Transrenal Fixation of Aortic Endografts: Intermediate Follow-up of a Single-Center Experience

Lobato, Armando C.; Quick, Rhonda C.; Vaughn, Paul L.; Rodriguez‐Lopez, Julio A.; Douglas, Myles; Diethrich, Edward B.

doi:10.1583/1545-1550(2000)007<0273:tfoaei>2.3.co;2

Cited by 44 publications

(43 citation statements)

References 28 publications

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“…Since its first introduction into the clinical practice in 1991, endovascular stent grafting has been widely used in clinical practice with satisfactory results being achieved [1][2][3][4][5] . Over the last decade, the technique of endovascular stent grafting has progressed rapidly following an improved understanding of the strengths and limitations of various devices and treated patient populations [3][4][5][6] . Application of this technology is still limited to patients with suitable proximal and distal sealing zones.…”

Section: Endovascular Repair (Evar) Of Abdominal Aortic Aneurysm (Aaamentioning

confidence: 99%

“…Application of this technology is still limited to patients with suitable proximal and distal sealing zones. It is estimated that up to 40% of patients are unsuitable for conventional infrarenal EVAR as complicated aneurysm necks prevent the patients from being candidates to receive treatment with placement of stent grafts infrarenally due to inadequate sealing zones in the aneurysm neck [5,6] .…”

Section: Endovascular Repair (Evar) Of Abdominal Aortic Aneurysm (Aaamentioning

confidence: 99%

“…Unfavorable aneurysm necks (neck length less than 10 mm, severe angulation > 60°, and severe calcification or presence of thrombus in the aneurysm neck) remain challenging for conventional infrarenal EVAR, and this has been addressed by using suprarenal and fenestration endovascular techniques [5][6][7][8][9][10] . Currently, helical computed tomography (CT) angiography is the preferred method for assessment of suprarenal and fenestrated stent grafting due to its rapid technical developments, which allow for acquisition of high spatial and temporal resolution images [11][12][13] .…”

Section: Sun Z Endovascular Stent Graft Repair Of Aortic Aneurysmsmentioning

confidence: 99%

“…This allows for proximal fixation of stent grafts with aim of reducing the migration of stent grafts after deployment, thus decreasing the incidence of procedure-related complications, mainly type Ⅰ endoleak or stent graft migration [5,6] . Attachment may be improved by adding hooks and barbs to the proximal stent ( Figure 1) [22,23] .…”

Section: Suprarenal Fixation Of Stent Grafts-technical Detailsmentioning

confidence: 99%

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Endovascular stent graft repair of abdominal aortic aneurysms: Current status and future directions

Sun¹

2009

WJR

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Endovascular stent graft repair of abdominal aortic aneurysm (AAA) has undergone rapid developments since it was introduced in the early 1990s. Two main types of aortic stent grafts have been developed and are currently being used in clinical practice to deal with patients with complicated or unsuitable aneurysm necks, namely, suprarenal and fenestrated stent grafts. Helical computed tomography angiography has been widely recognized as the method of choice for both pre-operative planning and post-operative followup of endovascular repair (EVAR). In addition to 2D axial images, a number of 2D and 3D reconstructions are generated to provide additional information about imaging of the stent grafts in relation to the aortic aneurysm diameter and extent, encroachment of stent wires to the renal artery ostium and position of the fenestrated vessel stents. The purpose of this article is to provide an overview of applications of EVAR of AAA and diagnostic applications of 2D and 3D image visualizations in the assessment of treatment outcomes of EVAR. Interference of stent wires with renal blood flow from the hemodynamic point of view will also be discussed, and future directions explored.

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Section: Endovascular Repair (Evar) Of Abdominal Aortic Aneurysm (Aaamentioning

confidence: 99%

Section: Endovascular Repair (Evar) Of Abdominal Aortic Aneurysm (Aaamentioning

confidence: 99%

Section: Sun Z Endovascular Stent Graft Repair Of Aortic Aneurysmsmentioning

confidence: 99%

Section: Suprarenal Fixation Of Stent Grafts-technical Detailsmentioning

confidence: 99%

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Endovascular stent graft repair of abdominal aortic aneurysms: Current status and future directions

Sun¹

2009

WJR

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“…With experience gathered, it was found that 30-40% of patients were excluded from the traditional infrarenal fixation of stent grafts due to complicated infrarenal aneurysm necks, either because of short necks (less than 10 mm), severe angulation (more than 60 degrees) or poor quality (extensive calcification or presence of thrombus). Therefore, a modification of the aortic stent grafts, suprarenal fixation has been developed to accommodate these patients unsuitable for infrarenal stent grafting [4][5][6]. Suprarenal fixation of stent grafts involves placing an uncovered suprarenal component above the renal arteries with aim of acquiring proximal fixation without compromising the renal blood flow or renal function.…”

Section: Introductionmentioning

confidence: 99%

Investigation of the Hemodynamic Effect of Stent Wires on Renal Arteries in Patients with Abdominal Aortic Aneurysms Treated with Suprarenal Stent-Grafts

Sun

Chaichana

2009

Cardiovasc Intervent Radiol

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Investigation of hemodynamic effect of stent wires on renal arteries in patients with abdominal aortic aneurysms treated with suprarenal stent grafts 2 Abstract Purpose: The purpose of the study was to investigate the hemodynamic effect of stent struts (wires) on renal arteries in patients with abdominal aortic aneurysms (AAA) treated with suprarenal stent grafts. Materials and Methods:Two sample patients with AAA undergoing multislice CT angiography pre-and post-suprarenal fixation of stent grafts were selected for inclusion in the study. Eight juxtarenal models focusing on the renal arteries were generated from the multislice CT datasets. Four types of configurations of stent wires crossing the renal artery ostium, namely single wire centrally crossing, single wire peripherally crossing, Vshaped wire centrally crossing and multiple wires peripherally crossing were simulated in the segmented aorta models. The blood flow pattern, flow velocity, wall pressure and wall shear stress at the renal arteries pre-and post-stent grafting were analyzed and compared using a two-way fluid structure interaction analysis. The stent wire thickness was simulated with a diameter of 0.4 mm, 1.0 mm and 2.0 mm, and hemodynamic analysis was performed at different cardiac cycles. Results:The interference of stent wires with renal blood flow was mainly determined by the thickness of stent wires, and the type of configuration of stent wires crossing the renal ostium. The flow velocity was reduced by 20-30% in most of the situations when the stent wire thickness increased to 1.0 mm and 2.0 mm. Of 4 types of configuration, the single wire crossing centrally resulted in the highest reduction of flow velocity, ranging from 21% to 28.9% among three different wire thicknesses. Wall shear stress was also dependent on the wire thickness, which decreased significantly when the wire thickness reached 1.0 and 2.0 mm.3 Conclusion: Our preliminary study showed that the hemodynamic effect of suprarenal stent wires in patients with AAA treated with suprarenal stent grafts was determined by the thickness of suprarenal stent wires. Research findings in our study are useful for follow-up of patients treated with suprarenal stent grafts to ensure long-term safety of the suprarenal fixation.

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Endovascular treatment of abdominal aortic aneurysm

Gorham

Taylor

Raptis

2004

British Journal of Surgery

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Endoleak is a potentially serious complication of the endovascular technique and occurs in a significant proportion of patients. It is still not possible to judge whether the presence of an endoleak alone signifies failure of treatment, and the long-term durability of prosthetic covered stents is unknown. However, endovascular repair does appear to confer a degree of protection from rupture although patients must be advised of the need for life-long imaging surveillance and, perhaps, further intervention.

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Transrenal Fixation of Aortic Endografts: Intermediate Follow-up of a Single-Center Experience

Cited by 44 publications

References 28 publications

Endovascular stent graft repair of abdominal aortic aneurysms: Current status and future directions

Endovascular stent graft repair of abdominal aortic aneurysms: Current status and future directions

Investigation of the Hemodynamic Effect of Stent Wires on Renal Arteries in Patients with Abdominal Aortic Aneurysms Treated with Suprarenal Stent-Grafts

Endovascular treatment of abdominal aortic aneurysm

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