Clinical outcomes and material properties of in situ fenestration of endovascular stent grafts

Crawford, Sean A.; Sanford, Ryan M.; Forbes, Thomas L.; Amón, Cristina H.; Doyle, Matthew G.

doi:10.1016/j.jvs.2016.03.445

Cited by 63 publications

(46 citation statements)

References 39 publications

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“…Fabric tear is an important factor in the occurrence of endoleak and stent displacement. Unlike fenestration created with a needle and cutting balloon, the use of an energy laser has the potential to decrease the mechanical force required for puncture and the gross integrity of the fabric is always maintained . The graft used in the present study was tested in vivo before its application, and no significant tear was observed during fenestration with the 810 nm fiber lasers, which was consistent with previous research (Supplemental video).…”

Section: Discussionsupporting

confidence: 87%

Endovascular repair of aortic arch intramural hematoma and penetrating ulcers with 810 nm in situ laser‐assisted fenestration: Preliminary results of a single‐center

et al. 2018

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Purpose The aim of the present study was to report the clinical outcomes of the use of 810 nm in situ laser‐generated fenestration (ISLF) for the treatment of aortic aneurysms (AAs) and intramural hematomas (IMHs) located in the aortic arch. Study Design and Methods Between April 2014 and September 2017, 23 patients (15 men, mean age 66.0 years) with AAs (n = 12) or IMHs (n = 11) underwent thoracic endovascular aortic repair (TEVAR) with 810 nm ISLF of the arch. The primary outcomes of the safety assessment were the presence of endoleaks, mortality and morbidity, including adverse in situ fenestration‐related, cardiovascular, and cerebral events. Results Technical success was achieved in all cases. Urgent intervention was performed in 15 (65.2%) cases. Left subclavian artery (LSA) ISLF was applied in six patients, LSA and left common carotid artery (LCCA) ISLF in three patients, and total aortic arch vessel ISLF in two patients. One patient suffered minimal stroke after the procedure and recovered without permanent disability to the extremities in 2 weeks. There were no fenestration‐related complications except in one patient with brachial artery access who suffered a hematoma and underwent incision repair at the puncture site. All fenestrations remained patent, and there were no endoleaks during a mean follow‐up of 10.5 ± 5.7 (range: 2–21) months. Conclusions Complete or incomplete endovascular arch reconstruction by ISLF in arch diseases (AAs and IMHs) is feasible and reproducible with safe, effective, and favorable primary results and no need for customized endografts. Lasers Surg. Med. 50:837–843, 2018. © 2018 Wiley Periodicals, Inc.

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Section: Discussionsupporting

confidence: 87%

Endovascular repair of aortic arch intramural hematoma and penetrating ulcers with 810 nm in situ laser‐assisted fenestration: Preliminary results of a single‐center

et al. 2018

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“…The choices of wavelength, energy range, and pulse interval of laser excitation were related to the type and size of the target arteries and graft fabric. 25 Previous researchers have used only 10 W. 30 We suggest that it may be necessary to use 14 to 18W. High laser energy levels can destroy the PTFE and Dacron fabrics completely, which might limit the potential ischemia time to <2 minutes during operations.…”

Section: Discussionmentioning

confidence: 99%

In Situ Laser Fenestration Is a Feasible Method for Revascularization of Aortic Arch During Thoracic Endovascular Aortic Repair

Qin

Zhao

Wang

et al. 2017

JAHA

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BackgroundReconstruction of the aortic major branches during thoracic endovascular aortic repair is complicated because of the complex anatomic configuration and variation of the aortic arch. In situ laser fenestration has shown great potential for the revascularization of aortic branches. This study aims to evaluate the feasibility, effectiveness, and safety of in situ laser fenestration on the three branches of the aortic arch during thoracic endovascular aortic repair.Methods and ResultsBefore clinical application, the polytetrafluoroethylene and Dacron grafts were fenestrated by an 810‐nm laser system ex vivo, which did not damage the bare metal portion of the endografts and created a clean fenestration while maintaining the integrity of the endografts. In vivo, 6 anesthetized female swine survived after this operation, including stent‐graft implantation in the aortic arches, laser fenestration, and conduit implantation through the innominate arteries and the left carotid arteries. Based on the animal experiments, in situ laser fenestration during thoracic endovascular aortic repair was successively performed on 24 patients (aged 33–86 years) with aortic artery diseases (dissection type A: n=4, type B: n=7, aneurysm: n=2, mural thrombus: n=7). Fenestration of 3 aortic branches was performed in 2 (8.3%) patients. Both the left carotid artery and the left subclavian artery were fenestrated in 6 (25%) patients. Only left subclavian artery fenestration surgery was done in 16 (66.7%) patients. Among these patients, 1 fenestration was abandoned secondary to an acute takeoff of the innominate artery in a type III aortic arch. The average operative time was 137±15 minutes. The technical success rate was 95.8% (n=23). No fenestration‐related complications or neurological morbidity occurred after this operation. During a mean postoperative 10‐month follow‐up (range: 2–17 months), 1 patient died of severe pneumonia, and all the left subclavian artery and carotid artery stents were patent with no fenestration‐related endoleaks upon computed tomography angiography images.ConclusionsIn situ laser fenestration is a feasible, effective, rapid, repeatable, and safe option for the reconstruction of aortic arch during thoracic endovascular aortic repair, which might be available to revascularize the 3 branches. However, follow‐up periods should be extended to evaluate the robustness of this technique.

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“…These modalities may create some defects, such as huge trauma, endoleak, extended hospitalization, etc. ISF was first reported by McWilliams et al (13) in year 2004 and has been now indicated as a safe, effective procedure for recanalization of supraaortic arch during TEVAR (14). This technique may be adequate for the fenestration of LCCA in the indicated case.…”

Section: Quick-fenestratermentioning

confidence: 96%

“…It may cause heat injuries to adjacent vessels. Homemade needle, uncontrollable in strength and directional regulation, may also cause harm to surrounding tissue (14). Although current research has indicated that laser or mechanistic needle-guided procedure is effective during ISF for multiple supraaortic arteries (15), the case cohort is small so that the safety of these processes cannot be guaranteed.…”

Section: Quick-fenestratermentioning

confidence: 99%

Single-stage endovascular management of complicated thoracic aorta coarctation concurrent with aortic arch aneurysm using a novel fenestration device

et al. 2018

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To present a case with aorta coarctation complicated by aortic arch aneurysm which is clinical rare and entails a high risk of rupture. Here we reported a 46-year-old female patient diagnosed with aortic arch aneurysm combined with coarctation. The computed tomography angiography shows that an irregular aneurysm was located at the aortic arch site with its maximal diameter 86.55 mm and the right end of aneurysm was located 10 mm away from the ostium of left common carotid artery (LCCA). The aneurysm body invaded the left subclavian artery, and at the distal end of aneurysm a coarctation had been observed with a minimum diameter reaching 2.7 mm. We performed percutaneous balloon angioplasty, thoracic endovascular aortic repair to exclude the aneurysm, and simultaneously used a novel in situ fenestration device (Quick-Fenestrater) to revascularize the covered LCCA. This is first case of using a novel fenestration device single-stage endovascular treatment of complicated thoracic aorta coarctation concurrent with aortic arch aneurysm. Combined endovascular techniques can elevate the success rate of reconstruct complicated aorta aneurysm concurrent with coarctation and reduce complications. Under the guidance of QuickFenestrater, in situ fenestration could be performed with safety and a high success frequency.

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Clinical outcomes and material properties of in situ fenestration of endovascular stent grafts

Cited by 63 publications

References 39 publications

Endovascular repair of aortic arch intramural hematoma and penetrating ulcers with 810 nm in situ laser‐assisted fenestration: Preliminary results of a single‐center

Endovascular repair of aortic arch intramural hematoma and penetrating ulcers with 810 nm in situ laser‐assisted fenestration: Preliminary results of a single‐center

In Situ Laser Fenestration Is a Feasible Method for Revascularization of Aortic Arch During Thoracic Endovascular Aortic Repair

Single-stage endovascular management of complicated thoracic aorta coarctation concurrent with aortic arch aneurysm using a novel fenestration device

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