Endovascular Repair Techniques Research Articles

Expert consensus on endovascular reconstruction of visceral branch arteries in the treatment of aortic expansion diseases (2024 edition)

Aortic expansion diseases, especially those involving visceral branch arteries, pose significant challenges for clinicians in terms of treatment strategy selection and implementation. With the advancement of endovascular repair techniques, the mode of treatment is shifting gradually from open surgery to minimally invasive surgery, significantly reducing perioperative mortality and complication rates. However, the application of techniques for reconstructing visceral artery branches is not yet widespread, and there is considerable controversy in the management of complex cases. In response, the Vascular Surgery Group of Surgery Society of Chinese Medical Association, the Vascular Surgery Group of Cross-straits Medicine Exchange Association and the Thoracic Aorta Group of Vascular Surgeons Society of Chinese Medical Doctor Association convened relevant experts in China with extensive experience in the endovascular reconstruction of visceral branches for aortic expansion diseases, based on systematic reviews of clinical practice and domestic and international literature, and after in-depth discussions, have developed the Expert consensus on endovascular reconstruction of visceral branch arteries in the treatment of aortic expansion diseases (2024 edition). The consensus focuses on endovascular techniques involving the reconstruction of visceral artery branches, aiming to provide principled guidance for clinicians and to promote the improvement of diagnostic and treatment levels in this field within China.

Programmed cell death-related ABI1 is a critical mediator of abdominal aortic aneurysm

Abdominal aortic aneurysm (AAA) is a life-threatening condition characterized by localized dilation of the abdominal aorta, posing a significant risk of rupture and fatal hemorrhage. While surgical and endovascular repair techniques have advanced, the underlying mechanisms driving AAA development remain unclear, hindering the development of effective preventive and therapeutic strategies. Using bioinformatics analysis of publicly available data sets, the study identified a strong correlation between cell death (CD) score and different types of programmed cell death scores in AAA samples. WGCNA analysis revealed a module enriched in genes related to proteasome-mediated protein degradation, nuclear envelope, and endocytosis, significantly correlated with CD score. Further analysis identified ABI1 as a dominant feature gene, highlighting its potential role in AAA pathogenesis. In vitro validation using an Angiotensin II-induced AAA model in human aortic smooth muscle cells demonstrated that siRNA-mediated knockdown of ABI1 significantly reduced cell apoptosis, migration, and the expression of pro-apoptotic proteins, confirming ABI1's crucial role in promoting CD and AAA progression. The findings suggest that ABI1 may represent a promising therapeutic target for the prevention and treatment of AAA. Further research is warranted to fully understand the role of ABI1 in AAA and to develop targeted therapies based on this promising target.

Sandwich thoracic branch endoprosthesis technique for endovascular repair of thoracic aortic aneurysm with aberrant right subclavian artery

Subclavian artery coverage is frequently required to achieve an adequate proximal seal during thoracic endovascular aortic repair. The thoracic branch endoprosthesis (TBE; W.L. Gore & Associates) is the first U.S. Food and Drug Administration–approved branched device for thoracic endovascular aortic repair, designed for left subclavian artery incorporation. However, anatomic suitability of the TBE has been shown to be limited. In the present report, we describe a novel technique using the TBE in a sandwich periscope configuration to allow for emergent repair of a ruptured thoracic aortic aneurysm with a highly angulated proximal seal zone and aberrant right subclavian artery.

The choice of tactics for surgical treatment of abdominal aortic aneurysm in octogenarians

Currently, the treatment of abdominal aortic aneurysm does not pose significant difficulties, with modern cardiovascular surgery offering the possibility of both open and endovascular repair (EVAR) techniques. However, the personalized selection of the most optimal surgical intervention for each patient remains a relevant question. In some cases, one of the important factors influencing the choice of surgical method is the patient’s age and accompanying diseases. Abdominal aortic aneurysm is an age-related condition with a high risk of fatal outcomes. In our practice, we encountered a rare case of abdominal aortic aneurysm in an octogenarian woman with severe somatic status, poorly controlled arterial hypertension, and complex anatomical enlargement of the aneurysm. The question arose regarding the choice of optimal tactics and surgical treatment method. According to the MSCT, the diameter of the expansion was 67 mm, posing a 20% risk of rupture in the first year. In this clinical case, EVAR technique was unsuitable due to the anatomical features of the aneurysm, as the length of the neck in the infrarenal segment of the aorta was 2.5–3 cm, and the angle of inclination to the right exceeded 85°. Additionally, considering gender-specific factors, particularly female gender, indications for EVAR need to be carefully determined, as women have a higher likelihood of complications following the operation, as shown in several studies. After a detailed analysis of the re-evaluation results and assessment of surgical risk factors, we determined an individual surgical strategy and minimized risks, ultimately achieving a good outcome.

International RELAY®, branched outcomes - designed to respect and repair the thoracic aorta: A comparative analysis between double and triple branched configurations.

Endovascular aortic arch repair (EAR) has emerged as an alternative to open surgical repair. A growing interest in endovascular repair techniques for aortic arch aneurysms and dissection has been met with a focus on the clinical efficacy of EAR devices. We present multicentre comparative data on the clinical outcomes associated with EAR using the double- and triple-branched configurations of the RELAY™ (Terumo Aortic, Scotland, UK) endograft. Multicentre data on EAR procedures, carried out from January 2019 to January 2022, using the double- and triple-branched RELAY™ endograft were collected prospectively. Follow-up data were collected at 30 days, 6 months, 12 months, and 24 months postoperative. Retrospective descriptive analysis, logistic regression, and Kaplan-Meier analysis were carried out on procedural and follow-up data. A total of 131 patients were included in the series. In total, 103 and 28 patients were treated with the double-branched and triple-branched RELAY™ endograft, respectively. Over the 24-month follow-up period, zero mortality, cases of stroke, or reinterventions were recorded in the triple-branched group. Four mortalities, 19 disabling strokes, and 50 reinterventions were recorded in the double-branched group within 30 postoperative days. Target vessel patency was maintained in all patients in the triple-branched group, while vessel patency was maintained in 74.0% of patients in the double-branched group. Outcomes associated with the triple-branched group are consistent with those reported in the literature. Our data suggest that EAR with the RELAY™ endograft is associated with favourable clinical outcomes and clinical efficacy. Further comparative research into EAR devices is needed.

Anaesthesia for vascular emergencies - a state of the art review.

In this state-of-the-art review, we discuss the presenting symptoms and management strategies for vascular emergencies. Although vascular emergencies are best treated at a vascular surgical centre, patients may present to any emergency department and may require both immediate management and safe transport to a vascular centre. We describe the surgical and anaesthetic considerations for management of aortic dissection, aortic rupture, carotid endarterectomy, acute limb ischaemia and mesenteric ischaemia. Important issues to consider in aortic dissection are extent of the dissection and surgical need for bypasses in addition to endovascular repair. From an anaesthetist's perspective, aortic dissection requires infrastructure for massive transfusion, smooth management should an endovascular procedure require conversion to an open procedure, haemodynamic manipulation during stent deployment and prevention of spinal cord ischaemia. Principles in management of aortic rupture, whether open or endovascular treatment is chosen, include immediate transfer to a vascular care centre; minimising haemodynamic changes to reduce aortic shear stress; permissive hypotension in the pre-operative period; and initiation of massive transfusion protocol. Carotid endarterectomy for carotid stenosis is managed with general or regional techniques, and anaesthetists must be prepared to manage haemodynamic, neurological and airway issues peri-operatively. Acute limb ischaemia is a result of embolism, thrombosis, dissection or trauma, and may be treated with open repair or embolectomy, under either general or local anaesthesia. Due to hypercoagulability, there may be higher numbers of acutely ischaemic limbs among patients with COVID-19, which is important to consider in the current pandemic. Mesenteric ischaemia is a rare vascular emergency, but it is challenging to diagnose and associated with high morbidity and mortality. Several peri-operative issues are common to all vascular emergencies: acute renal injury; management of transfusion; need for heparinisation and reversal; and challenging postoperative care. Finally, the important development of endovascular techniques for repair in many vascular emergencies has improved care, and the availability of transoesophageal echocardiography has improved monitoring as well as aids in surgical placement of endovascular grafts and for post-procedural evaluation.

Flossing technique for endovascular repair of a penetrating cerebrovascular injury: illustrative case.

BACKGROUNDA teenage boy who had been stabbed in the neck presented with an extracranial traumatic functional carotid artery occlusion that could not be crossed in an antegrade fashion. Endovascular repair depends on obtaining catheter access proximal and distal to an injury within the true lumen.OBSERVATIONSThe occlusion was treated with flossing technique via the posterior communicating artery. After successful recanalization from a retrograde approach, the carotid artery occlusion was treated with a covered stent.LESSONSThe flossing technique is well established in peripheral vascular disease and may be beneficial in certain cases in the neck vasculature when antegrade access is difficult to obtain. Recanalization of an occluded carotid artery from retrograde approach may be successful in cases of trauma from knife wounds.

Treatment of acute aortic dissection type A with paraplegia and distal limb ischemia within a hybrid operating room

ObjectiveAcute aortic dissection type A is among the most lethal surgical emergencies. Patients may suffer from occlusion of the aorta or its branches causing end-organ malperfusion complicating the diagnosis and worsening the prognosis. Paraplegia is a rare manifestation that affects less than 5% of patients. If type A aortic dissection and occlusion of the downstream thoraco-abdominal aorta occur simultaneously and require acute treatment, a medical dilemma occurs; what should be treated first?Case reportWe describe a case with an extensive acute type A aortic dissection with signs of consciousness and severe malperfusion syndrome.ResultsThe treatment was successfully performed within a hybrid surgery suite with simultaneous open surgery and endovascular repair techniques supported by cardiopulmonary bypass circulation.ConclusionA hybrid operating room might offer the opportunity to simultaneously repair complicated aortic dissection with malperfusion syndrome, by open aortic surgery and endovascular techniques.

“Octafen”: A Noninvestigational Alternative Endograft Configuration for the Treatment of Thoracoabdominal Aortic Aneurysms

Purpose: To demonstrate the feasibility of Octafen technique, a novel endovascular configuration for the treatment of thoracoabdominal aortic aneurysms (TAAA). Technique: Two patients with complex TAAA and high surgical risk were treated with Octafen endograft configuration in a hybrid operating room with computed tomography (CT)-fluoroscopy image fusion guidance, using 3D-3D fusion techniques to facilitate procedural success. The procedure is a modification of the previously-described Octopus technique for endovascular repair of TAAA. The main advantage of this technique is the ability to use devices to repair a TAAA with the combination of off-the-shelf and noninvestigational custom-made devices. The devices used are readily available to most practicing vascular surgeons, which provides an alternative treatment in case of limited access to investigational devices, in time-sensitive cases, and in patients with limited functional capacity who cannot undergo open repair. In the modification described herein, we use a combination of standard bifurcated endovascular aneurysm repair (EVAR) devices (Excluder; W.L. Gore & Associates, Flagstaff, Arizona) in combination with a 2-vessel renal fenestrated device (Z-Fen; Cook Medical, Bloomington, Indiana). The article describes a step-by-step approach to this technique to elucidate pitfalls, benefits, and advantages. Conclusion: The Octafen technique might offer an alternative option for thoracoabdominal aneurysm treatment circumventing the need for access to custom-made, investigational devices. Clinical Impact In this manuscript, we describe a technique for endovascular repair of thoraco-abdominal aortic aneurysms that involves the combination of off-the-shelf and non-investigational, custom-made devices. The ‘Octafen’ technique provides a treatment alternative in case of limited access to investigational devices and can be adjusted according to patient anatomy.

C34 INDIRECT MITRAL ANNULOPLASTY USING THE CARILLON CONTOUR SYSTEM, SINGLE CENTER EXPERIENCE

Abstract Mitral Regurgitation (MR) is both the most common and the most underdiagnosed valvulopathy in Western countries. When MR’s entity is moderate to severe it is highly burdened by incident heart failure causing an important impact on prognosis, in terms of mortality and re–hospitalization. Unfortunately a lot of symptomatic patients are not elegible to reparative or replacement surgery also due to the high procedural risks. Hence, the need for a less invasive treatment has grown, so endovascular repair techniques have been developed such as the CARILLON Mitral Contour System, a percutaneous procedure for reshape the mitral annulus reducing its dilation and mitral regurgitation. This technique is indicated for patients with secondary mitral regurgitation. The CARILLON is a simple and fast procedure with a right jugular approach that requires neither general anesthesia nor anticoagulant/antiplatelet therapy. Four patients including 3 men, aged 37–64 years, suffering from heart failure and moderate to severe secondary mitral regurgitation who were symptomatic in optimal medical therapy, NYHA II – III class, were admitted to our Cardiological Intensive Care Unit from April to September 2021. All patients underwent coronary angiography and three patients had no obstructive coronary artery disease (CAD). All patients underwent transthoracic and transesophageal echocardiography showing severely dilated left ventricles (DTD 70 ± 10mm, DTS 46 ± 21mm, VTD 264 ± 6ml, VTS 204 ± 6ml), severe reduction in ejection fraction (mean EF 24 ± 5%), severely dilated left atrium, mean volume values 47 ± 13ml/m2, moderate to severe mitral regurgitation (vena contracta 6 ± 2mm, EROA 34 ± 9mm2, regurgitation volume 37 ± 12 ml, regurgitation fraction mean 54 ± 4%). After implantation of the Carillon no complications were observed. In the 3–month follow–up, patients reported improvement in symptoms, exercise capacity and NYHA class. At the echocardiographic evaluation we saw improvement in contractile function and left ventricular size, reduction in the degree of mitral regurgitation to mild–moderate. There were no further hospitalizations for heart failure during the follow–up. The data, albeit limited to our little experience, show how the Carillon reduces mitral regurgitation and improves clinical outcomes in terms of exercise tolerance, quality of life and reduction of hospital admissions, which have social and economic relevance.

675 ICA Ligation and Malignant MCA Syndrome Secondary to A Gunshot Wound: A Case Presentation

Abstract Penetrating carotid injuries occur infrequently in the UK. Without surgical intervention, mortality rates are close to 100%. Whilst vessel repair is the optimal surgical choice, zone III neck injuries or haemodynamic instability in particular often require vessel ligation, which carries higher mortality rates, increased risk of stroke and poorer outcomes overall. We present a young patient who sustained a gunshot wound to the neck. Emergency exploration revealed a penetrating injury to zone III of the left side of the neck and a complete transection of the left internal carotid artery. Due to haemodynamic instability, damage control surgery was mandated, and the internal carotid artery was ligated. The patient was admitted to ITU but had a severe acute neurological deterioration post-operation. CT head imaging revealed a large left frontal-parietal infarct with rightward midline shift, in keeping with malignant MCA syndrome. He underwent an emergency decompressive craniectomy, with resolution of the midline shift seen on subsequent imaging. At 3 months, the patient walked independently out of hospital, with a reduction in his modified Rankin Scale score from 5 to 2 following intensive therapies input. Whilst rare, the importance of timely recognition and intervention of an infrequent complication of carotid ligation is paramount. Decompressive craniectomy is the mainstay of treatment for malignant MCA syndrome, yet outcomes remain poor in all ages, highlighting the patient’s noteworthy recovery. Though emerging evidence suggests novel endovascular repair techniques may provide favourable outcomes and reduced complications in carotid injuries, open surgery remains the treatment of choice.

Technique of endovascular repair of iatrogenic subclavian artery injury following subclavian vein catheterization

The iatrogenic subclavian artery injury is a rare but potentially serious complication of subclavian vein cannulation. The use of endovascular techniques is an alternative to surgical repair especially in patients with concomitant diseases in whom immediate, potentially large surgery would be associated with a high risk of perioperative complications. This article discusses technical aspects of endovascular repair of iatrogenic injury of subclavian artery with implantation of covered stents based on two cases. Author’s experience and data from literature suggests that endovascular management including covered stent implantation is safe and effective treatment and should be considered as a method of choice especially among patients in poor general condition and/or major comorbidities.

Cost-Effectiveness of Endovascular Versus Open Repair of Abdominal Aortic Aneurysm: A Systematic Review.

Abdominal aortic aneurysm (AAA) is a life-threatening condition which, in the absence of increasing diameter or rupture, often remains asymptomatic, and a diameter greater than 5.5cm requires elective surgical repair. This study aimed to evaluate the cost-effectiveness of endovascular repair (EVAR) versus open surgical repair (OSR) in patients with AAA through a systematic review of published health economics studies. Using a systematic review method, an electronic search was conducted for cost-effectiveness studies published on AAA (both in English and Persian) on PubMed, Embase, ISI/Web of Science (WoS), SCOPUS, Global Health databases, and the national databases of Iran from 1990 to 2020 including the keywords "cost-effectiveness", "endovascular", "open surgical", and "abdominal aortic aneurysms". The quality of the studies was assessed using the Quality of Health Economic Studies (QHES) checklist. In total, 958 studies were found, of which 16 were eligible for further study. All studies were conducted in developed countries, and quality-adjusted life years (QALY) and life years (LY) were used to measure the outcomes. According to the QHES checklist, most studies were of good quality. In European countries and Canada, EVAR has not been cost-effective, while most studies in the United States regard this technique as a cost-effective intervention. For example, incremental cost-effectiveness ratio (ICER) values ranged from $14,252.12 to $34,446.37 per QALY in the USA, while ICER was €116,600.40 per QALY in Portugal. According to the results, the EVAR technique has been more cost-effective than OSR for high-risk patients, but the need for continuous follow-up, increased costs, and re-intervention over the long term and for low-risk patients has reduced the cost-effectiveness of this method. As the health systems vary among different countries (i.e. quality of care, cost of devices, etc.), and due to the heterogeneity of studies in terms of the follow-up period, time horizon, and threshold, all of which are inherent features of economic evaluation, generalizing the results should be done with much caution, and policymaking must be based on national evidence.

Abdominal aortic aneurysms – how to treat in today’s practice

Open and endovascular repair of abdominal aortic aneurysms (AAA) are being extensively practised today. Comparison of both endovascular (EVAR) and open repair (OSR) in randomised controlled trials confirmed that early gains in survival and aneurysm-related mortality tend to vanish after four years of follow-up. The aim of this paper is to review open and endovascular repair techniques, their early and late benefits, based on scientific evidence and experience from an academic vascular unit, and to assess present and future strategy for management of both intact and ruptured AAA.

Challenges and experience of setting up an aortic service.

Aortic surgery is a complex procedure posing high risks in comparison to other adult cardiac surgeries. Novel surgical approaches including minimally invasive procedures, sutureless aortic valve replacement, and transcatheter aortic valve implantation have been found to be acceptable alternatives to conventional surgeries. In addition, novel endovascular repair techniques and hybrid procedures have been introduced for the management of patients with thoracoabdominal aortic pathologies. However, these modalities are not readily available in every center, and such novel procedures impose a learning curve for surgeons and high costs for affected patients. In this review, we discuss the challenges of setting up an aortic service, having regard to the Iranian experience.

Optimization schemes for endovascular repair with parallel technique based on hemodynamic analyses.

Endovascular repair with parallel stent-grafts (SG) is a challenging technique that reconstructs the luminal flow pathways by implanting parallel-placed SGs into the vessel. After treatment, occlusion and shifting of the parallel SGs are sometimes reported, which could be fatal and difficult to be re-operated. These issues are highly related to the local hemodynamic conditions in the stented region. In this study, a patient case treated by the octopus endograft technique (a head-SG with three limb-SGs) and experienced limb-SG occlusion is studied. 3-D models are established based on computed tomography (CT) angiography datasets pretreatment and posttreatment as well as during follow-ups. Hemodynamic quantities such as pressure drop, wall shear stress-related parameters, and flow division in limb-SGs and visceral arteries are quantitatively investigated. Optimizations on the length of the head-SG and diameter of the limb-SGs are analyzed based on various scenarios. The results indicate that when reconstructing the flow pathways via octopus stenting, it is important to ensure the flow distribution as physiologically required with this new morphology. Position (or length) of the head-SG and diameter of the limb-SGs play an important role in controlling flow division, and high time average wall shear stress (TAWSS) around the head-SG acts as a main factor for graft immigration. This study, by proposing optimization suggestions with hemodynamic analyses for a specific case, implicates that pretreatment SG scenarios may assist in wise selection and placement of the device and thus may improve long-term effectiveness of this kind of challenging endovascular repair techniques.

Outcomes of the Chimney Technique for Endovascular Repair of Aortic Dissection Involving the Arch Branches

The results of different chimney techniques in different zones of aortic arch were analyzed, so as to provide clues to decrease the complications of chimney thoracic endovascular repair (cTEVAR). Between April 2012 and April 2017, 234 patients with aortic dissection involving arch branches received cTEVAR. Among these patients, 156 (66.7%) received single chimney (SC), 48 (20.5%) received double chimneys (DCs), and 30 (12.8%) received triple chimneys (TCs). A total of 342 chimney grafts (CGs) were used. All chimney grafts were successfully implanted, and no migration or occlusion was observed during follow-up. Mortality of this cohort was 1.7% (4/234). Three (3/234, 1.3%) patients suffered from cerebral vascular events. Seventy-five (75/234, 32.1%) had intraoperative type I endoleak. Twenty-seven (27/75, 36.0%) of them were found to have automatically disappeared in the follow-up period. The false lumens of 33 (33/75, 44.0%) were found to be stable, and 15 (15/75, 20%) were found to have expanded and were successfully retreated by endoleak embolization. The proximal tear located in zone 0 had higher instant endoleak rate than zone 1, zone 2, and zone 3 (P=0.041; P=0.042; P=0.009). TC were found to have more instant endoleak than SC (P<0.001) and DC (P=0.012). But in the follow-up period, there was no significant difference. TCs and the proximal tear locating in zone 0 were found to be with higher instant endoleak rate, and it may need more rigorous follow-up. Some of the endoleak after cTEVAR could automatically disappear and some could be completely re-treated by gutter embolization procedure.

Outcomes of an iliac branch endoprosthesis using an “up-and-over” technique for endovascular repair of failed bifurcated grafts

ObjectiveType IB endoleak after endovascular aneurysm repair may be treated by an iliac branch endoprosthesis (IBE) through brachial access for internal iliac artery (IIA) stenting. The aim of this study was to evaluate outcomes of the IBE using an “up-and-over” transfemoral technique in patients with prior aortic repair compared with the standard technique in patients with de novo iliac aneurysms. MethodsWe reviewed the clinical data of patients treated for aortoiliac aneurysms using Gore IBE (W. L. Gore & Associates, Flagstaff, Ariz) between 2014 and 2017. The up-and-over technique was indicated in patients with type IB endoleak or common iliac aneurysms after prior aortic repair with bifurcated endografts or surgical grafts. End points were technical success, mortality, major adverse events, IIA patency, freedom from IIA branch instability (composite end point of any IIA branch-related complication leading to aneurysm rupture, death, occlusion, component separation, or reintervention to maintain branch patency or to treat a branch-related separation or endoleak), and freedom from secondary interventions or new-onset buttock claudication. ResultsThere were 53 patients (51 male; 74 ± 8 years old) treated by 62 IBEs (9 bilateral). Standard technique was used in 36 patients (43 IBEs) and up-and-over technique in 17 (19 IBEs). Three patients had contralateral IIA embolization. Total procedure time, contrast material volume, and radiation dose averaged 168 ± 98 minutes, 140 ± 50 mL, and 1096 ± 1009 mGy, with no difference between techniques. Technical success was achieved in 98% of patients. Eleven patients had extension of IIA bridging stent into the posterior branch (eight standard, three up-and-over). Four patients (8%) had major adverse events due to estimated blood loss >1000 mL in all patients. There was no 30-day mortality after a median follow-up of 7 months (interquartile range, 3-12 months). There were two IIA stent occlusions (all standard), three iliac-related type I endoleaks (one standard, two up-and-over), and four secondary interventions (three standard, one up-and-over). At 1 year, patients treated by standard or up-and-over technique had similar primary patency (94% ± 4% vs 100%; P = .38) and secondary patency (97% ± 3% vs 100%; P = .54) and freedom from IIA branch instability (90% ± 6% vs 93% ± 7%; P = .48), secondary intervention (84% ± 8% vs 90% ± 9%; P = .63), and new-onset buttock claudication (90% ± 6% vs 100%; P = .35). ConclusionsEndovascular repair using IBE was associated with high technical success, no mortality, and low rate of complications using either the standard technique for de novo aneurysms or an up-and-over technique for patients with failed bifurcated endografts or grafts. The up-and-over technique should be considered a suitable alternative to brachial access in patients who require distal extension using IBEs.

Endovascular Rescue of Simultaneous Renal Stent Thrombosis: Case Report

The chimney/periscope technique has been used to address complex aortic pathologies. This case report aims to report the outcomes of the endovascular management of the acute and simultaneous thrombosis of both renal covered stent grafts after bilateral renal arteries chimney technique for endovascular repair (CH-EVAR) of a juxtarenal abdominal aortic aneurysm. The cause of this early occlusion of stent grafts may be related to how procedures and devices combinations alter the native anatomy. The authors aimed to compare renal artery geometry before and after CH-EVAR to find a possible cause of stent thrombosis.

Radical treatment of primary type B aortic dissection or after thoracic endovascular aortic repair to manage disseminated intravascular coagulation.

Disseminated intravascular coagulation (DIC) secondary to type B aortic dissection is an unusual and fatal complication that has not been fully investigated. The aim of our study is to report a novel endovascular technique excluding all tears to manage DIC. From April 2017 to October 2017, we performed 2 cases of DIC complicated to type B aortic dissection using this novel radical endovascular repair technique. Clinical data of patients were collected and technical details were presented. These two cases were successfully treated with novel radical endovascular repair technique. DIC was managed and FL thrombosis was formed in these two patients. Follow-up at 6 months revealed no recurrent DIC and a stable aortic diameter with complete FL thrombosis. This endovascular repair technique that excluding all the tears is a feasible approach to prevents continuous coagulation components consumption and thus to manage DIC effectively.