EndoAnchors Minimize Endoleaks in Chimney-Graft Endovascular Repair of Juxtarenal Abdominal Aortic Aneurysms

Galiñanes, Edgar Luis; Hernandez-Vila, Eduardo A.; Krajcer, Zvonimir

doi:10.14503/thij-17-6520

Cited by 7 publications

(6 citation statements)

References 11 publications

(10 reference statements)

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“…Other authors describe the endoachors use in primary ch-EVAR to close gutters, deploying them sorrounding visceral stents with techincal success. 9 These data supported our choice using this unique combined technique.…”

Section: Discussionsupporting

confidence: 55%

Chimney technique with endoanchors in treatment of late type 1a endoleak after endovascular aortic repair

Gatta

Pagliariccio

Schiavon

et al. 2020

SAGE Open Medical Case Reports

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The late type Ia endoleak after endovascular aortic repair could be a challenging issue. Over the last years, in case of short or enlarged neck, fenestrated and branched stent grafts have been increasingly employed with improving results. However, these devices have limited use in urgent/emergent cases as custom graft manufacturing takes long time, and may not be fit in patients with particular anatomic features. In this setting, chimney and relining remain an alternative but sometimes may not be adequate. According to literature, the use of the endoanchors associated to chimney technique can improve the procedure results in primary endovascular aortic repair. We treated two patients with a late type Ia endoleak after endovascular aortic repair with a simultaneous relining, single renal chimney, and endoanchors implant. These patients were valuated unfit for open repair with neck configuration unadapt for a simple relining, ballooning, or stenting. The patient conditions were unfavorable for an endovascular repair with branched endovascular aortic repair–fenestrated endovascular aortic repair. The same procedure was performed in both patients. Postoperative angio-computed tomographic scan demonstrated the resolution of the endoleak with patency of renal graft. Our preliminary experience, in these selected cases, demonstrate the feasibility of the technique in late type Ia endoleak.

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Section: Discussionsupporting

confidence: 55%

Chimney technique with endoanchors in treatment of late type 1a endoleak after endovascular aortic repair

Gatta

Pagliariccio

Schiavon

et al. 2020

SAGE Open Medical Case Reports

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“… 13 Endoanchors reduce early and late endoleaks by affixing the aortic stent grafts firmly to the native aortic wall. 14 Indications for use comprise primary implantation to secure the proximal or distal landing zone, in case of unfavorable anatomy or intra-operative endoleak or suboptimal apposition to the aortic wall, as well as secondary use for the treatment of endoleaks and stent-graft migration often in conjunction with a proximal or distal extension of the stent graft. 13 In our case, the aim of endoanchors was to fix the second cuff with first implanted graft.…”

Section: Discussionmentioning

confidence: 99%

An unusual complication after endovascular aneurysm repair for giant abdominal aortic aneurysm with aortocaval fistula: High bilirubin levels

Marchetti

Oddi

Diotallevi

et al. 2020

SAGE Open Medical Case Reports

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Abdominal aortic aneurysm has among its rare complications the aortocaval fistula. It is observed in less than 1% of all abdominal aortic aneurysms and represents 3%–7% of clinical presentation in case of rupture. A male patient was presented to the emergency department with pulsating mass with continuous vascular systo-diastolic bruit, located in the lower part of abdomen with the back pain radiating anteriorly in lower abdomen. After diagnosis of abdominal aortic aneurysm with aortocaval fistula, a trimodular Endurant endograft was placed. Migration of the endoprosthesis was treated with Endoanchor and endovascular aneurysm sealing device. In the postoperative course, the patient had jaundice due to high bilirubin levels, cholestasis and increased hepatocyte cytolysis: aspartate aminotransferase and alanine aminotransferase. The treatment with appropriate continuous filtration rapidly reduced bilirubin values and the patient gradually improved.

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“… 19 Use of EndoAnchors (Medtronic), endovascular stiches with helical screws, is also suggested to decrease gutter leak. 20 Bannazadeh and colleagues 21 also reported that oversizing should be adjusted by number of chimney grafts. They recommend use of 20% oversizing for the main graft when <2 chimney grafts are used and 30% oversizing for 3 chimney grafts.…”

Section: Endovascular Taaa Repair With Chimney/parallel Graftsmentioning

confidence: 99%

Total abdominal debranching hybrid thoracoabdominal aortic aneurysm repair versus chimneys and snorkels

2021

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Open thoracoabdominal aortic aneurysm (TAAA) repair remains a surgical challenge. Hybrid and total endovascular repair have emerged as alternatives in treating TAAA. Total endovascular TAAA repair may be best performed with branched/ fenestrated stent grafts. However, these technologies are not yet widely available. Thus, currently total endovascular TAAA repair using the chimney/snorkel techniques is considered a viable option in many centers.In this article, we briefly review 2 readily available techniques with off-the-shelf devices, hybrid procedure using total abdominal debranching, and total endovascular repair using chimney/snorkel procedures. The hybrid TAAA repair avoids thoracotomy but requires laparotomy and carries high morbidity and mortality (eg, operative mortality, 4%-26% and renal failure, 4%-26%), comparable to traditional open repair. The staged hybrid approach has been proposed to minimize the invasiveness of the procedure, whereas the associated risk of interval aortic deaths is not negligible. Total endovascular repair reduces the morbidity and mortality after TAAA repair (eg, operative mortality, 3%-20% and renal failure, 0%-20%). However, it is technically demanding and the risks of future reinterventions-and need for repetitive surveillance-is inevitable (eg, immediate type I endoleak, 7%-16% and 1-year branch patency, 93%-98%). Currently, there are not enough data to determine which less-invasive option for open repair in patients with TAAA is superior. These alternatives should complement each other and be applied to carefully selected populations as a part of the overall toolbox in treating TAAA. (JTCVS Techniques 2021-:1-6) Illustration of the sandwich technique. CENTRAL MESSAGEMore data are required to determine the best option for open TAAA repair. Options should complement one another and be applied to selected populations as a part of the overall toolbox to treat TAAA. See Commentary on page XXX.Video clip is available online. BACKGROUNDOpen thoracoabdominal aortic aneurysm (TAAA) repair remains among the most difficult surgical challenges due to the associated vital structures, such as visceral/renal branches and segmental arteries involved in the lesion. Recent reports from large-volume aortic centers demonstrate operative mortality after open TAAA repairs in young patients (younger than age 50 years) is 3% to 6%. 1,2 However, despite the evolution in surgical techniques and perioperative care, mortality in older patients remains 8% to 17%, even in experienced hands. 1,2 Hybrid procedures, which combine open and endovascular techniques, to treat TAAA has been proposed 3 to minimize the surgical insults and improve outcomes, especially in high-risk patients. Another alternative approach to traditional open repair is total endovascular repair with visceral parallel graft (chimney/snorkel) techniques using off-the-shelf devices. Further, physicianmodified, multibranched stent graft was introduced in 2001, 4 and now off-the-shelf and custom-made branched/fenestrated stent grafts to t...

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EndoAnchors Minimize Endoleaks in Chimney-Graft Endovascular Repair of Juxtarenal Abdominal Aortic Aneurysms

Cited by 7 publications

References 11 publications

Chimney technique with endoanchors in treatment of late type 1a endoleak after endovascular aortic repair

Chimney technique with endoanchors in treatment of late type 1a endoleak after endovascular aortic repair

An unusual complication after endovascular aneurysm repair for giant abdominal aortic aneurysm with aortocaval fistula: High bilirubin levels

Total abdominal debranching hybrid thoracoabdominal aortic aneurysm repair versus chimneys and snorkels

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