Endovascular Repair Of Aortic Pathology Research Articles

Hemodynamic Parameters Predict In-stent Thrombosis After Multibranched Endovascular Repair of Complex Abdominal Aortic Aneurysms: A Retrospective Study of Branched Stent-Graft Thrombosis.

Background: Branch vessel occlusion is reported in endovascular repair of aortic pathology. This study aimed to evaluate the hemodynamic indicators associated with in-stent thrombosis (IST) of a branched stent-graft (BSG) after endovascular aortic repair (EVAR) of a complex abdominal aortic aneurysm.Methods: A retrospective evaluation was performed based on the computed tomography (CT) scans and clinical data of three patients who underwent multi-branched endovascular repair. Patient-specific 3-dimensional models were reconstructed, and hemodynamic analysis was performed for IST. Hemodynamics-related parameters including time-averaged wall shear stress (TAWSS), oscillatory shear stress index (OSI), and relative residence time (RRT) were compared among the individual patients.Results: The flow velocity, TAWSS, OSI, and RRT were radically changed in the area of the IST. In BSGs, IST tended to occur in the regions of hemodynamic alteration near the bends in the device, where a decreased flow velocity (<0.6 m/s) and TAWSS (<0.8 Pa) and an elevated OSI (>0.2) and RRT (>5 s) were consistently observed.Conclusions: Hemodynamic perturbations in BSGs cause a predisposition to IST, which can be predicted by a series of changes in the flow parameters. Early hemodynamic analysis might be useful for identifying and remediating IST after multibranched endovascular repair.

Carotid Access for Endovascular Repair of Aortic Pathology: A Systematic Review

Endovascular repair is now preferred to open access for the management of aortic diseases. This is typically performed via the femoral artery; however, not all patients are eligible for this. This systematic review summarizes the current evidence for utilizing the carotid artery as an alternative access route. A systematic review was conducted as per the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines using 4 electronic databases. The search found 11 case reports representing 12 patients eligible for analysis (mean age 64.5years). This included 3 thoracic aneurysms, 3 abdominal aneurysms, 4 penetrating ulcers, 1 endoleak, and 1 pseudoaneurysm. An open procedure was contraindicated in 83% (10/12) due to the poor physiological fitness of the patient. In 75% (9/12) of cases, traditional endovascular access was contraindicated by severe iliac disease. The remainder were contraindicated because of an existing ligated aortic stump (1/12, 8.3%) or technical difficulty with graft deployment via the femoral artery (2/12, 16.7%). There was 1 death, with the 30-day mortality 8.3%. The same patient suffered the only spinal ischemia before death (8.3%). There were no cases of stroke (0%), with one case of transient ischemic attack (8.3%). Although there is a relative paucity of literature, this study demonstrates whentraditional endovascular access is impossible and an open procedure contraindicated, carotid artery access for endovascular repair of aortic pathology is a viable alternative with good 30-day survival and low rates of neurological sequelae.

TCTAP A-047 Three-dimensional Printing Creates Models for Individualized Planning of Endovascular Repair for Aortic Pathology

Three-dimensional (3D) printing was first described in the early 1980s. This manufacturing process is unique because an object is built up layer by layer rather than being cut from a larger block of material, as is done using subtractive manufacturing techniques like machining. This technology

GW27-e0622 Endovascular Repair for Aortic Pathology involving Distal Arch or Ascending Aorta with Physician-modified Fenestrated Endografts

GW27-e0622 Endovascular Repair for Aortic Pathology involving Distal Arch or Ascending Aorta with Physician-modified Fenestrated Endografts

TCT-120 The Policy Of Total Percutaneous Abdominal Aortic Aneurysm Repair: One-year Follow-up

Endovascular abdominal aortic aneurysm repair (EVAR) is accepted therapeutic strategy. The use of a total percutaneous approach to endovascular repair of aortic pathology is becoming more common and further extends the EVAR indications. The aim of our retrospective analysis was assessment of safety

Percutaneous Thoracic and Abdominal Aortic Aneurysm Repair: Techniques and Outcomes

Endovascular repair of infrarenal abdominal aortic aneurysms (EVAR) has become a widely accepted treatment modality. The conventional approach of an EVAR involves bilateral groin incisions to expose the femoral arteries followed by introducer sheath placement, which is typically performed with the use of general or epidural anesthesia. As technology trends toward less invasive methods and sheath sizes become smaller, the use of a total percutaneous approach to endovascular repair of aortic pathology is becoming more common. In this review, we present a brief history of percutaneous closure devices for common femoral artery access, factors important in patient selection, the technique of performing a percutaneous EVAR procedure, early and late complications, and overall outcomes of percutaneous approaches for the endovascular treatment of aortic pathology.