Use of the Ovation Endograft System to Treat Abdominal Aortic Aneurysms With Hostile Anatomy

Morgan-Bates, Kersten; Chaudhuri, Arindam

doi:10.1016/j.ejvs.2020.08.018

Cited by 7 publications

(7 citation statements)

References 5 publications

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“…Since 2010, the Ovation Abdominal Stent Graft System (Endologix Inc. Irvine, CA, USA) has offered a new sealing concept, achieved by a network of O rings filled with a polymer, that can treat a great variety of difficult anatomies through a low profile platform. 1 , 2 In the latest version of the stent graft, called Ovation Alto, the conformable O rings with polyethylene glycol (PEG) polymer have been repositioned nearer the top of the endograft, providing a seal just below the renal arteries (optimally 7 mm below the lowest renal artery).…”

Section: Introductionmentioning

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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Section: Introductionmentioning

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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“…Freedom from aneurysm-related mortality was 99.6% at 1 year and 99.5% at 3 years. In comparison, another study (44) with a median follow-up of 37 months reported a 2% 30-day mortality (not aneurysm related). Overall freedom from re-intervention was 96%.…”

Section: Ovation IXmentioning

confidence: 85%

“…Up to 4 years after the intervention, the Ovation stent graft device has been proved to be a safe choice for patients with both conventional and hostile anatomy who may fall outside the IFUs of other commonly used device platforms, even in patients with conical proximal necks ( 44 ). Thus, the Ovation system seems to be a fair choice for patients with conical aortic necks.…”

Section: Discussionmentioning

confidence: 99%

Endografts for the treatment of abdominal aortic aneurysms with a hostile neck anatomy: A systematic review

2022

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BackgroundEndovascular aortic repair (EVAR) of abdominal aortic aneurysms (AAAs) has emerged as a better alternative to conventional open surgery for AAAs. The purpose of the review is to define the improvement in the clinical management of the patient with hostile neck AAAs due to the introduction of new endografts while giving a thorough description of their instructions for use (IFUs), main characteristics and part sizing, reporting their outcomes from clinical studies and categorizing their usability.MethodsA MEDLINE search was conducted using keyword-specific combinations. Clinical studies were searched via the clinicaltrials.gov website. Relevant articles' references were also hand-searched.ResultsWe retrieved 640 records describing Alto, Ovation iX, Treovance, Aorfix, Anaconda, Conformable, and Endurant II/IIs endografts. Aortic necks >60° can be managed with Anaconda, Aorfix, and Conformable, which can treat up to 90° necks requiring ≥15 mm (Anaconda ≥20 mm), and Treovance, which is eligible for necks ≤75° with ≥15 mm length. Ovation's innovation of combining polymer-filled O-rings with integral anchors can treat conical necked AAAs giving Ovation iX and Alto an advantage. Short-necked AAAs can be treated with Alto, eligible for necks as short as 7 mm, and Endurant II, which can treat ≥10 mm necks or 4 mm if used in conjunction with the EndoAnchors system, respectively. Alto and Conformable report a 100% technical success rate, absence of AAA-related death, migration, ruptures, and limb occlusion during follow-up. Endurant II and Ovation iX report >99% technical success rate and are almost free from the AAA mortality rate, ruptures, migration, and limb occlusion, while Ovation iX has a high rate of sac dilation (15.5%) in a 5-year follow-up. Anaconda is slightly better than Aorfix and Treovance, which are related to the lowest technical success rates, 98.3%, 96.3%, and 96%, respectively. Aorfix has the highest AAA mortality rate, 4% in a 60 month follow-up.ConclusionMost new generation endografts described have comparable results. They broaden the eligibility of patients for EVAR due to their unique technical characteristics described. There is a lack of comparative studies for newer endografts and postmarket clinical studies with long-term results concerning the most recently approved devices described, Alto and Conformable.

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“…Gregory et al [11] stated that although existing published data on the ALTO device are limited, if more published data show short-to long-term results comparable to those obtained using the Ovation iX [12][13][14][15][16][17][18][19], then the ALTO device can be used more widely. However, whether ALTO devices can be successfully used in patients with more hostile aortic anatomies remains to be seen, considering the satisfac-tory results of Ovation iX use reported by Sirignano et al [17] and Morgan-Bates and Chaudhuri [19]. Short-term results may be identical between Ovation iX and ALTO device use, but a thorough comparison between the two devices would require long-term follow-ups of patients using ALTO devices.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Juxtarenal Aortic Aneurysm Repair Using the ALTO Abdominal Stent Graft System: The First Case Series

Efthymiou

Tsimpoukis

Papatsirou

et al. 2022

Vasc Specialist Int

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The ALTO abdominal stent graft system (Endologix Inc., Irvine, CA, USA) is a latest-generation polymer-based device used to treat patients with abdominal aortic aneurysms. The present study describes the first case series of patients with abdominal aortic aneurysms, including two patients with juxtarenal aneurysms, treated using the ALTO stent graft system. Six males were treated using the ALTO device at a single public center. All procedures were uneventful, and the dosimetric results recorded in terms of kerma-area product and fluoroscopy time were similar to those reported in previous studies. At the 1-month follow-up, computed tomography angiography showed no evidence of endoleak, device migration, thrombosis, or structural graft failure. This clinical series demonstrates that the use of the ALTO stent graft system is associated with promising patient outcomes. Lifelong postoperative imaging surveillance may highlight possible late failures and suggest potential graft improvements.

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Use of the Ovation Endograft System to Treat Abdominal Aortic Aneurysms With Hostile Anatomy

Cited by 7 publications

References 5 publications

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

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

Endografts for the treatment of abdominal aortic aneurysms with a hostile neck anatomy: A systematic review

Endovascular Juxtarenal Aortic Aneurysm Repair Using the ALTO Abdominal Stent Graft System: The First Case Series

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