Experiences of Intentional Carotid Stenting in Endovascular Repair of Aortic Arch Aneurysms—Two Case Reports

Larzon, Thomas; Gruber, Göran; Friberg, Örjan; Geijer, Håkan; Norgren, Lars

doi:10.1016/j.ejvs.2005.02.049

Cited by 51 publications

(33 citation statements)

References 9 publications

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“…24,25,28 Ready availability of conventional endograft components and periph- eral stents has enabled the use of this technique in both urgent symptomatic and emergent ruptured aneurysms as an "off-the-shelf" solution. 26 Current pure endovascular approaches include fenestrated 9 and branched endografts, 17 which are not widely available and require 6 to 8 weeks to be custom manufactured.…”

Section: Discussionmentioning

confidence: 99%

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Endovascular chimney technique versus open repair of juxtarenal and suprarenal aneurysms

Bruen

Feezor

Daniels

et al. 2011

Journal of Vascular Surgery

174

153

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Section: Discussionmentioning

confidence: 99%

“…[24][25][26][27][28][29][30] A study comparing clinical outcomes to open repair has not yet been reported. The purpose of our study is to compare the early outcomes of endovascular repair of juxtarenal and suprarenal aneurysms using the chimney technique with open repair in anatomically-matched patients.…”

mentioning

confidence: 99%

Endovascular chimney technique versus open repair of juxtarenal and suprarenal aneurysms

Bruen

Feezor

Daniels

et al. 2011

Journal of Vascular Surgery

174

153

View full text Add to dashboard Cite

show abstract

“…There was a concern that the implanted CG would disturb the conformability of the main SG and the laminar blood flow, form a nidus for new thromboembolic or obstructive events and create gutters alongside the main SG, which may lead to EL-I and eventually rupture. However, the outcome turned out to be better than expected and encouraged several specialized centers to adopt this technique and expand its application to involve the juxtarenal, suprarenal and the thoracic aorta including the arch (Larzon et al 2005, 2008, Ohrlander et al 2008. Physicians simply could not resist the temptation to further expand this new technique in treating not only aneurysms but also aortic occlusive diseases, dissections, ruptures, infections, fistulas, traumatic transections and difficult complications of previous open as well as endovascular aortic repair ).…”

Section: Discussionmentioning

confidence: 99%

Impact of Renal Chimney Grafts on Anatomical Suitability for Endovascular Repair in Ruptured Abdominal Aortic Aneurysm

et al. 2015

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Introduction: Open repair of the aorta carries a high risk for morbidity and mortality especially in the elderly population and in patients unfit for major surgery. Endovascular aortic repair is safe, durable and effective when there is adequate proximal and distal sealing zone for the aortic stent graft. Fenestrated and branched stent grafts have made the repair possible for complex but elective cases that do not have an adequate sealing zone. Urgent complex cases and patients with midaortic occlusive diseases do not have any therapeutic alternative if they are not fit for open repair. Chimney graft technique fills this gap and allows the sealing zones for aortic stent graft to be extended as required. The aim of the present thesis is to study the applicability, safety and durability of CG technique in urgent cases with complex lesions in the thoracic and abdominal aorta including the midaortic occlusive diseases. Patients and Methods: All patients who received CG were treated urgently or semi-urgently. The majority of the treated aortic lesions were aneurysms, dissections, pseudoaneurysms, infection, and accidental overstented vital aortic side branches. The median age of all patients was 75 years (IQR, 69-78), of them 32% were female except for the first study where all ten patients were female with midaortic occlusive diseases. The second study evaluated the mid to long-term efficacy and durability of the CG technique in 29 patients with urgent and complex lesions of the thoracic aorta. The third study examined the long-term results of CG in preserving the visceral flow of 51 patients with urgent complex aortic lesions. The fourth study evaluated the CTA images of 206 patients with ruptured abdominal aortic aneurysm. The study measured the applicability of CG in patients for whom standard EVAR was contraindicated because of a short aneurysmal neck. Results:The results showed that CG is applicable and safe for midaortic occlusive diseases with high technical success and patency rate without major adverse effect. The treated patients with thoracic aortic lesions had 14% 30-day mortality, 21% type I endoleak, 7% CG-related mortality, 98% secondary patency and 68% of the aortic lesions shrank significantly. Visceral CG had a 10% 30-day mortality, 6% CG-related mortality, 12% type I endoleak, 93% secondary patency and 63% of the aortic lesions shrank significantly. Twenty-two patients had one renal arteriy sacrificed, 57% of these required permanent renal dialysis. The fourth study proved that CG technique increased the overall suitability for endovascular repair from 34% to 40-46%. Conclusions: Chimney graft seems effective and safe for treating midaortic occlusive diseases in patients unfit for open surgery. The early and mid to long-term results of the CG technique for urgent and complex lesions of the thoracic and abdominal aorta in high-risk patients are promising with a low early mortality, acceptable rate of type I endoleaks and long durability of the CGs, which may justify a broader applicability of this ...

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“…1 Several groups in the early days of TEVAR development reported branch stenting to preserve blood flow to the supraaortic trunks when their origins were covered by the main aortic endograft. [2][3][4][5]14,15 More recently, the chimney endograft technique has been reported to be a feasible endovascular approach to maintain LSA flow. 16 This technique requires additional brachial, axillary, or subclavian artery remote access, with its related potential morbidity.…”

Section: Discussionmentioning

confidence: 99%

Periscope Endograft Technique to Revascularize the Left Subclavian Artery During Thoracic Endovascular Aortic Repair

Lachat

Mayer

Pfammatter

et al. 2013

Journal of Endovascular Therapy

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Purpose : To present early and midterm results of the periscope endograft (PG) technique to maintain left subclavian artery (LSA) blood flow in thoracic endovascular aortic repairs (TEVAR) involving zone 3. Methods : From April 2010 to January 2013, 14 consecutive high-risk patients (11 men; mean age 70±8 years, range 56-87) underwent TEVAR with the PG technique for 10 thoracic aortic aneurysms (TAA), 2 traumatic aortic ruptures, and 2 aortic dissections without a suitable landing zone (>2 cm distal to the LSA). Five procedures were performed emergently for rupture (3 TAAs and the 2 trauma cases). Two patients had a periscope deployed in an aberrant right subclavian artery. The periscope endografts were sized 1 to 2 mm larger than the branch artery at the intended landing zone. The caudal end was extended distal to the intended distal landing site of the thoracic stent-graft, which was usually deployed after the PG. Both the PG and thoracic stent-grafts were generally molded using the kissing balloon technique. Outcomes analyzed were immediate technical success, perioperative mortality and morbidity, aneurysm diameter change, and periscope endograft patency. Results : Immediate technical success was 100%, with all procedures completed as planned. Perioperatively, one periscope occluded and one of the ruptured TAA patients died. One percutaneous access site hematoma required only conservative management. At a mean follow-up of 26±9 months (range 9-37), there was no additional PG occlusion. The Kaplan-Meier estimate of PG patency was 93% at 2 years. Conclusion : The periscope endograft is a simple technique to maintain perfusion to the LSA in cases where the aortic stent-graft crosses its ostium. The PG technique can be performed transfemorally and even percutaneously, and it can be applied to all supra-aortic branches. Early and midterm results are encouraging, but more experience and long-term results are mandatory before this technique can be widely recommended.

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Experiences of Intentional Carotid Stenting in Endovascular Repair of Aortic Arch Aneurysms—Two Case Reports

Cited by 51 publications

References 9 publications

Endovascular chimney technique versus open repair of juxtarenal and suprarenal aneurysms

Endovascular chimney technique versus open repair of juxtarenal and suprarenal aneurysms

Impact of Renal Chimney Grafts on Anatomical Suitability for Endovascular Repair in Ruptured Abdominal Aortic Aneurysm

Periscope Endograft Technique to Revascularize the Left Subclavian Artery During Thoracic Endovascular Aortic Repair

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