Thoracic Endovascular Aortic Repair: Review of Current Devices and Treatments Options

Bodell, Brycen D.; Taylor, Amy C.; Patel, Parag J.

doi:10.1053/j.tvir.2018.06.003

Cited by 12 publications

(6 citation statements)

References 21 publications

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“…For the longterm outcomes, the aorta-specific survival at 11.8 years was 96.2% (Ranney et al, 2018). Previous reports on commercially available devices have also shown an acceptable outcome with a major advance event rate of 5.6% in patient receiving Relay within 1 year after surgery; 2.8% in patient requiring secondary intervention within 1 year with Cook device; a major adverse event rate of 7.6% in patient receiving cTAG within 4 years after surgery (Bodell et al, 2018). Characterized by its minimal invasiveness and versatility, more young patients are now treated by this technology.…”

Section: Discussionmentioning

confidence: 88%

Treatment Site Does Not Affect Changes in Pulse Wave Velocity but Treatment Length and Device Selection Are Associated With Increased Pulse Wave Velocity After Thoracic Endovascular Aortic Repair

et al. 2021

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Background: Endovascular treatment of aortic aneurysm is associated with an increase in pulse wave velocity (PWV) after surgery. However, the effect of different types of endovascular devices on PWV at different sites of the thoracic aorta remains unclear.Objectives: The purposes of this study were (1) to investigate the changes in PWV after endovascular treatment of thoracic aortic aneurysm; (2) to evaluate whether there is a difference in the changes in PWV at different treatment sites; and (3) to evaluate the effect of treatment length on changes in PWV.Methods: From July 2008 to July 2021, 276 patients underwent endovascular treatment of the true thoracic aortic aneurysm. Of these patients, 183 patients who underwent preoperative and postoperative PWV measurement within 1 year of surgery were included in the study. The treatment length index was calculated by treatment length divided by the height of the patients.Results: Five different types of endovascular devices were used (Najuta, Kawasumi Laboratories, Inc., Tokyo, Japan; TAG, W.L. Gore & Associates, Inc., AZ, USA; Relay, Bolton Medical, Inc., FL, USA; Talent/Valiant, Medtronic, MN, USA; and Zenith, Cook Medical, IN, USA). There was no significant change in PWV in patients receiving Najuta (Before: 2,040 ± 346.8 cm/s vs. After: 2,084 ± 390.5 cm/s, p = 0.14). However, a significant increase was observed in other devices: TAG (Before: 2,090 ± 485.9 cm/s vs. After: 2,300 ± 512.1 cm/s, p = 0.025), Relay (Before: 2,102 ± 465.3 cm/s vs. After: 2,206 ± 444.4 cm/s, p = 0.004), Valiant (Before: 1,696 ± 330.2 cm/s vs. After: 2,186 ± 378.7 cm/s, p < 0.001), and Zenith (Before: 2,084 ± 431.7 cm/s vs. After: 2,321 ± 500.6 cm/s, p < 0.001). There was a significant increase in PWV in patients treated from aortic arch (Before: 2,006 ± 333.7 cm/s vs. After: 2,132 ± 423.7 cm/s, p < 0.001) and patients treated from descending thoracic aorta (Before: 2,116 ± 460.9 cm/s vs. After: 2,292 ± 460.9 cm/s, p < 0.001). Multivariate analysis showed that treatment site was not an independent factor associated with changes in PWV. However, Najuta (Coef −219.43, 95% CI −322.684 to −116.176, p < 0.001) and treatment index (Coef 147.57, 95% CI 24.826 to 270.312, p = 0.019) were independent factors associated with changes in PWV.Conclusion: Najuta did not show a significant increase in PWV, while other commercially available devices showed a significant increase. The treatment site did not have a different effect on PWV. However, the treatment length was an independent factor associated with an increase in PWV.

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Section: Discussionmentioning

confidence: 88%

Treatment Site Does Not Affect Changes in Pulse Wave Velocity but Treatment Length and Device Selection Are Associated With Increased Pulse Wave Velocity After Thoracic Endovascular Aortic Repair

et al. 2021

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“…Initially introduced for the treatment of abdominal aortic aneurysms, endovascular repair has now been extended to the thoracic aorta and arch. TEVAR offers several benefits to patients, including short post-operative time spent in the hospital and fast recovery ( 4 – 6 ).…”

Section: Introductionmentioning

confidence: 99%

Aortic haemodynamics and wall stress analysis following arch aneurysm repair using a single-branched endograft

Sengupta

Yuan

Maga

et al. 2023

Front. Cardiovasc. Med.

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IntroductionThoracic endovascular aortic repair (TEVAR) of the arch is challenging given its complex geometry and the involvement of supra-aortic arteries. Different branched endografts have been designed for use in this region, but their haemodynamic performance and the risk for post-intervention complications are not yet clear. This study aims to examine aortic haemodynamics and biomechanical conditions following TVAR treatment of an aortic arch aneurysm with a two-component single-branched endograft.MethodsComputational fluid dynamics and finite element analysis were applied to a patient-specific case at different stages: pre-intervention, post-intervention and follow-up. Physiologically accurate boundary conditions were used based on available clinical information.ResultsComputational results obtained from the post-intervention model confirmed technical success of the procedure in restoring normal flow to the arch. Simulations of the follow-up model, where boundary conditions were modified to reflect change in supra-aortic vessel perfusion observed on the follow-up scan, predicted normal flow patterns but high levels of wall stress (up to 1.3M MPa) and increased displacement forces in regions at risk of compromising device stability. This might have contributed to the suspected endoleaks or device migration identified at the final follow up.DiscussionOur study demonstrated that detailed haemodynamic and biomechanical analysis can help identify possible causes for post-TEVAR complications in a patient-specific setting. Further refinement and validation of the computational workflow will allow personalised assessment to aid in surgical planning and clinical decision making.

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“…In addition to other types of polymeric materials, polyesters have found diverse uses in biomedical applications, such as controlled drug release systems [ 1 , 2 , 3 , 4 , 5 ], time-tailored implants, screws, prostheses, and different 3D structures including scaffolds for bone reconstruction and tissue engineering [ 6 ]. Various medical products containing polyesters are commercially available, while new ones are awaiting patents for placement on the market.…”

Section: Introductionmentioning

confidence: 99%

Special Features of Polyester-Based Materials for Medical Applications

Darie-Niță¹,

Râpă

Frąckowiak

2022

Polymers

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This article presents current possibilities of using polyester-based materials in hard and soft tissue engineering, wound dressings, surgical implants, vascular reconstructive surgery, ophthalmology, and other medical applications. The review summarizes the recent literature on the key features of processing methods and potential suitable combinations of polyester-based materials with improved physicochemical and biological properties that meet the specific requirements for selected medical fields. The polyester materials used in multiresistant infection prevention, including during the COVID-19 pandemic, as well as aspects covering environmental concerns, current risks and limitations, and potential future directions are also addressed. Depending on the different features of polyester types, as well as their specific medical applications, it can be generally estimated that 25–50% polyesters are used in the medical field, while an increase of at least 20% has been achieved since the COVID-19 pandemic started. The remaining percentage is provided by other types of natural or synthetic polymers; i.e., 25% polyolefins in personal protection equipment (PPE).

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Thoracic Endovascular Aortic Repair: Review of Current Devices and Treatments Options

Cited by 12 publications

References 21 publications

Treatment Site Does Not Affect Changes in Pulse Wave Velocity but Treatment Length and Device Selection Are Associated With Increased Pulse Wave Velocity After Thoracic Endovascular Aortic Repair

Treatment Site Does Not Affect Changes in Pulse Wave Velocity but Treatment Length and Device Selection Are Associated With Increased Pulse Wave Velocity After Thoracic Endovascular Aortic Repair

Aortic haemodynamics and wall stress analysis following arch aneurysm repair using a single-branched endograft

Special Features of Polyester-Based Materials for Medical Applications

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