Treatment of Visceral Aneurysm Using Multilayer Stent: Two-Year Follow-Up Results in Five Consecutive Patients

Balderi, Alberto; Antonietti, Alberto; Pedrazzini, F.; Sortino, D.; Vinay, C; Grosso, Maurizio

doi:10.1007/s00270-013-0705-0

Cited by 45 publications

(29 citation statements)

References 15 publications

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“…Development of flow-diversion devices for treatment of aneurysm created a paradigm shift from traditional stent-grafts. Flow diversion concept of excluding aneurysm with a passive physical barrier has been successful in managing peripheral and visceral aneurysms (10)(11)(12)(13). Recently, the use of flow diversion stent device has been extended to treat complex aortic aneurysm with encouraging medium-term clinical outcomes (14-16).…”

Section: Introductionmentioning

confidence: 99%

Is Multiple Overlapping Uncovered Stents Technique Suitable for Aortic Aneurysm Repair?

Yeow

Leo

2017

Artificial Organs

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A computational fluid dynamic model to assess the impact of flow-diverter device on intra-aneurysmal flow in complex aortic aneurysm from the viewpoint of hemodynamics is presented. The aim of this study is to investigate the hemodynamic effects of an endovascular flow-diverter technique using multiple overlapping uncovered stents (MOUS) in the treatment of complex aortic aneurysm involving side branch. The placement of porous barrier such as MOUS across the aneurysm alters the blood flow pattern in the aneurysm sac. Subsequently, flow diversion effect creates a natural hemodynamic environment to promote aneurysm thrombosis, thus stabilizing the aneurysm. The study revealed that intra-aneurysmal flow was reduced and low time average wall shear stress (TAWSS), high relative residence time (RRT), and high oscillatory shear index (OSI) regions were observed in the aneurysm sac. Three to four MOUS stents produced the best hemodynamic environment for the formation of thrombus, with saccular aneurysm performing better than fusiform aneurysm from the viewpoint of hemodynamics. A result also revealed that flow in the branch vessel was not compromised suggesting the capacity of preserving patency of branch vessels while at the same time stabilizing the aneurysm. Based on the hemodynamic performance of this study coupled with existing reported clinical studies, deploying three to four MOUS stents is a feasible solution to treat aneurysm with side branch, favorably for saccular shape aneurysm.

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Section: Introductionmentioning

confidence: 99%

Is Multiple Overlapping Uncovered Stents Technique Suitable for Aortic Aneurysm Repair?

Yeow

Leo

2017

Artificial Organs

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“…Consequently, the continuity equation and Navier–Stokes equation are shown as follow.where P and u are pressure and blood velocity, respectively. In the computational models, the density (ρ) and dynamic viscosity (μ) were set as 1055 kg/m 3 and 3.5 × 10 −3 kg/ms [11], respectively.…”

Section: Methodsmentioning

confidence: 99%

“…Lowe et al [9] reported 14 patients were treated with MS, 7 patients died including one fatal rupture; Vojko et al [10] reported a 50-year-old man with two juxtarenal saccular aneurysms of abdominal aorta was treated with MS, and it showed the continuous shrinkage of the aneurysm sac in a 1 year follow-up. Alberto et al [11]. implanted 5 MSs in 5 patients to treat hepatic artery aneurysms, 2 years follow-up showed technical successes; Morris et al [12] treated visceral artery aneurysms (VAAs) in 5 patients with MSs and technical successes were achieved for all patients; Bouillot et al [13] compared the process of intracranial aneurysms (IAs) treated with flow diverter stents through both PIV and CFD, the results showed there was a good PIV–CFD agreement.…”

Section: Introductionmentioning

confidence: 99%

Hemodynamics study of a multilayer stent for the treatment of aneurysms

et al. 2016

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BackgroundThe changes of hemodynamics caused by the implantation of multilayer stent (MS) have significant effects for aneurysm sac.MethodsComparisons of 3D numerical models with/without a MS in an abdominal aortic aneurysm with a 90° branch vessel were numerically studied from the viewpoint of hemodynamics.ResultsThe results showed that: (1) The flow fields and Wall Shear Stress (WSS) are changed dramatically after MS implantation. The velocity of the blood flow in aneurysm sac decreases significantly and the regions of low-WSS increase. These help thrombus formation; (2) The pressure in aneurysm slightly decreases and keeps close to the normal level of blood pressure, however the risk of aneurysm enlargement or even rupture still exists; (3) The flux and the velocity in branch artery are reduced by about half after MS implantation. Due to the implantation of MS, the changes in the flow field causes the decrease of pressure/WSS in aneurysm sac and the blood flow in branch vessel.ConclusionsThe implantation of MS into abdominal artery results in more low-WSS regions inside aneurysm which induces thrombus formation. The pressure is reduced slightly means the risk of aneurysm rupture exists.

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“…Clinical results have been published on the MFM device used to treat aortic, peripheral and visceral aneurysms [7][8][9][15][16][17]. However, there is paucity of long-term data in relation to this new device, with current literature reporting relatively short follow up results [15][16][17].…”

Section: Discussionmentioning

confidence: 99%

“…However, there is paucity of long-term data in relation to this new device, with current literature reporting relatively short follow up results [15][16][17]. When conducted strictly in accordance with the device instructions for use (IFU), deployment of the MFM has produced consistently positive outcomes in aortic pathologies including TAAA and aortic type B dissections [7][8][9]15].…”

Section: Discussionmentioning

confidence: 99%

Assessment of Biocompatibility of the Multilayer Flow Modulator with Differing Thread Designs

Sultan

Kavanagh²,

Bonneau³

et al. 2014

J Vasc Med Surg

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IntroductionTotal exclusion of the aneurysm sac is the typical aim when stent grafts are deployed during endovascular repair. In treatment of thoraco abdominal aortic pathologies that would involve coverage of visceral arteries, fenestration holes and branching stent-grafts are placed in the endografts to allow for collateral branch flow [1]. However, the branched and fenestrated graft technologies have been found to present considerable difficulty for operator utilization and require greater preoperative preparation in terms of artery and aneurysm morphologies [2]. An alternative approach to management of aortic aneurysms involves disruptive technology, in the form of the Multilayer Flow Modulator (MFM) (Cardiatis, Isnes, Belgium) [3]. The MFM is a self-expandable mesh of cobalt alloy wires interconnected in five layers (Figure 1). The MFM is extremely flexible with high resistance to kinking and fatigue. The MFM design allows blood flow through the mesh in a manner that maintains collateral branch patency, while modulating the flow from turbulent to laminar within the device and the aneurysm sac. Laminar flow in the aneurysm reduces shear stress on the aneurysm wall and encourages the formation of organized thrombus, thereby reducing risk of rupture. The MFM could represent a viable treatment alternative in complex arterial pathologies and in situations where open surgery or endovascular repair using a branched or fenestrated graft would not be feasible. AbstractBackground: The Multilayer Flow Modulator (MFM) (Cardiatis, Isnes, Belgium) is a self-expandable mesh of cobalt alloy wires used for the treatment of aortic aneurysms. The impact of design thread count and duration of implantation on the biocompatibility of the MFM in porcine animal models was assessed in this study.

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Treatment of Visceral Aneurysm Using Multilayer Stent: Two-Year Follow-Up Results in Five Consecutive Patients

Abstract: Long-term results in a wider population are needed to validate the effectiveness of the CMFM.

Cited by 45 publications

References 15 publications

Is Multiple Overlapping Uncovered Stents Technique Suitable for Aortic Aneurysm Repair?

Is Multiple Overlapping Uncovered Stents Technique Suitable for Aortic Aneurysm Repair?

Hemodynamics study of a multilayer stent for the treatment of aneurysms

Assessment of Biocompatibility of the Multilayer Flow Modulator with Differing Thread Designs

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