Comprehensive Review of Physician Modified Aortic Stent Grafts: Technical and Clinical Outcomes

Canonge, Jennifer; Jayet, Jérémie; Heim, Frédéric; Chakfé, Nabil; Coggia, Marc; Coscas, Raphaël; Cochennec, Frédéric

doi:10.1016/j.ejvs.2021.01.019

Cited by 48 publications

(43 citation statements)

References 45 publications

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“…For instance, for abdominal aortic pathologies, the stent graft used was reported in 273 (60%) cases, a strikingly low percentage. (Canonge et al, 2021 ) In a matched cohort of 82 patients with cAAA treated with either CMD or PMEG, Dossabhoy et al reported no difference in perioperative complications, hospital length of stay, type I or III endoleak, or survival between the two devices. The only difference noted involved total fluoroscopy time, contrast volume used, and operative time.…”

Section: Discussionmentioning

confidence: 99%

Clinical application and technical details of cook zenith devices modification to treat urgent and elective complex aortic aneurysms

et al. 2021

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Purpose To describe technical details of modifying four different Cook Zenith devices to treat complex aortic aneurysms. Material In the first three cases, the modification process involved complete stent graft deployment on a sterile back table. Fenestrations were created using an ophthalmologic cautery and reinforced with a radiopaque snare using a double-armed 4–0 Ethibond locking suture based on measurements obtained on centerline of flow. In each instance, a nitinol wire was withdrawn and redirected through and through the fabric and used as a constraining wire. In the fourth patient, modification involved partial stent graft deployment and creation of additional two fenestrations to accommodate renal arteries. The devices are resheathed and implanted in the standard fashion. Results Four patients underwent exclusion of their aneurysms, including thoracoabdominal aneurysms (n = 2), a contained ruptured juxtarenal aneurysm (n = 1), and a ruptured failed previous endovascular repair (n = 1). Fifteen fenestrations were successfully bridged with Atrium iCAST stent grafts. Average graft modification time, operative time, contrast volume, radiation dose, estimated blood loss, and hospital length of stay were 89 min, 155.25 min, 58.8 mL, 2451 mGy, 175 mL, and 4.3 days, respectively. One patient required a secondary intervention to treat a type Ib endoleak. During an average follow-up of 25 months, aneurysm sacs progressively shrank without additional intervention. Conclusion Physician-modified fenestrated/branched endografts are a safe alternative to custom made devices, especially in urgent cases and should be part of the armamentarium of any complex aortic program.

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Section: Discussionmentioning

confidence: 99%

Clinical application and technical details of cook zenith devices modification to treat urgent and elective complex aortic aneurysms

et al. 2021

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“…Note that the PMSGs is a non-standardized technique and the long-term consequences of modifications remain unknown (39).…”

Section: Discussionmentioning

confidence: 99%

“…Research has illustrated the evolution from physicianmodified to company-manufactured fenestrated-branched endografts in the treatment of complex and thoracoabdominal aortic aneurysms (36,39). Through the evolution of devices, BSGs are typically used in multibranched endovascular aortic repairs.…”

Section: Discussionmentioning

confidence: 99%

Hemodynamic Parameters Predict In-stent Thrombosis After Multibranched Endovascular Repair of Complex Abdominal Aortic Aneurysms: A Retrospective Study of Branched Stent-Graft Thrombosis

Liu

Yang

Liu

et al. 2021

Front. Cardiovasc. Med.

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Background: Branch vessel occlusion is reported in endovascular repair of aortic pathology. This study aimed to evaluate the hemodynamic indicators associated with in-stent thrombosis (IST) of a branched stent-graft (BSG) after endovascular aortic repair (EVAR) of a complex abdominal aortic aneurysm.Methods: A retrospective evaluation was performed based on the computed tomography (CT) scans and clinical data of three patients who underwent multi-branched endovascular repair. Patient-specific 3-dimensional models were reconstructed, and hemodynamic analysis was performed for IST. Hemodynamics-related parameters including time-averaged wall shear stress (TAWSS), oscillatory shear stress index (OSI), and relative residence time (RRT) were compared among the individual patients.Results: The flow velocity, TAWSS, OSI, and RRT were radically changed in the area of the IST. In BSGs, IST tended to occur in the regions of hemodynamic alteration near the bends in the device, where a decreased flow velocity (<0.6 m/s) and TAWSS (<0.8 Pa) and an elevated OSI (>0.2) and RRT (>5 s) were consistently observed.Conclusions: Hemodynamic perturbations in BSGs cause a predisposition to IST, which can be predicted by a series of changes in the flow parameters. Early hemodynamic analysis might be useful for identifying and remediating IST after multibranched endovascular repair.

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“…Prinzipiell sind fast alle gebräuchlichen Stentgrafts für die Modifizierung geeignet. In der Regel werden Stentgrafts aus Polyethylenterephthalat verwendet, am weitesten verbreitet ist die Verwendung von Produkten der Zenith Platform (Cook Medical, USA) [18]. An unserem Zentrum verwenden wir Valiant Captivia Closed Web Stentgrafts (Medtronic, USA) [15].…”

Section: Auswahl Der Zu Modifizierenden Stentgraftsunclassified

“…An unserem Zentrum verwenden wir Valiant Captivia Closed Web Stentgrafts (Medtronic, USA) [15]. Auch die Modifikation von Gore Excluder-Prothesen (W. L. Gore & Associates, Inc., USA), Ankura (Lifetech Scientific, China) und anderer Hersteller ist beschrieben [18,19].…”

Section: Auswahl Der Zu Modifizierenden Stentgraftsunclassified

Surgeon-modified Stentgrafts für komplexe Aortenrekonstruktionen – was ist möglich?

et al. 2021

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Zusammenfassung Hintergrund Die enge anatomische Beziehung zu den Viszeralgefäßen macht die Behandlung der komplexen thorakoabdominellen Aortenpathologien zu einer Herausforderung. Im Notfall stehen zu ihrer endovaskulären Behandlung Off-the-Shelf-Prothesen und parallele Techniken zur Verfügung, alternativ kann für komplexe Aortenanatomien die Modifizierung herkömmlicher Stentgrafts durch die behandelnden Chirurginnen und Chirurgen erfolgen, im Sinne eines Surgeon-modified Stentgrafts (SMSG). Ziel der vorliegenden Publikation ist die Darstellung der Möglichkeiten und Ergebnisse, die dieses Verfahren bietet. Ergebnisse Die Planung der Fenestrierungen des SMSG kann mittels manueller Messungen in Centerline of Flow-Rekonstruktionen der aortalen Computertomografie-Angiografie erfolgen. Vereinfacht und standardisiert wird die Planung des SMSG durch die Erstellung von personalisierten 3-D-Aortenmodellen und die Entwicklung von Algorithmen zur automatisierten Ermittlung der idealen Fenestrierungspositionen. Zur Herstellung des SMSG können die meisten zugelassenen Stentgrafts verwendet werden. Für die Anfertigung selbst sind unterschiedliche Techniken beschrieben. Außer der einfachen Fenestrierung ist auch die Erstellung von Mini-Cuffs, Directional Branches und Inner Branches beschrieben, weiterhin die Ergänzung von Diameter reducing Ties und das Vorladen von Führungsdrähten zur Erleichterung der Implantation. Die Behandlung mit SMSG zeigt gute Ergebnisse mit hohen technischen Erfolgsraten um 90–100% und niedriger 30-Tage-Mortalität, vor allem im Vergleich zur offen-chirurgischen Behandlung ähnlicher PatientInnen. Auch die Rate an Endoleaks ist mit 0–14% akzeptabel. Langzeitergebnisse zur Nachhaltigkeit der modifizierten Stentgrafts sind bislang noch nicht verfügbar. Schlussfolgerung Die Surgeon-modified Stentgrafts stellen eine sichere und machbare Ergänzung der Palette endovaskulärer Behandlungsoptionen für PatientInnen mit dringlichen komplexen thorakoabdominellen Aortenpathologien dar. Sie können im Rahmen eines individuellen Heilversuches eingesetzt werden und zeigen in der Literatur vielversprechende Ergebnisse.

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Comprehensive Review of Physician Modified Aortic Stent Grafts: Technical and Clinical Outcomes

Cited by 48 publications

References 45 publications

Clinical application and technical details of cook zenith devices modification to treat urgent and elective complex aortic aneurysms

Clinical application and technical details of cook zenith devices modification to treat urgent and elective complex aortic aneurysms

Hemodynamic Parameters Predict In-stent Thrombosis After Multibranched Endovascular Repair of Complex Abdominal Aortic Aneurysms: A Retrospective Study of Branched Stent-Graft Thrombosis

Surgeon-modified Stentgrafts für komplexe Aortenrekonstruktionen – was ist möglich?

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