Separation of Components in Fenestrated and Branched Endovascular Grafting – Branch Protection or a Potentially New Mode of Failure?

Abstract

Component movement is commonly observed in modular devices, but clinical consequences are rare. The degree of overlap, aneurysm diameter, aneurysm length, and stentgraft diameter can be used to predict the risk of inter-component movement which may result in component separation.

Durability of branches in branched and fenestrated endografts

“…We attribute the low risk of migration to the placement of the device within a long segment of healthy aorta proximally, the use of barbs on all proximal fixation sites, and the uncoupling of the downward forces on the distal bifurcation as previously described. 16 The second fundamental of device design that evolved with the program was the use of side arm branches rather than fenestrations to treat visceral branches in the setting of extensive aneurysms. This is a lesson that evolved more as a result of common sense durability issues than frequently observed failure (Fig 7).…”

“…Details of the patient population and methods of device implantation have been previously described. 4,9,15,16 All patients signed an informed consent approved by the Investigational Review Board. Data concerning patient outcomes and information about imaging end points are included in the database and were collected prospectively as defined by the study protocol.…”

“…Criteria for duplex imaging and methods for CT scan interpretation have been previously reported. 15,16 Any discrepancies were adjudicated by a nontreating surgeon with expertise in the field and knowledge of the devices. Imaging outcomes reported in this article conformed to the reporting standards document for branched and fenestrated aneurysm repair, 17 except where the definitions were incomplete and required modifications as defined in this document (Fig 1).…”

Mid-term Outcomes of Renal Branches Versus Renal Fenestrations for Thoraco-abdominal Aneurysm Repair

“…All imaging was reviewed at each participating center using center specific protocols. Duplex ultrasound criteria applied were defined by Mohabbat et al, 8 and MDCT scan interpretation was based on the methods described by Dowdall et al 9 Imaging outcomes were defined according to reporting standards and their modifications proposed by Mastracci et al 3,7 Early ( 30 days) and late (>30 days) renal occlusions and deaths (procedure related and any kind of death), and early (re-interventions, <30 days) and late renal secondary interventions (>30 days) were analyzed. Renal occlusion during follow up was diagnosed, excluding failed renal vessel catheterization during the initial procedure.…”

Adapting to a total endovascular approach for complex aortic aneurysm repair: Outcomes after fenestrated and branched endovascular aortic repair

“…8,9 Some authors have called for a unique nomenclature for target vessel follow-up. [10][11][12] Comparisons against open surgical repair are also difficult. Only recently have data been published on the patency of visceral arteries after open thoracoabdominal aortic aneurysm (TAAA) repair.…”