The application of individual open fenestrated stent graft in type A aortic dissection / 实用医学杂志

Objective To observe the recent clinical effect of application of individual open fenestrated stent graft in type A aortic dissection without developing the greater curve of the arch. Method From December 2014 to November 2016,15 patients of type A aortic dissection without developing the greater curve of the arch un-derwent endovascular total arch replacement using individual open fenestrated stent graft in the Anhui Province Hospital.Among them,8 cases were only operated with open fenestrated stent graft in aortic arch, 7 cases with open fenestrated stent graft in aortic arch added 1 or 2 small stent graft.Result There was 1 postoperative death caused by severe low cardiac output. The rest of the patients were successfully discharged from the hospital, without ner-vous system and related complications. Follow-up computerized tomographic angiography showed all implanted stents were wide expansion and in a good position. No endoleaks and thrombus obliterated of the corresponding false lumen was found. Conclusion Individual open fenestrated stent graft is suitable for type A aortic dissection without developed the greater curve of the arch.Its significantly simplify the total arch replacement operation steps, reduce anastomotic and shorten the lower body arrest time. Consequently, reduce the risk of operation difficulty, postoperative blood loss and other viscera damage probability significantly. The early and middle term clinical re-sults is satisfactory.

Fenestrated EVAR using physician-modified stent-grafts for thoraco-abdominal aortic lesions / 中华普通外科杂志

Objective To evaluate fenestrated endovascular aortic repair (FEVAR) using physician-modified stent-grafts (PMSGs) for thoraco-abdominal aortic lesions.Methods Seven cases of thoraco-abdominal aortic lesions (1 type Ⅲ thoraco-abdominal aortic aneurysm,1 type Ⅳ thoraco-abdominal aortic aneurysm,4 chronic thoraco-abdominal aortic dissection and 1 type Ⅰ endoleak after EVAR due to abdominal aortic aneurysm) were treated with FEVAR from Nov 2016 to Nov 2017.Results FEVAR was performed successfully in all cases.Type Ⅱ and Ⅲ endoleak occurred in 4 cases.One died of acute myocardial infarction 2 days postoperatively.Renal dysfunction deterioration occurred in one case of chronic dissection and improved after the medical treatment.Renal subcapsular hematoma was found in 2 cases postoperatively,and resolved after conservative therapy.Mean follow-up period was 7.2 months,target vessel patency was identified in 5 of the 6 cases.Conclusions FEVAR using PMSGs is a viable alternative to treat thoraco-abdominal aortic lesions.

On table fenestrated stent graft in zone 0 and zone 1 for aortic arch diseases / 中华普通外科杂志

Objective To evaluate fenestrated thoracic endovascular aortic repair (f-TEVAR) using fenestrated stent graft on table in zone 0 and zone 1 for aortic arch diseases.Methods 13 patients undergoing f-TEVAR by using physician modified fenestrated stent grafts (PMSGs) on table in zone 0 and zone 1 for aortic arch diseases between Nov 2015 and Mar 2018 were retrospectively reviewed.Results The median age was 59 years(range,33-81 years).PMSGs were deployed from Z0 in 5 patients and Z1 in remaining 8 patients.All but 3 patients underwent elective procedure.The technical success rate was 92.3％.Overall mortality was 7.7％ (1/13).There were no perioperative neurologic complications and paraplegia.One patient suffering from acute left leg ischemia and renal failure recovered after openembolectomy and dialysis.Median length of stay was 9.0 days (range,4-35 days).12 patients were survival at a median follow-up of 11.5 months (range,1.0-19.0 months).Retrograde dissection occurred in one patient and resolved after open repair.During follow up,all target vessels remained patent,with no fenestration-related type Ⅰ or Ⅲ endoleaks.Conclusions f-TEVAR using modified fenestrated stent grafts on table in Z0 and Z1 is feasible for the treatment of aortic arch diseases.

Preservation of Internal Iliac Artery after Endovascular Repair of Common Iliac Artery Dissection Using Modified Fenestrated Stent Graft

Standard endovascular repair of iliac/aortoiliac pathologies can lead to complications, such as buttock claudication, colon ischemia and erectile dysfunction. Branch grafts have been developed but require at least 6 weeks for customization and are not currently available in China; they are also quite expensive. To our knowledge, modified fenestrated stent grafts (MFSGs) are a safe and effective alternative for treating patients with juxtarenal aneurysms. Most MFSGs are used for the preservation of renal and left subclavian arteries. Few cases of MFSGs have been reported in the treatment of iliac pathologies. The use of an MFSG is decided on a case-by-case basis. This report presents our first clinical use of an MFSG for preservation of the internal iliac artery.

Endovascular Repair with a Fenestrated Stent Graft for Kommerell's Diverticulum with a Right Aortic Arch / 日本心臓血管外科学会雑誌

A 77-year-old man with an abnormal shadow on chest x-ray film, was found to have Kommerell's diverticulum associated with a right aortic arch 2 years previously. During the period of follow-up, the Kommerell's diverticulum was expanded to 5.3 cm in diameter. CT revealed a right aortic arch with mirror-image branching and Kommerell's diverticulum. To eliminate the risk of rupture, the Kommerell's diverticulum was excluded by deployment of a handmade fenestrated stent-graft using the brachial wire traction technique via the right femoral artery and left brachial artery. At 30-months of follow-up the patient is doing well, with no signs of endoleak or migration. Endovascular repair of Kommerell's diverticulum with a right aortic arch is feasible, safe and effective. This is a rare case of a right aortic arch with Kommerell's diverticulum and without left aberrant subclavian artery.

A Case of Thoracic Endovascular Aortic Repair with Fenestrated Stentgraft for Ulcer-like Projection of the Proximal Anastomosis after Total Arch Replacement for Acute Type A Aortic Dissection after Open Heart Surgery / 日本心臓血管外科学会雑誌

We report a case of thoracic endovascular aortic repair (TEVAR) with a fenestrated stent graft for ulcer-like projection (ULP) of the proximal anastomosis after total arch replacement (TAR) for acute type A aortic dissection (DAA). A 73-year-old woman with a history of surgical resection of a left atrial myxoma in January 2009 underwent TAR for DAA in November 2011. The contrast enhanced CT (CE-CT) 72 days after TAR revealed two ULPs anterior and posterior to the proximal anastomosis. Surgical repair would be difficult because of the history of cardiac and aortic surgery, therefore TEVAR with a fenestrated stent graft was performed. The postoperative course was uneventful and she was discharged on the 8th postoperative day. The CE-CT 3 months after TEVAR showed almost completely thrombosed ULPs. Endovascular repair with fenestrated stent graft for the proximal anastomotic ULP can be a useful and effective treatment.

Surgeon-Modified Zenith Stent Graft System for Endovascular Repair of Abdominal Aortic Aneurysm with Short Proximal Neck / 日本心臓血管外科学会雑誌

Endovascular repair for abdominal aortic aneurysm (EVAR) has become widespread in Japan because of its low invasiveness. However adequate proximal neck length is required for EVAR. Unfortunately the surgical mortality of para-renal aortic aneurysm cases has been higher than that of infrarenal aortic aneurysm cases, especially in high-risk patients. A manufacture-modified fenestrated Zenith stent graft system has already been developed, however this new device is not yet available in Japan. Furthermore this device could not be used in an emergency situation because it takes 2-3 weeks for preparation. Therefore we introduced a surgeon-modified fenestrated Zenith stent graft (fenestrated Zenith) system in December 2010 for patients with a proximal neck length of 5-10 mm. The fenestrated Zenith was not indicated if the supra-renal angle and proximal neck angle exceeded 35°. From May 2007 to February 2012, abdominal aortic aneurysms (AAA) with a short neck were repaired with fenestrated Zenith in 11 high-risk patients (group Fene), and AAAs with a proximal neck length of more than 15 mm were repaired with a standard Zenith in 43 patients (group IFU). There were two ruptured AAA in the Fene group. Proximal neck length was significantly shorter in the Fene group (5.5±1.4 mm in the Fene group, 26.4±9.5 mm in the IFU group, <i>p</i><0.0001) and proximal neck angle was significantly less in the Fene group (20±13° in the Fene group, 36±18° in the IFU group, <i>p</i>=0.008). The Zenith stentgraft system was deployed successfully in all patients. The frequency of type Ia endoleak detected by angiography after stent graft deployment and balloon attachment did not differ significantly (36% in the Fene group 26% in the IFU group, <i>p</i>=0.475) and the frequency of Palmaz stent requirement for type Ia endoleak which persisted after 10 min of additional balloon attachment also did not differ significantly (27% in Fene group, 9% in IFU group). All fenestrated renal arteries were shown to be patent by angiography. There was no hospital death despite 2 cases of ruptured AAA, nor were these major complications in either group. Serum creatinine levels at 1, 3, 6 and 30 days after EVAR did not differ significantly between the 2 groups. In 9 out of 11 patients, only type II endoleaks were detected and aneurysm shrinkage tended to be more in Fene group (9.9±5.7 mm in Fene group, 5.4±6.1 mm in IFU group, <i>p</i>=0.062) on enhanced CT 6 months after EVAR. Also all fenestrated renal arteries were patent in these 9 patients. The surgeon-modified fenestrated Zenith system seemed to be effective for AAA patients with short proximal necks, but long term follow up is mandatory.

Endovascular Repair of Thoracic Aortic Aneurysm Using a Custom-made Fenestrated Stent Graft to Preserve the Left Subclavian Artery

Endovascular repair for thoracic aortic aneurysm is widespread and recently, the advent of new device-fenestrated stent graft enables endovascular repair for aortic aneurysm to be close or involved in the orifice of left subclavian artery. However, fenestrated stent graft is not available in Korea. We report herein a case in which endovascular repair for thoracic aortic aneurysm closed to the orifice of left subclavian artery using custom made fenestrated stent graft. The aneurysm was successfully repaired by a total endovascular approach without open surgical repair.