Experience with inner branch off the shelf device for thoracoabdominal aneurysms.

Endovascular treatment of complex aortic aneurysms (cAAA) including thoracoabdominal aortic aneurysms is becoming more common. Most patients require custom made devices and until recently the off the shelf (OTS) options were limited. The aim of this manuscript was to describe a new inner branch OTS device and its clinical applications. A review of the current literature on the ENSIDE device from Artivion was performed and the authors' experience presented. The short outcomes of this particular OTS device are acceptable and the anatomical suitability on par with other similar devices. The preloaded configuration of the device can offer benefits in complex anatomy. New OTS devices for cAAA can provide treatment in emergent or urgent situations in many patients. Long term follow-up is needed and caution must be made against excessive use in less extensive aneurysms due to the risk of spinal cord ischemia.

Endovascular treatment for chronic type B dissection: limitations of short stent-grafts revealed at midterm follow-up.

PURPOSE: To examine the incidence of and the indications for re-intervention, as well as the changes in aortic morphology, in patients with chronic type B aortic dissection who underwent endovascular intervention for false lumen aneurysms. METHODS: A retrospective analysis was conducted of 10 patients (8 men; mean age 63 years, range 45-79) who underwent stent-graft repair of aneurysmal false lumen expansion related to chronic type B aortic dissection at a median 16 months (range 2-71) from the initial diagnosis. All grafts had been oversized by 10% relative to the normal non-dissected aorta and were implanted to cover the primary entry tear. Follow-up computed tomography scans were analyzed to define changes in aortic morphology. RESULTS: Mean radiological follow-up was 56 months (median 64.5; range 19-86.5). There was no perioperative mortality or stroke; no cases of aortic rupture were recorded during follow-up. One patient suffered a procedure-related stroke with postoperative hemiparesis following re-intervention for proximal erosion 15 months after the initial treatment. In 6 of the 7 re-interventions performed in 6 patients at a median 42 months after the index procedure, stent-graft extension was required to treat erosion of the dissection membrane that had resulted in endoleak with false lumen reperfusion. The extent of dissection, duration of follow-up, or length of aortic coverage was not predictive of the need for re-intervention during follow-up. At last follow-up, the mean false lumen diameter at the level of the stented aorta was significantly smaller than at baseline (11+/-15 versus 24+/-15 mm, p<0.01). This was associated with false lumen thrombosis at the level of the stent-graft in 9 of 10 cases, although 7 patients had persistent false lumen perfusion distal to the stent-graft. CONCLUSION: Endovascular stent-graft treatment is effective therapy for chronic type B dissection patients with false lumen aneurysms. Erosion of the dissection membrane, causing proximal or distal endoleak, is the most common reason for re-intervention during midterm follow-up.

Endovascular treatment of acute complicated type B dissection: morphological changes at midterm follow-up.

PURPOSE: To review midterm results and morphological changes following endovascular treatment of acute complicated type B dissection and to study the relation between extent of dissection and treatment outcome. METHODS: Between February 2001 and March 2008, 52 patients (38 men; median age 67 years, range 40-82) received thoracic stent-grafts for acute complicated type B dissections. Outcome for those patients treated for intramural hematoma (IMH; group 1, n = 7) or type IIIa dissection (group 2, n = 17) were compared to those with type IIIb dissection (group 3, n = 28). True lumen index (TLi), false lumen index (FLi; ratio of true or false lumen diameter, respectively, to the sum of both), and FL perfusion were calculated prior to treatment and at the last follow-up from computed tomographic angiography (CTA) scans. RESULTS: Perioperative morbidity and mortality rates were 28.5% and 28.5% in group 1, 18% and 12%, respectively, for group 2, and 18% and 11% for group 3. No adjunctive treatment or re-intervention was required in groups 1 or 2, while the rates were 37% and 22%, respectively, for these events in group 3 (p = 0.009 and p = 0.034, respectively, versus groups 1 + 2). Mean imaging surveillance was 31 months, and no patients were lost to follow-up. In group 2, there was 1 case of persistent FL perfusion at last CTA, whereas in group 3, 68% had persistent FL perfusion detected; the mean FLi ranged from 0.12 at the level of the carina to 0.33 at the level of the inferior mesenteric artery. Half of the patients in this group had an increase in FL diameter correlating significantly with FL perfusion, mostly distal to the stented aorta. CONCLUSION: Despite similar morbidity and perioperative mortality rates, outcomes following endovascular treatment of acute complicated type B dissection varied with the extent of the dissection. Persistent FL perfusion below the stent-graft, associated with aneurysm expansion and the need for re-intervention, was seen most often in type IIIb dissection. Patients with the more limited type IIIa dissection or IMH were likely to be cured by endovascular therapy.