Late rescue of proximal endograft failure using fenestrated and branched devices

Abstract

Our series demonstrates the risk for late failure after EVAR is greater in patients who are younger and have chronic renal impairment at the time of implantation. Branched and fenestrated repair after failed EVAR is more complex than repair in the native aorta. More research is needed to identify patients at higher risk of failure after EVAR to prevent the need for rescue in the future.

Use of parallel grafts to save failed prior endovascular aortic aneurysm repair and type Ia endoleaks

“…In agreement with the Nurnberg experience, the Cleveland Clinic published recently that branched and fenestrated repair after failed EVAR is more complex than repair in the native aorta. 17 In contrast to this, use of parallel grafts has some clear advantages. First, repair with use of off-the-shelf devices makes possible immediate treatment without delay.…”

A Rare Complication of Iliac Limb Occlusion After Endovascular Aortic Aneurysm Repair Using the Zenith Inverted Limb

“…This device can be deployed in cases involving a lower branching renal artery (including an accessory renal artery), an anastomosis site aneurysm after surgical repair, and cases that require a short proximal device (fenestrated or branched device) [2][3][4]. In this case, the patient had a lower branching renal anatomy that we treated with the Zenith inverted limb.…”

“…There are several reports on the Zenith inverted limb [2][3][4], but to date there have been no published reports of limb occlusion after implantation of this device.…”

“…To utilize the commercially available stent grafts, the LR-AB length needs to be at least 60 mm. To overcome certain anatomical challenges, the Zenith inverted limb (Cook Inc. Bloomington, IN, USA) was developed; this device has a contralateral gate inverted into the main body [2][3][4] (Figure 1a, b).…”

Thoracoabdominal aortic aneurysm repair: current endovascular perspectives

“…As Martin et al described, branched and fenestrated devices have a role in salvage of late failure of proximal type Ia endoleaks in infrarenal devices 55. As one would imagine, with the increasing number of components required to complete total endovascular thoracoabdominal repairs, the incidence of intercomponent failures increases, leading to higher rates of type III endoleaks.…”