Early and Mid-Term Results of Endovascular Aortic Repair Using a Crossed-Limb Technique for Patients with Severely Splayed Iliac Angulation

Yagihashi, Kunihiro; Nishimaki, Hiroshi; Ogawa, Yoshiaki; Chiba, Kiyoshi; Murakami, Kenji; Ro, Daijun; Ono, Hirokuni; Sakurai, Yoshinori; Miyairi, Takeshi; Nakajima, Yasuo

doi:10.3400/avd.oa.16-00135

Cited by 8 publications

(6 citation statements)

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“…The comparison showed an insignificant difference between the two techniques and rendered it safe to use on AAA patients [ 43 ]. Yagihashi et al [ 44 ] reported similar results in another investigation based on the early and midterm results of crosslimb and conventional EVAR techniques. The researchers considered EVAR technique to be safe for the treatment of all AAA cases including the severely splayed iliac angulation [ 44 ].…”

Section: Discussionmentioning

confidence: 63%

Comparative evaluation of ballet-type and conventional stent graft configurations for endovascular aneurysm repair: A CFD analysis

Ashraf

Ambreen

Park

et al. 2021

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PURPOSE: Cross limb stent graft (SG) configuration technique for endovascular aneurysm repair (EVAR) is employed for splayed aortic bifurcations to avoid device kinking and smoothen cannulation. The present study investigates three types of stent graft (SG) configurations for endovascular aneurysm repair (EVAR) in abdominal aortic aneurysm. A computational fluid dynamic analysis was performed on the pulsatile non-Newtonian flow characteristics in three ideally modeled geometries of abdominal aortic (AA) SG configurations. METHODS: The three planar and crosslimb SG configurations were ideally modeled, namely, top-down nonballet-type, top-down ballet-type, and bottom-up nonballet-type configurations. In top-down SG configuration, most of the device is deployed in the main body in the vicinity of renal artery and the limbs are extended to the iliac artery. While in the bottom-up configuration, some of the SG device is deployed in the main body, the limbs are deployed in aortic bifurcation, and the extra stent graft of the main body is extended to the proximal aorta until the below of the renal artery. The effects of non-Newtonian pulsatile flow on the wall stresses and flow patterns of the three models were investigated and compared. Moreover, the average wall shear stress (AWSS), oscillatory shear stress index (OSI), absolute helicity, pressure distribution, graft displacement and flow visualization plots were analyzed. RESULTS: The top-down ballet-type showed less branch blockage effect than the top-down nonballet-type models. Furthermore, the top-down ballet-type configuration showed an increased tendency to sustain high WSS and higher helicity characteristics than that of the bottom-up and top-down non-ballet type configurations. However, displacement forces of the top-down ballet-type configuration were 40%and 9.6%higher than those of the bottom-up and top-down nonballet-type configurations, respectively. CONCLUSIONS: Some complications such as graft tearing, thrombus formation, limb disconnection during long term follow up periods might be relevant to hemodynamic characteristics according to the configurations of EVAR. Hence, the reported data required to be validated with the clinical results.

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Section: Discussionmentioning

confidence: 63%

Comparative evaluation of ballet-type and conventional stent graft configurations for endovascular aneurysm repair: A CFD analysis

Ashraf

Ambreen

Park

et al. 2021

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“…5 Similar results were also observed in a study focusing on patients with severely tortuous iliac arteries. 6 However, both studies were subject to limited sample size, with a maximum of 27 CL patients. Results of the current largest cohort, involving 43 CL and 269 SL patients, indicated comparable outcomes except for a greater risk of type II endoleak (T2EL) in the CL group.…”

Section: Introductionmentioning

confidence: 99%

Editor's Choice – Mid Term Outcomes of Crossed Limb vs. Standard Limb Configuration in Endovascular Abdominal Aortic Aneurysm Repair: A Propensity Score Analysis

Wang

Zhao

et al. 2021

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDSThis cohort study with inverse probability of treatment weighting analyses suggests that endovascular aortic aneurysm repair (EVAR) with crossed limb (CL) configuration is safe and effective in general patients with abdominal aortic aneurysm and may decrease the risk of type IB endoleak in patients with a large aneurysm sac or tortuous iliac arteries. However, the application of the CL technique in patients with a severely angulated neck may be associated with a higher risk of re-intervention due to potential higher risks of adverse limb events.Objective: The aim was to compare mid term outcomes between crossed limb (CL) and standard limb (SL) configuration in patients who underwent endovascular aortic aneurysm repair (EVAR). Methods: This was a comparative cohort study. Eligible patients who underwent EVAR between September 2011 and March 2019 in a tertiary academic centre were included. Inverse probability of treatment weighting (IPTW) was used to balance the demographic, anatomical and operative baseline characteristics between the two groups. The primary outcome was adverse limb events including type IB endoleak (T1BEL), type III endoleak, and limb occlusion. Cox proportional hazards regression and marginal structural model were performed to compare time to event outcomes. Results: The study included 729 patients (194 CL and 535 SL) with a median follow up of 34 months (interquartile range 16 e 62 months). The weighted analyses revealed no significant difference between CL and SL EVAR in terms of adverse limb events, type IA endoleak (T1AEL), type II endoleak (T2EL), re-intervention, and overall survival. In the subgroup analysis of large aneurysm sac, the CL configuration was associated with a significantly decreased risk of T1BEL (hazard ratio [HR] 0.31, 95% confidence interval [CI] 0.12 e 0.78, p ¼ .014). Similar results were also observed in the subgroup of tortuous iliac arteries (HR 0.30, 95% CI 0.11 e 0.81, p ¼ .017). After stratification by severe neck angulation, no significant difference was found between CL and SL EVAR for T1AEL, but the CL configuration was associated with a significantly increased risk of reintervention (HR 2.69, 95% CI 1.31 e 5.51, p ¼ .007). In addition, a trend towards a higher risk of adverse limb events in the CL group with severely angulated proximal neck was observed. Conclusion: CL configuration in EVAR is safe and may be associated with a lower risk of T1BEL in patients with a large aneurysm sac or tortuous iliac arteries. However, it should be applied cautiously to aneurysms with a severely angulated neck due to the potentially higher risk of re-intervention.

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“…However solely deployment of the main body in crossed limb "ballerina" configuration does not decrease time of the cannulation [8,9].…”

Section: Discussionmentioning

confidence: 99%

Improved technique for sheath supported contralateral limb gate cannulation in endovascular abdominal aortic aneurysm repair

Pakeliani

Lachat

Blohmé

et al. 2020

Vasa

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Summary: Background: To present a technique of sheath supported contralateral limb gate (CLG) cannulation of modular bifurcated stent-graft in endovascular abdominal aortic repair. Materials and methods: After totally percutaneous bilateral femoral access, the 9F introducer sheath is exchanged to a 30 cm 12 fr introducer sheath over a stiff wire contralateral to the intended main stent-graft insertion side and advanced into the aorta below the lowest renal artery. Parallel to the stiff wire within the sheath an additional standard J-tip guidewire with a 5 fr Pigtail angiographic catheter is advanced to the level of the renal arteries. After main body deployment, the 12 fr introducer sheath and J-tip wire with pigtail catheter are retracted until the CLG opening level, maintaining the stiff “buddy” wire in position to support the 12 fr sheath, maintaining its distal opening close to the contralateral gate opening to achieve easy cannulation. Results: Retrospective analysis of video archive from July 2016 to February 2018 evidenced 55 recorded EVAR cases. All CLG cannulations were obtained with Standard J-tip or Terumo Glidewire wires and with Pig-Tail or Berenstein catheters. Technical success was 100 %. Mean fluoroscopy time to accomplish CLG cannulation was 37.6 33 (range 1–105) seconds. The aortic carrefour angulation on coronal axis strongly correlates with cannulation time p = <.001, with longer cannulation time for higher carrefour angulations on coronal axis (Pearson correlation coefficient 0.47). Conclusions: The use of 12 fr sheath with parallel wire introduction technique, appears to be a safe and reliable tool to facilitate CLG cannulation during EVAR procedures.

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Early and Mid-Term Results of Endovascular Aortic Repair Using a Crossed-Limb Technique for Patients with Severely Splayed Iliac Angulation

Cited by 8 publications

References 10 publications

Comparative evaluation of ballet-type and conventional stent graft configurations for endovascular aneurysm repair: A CFD analysis

Comparative evaluation of ballet-type and conventional stent graft configurations for endovascular aneurysm repair: A CFD analysis

Editor's Choice – Mid Term Outcomes of Crossed Limb vs. Standard Limb Configuration in Endovascular Abdominal Aortic Aneurysm Repair: A Propensity Score Analysis

Improved technique for sheath supported contralateral limb gate cannulation in endovascular abdominal aortic aneurysm repair

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