Treatment of aortic arch aneurysms with a modular transfemoral multibranched stent-graft: Initial experience

Cherrie Abraham, Christos Lioupis

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Objective: To present an initial experience with a new modular transfemoral multibranched stent-graft for treating aortic arch aneurysms. Methods: Six patients, considered high risk for open surgery, were treated with a custom-made branched stent-graft. Two patients had aortic arch aneurysms, three had descending thoracic aortic aneurysms involving the distal arch, and one had a saccular aneurysm of the arch adjacent to the origin of the innominate artery. All patients had undergone a staged left carotid subclavian bypass before the endovascular procedure. Each branched graft had a 12-mm side branch for the innominate artery and an 8-mm side branch for the left common carotid artery. The branches were extended into their respective target arteries with covered self-expanding stents. Results: Aneurysm exclusion without endoleak was successful in 5 of the 6 patients, and 11 of the 12 target vessels were successfully cannulated and preserved. Patient 1 developed a type I endoleak that was managed successfully with coiling and gluing of the aneurysm sac. Patients 2, 3, 5, and 6 had uneventful placement of the prostheses, with successful exclusion of the aneurysm sac. In patient 4, cannulation of the innominate branch was unsuccessful, and an extra-anatomic bypass was necessary to perfuse the right carotid and vertebral arteries. Conclusions: We have demonstrated the technical feasibility of a modular transfemoral branched stent-graft for treatment of aortic arch aneurysms. Our initial experience has shown that the method is relatively safe. Long-term follow-up is necessary to evaluate the efficacy and safety of this new device.

Original languageEnglish (US)
JournalJournal of Thoracic and Cardiovascular Surgery
Volume145
Issue number3 SUPPL.
DOIs
StatePublished - Mar 2013
Externally publishedYes

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Aortic Aneurysm
Thoracic Aorta
Stents
Transplants
Aneurysm
Brachiocephalic Trunk
Endoleak
Therapeutics
Protective Devices
Thoracic Aortic Aneurysm
Endovascular Procedures
Vertebral Artery
Common Carotid Artery
Carotid Arteries
Catheterization
Prostheses and Implants
Arteries

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

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abstract = "Objective: To present an initial experience with a new modular transfemoral multibranched stent-graft for treating aortic arch aneurysms. Methods: Six patients, considered high risk for open surgery, were treated with a custom-made branched stent-graft. Two patients had aortic arch aneurysms, three had descending thoracic aortic aneurysms involving the distal arch, and one had a saccular aneurysm of the arch adjacent to the origin of the innominate artery. All patients had undergone a staged left carotid subclavian bypass before the endovascular procedure. Each branched graft had a 12-mm side branch for the innominate artery and an 8-mm side branch for the left common carotid artery. The branches were extended into their respective target arteries with covered self-expanding stents. Results: Aneurysm exclusion without endoleak was successful in 5 of the 6 patients, and 11 of the 12 target vessels were successfully cannulated and preserved. Patient 1 developed a type I endoleak that was managed successfully with coiling and gluing of the aneurysm sac. Patients 2, 3, 5, and 6 had uneventful placement of the prostheses, with successful exclusion of the aneurysm sac. In patient 4, cannulation of the innominate branch was unsuccessful, and an extra-anatomic bypass was necessary to perfuse the right carotid and vertebral arteries. Conclusions: We have demonstrated the technical feasibility of a modular transfemoral branched stent-graft for treatment of aortic arch aneurysms. Our initial experience has shown that the method is relatively safe. Long-term follow-up is necessary to evaluate the efficacy and safety of this new device.",
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N2 - Objective: To present an initial experience with a new modular transfemoral multibranched stent-graft for treating aortic arch aneurysms. Methods: Six patients, considered high risk for open surgery, were treated with a custom-made branched stent-graft. Two patients had aortic arch aneurysms, three had descending thoracic aortic aneurysms involving the distal arch, and one had a saccular aneurysm of the arch adjacent to the origin of the innominate artery. All patients had undergone a staged left carotid subclavian bypass before the endovascular procedure. Each branched graft had a 12-mm side branch for the innominate artery and an 8-mm side branch for the left common carotid artery. The branches were extended into their respective target arteries with covered self-expanding stents. Results: Aneurysm exclusion without endoleak was successful in 5 of the 6 patients, and 11 of the 12 target vessels were successfully cannulated and preserved. Patient 1 developed a type I endoleak that was managed successfully with coiling and gluing of the aneurysm sac. Patients 2, 3, 5, and 6 had uneventful placement of the prostheses, with successful exclusion of the aneurysm sac. In patient 4, cannulation of the innominate branch was unsuccessful, and an extra-anatomic bypass was necessary to perfuse the right carotid and vertebral arteries. Conclusions: We have demonstrated the technical feasibility of a modular transfemoral branched stent-graft for treatment of aortic arch aneurysms. Our initial experience has shown that the method is relatively safe. Long-term follow-up is necessary to evaluate the efficacy and safety of this new device.

AB - Objective: To present an initial experience with a new modular transfemoral multibranched stent-graft for treating aortic arch aneurysms. Methods: Six patients, considered high risk for open surgery, were treated with a custom-made branched stent-graft. Two patients had aortic arch aneurysms, three had descending thoracic aortic aneurysms involving the distal arch, and one had a saccular aneurysm of the arch adjacent to the origin of the innominate artery. All patients had undergone a staged left carotid subclavian bypass before the endovascular procedure. Each branched graft had a 12-mm side branch for the innominate artery and an 8-mm side branch for the left common carotid artery. The branches were extended into their respective target arteries with covered self-expanding stents. Results: Aneurysm exclusion without endoleak was successful in 5 of the 6 patients, and 11 of the 12 target vessels were successfully cannulated and preserved. Patient 1 developed a type I endoleak that was managed successfully with coiling and gluing of the aneurysm sac. Patients 2, 3, 5, and 6 had uneventful placement of the prostheses, with successful exclusion of the aneurysm sac. In patient 4, cannulation of the innominate branch was unsuccessful, and an extra-anatomic bypass was necessary to perfuse the right carotid and vertebral arteries. Conclusions: We have demonstrated the technical feasibility of a modular transfemoral branched stent-graft for treatment of aortic arch aneurysms. Our initial experience has shown that the method is relatively safe. Long-term follow-up is necessary to evaluate the efficacy and safety of this new device.

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