 97%

“…The current 34 mm diameter of the t-Branch system limits its use as a standalone device, because it requires off-the-shelf proximal extensions [ 31 ]. The ideal proximal landing zone for the t-Branch device is 24–30 mm (outer to outer wall), which may result in 12–29% oversizing [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

The Colt Device for Treating Thoraco-Abdominal Aneurysms - Concept and Clinical Results

Szopiński¹,

Pleban²,

Iwanowski³

2022

Rev. Cardiovasc. Med.

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“…Several studies have demonstrated promising early results, though longerterm data are pending. [36][37][38] Gore has also developed an off-the-shelf device intended for thoracoabdominal aortic aneurysms, the Gore Excluder Thoracoabdominal Branch Endoprosthesis. The Gore Thoracoabdominal Aortic Aneurysm Clinical Study is evaluating a device in Brazil with hopes to begin a subsequent feasibility study in the United States (W. L. Gore & Associates, Flagstaff, AZ).…”

Section: Aortic Branched Devicesmentioning

confidence: 99%

The Current State of Fenestrated and Branched Devices for Abdominal Aortic Aneurysm Repair

Graves

Jackson

2015

Semin intervent Radiol

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Endovascular abdominal aortic aneurysm repair (EVAR) provides an attractive alternative to traditional open techniques. Endovascular repair is frequently limited by aortic aneurysm neck angulation, the absence of an adequate infrarenal neck, and the need for internal iliac preservation. Several devices have been created to incorporate visceral artery segments as well as preserve the internal iliac artery, thus broadening the patient population suited for endovascular repair. This article will provide a review of the current literature regarding fenestrated devices, branch devices, off-the-shelf devices, and physician-modified devices. It will also highlight the iliac branch stent grafts currently on trial for internal iliac artery preservation. Data thus far have suggested that these devices will be both a safe and effective option for anatomically challenging abdominal aortic aneurysms.

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“…Currently, fenestrated-branched endovascular aneurysm repair (F/B-EVAR) is used in the United States, in the context of Food and Drug Administration (FDA)-sponsored investigational device exemption (IDE) trials, to treat TAAA in patients who are at high risk for open repair 11, 12, 13, 14, 15. Whereas off-the-shelf and physician-modified designs confer certain advantages, company-manufactured, custom-made devices are well suited to endovascular repair of Carrel patch aneurysms 11, 12, 13, 16. In cases of prior open repair, in which reimplantation and patch degeneration often lead to significant distortions of the normal anatomic configuration, custom-made F/B-EVAR can be designed to be patient specific and to accommodate a variety of branch vessel anatomy.…”

mentioning

confidence: 99%

Use of fenestrated-branched endovascular aneurysm repair to treat Carrel patch aneurysmal degeneration after open thoracoabdominal aortic aneurysm repair

Nguyen

Simons

Schanzer

2019

Journal of Vascular Surgery Cases, Innovations and Techniques

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Two patients with a history of open type II thoracoabdominal aortic aneurysm repair presented with saccular aneurysmal degeneration of the Carrel patch. The degenerated segments measured 6.2 cm and 7.4 cm, respectively, and involved the celiac artery, superior mesenteric artery, and right renal artery. Both patients successfully underwent a custom fenestrated-branched endovascular aneurysm repair with downgoing branches to the celiac artery, superior mesenteric artery, and right renal artery and a stented fenestration to the left renal artery. Completion angiography demonstrated no endoleak and patent visceral-renal segments. Both patients were discharged home on postoperative day 2.

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Commentary: From Bespoke to Off-the-Shelf: The t-Branch Stent-Graft for Total Endovascular TAAA Repair

Cited by 3 publications

References 7 publications

The Colt Device for Treating Thoraco-Abdominal Aneurysms - Concept and Clinical Results

The Colt Device for Treating Thoraco-Abdominal Aneurysms - Concept and Clinical Results

The Current State of Fenestrated and Branched Devices for Abdominal Aortic Aneurysm Repair

Use of fenestrated-branched endovascular aneurysm repair to treat Carrel patch aneurysmal degeneration after open thoracoabdominal aortic aneurysm repair

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