On-table Zenith® CE Fenestrated Stent Graft Modifcation for the Treatment of Delayed Type Ia Endoleak
Main Author: | |
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Publication Date: | 2022 |
Other Authors: | , , , , , , , |
Format: | Article |
Language: | eng |
Source: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Download full: | http://hdl.handle.net/10400.17/4610 |
Summary: | INTRODUCTION: Delayed type Ia endoleaks are often associated with proximal extension of the aneurysmal degeneration to the juxtarenal aortic segment. Endovascular treatment of type Ia endoleaks secondary to aortic neck dilatation can raise many technical challenges related to the previous implanted stent graft. CASE REPORT: The authors present a clinical case of an 84 year-old man, with a past medical history of atrial fbrillation, acute ischemic stroke, hypertension and dyslipidemia, that initially underwent an EVAR for a 5.5.cm infrarenal AAA with a TREO Bolton® endograft. After 3 years of follow-up, the CTA scan showed a delayed type Ia endoleak secondary to aortic neck dilatation with signifcant growth of the aneurysmatic sac. An endovascular proximal extension was planned, using a Zenith Fenestrated (ZFEN) platform (Cook Medical, Bloomington, Ind) but the short distance to the previous EVAR bifurcation did not allow the implantation of a standard 94cm CE fenestrated stent graft. To overcome this challenge, on-table modifcation of the fenestrated stent graft was performed by cutting the distal aortic stent. The stent graft was partially deployed on-table, the distal stent was cut with thermocautery, and the device was re-sheathed. The fenestrated cuff was then implanted in the standard fashion with target vessel catheterization and stenting. Two aortic covered stents (Aortic Begraft Bentley® 18mm) were implanted inside each iliac limb of the previous EVAR and sealed proximally in a parallel graft confguration on the fenestrated cuff. The fnal completion angiogram demonstrated perfusion of the visceral arteries, resolution of the Ia endoleak and without further endoleaks, as well as perfusion of both hypogastric arteries. At two months of follow up, the patient remains asymptomatic and the CTA scan showed resolution of the type Ia endoleak but the presence of a late type II endoleak. DISCUSSION: Delayed type Ia endoleaks associated with proximal extension of the aneurysmal degeneration to the juxtarenal aortic segment, can raise some technical diffculties related to the previous implanted stent graft. Careful evaluation of patient anatomy and previous endografts should be done in planning for these procedures. On table physician modifcation of stent grafts is a valid solution to overcome challenging cases limitations. Further long-term follow-up is needed. |
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On-table Zenith® CE Fenestrated Stent Graft Modifcation for the Treatment of Delayed Type Ia EndoleakType Ia endoleakFenestrated stent grafAortic Aneurysm, AbdominalPhysician modifed stent graftsHSM CIR VASCINTRODUCTION: Delayed type Ia endoleaks are often associated with proximal extension of the aneurysmal degeneration to the juxtarenal aortic segment. Endovascular treatment of type Ia endoleaks secondary to aortic neck dilatation can raise many technical challenges related to the previous implanted stent graft. CASE REPORT: The authors present a clinical case of an 84 year-old man, with a past medical history of atrial fbrillation, acute ischemic stroke, hypertension and dyslipidemia, that initially underwent an EVAR for a 5.5.cm infrarenal AAA with a TREO Bolton® endograft. After 3 years of follow-up, the CTA scan showed a delayed type Ia endoleak secondary to aortic neck dilatation with signifcant growth of the aneurysmatic sac. An endovascular proximal extension was planned, using a Zenith Fenestrated (ZFEN) platform (Cook Medical, Bloomington, Ind) but the short distance to the previous EVAR bifurcation did not allow the implantation of a standard 94cm CE fenestrated stent graft. To overcome this challenge, on-table modifcation of the fenestrated stent graft was performed by cutting the distal aortic stent. The stent graft was partially deployed on-table, the distal stent was cut with thermocautery, and the device was re-sheathed. The fenestrated cuff was then implanted in the standard fashion with target vessel catheterization and stenting. Two aortic covered stents (Aortic Begraft Bentley® 18mm) were implanted inside each iliac limb of the previous EVAR and sealed proximally in a parallel graft confguration on the fenestrated cuff. The fnal completion angiogram demonstrated perfusion of the visceral arteries, resolution of the Ia endoleak and without further endoleaks, as well as perfusion of both hypogastric arteries. At two months of follow up, the patient remains asymptomatic and the CTA scan showed resolution of the type Ia endoleak but the presence of a late type II endoleak. DISCUSSION: Delayed type Ia endoleaks associated with proximal extension of the aneurysmal degeneration to the juxtarenal aortic segment, can raise some technical diffculties related to the previous implanted stent graft. Careful evaluation of patient anatomy and previous endografts should be done in planning for these procedures. On table physician modifcation of stent grafts is a valid solution to overcome challenging cases limitations. Further long-term follow-up is needed.Sociedade Portuguesa de Angiologia e Cirurgia VascularRepositório do Centro Hospitalar Universitário de Lisboa Central, EPEFábio Pais, FAnita Quintas, AGonçalo Alves, GJoana Catarino, JRicardo Correia, RRita Bento, RRita Ferreira, RMaria Emília Ferreira, MERita Garcia, R2023-07-24T12:01:12Z20222022-01-01T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10400.17/4610engAngiol Vasc Surg 2022;18(1):90-94info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-07-30T07:05:33Zoai:repositorio.chlc.min-saude.pt:10400.17/4610Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T20:10:14.097899Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
On-table Zenith® CE Fenestrated Stent Graft Modifcation for the Treatment of Delayed Type Ia Endoleak |
title |
On-table Zenith® CE Fenestrated Stent Graft Modifcation for the Treatment of Delayed Type Ia Endoleak |
spellingShingle |
On-table Zenith® CE Fenestrated Stent Graft Modifcation for the Treatment of Delayed Type Ia Endoleak Fábio Pais, F Type Ia endoleak Fenestrated stent graf Aortic Aneurysm, Abdominal Physician modifed stent grafts HSM CIR VASC |
title_short |
On-table Zenith® CE Fenestrated Stent Graft Modifcation for the Treatment of Delayed Type Ia Endoleak |
title_full |
On-table Zenith® CE Fenestrated Stent Graft Modifcation for the Treatment of Delayed Type Ia Endoleak |
title_fullStr |
On-table Zenith® CE Fenestrated Stent Graft Modifcation for the Treatment of Delayed Type Ia Endoleak |
title_full_unstemmed |
On-table Zenith® CE Fenestrated Stent Graft Modifcation for the Treatment of Delayed Type Ia Endoleak |
title_sort |
On-table Zenith® CE Fenestrated Stent Graft Modifcation for the Treatment of Delayed Type Ia Endoleak |
author |
Fábio Pais, F |
author_facet |
Fábio Pais, F Anita Quintas, A Gonçalo Alves, G Joana Catarino, J Ricardo Correia, R Rita Bento, R Rita Ferreira, R Maria Emília Ferreira, ME Rita Garcia, R |
author_role |
author |
author2 |
Anita Quintas, A Gonçalo Alves, G Joana Catarino, J Ricardo Correia, R Rita Bento, R Rita Ferreira, R Maria Emília Ferreira, ME Rita Garcia, R |
author2_role |
author author author author author author author author |
dc.contributor.none.fl_str_mv |
Repositório do Centro Hospitalar Universitário de Lisboa Central, EPE |
dc.contributor.author.fl_str_mv |
Fábio Pais, F Anita Quintas, A Gonçalo Alves, G Joana Catarino, J Ricardo Correia, R Rita Bento, R Rita Ferreira, R Maria Emília Ferreira, ME Rita Garcia, R |
dc.subject.por.fl_str_mv |
Type Ia endoleak Fenestrated stent graf Aortic Aneurysm, Abdominal Physician modifed stent grafts HSM CIR VASC |
topic |
Type Ia endoleak Fenestrated stent graf Aortic Aneurysm, Abdominal Physician modifed stent grafts HSM CIR VASC |
description |
INTRODUCTION: Delayed type Ia endoleaks are often associated with proximal extension of the aneurysmal degeneration to the juxtarenal aortic segment. Endovascular treatment of type Ia endoleaks secondary to aortic neck dilatation can raise many technical challenges related to the previous implanted stent graft. CASE REPORT: The authors present a clinical case of an 84 year-old man, with a past medical history of atrial fbrillation, acute ischemic stroke, hypertension and dyslipidemia, that initially underwent an EVAR for a 5.5.cm infrarenal AAA with a TREO Bolton® endograft. After 3 years of follow-up, the CTA scan showed a delayed type Ia endoleak secondary to aortic neck dilatation with signifcant growth of the aneurysmatic sac. An endovascular proximal extension was planned, using a Zenith Fenestrated (ZFEN) platform (Cook Medical, Bloomington, Ind) but the short distance to the previous EVAR bifurcation did not allow the implantation of a standard 94cm CE fenestrated stent graft. To overcome this challenge, on-table modifcation of the fenestrated stent graft was performed by cutting the distal aortic stent. The stent graft was partially deployed on-table, the distal stent was cut with thermocautery, and the device was re-sheathed. The fenestrated cuff was then implanted in the standard fashion with target vessel catheterization and stenting. Two aortic covered stents (Aortic Begraft Bentley® 18mm) were implanted inside each iliac limb of the previous EVAR and sealed proximally in a parallel graft confguration on the fenestrated cuff. The fnal completion angiogram demonstrated perfusion of the visceral arteries, resolution of the Ia endoleak and without further endoleaks, as well as perfusion of both hypogastric arteries. At two months of follow up, the patient remains asymptomatic and the CTA scan showed resolution of the type Ia endoleak but the presence of a late type II endoleak. DISCUSSION: Delayed type Ia endoleaks associated with proximal extension of the aneurysmal degeneration to the juxtarenal aortic segment, can raise some technical diffculties related to the previous implanted stent graft. Careful evaluation of patient anatomy and previous endografts should be done in planning for these procedures. On table physician modifcation of stent grafts is a valid solution to overcome challenging cases limitations. Further long-term follow-up is needed. |
publishDate |
2022 |
dc.date.none.fl_str_mv |
2022 2022-01-01T00:00:00Z 2023-07-24T12:01:12Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/10400.17/4610 |
url |
http://hdl.handle.net/10400.17/4610 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
Angiol Vasc Surg 2022;18(1):90-94 |
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info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
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application/pdf |
dc.publisher.none.fl_str_mv |
Sociedade Portuguesa de Angiologia e Cirurgia Vascular |
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Sociedade Portuguesa de Angiologia e Cirurgia Vascular |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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