First report of a late type III endoleak from fabric tears of a Zenith stent graft

Wanhainen, Anders; Nyman, Rickard; Eriksson, Mats-Ola; Björck, Martin

doi:10.1016/j.jvs.2008.03.047

Cited by 43 publications

(35 citation statements)

References 10 publications

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“…Fabric tear may be more frequent with Z-SG. Although very rare in clinical report, such complication with Z-SG has already been reported (Wanhainen et al, 2008).…”

Section: Discussionmentioning

confidence: 91%

Computational comparison of the bending behavior of aortic stent-grafts

Demanget

Avril

Badel

et al. 2012

Journal of the Mechanical Behavior of Biomedical Materials

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Secondary interventions after endovascular repair of abdominal aortic aneurysms are frequent because stent-graft (SG) related complications may occur (mainly endoleak and SG thrombosis). Complications have been related to insufficient SG flexibility, especially when devices are deployed in tortuous arteries. Little is known on the relationship between SG design and flexibility. Therefore, the aim of this study was to simulate numerically the bending of two manufactured SGs (Aorfix--Lombard Medical (A) and Zenith--Cook Medical Europe (Z)) using finite element analysis (FEA). Global SG behavior was studied by assessing stent spacing variation and cross-section deformation. Four criteria were defined to compare flexibility of SGs: maximal luminal reduction rate, torque required for bending, maximal membrane strains in graft and maximal Von Mises stress in stents. For angulation greater than 60°, values of these four criteria were lower with A-SG, compared to Z-SG. In conclusion, A-SG was more flexible than Z-SG according to FEA. A-SG may decrease the incidence of complications in the setting of tortuous aorto-iliac aneurysms. Our numerical model could be used to assess flexibility of further manufactured as well as newly designed SGs.

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“…Fabric tear may be more frequent with Z-SG. Although very rare in clinical report, such complication with Z-SG has already been reported (Wanhainen et al, 2008).…”

Section: Discussionmentioning

confidence: 91%

Computational comparison of the bending behavior of aortic stent-grafts

Demanget

Avril

Badel

et al. 2012

Journal of the Mechanical Behavior of Biomedical Materials

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“…Type 3b endoleak originates from a defect in the stent-graft fabric and it may be hard to detected with CTA and/or angiography, unless confirmed by open surgery [5,6]. Wanhainen et al [6] firstly reported about late type 3b endoleak diagnosed during the operation, performed due to large retroperitoneal hematoma and intraperitoneal bleeding induced by persistent enlargement of aneurysm sac despite of the embolization of lumbar arteries as a source of suspected type 2 endoleak. Preoperative CTA and emergency angiography could not detect any endoleak except aneurysm expansion.…”

Section: Discussionmentioning

confidence: 99%

Late Type 3b Endoleak Mimicking Type 2 Endoleak after Endovascular Aortic Aneurysm Repair

Cho

Choi

Cho

et al. 2017

VSI

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Endovascular abdominal aortic aneurysm (AAA) repair has been widely used for the treatment of AAA as a safe and efficient method, but endoleaks causing persistent expansion of aneurysm sac may cause aneurysmal rupture and death. Type 3 endoleak is rare but a predominant cause of late rupture. Type 3b endoleak can be misdiagnosed as type 2 endoleak, which is more frequent. Here we report two cases of type 3b endoleak mimicking type 2 endoleak, which were successfully treated by open surgery of partial explantation of the stent-graft and endoaneurysmal interposition graft replacement.

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“…Indeed, there is the possibility to extend the proximal According to EUROSTAR data, 21,22 the incidence of late type III endoleak after successful EVAR is reported to be ~2% to 3%, and it has been reported with 3 commercially available endoprostheses. [23][24][25] The source of these endoleaks is difficult to identify and often requires multimodal imaging, as demonstrated in the illustrated case ( Figure 2A). Suspected type III endoleaks should be treated promptly, and in an analysis of preliminary EUROSTAR data, patients with late type III endoleaks had 9 times greater chance of aneurysm rupture compared with other registry patients.…”

Section: Discussionmentioning

confidence: 99%

Type IIIb Endoleak and Relining

et al. 2016

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Purpose: To examine the changes in distraction force following relining of a conventional abdominal aortic stent-graft with a type IIIb endoleak using the Nellix endovascular sealing device compared to a unilateral stent-graft. Methods:Relining is often used to repair type IIIb endoleaks, but the consequences to graft stability are unknown. A mathematical model was constructed based on pressure and volume flow through the stent-grafts, incorporating recognized distraction force equations. Steady flow was presumed at peak systolic pressures to calculate the maximum distraction force, with gravity ignored. Distraction forces for 28-to 36-mmdiameter stent-graft bodies with 16-mm limbs were calculated and compared to forces following relining with single and double Nellix devices or the Renu unilateral device.Results: Distraction forces for the 28-, 32-, and 36-mm stent-grafts prior to relining were 5.99, 10.21, and 14.99 N, respectively. Similar forces were reported after relining with bilateral Nellix devices (5.86, 10.08, and 14.86 N, respectively). However, use of a unilateral Nellix increased the distraction forces to 9.92, 14.14, and 18.92 N, respectively. These were comparable to the increase observed after relining with a Renu unilateral stent-graft (9.87, 14.09, and 18.86 N, respectively). The proportional increase in distraction force for a unilateral relining ranged from 26% to 66%, with the greatest increase noted in the smaller diameter main bodies. Conclusion:Relining a stent-graft with a type IIIb endoleak using bilateral Nellix devices does not increase the distraction force. However, a unilateral Nellix device or the Renu system could theoretically increase the distraction force by up to 66%, potentially risking migration and type Ia endoleak. In clinical practice, these results suggest that a relining with bilateral Nellix may have benefits over the Renu unilateral stent-graft.

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First report of a late type III endoleak from fabric tears of a Zenith stent graft

Cited by 43 publications

References 10 publications

Computational comparison of the bending behavior of aortic stent-grafts

Computational comparison of the bending behavior of aortic stent-grafts

Late Type 3b Endoleak Mimicking Type 2 Endoleak after Endovascular Aortic Aneurysm Repair

Type IIIb Endoleak and Relining

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