Techniques of antegrade in situ laser fenestration for endovascular aortic repair of complex abdominal and thoracoabdominal aortic aneurysms

DiBartolomeo, Alexander D.; Han, Sukgu M.

doi:10.1016/j.jvscit.2022.11.004

Journal of Vascular Surgery Cases, Innovations and Techniques

2022

DOI: 10.1016/j.jvscit.2022.11.004

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Techniques of antegrade in situ laser fenestration for endovascular aortic repair of complex abdominal and thoracoabdominal aortic aneurysms

Alexander D. DiBartolomeo¹,

Sukgu M. Han²

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Cited by 7 publications

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“…The production of hazardous chemicals created by lasers in the fenestration of ePTFE remains a serious concern [36]. The following fenestrations can be safely achieved with non-compliant balloons 6 or 8 mm in diameter, as the tearing cannot extend beyond the limits of the corona [37][38][39][40][41][42]. Balloons of larger diameters are likely to cause significant and irregular tears, leading to an increased risk of endoleaks.…”

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Stent-Graft Fabrics Incorporating a Specific Corona Ready to Fenestrate

et al. 2023

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In situ fenestration of endovascular stent-grafts has become a mainstream bailout technique to treat complex emergent aneurysms while maintaining native anatomical visceral and aortic arch blood supplies. Fabric tearing from creating the in situ fenestration using balloon angioplasty may extend beyond the intended diameter over time. Further tearing may result from the physiologic pulsatile motion at the branching site. A resultant endoleak at the fenestrated sites in stent-grafts could ultimately lead to re-pressurization of the aortic sac and, eventually, rupture. In an attempt to address this challenge, plain woven fabrics were designed. They hold a specific corona surrounding a square-shaped cluster with a plain weave fabric structure, a 2/2 twill, or a honeycomb. The corona was designed to stop potential further tearing of the fabric caused by the initial balloon angioplasty and stent or later post-implantation motion. The cluster within the corona was designed with relatively loose fabric structures (plain weave, 2/2 twill weave, and honeycomb) to facilitate the laser fenestration. Two commercial devices, Anaconda (Vascutek, Terumo Aortic) and Zenith TX2 (Cook), were selected as controls for comparison against this new design. All the specimens were characterized by morphology, thickness, and water permeability. The results demonstrated that all specimens with a low thickness and water permeability satisfied the requirements for a stent graft material that would be low profile and resistant to endoleaks. The in situ fenestrations were performed on all fabrics utilizing an Excimer laser followed by balloon angioplasty. The fabrics were further observed by light microscopy and scanning electron microscopy. The dimension of the fenestrated apertures was smaller than the balloon’s diameter. The tearing was effectively confined within the corona. The clinical acceptability of this concept deserves additional bench testing and animal experimentation.

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confidence: 99%

Stent-Graft Fabrics Incorporating a Specific Corona Ready to Fenestrate

et al. 2023

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Adam

Claridge

2023

European Journal of Vascular and Endovascular Surgery

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Gastrointestinal complications and visceral circulation changes after intentional celiac artery embolization during complex endovascular aortic repair

Fereydooni,

Franca,

Sorondo

et al. 2024

Journal of Vascular Surgery

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Techniques of antegrade in situ laser fenestration for endovascular aortic repair of complex abdominal and thoracoabdominal aortic aneurysms

Cited by 7 publications

References 8 publications

Stent-Graft Fabrics Incorporating a Specific Corona Ready to Fenestrate

Stent-Graft Fabrics Incorporating a Specific Corona Ready to Fenestrate

Back Table Or In Situ? Select Your Window

Gastrointestinal complications and visceral circulation changes after intentional celiac artery embolization during complex endovascular aortic repair

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