Technical Aspects of Fenestrated Arch TEVAR With Preloaded Fenestration

Prendes, Carlota Fernández; Banafsche, Ramin; Stana, Jan; Binskin, Robert; Konstantinou, Nikolaos; Kölbel, Tilo; Tsilimparis, Nikolaos

doi:10.1177/15266028211007469

Cited by 9 publications

(5 citation statements)

References 15 publications

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“…Chassin-Trubert et al reported improvement in the success rate after applying the pre-loaded guidewire [from 94% (19/22) to 100% (28/28)], all of which were total endovascular aortic arch repair, revascularizing all supra-aortic trunks ( 22 ). Additionally, the alignment could be simplified and reassured with a pre-loaded guidewire, thus shortening the learning curve ( 23 ).…”

Section: Discussionmentioning

confidence: 99%

Outcomes of thoracic endovascular aortic repair with fenestrated surgeon-modified stent-graft for type B aortic dissections involving the aortic arch

Zhang²,

Song³

et al. 2023

Front. Cardiovasc. Med.

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ObjectivesThis retrospective analysis aimed to evaluate the early and midterm outcomes of thoracic endovascular aortic repair (TEVAR) with fenestrated surgeon-modified stent-graft (f-SMSG) for type B aortic dissections (TBAD) involving the aortic arch.MethodsFrom March 2016 to April 2021, 47 consecutive patients were treated using TEVAR with f-SMSG. All patients were diagnosed with TBAD involving the aortic arch.ResultsIn total, 47 patients with TBAD involving the aortic arch were treated with f-SMSGs. There were 21 zone 1 and 26 zone 2 TEVAR, and 65 arteries were revascularized successfully with fenestrations. Technical success was achieved in 46 patients (97.88%). The 30-day estimated survival (± SE) and reintervention was 93.6 ± 1.0% (95% Confidence Interval [CI], 92.6–94.6%) and 91.5 ± 1.2% (95% CI, 90.3–92.7%), respectively. During a median follow-up of 51 months (range, 16–71 months), 1 patient died of rupture of aortic dissection (AD) and 3 patients died of non-aortic-related reasons. Reintervention was performed for four patients, including two patients of type IA entry flow and two patients of type IB entry flow. No occlusion of the supra-aortic trunk was observed. The estimated survival and reintervention (± SE) at 4 years was 88.7 ± 1.4% (95% CI, 87.3–90.1%) and 84.8 ± 1.5% (95% CI, 83.3–86.3%), respectively.ConclusionThoracic endovascular aortic repair with f-SMSG is an alternative treatment option for TBAD involving the aortic arch in high-volume centers.

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Section: Discussionmentioning

confidence: 99%

Outcomes of thoracic endovascular aortic repair with fenestrated surgeon-modified stent-graft for type B aortic dissections involving the aortic arch

Zhang²,

Song³

et al. 2023

Front. Cardiovasc. Med.

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“…Using a variety of endografts, some authors have advocated the use of preloaded through-and-through guidewires through the LSA for endovascular aortic arch repair. [2][3][4][5][6][7][8][9][10] Some of these devices are fenestrated, associated or not with scallops or larger fenestrations, while others consist of inner or outer branches. All of them share the technical potential obstacle of wire wrapping.…”

Section: Discussionmentioning

confidence: 99%

“…These maneuvers involve partial deployment of the devices, rotation, and retraction in the aortic arch prior to full deployment. 8,9 This manipulation is fraught with device distortion, failure to cannulate a fenestration, cerebral embolization, or failure to advance the graft without losing preloaded guidewires.…”

Section: Discussionmentioning

confidence: 99%

“…Due to the angulation of the aortic arch, twisting and wire wrapping have been an important issue. 8,9 When using only one preloaded guidewire, the solution to this problem involves a series of maneuvers, including rotation and retraction of the delivery system and guidewires, as demonstrated by Prendes et al 8 This kind of movement can damage the device, in addition to increasing the risk of cerebral embolization, the Achilles' heel of the endovascular approach. When using 2 or 3 preloaded wires, they may easily wrap or intertwine in myriad ways, and, to our knowledge, endovascular arch repair with more than one precannulated supra-aortic branch has not been previously described.…”

Section: Introductionmentioning

confidence: 99%

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The End of Wire Wrapping: A Technique to Avoid Intertwining Preloaded Guidewires for Endovascular Aortic Arch Repair

et al. 2021

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Purpose: The purpose of this study was to present a new technique for endovascular aortic arch repair for 1, 2, or 3 vessels using preloaded wires and precannulated target vessels without wire wrapping. Technique: This technique uses a prototype catheter with 2 parallel lumens to position through-and-through guidewires in the supra-aortic branches and an extra-stiff guidewire in the ascending aorta with no wrapping. This allows the introduction and advancement of the device with the already precannulated target vessels. The endograft is advanced to the aortic arch without twisting or wrapping. Covered stents are deployed to align the graft and target vessels. Conclusion: To our knowledge, a technique that avoids wire wrapping has not been previously described. This technique allows safer and faster endovascular arch procedures and opens up new possibilities by enabling multi-vessel endovascular aortic arch repair with all precannulated target vessels.

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“…5 Commonly, OAR is reserved only for those fit patients in experienced highvolume centres and TEVAR arises as the best treatment for those anatomically suitable. 6 Many techniques have been described to achieve adequate proximal/distal landing zones (PLZ/DLZ); as scallops, 7 chimneys, 8,9 in-situ laser fenestration, 10 endograft modifications, 11 branched repair, 12 fenestrated repair 13 and hybrid procedures associating cervical supra-aortic debranching. These approaches are critical to optimising the length of the LZ in order to minimise the risk of type I endoleaks (T1ELs).…”

Section: Introductionmentioning

confidence: 99%

Mid-term outcomes of the use of endoanchors during thoracic endovascular aortic repair in multicentre analysis

et al. 2022

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Objective To describe mid-term outcomes of the use of EndoAnchors as an adjunct for arch and thoracic endovascular aortic repair (TEVAR). Methods A retrospective multicentre series from nine centres using the Heli-FX EndoAnchor System (Medtronic Inc, Minneapolis, USA) at TEVAR over May 2014–May 2019 is presented. The study is registered at ClinicalTrials.gov with number NCT04100499. The primary outcome was freedom from Type I endoleak at EndoAnchors deployments; secondary outcomes included evaluation of aortic wall penetration (AWP) at first computed tomography scan, EndoAnchor-related issues and mortality. Results 54 high-risk patients (35 males/19 females, age 73 ± 11 years) with arch, thoracic and thoracoabdominal aneurysmal disease (3 chronic post-dissection and one patch pseudoaneurysm), with a mean neck length 19.7 ± 6.6 mm that were treated with multiple hybrid and endovascular techniques were included. A total of 329 EndoAnchors were used with a mean of 6.1 ± 2.5 per patient. Overall adequate AWP was 86%, whereas arch (Ishimaru’s zones 0–2) deployments achieved 80.6% when compared to 87.3% in descending thoracic aorta (dTA); although there was no statistical significance. Freedom from type I endoleaks was 88% at 2 year follow-up, due to 4 type IA endoleaks, two of them successfully treated, one with conservative treatment due to complexity of repair and remaining patient died 1 year later due to endograft infection. There were reported five EndoAnchor-related issues; four losses and one renal stent-graft was crushed due to catheter deflection solved with balloon reinflation. None of the losses had clinical significance. Overall mortality is described for 7 (9.5%) patients, one of them aneurysm-related. Conclusions The adjunctive use of EndoAnchors in TEVAR and complex TEVAR procedures achieved acceptable outcomes at midterm in a high-risk series with hostile seal zones. Still, they should be still judiciously used as there is lack of data to suggest a more liberal use; therefore, the landing zone should not be compromised in favour of their use.

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Technical Aspects of Fenestrated Arch TEVAR With Preloaded Fenestration

Cited by 9 publications

References 15 publications

Outcomes of thoracic endovascular aortic repair with fenestrated surgeon-modified stent-graft for type B aortic dissections involving the aortic arch

Outcomes of thoracic endovascular aortic repair with fenestrated surgeon-modified stent-graft for type B aortic dissections involving the aortic arch

The End of Wire Wrapping: A Technique to Avoid Intertwining Preloaded Guidewires for Endovascular Aortic Arch Repair

Mid-term outcomes of the use of endoanchors during thoracic endovascular aortic repair in multicentre analysis

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