Superior mesenteric artery outcomes after fenestrated endovascular aortic aneurysm repair

Lala, Salim; Knowles, Martyn; Timaran, David E.; Baig, Mirza S.; Valentine, James; Timaran, Carlos H.

doi:10.1016/j.jvs.2016.02.031

Cited by 18 publications

(6 citation statements)

References 7 publications

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“…Conversely, in Lala’s series of 47 patients that compared the use of stent to no stent in large fenestrations and scallops, more MAEs were attributed to misalignment in the unstented group, with no misalignment occurring in the stented cohort. One patient developed SMA stenosis distal to the bridging stent that was remedied with angioplasty, similar to the case described in this report (Lala et al 2016 ).…”

Section: Discussionsupporting

confidence: 82%

Superior mesenteric artery outcomes after large fenestration strut relocation with the Zenith Fenestrated endoprosthesis

et al. 2020

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Background The Zenith® Fenestrated (ZFen) stent-graft is frequently configured with a strut-spanning large fenestration for superior mesenteric artery (SMA) incorporation. This has led some to relocate struts to create a strut-free fenestration and place a bridging stent. The aim of this study was to compare SMA outcomes with and without large fenestration strut relocation. Methods We performed a retrospective review of a prospective database of patients undergoing fenestrated endovascular repair with ZFen between 2013 and 2019. Those with SMA incorporation using large fenestrations were included and separated into strut relocation (SR) and no relocation (NR) groups. Endpoints included procedural metrics, technical success, major adverse events, and target-vessel instability. Results A total of 121 patients (77% male; mean age 76.1 ± 7.1 years) met inclusion criteria, including 94 with SR (78%) and 27 with NR (22%). A total of 369 target-vessels were incorporated, with a mean of 3.0 ± 0.2 per patient, and no differences between groups. Mean operative time, contrast volume, estimated blood loss, fluoroscopy time and radiation dose were lower ( p < 0.001) with SR, attributed to increased experience with time. Overall technical success (SR: 100%, NR: 96%, p = 0.22) was 99%. At a mean follow-up of 32 months, there were two endovascular interventions for mesenteric ischemia. One resulted in SMA dissection requiring bypass in the NR group, the other was successful ballooning of the bridging stent with symptom resolution in the SR group. Conclusions Relocating the spanning struts does not negatively impact procedural metrics or midterm outcomes. It may facilitate future endovascular interventions.

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Section: Discussionsupporting

confidence: 82%

Superior mesenteric artery outcomes after large fenestration strut relocation with the Zenith Fenestrated endoprosthesis

et al. 2020

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“…Beginning with our first case, SMA modifications in the main body were not routinely stented. In contrast to the report made by Lala et al, 17 no reinterventions on any of the unstented SMAs have been required. Last, we increased the complexity of disease treated over time as measured by number of visceral arteries stented (1.9 vs 2.2).…”

Section: Discussionmentioning

confidence: 80%

Institutional experience with the Zenith Fenestrated aortic stent graft

Wang

Gutwein

Gupta

et al. 2018

Journal of Vascular Surgery

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“… 2 In response, some have recommended either selective or routine SMA stenting. 2 , 3 , 4 At the Cleveland Clinic, 26 of 213 SMA scallops were stented. Whereas those without stents experienced no increased risk of SMA occlusion, those with stents had a higher rate of reintervention, 5 suggesting that SMA stenting in this setting is not risk free.…”

Section: Discussionmentioning

confidence: 99%

Balloon guidance for superior mesenteric artery scallop alignment during Cook Zenith Fenestrated AAA Endovascular Graft deployment

Kuwayama

Zacharias

2020

Journal of Vascular Surgery Cases, Innovations and Techniques

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To achieve seal, aortic endografts may require coverage of the aorta adjacent to or involving critical branch vessels. One technique for maintaining branch vessel patency at the leading edge of an endograft is use of a scallop. However, it may be difficult to ensure proper scallop alignment both before and after endograft deployment. We describe a technique for improving superior mesenteric artery scallop alignment of the Cook Zenith Fenestrated AAA Endovascular Graft (Cook Medical, Bloomington, Ind) using scallop precannulation and ostial superior mesenteric artery balloon inflation during both diameter expansion and top cap release.

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Superior mesenteric artery outcomes after fenestrated endovascular aortic aneurysm repair

Abstract: Misalignment of the SMA with the use of unstented unreinforced scallops or fenestrations occurs frequently. Routine stenting of single-wide and large fenestrations, when feasible, may be a safer option for patients undergoing FEVAR.

Cited by 18 publications

References 7 publications

Superior mesenteric artery outcomes after large fenestration strut relocation with the Zenith Fenestrated endoprosthesis

Superior mesenteric artery outcomes after large fenestration strut relocation with the Zenith Fenestrated endoprosthesis

Institutional experience with the Zenith Fenestrated aortic stent graft

Balloon guidance for superior mesenteric artery scallop alignment during Cook Zenith Fenestrated AAA Endovascular Graft deployment

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