In Situ Laser Fenestration for Revascularization of the Left Subclavian Artery During Emergent Thoracic Endovascular Aortic Repair

Ahanchi, Sadaf S.; Almaroof, Babatunde; Stout, Chris E.; Panneton, Jean M.

doi:10.1583/11-3770mr.1

Cited by 90 publications

(71 citation statements)

References 17 publications

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“…18 Also, in situ laser fenestration has been reported as a valid option to restore blood flow after LSA coverage. 6 However, it requires dedicated materials not always available, especially in the emergency setting. This report of a series of 14 consecutive patients shows that the PG technique is feasible and safe to maintain perfusion to the subclavian artery, with a 93% primary patency at 2 years.…”

Section: Discussionmentioning

confidence: 99%

Periscope Endograft Technique to Revascularize the Left Subclavian Artery During Thoracic Endovascular Aortic Repair

Lachat

Mayer

Pfammatter

et al. 2013

Journal of Endovascular Therapy

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Purpose : To present early and midterm results of the periscope endograft (PG) technique to maintain left subclavian artery (LSA) blood flow in thoracic endovascular aortic repairs (TEVAR) involving zone 3. Methods : From April 2010 to January 2013, 14 consecutive high-risk patients (11 men; mean age 70±8 years, range 56-87) underwent TEVAR with the PG technique for 10 thoracic aortic aneurysms (TAA), 2 traumatic aortic ruptures, and 2 aortic dissections without a suitable landing zone (>2 cm distal to the LSA). Five procedures were performed emergently for rupture (3 TAAs and the 2 trauma cases). Two patients had a periscope deployed in an aberrant right subclavian artery. The periscope endografts were sized 1 to 2 mm larger than the branch artery at the intended landing zone. The caudal end was extended distal to the intended distal landing site of the thoracic stent-graft, which was usually deployed after the PG. Both the PG and thoracic stent-grafts were generally molded using the kissing balloon technique. Outcomes analyzed were immediate technical success, perioperative mortality and morbidity, aneurysm diameter change, and periscope endograft patency. Results : Immediate technical success was 100%, with all procedures completed as planned. Perioperatively, one periscope occluded and one of the ruptured TAA patients died. One percutaneous access site hematoma required only conservative management. At a mean follow-up of 26±9 months (range 9-37), there was no additional PG occlusion. The Kaplan-Meier estimate of PG patency was 93% at 2 years. Conclusion : The periscope endograft is a simple technique to maintain perfusion to the LSA in cases where the aortic stent-graft crosses its ostium. The PG technique can be performed transfemorally and even percutaneously, and it can be applied to all supra-aortic branches. Early and midterm results are encouraging, but more experience and long-term results are mandatory before this technique can be widely recommended.

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Section: Discussionmentioning

confidence: 99%

Periscope Endograft Technique to Revascularize the Left Subclavian Artery During Thoracic Endovascular Aortic Repair

Lachat

Mayer

Pfammatter

et al. 2013

Journal of Endovascular Therapy

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“…Successful laser in situ fenestration of thoracic endografts via subclavian artery access has been described by some. 9,10 Later reports have demonstrated that this technique can be used to revascularize the innominate vessel for aortic arch aneurysms after carotid-carotid and carotidsubclavian bypass. 11 Retrograde in situ fenestration is difficult to apply to the abdominal aorta because of the lack of downstream branch artery access.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Once the fabric has been breached, the fabric hole can then be dilated to a desired diameter and a branch stent can be placed to maintain perfusion of the target vessel. This technique can be performed in either a retrograde 3,4 (from within the lumen of the side branch, therefore requiring downstream access) or an antegrade (from within the lumen of the stentgraft) 16,17 fashion and may be potentially applied to all major aortic side branches.…”

mentioning

confidence: 99%

In Vitro Fenestration of Aortic Stent-Grafts: Implications of Puncture Methods for in Situ Fenestration Durability

Riga

Bicknell

Basra³

et al. 2013

Journal of Endovascular Therapy

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“…In regard to the first issue, recent studies have proposed the use of laser systems to selectively and rapidly perforate the graft material preventing injuries to the arterial wall [6][7][8][9]. Concerning the second issue, our research group and others [10][11][12][13] have demonstrated that a three-dimensional (3 D) computer-aided guidance system, based on the electromagnetic (EM) tracking of the surgical tools, can be a reliable solution to guide the endovascular instruments to the target site.…”

Section: Introductionmentioning

confidence: 99%

Design of a sensorized guiding catheter for in situ laser fenestration of endovascular stent

Piazza

Condino

Alberti

et al. 2017

Computer Assisted Surgery

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Purpose: The in situ fenestration of a standard endograft is currently limited by difficulties in targeting the fenestration site under fluoroscopic control and by the lack of a safe method to perforate the graft. Evidence in the literature suggests the use of a 3 D electromagnetic navigator to accurately guide the endovascular instruments to the target and a laser to selectively perforate the graft. The aim of this work is to provide design guidelines to develop a sensorized catheter to guide the laser tool to the fenestration site and conduct preliminary testing of the feasibility of the proposed solution. Matherials and methods: Different catheter designs were delineated starting from engineering considerations, then prototypes were preliminarily tested to collect surgeon opinions and to steer the design process toward the preferred solution reported by the user. Finally, mechanical simulations were performed with CathCAD, a design software system for the development of composite tubing for endovascular catheters. Results: Based on surgeon feedback, a 9-French steerable catheter with a stabilization system was designed. CathCAD simulations allowed us to define the construction parameters (e.g., materials and geometric constrains) for the fabrication of composite tubes with mechanical properties (flexural, axial, and torsional rigidities) compatible with target values in the literature for guiding catheters. Conclusion:The presented results preliminarily demonstrate the clinical reasonability and feasibility of the designed tool in terms of mechanical properties. Further mechanical tests and extensive in vitro clinical trials are required prior to animal testing.

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In Situ Laser Fenestration for Revascularization of the Left Subclavian Artery During Emergent Thoracic Endovascular Aortic Repair

Abstract: In situ retrograde laser fenestration is a feasible and effective option for revascularizing the LSA during emergent TEVAR. Longer follow-up is necessary to determine the durability of this technique.

Cited by 90 publications

References 17 publications

Periscope Endograft Technique to Revascularize the Left Subclavian Artery During Thoracic Endovascular Aortic Repair

Periscope Endograft Technique to Revascularize the Left Subclavian Artery During Thoracic Endovascular Aortic Repair

In Vitro Fenestration of Aortic Stent-Grafts: Implications of Puncture Methods for in Situ Fenestration Durability

Design of a sensorized guiding catheter for in situ laser fenestration of endovascular stent

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