Graft Inflow Stenosis Induced by the Inflatable Ring Fixation Mechanism of the Ovation Stent-Graft System: Hemodynamic and Clinical Implications

Ioannou, Christos V.; Kontopodis, Nikolaos; Metaxa, Eleni; Papaharilaou, Yannis; Georgakarakos, Efstratios; Kafetzakis, Alexandros; Kehagias, Elias; Tsetis, Dimitrios

doi:10.1583/14-4771mr.1

Cited by 19 publications

(20 citation statements)

References 24 publications

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“…General anaesthesia was induced with propofol 1 mg kg 21 , fentanyl 1-2 mg kg 21 and cis-atracurium to facilitate endotracheal intubation. The patients were intubated, and maintenance of anaesthesia was achieved with propofol infusion and supplemental doses of fentanyl according to patients' needs.…”

Section: Device Descriptionmentioning

confidence: 99%

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Endovascular aneurysm repair with the Ovation TriVascular Stent Graft System utilizing a predominantly percutaneous approach under local anaesthesia

Ioannou

Kontopodis

Kehagias

et al. 2015

BJR

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Section: Device Descriptionmentioning

confidence: 99%

“…21 We now perform this technique on a routine basis. Completion angiography was always performed to evaluate good functioning, patency of renal arteries and the absence of endoleaks ( Figure 3).…”

mentioning

confidence: 99%

Endovascular aneurysm repair with the Ovation TriVascular Stent Graft System utilizing a predominantly percutaneous approach under local anaesthesia

Ioannou

Kontopodis

Kehagias

et al. 2015

BJR

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“…This aortic volume expands externally even though a residual volume occupies the endograft lumen [6,7]. If the neck is heavily and circumferentially calcified, the rings may fail to expand outside and converge toward the center of the endograft, narrowing the aortic lumen.…”

Section: Discussionmentioning

confidence: 99%

“…Other authors who observed 49 consecutive patients (48 men; mean age, 71.2 ± 7.7 years) successfully treated with the Ovation abdominal aortic stent graft at a single center concluded that its unique sealing mechanism comes at the expense of a median area inflow stenosis of ∼60% [6]. Moreover, some authors suggest that the coexistence of stenotic wall regions exposed to a high shear rate and post-stenotic recirculation zones may lead to platelet activation and a predisposition to thrombus formation and thromboembolic complications [7].…”

Section: Conflict Of Interestmentioning

confidence: 99%

“…The Ovation graft is suitable for a broad range of aortoiliac characteristics and provides effective sealing for complex proximal infrarenal aortic neck morphology [4,5]. However, some authors have observed asymptomatic inflow stenosis at the O-rings of the Ovation stent graft [6,7]. Here, we describe the imaging and treatment of an acute complication in a patient treated for AAA with an Ovation stent graft, leading to acute limb ischemia.…”

Section: Introductionmentioning

confidence: 99%

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Occlusive Shrinkage of Ovation Endograft™ Presenting as Acute Lower Limbs Ischemia: Effective Endovascular Management

Scalise¹,

Mortara²,

Lanzillo³

et al. 2017

aorta

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The aim of this report is to describe the imaging and successful treatment of an acute shrinkage of the Ovation Abdominal Stent Graft System. The Ovation Prime system utilizes a polymer-filled sealing ring that is cast in situ at the margin of the aneurysm; however, the residual endograft inner volume after ring filling may reduce volume and graft flow. Nevertheless, there are no reports about severe complications using the Ovation Prime system. A 75-year-old male presented to our hospital for acute lower limb ischemia. The patient reported a previous endograft for abdominal aortic aneurysm 1 month previously, which utilized the Ovation device. Computed tomography (CT) angiography demonstrated a critical narrowing of the endograft at the site of the proximal sealing rings. We decided on urgent treatment, delivering a covered stent graft (CP STENT NUMED™). Intraoperative intravascular ultrasound showed effective compaction of the proximal rings. Nine-month follow-up with CT angiography demonstrated good patency without ring recoil of the endograft. This is the first report of endovascular treatment for an acute and symptomatic shrinkage of proximal rings in the Ovation trivascular endograft. Angiographic and intravascular ultrasound findings showed that covered stenting is effective and that the ring polymer is safely moldable.

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Hemodynamic impact of abdominal aortic aneurysm stent-graft implantation-induced stenosis

Aristokleous

Kontopodis

Tzirakis

et al. 2015

Med Biol Eng Comput

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The current study aims to computationally evaluate the hemodynamic impact of a novel sealing mechanism employed by a recently developed endograft (Ovation TriVascular Stent-Graft System) for endovascular aneurysm repair. The exploitation of two inflatable O-rings to achieve sealing may be advantageous in terms of accommodating challenging anatomies, but comes at a price of a marked inflow stenosis. Here, four representative patient cases of inflow stenosis ranging from 30 to 80 % were analyzed. Lumen surface models were constructed from 1 month post-operative computed tomography images and then used to numerically compute the complex endograft flow field. Our results highlight coexistence of stenotic wall regions exposed to high shear rate and post-stenotic recirculation zones. These conditions may implicate platelet activation and predispose thrombus formation and thromboembolic complications. A clinically insignificant cycle-averaged pressure drop along the inflow stenosis and further in the endograft main body legs was predicted (range 0.01-1.72 mmHg) which was, however, notable at peak systole (range 3.52-19.73 mmHg). Although the functional impact of the endograft stenosis at rest flow conditions may appear insignificant, increased flow rate during exercise is expected to strongly accentuate the observed effects. Pressure drop in the endograft legs was attributed to suboptimal, based on Murray's scaling law, cross-sectional area ratio between trunk and legs of the device.

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Graft Inflow Stenosis Induced by the Inflatable Ring Fixation Mechanism of the Ovation Stent-Graft System: Hemodynamic and Clinical Implications

Cited by 19 publications

References 24 publications

Endovascular aneurysm repair with the Ovation TriVascular Stent Graft System utilizing a predominantly percutaneous approach under local anaesthesia

Endovascular aneurysm repair with the Ovation TriVascular Stent Graft System utilizing a predominantly percutaneous approach under local anaesthesia

Occlusive Shrinkage of Ovation Endograft™ Presenting as Acute Lower Limbs Ischemia: Effective Endovascular Management

Hemodynamic impact of abdominal aortic aneurysm stent-graft implantation-induced stenosis

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