ABSTRACT
OBJECTIVE: The INCRAFT stent graft system is an ultra-low profile endograft for the exclusion of infrarenal aortic aneurysms. In the market approval studies, an increased rate of device-related complications was observed and the endograft was approved with mandated postmarketing investigations. Our aim was to analyze midterm outcomes of a real-world patient cohort treated with the INCRAFT endograft. METHODS: Consecutive patients treated with the INCRAFT endograft between February 2015 and December 2022 at a single institution were included. In accordance with the Society for Vascular Surgery reporting standards, safety endpoints were reported and outcome endpoints included reinterventions, technical success, aortic-related and overall-mortality, endoleak, stent fracture, and endograft migration >5 mm. RESULTS: Eighty patients (85% male) with a mean age of 76 ± 7 years were included. Fifty-two patients (65%) were treated within the endograft's instruction for use (IFU). Mean aortic diameter was 59 ± 10 mm and 91% of the procedures were performed percutaneously. Mean follow-up was 37 ± 25 months and there was no aortic- or procedure-related mortality. Reinterventions occurred in 25 patients (31%) with a freedom from reintervention at 1, 3 and 5 years of 84%, 66% and 55%. The most frequent reinterventions were limb graft stenting (23%) and type II endoleak embolization (14%). Limb occlusion rate was 9% and in three patients (4%) distal endograft migrations >5 mm occurred. Persisting type II endoleaks were observed in 29% and aneurysm diameter was stable in 41% and had shrunk in 38%. Three type III endoleaks (4%) developed during follow-up and four open conversions (5%) were necessary. No known risk factors, including treatment outside IFU, were predictive for reinterventions. CONCLUSION: Treatment of infrarenal aortic aneurysms with the INCRAFT stent graft system was safe and successful. Nevertheless, a substantial rate of reinterventions was necessary during follow-up to maintain endograft patency and prevent aneurysm growth.
ABSTRACT
In this work we study various continuous finite element discretization for two dimensional hyperbolic partial differential equations, varying the polynomial space (Lagrangian on equispaced, Lagrangian on quadrature points (Cubature) and Bernstein), the stabilization techniques (streamline-upwind Petrov-Galerkin, continuous interior penalty, orthogonal subscale stabilization) and the time discretization (Runge-Kutta (RK), strong stability preserving RK and deferred correction). This is an extension of the one dimensional study by Michel et al. (J Sci Comput 89(2):31, 2021. 10.1007/s10915-021-01632-7), whose results do not hold in multi-dimensional frameworks. The study ranks these schemes based on efficiency (most of them are mass-matrix free), stability and dispersion error, providing the best CFL and stabilization coefficients. The challenges in two-dimensions are related to the Fourier analysis. Here, we perform it on two types of periodic triangular meshes varying the angle of the advection, and we combine all the results for a general stability analysis. Furthermore, we introduce additional high order viscosity to stabilize the discontinuities, in order to show how to use these methods for tests of practical interest. All the theoretical results are thoroughly validated numerically both on linear and non-linear problems, and error-CPU time curves are provided. Our final conclusions suggest that Cubature elements combined with SSPRK and OSS stabilization is the most promising combination.
