0000000000010748
AUTHOR
Thomas Pfammatter
showing 20 related works from this author
Mid-term results of zone 0 thoracic endovascular aneurysm repair after ascending aorta wrapping and supra-aortic debranching in high-risk patients
2017
Objectives Surgical repair of aneurysmal disease involving the ascending aorta, aortic arch and eventually the descending aorta is generally associated with significant morbidity and mortality. A less invasive approach with the ascending wrapping technique (WT), supra-aortic vessel debranching (SADB) and thoracic endovascular aneurysm repair (TEVAR) in zone 0 was developed to reduce the associated risk in these patients. Methods During a 10-year period, consecutive patients treated by the ascending WT, SADB and TEVAR in zone 0 were included. All patients were considered at high risk for conventional surgery. Measured outcomes included perioperative deaths and morbidity, maximal aortic trans…
Mid- and Longer-term Follow up of Chimney and/or Periscope Grafts and Risk Factors for Failure
2016
Objective The aim was to report on chimney and periscope grafts (CPGs) and their mid- and longer-term outcomes when they are used to preserve reno-visceral artery (RVA) perfusion in endovascular repair of pararenal (PRAAs) or thoraco-abdominal aortic aneurysm (TAAAs). In addition, factors associated with CPG failure are presented. Limited data exist on the outcomes of CPGs, and mid- and long-term results are generally not reported. Methods This was a prospective study in a cohort of 100 patients with PRAA (69) or TAAA (31). A total of 224 (mean 2.24 per patient) RVAs were preserved with 136 (61%) chimney and 88 (39%) periscope grafts. CPGs were constructed mainly using self expandable stent…
Predilation technique with balloon angioplasty to facilitate percutaneous groin access of large size sheath through scar tissue
2017
Purpose Percutaneous remote access for endovascular aortic repair is an advantageous alternative to open access. Previous surgery in the femoral region and the presence of synthetic vascular grafts in the femoral/iliac arteries represent major limitations to percutaneous remote access. The aim of this study was to evaluate an original technique used for enabling percutaneous remote access for thoracic or abdominal endovascular aortic repair in patients with scar tissue and/or a vascular graft in the groin. Methods Twenty-five consecutive patients with a thoracic (11/25; 44%) or an aortic aneurysm (14/25; 66%) and with a synthetic vascular graft in the groin (16/25; 64%) or a redo groin acce…
A clampless and sutureless aortic anastomosis technique using an endograft connector for aortoiliac occlusive disease in which the aorta cannot be cl…
2012
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 …
SS8. Chimney and Periscope Grafts: Mid-term Results in 77 Consecutive Patients with Complex Aortic Aneurysms
2012
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
2011
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 aneu…
2013
^ ^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
2012
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…
Improved technique for sheath supported contralateral limb gate cannulation in endovascular abdominal aortic aneurysm repair
2019
Summary: Background: To present a technique of sheath supported contralateral limb gate (CLG) cannulation of modular bifurcated stent-graft in endovascular abdominal aortic repair. Materials and methods: After totally percutaneous bilateral femoral access, the 9F introducer sheath is exchanged to a 30 cm 12 fr introducer sheath over a stiff wire contralateral to the intended main stent-graft insertion side and advanced into the aorta below the lowest renal artery. Parallel to the stiff wire within the sheath an additional standard J-tip guidewire with a 5 fr Pigtail angiographic catheter is advanced to the level of the renal arteries. After main body deployment, the 12 fr introducer sheath…
Patient-Specific Rehearsal Feasibility Before Endovascular Repair of Ruptured Abdominal Aortic Aneurysm.
2019
Purpose: To evaluate the feasibility of a patient-specific rehearsal (PsR) before emergency endovascular aneurysm repairs (eEVAR) and its influence on the operation. Materials and Methods: From February 2016 to October 2016, 10 consecutive patients (mean age 75 +/- 7.4 years; 9 men) presenting with a ruptured abdominal aortic aneurysm (rAAA) suitable for standard EVAR were enrolled in the study. A 3-dimensional (3D) model of the abdominal aorta was generated on a virtual reality simulator based on the patient's computed tomography (CT) images. Following the patient-specific simulation setup, PsR was conducted during patient admission or in parallel with the preoperative eEVAR workup. Measur…
Less invasive (common) femoral artery aneurysm repair using endografts and limited dissection
2013
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.
2015
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…
Chronic Mesenteric Ischemia: Critical review and guidelines for management
2011
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…
Early outcomes with a single-sided access endovascular stent
2018
Abstract Objective The objective of this study was to report the 1-year follow-up study results of the new Horizon stent graft (Endospan, Herzliya, Israel) from two different prospective consecutive trials. The Horizon abdominal aortic aneurysm stent graft system is a 14F profile system requiring only a single access site. It consists of three modules, introduced separately: base limb (iliac to iliac limb); distal aortic limb; and proximal aortic limb with a bare suprarenal crown and active fixation. Methods Data from the first in man (FIM) clinical study with 10 patients enrolled and the pivotal study with 30 patients were analyzed. Outcomes measured were freedom from major adverse events …
CT Angiography at 24 Months Demonstrates Durability of EVAR With the Use of Chimney Grafts for Pararenal Aortic Pathologies
2013
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…
Periscope endograft technique to revascularize the left subclavian artery during thoracic endovascular aortic repair.
2013
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 …
Mid-term Results of Chimney and Periscope Grafts in Supra-aortic Branches in High Risk Patients
2017
Purpose Report mid-term outcomes of thoracic endovascular aneurysm repair (TEVAR) with chimney and periscope grafts (CPG) in supra-aortic branches (SAB). Methods Retrospective analysis, from October 2009 to May 2014, of patients with aneurysms requiring TEVAR with zone 0/1/2 proximal landing in association with at least one CPG in the SAB. All patients were considered at high risk for conventional surgery. Peri-operative mortality and morbidity, retrograde type A dissection, maximum aortic transverse diameter (TD) and its post-operative evolution, endoleak, survival, freedom from cardiovascular re-interventions, and CPG freedom from occlusion during the follow-up were analysed. Results Fort…
Multiple periscope and chimney grafts to treat ruptured thoracoabdominal and pararenal aortic aneurysms
2011
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…
Classification of Chimney EVAR-Related Endoleaks: Insights from the PERICLES Registry
2017
Juxtarenal aortic aneurysms (JAAs) pose significant challenges for endovascular aneurysm repair (EVAR). A short or absent infrarenal neck typically excludes standard EVAR as a viable or reasonable treatment option. In this context, the use of chimney grafts (chEVAR) is gaining in popularity and applicability. These grafts are designed to course in the aortic lumen outside the main stent-graft to maintain normal perfusion to the involved target branches. As such, they may represent a promising and less resource-intensive option for management of JAAs. However, this technical strategy is not without challenges of its own, particularly the inevitable creation of “gutters” that result from the …
EVAR IN OUT CLINIC PATIENTS: IS IT FEASIBLE AND SAFE?
2013
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…