Commentary: Multilayer Stent for the Treatment of Complex Aortic Pathologies: A Long or Short Road Ahead?

Tolva, Valerio; Casana, Renato; Antoniou, George Α.

doi:10.1583/13-4514c.1

Cited by 4 publications

(6 citation statements)

References 20 publications

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“…For avoidance of endoleak and other complications, previous investigators also stress the importance of (1) deployment within nonaneurysmal native aortic landing zones of at least 20 mm, (2) pretreatment of concomitant stenosis in the collaterals to be covered by the device, (3) adequate device oversizing, and (4) adherence to dual antiplatelet therapy. 12,29,31…”

Section: Discussionmentioning

confidence: 99%

“…Published studies consistently stress the crucial importance of strict compliance with the MFM IFU, including the guidelines for patient selection. 12,15,[29][30][31]38 Established contradictions to use of the MFM include ruptured aneurysm, connective tissue disorders, mycotic aneurysms, and concomitant or previously implanted stent-grafts. 30 Vaislic et al 29 articulate some important technical points related to the reproducibility of positive outcomes with the MFM.…”

Section: Discussionmentioning

confidence: 99%

“…Exclusion criteria included active infection; allergy to aspirin, clopidogrel, or contrast agents; or other indications or medical history outside the device IFU, including ruptured aneurysm, connective tissue disorder, history of coagulation problems, inadequate landing zones, or use with concomitant or previously implanted stent-grafts. 30,31 Informed written consent was obtained from all enrolled patients.…”

Section: Methodsmentioning

confidence: 99%

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Multilayer Flow Modulator Treatment of Abdominal and Thoracoabdominal Aortic Aneurysms With Side Branch Coverage

Benjelloun¹,

Henry²,

Taberkant

et al. 2016

J Endovasc Ther

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Multilayer Flow Modulator Treatment of Abdominal and Thoracoabdominal Aortic Aneurysms With Side Branch Coverage

Benjelloun¹,

Henry²,

Taberkant

et al. 2016

J Endovasc Ther

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“…Rather than "excluding" the aneurysm, the MFMS is freely porous but blood-flow through the stent is laminated reducing turbulence in the aneurysm sac leading to sac thrombosis. As the stent is uncovered and highly porous, it can be deployed across the origins of major aortic branches maintaining organ perfusion 1,2 (Fig. 1).…”

Section: Introductionmentioning

confidence: 99%

“…Recent studies suggest acceptable early results in aortic aneurysms, 3,4 aortic dissections, 3,4 and peripheral and visceral aneurysms, 5 although the consequences of using this device outside of the instructions for use (IFU) have been well documented. 2,6 This study reports experience with the first-generation MFMS device in a UK pilot study recruiting patients with thoracoabdominal (TAAA) and peri-renal (PAA) aortic aneurysms.…”

Section: Introductionmentioning

confidence: 99%

Multi-layer Flow-modulating Stents for Thoraco-abdominal and Peri-renal Aneurysms: The UK Pilot Study

Lowe

Worthington

Serracino‐Inglott

et al. 2016

European Journal of Vascular and Endovascular Surgery

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These first-generation MFMS were unstable and dislocated frequently. It is uncertain whether MFMS implantation influenced the natural history of these aneurysms as none decreased in size, but two remain stable after a mean of 22.8 months. Although side branch patency was maintained, our results do not support the continued use of these first-generation devices. Further development is needed if this technology is to have a role in treatment of aortic aneurysm.

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Current status on aortic endografts

et al. 2020

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Background: Acute occlusion of renal bridging stent grafts after fenestrated/branched endovascular aortic repair (F/B-EVAR) is an acknowledged complication with high morbidity that often results in chronic dialysis dependence. The feasibility and effect of timely or late ($6 hours of ischemia) renal artery revascularization has not been adequately reported.Methods: We performed a retrospective, multicenter study across 11 tertiary institutions of all consecutive patients who had undergone revascularization of renal artery stent graft occlusions after complex EVAR. The end points were technical success, association between ischemia time and renal function salvage, interventional complications, mortality, and midterm outcomes.Results: From 2009 to 2019, 38 patients with 46 target vessels (TVs; eight bilateral occlusions) were treated for renal artery occlusions after complex EVAR (mean age, 63.5 6 10 years; 63.2% male). Six patients had a solitary kidney (15.8%). Of the 38 patients, 16 (42.1%) had undergone FEVAR and 22 (57.9%) had undergone BEVAR. The technical success rate was 95.7% (44 of 46 TVs). The recanalization technique used was sole aspiration thrombectomy in 5.3%, aspiration thrombectomy and stent graft relining in 52.6%, and sole stent graft relining in 36.8%. The median renal ischemia time was 27.5 hours (range, 4-720 hours; interquartile range, 4-36 hours). Most patients (94.4%) had been treated after $6 hours of renal ischemia time, and 55.6% had been treated after 24 hours. In 14 patients (36.8%), renal function had improved after intervention (mean glomerular filtration rate improvement, 14.2 6 9 mL/min/1.73 m 2 ). However, 24 patients (63.2%) showed no improvement. Improvement of renal function did not correlate with the length of renal ischemia time. Of the 14 patients with bilateral renal artery occlusion or a solitary kidney, 9 experienced partial recovery of renal function and no longer required hemodialysis. In-hospital mortality was 2.6%. The cause of renal stent graft occlusion could not be identified in 50% of the TVs (23 of 46). However, in 19 (41.3%), significant stenosis or a kink of the renal stent graft was found. The median follow-up was 11 months (interquartile range, 0-28 months). The estimated 1-year patient survival and patency rate of the renal stent grafts was 97.4% and 83.8%, respectively.Conclusions: Revascularization of occluded renal bridging stent grafts after F/B-EVAR is a safe and feasible technique and can lead to significant improvement of renal function, even after long ischemia times (>24 hours) of the renal parenchyma or bilateral occlusion, as long as residual perfusion of the renal parenchyma has been preserved. Also, the longterm patency rates justify aggressive management of renal artery occlusion after F/B-EVAR.

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Commentary: Multilayer Stent for the Treatment of Complex Aortic Pathologies: A Long or Short Road Ahead?

Cited by 4 publications

References 20 publications

Multilayer Flow Modulator Treatment of Abdominal and Thoracoabdominal Aortic Aneurysms With Side Branch Coverage

Multilayer Flow Modulator Treatment of Abdominal and Thoracoabdominal Aortic Aneurysms With Side Branch Coverage

Multi-layer Flow-modulating Stents for Thoraco-abdominal and Peri-renal Aneurysms: The UK Pilot Study

Current status on aortic endografts

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