Multilayer Flow Modulator Treatment of Abdominal and Thoracoabdominal Aortic Aneurysms With Side Branch Coverage

Abstract

Through midterm follow-up, treatment of high-surgical-risk TAAA and AAA patients with the MFM appears to be safe and effective, maintaining branch vessel patency and reducing rupture risk through reduction of aneurysm diameter and modulation of flow dynamics. Longer term follow-up is needed.

Aortic Remodeling After Total Endovascular Aortic Repair With Multilayer Stents: Computational Fluid Dynamics Analysis of Aortic Remodeling Over 3 Years of Follow-up

“…The true lumen was immediately decompressed after the procedure, and complete aortic remodeling was achieved, with complete disappearance of the false lumen aneurysm after 24 months ( Figure 1K). Once again, as we and other teams 6,14,15 have reported in the past, there were no signs of spinal cord ischemia despite covering all major arteries perfusing the spinal cord and without perioperative spinal cord drainage. In this case, even after total aortic endovascular repair for TBAD, lumbar and intercostal arteries remained patent despite being covered by the multilayer stent ( Figure 1F).…”

Contemporary strategies for repair of complex thoracoabdominal aortic aneurysms: real-world experiences and multilayer stents as an alternative

“…In the Moroccan registry, 18 patients (mean age 61.1 years, 16 men) with TAAA (n = 10, mean diameter 74.4 mm) and AAA (n = 8, mean diameter 67.8 mm) were treated with the MFM between June 2009 and September 2012. 42 The AAA were aorto-bi-iliac in 6 patients and juxtarenal in 5. Patient comorbidities included 9 with coronary artery disease, 7 with diabetes mellitus, and 6 each with respiratory insufficiency, hypertension, dyslipidemia, and peripheral artery disease.…”

“…Among studies of MFM treatment for TAAA are a prospective multicenter French trial, 40 , 41 a prospective single-center Moroccan registry, 42 and an independent global MFM registry. 43 , 44 Table 3 summarizes perioperative, midterm, and (in the multicenter trial) long-term outcomes for the patients in these studies.…”

“…As consistently noted in the published reports on the initial MFM studies that are summarized here, most of the type I and III endoleaks detected periprocedurally and during follow-up were adjudicated as being due to poor compliance with the device IFU — in terms of the adequacy of proximal or distal device landing zones and overlap zones or the correct procedure for overlapping devices (the smaller device should be deployed before the bigger one in an overlap situation). 40 - 42 Endoleaks as well as instances of device migration were also due to the failure during implantation to take into account the potential for foreshortening due to the interwoven design of the MFM and to perform the implantation at a slow enough pace to allow the device to achieve its natural compliance. 42 - 46 Data have not yet been published on outcomes with a new generation of the MFM with flared ends designed to promote aortic wall adherence and reduce the risk of leak at the proximal and distal landing zones.…”

“… 40 - 42 Endoleaks as well as instances of device migration were also due to the failure during implantation to take into account the potential for foreshortening due to the interwoven design of the MFM and to perform the implantation at a slow enough pace to allow the device to achieve its natural compliance. 42 - 46 Data have not yet been published on outcomes with a new generation of the MFM with flared ends designed to promote aortic wall adherence and reduce the risk of leak at the proximal and distal landing zones.…”