Complications and Bail-Out Situations during AAA Endovascular Repair

Overbeck, Klaus; Jackson, Ralph; Rose, John

doi:10.1053/j.tvir.2005.03.013

Cited by 8 publications

(7 citation statements)

References 12 publications

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“…18 The other 4 (2.6%) patients had an aortomonoiliac stent-graft system implanted via bilateral surgical exposure of the femoral arteries; a femorofemoral crossover bypass was performed to complete the procedure. Mean oversizing of the main body with respect to the proximal neck diameter was 18.4% (range [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]. In aneurysms with a neck ,5 mm, a ''chimney'' technique was used to implant one or more covered stents (Advanta V12; Atrium Medical, Hudson, NH, USA).…”

Section: Stent-graft Proceduresmentioning

confidence: 99%

Endurant Stent-Graft: A 2-Year, Single-Center Experience With a New Commercially Available Device for the Treatment of Abdominal Aortic Aneurysms

Troisi

Torsello

Donas

et al. 2010

Journal of Endovascular Therapy

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Section: Stent-graft Proceduresmentioning

confidence: 99%

Endurant Stent-Graft: A 2-Year, Single-Center Experience With a New Commercially Available Device for the Treatment of Abdominal Aortic Aneurysms

Troisi

Torsello

Donas

et al. 2010

Journal of Endovascular Therapy

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“…Then, another guidewire is inserted (cannulated) into the graft main body for the deployment of the contralateral (opposite) iliac graft limb. When a patient has significant aortic neck angulation or widely splayed common iliac arteries (CIAs), cannulation can become difficult and time consuming [1,2]. Successful cannulation can take up to 41 minutes and is currently an operative bottleneck in emergency EVAR [3].…”

Section: Introductionmentioning

confidence: 99%

Computational Fluid Dynamics Evaluation of the Cross-Limb Stent Graft Configuration for Endovascular Aneurysm Repair

Shek

Tse

Nabovati³

et al. 2012

Journal of Biomechanical Engineering

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The technique of crossing the limbs of bifurcated modular stent grafts for endovascular aneurysm repair (EVAR) is often employed in the face of splayed aortic bifurcations to facilitate cannulation and prevent device kinking. However, little has been reported about the implications of cross-limb EVAR, especially in comparison to conventional EVAR. Previous computational fluid dynamics studies of conventional EVAR grafts have mostly utilized simplified planar stent graft geometries. We herein examined the differences between conventional and cross-limb EVAR by comparing their hemodynamic flow fields (i.e., in the "direct" and "cross" configurations, respectively). We also added a "planar" configuration, which is commonly found in the literature, to identify how well this configuration compares to out-of-plane stent graft configurations from a hemodynamic perspective. A representative patient's cross-limb stent graft geometry was segmented using computed tomography imaging in Mimics software. The cross-limb graft geometry was used to build its direct and planar counterparts in SolidWorks. Physiologic velocity and mass flow boundary conditions and blood properties were implemented for steady-state and pulsatile transient simulations in ANSYS CFX. Displacement forces, wall shear stress (WSS), and oscillatory shear index (OSI) were all comparable between the direct and cross configurations, whereas the planar geometry yielded very different predictions of hemodynamics compared to the out-of-plane stent graft configurations, particularly for displacement forces. This single-patient study suggests that the short-term hemodynamics involved in crossing the limbs is as safe as conventional EVAR. Higher helicity and improved WSS distribution of the cross-limb configuration suggest improved flow-related thrombosis resistance in the short term. However, there may be long-term fatigue implications to stent graft use in the cross configuration when compared to the direct configuration.

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“…[8][9][10] The utilization of this particular pull-down technique in barbed grafts with uncovered, suprarenal fixation such as the Zenith device, is considered high risk for aortic transection and is also discouraged by some authors as technically unfeasible. Overbeck et al 7 reported that once released, the Zenith endograft is virtually irretrievable. On the contrary, the authors did not note any difficulty in adjusting the main body device which was successfully positioned below the level of the renal arteries, without any immediate complications.…”

Section: Discussionmentioning

confidence: 99%

“…The potential solutions include traction of the introduction system in cases in which the device is not fully deployed, stenting of the renal artery ostium, pull down of the graft using balloon catheters or the ‘lasso technique’ and conversion into open repair. 7,8 The term ‘lasso technique’ is used to describe the tugging of the graft using a guidewire positioned across the bifurcation of the graft. Although this technique has been previously reported, no data are available regarding its applicability in cases where a device with suprarenal fixation stent and anchoring barbs has been used.…”

Section: Introductionmentioning

confidence: 99%

First application of the ‘lasso technique’ on an endograft with suprarenal fixation stent

et al. 2013

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The authors report the use of the ‘lasso technique’ for the preservation of bilateral renal artery patency, following the intraoperative proximal migration of an aortic endograft with suprarenal bare metal fixation and anchoring barbs, due to device delivery failure.During an emergency endovascular repair of a ruptured mycotic abdominal aortic aneurysm using the Zenith Flex device, the main body of the graft migrated proximally to cover both renal arteries. Attempts to pull down the graft using balloons were not effective.Finally, the ‘lasso technique’ using a guidewire over the aortic bifurcation was employed and successfully adjusted the graft below the level of the renal arteries. No procedure-related complications were noted. The endovascular repair was used as a bridging procedure and two months following the primary endovascular procedure, open surgical repair of the infected aneurysm with excision of the stent graft was performed. The patient is alive after eight months follow-up.

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Complications and Bail-Out Situations during AAA Endovascular Repair

Cited by 8 publications

References 12 publications

Endurant Stent-Graft: A 2-Year, Single-Center Experience With a New Commercially Available Device for the Treatment of Abdominal Aortic Aneurysms

Endurant Stent-Graft: A 2-Year, Single-Center Experience With a New Commercially Available Device for the Treatment of Abdominal Aortic Aneurysms

Computational Fluid Dynamics Evaluation of the Cross-Limb Stent Graft Configuration for Endovascular Aneurysm Repair

First application of the ‘lasso technique’ on an endograft with suprarenal fixation stent

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