Technique for Fenestrated Stent-Graft Implantation as a Proximal Extension to a Previous Fenestrated Endovascular Repair for Abdominal Aortic Aneurysm
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Technique for Fenestrated Stent-Graft Implantation as a Proximal Extension to a Previous Fenestrated Endovascular Repair for Abdominal Aortic Aneurysm. / Spanos, Konstantinos; Tsilimparis, Nikolaos; Heidemann, Franziska; Rohlffs, Fiona; Behrendt, Christian-Alexander; Debus, Eike Sebastian; Kölbel, Tilo.
in: J ENDOVASC THER, Jahrgang 25, Nr. 1, 02.2018, S. 16-20.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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T1 - Technique for Fenestrated Stent-Graft Implantation as a Proximal Extension to a Previous Fenestrated Endovascular Repair for Abdominal Aortic Aneurysm
AU - Spanos, Konstantinos
AU - Tsilimparis, Nikolaos
AU - Heidemann, Franziska
AU - Rohlffs, Fiona
AU - Behrendt, Christian-Alexander
AU - Debus, Eike Sebastian
AU - Kölbel, Tilo
PY - 2018/2
Y1 - 2018/2
N2 - PURPOSE: To describe planning and a technique for fenestrated endovascular repair of a large Crawford type IV thoracoabdominal aortic aneurysm after previous 2-fenestration endovascular aneurysm repair (FEVAR).TECHNIQUE: The first FEVAR procedure performed at another center implanted a standard Zenith device with 2 fenestrations and 1 scallop for a juxtarenal abdominal aortic aneurysm. The diameter of the Crawford type IV thoracoabdominal aortic aneurysm had progressed from 68 to 75 mm within a year after the FEVAR. Since the celiac trunk was already occluded, a 3-fenestration 22-×172-mm stent-graft was chosen to extend the existing stent-graft further proximally. A tapered 38/22-×179-mm Zenith custom-made device was designed for the thoracic component. The technique addresses several issues that arise during a FEVAR-in-FEVAR case, such as the orientation of the new stent-graft and its fenestrations, the absence of space between the 2 devices for maneuvers, and the difficulty in catheterizing target vessels with existing bridging stents, for which a bailout "snare-ride" maneuver is described.CONCLUSION: FEVAR after previous FEVAR is a feasible and efficient treatment option. The modified "snare-ride" technique can be used to catheterize target vessels in the absence of an Indy snare.
AB - PURPOSE: To describe planning and a technique for fenestrated endovascular repair of a large Crawford type IV thoracoabdominal aortic aneurysm after previous 2-fenestration endovascular aneurysm repair (FEVAR).TECHNIQUE: The first FEVAR procedure performed at another center implanted a standard Zenith device with 2 fenestrations and 1 scallop for a juxtarenal abdominal aortic aneurysm. The diameter of the Crawford type IV thoracoabdominal aortic aneurysm had progressed from 68 to 75 mm within a year after the FEVAR. Since the celiac trunk was already occluded, a 3-fenestration 22-×172-mm stent-graft was chosen to extend the existing stent-graft further proximally. A tapered 38/22-×179-mm Zenith custom-made device was designed for the thoracic component. The technique addresses several issues that arise during a FEVAR-in-FEVAR case, such as the orientation of the new stent-graft and its fenestrations, the absence of space between the 2 devices for maneuvers, and the difficulty in catheterizing target vessels with existing bridging stents, for which a bailout "snare-ride" maneuver is described.CONCLUSION: FEVAR after previous FEVAR is a feasible and efficient treatment option. The modified "snare-ride" technique can be used to catheterize target vessels in the absence of an Indy snare.
KW - Aortic Aneurysm, Abdominal/diagnostic imaging
KW - Aortic Aneurysm, Thoracic/diagnostic imaging
KW - Blood Vessel Prosthesis
KW - Blood Vessel Prosthesis Implantation/instrumentation
KW - Disease Progression
KW - Endovascular Procedures/instrumentation
KW - Humans
KW - Prosthesis Design
KW - Stents
KW - Treatment Outcome
U2 - 10.1177/1526602817745779
DO - 10.1177/1526602817745779
M3 - SCORING: Journal article
C2 - 29235384
VL - 25
SP - 16
EP - 20
JO - J ENDOVASC THER
JF - J ENDOVASC THER
SN - 1526-6028
IS - 1
ER -