Custom-Made Endograft for Endovascular Repair of Thoraco-Abdominal Aneurysm and Type B Dissection: Single-Centre Experience

Lucatelli, Pierleone; Cini, Marco; Benvenuti, Antonio; Saba, Luca; Tommasino, Giulio; Guaccio, Giulia; Munneke, Graham; Neri, Eugénio; Ricci, Carmelo

doi:10.1007/s00270-018-1975-3

Cited by 18 publications

(9 citation statements)

References 26 publications

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“…None of the studies directly compared open and endovascular repair. 2,[11][12][13][14][15][16][17][18][19][20][21][22][23][24] An article quality evaluation is provided in Supplementary Table III (online only), with an aggregate score range of 8 to 11 out of 14. However, it must be considered that, owing to the low incidence of pD-TAAA none of the articles performed sample size calculation, therefore no points were scored in this category.…”

Section: Resultsmentioning

confidence: 99%

Proportional meta-analysis of open surgery or fenestrated endograft repair for postdissection thoracoabdominal aneurysms

Verzini

Gibello

Varetto

et al. 2021

Journal of Vascular Surgery

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Objective: To determine outcomes of postdissection thoracoabdominal aneurysms by either open or endovascular repair with fenestrated or branched endografts.Methods: A systematic review was conducted for open or endovascular repair of postdissection thoracoabdominal aneurysms, between January 2009 and February 2020. A meta-analysis was performed for postoperative complications and both early and late mortality and reinterventions.Results: Fifteen noncomparative studies (eight endovascular repair and seven open repair) were suitable for metaanalysis. Overall, 1337 patients were included, 1068 in the open repair group (73% male; mean age 58 years) and 269 in the endovascular repair group (79% male; mean age 65 years). The 30-day mortality was 6% for open repair vs 3% for endovascular repair (P ¼ .35), whereas the 30-day reintervention rate was 3% for open repair vs 1% for endovascular repair (P ¼ .66). The only significant difference was reported for 30-day respiratory complication rate (30% open repair vs 2% endovascular repair; P < .01). The incidence of spinal cord ischemia was 9% for open repair vs 8% for endovascular repair (P ¼ .95). The mean follow-up was 44 months: 48 months (range, 10-72 months) after open repair and 17 months (range, 12-25 months) after endovascular repair (P < .01). Late aortic reinterventions were more frequent after endovascular repair (11% vs 32%; P < .001). The late overall mortality rate was 19% for open repair vs 7% for endovascular repair (P ¼ .08), whereas aortic-related mortality was 7% for open repair vs 3% for endovascular repair (P ¼ .22).Conclusions: In the absence of comparative studies, this meta-analysis showed that endovascular repair seems to be a viable alternative for patients unfit for open repair.

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Section: Resultsmentioning

confidence: 99%

Proportional meta-analysis of open surgery or fenestrated endograft repair for postdissection thoracoabdominal aneurysms

Verzini

Gibello

Varetto

et al. 2021

Journal of Vascular Surgery

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“…Full technical details have been described in a previous report. 14 The technique differs with regard to the underlying pathology, dissection, or aneurysm. In dissected patients stent grafts were positioned into the true lumen only in those cases that showed favorable anatomical conditions (ie, visceral arteries arising from the true lumen) or to relieve dynamic compression of the true lumen.…”

Section: Methodsmentioning

confidence: 99%

Arch replacement with collared elephant trunks: The Siena approach

et al. 2021

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Objective: To illustrate our experience and results in patients with diffuse aneurysmal disease treated with arch replacement using the Siena collared graft, a device designed in 2002 to improve the elephant trunk technique. Results of the first step surgical implant and the subsequent treatment strategies, with extensive use of endovascular techniques, are reported.Methods: All aortic arch-replacement procedures using the Siena graft between February 2002 and January 2020 were retrospectively analyzed for early and late clinical outcomes.Results: Of 146 patients (54 women, 36.9%) with a median age of 69.1 years (interquartile range 58.4-75.0 years), 55 (37.6%) had acute/chronic dissection with false lumen aneurysmal dilatation, 91 (62.3%) had degenerative aneurysms, 45 (30.8%) were redo operations, and 14 (9.5%) had connective tissue disease. First-stage outcomes: 10.9% 30-day mortality (n ¼ 16); 5.4% stroke (n ¼ 8, 6 disabling, 2 nondisabling; 3 fatal); and 0.6% paraplegia. Outcomes for 113 second-stage procedures (77.3%, n ¼ 97 endovascular [66.4%], n ¼ 16 surgical [10.9%]) were 5.3% and 8.8% 30-day and 180-day mortality; no stroke; 10.6% paraplegia. Median followup was 5.7 years (range: 0-18.02 years) median survival was 16.65 years (95% lower confidence limit, 10.06 years) with no significant difference between aneurysm and dissection patients. Freedom from further treatment was 87.0% (95% confidence interval, 79.9%-94.7%) at 5 years and 71.4% (95% confidence interval, 71.4%-84.7%) at 10 years; median time to reintervention was 2.59 years (interquartile range, 0.52-5.20 years) with no difference (P ¼ .22) between dissection and aneurysm groups.Conclusions: Siena collared graft represents a reliable platform for the treatment of diffuse aneurysmal disease. This device offers the flexibility required in the treatment of extended aortic lesions and guarantees the choice of the most appropriate approach for treatment completion. In this context, the availability of hybrid grafts has not modified the role of this device in arch surgery. (JTCVS Techniques 2021;6:13-27) Three steps of a "delayed frozen" elephant trunk approach.

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“…A study from 2018 involved 49 patients who underwent custom stent-graft implantation due to thoraco-abdominal aneurysm. The mean intervention duration was 330 ± 120 min [30]. That is higher than the majority of the studies included in this systematic review, except Tong et al (336 ± 72min) [29].…”

Section: The Reference To Custom-made Stent Grafts and Conventional Pmsgmentioning

confidence: 58%

“…Taking into consideration the fluoroscopy time (79 ± 34 min), it was also higher than some of the trials, e.g., Branzan et al (55 min ranged 17-99 min). There was also a difference in the volumes administered at 212 ± 93 mL (Lucatelli et al) vs. 77.7 ± 34.9 mL (Branzan et al) [19,30]. It is noteworthy to highlight that those times and volumes in custom graft trials can be higher due to the complexity of the repair and it can also be the reason for higher 30-day mortality (10.2%) [30].…”

Section: The Reference To Custom-made Stent Grafts and Conventional Pmsgmentioning

confidence: 98%

The Utility of Three-Dimensional Printing in Physician-Modified Stent Grafts for Aortic Lesions Repair

Zasada,

Stępak,

Węglewska

et al. 2024

JCM

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Background: Three-dimensional (3D) printing is becoming increasingly popular around the world not only in engineering but also in the medical industry. This trend is visible, especially in aortic modeling for both training and treatment purposes. As a result of advancements in 3D technology, patients can be offered personalized treatment of aortic lesions via physician-modified stent grafts (PMSG), which can be tailored to the specific vascular conditions of the patient. The objective of this systematic review was to investigate the utility of 3D printing in PMSG in aortic lesion repair by examining procedure time and complications. Methods: The systematic review has been performed using the PRISMA 2020 Checklist and PRISMA 2020 flow diagram and following the Cochrane Handbook. The systematic review has been registered in the International Prospective Register of Systematic Reviews: CRD42024526950. Results: Five studies with a total number of 172 patients were included in the final review. The mean operation time was 249.95± 70.03 min, and the mean modification time was 65.38 ± 10.59 min. The analysis of the results indicated I2 of 99% and 100% indicating high heterogeneity among studies. The bias assessment indicated the moderate quality of the included research. Conclusions: The noticeable variance in the reviewed studies’ results marks the need for larger randomized trials as clinical results of 3D printing in PMSG have great potential for patients with aortic lesions in both elective and urgent procedures.

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Custom-Made Endograft for Endovascular Repair of Thoraco-Abdominal Aneurysm and Type B Dissection: Single-Centre Experience

Abstract: The results of the Jotec endograft are comparable to other devices, with acceptable complication and re-intervention rates. Fenestration and inner-branch should be preferred due to lower re-intervention rates.

Cited by 18 publications

References 26 publications

Proportional meta-analysis of open surgery or fenestrated endograft repair for postdissection thoracoabdominal aneurysms

Proportional meta-analysis of open surgery or fenestrated endograft repair for postdissection thoracoabdominal aneurysms

Arch replacement with collared elephant trunks: The Siena approach

The Utility of Three-Dimensional Printing in Physician-Modified Stent Grafts for Aortic Lesions Repair

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