EndoAnchors to Resolve Persistent Type Ia Endoleak Secondary to Proximal Cuff With Parallel Graft Placement

Donselaar, Esmé J.; Vijver-Coppen, Rozemarijn J. van der; Ham, Leo H. van den; Lardenoye, Jan Willem H. P.; Reijnen, Michel M.P.J.

doi:10.1177/1526602815621920

Cited by 17 publications

(19 citation statements)

References 15 publications

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“…Others have reported success with coil or glue embolization of the gutters 7,9,14 and use of Aptus Heli-FX EndoAnchors (Medtronic Cardiovascular). 15 Our early type Ia endoleak-associated reintervention rate of 3.3% is also consistent with the 0-12.5% rate cited in the literature. 2,5–8 …”

Section: Discussionsupporting

confidence: 91%

Natural history of gutter-related type Ia endoleaks after snorkel/chimney endovascular aneurysm repair

Ullery

Tran

Itoga

et al. 2017

Journal of Vascular Surgery

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Objective Alternative endovascular strategies utilizing parallel or snorkel/chimney (ch-EVAR) techniques have been developed to address the lack of widespread availability and manufacturing limitations with branched/fenestrated aortic devices for the treatment of complex abdominal aortic aneurysms. Despite high technical success and mid-term patency of snorkel stent configurations, concerns remain regarding the perceived increased incidence of early gutter-related type Ia endoleaks. We aimed to evaluate the incidence and natural history of gutter-related type Ia endoleaks following ch-EVAR. Methods Review of medical records and available imaging studies, including completion angiography and serial computed tomographic angiography, was performed for all patients undergoing ch-EVAR at our institution between September 2009 and January 2015. Only procedures involving ≥1 renal artery with or without visceral snorkel stents were included. Primary outcomes of the study were presence and persistence or resolution of early gutter-related type Ia endoleak. Secondary outcomes included aneurysm sac shrinkage and need for secondary intervention related to the presence of type Ia gutter endoleak. Results Sixty patients (mean age, 75.8 ± 7.6 years; male, 70.0%) underwent ch-EVAR with a total of 111 snorkel stents (97 renal [33 bilateral renal], 12 SMA, 2 celiac). A median of 2 (range, 1-4) snorkel stents were placed per patient. Early gutter-related type Ia endoleaks were noted on 30.0% (n=18) of initial postoperative imaging studies. Follow-up imaging revealed spontaneous resolution of these gutter endoleaks in 47.3% and 71.8% of patients at 6- and 12 months post-procedure, respectively. Long-term anticoagulation, degree of oversizing, stent type and diameter, and other clinical/anatomic variables were not significantly associated with presence of gutter endoleaks. Two patients (3.3%) required secondary intervention related to persistent gutter endoleak. At a mean radiologic follow-up of 20.1 months, no difference in mean aneurysm sac size change was observed between those with or without early type Ia gutter endoleak (−6.1 ± 10.0-mm vs. −4.9 ± 11.5-mm, P=.23). Conclusions Gutter-related type Ia endoleaks represent a relatively frequent early occurrence after ch-EVAR, but appears to resolve spontaneously in the majority of cases during early to mid-term follow-up. Given that few ch-EVAR patients require re-intervention related to gutter endoleaks and the presence of such endoleak did not correlate to increased risk for aneurysm sac growth, its natural history may be more benign than originally expected.

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Section: Discussionsupporting

confidence: 91%

Natural history of gutter-related type Ia endoleaks after snorkel/chimney endovascular aneurysm repair

Ullery

Tran

Itoga

et al. 2017

Journal of Vascular Surgery

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“…Because of the potential deleterious effects of this leak that can occur if left untreated, a variety of intraoperative adjunctive measures can be performed, such as balloon angioplasty of the proximal attachment site, proximal device extension, deployment of a large bare metal stent, embolization, or placement of endovascular screws. 18–20 Others have advocated the chimney technique and fenestrated extension. 21,22 …”

Section: Discussionmentioning

confidence: 99%

Management of Immediate Post-Endovascular Aortic Aneurysm Repair Type Ia Endoleaks and Late Outcomes

AbuRahma

Hass

AbuRahma

et al. 2017

Journal of the American College of Surgeons

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BACKGROUND Post-endovascular aortic aneurysm repair (EVAR) endoleaks and the need for reintervention are challenging. Additional endovascular treatment is advised for type Ia endoleaks detected on post-EVAR completion angiogram. This study analyzed management and late outcomes of these endoleaks. STUDY DESIGN This was a retrospective review of prospectively collected data from EVAR patients during a 10-year period. All post-EVAR type Ia endoleaks on completion angiogram were identified (group A) and their early (30-day) and late outcomes were compared with outcomes of patients without endoleaks (group B). Kaplan-Meier analysis was used for survival analysis, sac expansion, late type Ia endoleak, and reintervention. RESULTS Seventy-one of 565 (12.6%) patients had immediate post-EVAR type Ia endoleak. Early intervention (proximal aortic cuffs and/or stenting) was used in 56 of 71 (79%) in group A vs 31 of 494 (6%) in group B (p < 0.0001). Late type Ia endoleak was noted in 9 patients (13%) in group A at a mean follow-up of 28 months vs 10 patients (2%) in group B at a mean follow-up of 32 months (p < 0.0001). Late sac expansion and reintervention rates were 9% and 10% for group A vs 5% and 3% for group B (p = 0.2698 and p = 0.0198), respectively. Freedom rates from late type Ia endoleaks at 1, 3, and 5 years for group A were 88%, 85%, and 80% vs 98%, 98%, and 96% for group B (p < 0.001); and for late intervention, were 94%, 92%, and 77% for group A, and 99%, 97%, and 95% for group B (p = 0.007), respectively. Survival rates were similar. CONCLUSIONS Immediate post-EVAR type Ia endoleaks are associated with higher rates of early interventions, late endoleaks and reintervention, which will necessitate strict post-EVAR surveillance.

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“…The efficacy of the parallel SG technique, especially for the octopus strategy, has been investigated from the clinical aspect . A few suggestions on wise treatment plan have been proposed.…”

Section: Introductionmentioning

confidence: 99%

Optimization schemes for endovascular repair with parallel technique based on hemodynamic analyses

Mei

Han

et al. 2019

Numer Methods Biomed Eng

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Endovascular repair with parallel stent-grafts (SG) is a challenging technique that reconstructs the luminal flow pathways by implanting parallel-placed SGs into the vessel. After treatment, occlusion and shifting of the parallel SGs are sometimes reported, which could be fatal and difficult to be reoperated. These issues are highly related to the local hemodynamic conditions in the stented region. In this study, a patient case treated by the octopus endograft technique (a head-SG with three limb-SGs) and experienced limb-SG occlusion is studied. 3-D models are established based on computed tomography (CT) angiography datasets pretreatment and posttreatment as well as during follow-ups. Hemodynamic quantities such as pressure drop, wall shear stress-related parameters, and flow division in limb-SGs and visceral arteries are quantitatively investigated. Optimizations on the length of the head-SG and diameter of the limb-SGs are analyzed based on various scenarios. The results indicate that when reconstructing the flow pathways via octopus stenting, it is important to ensure the flow distribution as physiologically required with this new morphology. Position (or length) of the head-SG and diameter of the limb-SGs play an important role in controlling flow division, and high time average wall shear stress (TAWSS) around the head-SG acts as a main factor for graft immigration. This study, by proposing optimization suggestions with hemodynamic analyses for a specific case, implicates that pretreatment SG scenarios may assist in wise selection and placement of the device and thus may improve long-term effectiveness of this kind of challenging endovascular repair techniques.

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EndoAnchors to Resolve Persistent Type Ia Endoleak Secondary to Proximal Cuff With Parallel Graft Placement

Abstract: EndoAnchors may effectively resolve a persistent type Ia endoleak arising from gutter formation after placement of a proximal cuff and chimney grafts.

Cited by 17 publications

References 15 publications

Natural history of gutter-related type Ia endoleaks after snorkel/chimney endovascular aneurysm repair

Natural history of gutter-related type Ia endoleaks after snorkel/chimney endovascular aneurysm repair

Management of Immediate Post-Endovascular Aortic Aneurysm Repair Type Ia Endoleaks and Late Outcomes

Optimization schemes for endovascular repair with parallel technique based on hemodynamic analyses

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