Mechanical Performance Assessment of Physician Modified Aortic Stent Graft

Canonge, Jennifer; Heim, Frédéric; Chakfé, Nabil; Coscas, Raphaël; Cochennec, Frédéric; Jayet, Jérémie

doi:10.1016/j.ejvs.2022.11.004

Cited by 7 publications

(6 citation statements)

References 18 publications

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“…Eadie et al found that the diameter of these fenestrations increased during a cyclic fatigue test following in situ fenestration [17]. Although current data show a low and late complication rate, concerns remain regarding the durability of the assembly in the long term [12].…”

Section: Discussionmentioning

confidence: 72%

“…In a recent paper, Canonge et al compared the mechanical properties of various fenestration techniques currently used in the literature under in vitro conditions [12]. In their comprehensive and thorough study, they found that fenestration reinforcement improved fenestration stability and resistance.…”

Section: Discussionmentioning

confidence: 99%

“…The most widely accepted technique is to create the fenestration with cautery and reinforce the fenestration by either a snare loop or a guidewire tip stitched around the fenestration with braided polyester sutures [7,11]. These two techniques result in an open-ring reinforcement around the fenestration, which was shown to carry an inherent risk of distortion during flaring associated with the slippage of the unconnected ends [12]. Although the reported incidence of late-type IIIc endoleaks after PMEG repair is currently low, this design might be associated with failure in the long term [12,13].…”

Section: Introductionmentioning

confidence: 99%

“…These two techniques result in an open-ring reinforcement around the fenestration, which was shown to carry an inherent risk of distortion during flaring associated with the slippage of the unconnected ends [12]. Although the reported incidence of late-type IIIc endoleaks after PMEG repair is currently low, this design might be associated with failure in the long term [12,13].…”

Section: Introductionmentioning

confidence: 99%

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Comparison of the Snare Loop Technique and the Hungaroring Reinforcement for Physician-Modified Endograft Fenestrations—An In Vitro Study

Hüttl,

Nguyen,

Borzsák

et al. 2024

JCDD

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Background: We conducted an in vitro comparison of the snare loop reinforcement against a closed-loop reinforcement (Hungaroring) for physician-modified endograft (PMEG) fenestrations regarding preparation time and stability during flaring balloon dilatation. Materials and methods: The time to complete a PMEG fenestration with reinforcement was measured and compared between the Hungaroring and snare loop groups. The number of stitches was counted. Each fenestration was dilated using a 10 mm high-pressure, non-compliant balloon up to 21 atm in pressure, and fluoroscopic images were taken. The presence of indentation on the oversized balloon at the level of the reinforcement was evaluated at each fenestration. Results: Five fenestrations were created in each group (n = 5) for a total of ten pieces. The completion time in the snare loop group was 1070 s (IQR:1010–1090) compared to 760 s (IQR:685–784) in the Hungaroring group (p = 0.008). Faster completion time was achieved by faster stitching (23.2 s/stitch (IQR 22.8–27.3) for the snare loop group and 17.3 s/stitch (IQR 17.3–20.1) for the Hungaroring group (p = 0.016). None of the fluoroscopic images of the snare loop reinforcement showed an indentation on the balloon during the overexpansion; on the contrary, the Hungaroring showed indentation in every case, even at 21 atm. Conclusion: Fenestrations reinforced with Hungaroring can be completed significantly faster. Furthermore, the Hungaroring resists over-dilation even at high pressures, while snare loop reinforcements dilate at nominal pressure.

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparison of the Snare Loop Technique and the Hungaroring Reinforcement for Physician-Modified Endograft Fenestrations—An In Vitro Study

Hüttl,

Nguyen,

Borzsák

et al. 2024

JCDD

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“…Still, some researchers believe that the PMF aperture needs to be filled by bridging stent, which can prevent the occurrence of endoleak or branch artery occlusion 23 . While further research suggests that even bridging stents show signs of weakness and lack of stability in ISF procedures 24 . To step back, even the implantation of the bridging stent was needed during our procedure, we could effortlessly implant it through the anterograde PMF aperture via the transfemoral path.…”

Section: Discussionmentioning

confidence: 99%

Utilizing physician modified fenestration on the castor branched stent technique for reconstruction of an isolated left vertebral artery on the aortic arch

Luo,

Li,

Chen

et al. 2024

Sci Rep

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The study aimed to provide physician modified fenestration (PMF) on a single-branched stent for the aortic arch (Castor) to protect the isolated left vertebral artery (ILVA) during thoracic endovascular aortic repair (TEVAR). Patients who underwent TEVAR involving ILVA reconstruction through PMF performing on the Castor branched stent were included in a retrospective, multi-centre study from June 2018 to December 2022. In these patients, all proximal landing zones of "Castor" were positioned in Ishimaru zone 2a. A total of twenty-five patients met the inclusion criteria and the achievement rate showed 25/25 (100%) success in them. The twenty-five patients had a median follow-up length of 28.5 ± 14.6 months. One patient (4.0%) suffered from postoperative ischemic stroke before discharge. One patient (4.0%) died from a hemodialysis-related brain hemorrhage before discharge on the 29th day after the procedure. One patient died of advanced liver cancer in the 33th month after discharge. Aortic rupture, stroke or spinal cord injury did not occur throughout the follow-up period after discharge. Two patients (8.0%) experienced endoleak at the fenestration, however, resulting in only one’s necessity for reintervention. Notably, the procedure effectively maintained ILVAs patency for all patients during follow up. According to our preliminary findings, performing a TEVAR under local anaesthesia using PMF on a Castor branched stent for ILVA preservation appeared practical, secure, and effective.

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A hemodynamic analysis of fenestrated physician-modified endograft repair for complicated aortic dissections involving the visceral arteries

Jiang,

Xiang,

et al. 2023

Computer Methods and Programs in Biomedicine

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Mechanical Performance Assessment of Physician Modified Aortic Stent Graft

Cited by 7 publications

References 18 publications

Comparison of the Snare Loop Technique and the Hungaroring Reinforcement for Physician-Modified Endograft Fenestrations—An In Vitro Study

Comparison of the Snare Loop Technique and the Hungaroring Reinforcement for Physician-Modified Endograft Fenestrations—An In Vitro Study

Utilizing physician modified fenestration on the castor branched stent technique for reconstruction of an isolated left vertebral artery on the aortic arch

A hemodynamic analysis of fenestrated physician-modified endograft repair for complicated aortic dissections involving the visceral arteries

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