Current results of balloon expandable visceral stent-grafts in fenestrated endografting

Abstract

INTRODUCTION: endovascular repair of thoracoabdominal and juxtarenal aortic aneurysm has recently become a valuable alternative to open surgery especially in high-risk patients.Progressive improvements in graft materials and low-profile devices allow treatment of complex aneurysms even in adverse anatomical settings. However, all published experiences report risks of occlusion and reinterventions due to visceral stent-graft failures in the long term. The purpose of this systematic review is to analyze the results of currently used balloon expandable bridging stent-grafts and to evaluate the newest developments for FEVAR in juxtarenal endovascular repair. EVIDENCE ACQUISITION: data were retrieved from retrospective analyses, case series and case reports conducted from 2000 to September 2019. EVIDENCE SYNTHESIS: the literature analysis provided a list of the most commonly used balloon-expandable bridging stent-grafts for FEVAR. For each stent-graft a brief summary of structural characteristics and performances have been described. No Randomised Controlled Trials (RCTs) or comparative data between the stent-grafts are available for this specific topic. CONCLUSIONS: so far, several balloon-expandable stent-grafts have been used as bridging stents during FEVAR but the ideal bridging stent-graft is far to be designed. The better understanding of the system FEVAR-native aorta and the strict collaboration and exchange of expertise between physicians and engineers are mandatory in order to increase the performances of these important components and to reduce re-interventions and complications in FEVAR.

Physician-modified fenestrated Navion endograft for the treatment of a symptomatic postdissection thoracoabdominal aneurysm

“…12 BeGrafts have been chosen as bridging stent grafts for their low profile and the wide range of available lengths. 13 Residual type IIIc endoleak, decreased after first relining and then left untreated, may have occurred because fenestrations had been designed too large to decrease the risk of misalignment and failure to cannulate, but insufficient flaring of the mating stent graft was then not able to cope with the gap between the aortic and the visceral components. The procedure was, however, successful in promoting a false lumen thrombosis in the thoracic portion of the fissured TAAA, with a successful clinical result.…”

Fatigue Resistance of the Advanta V12/iCast and Viabahn Balloon-Expandable Stent-Graft as Bridging Stents in Experimental Fenestrated Endografting

“…The stent is fully encapsulated in the fluoropolymer and the inner surface is covered with a stable, covalently bound bioactive heparin of porcine origin. 2,11,15 The Advanta V12 (Getinge) endoprosthesis is a balloon-expandable stent-graft. It is characterized by a stainless-steel stent encapsulated in an ultrathin PTFE fabric.…”

“…Gore Inc, Flagstaff, AZ, USA) stent-graft has been introduced, with the potential to be used as bridging stent for fenestrated endografting. 10–13 In vitro studies have demonstrated an excellent impermeability and resistance to pull-out and shear forces in a fenestrated graft model. 9,14 However, fracture resistance to cyclic movement/loading over the time has not been evaluated so far.…”

Mid-Term Outcomes of Complex Endografting for Chronic Post-Dissection Thoracoabdominal Aortic Aneurysms

“…Visceral stent-grafts in different configurations (balloon expandable or self-expanding stent-grafts, eventually re-enforced by bare metal stents) were chosen in each dingle case depending on the vessel anatomy. Usually balloon expandable stent-graft was used for fenestrations (Advanta V12, Getinge; BeGraft, Bentley InnoMed) and self-expanding stent was used for branches (Fluency, Bard) [19]. Target vessels were engaged from a femoral access in case of fenestrations, while a brachial approach was used for branches.…”