Initial Experience and Potential Advantages of AFX2 Bifurcated Endograft System: Comparative Case Series

PURPOSE: The AFX2 endograft is a unibody, bifurcated stent graft that can be used to lower complications in certain patients. In this study, we retrospectively reviewed consecutive cases in which the AFX2 system was used to overcome the challenges of narrow distal aorta, as well as to reduce procedure time and contrast medium dose. Furthermore, we compared the results with matched patients treated using the Endurant II endograft system.MATERIALS AND METHODS: This was a retrospective observational study of nine patients with abdominal aortic aneurysm (AAA) who underwent endovascular aneurysm repair (EVAR) using the AFX2 device between June 2017 and April 2018 at Seoul National University Hospital. The patients had narrow distal aorta (n=3), reversed tapered neck (n=1), iliac artery aneurysm (n=2), chronic kidney disease patients (n=2), and impending rupture (n=1). Seven matched patients were treated using the Endurant II graft.RESULTS: In the AFX2 group, the mean procedure time was 87.2 minutes, mean blood loss volume was 157.7 mL, and mean volume of contrast medium used was 48.3 mL. In the Endurant II group, the mean procedure time was 140.0 minutes, mean blood loss volume was 175.0 mL, and mean volume of contrast medium used was 119.3 mL.CONCLUSION: Our preliminary experiences with selected AAA patients treated using the AFX2 endovascular repair system showed good outcomes compared with similar patients treated using the Endurant II system. Therefore, the AFX2 may be a good option to perform EVAR in patients of advanced age who have chronic kidney failure or narrow distal aorta.

Early-and mid-term clinical efficacy of endovascular repair for Stanford B aortic dissection / 实用医学杂志

Objective To evaluate the early and mid-term clinical efficacy and safety of endovascular re-pair for Stanford B aortic dissection. Methods Fifty-seven patients with Stanford B aortic dissection from July 2012 to July 2016 were selected.Based on the preoperative CTA image data,the appropriate stent grafts were cho-sen,and then endovascular graft exclusion was performed under the DSA perspective. The complications and mor-tality 3,6,12 and 24 months after the operation were observed,and the clinical features,curative effect and follow-up results were analyzed.Results The success rate of operation reached 100% and the average length of hospital-ization was 11 d.There were 1 case of postoperative 3 d leakage,1 postoperative 7 d death and 1 of recurrent dis-section 13 months later.Postoperative follow-up of 3 to 24 months showed that there were no postoperative paraple-gia,no dislocated and regressive stents and no occurrence of transposition and breakage of stent. Conclusions Covered stent in the treatment of Stanford B aortic dissection has the advantages of less trauma,safety,rapid recov-ery,simple operation,high success rate,less complications,definite curative effect in early-and middle-term and low fatality rate.

Initial Clinical Experience with the Endologix AFX Unibody Stent Graft System for Treating Patients with Abdominal Aortic Aneurysms: A Case Controlled Comparative Study

PURPOSE: The newly designed unibody AFX endograft system for endovascular aortic aneurysm repair is the only graft with anatomical fixation to the aortic bifurcation in comparison to most other grafts that use the infrarenal neck as the main fixation point. The aim of this study was to assess the preliminary results of the AFX stent-graft system used with infrarenal aortic component and compare them with those obtained in patients treated with a well established endograft of the same material and pure infrarenal fixation as the Gore Excluder. MATERIALS AND METHODS: A retrospective analysis of prospectively collected data from March 2014 to December 2014 identified 10 elective abdominal aortic aneurysm patients treated with the AFX endograft, in comparison to a matched group of 20 patients treated with the Excluder stent-graft. Endpoints included technical and clinical success, freedom from any secondary intervention, any type of endoleak and aneurysm related death. RESULTS: Primary technical success was achieved in all patients and no 30-day device related complications or deaths were occurred. The two groups were similar in terms of radiation burden, contrast media, duration of the procedure, post implantation syndrome and in-hospital stay. During a median follow-up period of 23 months (range, 18–26 months) there were no differences in clinical success, freedom from reintervention and aneurysm related death. No type I endoleak was observed in either group. Five of the 6 type II endoleaks (1 in the AFX and 4 in the Excluder group) spontaneously resolved, while in only one patient (Excluder) the endoleak remained without however any change in aneurysm sac diameter (log rank=0.34). CONCLUSION: The initial experience with the AFX stent graft system is promising, with successful aneurysm exclusion and good short-term results. Further and larger studies are needed to fully evaluate the sort as well as the long-term results.

Postimplantation Syndrome After Endovascular Aortic Aneurysm Repair in an Elderly Patient

Endovascular procedures have been proposed as minimally invasive alternative treatments, allowing safe and effective aortic aneurysm repair. Despite the potential benefits, endovascular stent grafting may elicit an unexpected systemic inflammatory response, called postimplantation syndrome (PIS). The main features of PIS include fever, elevated C-reactive protein levels, leukocytosis and/or coagulation disturbances, perigraft air on abdominal computed tomography, and no evidence of infection. The main management of PIS is supportive care. Antibiotics have no clinical benefit. We report a case of PIS after endovascular aortic aneurysm repair in an elderly patient.

Debranched Thoracic Endovascular Aortic Aneurysm Repair in a Case of Blunt Aortic Injury / 日本心臓血管外科学会雑誌

A 16-year-old boy had a motorcycle accident and was given a diagnosis of blunt aortic injury (BAI) by contrast computed tomography (CT), complicated by diffuse brain injury, lung contusions and blunt liver injury. Despite conservative treatment his anemia worsened and further CT images revealed mediastinal hematoma. It was difficult to perform cardiopulmonary bypass with systemic heparinization because of his multiple injuries and therefore decided to perform endovascular stentgrafting. Aortography revealed that the proximal stent-graft landing zone to be very small, and therefore it was necessary to the cover left common carotid artery. Before stentgrafting, we performed a right subclavian artery-left common carotid artery bypass to attain a sufficient proximal landing zone, and stentgrafting was successful. We concluded that endovascular stentgrafting is an effective initial treatment for BAI complicated with multiple injuries. However, endovascular stentgrafting for BAI has some limitations because of the morphologic and anatomical characteristics of the thoracic aorta in cases of BAI. It is therefore important to perform endovascular stentgrafting for BAI on a case-by-case basis.

Rapidly enlarging and asymptomatic abdominal aortic aneurysm in a male patient with chronic obstructive pulmonary disease: A case report of early experience of endovascular aortic aneurysm repair (EVAR).

Objective: to report a case of an incidental large asymptomatic AAA in an ex-smoker with severe COPD successfully treated by EVAR and to delineate the results and complications of EVAR performed in operative theater of Siriraj Hospital. Methods: A retrospective review of selected high-risk patients with asymptomatic AAA treated by EVAR in operative theater of our hospital from August 2003 to December 2005 was performed. Results: All nine cases (100%), including reported case (100%), were successfully treated by EVAR. Merely one of 30-day peri-operative death (11.1%), of post-operative cardiopulmonary arrest (11.1%), of early AAA rupture (11.1%), of early graft limb occlusion (11.1%), of late graft limb occlusion (11.1%), and of early type II endoleak (11.1%) took place in this study. Neither late AAA rupture, AAA sac enlargement, nor graft migration happened. Conclusion: EVAR was achieved as a minimal invasive treatment of an incidental large asymptomatic AAA in an ex-smoker with severe COPD. Although EVAR provides an excellent alternative of AAA in high-risk patients, its high peri-operative mortality rate around 10 % should be taken into account.