Fenestrated TEVAR Using a Guidewire Fixator for Anchoring in Aortic Arch Target Vessels

Kölbel, Tilo; Bosaeus, Linus; Tsilimparis, Nikolaos; Heidemann, Franziska; Rohlffs, Fiona; Liungman, Krister

doi:10.1177/1526602817744344

Cited by 4 publications

(4 citation statements)

References 16 publications

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“…In near future, we believe that, when associated with other endovascular advances, this technique could be used to perform totally percutaneous endovascular arch repairs, even with only femoral access. 12 The technique we have described will certainly make endovascular arch procedures faster and safer, with less endograft manipulation in the aortic arch.…”

Section: Discussionmentioning

confidence: 96%

The End of Wire Wrapping: A Technique to Avoid Intertwining Preloaded Guidewires for Endovascular Aortic Arch Repair

et al. 2021

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Purpose: The purpose of this study was to present a new technique for endovascular aortic arch repair for 1, 2, or 3 vessels using preloaded wires and precannulated target vessels without wire wrapping. Technique: This technique uses a prototype catheter with 2 parallel lumens to position through-and-through guidewires in the supra-aortic branches and an extra-stiff guidewire in the ascending aorta with no wrapping. This allows the introduction and advancement of the device with the already precannulated target vessels. The endograft is advanced to the aortic arch without twisting or wrapping. Covered stents are deployed to align the graft and target vessels. Conclusion: To our knowledge, a technique that avoids wire wrapping has not been previously described. This technique allows safer and faster endovascular arch procedures and opens up new possibilities by enabling multi-vessel endovascular aortic arch repair with all precannulated target vessels.

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Section: Discussionmentioning

confidence: 96%

The End of Wire Wrapping: A Technique to Avoid Intertwining Preloaded Guidewires for Endovascular Aortic Arch Repair

et al. 2021

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“…3 The use of a brachio-femoral through-and-through wire or specific anchoring devices in the LSA offer an improved control during bridging covered stents deployment. 4 In this technical note we describe a challenging complication during branched-TEVAR (B-TEVAR) with a retrograde LSA branch. After deployment of a Viabahn endoprosthesis (W. L.…”

Section: Introductionmentioning

confidence: 99%

“… 3 The use of a brachiofemoral through-and-through wire or specific anchoring devices in the LSA offers an improved control during bridging covered stent deployment. 4 …”

mentioning

confidence: 99%

Bail-out technique to detach a locked Viabahn endoprosthesis in branched thoracic endovascular aortic repair

Eilenberg

Panuccio

Rohlffs

et al. 2021

Journal of Vascular Surgery Cases, Innovations and Techniques

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A 69-year-old female patient presented with a 5.8 cm thoracoabdominal aortic aneurysm Crawford type II after partial arch replacement. She was treated by a branched thoracic endovascular aortic repair procedure using a branched arch endograft with one retrograde branch to the left subclavian artery. After deployment of a Viabahn as a bridging covered stent to the left subclavian artery, the deployment line did not detach and the delivery catheter could not be removed. With the use of a physician-modified sidehole catheter and balloon fixation, the pulling line could be released without displacement of the Viabahn endoprosthesis.

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“…3,8 Recently, early clinical experiences with next-generation fenestrated or branched stent-grafts (f/bSGs) have also been reported. 3,[9][10][11][12] These complex procedures obviously mandate precise and detailed anatomical analysis of the arch aneurysm. Interestingly, even though anatomical analysis of the aortic arch has been previously reported for various aortic pathologies, [13][14][15][16][17][18] a detailed and thorough analysis focusing on arch aneurysms is currently lacking.…”

Section: Introductionmentioning

confidence: 99%

Anatomical Analysis and Feasibility Study of Next-Generation Fenestrated or Branched Stent-Grafts for the Treatment of Arch Aneurysms

et al. 2020

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Purpose: To analyze the anatomical characteristics of arch aneurysms and evaluate the anatomical feasibility of 4 next-generation stent-grafts with either branched or fenestrated configurations. Materials and Methods: A retrospective analysis was conducted of 213 patients (mean age 75.0±7.1 years; 179 men) with arch aneurysms treated using total arch replacement or zone 0 or 1 thoracic endovascular aortic repair (TEVAR) from 2007 to 2017 at 2 Japanese hospitals. Anatomical analyses were performed using the centerline of flow technique on a 3-dimensional workstation. The anatomical feasibility of the Zenith A-branch, TAG Thoracic Branch Endoprosthesis (TBE), Terumo Aortic Relay Plus Double Branched (DB), and fenestrated Najuta stent-grafts were evaluated based on the instructions for use (IFU). Results: The mean lengths from the sinotubular junction (STJ) to the innominate artery (IA) and from the IA to the left common carotid artery were 114.9±15.9 and 12.8±5.6 mm, respectively. The mean aortic diameters at the STJ and IA were 31.3±3.4 and 34.1±5.3 mm, respectively. In terms of feasibility, 5.2% of patients were within the Zenith A-branch IFU, 40.8% for the TAG TBE, 24.9% for the Relay Plus DB, and 13.6% for the Najuta. Significant (>50% circumference) thrombus/calcification at the sealing zone affected nearly half of the patients, but there is currently no standardized definition or evaluation method for “significant” thrombus/calcification. Conclusion: Only 5% to 41% of arch aneurysm patients are anatomically suitable for TEVAR using any one of the next-generation branched or fenestrated stent-grafts. Furthermore, a definitive method of evaluating the thrombus/calcification burden needs to be established in future IFU.

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Fenestrated TEVAR Using a Guidewire Fixator for Anchoring in Aortic Arch Target Vessels

Abstract: The use of an LGF for anchoring in the target LSA during fenestrated arch endografting was feasible and safe.

Cited by 4 publications

References 16 publications

The End of Wire Wrapping: A Technique to Avoid Intertwining Preloaded Guidewires for Endovascular Aortic Arch Repair

The End of Wire Wrapping: A Technique to Avoid Intertwining Preloaded Guidewires for Endovascular Aortic Arch Repair

Bail-out technique to detach a locked Viabahn endoprosthesis in branched thoracic endovascular aortic repair

Anatomical Analysis and Feasibility Study of Next-Generation Fenestrated or Branched Stent-Grafts for the Treatment of Arch Aneurysms

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