Insights on Bridging Stent Grafts in Fenestrated and Branched Aortic Endografting

Abstract

Major branches of the aortic arch and visceral aorta pose a particular challenge for endovascular repair of aneurysms involving these regions. To preserve perfusion through these essential branches, fenestrated and branched endografts have been used. Current fenestrated and branched aortic endografts have evolved into modular devices in which the aortic main body provides appropriate access to the target branch vessel either through reinforced fenestrations or directional cuffs as the hinge point for bridging stent grafts (BSGs). BSGs are used to connect the aortic main body and target branch vessel, and must provide both unhindered flow and a seal. Appropriate selection of BSG for target vessels in branched and fenestrated endovascular aortic repair is critical for technical success and durability. At present, there are no dedicated devices for use as BSGs, and a variety of stent grafts are currently used off-label. In this report, we review the available published series on the performance of presently available BSGs in relation to their design and selection.

A Systematic Review and an Updated Meta-Analysis of Fenestrated/Branched Endovascular Aortic Repair of Chronic Post-Dissection Thoracoabdominal Aortic Aneurysms

“…Among the eligible studies were 15 patients with technical failure due to an inability to complete catheterization/stent deployment in TVs. The pooled estimates for TV patency were 97.6%, 96.7 and 94.3% at 12, 24 and 36 months, respectively, which are comparable to those reported for degenerative aneurysms [46,47]. Moreover, it has been observed that renal mating stents perform worse in comparison to those for the coeliac trunk or superior mesenteric artery, and fenestrations perform better when compared to branches in the mid-and long term [47,48].…”

Case Series on Double-Barrel Stenting for the Renal Arteries Associated With Fenestrated Repair (FEVAR) of Complex Anatomy Aortic Aneurysms

“…As for the bridging stent, the balloon-expandable iCAST (Getinge, Wayne, NJ) was the bridging stent of choice in all cases due to its precise deployment, rigidity and ability to flare its most proximal segment inside the main aortic device to avoid endoleaks. 11,12 Close life-long follow-up with imaging is required in patients submitted to FEVAR procedures to access for adverse events, regardless if the DBS technique was applied or not. Therefore, the utilization of this technique did not increase the demand of follow-up imaging.…”

“…As for the bridging stent, the balloon-expandable iCAST (Getinge, Wayne, NJ) was the bridging stent of choice in all cases due to its precise deployment, rigidity and ability to flare its most proximal segment inside the main aortic device to avoid endoleaks. 11,12…”

Uso de <i>stent</i> recubierto con balón expandible por vía cervical en estenosis sintomática del tronco braquiocefálico

“…5). La ecografía de control muestra mejoría de la velocidad En nuestro caso, al encontrarnos con una placa inestable, con alto riesgo de embolización, ubicada en el ostium del TBC, y siendo la estenosis del 90% y con diámetros diferentes entre la zona proximal y distal de la lesión, escogimos el stent recubierto con balón expandible (GORE ® VIABAHN ® VBX, Flagstaff, AZ), que está fabricado con anillos de acero inoxidable que brindan alta resistencia radial, flexibilidad, adaptabilidad y acortamiento mínimo con la posibilidad de posdilatar el diámetro nominal y adaptarlo a los diferentes diámetros arteriales a tratar [12][13][14] .…”