Editor's Choice – Multicentre Outcomes of Redo Fenestrated/Branched Endovascular Aneurysm Repair to Rescue Failed Fenestrated Endografts

“…This allowed placement of a bridging stent-graft from either the cranial or the caudal cuff to the target vessel, with intentional occlusion of the inner branch that is not used. 3 The procedure was performed percutaneously under general anesthesia with a duration of 217 minutes and fluoroscopy time of 49 minutes. The aortic stent-graft was deployed and the renal and superior mesenteric arteries were bridged from femoral access using standard technique.…”

Section: Techniquementioning

confidence: 99%

“…This allowed placement of a bridging stent-graft from either the cranial or the caudal cuff to the target vessel, with intentional occlusion of the inner branch that is not used. 3…”

Section: Techniquementioning

confidence: 99%

Double-Cuff Bidirectional Branch in Endovascular Aortic Repair: A New Way of Increasing the Flexibility of Inner Branch Endografting

et al. 2022

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Purpose: The purpose of the study was to describe the design and implantation of a branched stent-graft during endovascular aortic repair incorporating double-cuff bidirectional inner branch. Technique: A new double-cuff bidirectional antegrade and retrograde inner branched stent-graft with large diamond-shaped fenestration was designed for incorporation of a splenic artery. The inner cuffs of the branch were accessible using brachial and/or femoral access. The splenic artery was originating from an aortic segment with narrow inner aortic luminal diameter in a patient with extent IV thoracoabdominal aortic aneurysm with bilobed configuration. The retrograde, more distal inner cuff of the branch was extended into the splenic artery using a self-expandable bridging stent-graft from the femoral approach, whereas the antegrade, more proximal inner cuff of the branch was intentionally occluded using an endovascular plug. The recovery was uneventful and a computed tomography angiography 30 days postoperatively showed patency of all the target vessels without signs of endoleaks. Conclusion: This is the first design of a double-cuff bidirectional inner branched stent-graft. The technique can potentially expand the applications of directional branches to patients with more difficult anatomy in the thoracoabdominal or aortic arch segments. Potential indications are patients with target arteries that are not ideally suited for caudally-oriented branches, patients with accessory vessels, or targets with early branch bifurcations. Clinical Impact This report describes the use of a branched endograft with a new double-cuff bidirectional branch that can potentially address many of the limitations of current BEVAR solutions, such as early bifurcations, double arteries with adjacent origins and arteries with less favorable trajectories for the traditional caudally-oriented branches.

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“…1,2 Furthermore, failure of the primary attempt at endovascular aneurysm repair may complicate or even compromise future interventions. 5,6 We report a case of a patient with a large TAAA extent V treated with a custom-made F/B-EVAR after a failed attempt of Sandwich repair technique.…”

Section: Introductionmentioning

confidence: 99%

“…1,2 Furthermore, failure of the primary attempt at endovascular aneurysm repair may complicate or even compromise future interventions. 5,6…”

Section: Introductionmentioning

confidence: 99%

Salvage of an Incomplete Sandwich With a Covered Celiac Trunk and a “Floating” Superior Mesenteric Artery Stent in a Thoracoabdominal Aortic Aneurysm

et al. 2022

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Purpose: To report a case of a patient with a large thoracoabdominal aortic aneurysm (TAAA) extent V treated with a custom-made fenestrated and branched endovascular repair (F/B-EVAR) after a failed and incomplete attempt of a Sandwich repair technique. Report: An 83-year-old patient was referred to our department after a failed attempt at endovascular repair of type V TAAA with a sandwich technique. The celiac trunk was inadvertently covered with the first endograft and a covered long superior mesenteric artery stent was placed and left facing upward inside the aorta. We performed a staged repair, by first catheterizing and stenting the celiac trunk and bringing it under and inside the main aortic endograft. In interval, a F/B-EVAR was performed using a bimodular custom-made device (CMD) with a proximal 2 branch module for the celiac trunk and superior mesenteric artery and distal module with fenestrations for both renal arteries. The intervention was successful, and the follow-up was uneventful at 6 months. Conclusions: Re-intervention after failed endovascular attempts of TAAA repair are technically challenging and require advanced endovascular techniques. The ability to construct CMDs allowed to extend repair to our patient which had severe anatomical constraints for other techniques.

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Editor's Choice – Multicentre Outcomes of Redo Fenestrated/Branched Endovascular Aneurysm Repair to Rescue Failed Fenestrated Endografts

Cited by 15 publications

References 22 publications

Successful treatment of a persistent type IA endoleak with endoanchors following chimney endovascular aortic repair

Successful treatment of a persistent type IA endoleak with endoanchors following chimney endovascular aortic repair

Double-Cuff Bidirectional Branch in Endovascular Aortic Repair: A New Way of Increasing the Flexibility of Inner Branch Endografting

Salvage of an Incomplete Sandwich With a Covered Celiac Trunk and a “Floating” Superior Mesenteric Artery Stent in a Thoracoabdominal Aortic Aneurysm

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