JAG Tearing Technique with Radiofrequency Guide Wire for Aortic Fenestration in Thoracic Endovascular Aneurysm Repair

Ricci, Carmelo; Ceccherini, Claudio; Leonini, Sara; Cini, Marco; Vigni, Francesco; Neri, Eugénio; Tucci, Enrico; Benvenuti, Antonio; Tommasino, Giulio; Sassi, Carlo

doi:10.1007/s00270-011-0267-y

Cited by 6 publications

(6 citation statements)

References 10 publications

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“… 16 Endovascular fenestration was done using a “body floss” type wire technique where both ends of a snared wire were pulled longitudinally (caudally) across a chronic dissection membrane; organized dissection membranes seen in the setting of chronic dissection were penetrated using a radiofrequency device. 17 …”

Section: Methodsmentioning

confidence: 99%

“…16 Endovascular fenestration was done using a "body floss" type wire technique where both ends of a snared wire were pulled longitudinally (caudally) across a chronic dissection membrane; organized dissection membranes seen in the setting of chronic dissection were penetrated using a radiofrequency device. 17 Endovascular repair of aneurysms changed according to anatomical extension. In the case of lesions involving the descending aorta above the celiac trunk, straight or tapered endografts were employed, whereas in thoracoabdominal lesions, branched devices were used.…”

Section: Operative Technique: Second-stage Completion (Endovascular)mentioning

confidence: 99%

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Arch replacement with collared elephant trunks: The Siena approach

et al. 2021

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Objective: To illustrate our experience and results in patients with diffuse aneurysmal disease treated with arch replacement using the Siena collared graft, a device designed in 2002 to improve the elephant trunk technique. Results of the first step surgical implant and the subsequent treatment strategies, with extensive use of endovascular techniques, are reported.Methods: All aortic arch-replacement procedures using the Siena graft between February 2002 and January 2020 were retrospectively analyzed for early and late clinical outcomes.Results: Of 146 patients (54 women, 36.9%) with a median age of 69.1 years (interquartile range 58.4-75.0 years), 55 (37.6%) had acute/chronic dissection with false lumen aneurysmal dilatation, 91 (62.3%) had degenerative aneurysms, 45 (30.8%) were redo operations, and 14 (9.5%) had connective tissue disease. First-stage outcomes: 10.9% 30-day mortality (n ¼ 16); 5.4% stroke (n ¼ 8, 6 disabling, 2 nondisabling; 3 fatal); and 0.6% paraplegia. Outcomes for 113 second-stage procedures (77.3%, n ¼ 97 endovascular [66.4%], n ¼ 16 surgical [10.9%]) were 5.3% and 8.8% 30-day and 180-day mortality; no stroke; 10.6% paraplegia. Median followup was 5.7 years (range: 0-18.02 years) median survival was 16.65 years (95% lower confidence limit, 10.06 years) with no significant difference between aneurysm and dissection patients. Freedom from further treatment was 87.0% (95% confidence interval, 79.9%-94.7%) at 5 years and 71.4% (95% confidence interval, 71.4%-84.7%) at 10 years; median time to reintervention was 2.59 years (interquartile range, 0.52-5.20 years) with no difference (P ¼ .22) between dissection and aneurysm groups.Conclusions: Siena collared graft represents a reliable platform for the treatment of diffuse aneurysmal disease. This device offers the flexibility required in the treatment of extended aortic lesions and guarantees the choice of the most appropriate approach for treatment completion. In this context, the availability of hybrid grafts has not modified the role of this device in arch surgery. (JTCVS Techniques 2021;6:13-27) Three steps of a "delayed frozen" elephant trunk approach.

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Section: Methodsmentioning

confidence: 99%

Section: Operative Technique: Second-stage Completion (Endovascular)mentioning

confidence: 99%

Arch replacement with collared elephant trunks: The Siena approach

et al. 2021

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“…It can be performed by either an open approach [2] or an endovascular approach [3]. Endovascular fenestration of the dissection flap using an RF system was initially described in 2012 by Ricci and colleagues [4]. The technique involved puncture of the flap with the RF guidewire, entry of a snare wire into the contralateral lumen through the contralateral femoral access, connection of the two wires by snaring, and pulling down of the two wires to enlarge the intimal defect.…”

Section: Commentmentioning

confidence: 99%

Endovascular Fenestration for Distal Aortic Sealing After Frozen Elephant Trunk With Thoraflex

Wong

Kwok

et al. 2017

The Annals of Thoracic Surgery

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We describe a case of total arch replacement with frozen elephant trunk for chronic type B aortic dissecting aneurysm, which resulted in inadvertent landing of the frozen elephant trunk into the false lumen. A radiofrequency puncture system-assisted controlled endovascular fenestration of the dissection flap was performed at the upper abdominal aorta and subsequent thoracic endovascular stenting, successfully redirecting the blood flow from the false to the true lumen. Our case illustrated a possible way to seal distal reentry in chronic type B aortic dissection.

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“…8 Techniques described for the fenestration of the thick, organized dissection membranes seen in the setting of chronic dissection have generally focused on penetrating this membrane with endovascular needles or a percutaneous radiofrequency device with or without a "body-floss" type wire technique to create a longer fenestration. 9 In this report we add to the existing literature describing endovascular adjuncts for stent graft placement in the setting of chronic aortic dissection. These two patients were safely and effectively managed with fenestration done using a "body floss" type wire technique in which both ends of a snared wire were pulled longitudinally (caudally) across a chronic dissection membrane.…”

Section: Discussionmentioning

confidence: 98%

Endovascular longitudinal fenestration and stent graft placement for treatment of aneurysms developing after chronic type B aortic dissection

Barshes

Gravereaux

Semel

et al. 2015

Journal of Vascular Surgery

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The thickened intimal flap present in cases of chronic aortic dissection can present a challenge to attempts at endovascular stent graft treatment performed for subsequent aneurysmal degeneration by precluding adequate landing zones for the endograft and by constraining the endograft from full expansion. In this report we describe our technique and outcome for longitudinal endovascular fenestration of chronic aortic dissection flaps to facilitate endovascular stent graft treatment for thoracic aortic aneurysms developing after aortic dissection.

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JAG Tearing Technique with Radiofrequency Guide Wire for Aortic Fenestration in Thoracic Endovascular Aneurysm Repair

Cited by 6 publications

References 10 publications

Arch replacement with collared elephant trunks: The Siena approach

Arch replacement with collared elephant trunks: The Siena approach

Endovascular Fenestration for Distal Aortic Sealing After Frozen Elephant Trunk With Thoraflex

Endovascular longitudinal fenestration and stent graft placement for treatment of aneurysms developing after chronic type B aortic dissection

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