The Polymer-Based Technology in the Endovascular Treatment of Abdominal Aortic Aneurysms

Donato, Gianmarco de; Pasqui, Edoardo; Panzano, Claudia; Brancaccio, Brenda; Grottola, Gaia; Galzerano, G; Benevento, Domenico; Palasciano, Giancarlo

doi:10.3390/polym13081196

Cited by 18 publications

(15 citation statements)

References 95 publications

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“…Implementation in clinical routine will only be feasible once PC -series can be generated on the scanner without significant delay. Third, some stent-grafts use a polymer-based sealing technique frequently resulting in prolonged contrast material retainment within the polymer [30]; in these cases, VNC series are of limited use and TNC acquisitions will likely still be mandatory for followup scans. Fourth, this is a retrospective single-center study with somewhat heterogeneous scan protocols.…”

Section: Discussionmentioning

confidence: 99%

Virtual Non-Contrast Reconstructions of Photon-Counting Detector CT Angiography Datasets as Substitutes for True Non-Contrast Acquisitions in Patients after EVAR—Performance of a Novel Calcium-Preserving Reconstruction Algorithm

et al. 2022

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The purpose of this study was to evaluate virtual-non contrast reconstructions of Photon-Counting Detector (PCD) CT-angiography datasets using a novel calcium-preserving algorithm (VNCPC) vs. the standard algorithm (VNCConv) for their potential to replace unenhanced acquisitions (TNC) in patients after endovascular aneurysm repair (EVAR). 20 EVAR patients who had undergone CTA (unenhanced and arterial phase) on a novel PCD-CT were included. VNCConv- and VNCPC-series were derived from CTA-datasets and intraluminal signal and noise compared. Three readers evaluated image quality, contrast removal, and removal of calcifications/stent parts and assessed all VNC-series for their suitability to replace TNC-series. Image noise was higher in VNC- than in TNC-series (18.6 ± 5.3 HU, 16.7 ± 7.1 HU, and 14.9 ± 7.1 HU for VNCConv-, VNCPC-, and TNC-series, p = 0.006). Subjective image quality was substantially higher in VNCPC- than VNCConv-series (4.2 ± 0.9 vs. 2.5 ± 0.6; p < 0.001). Aortic contrast removal was complete in all VNC-series. Unlike in VNCConv-reconstructions, only minuscule parts of stents or calcifications were erroneously subtracted in VNCPC-reconstructions. Readers considered 95% of VNCPC-series fully or mostly suited to replace TNC-series; for VNCConv-reconstructions, however, only 75% were considered mostly (and none fully) suited for TNC-replacement. VNCPC-reconstructions of PCD-CT-angiography datasets have excellent image quality with complete contrast removal and only minimal erroneous subtractions of stent parts/calcifications. They could replace TNC-series in almost all cases.

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Section: Discussionmentioning

confidence: 99%

Virtual Non-Contrast Reconstructions of Photon-Counting Detector CT Angiography Datasets as Substitutes for True Non-Contrast Acquisitions in Patients after EVAR—Performance of a Novel Calcium-Preserving Reconstruction Algorithm

et al. 2022

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“…Hypothetical reasons include polymer line disconnection secondary to incorrect device manipulations during the procedure (excessive twisting of the delivery shaft), early ballooning before complete polymer cure, lower body temperature which can slow the polymer cure rate, or manufacturing issues (polymer network hole). 7 It will be important to collect these data on future prospective Alto dedicated registries.…”

Section: Discussionmentioning

confidence: 99%

Early Experience with the New Ovation Alto Stent Graft in Endovascular Abdominal Aortic Aneurysm Repair

Donato

Pasqui

Panzano

et al. 2022

EJVES Vascular Forum

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Introduction Since 2010, the Ovation Abdominal Stent Graft System has offered a new sealing concept, achieved by a sealing ring filled with polymer 13 mm from the renal arteries. In the latest version, called Ovation Alto, the sealing ring is relocated 6 mm closer to the top of the fabric. This study describes the early clinical outcomes, after CE Mark approval in August 2020, of endovascular aneurysm repair with the Alto endograft. Report Eleven patients underwent endovascular aneurysm repair with implantation of Ovation Alto endografts. All patients were male, and the median age was 75 (IQR 5.5) years. Hostile proximal aortic neck (<10 mm) was identified in six cases (54.5%). All procedures were performed using bilateral percutaneous approaches with no groin complications. The median procedure time was 58 (IQR 7.2) minutes, the median contrast volume used was 65 (IQR 4.2) mL, and the median blood loss 40 (IQR 12.4) mL. Technical success was achieved in all cases. The median stent graft landing distance between the top of the fabric and the lowest renal artery was 1.4 (IQR 0.8) mm. No intra-operative high flow endoleaks were registered. At one and six month follow up, there was 100% clinical success (no type I/III endoleak, sac enlargement, stent graft migration, polymer leakage, abdominal aortic aneurysm related mortality, or secondary intervention). Discussion Initial experience confirms the early technical and clinical success of the new Ovation Alto stent graft. Technical modifications to the endograft could allow for accommodation of a more comprehensive range of anatomies on label. Further studies are needed to evaluate long term durability outcomes.

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“…Endovascular aneurysm repair has been established as fundamental alternative to OR, allowing to treat patients with a minimally invasive technique. Time has permitted to develop new technologies capable of threating difficult anatomies (26)(27)(28)(29) and very high-risk patients (30). A similar sexual dysfunction has been reported after EVAR, but the recovery to the preoperative level was faster with EVAR than after OR (31).…”

Section: Discussionmentioning

confidence: 83%

Prevalence of Erectile Dysfunction in Patients With Abdominal Aortic Aneurysm: An Exploratory Study

Donato

Pasqui

Gargiulo

et al. 2022

Front. Cardiovasc. Med.

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IntroductionErectile dysfunction (ED) is defined as the recurrent inability to achieve and maintain a satisfactory erection for sexual intercourse. Many studies have highlighted that ED shares common cardiovascular risk factors with cardiovascular disease. No data are reported about the prevalence of ED in patients with the abdominal aortic aneurysm (AAA). The aim of our study was to investigate the preoperative information given about sexual functions of patients undergoing endovascular aneurysm repair (EVAR) and to compare it with the presence and severity of steno-occlusive atherosclerotic lesions of the pelvic arterial tree at pre-operative Computed Tomography Angiography (CTA).MethodsWe prospectively enrolled all men patients who underwent elective EVAR from September to November 2021. Preoperative ED was evaluated using the International Index of Erectile Function (IIEF-5) questionnaire. Preoperative imaging was routinely performed with CTA scan of the abdominal aorta and iliac-pelvic district. An innovative score of pelvic arterial disease associated to AAA was defined, dividing the iliac district in 4 zones attributing a grading of severity for each zone bilaterally (score ranges 0–24). Linear regression analysis was used to correlate IIEF-5 score to anatomical score of pelvic arterial steno-occlusive disease.ResultsA total of 25 patients were enrolled. Median age was 74 ± 5.3 years. IIEF-5 average score was 14.8 ± 7.1. Eight cases (32%) had severe ED; one case (4%) had moderate, five patients (20%) had mild to moderate ED; five patients (20%) had mild ED, and 6 (24%) patients had no ED. CTA evaluation revealed an average anatomical score of 7.9 ± 4.5. Pelvic disease was considered moderate-severe in 20 cases (80%) and not significant in 20% (five cases). Linear regression analysis confirmed the hypothesis that a more diseased pelvic arterial tree was correlated to a more severe ED (Y = −1.531* × + 26.35 [slope CI: −1.946 to −1.117, p < 0.0001]).ConclusionAlthough typically unreported, the prevalence of ED associated to AAA was found to be high. A vasculogenic origin of ED in patients with AAA is plausible and may be easily confirmed by the evaluation of pelvic arterial distribution at angio-CT performed for EVAR planning. Our proposed “MAPPING AND SCORING SHEET” may help to identify the vasculogenic origin of ED in AAA patients.

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The Polymer-Based Technology in the Endovascular Treatment of Abdominal Aortic Aneurysms

Cited by 18 publications

References 95 publications

Virtual Non-Contrast Reconstructions of Photon-Counting Detector CT Angiography Datasets as Substitutes for True Non-Contrast Acquisitions in Patients after EVAR—Performance of a Novel Calcium-Preserving Reconstruction Algorithm

Virtual Non-Contrast Reconstructions of Photon-Counting Detector CT Angiography Datasets as Substitutes for True Non-Contrast Acquisitions in Patients after EVAR—Performance of a Novel Calcium-Preserving Reconstruction Algorithm

Early Experience with the New Ovation Alto Stent Graft in Endovascular Abdominal Aortic Aneurysm Repair

Prevalence of Erectile Dysfunction in Patients With Abdominal Aortic Aneurysm: An Exploratory Study

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