Editor's Choice – Thirty day Outcomes and Costs of Fenestrated and Branched Stent Grafts versus Open Repair for Complex Aortic Aneurysms

Michel, Morgane; Becquemin, J. P.; Clément, M.-C.; Marzelle, J.; Quelen, Céline; Durand‐Zaleski, Isabelle

doi:10.1016/j.ejvs.2015.04.012

Cited by 74 publications

(54 citation statements)

References 29 publications

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“…Current delays in gaining designed devices exceed more than 6 weeks, and this latency time may be too long for critically frail patients, particularly those with varying anatomical structures. The technically difficult procedure may limit the applicability of this technology . In addition, during TEVAR the operators need to repetitiously rotate the endograft to ensure that the opening is aligned with the vessel branches, which may increase the risk of stroke.…”

Section: Introductionmentioning

confidence: 99%

In Situ Laser Fenestration Is a Feasible Method for Revascularization of Aortic Arch During Thoracic Endovascular Aortic Repair

Qin

Zhao

Wang

et al. 2017

JAHA

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BackgroundReconstruction of the aortic major branches during thoracic endovascular aortic repair is complicated because of the complex anatomic configuration and variation of the aortic arch. In situ laser fenestration has shown great potential for the revascularization of aortic branches. This study aims to evaluate the feasibility, effectiveness, and safety of in situ laser fenestration on the three branches of the aortic arch during thoracic endovascular aortic repair.Methods and ResultsBefore clinical application, the polytetrafluoroethylene and Dacron grafts were fenestrated by an 810‐nm laser system ex vivo, which did not damage the bare metal portion of the endografts and created a clean fenestration while maintaining the integrity of the endografts. In vivo, 6 anesthetized female swine survived after this operation, including stent‐graft implantation in the aortic arches, laser fenestration, and conduit implantation through the innominate arteries and the left carotid arteries. Based on the animal experiments, in situ laser fenestration during thoracic endovascular aortic repair was successively performed on 24 patients (aged 33–86 years) with aortic artery diseases (dissection type A: n=4, type B: n=7, aneurysm: n=2, mural thrombus: n=7). Fenestration of 3 aortic branches was performed in 2 (8.3%) patients. Both the left carotid artery and the left subclavian artery were fenestrated in 6 (25%) patients. Only left subclavian artery fenestration surgery was done in 16 (66.7%) patients. Among these patients, 1 fenestration was abandoned secondary to an acute takeoff of the innominate artery in a type III aortic arch. The average operative time was 137±15 minutes. The technical success rate was 95.8% (n=23). No fenestration‐related complications or neurological morbidity occurred after this operation. During a mean postoperative 10‐month follow‐up (range: 2–17 months), 1 patient died of severe pneumonia, and all the left subclavian artery and carotid artery stents were patent with no fenestration‐related endoleaks upon computed tomography angiography images.ConclusionsIn situ laser fenestration is a feasible, effective, rapid, repeatable, and safe option for the reconstruction of aortic arch during thoracic endovascular aortic repair, which might be available to revascularize the 3 branches. However, follow‐up periods should be extended to evaluate the robustness of this technique.

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Section: Introductionmentioning

confidence: 99%

In Situ Laser Fenestration Is a Feasible Method for Revascularization of Aortic Arch During Thoracic Endovascular Aortic Repair

Qin

Zhao

Wang

et al. 2017

JAHA

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“…The limitations associated with this study have already been presented. 16 The most important is that the WINDOW registry included patients at high risk of surgery. Randomisation was not permitted and it was not possible to select perfectly similar patients in the national discharge database.…”

Section: Discussionmentioning

confidence: 99%

“…The same inclusion and exclusion criteria as in the registry were applied whenever possible, as described previously. 16 The Charlson index 18 was chosen to compare patient comorbidities at baseline because it could be scored using hospital discharge data and has been validated for use with the claims database, including the French hospital discharge database. 19,20 Data sources For f/b EVAR patients, both case report forms (CRF) from the WINDOW registry and national discharge data were available.…”

Section: Study Populationmentioning

confidence: 99%

“…A detailed method of the cost computation for the initial admission has been published previously. 16 Readmissions within 2 years of the initial intervention were included in cost computations using their diagnosis related group tariffs.…”

Section: Economic Evaluationmentioning

confidence: 99%

“…In a previous article it was reported that f/b EVAR in high risk patients versus open surgery in normal risk patients was not cost-effective at 30 days. 16 The objective of the present study is to assess the cost-effectiveness of f/b EVAR at 2 years, comparing its outcomes and costs with those of OSR for complex AAA or TAAA.…”

Section: Introductionmentioning

confidence: 99%

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Editor's Choice – A Study of the Cost-effectiveness of Fenestrated/branched EVAR Compared with Open Surgery for Patients with Complex Aortic Aneurysms at 2 Years

Michel

Becquemin

Marzelle

et al. 2018

European Journal of Vascular and Endovascular Surgery

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Association of Pediatric Inpatient Socioeconomic Status With Hospital Efficiency and Financial Balance

et al. 2019

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Key PointsQuestionIs a pediatric patient’s socioeconomic status associated with the admitting hospital’s efficiency and financial balance?FindingsIn this cohort study of 4 121 187 pediatric admissions in France, the socioeconomic status of the child was statistically significantly associated with increased length of stay and cost. A disadvantaged case mix was also statistically significantly associated with the financial balance of the hospital.MeaningThese findings suggest that reform of hospital funding to better consider patients’ socioeconomic status and the specificities of pediatric care should be encouraged in France and similar countries that rely on a reimbursement system based on diagnosis related groups.

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Editor's Choice – Thirty day Outcomes and Costs of Fenestrated and Branched Stent Grafts versus Open Repair for Complex Aortic Aneurysms

Abstract: http://www.clinicaltrials.gov/ct2/show/NCT01168037; identifier: NCT01168037 (WINDOW registry).

Cited by 74 publications

References 29 publications

In Situ Laser Fenestration Is a Feasible Method for Revascularization of Aortic Arch During Thoracic Endovascular Aortic Repair

In Situ Laser Fenestration Is a Feasible Method for Revascularization of Aortic Arch During Thoracic Endovascular Aortic Repair

Editor's Choice – A Study of the Cost-effectiveness of Fenestrated/branched EVAR Compared with Open Surgery for Patients with Complex Aortic Aneurysms at 2 Years

Association of Pediatric Inpatient Socioeconomic Status With Hospital Efficiency and Financial Balance

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