Outcomes of total percutaneous endovascular aortic repair for thoracic, fenestrated, and branched endografts

Souza, Leonardo Reis de; Oderich, Gustavo S.; Banga, Péter; Hofer, Janet M.; Wigham, Jean; Cha, Stephen; Gloviczki, Péter

doi:10.1016/j.jvs.2015.07.072

Cited by 35 publications

(17 citation statements)

References 41 publications

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“…Open LSA and LCA revascularization usually requires longer operative time and presents more risks for artery ischemic attacks, nerve injury, or other neurologic complications. Because branch stent‐grafts and patient‐customized grafts often require extensive design, precise intraoperative DSA imaging, and refined manipulation, this application is limited . Furthermore, these modified grafts are often not available for patients with acute thoracic aortic pathologies.…”

Section: Discussionmentioning

confidence: 99%

“…Because branch stent-grafts and patient-customized grafts often require extensive design, precise intraoperative DSA imaging, and refined manipulation, this application is limited. 27 Furthermore, these modified grafts are often not available for patients with acute thoracic aortic pathologies. Therefore, intraoperative fenestration shows great potential for the revascularization of aortic branches.…”

Section: Discussionmentioning

confidence: 99%

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In Situ Laser Fenestration Is a Feasible Method for Revascularization of Aortic Arch During Thoracic Endovascular Aortic Repair

Qin

Zhao

Wang

et al. 2017

JAHA

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BackgroundReconstruction of the aortic major branches during thoracic endovascular aortic repair is complicated because of the complex anatomic configuration and variation of the aortic arch. In situ laser fenestration has shown great potential for the revascularization of aortic branches. This study aims to evaluate the feasibility, effectiveness, and safety of in situ laser fenestration on the three branches of the aortic arch during thoracic endovascular aortic repair.Methods and ResultsBefore clinical application, the polytetrafluoroethylene and Dacron grafts were fenestrated by an 810‐nm laser system ex vivo, which did not damage the bare metal portion of the endografts and created a clean fenestration while maintaining the integrity of the endografts. In vivo, 6 anesthetized female swine survived after this operation, including stent‐graft implantation in the aortic arches, laser fenestration, and conduit implantation through the innominate arteries and the left carotid arteries. Based on the animal experiments, in situ laser fenestration during thoracic endovascular aortic repair was successively performed on 24 patients (aged 33–86 years) with aortic artery diseases (dissection type A: n=4, type B: n=7, aneurysm: n=2, mural thrombus: n=7). Fenestration of 3 aortic branches was performed in 2 (8.3%) patients. Both the left carotid artery and the left subclavian artery were fenestrated in 6 (25%) patients. Only left subclavian artery fenestration surgery was done in 16 (66.7%) patients. Among these patients, 1 fenestration was abandoned secondary to an acute takeoff of the innominate artery in a type III aortic arch. The average operative time was 137±15 minutes. The technical success rate was 95.8% (n=23). No fenestration‐related complications or neurological morbidity occurred after this operation. During a mean postoperative 10‐month follow‐up (range: 2–17 months), 1 patient died of severe pneumonia, and all the left subclavian artery and carotid artery stents were patent with no fenestration‐related endoleaks upon computed tomography angiography images.ConclusionsIn situ laser fenestration is a feasible, effective, rapid, repeatable, and safe option for the reconstruction of aortic arch during thoracic endovascular aortic repair, which might be available to revascularize the 3 branches. However, follow‐up periods should be extended to evaluate the robustness of this technique.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

In Situ Laser Fenestration Is a Feasible Method for Revascularization of Aortic Arch During Thoracic Endovascular Aortic Repair

Qin

Zhao

Wang

et al. 2017

JAHA

View full text Add to dashboard Cite

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“…de Souza et al reported a 95% of technical success for total percutaneous endovascular aortic repair for thoracic, fenestrated, and branched stent grafts. In this series of 170 femoral arteries approached with >20-F-diameter sheaths, accessrelated complications occurred in 5% of cases within 30 days, and no late access-related events were reported [33].…”

Section: Access Vesselsmentioning

confidence: 74%

Toward an Entirely Endovascular World for Thoracoabdominal Aortic Disease: Myth or Reality?

Cao¹,

Ferrer

2019

Visceral Vessels and Aortic Repair

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“…Average effective puncture size was 22.1 F in the overall SAFE MANTA study vs 18.3 F in the PEVAR/TEVAR population. 12 De Souza et al 19 reported a percutaneous closure failure rate requiring conversion to open repair in 5% of access sites (n=170) in a single-center retrospective study in which procedure sheaths with diameters >20 F were utilized in 95% of access sites. While sheaths labeled >18-F inner diameter (ID) were excluded in the SAFE MANTA study, many sheaths with a labeled ID ≤18 F that had effective outer diameters approaching 25 F were utilized, specifically in the TAVR population, with similarly low complication results.…”

Section: Discussionmentioning

confidence: 99%

Pivotal Clinical Study to Evaluate the Safety and Effectiveness of the MANTA Vascular Closure Device During Percutaneous EVAR and TEVAR Procedures

et al. 2020

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Purpose: To evaluate the safety and effectiveness of the MANTA percutaneous vascular closure device in patients undergoing percutaneous endovascular aneurysm repair (PEVAR) or thoracic endovascular aortic repair (TEVAR). Materials and Methods: The SAFE MANTA Study ( ClinicalTrials.gov identifier NCT02908880) was a prospective, single-arm, multicenter trial in patients undergoing endovascular interventions using large-bore sheaths (transcatheter aortic valve replacement, PEVAR, or TEVAR) at 20 sites in North America. Patient selection intended to test the MANTA device in populations without morbid obesity, severe calcification, or a severely scarred femoral access area. Of the 263 patients enrolled in the primary analysis cohort, 53 (20.2%) patients (mean age 74.9±8.9 years; 41 men) underwent PEVAR (n=51) or TEVAR (n=2) procedures and form the cohort for this subgroup analysis. Per protocol a single MANTA device was deployed in all PEVAR/TEVAR cases. Results: The mean time to hemostasis in the PEVAR/TEVAR cohort was 35±91 seconds, with a median time of 19 seconds vs 24 seconds in the overall SAFE MANTA population. The MANTA device met the definition for technical success in 52 (98%) of 53 PEVAR/TEVAR cases compared with 97.7% in the overall SAFE MANTA population. One (1.9%) major complication (access-site stenosis) occurred in this subgroup compared to 14 (5.3%) events in the SAFE population. In the PEVAR/TEVAR group, 1 pseudoaneurysm was noted prior to discharge, another at 30-day follow-up, and one at 60 days. One (1.9%) of the 3 minor pseudoaneurysms was treated with ultrasound-guided compression and the other 2 required no treatment. Conclusion: The MANTA device demonstrated a short time to hemostasis and low complication rates compared with published literature results of other percutaneous closure devices. Time to hemostasis and complication rates were comparable between the PEVAR/TEVAR patients and the full SAFE MANTA study cohort. The MANTA device provides reliable closure with a single percutaneous device for PEVAR/TEVAR procedures.

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Outcomes of total percutaneous endovascular aortic repair for thoracic, fenestrated, and branched endografts

Cited by 35 publications

References 41 publications

In Situ Laser Fenestration Is a Feasible Method for Revascularization of Aortic Arch During Thoracic Endovascular Aortic Repair

In Situ Laser Fenestration Is a Feasible Method for Revascularization of Aortic Arch During Thoracic Endovascular Aortic Repair

Toward an Entirely Endovascular World for Thoracoabdominal Aortic Disease: Myth or Reality?

Pivotal Clinical Study to Evaluate the Safety and Effectiveness of the MANTA Vascular Closure Device During Percutaneous EVAR and TEVAR Procedures

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