Off-the-shelf multibranched endograft for total endovascular repair of the aortic arch

Bosse, Côme; Kölbel, Tilo; Mougin, Justine; Kratzberg, Jarin; Fabre, Dominique; Haulon, Stéphan

doi:10.1016/j.jvs.2019.11.046

Cited by 30 publications

(11 citation statements)

References 24 publications

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“…The only suitable graft available in our institution at the time of the rupture was a triple-branched arch endograft ordered for another patient. There are reports on the use of double-branched arch endografts for elective repair of arch lesions and emergency treatment of acute aortic syndromes, 7,9,10 but there has been no reported use of noncustomized triple-branched arch devices in the latter scenario. Being aware of the promising results of double-branched endografts in emergency situations, we assumed that the similar design of the triple-branched endograft with a tapered middle segment would leave enough space to successfully connect all 3 branches to the supra-aortic vessels.…”

Section: Discussionmentioning

confidence: 99%

Emergent Triple-Branched TEVAR and Redistribution of the Branches to the Supra-Aortic Target Vessels for Treatment of a Contained Ruptured Descending Aortic Aneurysm Associated With a Chronic Type A Aortic Dissection

et al. 2021

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Purpose: To demonstrate the feasibility of urgent endovascular treatment of a chronic type A dissection and contained rupture of the false lumen using a noncustomized triple-branched arch endograft, which necessitated reassignment of the branches to the supra-aortic vessels. Case Report:: A 57-year-old patient with a contained rupture of the descending thoracic aorta, in the setting of a chronic type A dissection and a maximum aortic diameter of 85 mm, was converted to endovascular repair after failure of an open surgical approach. A custom-made triple-branched arch endograft designed for another patient was employed, with concomitant occlusion of the false lumen using a Candy Plug occluder. To adjust the graft’s configuration to the patient’s anatomy, the supra-aortic vessels were not assigned to the originally planned branches. The 12-month follow-up angiography demonstrated a satisfactory result. Conclusion: A noncustomized triple-branched arch endograft can be used in an emergency setting to treat chronic type A dissection, reassigning the branches to the supra-aortic vessels as needed.

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Section: Discussionmentioning

confidence: 99%

Emergent Triple-Branched TEVAR and Redistribution of the Branches to the Supra-Aortic Target Vessels for Treatment of a Contained Ruptured Descending Aortic Aneurysm Associated With a Chronic Type A Aortic Dissection

et al. 2021

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“…In assessing the anatomical suitability of the supra-aortic arteries as TVs, one specific anatomical model showed a suitability of 79% in patients previously treated with a 2-IBAE. Bosse et al 21 showed that the supra-aortic vessel anatomy has a limited number of variations in terms of the IA and LCCA as TVs, thus 5 standardized off-the-shelf 2-IBAE configurations may cover a majority of aortic arch anatomies. 21 Other recent studies 22,23 have suggested that more than two-thirds of patients who had a type A aortic dissection repair would be technically eligible for IBAEs.…”

Section: Discussionmentioning

confidence: 99%

“…Bosse et al 21 showed that the supra-aortic vessel anatomy has a limited number of variations in terms of the IA and LCCA as TVs, thus 5 standardized off-the-shelf 2-IBAE configurations may cover a majority of aortic arch anatomies. 21 Other recent studies 22,23 have suggested that more than two-thirds of patients who had a type A aortic dissection repair would be technically eligible for IBAEs. Standardized off-the-shelf multibranched stent-grafts may cover the manufacturing gap of custom-made devices and can be used in urgent and emergent situations, providing a valuable option for high-risk patients in this setting.…”

Section: Discussionmentioning

confidence: 99%

“…In assessing the anatomical suitability of the supra-aortic arteries as TVs, one specific anatomical model showed a suitability of 79% in patients previously treated with a 2-IBAE. Bosse et al 21 showed that the supra-aortic Figure 1. The 3 different endograft designs that were applied to study the suitability of the supra-aortic arteries as target vessels.…”

Section: Discussionmentioning

confidence: 99%

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Anatomical Suitability of the Aortic Arch Arteries for a 3-Inner-Branch Arch Endograft

Σπανός¹,

Haulon

Eleshra³

et al. 2020

J Endovasc Ther

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Purpose: To analyze aortic arch anatomy of patients who were already treated with a 2-inner-branch arch endograft (2-IBAE) in order to assess the anatomical suitability of the supra-aortic arteries as target vessels for a 3-IBAE. Materials and Methods: Three different configurations of the Cook Zenith Arch endograft were designed with distances of 110 mm (model 1), 90 mm (model 2), and 70 mm (model 3) between the orifices of the first and third inner branches. Preoperative measurements of the aortic arch anatomy from 104 consecutive patients treated electively with custom-made 2-IBAEs at 2 European centers between 2014 and 2019 were analyzed. A previously described standard methodology with a planning sheet was used. Data and measurements included the treatment indication for the aortic arch pathology, the type of landing zone, the type of arch, and the inner and outer lengths of the ascending aorta from the sinotubular junction to the innominate artery (IA). Additionally, the diameters and clock positions of the IA, left common carotid artery (LCCA), and left subclavian artery (LSA) were assessed, along with the distances between the IA and the LCCA, the IA and the LSA, and the distal landing zone. Results: Type I was the most common arch configuration (75/104, 72%). The mean clock positions were 12:30±00:28 for the IA, 12:00±00:23 for the LCCA, and 12:15±00:29 for the LSA. The mean diameters were 14.2±2.2 mm for the IA, 8.8±1.8 mm for the LCCA, and 10.5±2 mm for the LSA. The mean distances between the IA and LCCA and between the IA and LSA were 14.7±5.8 mm and 33±9.4 mm, respectively. Model 2 (branch distance 90 mm) had the highest suitability (79%), while models 1 and 3 showed suitability rates of 73% and 68%, respectively. The most frequent exclusion criterion in all models was the diameter of the LSA, followed by the IA to LSA distance. Conclusion: The suitability for a 3-IBAE among patients who had a 2-IBAE implanted is high, favoring a 90-mm distance between the retrograde LSA branch and baseline.

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“…The third article, by Gallitto and coauthors from Bologna and Parma, Italy, is entitled “Off-the-shelf multibranched endograft for total endovascular repair of the aortic arch.” 3 In this retrospective, single-center study, 17 patients underwent urgent repair with the Cook Zenith t-branch device for contained rupture or symptomatic aneurysm in 24% for each or for a thoracoabdominal aortic aneurysm that was 8 cm or larger in maximum diameter. Technical success was 82% but adjunctive and complex intraoperative procedures were needed in 87%; 6% had spinal cord ischemia and 30-day mortality was also 6%.…”

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confidence: 99%

Journal of Vascular Surgery – September 2020 Audiovisual Summary

Gloviczki¹

2020

Journal of Vascular Surgery

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The COVID-19 pandemic continues to disrupt normal life in the United States and worldwide. As we go to the press today on June 30th, 2020, more than 10 million people have tested positive for the virus and over 508 thousand died worldwide. In the United States, more than 2.6 million people have been affected and over 126 million died. The JVS journals bring you a large collection of paper on how COVID-19 has affected vascular patients and how tens of thousands of health care professionals deal with this huge problem affecting mankind. I am pleased to introduce to you the September issue of the JVS and highlight four outstanding papers which are freely available for the next 2 months.The Editors' Choice article for this issue is titled "Results of fenestrated and branched endovascular aortic aneurysm repair after failed infrarenal endovascular aortic aneurysm repair"; it was written by Andres Schanzer and colleagues participating in the Aortic Research Consortium. 1 This was a prospective analysis of six physician-sponsored, nonrandomized investigational device exemption studies that included 893 patients who underwent fenestrated and branched endovascular aortic aneurysm repairs (F/BEVARs). Eighteen percent of the patients underwent previous EVAR. The 30-day major adverse event rates and mortality did not differ between groups. Freedom from type I or type III endoleak, target artery patency and freedom from reintervention at 1 year did not differ between groups (84.7% vs 88.7%; P ¼ .10). This study confirms the feasibility and safety of a fenestrated-branched EVAR after failed EVAR.Our next article is titled "Rapid increase in hybrid surgery for the treatment of peripheral artery disease in the Vascular Quality Initiative database," by Arash Fereydooni and colleagues from the Yale School of Medicine in new Haven, Connecticut. 2 This is our CME article for this month. This Vascular Quality Initiative study demonstrated a fivefold increase of hybrid surgery performed from 2010 to 2017 as a lower extremity revascularization procedure. Hybrid femoropopliteal procedures had better perioperative outcomes compared to open femoropopliteal bypass. However, the 1-year outcomes were comparable between the two procedures, suggesting that hybrid revascularization of femoropopliteal disease should be performed selectively in high-risk patients owing to its superior short-term outcomes.The third article, by Gallitto and coauthors from Bologna and Parma, Italy, is entitled "Off-the-shelf multibranched endograft for total endovascular repair of the aortic arch." 3 In this retrospective, single-center study, 17 patients underwent urgent repair with the Cook Zenith t-branch device for contained rupture or symptomatic aneurysm in 24% for each or for a thoracoabdominal aortic aneurysm that was 8 cm or larger in maximum diameter. Technical success was 82% but adjunctive and complex intraoperative procedures were needed in 87%; 6% had spinal cord ischemia and 30-day mortality was also 6%. One-year survival of these patients was 82% and...

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Off-the-shelf multibranched endograft for total endovascular repair of the aortic arch

Cited by 30 publications

References 24 publications

Emergent Triple-Branched TEVAR and Redistribution of the Branches to the Supra-Aortic Target Vessels for Treatment of a Contained Ruptured Descending Aortic Aneurysm Associated With a Chronic Type A Aortic Dissection

Emergent Triple-Branched TEVAR and Redistribution of the Branches to the Supra-Aortic Target Vessels for Treatment of a Contained Ruptured Descending Aortic Aneurysm Associated With a Chronic Type A Aortic Dissection

Anatomical Suitability of the Aortic Arch Arteries for a 3-Inner-Branch Arch Endograft

Journal of Vascular Surgery – September 2020 Audiovisual Summary

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