A clampless and sutureless aortic anastomosis technique using an endograft connector for aortoiliac occlusive disease in which the aorta cannot be clamped or sewn due to calcification or scarring
Bypass surgery in aortoiliac or aortofemoral occlusive disease can be technically demanding and hazardous due to huge calcifications and/or patient co-morbidities. We report about mid-term results of a telescoping sutureless aortic anastomosis technique using endografts as connectors to address such challenging situations. This is a single-center experience (2004–2011) in seven patients (63 ± 6 years) requiring aortoiliac (three) or aortofemoral (four) bypass surgery. In six cases, an aortic stent graft was telescoped into the infrarenal aorta and partly deployed within the aorta and partly outside the aorta. In the first case, a bifurcated stent graft was deployed and the iliac legs were …
Outpatient endovascular aortic aneurysm repair: Experience in 100 consecutive patients
OBJECTIVES:: To present the safety, feasibility, costs, and patient satisfaction of outpatient endovascular aneurysm repair (EVAR). BACKGROUND:: Our experience in more than 1000 patients indicated that in technically uncomplicated EVAR procedures, the only need for hospitalization was for access vessel complications (bleeding or occlusion) requiring secondary procedures. These complications could always be identified within the first 3 hours after EVAR. METHODS:: Two-center retrospective analysis of prospectively gathered data on 100 consecutive elective outpatient EVAR cases (Outpt EVAR). Inclusion criteria for Outpt EVAR were as follows: asymptomatic clinical state, informed consent, trav…
SS8. Chimney and Periscope Grafts: Mid-term Results in 77 Consecutive Patients with Complex Aortic Aneurysms
Author Disclosures: N. D. Andersen: Nothing to disclose; G. Hughes: W.L. Gore and Associates,Research Grants W.L. Gore and Associates, Consulting fees or other remuneration (payment) W.L. Gore and Associates, Speaker’s bureauMedtronic Vascular, Consulting fees or other remuneration (payment) Medtronic Vascular, Speaker’s bureauVascutek Terumo, Consulting fees or other remuneration (payment) Vascutek Terumo, Speaker’s bureau; R. L. McCann: Nothing to disclose; A. A. Shah: Nothing to disclose; J. B. Williams: Nothing to disclose.
Acute aortic dissection
An acute aortic syndrome with simultaneous presence of a penetrating aortic ulcer, an intramural haematoma, a thoracic aortic dissection and an abdominal aortic aneurysm rupture has not previously been reported. Herein, we describe our experience with a patient treated by endovascular means with an 8-year follow-up.
Chimney and periscope grafts observed over 2 years after their use to revascularize 169 renovisceral branches in 77 patients with complex aortic aneurysms
^ ^Purpose: To evaluate the performance of periscope and/or chimney grafts (CPGs) in theendovascular treatment of pararenal or thoracoabdominal aneurysms using off-the-shelfdevices.Methods: Between February 2002 and August 2012, 77 consecutive patients (62 men; meanage 7369 years) suffering from pararenal aortic (n¼55), thoracoabdominal (n¼16), or arch tovisceral artery aneurysms (n¼6) were treated with aortic stent-graft implantation requiringchimney and/or periscope grafts to maintain side branch perfusion. CPGs were planned inadvance and were not used as bailout. A standardized follow-up protocol includingcomputed tomographic angiography, laboratory testing, and clinical examination wasp…
A New Off-Pump Hybrid Open and Endovascular Repair to Treat Ductus Botalli and Ascendens Aneurysms
To report a combined ascending aorta and aortic arch hybrid repair, we performed off-pump with no aortic graft replacement. A 65-year-old man, developing progressive recurrent laryngeal nerve paralysis, underwent a computed tomography (CT) angiography detecting nonpatent residual ductus Botalli aneurysm and ascending aorta aneurysm. Due to severe multimorbidities, a less-invasive alternative was elaborated. In a first step, appropriate proximal landing zone for aortic stent grafting was achieved by ascending aorta diameter reduction, with epiaortic wrapping, and debranching the supra-aortic trunks. In the second step, endovascular stent grafts were deployed from proximal ascending aorta to…
Less invasive (common) femoral artery aneurysm repair using endografts and limited dissection
Objective We report our experience with the treatment of femoral artery aneurysms (FAAs) under local anaesthesia with limited dissection, using endografts to facilitate the proximal anastomosis and some distal anastomoses. Method Between January 2006 and December 2010, six males, mean age 72 years (range, 65–80 years) with FAAs were treated at the University Hospital of Zurich. All operations were performed under local anaesthesia with analgosedation, except for one performed under spinal anaesthesia. After limited dissection and puncture of the anterior wall of the FAA, a sheath and a self-expanding endograft were introduced over a guide wire and with fluoroscopy they were guided intralumi…
A 12-Year Experience With Chimney and Periscope Grafts for Treatment of Type I Endoleaks.
Purpose: To evaluate the midterm outcomes of chimney and/or periscope grafts (CPGs) in patients presenting type I endoleak after a previous endovascular aneurysm repair (EVAR). Methods: Between June 2002 and April 2014, 24 consecutive patients (mean age 73.9±9.2 years; 23 men) presenting a type I endoleak were addressed with CPGs to extend the proximal and/or distal landing zone and to maintain side branch perfusion. Indication for treatment was a type Ia endoleak in 23 (96%) patients and a type Ib endoleak in one. Median interval from the previous EVAR to endoleak treatment with CPGs was 52.2±48.9 months (range 0.2–179). All patients had proximal/distal landing zones precluding any standa…
EVAR IN OUT CLINIC PATIENTS: IS IT FEASIBLE AND SAFE?
Introduction Only little is known about endovascular aneurysm repair (EVAR) performed as an outpatient procedure. We report here a two-center (Middelares Hospital, Antwerp (Deurne), Belgium and University Hospital Zurich, Switzerland) experience in 104 EVAR patients of which a group of 52 patients have been treated on an outpatient (out-EVAR) basis and compared to a matched group of 52 patients that have been treated as inpatients (in-EVAR). Methods Selection criterions for out-EVAR were: informed consent, travel time to the hospital if readmission was required of <30-60 minutes, and technically uncomplicated EVAR. Most out-EVAR has been treated percutaneous. In-EVAR patients consisted in a…
Chronic Mesenteric Ischemia: Critical review and guidelines for management
Background CMI is caused by chronic occlusive disease of mesenteric arteries. In such an uncommon disease, clear recommendations are strongly needed. Unfortunately, treatment options for symptomatic CMI are still controversial and no guidelines exist. Methods A systematic literature review of the last 25-years was conducted through MEDLINE, Embase, and Cochrane Review/Trials register to identify studies reporting on CMI treatment with more than 10 patients. Primary outcomes were perioperative mortality and morbidity rates. Secondary outcomes were survival rates, primary and secondary patency rates, vessels treated, CMI recurrence, follow-up (FU), technical success (TS), and in-hospital leng…
CT Angiography at 24 Months Demonstrates Durability of EVAR With the Use of Chimney Grafts for Pararenal Aortic Pathologies
PURPOSE: To present the 24-month radiological follow-up data for patients with pararenal aortic pathologies treated with chimney and periscope grafts during endovascular repair. METHODS: Between January 2008 and December 2011, 124 high-risk patients with complex pararenal aortic pathologies were treated using the chimney technique at 2 European vascular and cardiovascular centers with advanced experience of the described technique. In particular, 50 patients were treated at Site 1 and 74 at Site 2. Forty (32.2%) patients (32 men; mean age 79.2±4.9 years) completed computed tomographic angiography follow-up at 24 months postoperatively. RESULTS: The overall technical success was 100%, and th…
Chimney and periscope grafts to facilitate endovascular treatment of aortic transection in a patient with aberrant right subclavian artery
Purpose: To report the use of parallel grafts to extend the proximal landing zone for stentgraft repair of aortic transection involving an aberrant right subclavian artery (ARSA). Case Report: A 28-year-old patient was referred for treatment of traumatic aortic transection with contained rupture at the level of an ARSA. Immediate thoracic endovascular aortic repair (TEVAR) was planned because of hemodynamic instability. To achieve rapid sealing and maintain perfusion to both subclavian arteries, a chimney stent to the left subclavian artery (LSA) and a periscope stent-graft to the ARSA were deployed successfully. After surgical repair of all fractures, the patient was discharged 1 month aft…
Periscope endograft technique to revascularize the left subclavian artery during thoracic endovascular aortic repair.
To present early and midterm results of the periscope endograft (PG) technique to maintain left subclavian artery (LSA) blood flow in thoracic endovascular aortic repairs (TEVAR) involving zone 3.From April 2010 to January 2013, 14 consecutive high-risk patients (11 men; mean age 70±8 years, range 56-87) underwent TEVAR with the PG technique for 10 thoracic aortic aneurysms (TAA), 2 traumatic aortic ruptures, and 2 aortic dissections without a suitable landing zone (2 cm distal to the LSA). Five procedures were performed emergently for rupture (3 TAAs and the 2 trauma cases). Two patients had a periscope deployed in an aberrant right subclavian artery. The periscope endografts were sized 1 …
Chimney and Periscope Grafts: Mid-term Results in 77 Consecutive Patients with Complex Aortic Aneurysms
Not applicable
Multiple periscope and chimney grafts to treat ruptured thoracoabdominal and pararenal aortic aneurysms
Purpose: To report midterm outcomes after urgent endovascular repair of ruptured pararenal or thoracoabdominal aortic aneurysms using multiple periscope and chimney grafts to preserve renovisceral branch perfusion and facilitate aneurysm exclusion. Methods: Nine consecutive men (mean age 72614 years, range 40–88) presenting with ruptured thoracoabdominal (n56), pararenal (n52), or infrarenal (n51) aortic aneurysm underwent urgent endovascular repair with at least 1 periscope graft delivered via a transfemoral access; chimney grafts were installed from an axillary access. In all, 17 periscope and 7 chimney grafts were used to reperfuse 11 renal and 13 visceral arteries in the 9 patients. The…
Use of covered chimney stents for pararenal aortic pathologies is safe and feasible with excellent patency and low incidence of endoleaks.
Background To present the clinical experience of consecutive series with use of balloon-expandable and self-expanding chimney endografts (balloon-expandable covered stent group [BECS] vs self-expanding covered stent group [SECS]) in the endovascular treatment of challenging aortic pathologies requiring renal and/or visceral revascularization. Methods Between January 2009 and May 2011, data for 37 high-risk patients from one center and 35 patients from another institution, with pararenal aortic pathologies treated by the chimney endovascular technique, were prospectively collected. The chimney-graft technique is based on the deployment of a covered or bare-metal stent parallel to the aortic …
Branch ligatures and blood aspiration for post-traumatic superficial temporal artery pseudoaneurysm: surgical technique
The aim of this study is to report a new minimally invasive technique of superficial temporal artery (STA) pseudoaneurysm treatment. Several surgical options have been employed to treat STA pseudoaneurysms. To address this rare condition, the employed techniques are ligation and excision of the aneurysm, endovascular coil embolization or percutaneous ultrasound-guided thrombin injection. Between techniques no significant differences are reported in terms of outcomes. The decision to adopt a technique depends on STA pseudoaneurysm morphology and surgeon preference. In the present report, STA pseudoaneurysm afferent and efferent branches were identified by ultrasound in a 92-year-old female. …
Early endovascular aneurysm repair after percutaneous coronary interventions
Objective The objective of this study was to report long-term results of early endovascular aortic aneurysm repair after percutaneous coronary intervention (PCI). Methods This was a retrospective analysis of all patients presenting with abdominal aortic aneurysm and coronary artery disease treated during the same hospitalization by endovascular aortic aneurysm repair performed soon after PCI. Primary outcomes were perioperative mortality, perioperative complications, survival after treatment, and freedom from reintervention. Results A total of 20 patients were included, and all completed both procedures. No deaths or abdominal aortic aneurysm ruptures occurred between the PCI and the aortic…