Type Ia endoleaks after fenestrated and branched endografts may lead to component instability and increased aortic mortality

O’Callaghan, Adrian; Greenberg, Roy K.; Eagleton, Matthew J.; Bena, James; Mastracci, Tara M.

doi:10.1016/j.jvs.2014.10.085

Cited by 46 publications

(35 citation statements)

References 25 publications

(22 reference statements)

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“…17,22 At 12 months, core laboratory-determined type IA endoleaks were identified in 1.9% (1/53) of patients. Although not a direct comparison, these results are in line with both fEVAR (<2% type IA endoleaks at 1 year) 23 and chEVAR (0%-6.3% type IA endoleaks in studies including >15 patients), 17,22 demonstrating the additive benefit of adjunctive EndoAnchor placement to augment proximal sealing within an otherwise hostile neck. Notably, no aneurysm sac growth, aneurysm rupture, or stent graft migration was observed at 12 months after ESAR.…”

Section: Discussionsupporting

confidence: 58%

Endosuture aneurysm repair in patients treated with Endurant II/IIs in conjunction with Heli-FX EndoAnchor implants for short-neck abdominal aortic aneurysm

Arko

Stanley

Pearce

et al. 2019

Journal of Vascular Surgery

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Objective: Endovascular repair of abdominal aortic aneurysm (AAA) remains a challenging clinical scenario when there is a short or nonexistent segment of healthy infrarenal aorta. This study sought to determine the safety and effectiveness of endosuture aneurysm repair (ESAR) using the Endurant II/IIs endograft (Medtronic Vascular, Santa Rosa, Calif) in conjunction with Heli-FX EndoAnchors (Medtronic Vascular) in the treatment of short-neck AAA.Methods: In this subgroup analysis, 70 patients were identified from the Aneurysm Treatment Using the Heli-FX EndoAnchor System Global Registry (ANCHOR) who had an infrarenal neck length <10 mm down to 4 mm based on core laboratory measurements. Primary outcomes included technical success of the index procedure, rate of type IA endoleak at 1 month and 12 months, and rate of secondary procedures at 12 months.Results: In this short-neck cohort (n ¼ 70), the average neck length and diameter were 6.9 6 1.6 mm and 25.7 6 4.0 mm, respectively. Investigators reported an overall procedural success rate of 97.1% and a technical success rate of 88.6%. The duration of the implant procedure, EndoAnchor implantation, and total fluoroscopy time was 148.0 6 80.0 minutes, 17.1 6 11.5 minutes, and 35.3 6 22.0 minutes, respectively, and an average of 5.5 6 2.1 EndoAnchors were implanted per patient. Through the 30-day follow-up, type IA endoleaks were reported in four patients, of which three resolved spontaneously by the 12-month follow-up. There was an additional type IA endoleak through the 12-month follow-up that has not resulted in AAA enlargement or required a secondary procedure. The Kaplan-Meier estimate for freedom from secondary endovascular procedures and all-cause mortality is 95.4% and 92.7% through 365 days, respectively. No patient in the short-neck cohort experienced main body stent migration, increase in maximum aneurysm diameter, or aneurysm rupture or required conversion to open surgical repair through 12 months. Conclusions:In this analysis of the short-neck cohort from ANCHOR, the Endurant II/IIs endograft in conjunction with Heli-FX EndoAnchor implants (ESAR) appears to be a safe and effective treatment option with a high technical success rate and low incidence of type IA endoleaks and secondary interventions. Despite the complex and hostile anatomies, the ESAR method required short procedure and fluoroscopy times. These short-term outcomes suggest that ESAR could be complementary to therapies currently available for treatment of hostile AAA anatomy and a viable off-the-shelf endovascular treatment option for patients with short-neck AAAs, although long-term follow-up is critically important. (J Vasc Surg 2019;70:732-40.)

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Section: Discussionsupporting

confidence: 58%

Endosuture aneurysm repair in patients treated with Endurant II/IIs in conjunction with Heli-FX EndoAnchor implants for short-neck abdominal aortic aneurysm

Arko

Stanley

Pearce

et al. 2019

Journal of Vascular Surgery

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“…However, their occurrence is considered a bad prognostic sign for the durability of the repair, as many of them, regardless of the immediate success, usually recur during follow-up. 99 The rates of early types I and III endoleak were 5.8% and 2.6%, respectively, and the rates of late endoleaks were 2.2% and 3.2% in the latest meta-analysis on FEVAR versus open repair. 9 Overall, and in a recent large data (607 patients receiving four design devices), the rates of types I, II and III endoleak through the entire follow-up period (mean = 8 years) were 3%, 16% and 4.6%, respectively.…”

Section: Type I and Type Iii Endoleaksmentioning

confidence: 89%

Fenestrated stent grafts for the treatment of complex aortic aneurysm disease: A mature treatment paradigm

et al. 2016

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The introduction of fenestrated stent grafts (SGs) to treat abdominal aortic aneurysms (AAAs) with short proximal necks began in 1999. Nowadays, the whole visceral aorta can be treated totally by endovascular means. The established use of fenestrated devices to treat complex AAAs as a first-line management option has been previously reported. An up-to-date evaluation of the literature was performed including all types of publications regarding the use of fenestrated technology to repair complex AAAs. Fenestrated repair is now an established alternative to hybrid/chimney/snorkel repairs. However, specific criteria and prerequisites are required for the use and improvement of this method. Multiple device morphologies have been used incorporating the visceral arteries in various combinations. This modular strategy connects different devices (bridging covered stents and bifurcated SGs) with the aortic main body, thus excluding the aneurysm from the circulation. Precise deployment of the fenestrated SG is mandatory for successful visceral vessel revascularization. Accurate SG sizing and customization, a high level of technical skill, and facilities with modern imaging techniques including 3D road mapping and dedicated hybrid rooms are required. Most experience has been with the custom-made Zenith Cook platform, although off-the-shelf devices have been recently implanted. More complex repairs have been performed over the last few years, but device complexity has also increased. Perioperative, mid-term, and a few recently reported long-term results are encouraging. Secondary interventions remain the main problem, similar to that observed after traditional endovascular abdominal aortic aneurysm repair (EVAR).

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“…O'Callaghan et al 7 reported a large experience with 924 patients, of whom 26 (2.8%) had type IA endoleak after fenestrated repair. In that study, use of more fenestrations was associated with significant decline in the rate of type IA endoleak.…”

Section: Discussionmentioning

confidence: 99%

Severe infolding of fenestrated-branched endovascular stent graft

Mirza

Sandri

Tenorio

et al. 2018

Journal of Vascular Surgery Cases, Innovations and Techniques

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Infolding of a fenestrated-branched stent graft is an infrequent complication due to excessive oversizing. We report the case of an 89-year-old man who underwent a four-vessel fenestrated-branched endovascular aortic repair for a pararenal aortic aneurysm. Computed tomography angiography revealed severe infolding across the mesenteric-renal vessels. The patient was treated by angioplasty and placement of Palmaz stent. Cone-beam computed tomography confirmed patent visceral vessels with resolution of the infolding. This case illustrates an uncommon complication that can be prevented by modifications in the stent design and by immediate assessment using intraoperative cone-beam computed tomography.

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Type Ia endoleaks after fenestrated and branched endografts may lead to component instability and increased aortic mortality

Cited by 46 publications

References 25 publications

Endosuture aneurysm repair in patients treated with Endurant II/IIs in conjunction with Heli-FX EndoAnchor implants for short-neck abdominal aortic aneurysm

Endosuture aneurysm repair in patients treated with Endurant II/IIs in conjunction with Heli-FX EndoAnchor implants for short-neck abdominal aortic aneurysm

Fenestrated stent grafts for the treatment of complex aortic aneurysm disease: A mature treatment paradigm

Severe infolding of fenestrated-branched endovascular stent graft

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