TAA 14. Short-term Outcomes of the t-Branch Off-the-Shelf Multibranched Stent Graft for Reintervention After Previous Infrarenal Aortic Repair
The objective of this study was to evaluate the outcome of the t-Branch (Cook Medical, Bloomington, Ind) stent graft for treatment of thoracoabdominal and pararenal aortic aneurysms in patients who had previous infrarenal aortic repair.
We evaluate the crimping strain, sealing stress and contact forces on a Nitinol stent deployed in the aorta during endovascular aortic (or aneurysm) repair (EVAR) procedures. Nitinol shape memory effect (SME) is used. We also study the fluid-structure interaction (FSI) of the blood flow on the stented aorta.
Authors: Yiğit G, Çetinkaya F, Aytekin B, Türkçü MA, Özen A, Sarıtaş A PMID: 31708991 [PubMed]
ConclusionOur experience and the results obtained with this new perioperative protocol with epidural corticosteroid and accurate hemodynamic control have been encouraging and it seems a valid proposal to be explored in future by well-structured prospective, randomized protocols.
An ageing population leads to more age related diseases, such as complex abdominal aortic aneurysms (AAA). Patients with complex AAAs and multiple comorbidities benefit from fenestrated endovascular aneurysm repair (FEVAR), but for the elderly this benefit is not completely clear.
Current clinical guidelines for surgical repair of abdominal aortic aneurysms (AAAs) are primarily based on maximum diameter assessment. From a biomechanical point of view, not only the diameter but also peak wall stresses will play an important role in rupture risk assessment. These methods require patient specific geometry which typically uses computed tomography (CT) or magnetic resonance imaging. Recently, wall stress analysis based on 3D ultrasound (US) has been proposed, and shows promising results.
The aim of this study was to compare intravascular-ultrasound (IVUS) assistance for Endovascular Aortic Aneurysm Repair (EVAR) to standard assistance by angiography.
Endovascular aortic stent graft technology radically altered aortic aneurysm repair from a maximally invasive procedure to a minimally invasive approach. Whereas the overall principle of the repair remained the same, the surgeon ceded control of the proximal seal when suturing was eliminated. In endovascular aneurysm repair (EVAR), no longer does the surgeon control the precise placement of mechanical fasteners (sutures) between graft and tissue; rather, the graft is kept in place by creation of a seal zone that often lacks any mechanical fastening.
Severe aortoiliac occlusive disease is a relative contraindication for endovascular aneurysm repair, owing to an association with high stent graft-related complication and reintervention rates in this population. Open AAA repair requiring aortofemoral bypass (AFB), however, may represent a unique population with differing outcomes from standard open repair. We sought to compare the demographic and procedural characteristics, as well as outcomes of patients undergoing standard intra-abdominal repairs (STD) versus those requiring AFB.
Open repair of extent II and III thoracoabdominal aortic aneurysms (TAAA) is associated with substantial morbidity. Alternative strategies, such as hybrid operations combining proximal thoracic endovascular aortic repair with either staged open distal TAAA repair or visceral debranching (hybrid), as well as fenestrated/branched endografts (FEVAR), have been increasingly reported; however, benefits of these approaches compared with direct open surgery remain unclear. The purpose of this study was to compare outcomes of these three different strategies in the management of extent II/III TAAA.
ConclusionModern imaging technology provides multiple methodologies highly successful at detecting the ASA. The ASA can then be preserved intraoperatively, contributing to low paraplegia rates. We strongly recommend routine application of this technology to arm the surgeon with precise information about the specific patient's spinal cord blood supply.