Technical Challenges in Endovascular Repair of Complex Thoracic Aortic Aneurysms

Kanaoka, Yuji; Ohki, Takao; Toya, Naoki; Ishida, Atsushi; Tachihara, Hiromasa; Hirayama, Shigeki; Kurosawa, Koji; Sumi, Makoto; Ohta, Hiroyuki; Kaneko, Kenjiro

doi:10.3400/avd.oa.11.01011

Cited by 21 publications

(15 citation statements)

References 13 publications

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“…The hybrid repair of arch lesions for zone 0 is feasible in patients unsuitable for open repair 8 . On the other hand, endografting in the aortic arch is associated with a higher mortality and morbidity than in zone 4 TEVAR 9 .…”

Section: Discussionmentioning

confidence: 99%

Aortic arch aneurysm repair using the Najuta stent graft in a challenging compromised seal zone

Toya

Shukuzawa

Fukushima

et al. 2016

Journal of Vascular Surgery Cases

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We report the case of a 67-year-old patient with an anatomically complex aneurysm of the aortic arch treated by fenestrated thoracic endovascular aortic repair with subclavian-carotid extrathoracic bypass. We used the Najuta thoracic stent graft, which was approved for use in January 2013 in Japan and successfully excluded the aneurysm. Our case shows that the Najuta stent graft procedure is a feasible treatment if open repair is unsuitable for cases of aortic arch aneurysm with a challenging compromised seal zone.

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Section: Discussionmentioning

confidence: 99%

Aortic arch aneurysm repair using the Najuta stent graft in a challenging compromised seal zone

Toya

Shukuzawa

Fukushima

et al. 2016

Journal of Vascular Surgery Cases

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“…The snorkel technique for a juxtarenal abdominal aortic aneurysm (JAAA) is an important treatment option in high-risk patients [ 1 , 2 ]. However, trans-brachial stent delivery is difficult in some cases, such as those involving occlusion of the subclavian or axillary artery, the type III aortic arch, post-arch replacement, or obtuse renal artery angle [ 3 – 5 ].…”

Section: Introductionmentioning

confidence: 99%

The lift snorkel technique for type Ia endoleak after fenestrated endovascular aneurysm repair of a juxtarenal abdominal aortic aneurysm

et al. 2021

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Background The snorkel technique for a juxtarenal abdominal aortic aneurysm (JAAA) is an important treatment option for high-risk patients. We report the lift snorkel technique through the trans-femoral access for a type Ia endoleak after fenestrated endovascular aneurysm repair (FEVAR) in a case of difficult trans-brachial access. Case presentation A 76-year-old woman who had JAAA presented with a type Ia endoleak and sac expansion after FEVAR. We planned for proximal additional stentgraft with the bilateral renal artery snorkel technique. However, during the secondary intervention, it was difficult to cannulate to the left renal artery through the trans-brachial access due to interference of the supra-renal stent. Stentgraft was eventually delivered into the left renal artery via the trans-femoral access with a 5 Fr sheath. A plain angioplasty balloon was inserted coaxially through the sheath. The balloon was inflated in the proximal end of the stentgraft and then pushed up to replace the proximal end from down to up. The additional aortic cuff was deployed parallel to the snorkel stentgraft. One year after the additional treatment, computed tomography (CT) revealed aneurysm sac shrinkage. Conclusion The lift snorkel technique is a unique method converting the retrograde approach to antegrade renal artery stenting and would be an effective option for difficult trans-brachial cases for a type Ia endoleak after FEVAR of a JAAA.

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“…The majority of these devices have to be customized however and their availability as well as costs remain a major concern [ 8 – 10 ]. Furthermore, positioning and deployment are still considered difficult [ 11 , 12 ]. In this study, we report on a new design of a fenestrated stent graft with a novel modification of the olive tip and delivery system with its first application in two patients.…”

Section: Introductionmentioning

confidence: 99%

Two Wire System and Modified Olive Tip to Facilitate Implantation of Fenestrated TEVAR in Patient with Proximal Descending Aortic Pathology: First Two Cases

Adiarto

Kang

Sunu

et al. 2019

Cardiovasc Intervent Radiol

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IntroductionAlthough Fenestrated TEVAR (F-TEVAR) has been considered to be a more physiologic approach to treat proximal descending aortic pathology, its application is still limited due to availability, cost and technical difficulties. We introduce a new design of fenestrated stent graft with a new delivery system and successfully performed first in human implantation in two patients, one with an aortic aneurysm and one with an acute aortic dissection.Materials and MethodsThe design of these two wires fenestrated stent graft include creation of an additional lumen at the side of the olive tip during manufacture, from which an additional wire can be introduced for a side branch passing into the fenestration, running inside the stent graft and exit the delivery sheath through additional hub. The two wires will facilitate delivery and deployment of the stent graft. One patient with descending aortic aneurysm and another with Stanford B aortic dissection is included in this first in human study.ResultsThe aneurysm and dissection were completely excluded immediately after the TEVAR. Six month follow up CT showed good position of the stent graft and patent LSA in both patients. In the patient with aortic dissection, expansion of the true lumen and partial thrombosis of the false lumen was seen.ConclusionsThis is a report of a two wire system in 2 patients with distal aortic arch pathology demonstrating a good technical and clinical success using pre-cannulated fenestrations through a modified nose cone olive.Level of EvidenceLevel 4, report of two cases.

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Technical Challenges in Endovascular Repair of Complex Thoracic Aortic Aneurysms

Cited by 21 publications

References 13 publications

Aortic arch aneurysm repair using the Najuta stent graft in a challenging compromised seal zone

Aortic arch aneurysm repair using the Najuta stent graft in a challenging compromised seal zone

The lift snorkel technique for type Ia endoleak after fenestrated endovascular aneurysm repair of a juxtarenal abdominal aortic aneurysm

Two Wire System and Modified Olive Tip to Facilitate Implantation of Fenestrated TEVAR in Patient with Proximal Descending Aortic Pathology: First Two Cases

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