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      Endovascular Repair of Aortic Arch Aneurysm with Surgeon-Modified Fenestrated Stent Graft

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          Abstract

          The authors describe a technique of treating patients with aortic arch aneurysm using surgeon-modified fenestrated stent graft (SMFSG). The technique is demonstrated in a 80-year-old patient whose aneurysm was successfully excluded with a SMFSG using Cook Alpha thoracic stent graft. The device was deployed, removed from its delivery system, and a fenestration created before being mounted back on the delivery system and constrained. It was transitioned through a series of sheaths before being introduced into its original sheath. The device was implanted via a common femoral artery access site; fenestration cannulated from the left brachial artery and bridged with a stent graft.

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          Global experience with an inner branched arch endograft

          Stephan Haulon, Roy Greenberg, Rafaelle Spear … (2014)
          Branched endografts are a new option to treat arch aneurysm in high-risk patients.
          Article 0 comments Cited 44 times – based on 0 reviews     Review now
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            Aortic arch reconstruction by transluminally placed endovascular branched stent graft.

            S Tamaki, Y Yoshida, Marcelino T. Suzuki … (1999)
            Recently, thoracic aortic stent grafting has emerged as an alternative therapeutic modality for patients with thoracic aortic aneurysms and aortic dissections. However, its application has been limited to descending thoracic aortic aneurysms distal to the aortic arch. We report our initial clinical experience of endovascular branched stent graft repair for aortic arch aneurysms. Endovascular grafting with Inoue branched stent grafts was attempted for 15 patients with thoracic aortic aneurysms and aortic dissections under local anesthesia (n=14) or general anesthesia (n=1). Single-branched stent grafts were used in 14 patients, and a triple-branched stent graft in one. The branched stent grafts were delivered through a 22F or a 24F sheath under fluoroscopic guidance and implanted across the aneurysmal aortic arch. In 2 patients, the single-branched stent graft did not pass through the 22F sheath used. Complete thrombosis of the aneurysm was ultimately achieved in 11 patients (73%). Of 4 persistent leaks, 1 minor leak spontaneously thrombosed and 1 major leak was successfully treated by additional straight stent graft placement. In 1 patient, the right external iliac artery ruptured during the withdrawal of the sheath and was successfully repaired by the implantation of a straight stent graft. One patient with severe stenosis of the aortic graft section was successfully managed by additional stent deployment. Peripheral microembolization to a toe occurred in 1 patient, and cerebral infarction occurred in 1 other patient. Two patients who had failed to receive endovascular stent grafts died during an average follow-up of 12.6 months, 1 of pneumonia and the other of rupture of a concomitant abdominal aortic aneurysm. This report demonstrates the technical feasibility of endovascular branched stent graft repair for aneurysms located at the aortic arch. Careful, longer follow-up and further extensive clinical trials are awaited toward establishing this technique as a recommendable alternative to surgical treatment of thoracic aortic aneurysms.
            Article 0 comments Cited 26 times – based on 0 reviews     Review now
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              Clinical outcomes of different approaches to aortic arch disease

              Arudo Hiraoka, Genta Chikazawa, Kentaro Tamura … (2015)
              The aim of this study was to evaluate the midterm clinical outcomes of various approaches, including hybrid procedures, to aortic arch pathologies.
              Article 0 comments Cited 21 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Aorta (Stamford)
                Journal ID (iso-abbrev): Aorta (Stamford)
                Journal ID (doi): 10.1055/s-00039245
                Title: AORTA Journal
                Publisher: Thieme Medical Publishers (333 Seventh Avenue, New York, NY 10001, USA. )
                ISSN (Electronic): 2325-4637
                Publication date Collection: April 2018
                Publication date (Electronic): 15 February 2019
                Volume: 6
                Issue: 2
                Pages: 70-74
                Affiliations
                [1 ]Department of Vascular and Endovascular Surgery, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota
                Author notes
                Address for correspondence Jesse Manunga, MD Department of Vascular and Endovascular Surgery, Minneapolis Heart Institute at Abbott Northwestern Hospital 920 E 28th Street, Suite 300, Minneapolis, MN 55407 jesse.manunga@ 123456allina.com
                Article
                Publisher ID: 170106
                DOI: 10.1055/s-0039-1677810
                PMC ID: 6377362
                PubMed ID: 30769366
                SO-VID: 70eeb157-c56c-48d5-a913-26c62820b5eb
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 28 September 2017
                Date accepted : 05 November 2018
                Funding
                Funding None.
                Categories
                Subject: How I Do It

                Keywords: aortic arch aneurysm,endovascular repair,fenestrated stent graft,surgeon-modified fenestrated graft
                Data availability:
                Keywords: aortic arch aneurysm, endovascular repair, fenestrated stent graft, surgeon-modified fenestrated graft

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