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Felice Pecoraro - One of the best experts on this subject based on the ideXlab platform.
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tevar and Periscope graft technique to treatment of huge aneurysm of aortic isthmus case report
International Journal of Surgery Case Reports, 2021Co-Authors: Ettore Dinoto, F Ferlito, M A La Marca, D Pakeliani, Guido Bajardi, Felice PecoraroAbstract:Abstract Introduction Thoracic endovascular aortic repair (TEVAR) has revolutionized the treatment of thoracic aortic aneurysms. Innovative techniques as chimney and Periscope grafts can improve the outcomes of procedure. Herein, we report a case in emergency of huge Thoracic aortic aneurism. Presentation of case An 86-year-old male with hypertension, diabetes mellitus, was referred to our hospital for chest pain. CT-angiography showed a huge aneurysm of aortic isthmus with signs of rupture. The patient was considered unfit for open surgery and an endovascular approach was chosen. This patient underwent endovascular repair with TEVAR, using the Periscope graft technique to preserve patency in left subclavian artery (LSA). Discussion Symptomatic ischemia from LSA coverage has been reported to occur in only a modest 6–10% of patients and is often sacrificed with impunity given coverage rates between 10 and 50%. In this case reported the lack of revascularization of LSA increased the risk of neurological manifestations or stroke. Periscope technique is feasible and safe to maintain perfusion to the subclavian artery, with a 93% primary patency at 2 years. Conclusions Our experience using TEVAR with Periscope graft technique as solution to address thoracic aneurysm of aortic isthmus was feasible and safe.
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mid and longer term follow up of chimney and or Periscope grafts and risk factors for failure
European Journal of Vascular and Endovascular Surgery, 2016Co-Authors: Thomas Pfammatter, Zoran Rancic, Frank J Veith, Felice Pecoraro, Gilbert Puippe, Dominique Bettex, Beatrice Ammanvesti, Mario LachatAbstract:Objective The aim was to report on chimney and Periscope grafts (CPGs) and their mid- and longer-term outcomes when they are used to preserve reno-visceral artery (RVA) perfusion in endovascular repair of pararenal (PRAAs) or thoraco-abdominal aortic aneurysm (TAAAs). In addition, factors associated with CPG failure are presented. Limited data exist on the outcomes of CPGs, and mid- and long-term results are generally not reported. Methods This was a prospective study in a cohort of 100 patients with PRAA (69) or TAAA (31). A total of 224 (mean 2.24 per patient) RVAs were preserved with 136 (61%) chimney and 88 (39%) Periscope grafts. CPGs were constructed mainly using self expandable stent grafts. Patients were followed by clinical examination, CTA (82%), and/or duplex (18%). Data were collected until February 2015. Results CPG immediate technical success was 99% (222/224 branches). Mean follow up was 29 months (range 0–65; SD 17); 59% patients were followed > 2 years, 30% > 3 years, and 16% > 4 years. Post-operatively, CPG occlusion was observed early (≤30 days) in three (1.3%) branches and during follow up in 10 (4.5%). At 36 and 48 months, the estimated primary patency was 93% and 93%. After corrective percutaneous (10) or surgical (3) re-interventions, the estimated secondary patency was 96% and 96%. Thirty day mortality was 2%; at 36 and 48 months the estimated patient survival was 79%. Significant shrinkage (72 [SD 23] vs. 62 [SD 24] mm; p .001) was observed, with a substantial reduction (>5 mm) in 55 patients, and sac enlargement in four. Incomplete aneurysm sac sealing was treated successfully by a secondary intervention in 15 patients. Conclusions Self expandable CPGs have proved to be a highly successful and durable treatment for RVA preservation up to 5 years. Incomplete CPG expansion, inadequate length, and CPG use in small and diseased target arteries were risk factors for occlusion. These mid- and longer-term results support CPG use to treat PRAAs or TAAAs in patients unfit for open surgery or fenestrated/branched stent grafts.
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a 12 year experience with chimney and Periscope grafts for treatment of type i endoleaks
Journal of Endovascular Therapy, 2015Co-Authors: Nunzio Montelione, Dieter Mayer, Thomas Pfammatter, Zoran Rancic, Felice Pecoraro, Gilbert Puippe, Lyubov Chaykovska, Beatrice Amannvesti, Marc Husmann, Frank J VeithAbstract:Purpose: To evaluate the midterm outcomes of chimney and/or Periscope grafts (CPGs) in patients presenting type I endoleak after a previous endovascular aneurysm repair (EVAR). Methods: Between Jun...
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Periscope endograft technique to revascularize the left subclavian artery during thoracic endovascular aortic repair
Journal of Endovascular Therapy, 2013Co-Authors: Mario Lachat, Dieter Mayer, Thomas Pfammatter, Frank J Criado, Zoran Rancic, Thomas Larzon, Frank J Veith, Felice PecoraroAbstract:Purpose: To present early and midterm results of the Periscope endograft (PG) technique to maintain left subclavian artery (LSA) blood flow in thoracic endovascular aortic repairs (TEVAR) involving...
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Periscope endograft technique to revascularize the left subclavian artery during thoracic endovascular aortic repair
Journal of Endovascular Therapy, 2013Co-Authors: Mario Lachat, Dieter Mayer, Thomas Pfammatter, Frank J Criado, Zoran Rancic, Thomas Larzon, Frank J Veith, Felice PecoraroAbstract:Purpose : To present early and midterm results of the Periscope endograft (PG) technique to maintain left subclavian artery (LSA) blood flow in thoracic endovascular aortic repairs (TEVAR) involving zone 3. Methods : From April 2010 to January 2013, 14 consecutive high-risk patients (11 men; mean age 70±8 years, range 56-87) underwent TEVAR with the PG technique for 10 thoracic aortic aneurysms (TAA), 2 traumatic aortic ruptures, and 2 aortic dissections without a suitable landing zone (>2 cm distal to the LSA). Five procedures were performed emergently for rupture (3 TAAs and the 2 trauma cases). Two patients had a Periscope deployed in an aberrant right subclavian artery. The Periscope endografts were sized 1 to 2 mm larger than the branch artery at the intended landing zone. The caudal end was extended distal to the intended distal landing site of the thoracic stent-graft, which was usually deployed after the PG. Both the PG and thoracic stent-grafts were generally molded using the kissing balloon technique. Outcomes analyzed were immediate technical success, perioperative mortality and morbidity, aneurysm diameter change, and Periscope endograft patency. Results : Immediate technical success was 100%, with all procedures completed as planned. Perioperatively, one Periscope occluded and one of the ruptured TAA patients died. One percutaneous access site hematoma required only conservative management. At a mean follow-up of 26±9 months (range 9-37), there was no additional PG occlusion. The Kaplan-Meier estimate of PG patency was 93% at 2 years. Conclusion : The Periscope endograft is a simple technique to maintain perfusion to the LSA in cases where the aortic stent-graft crosses its ostium. The PG technique can be performed transfemorally and even percutaneously, and it can be applied to all supra-aortic branches. Early and midterm results are encouraging, but more experience and long-term results are mandatory before this technique can be widely recommended.
Frank J Veith - One of the best experts on this subject based on the ideXlab platform.
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mid and longer term follow up of chimney and or Periscope grafts and risk factors for failure
European Journal of Vascular and Endovascular Surgery, 2016Co-Authors: Thomas Pfammatter, Zoran Rancic, Frank J Veith, Felice Pecoraro, Gilbert Puippe, Dominique Bettex, Beatrice Ammanvesti, Mario LachatAbstract:Objective The aim was to report on chimney and Periscope grafts (CPGs) and their mid- and longer-term outcomes when they are used to preserve reno-visceral artery (RVA) perfusion in endovascular repair of pararenal (PRAAs) or thoraco-abdominal aortic aneurysm (TAAAs). In addition, factors associated with CPG failure are presented. Limited data exist on the outcomes of CPGs, and mid- and long-term results are generally not reported. Methods This was a prospective study in a cohort of 100 patients with PRAA (69) or TAAA (31). A total of 224 (mean 2.24 per patient) RVAs were preserved with 136 (61%) chimney and 88 (39%) Periscope grafts. CPGs were constructed mainly using self expandable stent grafts. Patients were followed by clinical examination, CTA (82%), and/or duplex (18%). Data were collected until February 2015. Results CPG immediate technical success was 99% (222/224 branches). Mean follow up was 29 months (range 0–65; SD 17); 59% patients were followed > 2 years, 30% > 3 years, and 16% > 4 years. Post-operatively, CPG occlusion was observed early (≤30 days) in three (1.3%) branches and during follow up in 10 (4.5%). At 36 and 48 months, the estimated primary patency was 93% and 93%. After corrective percutaneous (10) or surgical (3) re-interventions, the estimated secondary patency was 96% and 96%. Thirty day mortality was 2%; at 36 and 48 months the estimated patient survival was 79%. Significant shrinkage (72 [SD 23] vs. 62 [SD 24] mm; p .001) was observed, with a substantial reduction (>5 mm) in 55 patients, and sac enlargement in four. Incomplete aneurysm sac sealing was treated successfully by a secondary intervention in 15 patients. Conclusions Self expandable CPGs have proved to be a highly successful and durable treatment for RVA preservation up to 5 years. Incomplete CPG expansion, inadequate length, and CPG use in small and diseased target arteries were risk factors for occlusion. These mid- and longer-term results support CPG use to treat PRAAs or TAAAs in patients unfit for open surgery or fenestrated/branched stent grafts.
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a 12 year experience with chimney and Periscope grafts for treatment of type i endoleaks
Journal of Endovascular Therapy, 2015Co-Authors: Nunzio Montelione, Dieter Mayer, Thomas Pfammatter, Zoran Rancic, Felice Pecoraro, Gilbert Puippe, Lyubov Chaykovska, Beatrice Amannvesti, Marc Husmann, Frank J VeithAbstract:Purpose: To evaluate the midterm outcomes of chimney and/or Periscope grafts (CPGs) in patients presenting type I endoleak after a previous endovascular aneurysm repair (EVAR). Methods: Between Jun...
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Periscope endograft technique to revascularize the left subclavian artery during thoracic endovascular aortic repair
Journal of Endovascular Therapy, 2013Co-Authors: Mario Lachat, Dieter Mayer, Thomas Pfammatter, Frank J Criado, Zoran Rancic, Thomas Larzon, Frank J Veith, Felice PecoraroAbstract:Purpose: To present early and midterm results of the Periscope endograft (PG) technique to maintain left subclavian artery (LSA) blood flow in thoracic endovascular aortic repairs (TEVAR) involving...
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Periscope endograft technique to revascularize the left subclavian artery during thoracic endovascular aortic repair
Journal of Endovascular Therapy, 2013Co-Authors: Mario Lachat, Dieter Mayer, Thomas Pfammatter, Frank J Criado, Zoran Rancic, Thomas Larzon, Frank J Veith, Felice PecoraroAbstract:Purpose : To present early and midterm results of the Periscope endograft (PG) technique to maintain left subclavian artery (LSA) blood flow in thoracic endovascular aortic repairs (TEVAR) involving zone 3. Methods : From April 2010 to January 2013, 14 consecutive high-risk patients (11 men; mean age 70±8 years, range 56-87) underwent TEVAR with the PG technique for 10 thoracic aortic aneurysms (TAA), 2 traumatic aortic ruptures, and 2 aortic dissections without a suitable landing zone (>2 cm distal to the LSA). Five procedures were performed emergently for rupture (3 TAAs and the 2 trauma cases). Two patients had a Periscope deployed in an aberrant right subclavian artery. The Periscope endografts were sized 1 to 2 mm larger than the branch artery at the intended landing zone. The caudal end was extended distal to the intended distal landing site of the thoracic stent-graft, which was usually deployed after the PG. Both the PG and thoracic stent-grafts were generally molded using the kissing balloon technique. Outcomes analyzed were immediate technical success, perioperative mortality and morbidity, aneurysm diameter change, and Periscope endograft patency. Results : Immediate technical success was 100%, with all procedures completed as planned. Perioperatively, one Periscope occluded and one of the ruptured TAA patients died. One percutaneous access site hematoma required only conservative management. At a mean follow-up of 26±9 months (range 9-37), there was no additional PG occlusion. The Kaplan-Meier estimate of PG patency was 93% at 2 years. Conclusion : The Periscope endograft is a simple technique to maintain perfusion to the LSA in cases where the aortic stent-graft crosses its ostium. The PG technique can be performed transfemorally and even percutaneously, and it can be applied to all supra-aortic branches. Early and midterm results are encouraging, but more experience and long-term results are mandatory before this technique can be widely recommended.
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chimney and Periscope grafts observed over 2 years after their use to revascularize 169 renovisceral branches in 77 patients with complex aortic aneurysms
Journal of Endovascular Therapy, 2013Co-Authors: Mario Lachat, Dieter Mayer, Thomas Pfammatter, Zoran Rancic, Frank J Veith, Michael Glenck, Dominique Bettex, Steffen Gloekler, Felice PecoraroAbstract:^ ^Purpose: To evaluate the performance of Periscope and/or chimney grafts (CPGs) in theendovascular treatment of pararenal or thoracoabdominal aneurysms using off-the-shelfdevices.Methods: Between February 2002 and August 2012, 77 consecutive patients (62 men; meanage 7369 years) suffering from pararenal aortic (n¼55), thoracoabdominal (n¼16), or arch tovisceral artery aneurysms (n¼6) were treated with aortic stent-graft implantation requiringchimney and/or Periscope grafts to maintain side branch perfusion. CPGs were planned inadvance and were not used as bailout. A standardized follow-up protocol includingcomputed tomographic angiography, laboratory testing, and clinical examination wasperformed at 6 weeks; 3, 6, and 12 months; and annually thereafter.Results: Technical success was achieved in 76 (99%) patients; 1 branch stent-graft becamedislocated from a renal artery, which could not be re-accessed. Overall, 169 target vessels(121 renal arteries, 30 superior mesenteric arteries, 17 celiac trunks, and 1 inferior mesentericartery) were addressed with the chimney graft configuration in 111 and the Periscope graftconfiguration in 58. In total, 228 devices were used for the CPGs: 213 Viabahn stent-grafts and15 bare metal stents. Over a mean 25616 months (range 1–121), 9 patients died of unrelatedcauses. Nearly all (95%) of the patients demonstrated a decreased or stable aneurysm size onimaging; there was a mean 13% shrinkage in aneurysm diameter. Twenty patients hadprimary type I/III endoleaks at discharge; in follow-up, only 3 of these were still present (nosecondary or recurrent endoleaks were noted). Additional endovascular maneuvers wererequired for CPG-related complications in 13 patients from intervention throughout follow-up.Overall, 4 CPGs occluded (98% target vessel patency); no stent-graft migration was observed.Renal function remained stable in all patients.Conclusion: In this series, the use of CPGs has proven to be a feasible, safe, and effective wayto treat thoracoabdominal and pararenal aneurysms with maintenance of blood flow to therenovisceral arteries. Nearly all of the aneurysms showed no increase in diameter over a .2-year mean follow-up, which supports the midterm adequacy of the CPG technique as amethod to effectively revascularize branch vessels with few endoleaks or branch occlusions.J Endovasc Ther. 2013;20:597–605
Mario Lachat - One of the best experts on this subject based on the ideXlab platform.
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mid and longer term follow up of chimney and or Periscope grafts and risk factors for failure
European Journal of Vascular and Endovascular Surgery, 2016Co-Authors: Thomas Pfammatter, Zoran Rancic, Frank J Veith, Felice Pecoraro, Gilbert Puippe, Dominique Bettex, Beatrice Ammanvesti, Mario LachatAbstract:Objective The aim was to report on chimney and Periscope grafts (CPGs) and their mid- and longer-term outcomes when they are used to preserve reno-visceral artery (RVA) perfusion in endovascular repair of pararenal (PRAAs) or thoraco-abdominal aortic aneurysm (TAAAs). In addition, factors associated with CPG failure are presented. Limited data exist on the outcomes of CPGs, and mid- and long-term results are generally not reported. Methods This was a prospective study in a cohort of 100 patients with PRAA (69) or TAAA (31). A total of 224 (mean 2.24 per patient) RVAs were preserved with 136 (61%) chimney and 88 (39%) Periscope grafts. CPGs were constructed mainly using self expandable stent grafts. Patients were followed by clinical examination, CTA (82%), and/or duplex (18%). Data were collected until February 2015. Results CPG immediate technical success was 99% (222/224 branches). Mean follow up was 29 months (range 0–65; SD 17); 59% patients were followed > 2 years, 30% > 3 years, and 16% > 4 years. Post-operatively, CPG occlusion was observed early (≤30 days) in three (1.3%) branches and during follow up in 10 (4.5%). At 36 and 48 months, the estimated primary patency was 93% and 93%. After corrective percutaneous (10) or surgical (3) re-interventions, the estimated secondary patency was 96% and 96%. Thirty day mortality was 2%; at 36 and 48 months the estimated patient survival was 79%. Significant shrinkage (72 [SD 23] vs. 62 [SD 24] mm; p .001) was observed, with a substantial reduction (>5 mm) in 55 patients, and sac enlargement in four. Incomplete aneurysm sac sealing was treated successfully by a secondary intervention in 15 patients. Conclusions Self expandable CPGs have proved to be a highly successful and durable treatment for RVA preservation up to 5 years. Incomplete CPG expansion, inadequate length, and CPG use in small and diseased target arteries were risk factors for occlusion. These mid- and longer-term results support CPG use to treat PRAAs or TAAAs in patients unfit for open surgery or fenestrated/branched stent grafts.
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Periscope endograft technique to revascularize the left subclavian artery during thoracic endovascular aortic repair
Journal of Endovascular Therapy, 2013Co-Authors: Mario Lachat, Dieter Mayer, Thomas Pfammatter, Frank J Criado, Zoran Rancic, Thomas Larzon, Frank J Veith, Felice PecoraroAbstract:Purpose: To present early and midterm results of the Periscope endograft (PG) technique to maintain left subclavian artery (LSA) blood flow in thoracic endovascular aortic repairs (TEVAR) involving...
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Periscope endograft technique to revascularize the left subclavian artery during thoracic endovascular aortic repair
Journal of Endovascular Therapy, 2013Co-Authors: Mario Lachat, Dieter Mayer, Thomas Pfammatter, Frank J Criado, Zoran Rancic, Thomas Larzon, Frank J Veith, Felice PecoraroAbstract:Purpose : To present early and midterm results of the Periscope endograft (PG) technique to maintain left subclavian artery (LSA) blood flow in thoracic endovascular aortic repairs (TEVAR) involving zone 3. Methods : From April 2010 to January 2013, 14 consecutive high-risk patients (11 men; mean age 70±8 years, range 56-87) underwent TEVAR with the PG technique for 10 thoracic aortic aneurysms (TAA), 2 traumatic aortic ruptures, and 2 aortic dissections without a suitable landing zone (>2 cm distal to the LSA). Five procedures were performed emergently for rupture (3 TAAs and the 2 trauma cases). Two patients had a Periscope deployed in an aberrant right subclavian artery. The Periscope endografts were sized 1 to 2 mm larger than the branch artery at the intended landing zone. The caudal end was extended distal to the intended distal landing site of the thoracic stent-graft, which was usually deployed after the PG. Both the PG and thoracic stent-grafts were generally molded using the kissing balloon technique. Outcomes analyzed were immediate technical success, perioperative mortality and morbidity, aneurysm diameter change, and Periscope endograft patency. Results : Immediate technical success was 100%, with all procedures completed as planned. Perioperatively, one Periscope occluded and one of the ruptured TAA patients died. One percutaneous access site hematoma required only conservative management. At a mean follow-up of 26±9 months (range 9-37), there was no additional PG occlusion. The Kaplan-Meier estimate of PG patency was 93% at 2 years. Conclusion : The Periscope endograft is a simple technique to maintain perfusion to the LSA in cases where the aortic stent-graft crosses its ostium. The PG technique can be performed transfemorally and even percutaneously, and it can be applied to all supra-aortic branches. Early and midterm results are encouraging, but more experience and long-term results are mandatory before this technique can be widely recommended.
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chimney and Periscope grafts observed over 2 years after their use to revascularize 169 renovisceral branches in 77 patients with complex aortic aneurysms
Journal of Endovascular Therapy, 2013Co-Authors: Mario Lachat, Dieter Mayer, Thomas Pfammatter, Zoran Rancic, Frank J Veith, Michael Glenck, Dominique Bettex, Steffen Gloekler, Felice PecoraroAbstract:^ ^Purpose: To evaluate the performance of Periscope and/or chimney grafts (CPGs) in theendovascular treatment of pararenal or thoracoabdominal aneurysms using off-the-shelfdevices.Methods: Between February 2002 and August 2012, 77 consecutive patients (62 men; meanage 7369 years) suffering from pararenal aortic (n¼55), thoracoabdominal (n¼16), or arch tovisceral artery aneurysms (n¼6) were treated with aortic stent-graft implantation requiringchimney and/or Periscope grafts to maintain side branch perfusion. CPGs were planned inadvance and were not used as bailout. A standardized follow-up protocol includingcomputed tomographic angiography, laboratory testing, and clinical examination wasperformed at 6 weeks; 3, 6, and 12 months; and annually thereafter.Results: Technical success was achieved in 76 (99%) patients; 1 branch stent-graft becamedislocated from a renal artery, which could not be re-accessed. Overall, 169 target vessels(121 renal arteries, 30 superior mesenteric arteries, 17 celiac trunks, and 1 inferior mesentericartery) were addressed with the chimney graft configuration in 111 and the Periscope graftconfiguration in 58. In total, 228 devices were used for the CPGs: 213 Viabahn stent-grafts and15 bare metal stents. Over a mean 25616 months (range 1–121), 9 patients died of unrelatedcauses. Nearly all (95%) of the patients demonstrated a decreased or stable aneurysm size onimaging; there was a mean 13% shrinkage in aneurysm diameter. Twenty patients hadprimary type I/III endoleaks at discharge; in follow-up, only 3 of these were still present (nosecondary or recurrent endoleaks were noted). Additional endovascular maneuvers wererequired for CPG-related complications in 13 patients from intervention throughout follow-up.Overall, 4 CPGs occluded (98% target vessel patency); no stent-graft migration was observed.Renal function remained stable in all patients.Conclusion: In this series, the use of CPGs has proven to be a feasible, safe, and effective wayto treat thoracoabdominal and pararenal aneurysms with maintenance of blood flow to therenovisceral arteries. Nearly all of the aneurysms showed no increase in diameter over a .2-year mean follow-up, which supports the midterm adequacy of the CPG technique as amethod to effectively revascularize branch vessels with few endoleaks or branch occlusions.J Endovasc Ther. 2013;20:597–605
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ct angiography at 24 months demonstrates durability of evar with the use of chimney grafts for pararenal aortic pathologies
Journal of Endovascular Therapy, 2013Co-Authors: Konstantinos P Donas, Mario Lachat, Dieter Mayer, Thomas Pfammatter, Zoran Rancic, Felice Pecoraro, Theodosios Bisdas, Giovanni Torsello, Martin Austermann, Stefan PuchnerAbstract:PURPOSE: To present the 24-month radiological follow-up data for patients with pararenal aortic pathologies treated with chimney and Periscope grafts during endovascular repair. METHODS: Between January 2008 and December 2011, 124 high-risk patients with complex pararenal aortic pathologies were treated using the chimney technique at 2 European vascular and cardiovascular centers with advanced experience of the described technique. In particular, 50 patients were treated at Site 1 and 74 at Site 2. Forty (32.2%) patients (32 men; mean age 79.2±4.9 years) completed computed tomographic angiography follow-up at 24 months postoperatively. RESULTS: The overall technical success was 100%, and the early- and midterm procedure-related mortality was 0%. Three (2.4%) patients had a perioperative type Ia endoleak that persisted; two were treated by transbrachial perigraft embolization and cuff implantation. The last patient is under radiological surveillance due to a "low-flow" type Ia endoleak and stable sac size. A type II endoleak was detected in 7 (5.6%) patients. During the 2-year follow-up, significant shrinkage (>5 mm; n=22) or stable aneurysm diameter (n=14) was seen in 36 (90%) of the cases. Overall, mean aneurysm sac shrinkage was 12% (p=0.002) and 10% (p=0.014) for the 2 centers, respectively (overall p=0.008). The causes for sac progression in the 4 (10%) patients were a type Ia endoleak, 2 type II endoleaks, and endotension. CONCLUSION: The present study demonstrates that the use of chimney and/or Periscope endografts for pararenal aortic pathologies achieves and maintains successful exclusion of the aneurysm in 90% of the cases at 24 months of radiological follow-up. In centers experienced with this approach, the chimney technique may represent a reliable therapeutic modality in selected patients.
Dieter Mayer - One of the best experts on this subject based on the ideXlab platform.
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a 12 year experience with chimney and Periscope grafts for treatment of type i endoleaks
Journal of Endovascular Therapy, 2015Co-Authors: Nunzio Montelione, Dieter Mayer, Thomas Pfammatter, Zoran Rancic, Felice Pecoraro, Gilbert Puippe, Lyubov Chaykovska, Beatrice Amannvesti, Marc Husmann, Frank J VeithAbstract:Purpose: To evaluate the midterm outcomes of chimney and/or Periscope grafts (CPGs) in patients presenting type I endoleak after a previous endovascular aneurysm repair (EVAR). Methods: Between Jun...
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Periscope endograft technique to revascularize the left subclavian artery during thoracic endovascular aortic repair
Journal of Endovascular Therapy, 2013Co-Authors: Mario Lachat, Dieter Mayer, Thomas Pfammatter, Frank J Criado, Zoran Rancic, Thomas Larzon, Frank J Veith, Felice PecoraroAbstract:Purpose: To present early and midterm results of the Periscope endograft (PG) technique to maintain left subclavian artery (LSA) blood flow in thoracic endovascular aortic repairs (TEVAR) involving...
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Periscope endograft technique to revascularize the left subclavian artery during thoracic endovascular aortic repair
Journal of Endovascular Therapy, 2013Co-Authors: Mario Lachat, Dieter Mayer, Thomas Pfammatter, Frank J Criado, Zoran Rancic, Thomas Larzon, Frank J Veith, Felice PecoraroAbstract:Purpose : To present early and midterm results of the Periscope endograft (PG) technique to maintain left subclavian artery (LSA) blood flow in thoracic endovascular aortic repairs (TEVAR) involving zone 3. Methods : From April 2010 to January 2013, 14 consecutive high-risk patients (11 men; mean age 70±8 years, range 56-87) underwent TEVAR with the PG technique for 10 thoracic aortic aneurysms (TAA), 2 traumatic aortic ruptures, and 2 aortic dissections without a suitable landing zone (>2 cm distal to the LSA). Five procedures were performed emergently for rupture (3 TAAs and the 2 trauma cases). Two patients had a Periscope deployed in an aberrant right subclavian artery. The Periscope endografts were sized 1 to 2 mm larger than the branch artery at the intended landing zone. The caudal end was extended distal to the intended distal landing site of the thoracic stent-graft, which was usually deployed after the PG. Both the PG and thoracic stent-grafts were generally molded using the kissing balloon technique. Outcomes analyzed were immediate technical success, perioperative mortality and morbidity, aneurysm diameter change, and Periscope endograft patency. Results : Immediate technical success was 100%, with all procedures completed as planned. Perioperatively, one Periscope occluded and one of the ruptured TAA patients died. One percutaneous access site hematoma required only conservative management. At a mean follow-up of 26±9 months (range 9-37), there was no additional PG occlusion. The Kaplan-Meier estimate of PG patency was 93% at 2 years. Conclusion : The Periscope endograft is a simple technique to maintain perfusion to the LSA in cases where the aortic stent-graft crosses its ostium. The PG technique can be performed transfemorally and even percutaneously, and it can be applied to all supra-aortic branches. Early and midterm results are encouraging, but more experience and long-term results are mandatory before this technique can be widely recommended.
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chimney and Periscope grafts observed over 2 years after their use to revascularize 169 renovisceral branches in 77 patients with complex aortic aneurysms
Journal of Endovascular Therapy, 2013Co-Authors: Mario Lachat, Dieter Mayer, Thomas Pfammatter, Zoran Rancic, Frank J Veith, Michael Glenck, Dominique Bettex, Steffen Gloekler, Felice PecoraroAbstract:^ ^Purpose: To evaluate the performance of Periscope and/or chimney grafts (CPGs) in theendovascular treatment of pararenal or thoracoabdominal aneurysms using off-the-shelfdevices.Methods: Between February 2002 and August 2012, 77 consecutive patients (62 men; meanage 7369 years) suffering from pararenal aortic (n¼55), thoracoabdominal (n¼16), or arch tovisceral artery aneurysms (n¼6) were treated with aortic stent-graft implantation requiringchimney and/or Periscope grafts to maintain side branch perfusion. CPGs were planned inadvance and were not used as bailout. A standardized follow-up protocol includingcomputed tomographic angiography, laboratory testing, and clinical examination wasperformed at 6 weeks; 3, 6, and 12 months; and annually thereafter.Results: Technical success was achieved in 76 (99%) patients; 1 branch stent-graft becamedislocated from a renal artery, which could not be re-accessed. Overall, 169 target vessels(121 renal arteries, 30 superior mesenteric arteries, 17 celiac trunks, and 1 inferior mesentericartery) were addressed with the chimney graft configuration in 111 and the Periscope graftconfiguration in 58. In total, 228 devices were used for the CPGs: 213 Viabahn stent-grafts and15 bare metal stents. Over a mean 25616 months (range 1–121), 9 patients died of unrelatedcauses. Nearly all (95%) of the patients demonstrated a decreased or stable aneurysm size onimaging; there was a mean 13% shrinkage in aneurysm diameter. Twenty patients hadprimary type I/III endoleaks at discharge; in follow-up, only 3 of these were still present (nosecondary or recurrent endoleaks were noted). Additional endovascular maneuvers wererequired for CPG-related complications in 13 patients from intervention throughout follow-up.Overall, 4 CPGs occluded (98% target vessel patency); no stent-graft migration was observed.Renal function remained stable in all patients.Conclusion: In this series, the use of CPGs has proven to be a feasible, safe, and effective wayto treat thoracoabdominal and pararenal aneurysms with maintenance of blood flow to therenovisceral arteries. Nearly all of the aneurysms showed no increase in diameter over a .2-year mean follow-up, which supports the midterm adequacy of the CPG technique as amethod to effectively revascularize branch vessels with few endoleaks or branch occlusions.J Endovasc Ther. 2013;20:597–605
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ct angiography at 24 months demonstrates durability of evar with the use of chimney grafts for pararenal aortic pathologies
Journal of Endovascular Therapy, 2013Co-Authors: Konstantinos P Donas, Mario Lachat, Dieter Mayer, Thomas Pfammatter, Zoran Rancic, Felice Pecoraro, Theodosios Bisdas, Giovanni Torsello, Martin Austermann, Stefan PuchnerAbstract:PURPOSE: To present the 24-month radiological follow-up data for patients with pararenal aortic pathologies treated with chimney and Periscope grafts during endovascular repair. METHODS: Between January 2008 and December 2011, 124 high-risk patients with complex pararenal aortic pathologies were treated using the chimney technique at 2 European vascular and cardiovascular centers with advanced experience of the described technique. In particular, 50 patients were treated at Site 1 and 74 at Site 2. Forty (32.2%) patients (32 men; mean age 79.2±4.9 years) completed computed tomographic angiography follow-up at 24 months postoperatively. RESULTS: The overall technical success was 100%, and the early- and midterm procedure-related mortality was 0%. Three (2.4%) patients had a perioperative type Ia endoleak that persisted; two were treated by transbrachial perigraft embolization and cuff implantation. The last patient is under radiological surveillance due to a "low-flow" type Ia endoleak and stable sac size. A type II endoleak was detected in 7 (5.6%) patients. During the 2-year follow-up, significant shrinkage (>5 mm; n=22) or stable aneurysm diameter (n=14) was seen in 36 (90%) of the cases. Overall, mean aneurysm sac shrinkage was 12% (p=0.002) and 10% (p=0.014) for the 2 centers, respectively (overall p=0.008). The causes for sac progression in the 4 (10%) patients were a type Ia endoleak, 2 type II endoleaks, and endotension. CONCLUSION: The present study demonstrates that the use of chimney and/or Periscope endografts for pararenal aortic pathologies achieves and maintains successful exclusion of the aneurysm in 90% of the cases at 24 months of radiological follow-up. In centers experienced with this approach, the chimney technique may represent a reliable therapeutic modality in selected patients.
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mid and longer term follow up of chimney and or Periscope grafts and risk factors for failure
European Journal of Vascular and Endovascular Surgery, 2016Co-Authors: Thomas Pfammatter, Zoran Rancic, Frank J Veith, Felice Pecoraro, Gilbert Puippe, Dominique Bettex, Beatrice Ammanvesti, Mario LachatAbstract:Objective The aim was to report on chimney and Periscope grafts (CPGs) and their mid- and longer-term outcomes when they are used to preserve reno-visceral artery (RVA) perfusion in endovascular repair of pararenal (PRAAs) or thoraco-abdominal aortic aneurysm (TAAAs). In addition, factors associated with CPG failure are presented. Limited data exist on the outcomes of CPGs, and mid- and long-term results are generally not reported. Methods This was a prospective study in a cohort of 100 patients with PRAA (69) or TAAA (31). A total of 224 (mean 2.24 per patient) RVAs were preserved with 136 (61%) chimney and 88 (39%) Periscope grafts. CPGs were constructed mainly using self expandable stent grafts. Patients were followed by clinical examination, CTA (82%), and/or duplex (18%). Data were collected until February 2015. Results CPG immediate technical success was 99% (222/224 branches). Mean follow up was 29 months (range 0–65; SD 17); 59% patients were followed > 2 years, 30% > 3 years, and 16% > 4 years. Post-operatively, CPG occlusion was observed early (≤30 days) in three (1.3%) branches and during follow up in 10 (4.5%). At 36 and 48 months, the estimated primary patency was 93% and 93%. After corrective percutaneous (10) or surgical (3) re-interventions, the estimated secondary patency was 96% and 96%. Thirty day mortality was 2%; at 36 and 48 months the estimated patient survival was 79%. Significant shrinkage (72 [SD 23] vs. 62 [SD 24] mm; p .001) was observed, with a substantial reduction (>5 mm) in 55 patients, and sac enlargement in four. Incomplete aneurysm sac sealing was treated successfully by a secondary intervention in 15 patients. Conclusions Self expandable CPGs have proved to be a highly successful and durable treatment for RVA preservation up to 5 years. Incomplete CPG expansion, inadequate length, and CPG use in small and diseased target arteries were risk factors for occlusion. These mid- and longer-term results support CPG use to treat PRAAs or TAAAs in patients unfit for open surgery or fenestrated/branched stent grafts.
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a 12 year experience with chimney and Periscope grafts for treatment of type i endoleaks
Journal of Endovascular Therapy, 2015Co-Authors: Nunzio Montelione, Dieter Mayer, Thomas Pfammatter, Zoran Rancic, Felice Pecoraro, Gilbert Puippe, Lyubov Chaykovska, Beatrice Amannvesti, Marc Husmann, Frank J VeithAbstract:Purpose: To evaluate the midterm outcomes of chimney and/or Periscope grafts (CPGs) in patients presenting type I endoleak after a previous endovascular aneurysm repair (EVAR). Methods: Between Jun...
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Periscope endograft technique to revascularize the left subclavian artery during thoracic endovascular aortic repair
Journal of Endovascular Therapy, 2013Co-Authors: Mario Lachat, Dieter Mayer, Thomas Pfammatter, Frank J Criado, Zoran Rancic, Thomas Larzon, Frank J Veith, Felice PecoraroAbstract:Purpose: To present early and midterm results of the Periscope endograft (PG) technique to maintain left subclavian artery (LSA) blood flow in thoracic endovascular aortic repairs (TEVAR) involving...
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Periscope endograft technique to revascularize the left subclavian artery during thoracic endovascular aortic repair
Journal of Endovascular Therapy, 2013Co-Authors: Mario Lachat, Dieter Mayer, Thomas Pfammatter, Frank J Criado, Zoran Rancic, Thomas Larzon, Frank J Veith, Felice PecoraroAbstract:Purpose : To present early and midterm results of the Periscope endograft (PG) technique to maintain left subclavian artery (LSA) blood flow in thoracic endovascular aortic repairs (TEVAR) involving zone 3. Methods : From April 2010 to January 2013, 14 consecutive high-risk patients (11 men; mean age 70±8 years, range 56-87) underwent TEVAR with the PG technique for 10 thoracic aortic aneurysms (TAA), 2 traumatic aortic ruptures, and 2 aortic dissections without a suitable landing zone (>2 cm distal to the LSA). Five procedures were performed emergently for rupture (3 TAAs and the 2 trauma cases). Two patients had a Periscope deployed in an aberrant right subclavian artery. The Periscope endografts were sized 1 to 2 mm larger than the branch artery at the intended landing zone. The caudal end was extended distal to the intended distal landing site of the thoracic stent-graft, which was usually deployed after the PG. Both the PG and thoracic stent-grafts were generally molded using the kissing balloon technique. Outcomes analyzed were immediate technical success, perioperative mortality and morbidity, aneurysm diameter change, and Periscope endograft patency. Results : Immediate technical success was 100%, with all procedures completed as planned. Perioperatively, one Periscope occluded and one of the ruptured TAA patients died. One percutaneous access site hematoma required only conservative management. At a mean follow-up of 26±9 months (range 9-37), there was no additional PG occlusion. The Kaplan-Meier estimate of PG patency was 93% at 2 years. Conclusion : The Periscope endograft is a simple technique to maintain perfusion to the LSA in cases where the aortic stent-graft crosses its ostium. The PG technique can be performed transfemorally and even percutaneously, and it can be applied to all supra-aortic branches. Early and midterm results are encouraging, but more experience and long-term results are mandatory before this technique can be widely recommended.
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chimney and Periscope grafts observed over 2 years after their use to revascularize 169 renovisceral branches in 77 patients with complex aortic aneurysms
Journal of Endovascular Therapy, 2013Co-Authors: Mario Lachat, Dieter Mayer, Thomas Pfammatter, Zoran Rancic, Frank J Veith, Michael Glenck, Dominique Bettex, Steffen Gloekler, Felice PecoraroAbstract:^ ^Purpose: To evaluate the performance of Periscope and/or chimney grafts (CPGs) in theendovascular treatment of pararenal or thoracoabdominal aneurysms using off-the-shelfdevices.Methods: Between February 2002 and August 2012, 77 consecutive patients (62 men; meanage 7369 years) suffering from pararenal aortic (n¼55), thoracoabdominal (n¼16), or arch tovisceral artery aneurysms (n¼6) were treated with aortic stent-graft implantation requiringchimney and/or Periscope grafts to maintain side branch perfusion. CPGs were planned inadvance and were not used as bailout. A standardized follow-up protocol includingcomputed tomographic angiography, laboratory testing, and clinical examination wasperformed at 6 weeks; 3, 6, and 12 months; and annually thereafter.Results: Technical success was achieved in 76 (99%) patients; 1 branch stent-graft becamedislocated from a renal artery, which could not be re-accessed. Overall, 169 target vessels(121 renal arteries, 30 superior mesenteric arteries, 17 celiac trunks, and 1 inferior mesentericartery) were addressed with the chimney graft configuration in 111 and the Periscope graftconfiguration in 58. In total, 228 devices were used for the CPGs: 213 Viabahn stent-grafts and15 bare metal stents. Over a mean 25616 months (range 1–121), 9 patients died of unrelatedcauses. Nearly all (95%) of the patients demonstrated a decreased or stable aneurysm size onimaging; there was a mean 13% shrinkage in aneurysm diameter. Twenty patients hadprimary type I/III endoleaks at discharge; in follow-up, only 3 of these were still present (nosecondary or recurrent endoleaks were noted). Additional endovascular maneuvers wererequired for CPG-related complications in 13 patients from intervention throughout follow-up.Overall, 4 CPGs occluded (98% target vessel patency); no stent-graft migration was observed.Renal function remained stable in all patients.Conclusion: In this series, the use of CPGs has proven to be a feasible, safe, and effective wayto treat thoracoabdominal and pararenal aneurysms with maintenance of blood flow to therenovisceral arteries. Nearly all of the aneurysms showed no increase in diameter over a .2-year mean follow-up, which supports the midterm adequacy of the CPG technique as amethod to effectively revascularize branch vessels with few endoleaks or branch occlusions.J Endovasc Ther. 2013;20:597–605
