Reentry Devices for Lamella Neofenestration During Endovascular Aortic Repair of Chronic Type B Aortic Dissection

Bertoglio, Luca; Cambiaghi, Tommaso; Grandi, Alessandro; Kahlberg, Andrea; Melissano, Germano; Chiesa, Roberto

doi:10.1177/1526602818759756

Cited by 5 publications

(4 citation statements)

References 8 publications

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“…[12][13][14] In 2014, Bertoglio et al also described neofenestration using a standard or IVUSguided reentry device in either the TL or FL, while a balloon simultaneously inflated in the opposite lumen to stabilize the lamella provided needle counterforce, and prevented displacement of the lamella away from the reentry needle. 3 In our rescue cases, a transbrachial antegrade endovascular access to the aorta may have reduced contrast exposure and procedure time using a through-and-through brachial-femoral wire to enable retrograde delivery of the TEVAR extension across the aortic septum. However, fenestration from the stented FL to the almost completely collapsed TL would have borne high risk for fatal aortic perforation.…”

Section: Discussionmentioning

confidence: 94%

“…This technique and situation obviated the need for an additional balloon. 3 Successful TL-FL fenestration must be verified before ballooning. During ballooning downward traction was omitted in order to avoid further unpredictable damage to the dissected aorta.…”

Section: Discussionmentioning

confidence: 99%

“…12–14 In 2014, Bertoglio et al also described neofenestration using a standard or IVUS-guided reentry device in either the TL or FL, while a balloon simultaneously inflated in the opposite lumen to stabilize the lamella provided needle counterforce, and prevented displacement of the lamella away from the reentry needle. 3…”

Section: Discussionmentioning

confidence: 99%

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Endovascular Rescue Aortic Fenestration After Accidental False Lumen TEVAR in Type B Dissection

et al. 2022

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Purpose: Unintended false-lumen thoracic endovascular aortic repair (TEVAR) is under-reported and often fatal. We present percutaneous endovascular rescue techniques for true-lumen reperfusion with strategies to address the peripheral artery perfusion needs unique to each case. Case Report: Two patients deteriorated 24 hours after uncomplicated and complicated acute aortic type-B dissection TEVAR treatment at a tertiary community hospital. Reevaluation of index and repeated imaging studies revealed inadvertent false-lumen TEVAR with severe visceral and peripheral ischemia. Stepwise subtraction angiography was used to confirm continuous true-lumen catheterization from femoral puncture into the thoracic aorta. Retrograde fenestration distal to the misplaced TEVAR from the true- into the false-lumen allowed for snorkeling by distal stent-extension across the dissection membrane. In one case, TEVAR stent graft extension resulted in true-lumen re-expansion and in the other case, bare-metal stent-extension for stabilization of the dissection membrane resulted in true-lumen re-expansion in addition to preservation of visceral and peripheral perfusion via the false-lumen. Despite excellent acute hemodynamic results and initial signs of recovery, both patients eventually died (multiorgan failure; cerebral hemorrhagic infarction). Conclusion: Correct indication and prompt recognition of potential inadvertent false-lumen stenting is critical to avoid disastrous sequelae, for example, malperfusion. Endovascular salvage is feasible for restoration of correct perfusion and must be performed in a timely manner. Clinical Impact Clinically apparent, complicated type-B dissection necessitates instantaneous treatment. Prerequisite for an endovascular approach is a true-lumen guidewire continuously from access to the ascending aorta. DSA after TEVAR and prompt clinical re-evaluation are to verify effective visceral and peripheral restoration of blood flow. Despite these measures, inadvertent false-lumen TEVAR may occur rarely. Immediate recognition may allow for timely true-lumen re-expansion using percutaneous endovascular salvage techniques e.g. retrograde fenestration from the true- into the false-lumen for distal snorkeling of the misplaced TEVAR across the dissection membrane. However, morbidity and mortality are very high, if erroneous stent graft placement is not identified early.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

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Endovascular Rescue Aortic Fenestration After Accidental False Lumen TEVAR in Type B Dissection

et al. 2022

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“…All 3 patients received a Zenith Alpha stent-graft (William Cook Europe, Bjaeverskov, Denmark) in the true lumen landed distally 1 to 3 cm above the celiac trunk; the stentgraft was oversized with regard to previous thoracic or FET stent-grafts and deployed with adequate overlapping. In 1 case, the celiac trunk originated from the FL, so a neofenestration in the dissecting lamella was created 3 cm above the celiac trunk origin 15 to facilitate easy catheterization during the third step ( Figure 1).…”

Section: First Stepmentioning

confidence: 99%

Staged Fenestrated/Branched Repair of Postdissecting Thoracoabdominal Aneurysm With Candy-Plug False Lumen Occlusion for Spinal Cord Preconditioning

et al. 2020

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Purpose: To describe a possible application of thoracic false lumen occlusion techniques with a Candy-Plug occluder to induce false lumen thrombosis for preconditioning the spinal cord during staged fenestrated repair of postdissecting thoracoabdominal aneurysms. Technique: A Candy-Plug occluder is deployed within the thoracic false lumen after proximal entry tear coverage with a standard thoracic stent-graft during staged repair of postdissecting thoracoabdominal aneurysms. The blockade of thoracic false lumen retrograde reperfusion from distal entry tears induces a controlled thrombosis of both the thoracic false lumen and intercostal arteries. Then, when the fenestrated device is delivered 4 to 6 weeks later, the procedure is completed with standard techniques according to the staging protocols of individual centers. Conclusion: A new possible application of a Candy-Plug false lumen occlusion technique might be an intermediate procedure aimed at preconditioning the spinal cord by occluding the thoracic false lumen during complex staged fenestrated thoracoabdominal repairs.

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Descending Aortic Dissection, Penetrating Aortic Ulcer, and Intramural Hematoma (Acute and Chronic) Including Kommerell’s Diverticulum

Bonaca

2019

Diseases of the Aorta

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Reentry Devices for Lamella Neofenestration During Endovascular Aortic Repair of Chronic Type B Aortic Dissection

Cited by 5 publications

References 8 publications

Endovascular Rescue Aortic Fenestration After Accidental False Lumen TEVAR in Type B Dissection

Endovascular Rescue Aortic Fenestration After Accidental False Lumen TEVAR in Type B Dissection

Staged Fenestrated/Branched Repair of Postdissecting Thoracoabdominal Aneurysm With Candy-Plug False Lumen Occlusion for Spinal Cord Preconditioning

Descending Aortic Dissection, Penetrating Aortic Ulcer, and Intramural Hematoma (Acute and Chronic) Including Kommerell’s Diverticulum

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