Treatment of Short-necked Infrarenal Aortic Aneurysms with Fenestrated Stent-grafts: Short-term Results

Verhoeven, Eric L.G.; Prins, Ted R.; Tielliu, Ignace F.J.; Dungen, J.J.A.M. van den; Zeebregts, Clark J.; Hulsebos, R.G.; Kempenaer, M.G. van Andringa de; Oudkerk, Matthijs; Schilfgaarde, R. van

doi:10.1016/j.ejvs.2003.09.007

Cited by 135 publications

(96 citation statements)

References 30 publications

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“…In case of small and calcified external iliac arteries, a retroperitoneal approach and an iliac conduit may be required. The PC is introduced in one side (the delivery sheath of the PC has a diameter of 22-24 Fr and a large (20)(21)(22)(23)(24) sheath is inserted on the contralateral side, each over a stiff wire. The latter is positioned just above the aortic bifurcation and after retrieval of the stiff wire three or four smaller sheaths are introduced through the large sheath valve.…”

Section: Details Of the Techniquementioning

confidence: 99%

“…2,22,24,27,28,30,34,[39][40][41][42][43][44][45][46][47][48][49][50] Owing to the normal suprarenal aortic lumen, it is generally accepted that fenestrated devices are preferably used for pararenal aneurysms (PRAs).…”

Section: General Criteriamentioning

confidence: 99%

“…Some designs are without fenestrations but with branches (pre-attached limbs or cuffs) targeted for the visceral aortic vessels, suitable for the endovascular treatment of thoracoabdominal aortic aneurysms (TAAAs). At least for short-necked and juxtarenal aortic aneurysms (JRAs), fenestrated stent-grafting technology has been shown to be feasible, [12][13][14][15][16][17][18][19][20] with published results of highvolume experienced single centers [21][22][23][24][25][26][27][28][29][30][31] and a few recent multicenter trials 32,33 sharing remarkable short-and midterm results, with the durability of the technique being satisfactory (technical success > 95%, low mortality rates averaging 1-2% and low rates of mid-term branch vessel occlusion averaging 4-9%). [25][26][27][28][29]34 Other imaginative procedures have also been developed or modified to allow for the segmental or complete coverage of the aorta in the region of vital branches, including the 'chimney', 'snorkel', 'periscope' [35][36][37] and combined endovascular exclusion and extra-anatomic mesenteric/renal bypasses (hybrid visceral revascularization).…”

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confidence: 99%

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Fenestrated stent grafts for the treatment of complex aortic aneurysm disease: A mature treatment paradigm

et al. 2016

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The introduction of fenestrated stent grafts (SGs) to treat abdominal aortic aneurysms (AAAs) with short proximal necks began in 1999. Nowadays, the whole visceral aorta can be treated totally by endovascular means. The established use of fenestrated devices to treat complex AAAs as a first-line management option has been previously reported. An up-to-date evaluation of the literature was performed including all types of publications regarding the use of fenestrated technology to repair complex AAAs. Fenestrated repair is now an established alternative to hybrid/chimney/snorkel repairs. However, specific criteria and prerequisites are required for the use and improvement of this method. Multiple device morphologies have been used incorporating the visceral arteries in various combinations. This modular strategy connects different devices (bridging covered stents and bifurcated SGs) with the aortic main body, thus excluding the aneurysm from the circulation. Precise deployment of the fenestrated SG is mandatory for successful visceral vessel revascularization. Accurate SG sizing and customization, a high level of technical skill, and facilities with modern imaging techniques including 3D road mapping and dedicated hybrid rooms are required. Most experience has been with the custom-made Zenith Cook platform, although off-the-shelf devices have been recently implanted. More complex repairs have been performed over the last few years, but device complexity has also increased. Perioperative, mid-term, and a few recently reported long-term results are encouraging. Secondary interventions remain the main problem, similar to that observed after traditional endovascular abdominal aortic aneurysm repair (EVAR).

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Section: Details Of the Techniquementioning

confidence: 99%

Section: General Criteriamentioning

confidence: 99%

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confidence: 99%

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Fenestrated stent grafts for the treatment of complex aortic aneurysm disease: A mature treatment paradigm

et al. 2016

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“…Hence, the development of fenestrated covered stent-grafts allowing for covering aortic side orifices without compromising side branch blood flow [5] as well as the design of covered stent-grafts with modular side branches [6] address both these issues and have the potential to push the current limits significantly further as endo-vascular repair of juxtarenal abdominal aortic aneurysms, abdominal aortic aneurysms with suprarenal extension, thoraco-abdominal aneurysms as well as aortic arch aneurysms may eventually be cured with such devices. An interesting development based on the knowledge gathered from covered stent-grafts, is the already available venous smart canula for less invasive cardio-pulmonary bypass.…”

Section: Impact For the Futurementioning

confidence: 99%

Impact of endoluminal stenting for aortic surgery

VONSEGESSER¹,

Marty²,

Tozzi³

et al. 2004

European Journal of Cardio-Thoracic Surgery

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SummaryThe advent of stents has profoundly changed percutaneous transluminal coronary angioplasty (PTCA), peripheral transluminal artery angioplasty (PTA), and treatment strategies of numerous other problems. Similar developments can be observed for stent applications in peripheral vascular lesions, cerebro-vascular disease, and many other fields. With the advent of covered stent-grafts, aneurysm surgery, has been put up for competitive treatment approaches. Such new approaches are perceived as less invasive, and draw significant attention. Endovsacular aneurysm repair (EVAR) is here to stay. In addition new developments are coming in many ways and stent derived devices can by now be found everywhere in the cardio-vascular system. This includes stenosed vessels, aneurysmal vessels, diseased valves, all sorts of congenital heart defects, and even cardiopulmonary bypass. Impact in the pastThe advent of stents has profoundly changed percutaneous transluminal coronary angioplasty (PTCA), peripheral transluminal artery angioplasty (PTA), and treatment strategies of numerous other problems.As a matter of fact, stent-based treatments of coronary artery stenoses are by now in many countries far more frequent than the formerly so successful coronary artery bypass graft (CABG) procedures. This development has occurred despite the fact, that traditional left internal thoracic artery to the left anterior descending coronary artery implants have the best long-term patency, and that coronary artery bypass graft (CABG) procedures provide superior long-term outcome with less adverse events. In addition, off-pump coronary artery bypass (OPCAB) allowing for elimination of pump related events, did not substantially change the increased use of the even lesser invasive stentbased treatments strategies.Similar developments can be observed for stent applications in peripheral vascular lesions, cerebro-vascular lesions, tracheo-bronchial lesions, hepato-biliary and pancreatic problems, as well as genito-urinary affections. In addition, a number of stent-derived treatment modalities are proposed, and used in increasing proportions for closure of the patent ductus arteriosus, foramen ovale, atrial septal defects, ventricular septal defects, etc. Despite non-negligible complication rates and incomplete treatments, percutaneous procedures are overall far more popular among both, doctors and patients.With the advent of covered stent-grafts, yet another field of cardio-vascular surgery, namely aneurysm surgery, has been put up for competitive treatment approaches, and once again, the new approach is perceived as less invasive, and draws significant attention. Impact in generalThoracic aortic aneurysm and thoracic aortic dissection repair has traditionally been an almost exclusive domain of cardiac and cardio-vascular surgery. However, this activity based on open surgery with and without adjuncts (cardiopulmonary bypass, deep hypothermic circulatory arrest, left heart bypass, selective perfusion, etc.) is more and more under attack by (non-)...

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“…[22][23][24] CE mark for the fenestrated stent-graft has been obtained by William Cook Europe, and a FDA study in the USA has been carried out. In our opinion, fenestrated stent-grafting will become the primary treatment option in many patients with complex aneurysms that are not suitable for standard endovascular aortic repair.…”

Section: Fenestrated and Branched Evarmentioning

confidence: 99%

Open Treatment Versus Endovascular Repair for Aortic Abdominal Aneurysm-Keeping the Balance

Bos¹,

Cohen²,

Vourliotakis³

et al. 2009

Annals of Vascular Diseases

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E ndovascular repair of abdominal aortic aneurysms (EVAR) has enjoyed a quick and widespread growth over the last 15 years. Both clinicians and patients have embraced the minimal invasive alternative to open surgery. Although early benefits of EVAR have been confirmed in two randomized trials, the number of late complications and re-interventions remains an issue for debate.1, 2) However, the trials failed to demonstrate a late overall survival gain. This opened the way for some epidemiologists and other financial decision makers to question the technique or even worse, to qualify the technique as a failed experiment.3) Despite this, this important surgical innovation has continued to evolve with expansion into the treatment of acute aneurysms and the development of fenestrated and branched grafts. This paper discusses the ongoing evolution of EVAR with respect to the available literature and our personal experience. Elective EvarAs mentioned, the short-term benefits have undoubtedly been demonstrated by two randomized trials. In summary, EVAR presents with a threefold lower mortality than open repair (P = 0.009, EVAR trial) and almost a twofold lower aneurysm related mortality at four years (4% versus 7%, P = 0.04 EVAR trial). In addition, the health related quality of life, often regarded as non-different due to similar results after one year, demonstrated a better outcome from 3 to 12 months.2) Costs were higher in the trial setting, but the difference was marginal, and there are no post-trial comparisons available. The flip side was that the two randomized trials demonstrated a higher late complication rate which resulted in a higher reintervention rate of EVAR compared to open repair.Since the trials, the technique has matured and devices have undergone further development. This has widely resulted in better results especially with regard to durability and reintervention rate. Many reports were published on these changes in outcome with maturation of the technique with the lifeline Registry and Eurostar Registry reporting a decrease in secondary interventions over time. 4,5) With increased experience it is also became clear that Type II endoleaks were not presenting with increased risk of rupture as initially thought. Silverberg et al. reported an incidence of Type II endoleaks of 16% (154/ 946), but 35% of these Type II endoleaks resolved spontaneously during a mean follow-up of 14.5 months.6) A Kaplan Meier analysis suggested spontaneous seal of Type II endoleak of 75% within 5 years. Franks et al. reported in a systematic review a decreasing trend over time in operative mortality, endoleak rate and post-operative rupture. 7)Our personal results show a mortality below 1% which includes all patients, both low-and high risk, and difficult anatomy. The overall reintervention rate dropped from 15% to below 10% with 75% of all reinterventions performed by endovascular means. Furthermore reinterventions were not associated with mortality.

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Treatment of Short-necked Infrarenal Aortic Aneurysms with Fenestrated Stent-grafts: Short-term Results

Cited by 135 publications

References 30 publications

Fenestrated stent grafts for the treatment of complex aortic aneurysm disease: A mature treatment paradigm

Fenestrated stent grafts for the treatment of complex aortic aneurysm disease: A mature treatment paradigm

Impact of endoluminal stenting for aortic surgery

Open Treatment Versus Endovascular Repair for Aortic Abdominal Aneurysm-Keeping the Balance

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