Use of parallel grafts to save failed prior endovascular aortic aneurysm repair and type Ia endoleaks

Donas, Konstantinos P.; Telve, Diego; Torsello, Giovanni; Pitoulias, Georgios A.; Schwindt, Arne; Austermann, Martin

doi:10.1016/j.jvs.2015.04.395

Cited by 36 publications

(26 citation statements)

References 17 publications

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“…First, f/b-EVAR is only one of two endovascular options for failed EVAR. The use of parallel grafts, especially when incorporating 1 or 2 vessels, has an important role in the treatment of these patients (Donas et al, 2015). This is particularly true in the United States and other parts of the world where access to device customization is limited.…”

Section: Discussionmentioning

confidence: 99%

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Technical approach and outcomes of failed infrarenal endovascular aneurysm repairs rescued with fenestrated and branched endografts

et al. 2019

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Background: Endovascular rescue of failed infrarenal repair (EVAR) has emerged as an attractive option to stent graft explantation. The procedure, however, is underutilized due to limited devices accessibility and the challenges associated with their implantation in this patient population. The purpose of this study was to report our outcomes and discuss our approach to rescuing previously failed infrarenal endovascular aneurysm repairs (EVAR) with fenestrated/ branched endografts (f/b-EVAR). Methods: A retrospective analysis of prospectively collected data of consecutive patients with failed EVAR rescued with f/ b-EVAR at our institution from November 2013 to March 2019 was conducted. The study primary end point was technical success; defined as the implantation of the device with no type I a/b or type III endoleak or conversion to open repair. Secondary endpoints included major adverse events (MAEs), graft patency and reintervention rates. Results: During this time, 202 patients with complex aortic aneurysms were treated with f/b-EVAR. Of these, 19 patients (Male: 17, mean age 79 ± 7 years) underwent repair for failed EVAR. The median time from failed repair to f/b-EVAR was 48 (30, 60) months. Treatment failure was attributed to stent graft migration in 9 (47.4%) patients, disease progression in 5 (26.3%), short initial neck in 3 (15.8%) and unable to be determined in 2 (10.5%). Three patients were treated urgently with surgeon modified stent graft. Technical success was achieved in 18 patients (95%), including two who had undergone emergent repair for rupture. Seventy-two targeted vessels (97.3%) were successfully incorporated. Sixteen (84.2%) patients required a thoracoabdominal repair to achieve a durable seal. Major adverse events (MAEs) occurred in 3 patients (15.7%) including paralysis and death in one (5.3%), compartment syndrome and temporary dialysis in another and laparotomy with snorkeling of one renal and bypass of the other in the third patient. Median (IQR) hospital length of stay was 3 (2, 4) days. Late reintervention, primary target vessel patency and primary assisted patency rates were 5.3%, 98.6% and 100%, respectively. Conclusion: Implantation of f/b-EVAR in patients with failed previous EVAR is a challenging undertaking that can be performed safely with a high technical success and low reintervention rates.

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Section: Discussionmentioning

confidence: 99%

“…Parallel grafts have the advantage of using readily available, off-the-shelf components approved for other indications. However, the technique has a high incidence of gutter endoleaks (Scali et al, 2014;Lee et al, 2012;Donas et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

Technical approach and outcomes of failed infrarenal endovascular aneurysm repairs rescued with fenestrated and branched endografts

et al. 2019

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“…Treatment options depend on the length of the remaining infrarenal aortic neck, the extent of aortic disease, and the degree of graft migration. They include a simple extension of the sealing zone using a cuff device, improvement of graft alignment to the aortic wall using uncovered stents 1 or EndoAnchors (Aptus Endosystems, Sunnyvale, Calif), 2,3 implantation of covered parallel grafts, 4 or conversion to open repair. 5 Fenestrated endografts allow for an extension of the proximal sealing zone toward the visceral aortic segment while preserving blood flow to the visceral and renal arteries.…”

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confidence: 99%

Rescue of failed endovascular aortic aneurysm repair using the fenestrated Anaconda device

Falkensammer

Taher

Uhlmann

et al. 2017

Journal of Vascular Surgery

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The risk of a failure to cannulate one or more visceral arteries through the respective fenestrations was increased in patients who had previously undergone EVAR. This is most likely caused by increased friction between the fenestrated endograft and the failing graft in situ, which may impair the adaption of the unsupported Anaconda device to the aortic wall. As a consequence, fenestrations may not line up perfectly at the respective openings of the visceral or renal arteries, and folding of the fabric may be increased, making cannulation of the fenestrations more difficult.

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“…[26][27][28] The chimney technique seems a feasible and relatively safe option in endoleak treatment. The Münster group 29 reported an experience with 18 EVAR patients with juxtarenal aneurysms and type I endoleak treated using primarily the Endurant stent-graft in conjunction with the Advanta stent-graft as the chimney. Primary CG patency was 94.4% and secondary patency was 100%.…”

Section: Discussionmentioning

confidence: 99%

Collected Transatlantic Experience From the PERICLES Registry: Use of Chimney Grafts to Treat Post-EVAR Type Ia Endoleaks Shows Good Midterm Results

et al. 2018

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Use of parallel grafts to save failed prior endovascular aortic aneurysm repair and type Ia endoleaks

Cited by 36 publications

References 17 publications

Technical approach and outcomes of failed infrarenal endovascular aneurysm repairs rescued with fenestrated and branched endografts

Technical approach and outcomes of failed infrarenal endovascular aneurysm repairs rescued with fenestrated and branched endografts

Rescue of failed endovascular aortic aneurysm repair using the fenestrated Anaconda device

Collected Transatlantic Experience From the PERICLES Registry: Use of Chimney Grafts to Treat Post-EVAR Type Ia Endoleaks Shows Good Midterm Results

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