The Experts below are selected from a list of 16596 Experts worldwide ranked by ideXlab platform

Nicola Mangialardi - One of the best experts on this subject based on the ideXlab platform.

Gustav Fraedrich - One of the best experts on this subject based on the ideXlab platform.

  • serious complications following endovascular thoracic Aortic Stent graft repair for type b dissection
    European Journal of Cardio-Thoracic Surgery, 2008
    Co-Authors: Beate Neuhauser, W Jaschke, Andreas Chemelli, Andreas Greiner, Gustav Fraedrich
    Abstract:

    AbstractObjective: To describe our experience with endovascular Stent-graft repairs in type B Aortic dissection focusing on serious secondarycomplications resulting in immediate or late conversion to open repair. Methods: From November 1997 to May 2007, 28 patients underwent athoracicendovascular Stent-graft procedurefor acute symptomatic typeB dissection atour institution.Indicationfor endovascular repairat ourdepartment is a complicated course of type B dissection, including thoracic Aortic rupture, suspicion of impending rupture, visceral and/orperipheral ischemia, uncontrollable hypertension, and severe therapy-resistant pain. Median follow-up time was 48.3 months (range 2—97months). Results: Secondary complications with indication for a secondary intervention occurred in 5/28 patients, resulting in additionalproceduresin 4 patients. Onepatient declinedany further therapy. Conversionto an open procedurewas performedin four patients, one due totype I endoleak followed by retrograde type A dissection, and three due to retrograde type A dissection. One of these patients had an additionalStent-graftprocedureperformedduetoatypeIIIendoleak20monthspostStentgrafting.RetrogradetypeAdissectionoccurred39monthslater,finally leading to conversion to an open procedure. Open surgery was performed in four patients after 3, 26, 29, and 1170 days post Stent-graftplacement and was successful in three patients. The fourth patient died 3 months post-surgically due to multi-organ failure. The procedure-related mortality rate following secondary complications was (1/5) 20%. Conclusions: Endovascular Stent-graft repair of the thoracic aorta isan alternative to surgical repair, however not without significant morbidity and mortality. Potentially lethal complications, acute or delayed,may occur.# 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

  • type a dissection following endovascular thoracic Aortic Stent graft repair
    Journal of Endovascular Therapy, 2005
    Co-Authors: Beate Neuhauser, Benedikt V Czermak, John H Fish, Reinhold Perkmann, W Jaschke, Andreas Chemelli, Gustav Fraedrich
    Abstract:

    Purpose:To describe our experience with endovascular Stent-graft repairs in the thoracic aorta focusing on the secondary complication of type A dissection.Methods:Between January 1996 and April 2004, 73 patients were treated for traumatic thoracic Aortic rupture (n=15), type B dissection (n=22), or atherosclerotic descending thoracic Aortic aneurysms (TAA, n=36). A retrospective review of the records found 5 (6.8%) patients (3 men; median age 64 years, range 43–87) who experienced a type A dissection at a median 20 days (range 2–124) after thoracic Stent-graft repair for 3 type B dissections, 1 TAA, and a late type I endoleak that appeared 28 months after initial Stent-graft repair of a traumatic dissection.Results:In 3 patients (2 dissections, 1 endoleak), a tear in the Aortic wall at the proximal Stent-graft was responsible for a retrograde type A dissection. Underlying disease was the cause of the type A dissection in the 2 other patients (1 dissection, 1 TAA) and was unrelated to the Stent-grafts. Thr...

Timothy A M Chuter - One of the best experts on this subject based on the ideXlab platform.

  • standard off the shelf versus custom made multibranched thoracoabdominal Aortic Stent grafts
    Journal of Vascular Surgery, 2016
    Co-Authors: Charlene C Fernandez, Julia D Sobel, Warren J Gasper, Shant M Vartanian, Linda M Reilly, Timothy A M Chuter, Jade S Hiramoto
    Abstract:

    Objective The complex Aortic branch anatomy in thoracoabdominal Aortic aneurysms (TAAAs) and pararenal Aortic aneurysms (PRAAs) presents a challenge for endovascular repair. The multibranched endovascular device has durable midterm results with use of a custom branch Stent graft (CSG) configuration. The midterm results with use of the standard branch Stent graft (SSG) configuration are unknown, but it has the advantage of off-the-shelf technology. The goal of this study was to compare the midterm outcomes of CSG and SSG multibranched endovascular devices. Methods From July 2005 to September 2014, 133 patients underwent elective endovascular repair of TAAA and PRAA in a prospective trial. Beginning in December 2008, SSGs were used in those with suitable anatomy. Results Fifty patients (mean age, 71 ± 7 years; 11 women [22%]) were treated using SSGs, and 83 patients (mean age, 74 ± 9 years; 22 women [26.5%]) underwent repair using CSGs. The SSG and CSG groups were similar with regard to aneurysm size, aneurysm extent, and medical comorbidities, with the sole exception of lung disease, which was more common in the SSG group. All Stent grafts were deployed as intended, with no conversions to open repair. Mean ± standard deviation follow-up (days) was 694 ± 525 for the SSG group and 942 ± 764 for the CSG group ( P  = .045). There were no significant differences in aneurysm-related death, renal failure requiring dialysis, stroke, endoleak, visceral or renal branch occlusion, lower extremity weakness, or reintervention ( P > .05 for each). The volume of contrast material was significantly lower in those with SSGs compared with CSGs ( P  = .016), but there were no significant differences in operative or fluoroscopy times. Time to treatment (days from consent to surgery) was significantly lower in SSG patients compared with CSG patients ( P  = .01). Conclusions For patients with suitable anatomy, the use of SSGs for TAAA and PRAA repair results in significantly shorter wait times to surgery and is as safe, effective, and durable in the midterm compared with CSGs.

  • a modular multi branched system for endovascular repair of bilateral common iliac artery aneurysms
    Journal of Endovascular Therapy, 2003
    Co-Authors: Cherrie Z Abraham, Linda M Reilly, Darren B Schneider, Shelley Dwyer, Rajiv Sawhney, Louis M Messina, Timothy A M Chuter
    Abstract:

    PURPOSE To describe a modular Stent-graft for cases of bilateral common iliac aneurysm. TECHNIQUE The Aortic aneurysm is repaired using a standard bifurcated modular system (Zenith). A modified bifurcated component is deployed with its trunk in one limb of the original Aortic Stent-graft, its long limb in the external iliac artery, and its short limb in the iliac aneurysm just above the internal iliac orifice. A flexible extension is introduced from the right brachial artery and used to bridge the gap between the short limb of the modified bifurcated component and the left internal iliac artery. CONCLUSIONS Endovascular repair of bilateral iliac aneurysm is feasible using a modular Stent-graft with separate branches to the internal and external iliac arteries.

Tilo Kolbel - One of the best experts on this subject based on the ideXlab platform.

  • use of a steerable sheath for retrograde access to antegrade branches in branched Stent graft repair of complex Aortic aneurysms
    Journal of Endovascular Therapy, 2018
    Co-Authors: Vladimir Makaloski, Nikolaos Tsilimparis, Fiona Rohlffs, Konstantinos Spanos, Sebastian E Debus, Tilo Kolbel
    Abstract:

    Purpose: To describe how to use a steerable sheath from a femoral access to catheterize antegrade branches in a branched Aortic Stent-graft. Technique: Following femoral cutdown, a Stent-graft with...

  • use of a steerable sheath for retrograde access to antegrade branches in branched Stent graft repair of complex Aortic aneurysms
    Journal of Endovascular Therapy, 2018
    Co-Authors: Vladimir Makaloski, Nikolaos Tsilimparis, Fiona Rohlffs, Konstantinos Spanos, Sebastian E Debus, Tilo Kolbel
    Abstract:

    PURPOSE To describe how to use a steerable sheath from a femoral access to catheterize antegrade branches in a branched Aortic Stent-graft. TECHNIQUE Following femoral cutdown, a Stent-graft with antegrade branches destined for renovisceral target vessels was deployed in the desired position. A steerable sheath with a tip that rotates up to 180° was introduced from the common femoral artery and navigated to the antegrade branches for consecutive catheterization of the target vessels and deployment of one or more bridging Stents per branch. The technique is demonstrated in 4 patients who underwent successful complex abdominal and thoracoabdominal branched endovascular repairs with 1, 2, and 4 antegrade branches. CONCLUSION Retrograde access for complex Aortic endografts with antegrade branches using a steerable sheath appears feasible and effective and may serve as an alternative to upper extremity access.

Björn Sonesson - One of the best experts on this subject based on the ideXlab platform.

  • disintegration of the top Stent on zenith abdominal Aortic Stent grafts
    Journal of Endovascular Therapy, 2016
    Co-Authors: Björn Sonesson, David Lindstrom, Carlmagnus Wahlgren, Timothy Resch
    Abstract:

    PURPOSE: To describe a heretofore unreported complication involving the Zenith Low Profile (LP) Stent-graft. CASE REPORT: Two men, aged 75 and 67 years, respectively, underwent abdominal Aortic aneurysm repair with a Zenith LP device. At 4 and 3 years, respectively, computed tomography angiography revealed separation of the proximal fixation Stent from the Stent-graft. In the first patient, there was Stent-graft migration but no evidence of an endoleak; however, the aneurysm had grown. A fenestrated cuff was placed, sealing distally in the previous LP graft. The second patient had a type I endoleak. Open surgery was performed, and the main body of the graft was explanted. Postoperative examination of the device revealed that the fixation sutures on the suprarenal Stent were still attached to the Stent and had eroded through the graft material. CONCLUSION: Physicians should be aware of the potential for top Stent separation from the Zenith LP Stent-graft as a cause of endoleak and migration. (Less)

  • chimney grafts preserve visceral flow and allow safe Stenting of juxtarenal Aortic occlusion
    Journal of Vascular Surgery, 2013
    Co-Authors: Adel Bin Jabr, Björn Sonesson, Timothy Resch, Nuno Dias, Bengt Lindblad, Martin Malina
    Abstract:

    OBJECTIVE: Chimney grafts have proven useful for urgent endovascular repair of juxtarenal Aortic aneurysms. Stenting of juxtarenal Aortic occlusive disease is not routinely advocated due to the risk of visceral artery obstruction. We report on the potential applicability of chimney grafts in 10 patients with juxtarenal Aortic stenosis or occlusion. To our best knowledge, chimney grafts have not been applied previously in this challenging setting. METHODS: Ten high-risk female patients (mean age, 68 years) with severe stenosis or occlusion of the aorta at the level of the visceral arteries were offered Stenting. "Chimney" Stents or Stent grafts (20-40 mm long) were implanted from a brachial approach into visceral arteries that needed to be covered by the Aortic Stent. The chimney Stents were then temporarily obstructed by balloon catheters to prevent visceral embolization until the Aortic Stent or Stent graft was deployed. RESULTS: All procedures were technically successful, and patency was obtained in all visceral arteries and the aorta without distal embolization. One patient died after 9 days of acute heart failure. The nine surviving patients presented no complications, and all Stented vessels remained patent at up to 6 years. Another patient died after 5.5 years due to lung cancer. All three patients with renal impairment have improved renal function, and a reduction in antihypertensive medication has been possible. CONCLUSIONS: Chimney grafts may allow Stenting of juxtarenal Aortic occlusive disease by protecting the patency of visceral arteries. Further evaluation with more patients and longer follow-up is required.

  • the chimney graft a technique for preserving or rescuing Aortic branch vessels in Stent graft sealing zones
    Journal of Endovascular Therapy, 2008
    Co-Authors: T Ohrlander, Björn Sonesson, Krasnodar Ivancev, Timothy Resch, Nuno Dias, Martin Malina
    Abstract:

    PURPOSE: To report an alternative to the fenestrated Stent-graft for preserving blood flow to side branches in the sealing zones of Aortic Stent-grafts. TECHNIQUE: A covered Stent is deployed parallel to the main Aortic Stent-graft, protruding somewhat proximally, like a chimney, to preserve flow to a vital side branch covered by the Aortic Stent-graft. Use of a chimney graft makes it possible to use standard off-the-shelf Stent-grafts to instantly treat lesions with inadequate fixation zones, providing an alternative to fenestrated Stent-grafts in urgent cases, in aneurysms with challenging neck morphology, and for reconstituting an Aortic side branch unintentionally compromised during endovascular repair. This technique has been used successfully in 10 patients, combining chimney grafts in the renal, superior mesenteric, left subclavian, left common carotid, and innominate arteries with Stent-grafts in the abdominal (n=6) or thoracic (n=4) aorta. There has been no late chimney graft-related endoleak on imaging studies up to 8 months. CONCLUSION: The use of chimney grafts is feasible in the renal and superior mesenteric arteries, as well as in the supra-Aortic branches, to facilitate Stent-graft repair of thoracic or abdominal Aortic lesions with inadequate fixation zones.

  • balloon occlusion of the aorta during endovascular repair of ruptured abdominal Aortic aneurysm
    Journal of Endovascular Therapy, 2005
    Co-Authors: Martin Malina, Franck J Veith, Björn Sonesson
    Abstract:

    Purpose:To describe a technique of Aortic clamping during endovascular aneurysm repair (EVAR) in patients with ruptured abdominal Aortic aneurysms (AAA) and circulatory collapse.Technique:A balloon catheter is inserted percutaneously from the femoral artery and inflated in the suprarenal aorta. An introducer sheath must support the balloon. The Stent-graft is passed from the contralateral groin and deployed beneath the balloon. The sheath makes it possible to retrieve the balloon after the endograft has been deployed. Carbon dioxide facilitates angiography while the Aortic blood flow is arrested.Conclusions:The Aortic Stent-graft can be deployed while the aorta is continuously “clamped” from a transfemoral approach. This may allow EVAR in patients with circulatory collapse due to aneurysm rupture.