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

Riga, Celia; Bicknell, Colin; Basra, Melvinder; Hamady, Mohamad; Cheshire, Nicholas

doi:10.1583/12-4175.1

Cited by 54 publications

(49 citation statements)

References 24 publications

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“…A type I arch anatomy exhibits a better approach with a laser fiber located perpendicularly to the graft. This arch decreases the chance that the laser fiber will slip forward proximally from the graft to the aortic arch . According to Riga et al, the quality of in situ fenestrations correlated with a more perpendicular approach .…”

Section: Discussionmentioning

confidence: 99%

“…This arch decreases the chance that the laser fiber will slip forward proximally from the graft to the aortic arch . According to Riga et al, the quality of in situ fenestrations correlated with a more perpendicular approach . Redlinger et al noted that a type III arch should be better deployed with a chimney graft .…”

Section: Discussionmentioning

confidence: 99%

“…29 According to Riga et al, the quality of in situ fenestrations correlated with a more perpendicular approach. 29 Redlinger et al noted that a type III arch should be better deployed with a chimney graft. 25 The chimney technique can save time for aortic arch type III, compared with laser fenestration to reconstruct the carotid artery.…”

Section: Discussionmentioning

confidence: 99%

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In Situ Laser Fenestration Is a Feasible Method for Revascularization of Aortic Arch During Thoracic Endovascular Aortic Repair

Qin

Zhao

Wang

et al. 2017

JAHA

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BackgroundReconstruction of the aortic major branches during thoracic endovascular aortic repair is complicated because of the complex anatomic configuration and variation of the aortic arch. In situ laser fenestration has shown great potential for the revascularization of aortic branches. This study aims to evaluate the feasibility, effectiveness, and safety of in situ laser fenestration on the three branches of the aortic arch during thoracic endovascular aortic repair.Methods and ResultsBefore clinical application, the polytetrafluoroethylene and Dacron grafts were fenestrated by an 810‐nm laser system ex vivo, which did not damage the bare metal portion of the endografts and created a clean fenestration while maintaining the integrity of the endografts. In vivo, 6 anesthetized female swine survived after this operation, including stent‐graft implantation in the aortic arches, laser fenestration, and conduit implantation through the innominate arteries and the left carotid arteries. Based on the animal experiments, in situ laser fenestration during thoracic endovascular aortic repair was successively performed on 24 patients (aged 33–86 years) with aortic artery diseases (dissection type A: n=4, type B: n=7, aneurysm: n=2, mural thrombus: n=7). Fenestration of 3 aortic branches was performed in 2 (8.3%) patients. Both the left carotid artery and the left subclavian artery were fenestrated in 6 (25%) patients. Only left subclavian artery fenestration surgery was done in 16 (66.7%) patients. Among these patients, 1 fenestration was abandoned secondary to an acute takeoff of the innominate artery in a type III aortic arch. The average operative time was 137±15 minutes. The technical success rate was 95.8% (n=23). No fenestration‐related complications or neurological morbidity occurred after this operation. During a mean postoperative 10‐month follow‐up (range: 2–17 months), 1 patient died of severe pneumonia, and all the left subclavian artery and carotid artery stents were patent with no fenestration‐related endoleaks upon computed tomography angiography images.ConclusionsIn situ laser fenestration is a feasible, effective, rapid, repeatable, and safe option for the reconstruction of aortic arch during thoracic endovascular aortic repair, which might be available to revascularize the 3 branches. However, follow‐up periods should be extended to evaluate the robustness of this technique.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

In Situ Laser Fenestration Is a Feasible Method for Revascularization of Aortic Arch During Thoracic Endovascular Aortic Repair

Qin

Zhao

Wang

et al. 2017

JAHA

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show abstract

“…In 2011, Saari et al 13 characterized the acute changes with various combinations of devices. Most recently, Riga et al 14 have investigated the effects of the puncture angle during in situ fenestration on various devices, in addition to the use of cutting balloons. This has added much more insight into the technique of in situ fenestration.…”

Section: Discussionmentioning

confidence: 99%

Graft Durability and Fatigue after In Situ Fenestration of Endovascular Stent Grafts Using Radiofrequency Puncture and Balloon Dilatation

Eadie

Soulez

King

et al. 2014

European Journal of Vascular and Endovascular Surgery

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“…Bench examination of the fenestration under various circumstances revealed that fenestrations of the graft with an acute angle between the fabric and the needle tend to create a non-circular hole or tear on the fringe of the fenestration [7,8], which compromises the quality of fenestration and can potentially lead to type III endoleaks or tear Fig. 2 A Schematic drawing of the squid-capture technique for in situ fenestration.…”

Section: Discussionmentioning

confidence: 99%

“Squid-Capture” Modified In Situ Stent–Graft Fenestration Technique for Aortic Arch Aneurysm Repair

Hongo

Miyamoto

Shuto

et al. 2014

Cardiovasc Intervent Radiol

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An 83-year-old female was found to have an fusiform aneurysm in the aortic arch. She was deemed to be a high surgical risk; therefore, endovascular stent-graft placement followed by revascularization of the brachiocephalic trunk using in situ stent-graft fenestration was considered. However, the safe application of fenestration was deemed difficult due to the tortuosity of the brachiocephalic artery. The patient was successfully treated with the aid of the ''squid-capture'' technique, which consists of deployment of the stent-graft in a snare wire loop that was advanced from the brachiocephalic artery and fenestration of the stent-graft with the support of the loop. A follow-up exam revealed complete sealing of the aneurysm without any complications. The squid-capture technique allows for the safe and secure puncture of the graft.

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

Cited by 54 publications

References 24 publications

In Situ Laser Fenestration Is a Feasible Method for Revascularization of Aortic Arch During Thoracic Endovascular Aortic Repair

In Situ Laser Fenestration Is a Feasible Method for Revascularization of Aortic Arch During Thoracic Endovascular Aortic Repair

Graft Durability and Fatigue after In Situ Fenestration of Endovascular Stent Grafts Using Radiofrequency Puncture and Balloon Dilatation

“Squid-Capture” Modified In Situ Stent–Graft Fenestration Technique for Aortic Arch Aneurysm Repair

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