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Endovascular aneurysm repair of the infrarenal or thoracic aorta has been shown to be a less invasive alternative to open surgery. A combined aneurysm of the thoracic and abdominal aorta is complex and challenging; the involvement of renal and/or visceral branches requires new treatment methods.
A hybrid approach is currently an accepted alternativ...
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Background and objectives: Abdominal aortic aneurysm (AAA) growth is unpredictable after the endovascular aneurysm repair (EVAR). Continuing aortic wall degradation and weakening due to hypoxia may have a role in post-EVAR aneurysm sac growth. We aimed to assess the association of aortic wall density on computed tomography angiography (CTA) with an...
Endovascular aneurysm repair has revolutionized the therapeutic strategy for abdominal aortic aneurysm. However, hostile proximal aneurysmal neck and tortuosity of access vessels remain challenges in selecting optimal stent-grafts in abdominal aortic aneurysms with difficult anatomy.
A 65-year-old woman complained of intermittent abdominal pain for...
Citations
... Before discharge, patients were switched to dual antiplatelet therapy or single antiplatelet therapy combined with an oral anticoagulant for at least 3 months. To reduce the risk of post-implantation systemic inflammatory syndrome, 13 vaso-plegic syndrome, 14,15 and/or atrial fibrillation 16 and the consequent low cardiac output, 17 low dose steroids were administered orally for 5 days (prednisone 20 mg/day for 2 days, prednisone 10 mg/day for 2 days and prednisone 5 mg/day for 2 days). ...
... Before discharge, patients were switched to dual antiplatelet therapy or single antiplatelet therapy combined with an oral anticoagulant for at least 3 months. To reduce the risk of post-implantation systemic inflammatory syndrome, 13 vaso-plegic syndrome, 14,15 and/or atrial fibrillation 16 and the consequent low cardiac output, 17 low dose steroids were administered orally for 5 days (prednisone 20 mg/day for 2 days, prednisone 10 mg/day for 2 days and prednisone 5 mg/day for 2 days). ...
Objective:
The aim was to report on chimney and periscope grafts (CPGs) and their mid- and longer-term outcomes when they are used to preserve reno-visceral artery (RVA) perfusion in endovascular repair of pararenal (PRAAs) or thoraco-abdominal aortic aneurysm (TAAAs). In addition, factors associated with CPG failure are presented. Limited data exist on the outcomes of CPGs, and mid- and long-term results are generally not reported.
Methods:
This was a prospective study in a cohort of 100 patients with PRAA (69) or TAAA (31). A total of 224 (mean 2.24 per patient) RVAs were preserved with 136 (61%) chimney and 88 (39%) periscope grafts. CPGs were constructed mainly using self expandable stent grafts. Patients were followed by clinical examination, CTA (82%), and/or duplex (18%). Data were collected until February 2015.
Results:
CPG immediate technical success was 99% (222/224 branches). Mean follow up was 29 months (range 0-65; SD 17); 59% patients were followed > 2 years, 30% > 3 years, and 16% > 4 years. Post-operatively, CPG occlusion was observed early (≤30 days) in three (1.3%) branches and during follow up in 10 (4.5%). At 36 and 48 months, the estimated primary patency was 93% and 93%. After corrective percutaneous (10) or surgical (3) re-interventions, the estimated secondary patency was 96% and 96%. Thirty day mortality was 2%; at 36 and 48 months the estimated patient survival was 79%. Significant shrinkage (72 [SD 23] vs. 62 [SD 24] mm; p < .001) was observed, with a substantial reduction (>5 mm) in 55 patients, and sac enlargement in four. Incomplete aneurysm sac sealing was treated successfully by a secondary intervention in 15 patients.
Conclusions:
Self expandable CPGs have proved to be a highly successful and durable treatment for RVA preservation up to 5 years. Incomplete CPG expansion, inadequate length, and CPG use in small and diseased target arteries were risk factors for occlusion. These mid- and longer-term results support CPG use to treat PRAAs or TAAAs in patients unfit for open surgery or fenestrated/branched stent grafts.
... MPR is a technique that enables the viewer to generate cross-sections in any plane. A curved plane provides a curved MPR, useful for more accurate assessment of tortuous vessels [15]. VR is commonly used to generate a volumetric display by rendering the entire volume of data and is especially useful for better illustration of complex vascular anatomy (Fig. 1). ...
Purpose:
This study was designed to evaluate retrospectively the long-term stent-graft patency after renovisceral revascularization with Viabahn Open Revascularization Technique (VORTEC) using computed tomography angiography (CTA) and magnetic resonance angiography (MRA).
Methods:
In 34 patients (seven women; mean age 72 ± 8 years) with aortic aneurysm, 63 renovisceral vessels (i.e., 54 renal, nine visceral arteries) were revascularized with VORTEC between 2004 and 2009. All patients obtained a pre- and postinterventional CTA and at least one follow-up CTA or MRA after 6 or more months following intervention (median follow up: 43 months). Detection of bypass occlusion, bypass stenosis, infolding, stent-graft fractures and dislocations, and kidney shrinkage were noted by two readers in consensus. Furthermore, mortality during follow-up was assessed using the medical report.
Results:
During follow-up, 12.6 % of stent-grafts occluded. Cumulative patency rate was 95.2 ± 2.7 % at 12 months, 87.7 ± 4.4 % at 24 and 36 months, and 84.7 ± 5.2 % at 48, 60, 72, 84, and 89 months, respectively. Overall, 19 % of stent-grafts (12/63) developed bypass stenosis (<50 %, 10 stent-grafts; > 50 %, 2 stent-grafts), in one case stenosis (>70 %) was suspected to be hemodynamically significant. No secondary dislocation, no infolding of renovisceral stent-grafts, and no stent-graft fracture occurred. Kidney shrinkage occurred in nine patients, primarily in patients with an occluded Viabahn (n = 7). Eleven patients (32.3 %) died within the follow-up time period.
Conclusions:
In long-term survivors after VORTEC cumulative patency rate remained high, and no stent-graft fractures or secondary dislocations occurred.
... Advancements in minimally invasive image-guided techniques have underpinned the development of abnormalities of the aorta formerly treated with open vessel surgery that are now being treated with transfemoral endovascular aneurysm repair (EVAR) applying stent grafts [1]. Both interventional radiologists and vascular surgeons practice these endovascular implantation techniques2345. To accommodate these new endovascular techniques, a merging of the OR and the angiographic suite is desirable. The implementation of such a hybrid OR within the surgical unit means that an angiography system is permanently installed in the OR. ...
A permanently mounted angiography suite in an operating room (OR) is considered to be a hybrid OR. However, regular use for angiographic interventions is restricted with this setup. We introduce an alternative use of space for the efficient utilisation of an angiographic suite outside the surgical unit. This concept includes three scenarios that describe a modification of the catheter suite according to the specific clinical demands by adapting the workflow.
