Incidence and treatment results of Endurant endograft occlusion

Zeggeren, Laura van; Gonçalves, Frederico Bastos; Herwaarden, Joost A. van; Zandvoort, Herman J.A.; Werson, Debora A.B.; Vos, Jan‐Albert; Moll, Frans L.; Verhagen, Hence J.M.; Vries, Jean‐Paul P.M. de

doi:10.1016/j.jvs.2012.11.069

Cited by 67 publications

(64 citation statements)

References 39 publications

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“…Compared with unilateral limb occlusion, bilateral limb occlusion is relatively uncommon, with a reported incidence ranging from 0% to 0.6% and accounting for 0% to 15% of endograft occlusion cases. 2,3,[6][7][8] Total occlusion of the main body of the bifurcated stent graft is a rare condition and no previous studies have been reported on its detailed therapeutic process.…”

Section: Resultsmentioning

confidence: 99%

“…Second-or third-generation endografts have been reported to have lower incidences of graft occlusion than firstgeneration endografts. 3,7) Notably, Gore Excluder endoprosthesis (W.L. Gore & Associates, Flagstaff, Arizona), one of the currently available third-generation endografts, has been reported to more suitable for complex iliac anatomy, with a limb occlusion incidence of 0%-1.4%, 4,9) which is lower than that of Zenith stent graft (4.8%-5.5%) 4,6,8) or Endurant endograft (Medtronic Inc, Minneapolis, Minnesota) (3.4%).…”

Section: Discussionmentioning

confidence: 99%

“…Gore & Associates, Flagstaff, Arizona), one of the currently available third-generation endografts, has been reported to more suitable for complex iliac anatomy, with a limb occlusion incidence of 0%-1.4%, 4,9) which is lower than that of Zenith stent graft (4.8%-5.5%) 4,6,8) or Endurant endograft (Medtronic Inc, Minneapolis, Minnesota) (3.4%). 7) Treatment modalities for endograft limb occlusion are determined by the area and length of thrombosis, pattern of disease progression, clinical presentation, and severity of leg ischemia. In cases of acute limb occlusion, urgent revascularization is mandatory.…”

Section: Discussionmentioning

confidence: 99%

“…1,3,7) Open surgical repair procedures include embolectomy with or without endograft replacement, anatomic bypass, and extra-anatomic bypass, such as femorofemoral crossover bypass and axillofemoral bypass. 1,3,7) If remnant thrombus is expected to remain in an endogarft after successful thrombectomy, additional endograft insertion would have been a preferable treatment option to reestablish the anatomic blood route. 11) We initially tried to open embolectomy; however, the clot in the endograft limbs could not be removed.…”

Section: Discussionmentioning

confidence: 99%

“…Endograft occlusion, a serious late complication following EVAR, has been reported to have an incidence ranging from 1.1% to 7.1%. [1][2][3][4][5][6][7][8][9] Typically, endograft limb occlusion occurs unilaterally. If endograft occlusion occurs acutely in the bilateral limb or the main body of the endograft, its pathological condition may be similar to that of acute occlusion of the abdominal aorta, a emergency treatment.…”

Section: Introductionmentioning

confidence: 99%

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Total Occlusion of Abdominal Aortic Endograft Successfully Treated with Axillobifemoral Bypass

Shirasugi

Kimura

Yasuda

et al. 2015

Annals of Vascular Diseases

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We report a case of total occlusion of a Zenith bifurcated stent graft 16 months after implantation. A 72-year-old man was admitted to our hospital complaining of bilateral lower extremity numbness, followed by severe rest pain 4 h after sudden onset of symptoms. Computed tomography showed total occlusion of the endograft at the mid-portion of the main body. He underwent left axillobifemoral bypass using a reinforced polytetrafluoroethylene T-shaped graft, leading to resolution of symptoms 7 h after onset. Axillobifemoral bypass successfully relieved acute lower extremity ischemia caused by total occlusion of the abdominal aortic endograft.Keywords: abdominal aortic endograft, total occlusion, axillobifemoral bypass life-threatening disease associated with high morbidity and mortality. Here we report a case of abdominal aortic endograft total occlusion that was successfully managed with axillobifemoral bypass; in addition, we discuss the treatment strategies for this critical situation. Case ReportA 72-year-old man was admitted to an emergency department of a district hospital, complaining of sudden bilateral lower extremity numbness and severe rest pain. At the age of 62, he had undergone mechanical valve replacement for aortic valve stenosis and permanent pacemaker insertion for sick sinus syndrome at the same hospital. Sixteen months ago, he had undergone abdominal aortic endograft implantation for infrarenal abdominal aortic aneurysm at a different hospital. Preoperative computed tomography (CT) showed the maximum aneurysm diameter of 62 mm, the neck angulation 10) of 77°, and the terminal aorta diameter of 21 mm (Fig. 1). A Zenith endovascular graft (Cook Inc., Bloomington, Indiana) was implanted through the right femoral approach. The procedure was performed successfully and the postoperative course was uneventful. A postoperative CT showed the neck angulation of 56° and the terminal aorta diameter of 21 mm (Fig. 1). The patient was discharged from the hospital with no endoleak. Subsequently, he had been regularly followed-up for anticoagulation therapy at a local hospital. He had not experienced intermittent claudication previously.On further examination at the district hospital, a CT showed an abdominal endograft implanted from below the orifice of the renal arteries to the bilateral common iliac arteries with complete occlusion at the mid-portion of the main body (Fig. 2). The neck angulation was 54°, and the terminal aorta diameter of 21 mm (Fig. 2). Preoperative echocardiography showed that there was no obvious thrombus in the left atrium and the left ventricle, and around the mechanical aortic valve. A diagnosis of acute endograft occlusion was made. The patient was transferred to our hospital 4 h after the onset of symptoms for

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Total Occlusion of Abdominal Aortic Endograft Successfully Treated with Axillobifemoral Bypass

Shirasugi

Kimura

Yasuda

et al. 2015

Annals of Vascular Diseases

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The Technological Advancement to Engineer Next‐Generation Stent‐Grafts: Design, Material, and Fabrication Techniques

Vahabli

Mann

Heidari

et al. 2022

Adv Healthcare Materials

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Endovascular treatment of aortic disorders has gained wide acceptance due to reduced physiological burden to the patient compared to open surgery, and ongoing stent-graft evolution has made aortic repair an option for patients with more complex anatomies. To date, commercial stent-grafts are typically developed from established production techniques with simple design structures and limited material ranges. Despite the numerous updated versions of stent-grafts by manufacturers, the reoccurrence of device-related complications raises questions about whether the current manfacturing methods are technically able to eliminate these problems. The technology trend to produce efficient medical devices, including stent-grafts and all similar implants, should eventually change direction to advanced manufacturing techniques. It is expected that through recent advancements, especially the emergence of 4D-printing and smart materials, unprecedented features can be defined for cardiovascular medical implants, like shape change and remote battery-free self-monitoring. 4D-printing technology promises adaptive functionality, a highly desirable feature enabling printed cardiovascular implants to physically transform with time to perform a programmed task. This review provides a thorough assessment of the established technologies for existing stent-grafts and provides technical commentaries on known failure modes. They then discuss the future of advanced technologies and the efforts needed to produce next-generation endovascular implants.

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Early sac shrinkage predicts a low risk of late complications after endovascular aortic aneurysm repair

Gonçalves

Hassan

Verhagen³

et al. 2014

British Journal of Surgery

103

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BackgroundAneurysm shrinkage has been proposed as a marker of successful endovascular aneurysm repair (EVAR). Patients with early postoperative shrinkage may experience fewer subsequent complications, and consequently require less intensive surveillance.MethodsPatients undergoing EVAR from 2000 to 2011 at three vascular centres (in 2 countries), who had two imaging examinations (postoperative and after 6–18 months), were included. Maximum diameter, complications and secondary interventions during follow-up were registered. Patients were categorized according to early sac dynamics. The primary endpoint was freedom from late complications. Secondary endpoints were freedom from secondary intervention, postimplant rupture and direct (type I/III) endoleaks.ResultsSome 597 EVARs (71·1 per cent of all EVARs) were included. No shrinkage was observed in 284 patients (47·6 per cent), moderate shrinkage (5–9 mm) in 142 (23·8 per cent) and major shrinkage (at least 10 mm) in 171 patients (28·6 per cent). Four years after the index imaging, the rate of freedom from complications was 84·3 (95 per cent confidence interval 78·7 to 89·8), 88·1 (80·6 to 95·5) and 94·4 (90·1 to 98·7) per cent respectively. No shrinkage was an independent risk factor for late complications compared with major shrinkage (hazard ratio (HR) 3·11; P < 0·001). Moderate compared with major shrinkage (HR 2·10; P = 0·022), early postoperative complications (HR 3·34; P < 0·001) and increasing abdominal aortic aneurysm baseline diameter (HR 1·02; P = 0·001) were also risk factors for late complications. Freedom from secondary interventions and direct endoleaks was greater for patients with major sac shrinkage.ConclusionEarly change in aneurysm sac diameter is a strong predictor of late complications after EVAR. Patients with major sac shrinkage have a very low risk of complications for up to 5 years. This parameter may be used to tailor postoperative surveillance.

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Incidence and treatment results of Endurant endograft occlusion

Cited by 67 publications

References 39 publications

Total Occlusion of Abdominal Aortic Endograft Successfully Treated with Axillobifemoral Bypass

Total Occlusion of Abdominal Aortic Endograft Successfully Treated with Axillobifemoral Bypass

The Technological Advancement to Engineer Next‐Generation Stent‐Grafts: Design, Material, and Fabrication Techniques

Early sac shrinkage predicts a low risk of late complications after endovascular aortic aneurysm repair

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