Benchtop quantification of gutter formation and compression of chimney stent grafts in relation to renal flow in chimney endovascular aneurysm repair and endovascular aneurysm sealing configurations

Boersen, Johannes T.; Donselaar, Esmé J.; Jebbink, Erik Groot; Starreveld, Roeliene; Overeem, Simon P.; Slump, Cornelis H.; Vries, Jean‐Paul P.M. de; Reijnen, Michel M.P.J.

doi:10.1016/j.jvs.2016.10.058

Cited by 19 publications

(29 citation statements)

References 26 publications

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“…Similarly, there have been no in vitro studies or clinical reports describing chimney deformation when devices are deployed in an adjacent fashion parallel to a primary endograft. In general, the D-ratios reported here follow trends reported elsewhere [15,27], namely: SE covered chimney grafts exhibit higher degrees of deformation compared to their BE counterparts. The distinctly unique findings of this study, however, are derived from the observed interactions of the adjacent self-expandable CGs deployed into the brachiocephalic trunk and left common carotid artery, as manifested by their varying lumen deformations ( Figure 7B).…”

Section: Discussionsupporting

confidence: 88%

“…Given the low sample size in this study, and uncontrolled implant positioning between groups, exact inferences could not be made. Nevertheless, these findings further support the notion that there exists an underlying structurefunction relation, primarily attributed to the native properties of nitinol [28], that may influence the optimal configuration of devices in chimney-type procedures [14,27].…”

Section: Discussionsupporting

confidence: 70%

“…Notably, the BE configuration resulted in 3-times the total gutter volume in comparison to its SE counterpart, which extends the results of previously reported ch-EVAR/EVAS studies [14,15,25,26] to the ch-TEVAR case. Indeed, gutters may be inherent to this endovascular technique [27], regardless of CG type or anatomical location. Quantitatively, comparison of absolute gutter volumes between reported studies is inappropriate given the difference in devices, anatomies, and measurement techniques employed.…”

Section: Discussionmentioning

confidence: 99%

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In Vitro Quantification of Stent-Graft Behaviour During ch-TEVAR

Kwieciński¹,

Uberoi²,

Hadi³

et al. 2020

Preprint

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Purpose: To quantify dynamic gutter phenomena and endograft deformations during double chimney thoracic endovascular aortic repair (ch-TEVAR) in a physiological model of the thoracic aorta subjected to pulsatile haemodynamic conditions. Methods: Two in vitro procedures revascularizing the brachiocephalic trunk and left common carotid artery were performed representing both balloon-expandable (BE, Ankura-BeGraft) and self-expandable (SE, Ankura-Viabahn) double ch-TEVAR configurations. Retrospectively gated computed tomography (CT) was used to evaluate endograft behaviour. Device interactions were characterised according to gutter volume, gutter surface deviation, and endograft deformation (D-ratio) at end-diastolic and peak-systolic aortic pressure. Results: Use of BE chimney grafts resulted in three times total gutter volume compared to SE chimney grafts. Gutter volumes were observed to vary dynamically between the end-diastolic and peak-systolic phases of the cardiac cycle, with the most substantial change associated with the BE configuration. Chimney graft deformations were dependent on device type, with SE devices exhibiting up to twice the deformation as BE devices. When adjacent, SE chimney grafts were observed to support each other, and thus tended towards a more consistently circular shape. Conclusions: Gutter and chimney graft behaviour were dependent on device type, and exhibited both spatial and temporal variability. This study emphasizes notable differences between BE and SE double ch-TEVAR configurations which should be considered when evaluating risk of endoleak. The findings reported here also support the use of gated CT to better identify and predict device related complications in ch-TEVAR, and can be used in the design of next generation devices.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

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In Vitro Quantification of Stent-Graft Behaviour During ch-TEVAR

Kwieciński¹,

Uberoi²,

Hadi³

et al. 2020

Preprint

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“…Theoretically, chEVAS should be better than chEVAR because the compliant endobags fill the space between the Nellix stents and the chimney grafts, reducing the incidence of gutter type Ia endoleak. This advantage of chEVAS has been confirmed in bench models 15,16 and subsequently reported in clinical practice, most notably in the ASCEND Registry. 17 Logically, migration after chEVAS might occur less frequently and to a lesser degree compared to standard EVAS for several reasons.…”

Section: Introductionmentioning

confidence: 58%

Migration After Endovasclar Aneurysm Sealing in Conjunction With Chimney Grafts

et al. 2020

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Purpose To assess the incidence of migration after endovascular aneurysm sealing (EVAS) in conjunction with chimney grafts (chEVAS) for repair of abdominal aortic aneurysms (AAAs). Materials and Methods A retrospective, observational cohort study was conducted of 31 patients (mean age 75.7 years; 27 men) treated for juxtarenal AAA between April 2013 and December 2018 at single centers in New Zealand and the Netherlands. The majority of patients received >1 chimney graft (13 single, 13 double, and 5 triple) during chEVAS. Six patients had only the first postoperative scan, so the migration analysis was based on 25 patients. Results Median seal length assessed on the first postoperative computed tomography scan was 36.5 mm. The assisted technical success rate was 93.5% with 2 technical failures. Median time to final imaging follow-up was 17 months in 25 patients. At the latest follow-up, there were no cases of caudal migration >10 mm. Freedom from caudal movement of 5 to 9 mm was estimated as 86.1% at 1 year and 73.9% at 2 years; freedom from clinically relevant migration (movement requiring reintervention) was 100% at both time intervals. However, at 3 years there were 2 cases of caudal movement of 5 to 9 mm and a type Ia endoleak warranting reintervention. No correlation between migration and aneurysm growth (p=0.851), endoleak (p=0.562), or the number of chimney grafts (p=0.728) was found. During follow-up, 2 patients (7%) had aneurysm rupture and 10 (33%) had reinterventions. Eight patients (27%) died; 2 were aneurysm-related (7%) and due to the consequences of a reintervention. Conclusion In the 2 years following chEVAS, there was no caudal migration >10 mm, but nearly a quarter of patients had caudal movement of 5 to 9 mm. A trend was observed toward ongoing migration that required intervention at 3-year follow-up. chEVAS is technically challenging and should be considered only for patients with no viable alternative treatment option.

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“…The main advantage of this novel pump compared with other commercially available pumps is its simplicity in generating the peripheral flow profiles. Traditionally, two needle valves located at renal artery outlets, an air chamber and a needle valve in series located at the combined common iliac artery outlets representing a twoelement Windkessel were used 1,2,17,18 to simulate the vessel resistance and peripheral compliance in order to generate flow profile with reverse flow in the early diastolic phase. With the reciprocating roller pump design, it can produce back flow in the peripheral artery without the use of renal artery flow in the circuit, therefore it simplifies the flow circuit for in vitro studies involving infrarenal aorta, iliac, femoral, and other peripheral arteries.…”

Section: Discussionmentioning

confidence: 99%