Akute komplexe endovaskuläre Aortenchirurgie – Off-the-Shelf vs. Surgeon-modified Stentgrafts
Standard
Akute komplexe endovaskuläre Aortenchirurgie – Off-the-Shelf vs. Surgeon-modified Stentgrafts. / Kapetanios, Dimitrios; Stana, Jan; Prendes, Carlota Fernandez; Stavroulakis, Konstantinos; Kölbel, Tilo; Rantner, Barbara; Tsilimparis, Nikolaos.
in: ZBL CHIR, Jahrgang 146, Nr. 5, 10.2021, S. 521-527.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Review › Forschung
Harvard
APA
Vancouver
Bibtex
}
RIS
TY - JOUR
T1 - Akute komplexe endovaskuläre Aortenchirurgie – Off-the-Shelf vs. Surgeon-modified Stentgrafts
AU - Kapetanios, Dimitrios
AU - Stana, Jan
AU - Prendes, Carlota Fernandez
AU - Stavroulakis, Konstantinos
AU - Kölbel, Tilo
AU - Rantner, Barbara
AU - Tsilimparis, Nikolaos
N1 - Thieme. All rights reserved.
PY - 2021/10
Y1 - 2021/10
N2 - INTRODUCTION: Treatment of complex abdominal and thoracoabdominal aortic aneurysms is challenging. Open surgical repair is a high-risk operation, especially in emergency cases. Endovascular aneurysm repair with a patient-specific custom-made stent graft in patients with symptomatic or ruptured complex aortic aneurysms is not possible, due to the manufacturing time required. In such cases, alternative endovascular techniques can be used.RESULTS: The "off-the-shelf" and "surgeon-modified" stent grafts are valid options for the endovascular treatment of complex aneurysms in urgent and emergent patients. The former are standardised commercially manufactured fenestrated or branched stent grafts, which are available off-the-shelf with an anatomical feasibility in 50 - 80% of the patients. The "surgeon-modified" stent grafts refer to a technique, in which a commercially available stent graft is modified by the surgeon under sterile conditions directly before the implantation, in order to add the required fenestrations, scallops and/or branches. The modification takes approximately 60 - 120 min and haemodynamic stability of the patient is mandatory. Because of the off-label use of the commercial stent graft, detailed patient consent about the modification complications and risks should be performed whenever possible. A comparison of results on mortality and morbidity between "off-the-shelf" and "surgeon-modified" stent grafts has been published, although a direct comparison would be unfair for several reasons (different design, lack of extensive outcomes reports, long learning curve and different modification techniques).CONCLUSION: The "surgeon-modified" and "off-the-shelf" fenestrated/branched stent grafts are used in the treatment of high-risk patients with symptomatic or contained ruptured complex aneurysms. The outcomes of the two techniques are good, although the long-term durability of the former should be further investigated.
AB - INTRODUCTION: Treatment of complex abdominal and thoracoabdominal aortic aneurysms is challenging. Open surgical repair is a high-risk operation, especially in emergency cases. Endovascular aneurysm repair with a patient-specific custom-made stent graft in patients with symptomatic or ruptured complex aortic aneurysms is not possible, due to the manufacturing time required. In such cases, alternative endovascular techniques can be used.RESULTS: The "off-the-shelf" and "surgeon-modified" stent grafts are valid options for the endovascular treatment of complex aneurysms in urgent and emergent patients. The former are standardised commercially manufactured fenestrated or branched stent grafts, which are available off-the-shelf with an anatomical feasibility in 50 - 80% of the patients. The "surgeon-modified" stent grafts refer to a technique, in which a commercially available stent graft is modified by the surgeon under sterile conditions directly before the implantation, in order to add the required fenestrations, scallops and/or branches. The modification takes approximately 60 - 120 min and haemodynamic stability of the patient is mandatory. Because of the off-label use of the commercial stent graft, detailed patient consent about the modification complications and risks should be performed whenever possible. A comparison of results on mortality and morbidity between "off-the-shelf" and "surgeon-modified" stent grafts has been published, although a direct comparison would be unfair for several reasons (different design, lack of extensive outcomes reports, long learning curve and different modification techniques).CONCLUSION: The "surgeon-modified" and "off-the-shelf" fenestrated/branched stent grafts are used in the treatment of high-risk patients with symptomatic or contained ruptured complex aneurysms. The outcomes of the two techniques are good, although the long-term durability of the former should be further investigated.
KW - Aortic Aneurysm, Abdominal/surgery
KW - Aortic Aneurysm, Thoracic/surgery
KW - Blood Vessel Prosthesis
KW - Blood Vessel Prosthesis Implantation
KW - Endovascular Procedures
KW - Humans
KW - Postoperative Complications
KW - Prosthesis Design
KW - Stents
KW - Surgeons
KW - Treatment Outcome
U2 - 10.1055/a-1647-3549
DO - 10.1055/a-1647-3549
M3 - SCORING: Review
C2 - 34666365
VL - 146
SP - 521
EP - 527
JO - ZBL CHIR
JF - ZBL CHIR
SN - 0044-409X
IS - 5
ER -