Fenestrated and Scalloped Endovascular Grafts in Zone 0 and Zone 1 for Aortic Arch Disease

Fernández-Alonso, Leopoldo; Alonso, Sergio; Aguilar, Esther Martínez; Fariña, Estéfana Santamarta; Solé, Jordi Alegret; Pascual, Margarita Atienza; Martín, Marina López San; Rodríguez, José María Sánchez; Álvarez, Andrés Salazar; Vallepuga, Roberto Centeno

doi:10.1016/j.avsg.2020.06.009

Cited by 22 publications

(34 citation statements)

References 22 publications

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“…Furuta et al [ 1 ] reported a recent and large experience with the use of fenestrated stent grafts: among 205 aortic repairs, 7 type IA endoleaks occurred, with a 3.4% incidence. Fernandez-Alonso et al [ 13 ] described 1 type IA endoleak among 14 patients, but it was not detectable at discharge. Canaud et al [ 14 , 15 ] (with two patient samples, one of 35 patients and one of 17), Tsilimparis et al [ 20 ] (44 patients), Tan et al [ 19 ] (7 patients), Yap et al [ 21 ] (5 repairs), Zhou et al [ 22 ] (42 patients), and Zhu et al [ 23 ] (10 patients) all reported the absence of endoleaks in their samples both at discharge and at follow-up.…”

Section: Resultsmentioning

confidence: 99%

“…Out of the 48 studies selected: 10 [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 ] described outcomes in chimney procedures, 13 [ 1 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ] with the use of fenestrated devices, 9 [ 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ] focused on in situ fenestration outcomes, 14 [ 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 ] on branched devices, one study compared fenestrated and branched devices [ 48 ], and one compared in situ fenestration and the chimney technique [ 49 ].…”

Section: Resultsmentioning

confidence: 99%

“…This technique requires good apposition of the stent grafts to the aortic wall at the level of the gaps created in the fabric of the stent graft to preserve flow to the supra-aortic trunks; hence, in most circumstances, it is not indicated to treat circumferential dilatations of the arch. In patients with aortic arch disease and short proximal landing zones, the use of fenestrated stent grafts increases sealing length and enables accurate deployment while maintaining supra-aortic trunk patency [ 13 ]. Fenestrated stent grafts can be associated with stenting or not, and while some authors stated that no statistically significant difference in endoleak rates was described [ 16 ], others [ 17 ] strongly advised supra-aortic stenting due to the way in which the aortic arch curvature could affect device positioning, reporting a significant success rate and a 97% 3-year patency rate.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Type 1A Endoleak after TEVAR in the Aortic Arch: A Review of the Literature

Scurto

Peluso

Pascucci

et al. 2022

JPM

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Aortic arch repair is a challenging intervention. Open surgical repair is still considered the gold standard, but in high-risk patients, it is not always a reasonable option, making endovascular approaches an enticing, when not the only available, alternative for treatment. The strategies more commonly adopted are surgical supra-aortic trunk (SAT) rerouting followed by deployment of a standard thoracic endoprosthesis, chimney techniques, custom-made scalloped, fenestrated, and branched devices, and in situ or physician-modified fenestrations. If we excluded techniques involving SAT rerouting where the arch anatomy is surgically modified in order to make deployment in the aortic arch of a standard thoracic endoprosthesis possible, in the other techniques, one or more SATs are incorporated in the thoracic endoprosthesis. In these cases, no matter what solution is adopted, because of the morphology of the aorta at this level, achieving an ideal sealing is extremely difficult, and endovascular treatments of the arch are burdened by an increased risk of type IA endoleaks. PubMed, EMBASE, and Cochrane Library were searched. We identified 1277 records. After reading titles, abstracts, and full texts, we excluded 1231 records. Exclusion criteria were low-quality evidence, abstracts, case reports, conference presentations, reviews, editorials, and expert opinions. A total of 48 studies were included, for a total of 3114 patients. A type IA endoleak occurred in 248 patients (7.7%) with a mean incidence of 18.8% in chimney procedures, 4.8% and 3%, respectively, in fenestrated and branched devices, and 2.2% in in situ fenestration. We excluded from our analysis scalloped technology that is used when the target vessel originates from a healthy landing zone and represents a different anatomical setting. Type IA endoleaks are a concern with all types of endovascular aortic arch repair, and they can compromise the outcomes of the procedure. The rate of type IA endoleaks appears to be significantly higher in chimney procedures. In order to maximize sealing, whenever possible, endovascular repair of the arch should be achieved with custom-made fenestrated devices. However, chimney configurations are still a valuable solution particularly in the emergency setting, although in such a procedure, to guarantee accurate postoperative management and follow-up, an imaging protocol could be useful.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Type 1A Endoleak after TEVAR in the Aortic Arch: A Review of the Literature

Scurto

Peluso

Pascucci

et al. 2022

JPM

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“…As mentioned, the short distance between the pseudoaneurysm entry tear and the IA branch-off presented a challenge for SG selection. Several techniques have been described for ascending aortic pathologies with landing zones too short to deploy a conventional SG, including fenestrated TEVAR [ 21 ], IA debranching and Ishimaru zone 0 TEVAR with a single chimney to the IA [ 3 ], closing the pseudoaneurysm using an Amplatz Type II or Type III vascular plug (AVP) only, or first coil embolizing the pseudoaneurysm followed by AVP insertion [ 22 ], and even a novel Endo-Bentall procedure [ 23 ]. In our case, the short landing zone challenge was overcome by selecting an off-the-shelf SG of the appropriate dimensions and by careful deployment preplanning to ensure continued patency of the IA.…”

Section: Discussionmentioning

confidence: 99%

Abdominal Stent-Graft Treatment of Ascending Aortic Pseudoaneurysm Following Transcatheter Aortic Valve Implantation

et al. 2022

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“…Im vergangenen Jahrzehnt trug dazu vorwiegend ihre Verwendung in der endovaskulären Aortenbogenchirurgie bei, wo sie sich zur ersten Option entwickelt haben mit einer größeren Evidenz als bspw. fenestrierte Aortenbogenprothesen [26,27,28].…”

Section: Fazit Und Ausblickunclassified

Stellenwert der „inner Branches“ in der komplexen endovaskulären Aortenchirurgie

Lescan

2022

Zentralbl Chir

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ZusammenfassungDie komplexe endovaskuläre Therapie der Aorta mit fenestrierten und gebranchten Prothesen spielt eine wichtige Rolle in der heutigen Gefäßmedizin. Daraus resultieren innovative medizintechnische Lösungen, die für immer anspruchsvollere Aortenpathologien eingesetzt werden. Das Ziel dieser Arbeit war es, die zunehmende Bedeutung der „inner Branches“ in der komplexen Aortenchirurgie darzustellen. Die Vorteile und Grenzen dieser Technik sollten aufgezeigt und die aktuelle Datenlage zusammengefasst werden. Dazu wurden die „inner Branches“ (iBEVAR) den Standardverfahren (Fenestrationen [FEVAR], „outer Branches“ [BEVAR]) gegenübergestellt und ihre technischen Vor- und Nachteile erarbeitet. Kennzeichnend ist der weit verbreitete Einsatz der iBEVAR im Aortenbogen im Gegensatz zur thorakoabdominellen Aorta, was sich auch in der spärlichen Datenlage im thorakoabdominellen Abschnitt widerspiegelt. Die Letztere basiert auf kleineren retrospektiven Studien mit 1-jährigem Follow-up. Die seit 2 Jahren verfügbare thorakoabdominelle „off-the-shelf“-Prothese wird voraussichtlich zu einer weiteren Verbreitung der „inner Branches“ im thorakoabdominellen Abschnitt führen, wobei die von der Industrie geförderte Registerstudie wichtige Evidenz zur erörterten Technik bereitstellen könnte.

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Fenestrated and Scalloped Endovascular Grafts in Zone 0 and Zone 1 for Aortic Arch Disease

Cited by 22 publications

References 22 publications

Type 1A Endoleak after TEVAR in the Aortic Arch: A Review of the Literature

Type 1A Endoleak after TEVAR in the Aortic Arch: A Review of the Literature

Abdominal Stent-Graft Treatment of Ascending Aortic Pseudoaneurysm Following Transcatheter Aortic Valve Implantation

Stellenwert der „inner Branches“ in der komplexen endovaskulären Aortenchirurgie

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