Four-year results of the Bolton relay proximal scallop endograft in the management of thoracic and thoracoabdominal aortic pathology with unfavorable proximal landing zone

Hanna, Lydia; Abdullah, Ammar; Kashef, Elika; Riga, Celia; Jenkins, Michael; Bicknell, Colin; Gibbs, Richard; Hamady, Mohammad

doi:10.1016/j.jvs.2021.04.027

Cited by 17 publications

(6 citation statements)

References 33 publications

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“…Several thoracic stent graft manufacturers are investigating designs to address the distal aortic arch with fenestrations, directional branches, or a wider scallop [ 8 – 11 ]. The third-generation arch branch endovascular graft designed by Cook Medical (William Cook Europe, Bjaeverskov, Denmark) incorporates a retrograde LSA branch into the design with a pre-loaded catheter to facilitate access into the branch.…”

Section: Introductionmentioning

confidence: 99%

Early Feasibility of Endovascular Repair of Distal Aortic Arch Aneurysms Using Patient-Specific Single Retrograde Left Subclavian Artery Branch Stent Graft

Wong

Tenorio

Lima

et al. 2022

Cardiovasc Intervent Radiol

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Objective To describe the feasibility and outcomes of endovascular repair of distal aortic arch aneurysms using a patient-specific stent graft with a pre-loaded single retrograde left subclavian artery (LSA) branch stent graft. Methods We reviewed the clinical data and outcomes of consecutive patients enrolled in an ongoing prospective, non-randomized physician-sponsored investigational device exemption study to evaluate the outcomes of endovascular aortic arch repair using patient-specific arch branch stent grafts (William Cook Europe, Bjaeverskov, Denmark) between 2019 and 2022. All patients received a design with triple-wide scallop and a single retrograde LSA branch with a pre-loaded catheter. Results There were five male patients with median age of 77 years old (72–80) treated using the single LSA branch stent graft. Technical success was achieved in all patients. Median operating time, fluoroscopy time, and total radiation dose area product were 103 (78–134) minutes, 26 (19–39) minutes, and 123 (71–270) mGy.cm 2 , respectively. There were no 30-day or in-hospital mortality, neurological or other major adverse events (MAEs). During median follow-up of 21 (20–27) months, all patients were alive with patent LSA branches, except for one who died of COVID-19 complications. There was no branch instability or secondary interventions. Conclusion This early feasibility study demonstrates successful endovascular repair of distal aortic arch aneurysms using a patient-specific stent graft with single retrograde LSA branch without technical failures, mortality or neurological events. Larger clinical experience and longer follow-up are needed to determined effectiveness of this approach in patients who need endovascular repair with proximal extension into Zone 2.

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Section: Introductionmentioning

confidence: 99%

Early Feasibility of Endovascular Repair of Distal Aortic Arch Aneurysms Using Patient-Specific Single Retrograde Left Subclavian Artery Branch Stent Graft

Wong

Tenorio

Lima

et al. 2022

Cardiovasc Intervent Radiol

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“…Considering the potential perspective applicability of this procedure with these new devices, one of the important (e.g., potential) drawbacks lies in the absence of reinforced fenestration like occurs in custom-made devices, or already incorporated in single-side branch devices that reasonably and intuitively may be better perceived in terms of EG integrity [ 7 , 9 , 34 ]. However, not only does the ISF technique perfectly mimic the principle of open surgery at “zone 2”, there are promising data showing the effectiveness and durability of this procedure [ 26 , 35 ] giving it dignity to be implemented in the daily practice armamentarium of cardiovascular operators.…”

Section: Discussionmentioning

confidence: 99%

“…Recent meta-analyses demonstrated that revascularization of the LSA is associated with decreased risks of cerebrovascular accidents, spinal cord ischemia (SCI), and left upper limb ischemia but at the cost of worrying local complications [ 3 , 4 , 5 ]. Different alternative endovascular solutions, such as the parallel grafts techniques, customized fenestrated or scalloped or branched endograft, have been designed to challenge left carotid-LSA bypass or transposition [ 6 , 7 , 8 , 9 , 10 , 11 , 12 ]. Among total endovascular solutions, the former are versatile but have inconsistent durability, while the latter offer encouraging results but are complex procedures and require long manufacturing time.…”

Section: Introductionmentioning

confidence: 99%

Anatomic Feasibility of In-Situ Fenestration for Isolate Left Subclavian Artery Preservation during Thoracic Endovascular Aortic Repair Using an Adjustable Needle Puncturing System

Piffaretti,

Franchin,

Gnesutta

et al. 2023

JCM

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Objectives: To evaluate the feasibility of thoracic endovascular aortic repair (TEVAR) using the Ankura™ device (Lifetech Scientific, Shenzhen, China) with left subclavian artery (LSA) in-situ fenestration (ISF) using an adjustable puncture device system. Methods: It is a single center, retrospective, financially unsupported cohort study of TEVAR performed from 16 February 2007 to 10 January 2023. Inclusion criteria were isolate LSA revascularization for elective or urgent/emergent “zone 2” TEVAR, and the availability of the preoperative computed tomography angiography. Results: Post-hoc analysis identified 52 TEVARs. There were 39 (75.0%) males, and 13 (25.0%) females: median age was 74.5 years (IQR, 65.5–78). Index TEVAR was performed for atherosclerotic aneurysm in 27 (51.9%) cases, dissection-related diseases in 18 (34.6%), penetrating aortic ulcer in 5 (9.6%), and blunt traumatic aortic injury in 2 (3.8%). Access-vessel feasibility rate of TEVAR using the Ankura™ device would have been 98.1% (51/52). Considering the morphology of the aortic arch, ISF TEVAR feasibility would have been 61.5% (32/52). Binary logistic regression analysis identified LSA angulation (OR: 1.1, 95%CI: 1.03–1.14, p = 0.003) to be associated with ISF feasibility using this endograft and a self-centering adjustable needle-based puncture device. Conclusions: Potential feasibility of TEVAR using the Ankura™ endograft with ISF using a self-centering adjustable needle system was 61.5%. Left subclavian artery angulation seems to be the most important and limiting anatomical constraint.

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“…An unfavorable landing zone can later influence the long-term durability of TEVAR's outcome in the arch. Hanna et al [26] evaluated the Bolton Relay scallop endograft (Terumo Aortic, Sunrise, FL, US). This custom-made stent graft has a U-shaped gap (for the "scallop" approach) in the exterior of the stent graft fabric that is designed to extend the seal zone along the aorta's inner curvature, whereas the scallop maintains normal perfusion of the supraaortic branches from the greater aortic curvature.…”

Section: Current Tevar Platformsmentioning

confidence: 99%

Thoracic endovascular aortic repair: Current evidence and challenges

Juraszek¹,

Czerny²,

Rylski³

2022

Kardiol Pol

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In 1987 Nikolay Volodos performed the world's first endovascular treatment of aortic aneurysms. Endovascular technology has progressed significantly since then. There are now many thoracic endovascular aortic repair (TEVAR) systems commercially available. By applying them, we can treat many pathologies: aneurysms, dissections, aortic ruptures, and penetrating aortic ulcers. However, TEVAR technology still has its limitations, namely the risk of a retrograde type A dissection, the issue of precise landing in the distal landing zone, and the risk of air embolism and paraplegia. Furthermore, there are no appropriate stent grafts widely available to treat acute dissections. Those currently used are designed for aneurysms, not for dissections. As a result, there are several challenges facing the future TEVAR surgical community, such as the need to develop new and more precise systems with retrograde deployment for the distal landing zone, as well as to introduce flexible stent grafts to treat dissections. The endo-Bentall is being developed as an alternative treatment method for acute type-A aortic dissection.

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Four-year results of the Bolton relay proximal scallop endograft in the management of thoracic and thoracoabdominal aortic pathology with unfavorable proximal landing zone

Cited by 17 publications

References 33 publications

Early Feasibility of Endovascular Repair of Distal Aortic Arch Aneurysms Using Patient-Specific Single Retrograde Left Subclavian Artery Branch Stent Graft

Early Feasibility of Endovascular Repair of Distal Aortic Arch Aneurysms Using Patient-Specific Single Retrograde Left Subclavian Artery Branch Stent Graft

Anatomic Feasibility of In-Situ Fenestration for Isolate Left Subclavian Artery Preservation during Thoracic Endovascular Aortic Repair Using an Adjustable Needle Puncturing System

Thoracic endovascular aortic repair: Current evidence and challenges

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