Early Results of Physician Modified Fenestrated Stent Grafts for the Treatment of Thoraco-abdominal Aortic Aneurysms

Cochennec, Frédéric; Kobeiter, Hicham; Gohel, M.S.; Leopardi, Marco; Raux, Maxime; Majewski, Marek; Desgranges, Pascal; Allaire, Éric; Becquemin, J. P.

doi:10.1016/j.ejvs.2015.07.002

Cited by 38 publications

(9 citation statements)

References 38 publications

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“…Furthermore, such modified thoracic stent-grafts can also be used to preserve flow into the LCCA or the innominate artery if the more distal arch branches are revascularized by other means, such as bypass surgery. Some centers have reported good short-term results for juxta- and suprarenal aneurysms, 9,10 but there are no data on their applicability for aortic arch lesions. Moreover, there are concerns regarding feasibility and durability.…”

Section: Introductionmentioning

confidence: 99%

Physician-Modified Thoracic Stent-Grafts for the Treatment of Aortic Arch Lesions

et al. 2017

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Section: Introductionmentioning

confidence: 99%

Physician-Modified Thoracic Stent-Grafts for the Treatment of Aortic Arch Lesions

et al. 2017

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“…It is the first-line option in fit patients but is associated with appreciable procedure-related risks 9 . In circumstances of urgency (symptomatic or very large aneurysms), treatment options include chimney EVAR, 14 in situ laser fenestrations, 15 physician-modified endografts, 16 and use of off-the-shelf endografts such as the t-Branch endograft 17 …”

Section: Discussionmentioning

confidence: 99%

Consecutive failing proximal landing zones

Bosse

Houérou

Soler

et al. 2019

Journal of Vascular Surgery Cases, Innovations and Techniques

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We report the case of a 77-year-old man who presented with successive aortic aneurysms during a 12-year period. He was first treated in 2006 for an abdominal aortic aneurysm with a bifurcated endograft, then in 2016 for a tender type IV thoracoabdominal aortic aneurysm with a proximal aortic cuff with in situ laser fenestrations. He presented in 2018 with a 9-cm distal thoracic aorta aneurysm managed by an off-the-shelf t-Branch endograft (Cook Medical, Bloomington, Ind). The perioperative course was uneventful, and 6-month follow-up computed tomography scan has shown freedom from endoleaks and branch patency. This case illustrates that apparently "healthy" aortic necks can degenerate after endovascular aneurysm repair.

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“…Detailed planning and sizing steps, device preparation, and stent graft implantation were described in a previous publication from our group. 12 For target vessel stenting, Advanta V12 balloonexpandable covered stents (Maquet, Rastatt, Germany) were used in both groups as bridging stents from 2012 to early 2015. Each stent was flared using Mustang 10-mm Â 2-cm or 12-mm Â 2-cm balloons (Boston Scientific, Marlborough, Mass).…”

Section: Study Population and Technical Featuresmentioning

confidence: 99%

Intraoperative adverse events and early outcomes of custom-made fenestrated stent grafts and physician-modified stent grafts for complex aortic aneurysms

Sénémaud

Abdallah

Boissieu

et al. 2020

Journal of Vascular Surgery

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Objective: Physician-modified fenestrated stent grafts (PMSGs) are a useful option for urgent or semiurgent treatment of complex abdominal aortic aneurysms (CAAAs). The aim of this study was to describe in-hospital outcomes of custommade fenestrated stent grafts (CMSGs) and PMSGs for the treatment of CAAAs and thoracoabdominal aortic aneurysms (TAAAs).Methods: In this single-center, retrospective study, all consecutives patients with CAAAs or TAAAs undergoing endovascular repair using Zenith CMSGs (Cook Medical, Bloomington, Ind) or PMSGs between January 2012 and November 2017 were included. End points were intraoperative adverse events, in-hospital mortality, postoperative complications, reinterventions, target vessel patency, and endoleaks.Results: Ninety-seven patients were included (CMSGs, n ¼ 69; PMSGs, n ¼ 28). The PMSG group included more patients assigned to American Society of Anesthesiologists class 4 (n ¼ 14 [50%] vs n ¼ 16 [23%]; P ¼ .006) and more TAAAs (n ¼ 17 [61%] vs n ¼ 10 [15%]; P < .0001). Intraoperative adverse events were recorded in eight (11%) patients in the CMSG group vs six (21%) patients in the PMSG group. No intraoperative death or open conversion occurred. In-hospital mortality rates were of 4% (n ¼ 3) in the CMSG group and 14% in the PMSG group (n ¼ 4). Chronic renal failure was an independent preoperative risk factor of postoperative death or complications (odds ratio, 4.88; 95% confidence interval, 1.65-14.43; P ¼ .004). Rates of postoperative complications were 22% (n ¼ 15) and 25% (n ¼ 7) in the CMSG and PMSG groups. Spinal cord ischemia rates were 4% (n ¼ 3) and 7% (n ¼ 2) in the CMSG and PMSG groups. Reintervention rates were 16% (n ¼ 11) in the CMSG group and 32% (n ¼ 9) in the PMSG group. At discharge, target vessel patency rate in CMSGs was 98% (n ¼ 207/210). All target vessels (n ¼ 98) were patent in the PMSG group. Endoleaks at discharge were observed in 24% of the CMSG group (n ¼ 16) vs 8% of the PMSG group (n ¼ 2). Conclusions:Our study showed clinically relevant differences of several important in-hospital outcomes in the CMSG and PMSG groups. Larger cohorts and longer follow-up are needed to allow direct comparison. PMSGs may offer acceptable in-hospital results in patients requiring urgent interventions when CMSGs are not available or possible. (J Vasc Surg 2019;-:1-9.)

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Early Results of Physician Modified Fenestrated Stent Grafts for the Treatment of Thoraco-abdominal Aortic Aneurysms

Abstract: PMSGs provided acceptable short-term results and may be a management option for the treatment of TAAA in selected high risk patients. Durability concerns need to be assessed in additional studies with long-term follow up.

Cited by 38 publications

References 38 publications

Physician-Modified Thoracic Stent-Grafts for the Treatment of Aortic Arch Lesions

Physician-Modified Thoracic Stent-Grafts for the Treatment of Aortic Arch Lesions

Consecutive failing proximal landing zones

Intraoperative adverse events and early outcomes of custom-made fenestrated stent grafts and physician-modified stent grafts for complex aortic aneurysms

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