Changes in Aortoiliac Anatomy After Elective Treatment of Infrarenal Abdominal Aortic Aneurysms with a Sac Anchoring Endoprosthesis

Boersen, Johannes T.; Schuurmann, Richte C. L.; Slump, Cornelis H.; Heuvel, D.A.F. van den; Reijnen, Michel M.P.J.; Mors, Thijs G. ter; Vahl, A.C.; Vries, J.P.P.M. de

doi:10.1016/j.ejvs.2015.08.019

Cited by 19 publications

(16 citation statements)

References 19 publications

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“…Previous reports have also shown there were only slight changes in aortic angulation after repair with the Nellix device. 10 Conventional EVAR endografts have inherent axial and bending stiffness, in addition to the stiffness of the guidewire, that straighten the aorta to a greater extent. 11 Furthermore, since conventional EVAR endografts have inherent flexibility, they may undergo more significant cyclic bending or angulation in vivo .…”

Section: Discussionmentioning

confidence: 99%

Stabilization of the Abdominal Aorta During the Cardiac Cycle with the Sac-Anchoring Nellix Device

Itoga

Suh

Cheng

2018

Annals of Vascular Surgery

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The Nellix device uses polymer-filled endobags to stabilize the abdominal aortic aneurysm (AAA) sac which is described as endovascular aneurysm sealing (EVAS). We analyzed cardiac-gated computed tomography angiography scans of repaired AAA with EVAS in 4 patients to evaluate the geometry and cardiac pulsatility-induced deformation. Graft translation and aortic curvature changes were found to be minimal during the cardiac cycle. The mean ± standard deviation changes in renal-aorta angles (1.0 ± 0.9°) were less than the changes in the superior mesenteric artery-aorta angle (4.0 ± 2.1°) (P < 0.01), during the cardiac cycle, demonstrating greater stabilization of the visceral branches closer to the device. These findings confirm stabilization of the abdominal aorta during the cardiac cycle using EVAS.

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Section: Discussionmentioning

confidence: 99%

Stabilization of the Abdominal Aorta During the Cardiac Cycle with the Sac-Anchoring Nellix Device

Itoga

Suh

Cheng

2018

Annals of Vascular Surgery

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“…More recently, endovascular aneurysm sealing (EVAS) has been increasingly used for endovascular repair of AAAs, revision procedures, and iliac aneurysms. [5][6][7] Similar to traditional stent-graft EVAR, EVAS with sac-filling polymer technology has shown good early results when combined with parallel snorkel stents. 8 Despite these favorable early outcomes for snorkel endovascular aneurysm sealing (Sn-EVAS), there are still questions about medium-to long-term durability, which is undoubtedly related to device-tissue interactions.…”

Section: Introductionmentioning

confidence: 99%

Cardiac Pulsatility– and Respiratory-Induced Deformations of the Renal Arteries and Snorkel Stents After Snorkel Endovascular Aneurysm Sealing

et al. 2019

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Purpose: To quantify deformations of renal arteries and snorkel stents after snorkel endovascular aneurysm sealing (Sn-EVAS) resulting from cardiac pulsatility and respiration and compare these deformations to patients with untreated abdominal aortic aneurysms (AAA) and snorkel endovascular aneurysm repair (Sn-EVAR). Materials and Methods: Ten Sn-EVAS patients (mean age 75±6 years; 8 men) were scanned with cardiac-gated, respiration-resolved computed tomography angiography. From 3-dimensional geometric models, changes in renal artery and stent angulation and curvature due to cardiac pulsatility and respiration were quantified. Respiration-induced motions were compared with those of 16 previously reported untreated AAA patients and 11 Sn-EVAR patients. Results: Renal artery bending at the stent end was greater for respiratory vs cardiac influences (6°±7° vs −1°±2°, p<0.025). Respiration caused a 3-fold greater deformation on the left renal artery as compared with the right side. Maximum curvature change was higher for respiratory vs cardiac influences (0.49±0.29 vs 0.24±0.17 cm−1, p<0.025), and snorkel renal stents experienced similar maximum curvature change due to cardiac pulsatility and respiration (0.14±0.10 vs 0.19±0.09 cm−1, p=0.142). When comparing the 3 patient cohorts for respiratory-induced deformation, there was significant renal branch angulation in untreated AAAs, but not in Sn-EVAR or Sn-EVAS, and there was significant bending at the stent end in Sn-EVAR and Sn-EVAS. Maximum curvature change due to respiration was ~10-fold greater in Sn-EVAR and Sn-EVAS compared to untreated AAAs. Conclusion: The findings suggest that cardiac and respiratory influences may challenge the mechanical durability of snorkel stents of Sn-EVAS; similarly, however, respiration may be the primary culprit for tissue irritation, increasing the risk for stent-end thrombosis, especially in the left renal artery. The bending stiffness of snorkel stents in both the Sn-EVAR and Sn-EVAS cohorts damped renal branch angulation while it intensified bending of the artery distal to the snorkel stent. Understanding these device-to-artery interactions is critical as they may affect mechanical durability of branch stents and quality and durability of treatment.

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“…Studies have shown that intraluminal thrombus cannot be addressed as a rigid structure and might change over time. [11][12][13] This spongelike effect in combination with a larger AAA diameter might result in bending of the stent frames into the thrombus and parting of the stent frames, which can make the EVAS configuration unstable. A low amount of polymer surrounding the stent frames in small flow lumens might also induce instability into the EVAS configuration.…”

Section: Discussionmentioning

confidence: 99%

Anatomical Predictors of Endoleaks or Migration After Endovascular Aneurysm Sealing

et al. 2018

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To identify preoperative anatomical aortic characteristics that predict seal failures after endovascular aneurysm sealing (EVAS) and compare the incidence of events experienced by patients treated within vs outside the instructions for use (IFU). Methods: Of 355 patients treated with the Nellix EndoVascular Aneurysm Sealing System (generation 3SQ+) at 3 high-volume centers from March 2013 to December 2015, 94 patients were excluded, leaving 261 patients (mean age 76±8 years; 229 men) for regression analysis. Of these, 83 (31.8%) suffered one or more of the following events: distal migration ⩾5 mm of one or both stent frames, any endoleak, and/or aneurysm growth >5 mm. Anatomical characteristics were determined on preoperative computed tomography (CT) scans. Patients were divided into 3 groups: treated within the original IFU (n=166), outside the original IFU (n=95), and within the 2016 revised IFU (n=46). Categorical data are presented as the median (interquartile range Q1, Q3). Results: Neck diameter was significantly larger in the any-event cohort vs the control cohort [23.7 mm (21.7, 26.3) vs 23.0 mm (20.9, 25.2) mm, p=0.022]. Neck length was significantly shorter in the any-event cohort [15.0 mm (10.0, 22.5) vs 19.0 mm (10.0, 21.8), p=0.006]. Maximum abdominal aortic aneurysm (AAA) diameter and the ratio between the maximum AAA diameter and lumen diameter in the any-event group were significantly larger than the control group (p=0.041 and p=0.002, respectively). Regression analysis showed aortic neck diameter (p=0.006), neck length (p=0.001), and the diameter ratio (p=0.011) as significant predictors of any event. In the comparison of events to IFU status, 52 (31.3%) of 166 patients in the inside the original IFU group suffered an event compared to 13 (28.3%) of 46 patients inside the 2016 IFU group (p=0.690). Conclusion: Large neck diameter, short aortic neck length, and the ratio between the maximum AAA and lumen diameters are preoperative anatomical predictors of the occurrence of migration (⩾5 mm), any endoleak, and/or aneurysm growth (>5 mm) after EVAS. Even under the refined 2016 IFU, more than a quarter of patients suffered from an event. Improvements in the device seem to be necessary before this technique can be implemented on a large scale in endovascular AAA repair.

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Changes in Aortoiliac Anatomy After Elective Treatment of Infrarenal Abdominal Aortic Aneurysms with a Sac Anchoring Endoprosthesis

Cited by 19 publications

References 19 publications

Stabilization of the Abdominal Aorta During the Cardiac Cycle with the Sac-Anchoring Nellix Device

Stabilization of the Abdominal Aorta During the Cardiac Cycle with the Sac-Anchoring Nellix Device

Cardiac Pulsatility– and Respiratory-Induced Deformations of the Renal Arteries and Snorkel Stents After Snorkel Endovascular Aneurysm Sealing

Anatomical Predictors of Endoleaks or Migration After Endovascular Aneurysm Sealing

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