Endovascular Stent-graft Treatment Research Articles

Off the Shelf Multibranched Endograft for Thoraco-Abdominal and Pararenal Abdominal Aortic Aneurysms: a Prospective, Single Centre Study of the G-Branch Endograft

To investigate outcomes of a novel, off the shelf multibranched endovascular stent graft for the treatment of thoraco-abdominal aortic aneurysm (TAAA) and pararenal abdominal aortic aneurysm (PAAA). A prospective, single centre study including 15 patients (mean age, 63.4 ± 10.7 years; 13 male) with TAAA or PAAA treated from October 2019 to March 2021 with a G-Branch endograft (Lifetech Scientific, Shenzhen, China) featuring a mixed multibranch design with two inner and two outer branches for reconstruction of the visceral and bilateral renal arteries, respectively. Follow up assessments were scheduled before discharge and at 30 days, six and 12 months after the index procedure. Annual telephone interviews were performed beyond the initial 12 months. The Kaplan-Meier method was used to estimate cumulative mortality and morbidity rates after endovascular repair. Technical success was achieved in all 15 patients. Nine patients (60%) had TAAA and six (40%) had PAAA (mean maximum aneurysm diameter, 73.7 ± 15.8 mm). The median follow up was 31.4 months (range, 10.1 - 44.0 months). At 30 days, there was no death and 7% morbidity (one case of temporary spinal cord ischaemia on Day 4). At one year, the mortality rate was 7% (one death from stroke at 10 months) and morbidity was 13% (one other case of renal function decline at six months). There were no aneurysm dilatations, re-interventions, or access related complications, and two (13%) persistent type II endoleaks. The one year primary branch patency rate was 100% for the four renovisceral arteries in all 13 patients who underwent computed tomography examinations. One patient died of hepatocellular carcinoma 29 months post-operatively, resulting in an estimated three year mortality rate of 13%. The G-Branch endograft yielded high technical success with good early and midterm outcomes for the treatment of TAAA and PAAA. A large multicentre study is warranted.

Prospective First-in-Human Study of the Merit WRAPSODY Endovascular Stent Graft for Treatment of Access Circuit Outflow Stenosis in Hemodialysis Patients

The aim of this study was to evaluate the safety and effectiveness of the WRAPSODY stent graft in the treatment of outflow and central (brachiocephalic and/or subclavian) stenoses or occlusions in the arteriovenous venous circuit of persons requiring dialysis for end-stage renal disease.

Alternative management of proximal aortic dissection: concept and application

Open surgery remains the mainstay of treatment for acute type A aortic dissection and should be offered to most patients. However, there are elderly patients in which surgical treatment may be deemed extremely high risk or futile. Endovascular treatment approaches have been applied to a small number of these patients and data are limited to case reports and small series. The application of endovascular therapies to ascending aorta is currently limited by anatomical and technical challenges posed by the dynamic motion of the ascending aorta and the proximity of vital structures to intended landing zones (aortic valve, coronary arteries, and supra-aortic branches) and lack of specially designed endografts to address these issues. While thoracic endovascular aortic repair (TEVAR) has replaced open aortic repair for a suitable lesion in distal aortic dissection, some selected patients with type A aortic dissection at high surgical may be candidates. Hence, there is potential because, in proximal (Stanford type A) dissections, 10–30% of patients are not accepted for surgery, and 30–50% are technically amenable for TEVAR. Recent experience has shown that carefully selected patients with favorable anatomical characteristics may be subject to endovascular stent-graft treatment as a last resort with mixed results. Technical improvement is necessary to offer. satisfactory endovascular options in non-surgical candidates.

Endovascular treatment of traumatic azygous vein injuries: a case report

BackgroundManagement of thoracic vascular injury predominantly focuses on the aorta and its tributaries while reports of venous injury are less frequent. Although rare, traumatic azygous vein injuries are associated with high mortality. Prompt treatment is required and has traditionally been open surgery. We present a case of an endovascular repair of an azygous vein injury.Case presentationA female patient presented to our trauma center following ejection after a motor vehicle collision (MVC). CT imaging workup revealed mediastinal and periaortic hematoma with active contrast extravasation adjacent to the azygos vein. She was referred to interventional radiology for vascular evaluation and potential endovascular intervention. The patient met criteria for class III hypovolemic shock upon arrival in the endovascular suite. Aortography demonstrated no arterial injury. Venography revealed a pseudoaneurysm on the superior aspect of the azygos arch and contrast extravasation from the inferior margin of the azygous arch. A stent-graft was deployed and post-deployment venogram showed no extravasation and successful exclusion of the injuries. The patient did not have further signs of bleeding. She left the interventional suite with improved vital signs, yet her condition remained guarded. Follow-up CT chest confirmed continued patency of the stent-graft at 8 days and 2 years post-procedure.ConclusionHistorically, azygos vein injuries are a rare occurrence and managed with open surgery. Swift management is necessary to prevent the increased morbidity and mortality associated with azygous vein injury, particularly in polytrauma patients such as the one presented here. We believe endovascular stent-graft treatment offers an innovative alternative to the current standard of operative management of azygos vein injury.

First Case Report of a Severe Stent Frame Infolding of a Self-Expanding Transcatheter Aortic Valve (CoreValve Evolut R 34 mm) in a Complex Patient With Calcific Bicuspid Aortic Valve Stenosis

• Infolding of the self-expanded nitinol valve is a rare complication and is likely to be related to several contributing factors (e.g. improper valve loading). This type of complication has been also reported with self-expanding nitinol endovascular stent grafts for treatment of abdominal and thoracic aorta aneurysms. • Recognizing infolding before the complete release of the valve allows to prevent extreme hemodynamic instability, that can be fatal. • The guidewire in the correct position in left ventricle should never be withdrawn or lost. So that the malfunctioning infolded valve can be corrected by post-dilation. • To our knowledge, this is the first case of valve infolding in a patient with Bicuspid Aortic Valve (BAV) stenosis early recognized by rotational fluoroscopy.

Successful Endovascular Stent-graft Treatment for Two Cases of Aortoesophageal Fistula Secondary to Thoracic Aortic Aneurysm

緒言:大動脈食道瘻はまれな疾患であるが，発症した場合は致死的となる．しかし，未だ治療法は確立されていない．今回，ステントグラフト内挿術後に異なる経過をたどるも，救命しえた2例を経験した．症例:症例1は69歳，女性．発熱，背部痛，大量吐血を主訴に救急搬送．症例2は67歳，男性．嚥下障害，大量吐血を主訴に救急搬送．いずれも造影CT検査で下行大動脈食道瘻と診断とされ，同日緊急ステントグラフト内挿術を施行された．症例1は食道瘻孔部単純閉鎖，広背筋弁充填，腸瘻造設術を行ったが，閉鎖部に縫合不全をきたし，胸部食道単純切除術後，二期的に消化管再建術を行った．症例2は一期的に消化管再建術を行った．いずれも3年以上，グラフト感染の兆候はない．結論:大動脈食道瘻に対してステントグラフト内挿術を行い救命しえた2例を経験した．出血制御目的のステントグラフト内挿術，および感染制御のための食道切除が有用と考えられた．

Endovascular approach in isolated abdominal aortic dissections.

Background Here, we report the mid-term results of endovascular treatment of isolated dissection of the abdominal aorta, which is a very rare pathology. Materials and methods A total of 11 patients (4 males (36.3%) and 7 females (63.6%)) aged 42-72 (mean, 60.3 ± 10.45) years with isolated dissection of the abdominal aorta underwent endovascular stent-graft treatment at our institution between August 2010 and September 2015. Eight patients were symptomatic, and the remaining three were asymptomatic. The asymptomatic patients had aortic aneurysms coexisting with dissection. Eight patients without aneurysm had spontaneous dissections, and the most common symptom was unresponsive abdominal pain. Results The mean abdominal aorta diameter was 46.7 ± 20.6 (range, 31.2-100.9) mm and the mean dissection length was 71.1 ± 47.3 (range, 17-162) mm. Aorto-bi-iliac stent grafts were used in all patients, and were placed successfully under spinal anesthesia in all but one (90.9%) patient. Occlusion developed in one patient due to compression of the aorto-bi-iliac graft. Right-left femoral-femoral bypass was performed in this patient, who could not be placed on the opposite side. In addition, the graft was placed in one patient using the left renal artery chimney technique. No intraoperative mortality occurred, and open surgery was not required. In addition, no death occurred and no additional intervention was required during the mean follow-up period of 25.5 ± 17.1 (range, 6-60) months. Conclusion Limited data regarding endovascular treatment of isolated dissection of the abdominal aorta are available in the literature. Based on data obtained in a limited number of patients, we consider endovascular aortic repair to be a good alternative to surgery due to its low morbidity and mortality rates.

Ruptured abdominal aortic aneurysm after endovascular repair

Introduction. An aneurysm is a localized, permanent dilation of an arterial blood vessel with a diameter greater than 50% of the usual diameter for that aortic segment. It is treated with endovascular stent graft placement or open surgery. Endovascular stent grafting of the abdominal aorta has become popular as an elective treatment. but one of the complications is increased aneurysm diameter that may lead to rupture. Case Series. This case series reviews open reconstructive surgery of ruptured abdominal aortic aneurysms in three patients treated with endovascular repair. The diameter of the aneurysm increased due to endoleak or stent graft migration, leading to rupture. Due to the inability to extract the stent graft in two patients, the graft was transversely cut at the proximal part, where upper anastomosis was created using a Dacron graft prosthesis. Conclusion. Regular annual controls for the rest of patients lives are of great importance in order to avoid fatal complications after endovascular aneurysm repair. One of the methods after the abdominal aortic rupture after endovascular stent graft treatment that significantly shortens the duration of the surgery and gives a more stable upper anastomosis, is transverse stent graft cut in the proximal part. Complete prevention remains a challenge because a rupture may occur even if the abnormalities are not evident. The ultimate goal is to increase the survival rate after the ruptured abdominal aortic aneurysm.

4:12 PMAbstract No. 334 - Superiority of intra-sac ethylene vinyl alcohol copolymer liquid embolic (Onyx®) embolization compared with other embolization agents and techniques for the treatment of type II endoleaks following endovascular stent-graft treatment of abdominal aortic aneurysms

4:12 PMAbstract No. 334 - Superiority of intra-sac ethylene vinyl alcohol copolymer liquid embolic (Onyx®) embolization compared with other embolization agents and techniques for the treatment of type II endoleaks following endovascular stent-graft treatment of abdominal aortic aneurysms

Endovascular stent-graft treatment for graft-vein anastomotic stenosis in haemodialysis patients with arteriovenous grafts.

In this study, we investigated the patency of endovascular stent grafts in haemodialysis patients with arteriovenous grafts, the modes of patency loss, and the risk factors for re-intervention. Haemodialysis patients with graft-vein anastomotic stenosis of their arteriovenous grafts who were treated with endovascular stent-grafts between 2008 and 2013 were entered into this retrospective study. Primary and secondary patency, modes of patency loss, and risk factors for intervention were recorded. Cumulative circuit primary patency rates decreased from 40.0% at 6 months to 7.3% at 24 months. Cumulative target lesion primary patency rates decreased from 72.1% at 6 months to 22.0% at 24 months. Cumulative secondary patency rates decreased from 81.3% at 12 months to 31.6% at 36 months. Patients with a history of cerebrovascular accident had a significantly higher risk of secondary patency loss, and graft puncture site stenosis jeopardised the results of stent-graft treatment. Our data can help to improve outcomes in haemodialysis patients treated with stent-grafts for venous anastomosis of an arteriovenous graft.

Endovascular longitudinal fenestration and stent graft placement for treatment of aneurysms developing after chronic type B aortic dissection

The thickened intimal flap present in cases of chronic aortic dissection can present a challenge to attempts at endovascular stent graft treatment performed for subsequent aneurysmal degeneration by precluding adequate landing zones for the endograft and by constraining the endograft from full expansion. In this report we describe our technique and outcome for longitudinal endovascular fenestration of chronic aortic dissection flaps to facilitate endovascular stent graft treatment for thoracic aortic aneurysms developing after aortic dissection.

Endovascular Stent-graft Placement for the Emergency Treatment of Ruptured Descending Aortic Aneurysm

Ruptured aortic aneurysm is a condition that requires emergency treatment because of its high mortality rate. In this case, we presented the emergency endovascular treatment of a ruptured descending thoracic aortic aneurysm. A female patient, admitted to the emergency with sudden onset back pain, was treated by emergency endovascular stent-graft after CT angiography examination. According to endovascular treatment, surgical treatment has a high mortality and morbidity rate in the treatment of the ruptured descending thoracic aortic aneurysms. The endovascular stent-graft treatment is applied safely and successfully to the intervention of this pathology. (JAEM 2014; 13: 97-8)

Recurrent aneursyms following endovascular stent-grafting repair in vascular Behçet’s disease

Endovascular stent-graft treatment is one of the treatment modalities in prevention of recurrent aneurysms at the anastomosis site which are common following surgical repair of aneurysms in vascular Behçet’s disease. Pseudoaneurysms may also develop at the distal and proximal landing zones of the stent-graft. In this article, we report a 38-year-old male case of vascular Behçet’s disease in whom ineffective immunosuppression resulted in the development of recurrent pseudoaneurysms at the proximal and distal ends of the stent graft and all around it. Although stent graft placement may be considered as an alternative treatment to surgery in patients with vascular Behçet’s disease, a relatively low, but ongoing risk of recurrent pseudoaneurysm still remains.

TCTAP C-192 A Successful Endovascular Stent Graft Treatment Case in Common Femoral Artery Rupture Induced During Femoral Catheterization

TCTAP C-192 A Successful Endovascular Stent Graft Treatment Case in Common Femoral Artery Rupture Induced During Femoral Catheterization

Short-Term Curative Effect of Endovascular Stent-Graft Treatment for Aortic Diseases in China: A Systematic Review

IntroductionWe analyzed the short-term efficacy of endovascular treatment for aortic diseases by summarizing all available published data on endovascular stent-graft treatment for abdominal aortic aneurysm (AAA), thoracic aortic aneurysm (TAA), type A aortic dissection (type A AD) and type B aortic dissection (type B AD) in China.MethodsWe performed a systematic analysis of 935 published series on retrograde endovascular treatment for aortic diseases in China from January 1996 to November 2010. Based on the inclusion criteria, 159 studies, involving a total of 5531 patients, were included.ResultsThere were no significant differences in procedural success among the studies (P>0.05). The rates of overall neurologic complications and stroke were significantly different in all two-group comparisons (P<0.01). The type A AD patients had the highest rates of neurologic complications (both 6.67±0.00%), and the AAA patients had the lowest rates (0.31±0.04% and 0.11±0.02%). Significant differences were noted in the rates of cardiac, renal, pulmonary and visceral complications, which were all higher in the type A AD patients than in the other three groups (P<0.01). The endoleak rate was highest in the TAA patients (19.27±5.74%) and was similar in the type A AD patients (P>0.05). A significant difference was noted between the 30-day mortality rate of the type A AD patients and the AAA or type B AD patients (P<0.05).ConclusionEndovascular stent-graft is a feasible and safe treatment for aortic diseases, with high procedural success and low incidences of post-procedural complications and short-term mortality. Endovascular treatment for AAA and type B AD is more efficient than for type A AD and TAA.

Successful endovascular stent-graft treatment in a patient with Marfan syndrome presenting with complicated acute Type B dissection

Successful endovascular stent-graft treatment in a patient with Marfan syndrome presenting with complicated acute Type B dissection

Endovascular Stent Graft for Treatment of Complicated Spontaneous Dissection of Celiac Artery: Report of Two Cases

We report 2 cases of complicated spontaneous dissection of the celiac artery, which were successfully treated by a stent graft. The first patient was a 47-year-old man who presented with acute abdominal pain. CT scan showed ruptured saccular aneurysm with surrounding retroperitoneal hematoma. The second patient was a 57-year-old man with progressive dissecting aneurysm. Endovascular stent graft was placed in the celiac trunk to control bleeding, and to prevent rupture in each patient. Follow-up CT scans showed complete obliteration of a dissecting aneurysm.

Abdominal Aort Anevrizmalarında Endovasküler Stent-Greft Tedavi Açık Cerrahi Tedaviye Göre Morbidite Açısından Daha Uygundur

Abdominal Aort Anevrizmalarında Endovasküler Stent-Greft Tedavi Açık Cerrahi Tedaviye Göre Morbidite Açısından Daha Uygundur

Percutaneous Balloon-Expandable Covered Stent Implantation for Treatment of Traumatic Aortic Injury in Children and Adolescents

Surgical treatment of pediatric acute traumatic aortic injury (TAI) after blunt chest trauma is standard of care. Use of endovascular stent grafts for treatment of TAI in adults is common but has important limitations in children. We sought to describe the use of balloon-expandable covered endovascular stents for treatment of TAI in children and adolescents. Participants of the multicenter Coarctation of the Aorta Stent Trial (COAST) had access to investigational large-diameter, balloon-expandable, covered stents (covered Cheatham-platinum stents; NuMed, Inc., Hopkinton, New York) on an emergency-use basis. From 2008 through 2011, 6 covered stents were implanted in 4 patients at 3 COAST centers for treatment of TAI. Median patient age was 13.5 years (range 11 to 14) and weight was 58 kg (40 to 130). All patients sustained severe extracardiac injuries that were judged to preclude safe open surgical repair of TAI. Median aortic isthmus and stent implantation balloon diameters were 16.4 mm (13.2 to 19) and 19 mm (16 to 20), respectively. Stent implantation was technically successful in all attempts. Complete exclusion of aortic wall injury was achieved in all cases. There were no access site complications. At a median follow-up of 24 months, there was 1 early death (related to underlying head trauma) and 1 patient with recurrent aortic aneurysm who required additional stent implantation. In conclusion, balloon-expandable covered-stent implantation for treatment of pediatric TAI after blunt trauma is generally safe and effective. Availability of this equipment may alter the standard approach to treatment of pediatric TAI.

The incidence of deep venous thrombosis after endovascular stent-graft treatment of abdominal aortic aneurysms

Background: In this study, we aimed to establish the incidence of deep venous thrombosis (DVT) after endovascular stent-graft (EVSG) treatment of abdominal aortic aneurysms (AAA). Methods: Between January 2005 - April 2011, 114 patients (109 males; 5 females; mean age 69.6 years; range 43 to 92 years) who underwent EVSG treatment of AAA in our clinic were prospectively evaluated. Patients were monitored for the development of DVT on day 13 and at three months through color Doppler ultrasonography and physical examination. Results: Two patients (1.75%) developed DVT after EVSG treatment. Conclusion: Although patients who undergo surgical treatment of AAA are at high-risk for the development of DVT, the incidence of DVT associated with EVSG treatment is found to be low.