Classification of gutter type in parallel stenting during endovascular aortic aneurysm repair

Overeem, Simon P.; Boersen, Johannes T.; Schuurmann, Richte C. L.; Jebbink, Erik Groot; Slump, Cornelis H.; Reijnen, Michel M.P.J.; Vries, Jean‐Paul P.M. de

doi:10.1016/j.jvs.2016.08.087

Cited by 23 publications

(33 citation statements)

References 30 publications

(29 reference statements)

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“…Thoracoabdominal aneurysm describes an aneurysm involving both the thoracic and abdominal aorta, as well as their visceral branches: the CA, SMA and RAs. The most common is a Crawford type III TAAA with lesions at the distal area of the aorta (below the T6 section) and the entire abdominal aorta, 2 as was the case in the patient described in the present report. Although vascular surgeons have been treating TAAA for many years, preservation of all visceral branches of the abdominal aorta remains a challenge.…”

Section: Discussionsupporting

confidence: 72%

“…At present, reconstructive methods for the visceral branches include parallel, fenestrated, sandwich, and branched stent graft technologies. The parallel stent graft method is technically convenient and preserves the blood supply via the branched stent graft released in parallel with the aortic stent graft; however, the gutter 2 between the two stent grafts leads to complications such as endoleak and branch stent occlusion. 2 , 4 The sandwich technique is an effective method for treatment but type III endoleaks have always been an issue and it is harder to operate than fenestration or parallel stent graft.…”

Section: Discussionmentioning

confidence: 99%

“…The parallel stent graft method is technically convenient and preserves the blood supply via the branched stent graft released in parallel with the aortic stent graft; however, the gutter 2 between the two stent grafts leads to complications such as endoleak and branch stent occlusion. 2 , 4 The sandwich technique is an effective method for treatment but type III endoleaks have always been an issue and it is harder to operate than fenestration or parallel stent graft. 5 Fenestrated stent graft technology is accurate and it is a viable alternative for patients without healthy proximal landing zones.…”

Section: Discussionmentioning

confidence: 99%

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Treatment for thoracoabdominal aortic aneurysm by fenestrated endovascular aortic repair with physician-modified stent graft

et al. 2018

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Despite being widely used for several years, the endovascular aortic repair (EVAR) of a thoracoabdominal aneurysm (TAAA) remains challenging, particularly the revascularization of the abdominal aortic visceral branches. A 66-year-old male was admitted to hospital with abdominal bloating and pain. Computed tomographic angiography (CTA) confirmed a Crawford type III TAAA from the distal descending aorta to the suprarenal abdominal aorta that involved the celiac axis, accompanied with an occlusion of the left subclavian artery. Fenestrated-EVAR was performed successfully and 1 week later CTA showed a type III endoleak, which had resolved 3 months later, without stent migration or visceral artery occlusion. In this present case, the surgeons preferred to perform the procedure in three surgical stages, postponing the deployment of a covered stent in the CA fenestration to provide additional time for the development of collateral circulation to the spinal cord as a possible means of preventing postoperative paraplegia.

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Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Treatment for thoracoabdominal aortic aneurysm by fenestrated endovascular aortic repair with physician-modified stent graft

et al. 2018

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“…It occurs when there is a loss of apposition between the parallel stent-grafts themselves and the vessel wall. 37 This can lead to a type 1 endoleak due to the interspace created between grafts, and is potentially difficult to treat. 38 Massmann et al, in a series of 41 patients treated with sandwichtechnique to preserve hypogastric flow, described post-procedure gutter-endoleaks 20 in 6,5% of patients.…”

Section: Parallel Graft Techniquesmentioning

confidence: 99%

Internal iliac artery preservation strategies in the endovascular treatment of aortoiliac aneurysms

Robalo¹,

Sousa²,

Mansilha³

2018

Int Angiol

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INTRODUCTION: Common iliac aneurysms are present in up to 40% of abdominal aortic aneurysms and frequently impair distal landing zones for endovascular aneurysm repair. Several techniques have been developed in order to overcome these issues, with different applications and conflicting results. Although long-term outcomes of hypogastric exclusion are favorable, the risks of pelvic ischemia and morbidity rates are high. We aim to review current hypogastric preservation strategies used in the endovascular treatment of aortoiliac aneurysms. EVIDENCE ACQUISITION: A thorough non-systematic review of the literature was conducted using PubMed/Medline. Forty-five articles were included, according to their scientific relevance and relation with the subject. EVIDENCE SYNTHESIS: The bell-bottom technique can be used in common iliac arteries with up to 24mm of diameter. Although apparently effective in the short-term, long-term durability is questionable with reported type 1b endoleak rates varying from 3,4-7,8% and high re-intervention rates reported. Iliac branches have better long-term outcomes, with 90,4% patency rates and 91,8% freedom from re-intervention at 10 years' follow-up. Nonetheless, its widespread application is limited by complex anatomies and increased costs. Finally, parallel-graft techniques are an effective option for hostile anatomies unsuitable for other techniques. Endoleak due to gutter development remains the biggest limitation for its long-term durability and solid evidence regarding its application is still lacking. CONCLUSIONS: When determining the appropriate hypogastric preservation strategy, several factors should be considered. Anatomic criteria, life-expectancy as well as physical and sexual activity are the most important criteria. Procedure complexity and cost should also be accounted for.

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“…The efficacy of the parallel SG technique, especially for the octopus strategy, has been investigated from the clinical aspect . A few suggestions on wise treatment plan have been proposed.…”

Section: Introductionmentioning

confidence: 99%

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

Mei

Han

et al. 2019

Numer Methods Biomed Eng

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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 reoperated. 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.

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Classification of gutter type in parallel stenting during endovascular aortic aneurysm repair

Abstract: The proposed gutter classification enables a uniform nomenclature in the current ch-EVAR literature and a more accurate risk assessment of gutter-associated endoleaks. Moreover, it allows monitoring of eventual progression of gutter size during follow-up.

Cited by 23 publications

References 30 publications

Treatment for thoracoabdominal aortic aneurysm by fenestrated endovascular aortic repair with physician-modified stent graft

Treatment for thoracoabdominal aortic aneurysm by fenestrated endovascular aortic repair with physician-modified stent graft

Internal iliac artery preservation strategies in the endovascular treatment of aortoiliac aneurysms

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

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