In vivo evaluation of a new hybrid graft using retrograde visceral perfusion for thoracoabdominal aortic repair in an animal model (original) (raw)
Related papers
Endoluminal stent grafting of the descending thoracic aorta
Italian Heart Journal Official Journal of the Italian Federation of Cardiology, 2002
technically difficult and the anastomosis is more difficult to secure without a definite neck beyond the left subclavian artery, especially in the presence of a large aneurysm. Furthermore, if the distal aortic arch exceeds 5-6 cm, there is an increased risk of rupture at the level of the distal anastomosis because of the mismatch between the graft and the aorta. Various approaches have been proposed to overcome these situations, such as performing the anastomosis between the left common carotid and the left subclavian arteries 7 or trimming the aorta at the level of the distal anastomosis. To circumvent these problems, we have developed a new prosthesis, named the 'Dumbo' graft ( ) because of its peculiar appearance and its use in facilitating the elephant-trunk technique. 9
Evolving experience with thoracic aortic stent graft repair
Journal of Vascular Surgery, 2002
We reviewed our initial thoracic aorta (TA) stent graft experience in 28 patients from the perspective of treatment with homemade devices (Dacron over Gianturco Z stents; 14 cases) and a commercial device (Excluder; W.L. Gore Co, Flagstaff, Ariz; 14 cases). Methods: From November 1996 to August 2001,28 patients with a spectrum of disease (degenerative aneurysm, n = 18; chronic dissection, n = 4; pseudoaneurysm, n = 3, with 1 trauma and 2 anastomotic; intramural hematoma, n = 2; and coarctation, n = 1) underwent TA stent grafting. Clinical parameters included a mean age of 71 years, 12 female (43%) and 16 male (57%) patients, 14 of 28 patients (50%) with major comorbidities that prohibited open repair, and nine of 28 patients (32%) with urgent or ruptured conditions. Seven patients (25%) needed open surgical access to the aorta or iliac artery for either concomitant abdominal aortic aneurysm repair (n = 3) or device deployment (n = 4), and six of 28 patients (21%) needed left subclavian-carotid transposition to provide for an adequate proximal fixation site. Focal (< 15 cm) grafts were used in 19 patients, and the remaining patients had at least two thirds of their descending aorta excluded. Results: The procedural mortality rate was 3.5% (1/28 patients); three additional deaths, (1 device-related) occurred during the mean follow-up period of 17 months. Access artery complications occurred in six of 28 patients (21%), with one fatal. No immediate or late open conversions were performed. One patient needed urgent dilation and stenting of a collapsed stent graft 3 weeks after deployment. Serious systemic complications included temporary dialysis (n = l ) , congestive heart failure (n = l), and unstable angina (n = 1). Complete exclusion of the TA lesion was noted in 27 of 28 cases (96%). No cases of spinal cord ischemia were noted. Ease and accuracy of deployment was superior for the second generation (commercial) device. Conclusion: TA stent graft repair, although in evolution, appears to be a safe and effective alternative to open repair for many patients with a spectrum of TA disease. Prospective trials for individual diseases will be necessary to define its ultimate role. (J Vasc Surg 2002;35:1129-36.)
Thoracic Aortic Stent-Graft Devices: Problems, Failure Modes, and Applicability
Seminars in Vascular Surgery, 2007
Optimal treatment strategies for pathologies of the descending thoracic aorta are still controversial. Open surgery is complex, while endovascular devices allow nonsurgical access to the thoracic aorta. Endografts can be inserted via a peripheral artery while maintaining aortic blood flow without any need for clamping. Both short-and mid-term outcomes after endografting thoracic aneurysm and type B aortic dissection are encouraging, with significantly lower morbidity and early mortality compared with open surgery. However, despite emerging popularity and growing interest as an alternative to surgery, endograft design and manufacturing have not kept pace with growing clinical ambition. Major challenges associated with endovascular procedures using the current generation of endografts range from the relative rigidity and size of the delivery system to the failure of thoracic endografts to conform snugly to the anatomy of the aortic arch. Nonconformity of grafts may lead to graft instability, endoleak, and procedural failure. Current delivery systems are potentially traumatizing and, at times, too inflexible to track through tortuous, calcified vessels, and often require surgical exposure of the access vessel. Although efforts have been made by the industry to improve conformability and fixation in the aortic arch, given the spiraling movement of the thoracic aorta with each ventricular contraction, much work needs to be done on miniaturization and creation of disease-specific devices. The aim of this work is to give an overview on thoracic aortic stent-graft devices with focus on problems, failure modes and potential improvements. Semin Vasc Surg 20:81-89.
Successful ventricular transapical thoracic endovascular graft deployment in a pig model
Journal of Vascular Surgery, 2008
Purpose: Aortoiliac occlusive disease may preclude retrograde thoracic endovascular aortic repair. This study evaluated the physiologic and anatomic feasibility of introducing an aortic endograft in an antegrade manner into the descending thoracic aorta of a pig through the left ventricular apex. Methods: Twelve adult pigs were to undergo antegrade endograft deployment. Under fluoroscopic guidance, a stiff guidewire was introduced past the aortic valve and into the distal abdominal aorta through the left ventricular apex on a beating heart. An 18F introducer sheath containing a 24 ؋ 36-mm aortic endograft was introduced and deployed in the descending thoracic aorta. The accuracy of graft delivery was determined at necropsy by measuring the distance from the trailing edge of the graft to the downstream margin of the ostium of the left subclavian artery. Aortic valve competency was assessed angiographically and at necropsy. Left ventricular function was assessed angiographically. Five hemodynamic and respiratory variables were recorded at 12 stages during the procedure and assessed for significant changes from baseline. Results: One animal died during the sternotomy. All remaining pigs survived the experiment with minimal hemodynamic support. A significant drop in systolic blood pressure (75 ؎ 2 to 60 ؎ 4 mm Hg, P ؍ .05) was noted when the aortic valve was crossed with an 18F sheath. The systolic blood pressure returned to baseline on endograft deployment and at the end of the procedure. Bradycardia was noted at several stages of the procedure, requiring treatment in two pigs. Eleven endografts were deployed; seven grafts were delivered within 5 mm and three grafts within 10 to 20 mm of the intended landing point. One graft was deployed 10 mm too proximally, covering the left subclavian artery. No aortic valvular insufficiency or left ventricular dysfunction was noted.
Stent-Grafting of the Thoracic Aorta by the Cardiothoracic Surgeon
The Annals of Thoracic Surgery, 2007
The Annals of Thoracic Surgery CME Program is located online at http://cme.ctsnetjournals.org. To take the CME activity related to this article, you must have either an STS member or an individual nonmember subscription to the journal.
Endoluminal stent grafting of the thoracic aorta: Initial experience with the Gore Excluder
Journal of Vascular Surgery, 2002
The purpose of this study was to describe our experience with endoluminal graft repair of a variety of thoracic aorta pathologies with a commercially developed device currently under investigation. Our patient population included patients eligible for open surgical repair and those with prohibitive surgical risk. Methods: From February 2000 to February 2001, endovascular stent-graft repair of the thoracic aorta was performed in 46 patients (mean age, 70 years; 29 male and 17 female patients) with the Gore Excluder. Twenty-three patients (50%) had atherosclerotic aneurysms, 14 patients (30%) had dissections, three patients (7%) had aortobronchial fistulas, three patients (7%) had pseudoaneurysms, two patients (4%) had traumatic ruptures, and one patient (2%) had a ruptured aortic ulcer. Patient characteristics, procedural variables, outcome, and complications were recorded. All patients were followed with chest computed tomographic scans at 1, 3, 6, and 12 months. Follow-up period ranged from 1 month to 15 months, with a mean of 8.5 months. Results: All the procedures were technically successful. There were no conversions. Average duration of the procedure was 120 minutes. Average length of stay was 6 days, but most patients (64%) left the hospital within 4 days after endoluminal grafting. The overall morbidity rate was 23%. Two patients (4%) had endoleaks that necessitated a second procedure for successful repair. Two patients (4%) died in the immediate postoperative period. There were no cases of paraplegia. At follow-up examination, one patient had an endoleak found the day after the procedure and another patient had an endoleak 6 months after the procedure. Both cases were treated successfully with additional stent-grafts. There were no cases of migration. One patient died of a myocardial infarction 6 months after graft placement. In patients treated for aneurysm (n ؍ 23), the aneurysm diameter ranged from 5.0 to 9.5 cm (mean, 6.8 cm). Residual sac measurements were obtained at 1, 6, and 12 months, with mean sac reductions of 0.59 cm, 0.77 cm, and 0.85 cm, respectively. In three cases, the sac remained unchanged, without evidence of endoleak. Conclusion: Thoracic endoluminal grafting with the Gore Excluder is a safe and feasible alternative to open graft repair and can be performed successfully with good results. Early data suggest an endoluminal approach to these disease entities may be favorable over classical resection and graft replacement. (
European Journal of Vascular and Endovascular Surgery, 2009
Introduction: This study reports the technical and mid-term clinical results of the second-generation Anacondaä AAA Stent Graft System endovascular device for treatment of abdominal aortic aneurysm (AAA). The design of the Anacondaä AAA Stent Graft System is characterised by a three-piece system consisting of two proximal independent saddle-shaped nitinol self-expandable rings with hooks fixation, zero body support and vacuum-cleaner tube leg design. Methods: From July 2002 to April 2005, a total of 61 patients with AAA were enrolled in a multicentre, prospective, non-randomised controlled design study. All patients received a secondgeneration Anacondaä AAA Stent Graft System. They entered a standard follow-up protocol at discharge for 3, 6, 12 and 24 months. Follow-up data included survival; rupture-free survival; incidence of aneurysm rupture, death from aneurysm rupture, aneurysm-related death; freedom from aneurysm expansion; freedom from Types I and III endoleaks; endograft patency and technical and clinical success rates. Results: Successful access to the arterial system was achieved in all patients. The primary technical success was 59 out of 61 and the primary assisted technical success was 60 out of 61. All endovascular grafts were patent without significant twists, kinks or obstructions. Migration was not observed in any of the grafts. During the first 30-day period, two serious adverse events (3%), both not related to the procedure, were observed. Nine patients (15%) needed a secondary intervention; two of these interventions were related to stent graft (3%). The mean aneurysm sac diameter decreased significantly from 57 mm pre-operative to 45 mm after 24 months, without aneurysm growth. There was one Type I endoleak at initial implantation,
Thoracic Aortic Stent Grafts – Early Experience from Two Centresusing Commercially Available Devices
European Journal of Vascular and Endovascular Surgery, 2001
Objectives: open surgical intervention for aneurysms of the distal arch and descending thoracic aorta is associated with high morbidity and mortality. Stent grafts offer an attractive alternative treatment for these aneurysms. The aim of this study was to assess the morbidity and mortality of endovascular treatment for these aneurysms with stent grafts. Design, patients and methods: a prospective observational study was performed of 37 consecutive patients treated from July 1997 to October 2000 (30 at Guy's and St. Thomas' and 7 at Sheffield). Indications included degenerative aneurysms (n=18), false aneurysm (5), acute dissection (4), aortic transection (4), aneurysm related to previous surgery for coarctation (3), chronic dissection (2) and traumatic dissection (1). Nineteen were performed as elective and 18 as non-elective procedures. Results: three non-elective patients died in hospital (in-hospital and 30-day mortality 8%) and one suffered a stroke with spontaneous full recovery. No elective patient died. One patient with a persistent proximal endoleak required conversion to open repair at 6 weeks. Two patients with persistent flow into the sac at 24 h spontaneously thombosed at subsequent 3 month follow-up. Two further patients developed new distal endoleaks at 3 months and required distal extension cuffs. One patient died at 28 months of aortic rupture. Serial CT scans had shown prolapse of the stent graft into the aneurysm sac and the patient died just before planned endovascular repair. No patient suffered paraplegia or renal failure. Intensive care facilities were only required for patients who needed them preoperatively. Conclusions: thoracic stent grafts can be performed with low morbidity and mortality. They offer a realistic alternative to open surgery. Long term follow up is required to assess their durability.
European Journal of Vascular and Endovascular Surgery, 2019
, correlations, and multivariate associations, respectively. Results-E-XDP levels were elevated in patients with AAA compared with controls (p ¼ 6.9e-14), predicted AAA with 98% sensitivity and 88% specificity and correlated with the AAA diameter (r ¼ 0.58, p ¼ 5.3e-05). The association between AAA and increased E-XDP was independent of smoking, comorbidities and prescription drugs (p ¼ 2.6e-06). Levels of E-XDP in patients with only a thin or macroscopically non-existent ILT were lower than those of patients with a large ILT, but remained significantly higher than in controls (p ¼ 0.0026). Concentration of E-XDP correlated with volume of the ILTs in the AAAs (r ¼ 0.75, p ¼ 1.0e-06) and mean ILT stress (r ¼ 0.42, p ¼ 0.017), and was independently raised if coexisting aneurysms existed (p ¼ 0.015). IHC revealed E-XDP expression in the ILT, which was spatially related to luminal neutrophil elastase and neutrophils. Conclusion-Circulating E-XDP is a novel marker of AAA and coexisting aneurysms, and correlates with AAA and ILT volume as well as with the mechanical stress of the ILT.