Clinical Outcomes After Crossed-Limb vs. Conventional Endograft Configuration in Endovascular AAA Repair

Georgiadis, George S.; Georgakarakos, Efstratios; Antoniou, George Α.; Trellopoulos, George; Argyriou, Christos; Nikolopoulos, Evagelos S.; Charalampidis, Dimitrios; Schoretsanitis, Nikolaos; Lazarides, Miltos K.

doi:10.1583/13-4286mr.1

Cited by 21 publications

(12 citation statements)

References 27 publications

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“…This technique also allows a shortened graft length in the aneurysmal sac to avoid covering the internal iliac artery when necessary. Similar to the reports of this study, Georgiadis et al 6 ) reported no difference between the crossed-limb technique and the conventional endograft position in terms of short- or mid-term clinical outcomes. However, unlike us, they used several kinds of devices (Talent, Medtronic Vascular, Santa Rosa, CA, USA), Endurant (Medtronic Vascular), and Excluder (W. L. Gore & Associates, Flagstaff, AZ, USA).…”

Section: Discussionsupporting

confidence: 89%

Early and Mid-Term Results of Endovascular Aortic Repair Using a Crossed-Limb Technique for Patients with Severely Splayed Iliac Angulation

Yagihashi

Nishimaki

Ogawa

et al. 2018

Annals of Vascular Diseases

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Objective: We evaluated early and mid-term results of endovascular aortic repair (EVAR) using crossed-limb and non-crossed-limb techniques.Material and Methods: From December 2011 to October 2013, 37 patients (31 men; mean age 75.4 years) were treated with EVAR (crossed-limb, 21 and non-crossed-limb, 16). We compared technical success, maximum short-axis diameter of abdominal aortic aneurysm, iliac angulation, time for catheterization of the short contralateral limb gate of the main body (SCT), and complications between the groups.Results: The mean follow-up period was 810±230 days. The technical success rate was 100%. There was no significant difference between the groups in terms of mean short-axis diameter. Iliac angulation was significantly wider in the crossed-limb group (53.3±14.6 vs. 39.4±13.0, p=0.0049). There was no significant difference between the groups in terms of SCT. Limb occlusion occurred in two cases (one crossed-limb and one non-crossed-limb). There were no aneurysm-related deaths.Conclusion: There were no differences between the crossed-limb and non-crossed-limb techniques in terms of early and mid-term results of EVAR. A crossed-limb technique can be performed safely without prolonged SCT even in severely splayed iliac angulation cases.

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Section: Discussionsupporting

confidence: 89%

Early and Mid-Term Results of Endovascular Aortic Repair Using a Crossed-Limb Technique for Patients with Severely Splayed Iliac Angulation

Yagihashi

Nishimaki

Ogawa

et al. 2018

Annals of Vascular Diseases

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“…Exchanging the assignment of the inner branches is a challenge due to the retrograde aspect of the third branch, which if reassigned creates a situation similar to the “crossed-limbs” configuration often found in infrarenal endografts. 12 In creating this “ballerina” configuration, it is crucial to cannulate and secure the second and third branches first then proceed with deploying the bridging stents in the second step. Although in vitro models showed that increased length of conduits connected to retrograde branches had a negative impact on blood flow, 13 retrograde branches for the LCCA have been described with the GORE TAG Thoracic Branch Endoprosthesis, with good early results.…”

Section: Discussionmentioning

confidence: 99%

Emergent Triple-Branched TEVAR and Redistribution of the Branches to the Supra-Aortic Target Vessels for Treatment of a Contained Ruptured Descending Aortic Aneurysm Associated With a Chronic Type A Aortic Dissection

et al. 2021

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Purpose: To demonstrate the feasibility of urgent endovascular treatment of a chronic type A dissection and contained rupture of the false lumen using a noncustomized triple-branched arch endograft, which necessitated reassignment of the branches to the supra-aortic vessels. Case Report:: A 57-year-old patient with a contained rupture of the descending thoracic aorta, in the setting of a chronic type A dissection and a maximum aortic diameter of 85 mm, was converted to endovascular repair after failure of an open surgical approach. A custom-made triple-branched arch endograft designed for another patient was employed, with concomitant occlusion of the false lumen using a Candy Plug occluder. To adjust the graft’s configuration to the patient’s anatomy, the supra-aortic vessels were not assigned to the originally planned branches. The 12-month follow-up angiography demonstrated a satisfactory result. Conclusion: A noncustomized triple-branched arch endograft can be used in an emergency setting to treat chronic type A dissection, reassigning the branches to the supra-aortic vessels as needed.

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“…The CXL and customary bifurcated stent-grafts reportedly present similar hemodynamic and clinical performances. 10) Since the implantation line’s wound portion tracked smoothly, this form of limb deployment would not make a significant difference in IBE clinical results. Similar to the CXL form of deployment, it may help avoid an abrupt curve of the DIL in case of a widespread angle of the common iliac arteries.…”

Section: Discussionmentioning

confidence: 99%

“…Similar to the CXL form of deployment, it may help avoid an abrupt curve of the DIL in case of a widespread angle of the common iliac arteries. 10) However, caution should be exercised because we may not be able to predict the accurate length of the CSG preoperatively. Therefore, intraoperative measurement is necessary for this technique.…”

Section: Discussionmentioning

confidence: 99%

One Technique to Modulate a Device Implantation Path in a Short Treatment Length Using the Gore IBE Device

Mitsuoka

Miyano

Terai

et al. 2019

Annals of Vascular Diseases

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The GORE EXCLUDER Iliac Branch Endoprosthesis (IBE; W. L. Gore and Associates, Flagstaff, AZ, USA) applicability is limited by the aorto-iliac length (AOL). The shortage may be a major exclusion criterion. An 85-year-old male presented with an abdominal aortic and left common iliac arterial aneurysm. The left-side AOL was 146-mm, which was deemed 19-mm too short for IBE usage. To increase implantation length, the contra-lateral connection stent graft was deployed along the implantation line, wound half-circumferentially around the ipsilateral limb. Any form of endoleak, limb occlusion, and device migration has not been observed for twelve months.

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Clinical Outcomes After Crossed-Limb vs. Conventional Endograft Configuration in Endovascular AAA Repair

Abstract: No difference was found between the crossed-limb technique and the conventional endograft position as regards short- or midterm clinical outcomes.

Cited by 21 publications

References 27 publications

Early and Mid-Term Results of Endovascular Aortic Repair Using a Crossed-Limb Technique for Patients with Severely Splayed Iliac Angulation

Early and Mid-Term Results of Endovascular Aortic Repair Using a Crossed-Limb Technique for Patients with Severely Splayed Iliac Angulation

Emergent Triple-Branched TEVAR and Redistribution of the Branches to the Supra-Aortic Target Vessels for Treatment of a Contained Ruptured Descending Aortic Aneurysm Associated With a Chronic Type A Aortic Dissection

One Technique to Modulate a Device Implantation Path in a Short Treatment Length Using the Gore IBE Device

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