nach oben

CardioVascular and Interventional Radiology

Erschienen in:

13.05.2019 | Clinical Investigation

Image Fusion Guidance for In Situ Laser Fenestration of Aortic Stent graft for Endovascular Repair of Complex Aortic Aneurysm: Feasibility, Efficacy and Overall Functional Success

verfasst von: Thomas Leger, Vania Tacher, Marek Majewski, Joseph Touma, Pascal Desgranges, Hicham Kobeiter

Erschienen in: CardioVascular and Interventional Radiology | Ausgabe 10/2019

Einloggen, um Zugang zu erhalten

Abstract

Objective

To evaluate feasibility, efficacy and overall functional success of image fusion guidance during laser-assisted in situ fenestration of aortic stent graft (LISFAS) for endovascular repair of complex aortic aneurysm (complex-EVAR) in a prospective study.

Methods

Between September 2016 and July 2018, 20 patients were included and treated with LISFAS for complex-EVAR. Aortic aneurysms were either para-renal (n = 15) or thoraco-abdominal (n = 5) with 57 mm [first quartile: 54; third quartile: 68] median aneurysm diameter in 69 years [68;78] patients. All interventions were performed using the same angiographic system and 3D image fusion software for overlying pre-intervention CTA on per-intervention 2D fluoroscopy with cone-beam CT images to display target vessels ostia.

Results

LISFAS for complex-EVAR with image fusion was performed in all patients, and no endovascular intervention required conversion to an open aortic repair. LISFAS of all target vessels was feasible in 18 patients (90%); 48 fenestrations out of 50 were performed successfully. Two fenestrations failed for renal arteries in two patients. Median ischemic times were as follows: 34 min [25;43] for superior mesenteric artery; 69 min [56;83] for left renal artery; 73 min [36;102] for right renal artery; and 93 min [89;96] for the celiac trunk. Median intervention and fluoroscopy times, iodinated contrast volume and X-ray exposure were 180 min [150;180], 74 min [64;87], 80 mL [59;113] and 338 Gy.cm² [259;495], respectively. Efficacy was found in 17 patients (85%) on one-week follow-up CTA: Two patients had type 1 and 3 endoleaks, respectively, that were successfully embolized. Overall functional success was 90%. Median hospitalization stay was 9 days [8, 17]. The 30-day safety analysis was 90% (n = 2 deaths) owing to an undetermined cause and to bowel ischemia after low flow in intensive care unit.

Conclusions

LISFAS using image fusion was feasible, efficient and overall functionally successful for complex-EVAR in this preliminary study.

Schanzer A, Simons JP, Flahive J, Durgin J, Aiello FA, Doucet D, et al. Outcomes of fenestrated and branched endovascular repair of complex abdominal and thoracoabdominal aortic aneurysms. J Vasc Surg. 2017;66(3):687–94. https://doi.org/10.1016/j.jvs.2016.12.111.CrossRefPubMed

Glorion M, Coscas R, McWilliams RG, Javerliat I, Goeau-Brissonniere O, Coggia M. A Comprehensive review of in situ fenestration of aortic endografts. Eur J Vasc Endovasc Sur. 2016;52(6):787–800. https://doi.org/10.1016/j.ejvs.2016.10.001.CrossRef

Coscas R, Glorion M, Javerliat I, Goeau-Brissonniere O, Coggia M. In situ fenestration through the contralateral iliac artery to convert an aortouni-iliac into a bifurcated endograft. J Endovasc Ther. 2015;22(3):421–5. https://doi.org/10.1177/1526602815583492.CrossRefPubMed

Kolbel T, Carpenter SW, Diener H, Wipper S, Debus ES, Larena-Avellaneda A. Antegrade in situ stent-graft fenestration for the renal artery following inadvertent coverage during EVAR. J Endovasc Ther. 2013;20(3):289–94. https://doi.org/10.1583/13-4231R.1.CrossRefPubMed

Tse LW, Bui BT, Lerouge S, Salazkin I, Therasse E, Benko A, et al. In vivo antegrade fenestration of abdominal aortic stent-grafts. J Endovasc Ther. 2007;14(2):158–67. https://doi.org/10.1177/152660280701400207.CrossRefPubMed

Qin J, Zhao Z, Wang R, Ye K, Li W, Liu X, et al. In situ laser fenestration is a feasible method for revascularization of aortic arch during thoracic endovascular aortic repair. J Am Heart Assoc. 2017;6(4):e004542. https://doi.org/10.1161/JAHA.116.004542.CrossRefPubMedPubMedCentral

Redlinger RE Jr, Ahanchi SS, Panneton JM. In situ laser fenestration during emergent thoracic endovascular aortic repair is an effective method for left subclavian artery revascularization. J Vasc Surg. 2013;58(5):1171–7. https://doi.org/10.1016/j.jvs.2013.04.045.CrossRefPubMed

Le Houerou T, Fabre D, Alonso CG, Brenot P, Bourkaib R, Angel C, et al. In Situ antegrade laser fenestrations during endovascular aortic repair. Eur J Vasc Endovasc Surg. 2018;56(3):356–62. https://doi.org/10.1016/j.ejvs.2018.05.014.CrossRefPubMed

Touma J, Kobeiter H, Majewski M, Tacher V, Desgranges P. Triple in situ antegrade laser fenestration of aortic stent-graft extension using fusion imaging for urgent treatment of symptomatic abdominal aneurysm with type 1 endoleak. Cardiovas Interv Radiol. 2018;41(3):513–7. https://doi.org/10.1007/s00270-017-1837-4.CrossRef

10.

Tacher V, Lin M, Desgranges P, Deux JF, Grunhagen T, Becquemin JP, et al. Image guidance for endovascular repair of complex aortic aneurysms: comparison of two-dimensional and three-dimensional angiography and image fusion. J Vasc Interv Radiol. 2013;24(11):1698–706. https://doi.org/10.1016/j.jvir.2013.07.016.CrossRefPubMedPubMedCentral

11.

Tacher V, Desgranges P, You K, Ridouani F, Marzelle J, Kobeiter H. Feasibility of three-dimensional mr angiography image fusion guidance for endovascular abdominal aortic aneurysm repair. J Vasc Interv Radiol JVIR. 2016;27(2):188–93. https://doi.org/10.1016/j.jvir.2015.08.028.CrossRefPubMed

12.

Chaikof EL, Dalman RL, Eskandari MK, Jackson BM, Lee WA, Mansour MA, et al. The society for vascular surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg. 2018;67(1):2–77. https://doi.org/10.1016/j.jvs.2017.10.044.CrossRefPubMed

13.

Haulon S, Amiot S, Magnan PE, Becquemin JP, Lermusiaux P, Koussa M, et al. An analysis of the French multicentre experience of fenestrated aortic endografts: medium-term outcomes. Ann Surg. 2010;251(2):357–62. https://doi.org/10.1097/SLA.0b013e3181bfda73.CrossRefPubMed

14.

AbuRahma AF, Yacoub M, Mousa AY, Abu-Halimah S, Hass SM, Kazil J, et al. Aortic neck anatomic features and predictors of outcomes in endovascular repair of abdominal aortic aneurysms following vs not following instructions for use. J Am Coll Surg. 2016;222(4):579–89. https://doi.org/10.1016/j.jamcollsurg.2015.12.037.CrossRefPubMedPubMedCentral

15.

Verhoeven EL, Vourliotakis G, Bos WT, Tielliu IF, Zeebregts CJ, Prins TR, et al. Fenestrated stent grafting for short-necked and juxtarenal abdominal aortic aneurysm: an 8-year single-centre experience. Eur J Vasc Endovasc Surg. 2010;39(5):529–36. https://doi.org/10.1016/j.ejvs.2010.01.004.CrossRefPubMed

16.

Eesa M, Hill MD, Al-Khathaami A, Al-Zawahmah M, Sharma P, Menon BK, et al. Role of CT angiographic plaque morphologic characteristics in addition to stenosis in predicting the symptomatic side in carotid artery disease. AJNR Am J Neuroradiol. 2010;31(7):1254–60. https://doi.org/10.3174/ajnr.A2078.CrossRefPubMed

17.

Crawford ES, Crawford JL, Safi HJ, Coselli JS, Hess KR, Brooks B, et al. Thoracoabdominal aortic aneurysms: preoperative and intraoperative factors determining immediate and long-term results of operations in 605 patients. J Vasc Surg. 1986;3(4):389–404.CrossRefPubMed

18.

Bakoyiannis CN, Economopoulos KP, Georgopoulos S, Klonaris C, Shialarou M, Kafeza M, et al. Fenestrated and branched endografts for the treatment of thoracoabdominal aortic aneurysms: a systematic review. J Endovasc Ther. 2010;17(2):201–9.CrossRefPubMed

19.

Greenberg R, Eagleton M, Mastracci T. Branched endografts for thoracoabdominal aneurysms. J Thorac Cardiovasc Surg. 2010;140(6 Suppl):S171–8.CrossRefPubMed

20.

Crawford ES, DeNatale RW. Thoracoabdominal aortic aneurysm: observations regarding the natural course of the disease. J Vasc Surg. 1986;3(4):578–82.CrossRefPubMed

21.

Moulakakis KG, Mylonas SN, Avgerinos E, Papapetrou A, Kakisis JD, Brountzos EN, et al. The chimney graft technique for preserving visceral vessels during endovascular treatment of aortic pathologies. J Vasc Surg. 2012;55(5):1497–503. https://doi.org/10.1016/j.jvs.2011.10.009.CrossRefPubMed

22.

Falkensammer J, Taher F, Uhlmann M, Hirsch K, Strassegger J, Assadian A. Rescue of failed endovascular aortic aneurysm repair using the fenestrated anaconda device. J Vasc Surg. 2017;66(5):1334–9. https://doi.org/10.1016/j.jvs.2017.02.048.CrossRefPubMed

23.

Kaladji A, Dumenil A, Castro M, Cardon A, Becquemin JP, Bou-Said B, et al. Prediction of deformations during endovascular aortic aneurysm repair using finite element simulation. Comput Med Imaging Graph. 2013;37(2):142–9. https://doi.org/10.1016/j.compmedimag.2013.03.002.CrossRefPubMed

24.

Cochennec F, Kobeiter H, Gohel MS, Majewski M, Marzelle J, Desgranges P, et al. Impact of intraoperative adverse events during branched and fenestrated aortic stent grafting on postoperative outcome. J Vasc Surg. 2014;60(3):571–8. https://doi.org/10.1016/j.jvs.2014.02.065.CrossRefPubMed

25.

Schwein A, Chinnadurai P, Behler G, Lumsden AB, Bismuth J, Bechara CF. Computed tomography angiography-fluoroscopy image fusion allows visceral vessel cannulation without angiography during fenestrated endovascular aneurysm repair. J Vasc Surg. 2018. https://doi.org/10.1016/j.jvs.2017.11.062.CrossRefPubMed

26.

Manunga J, Sullivan T, Garberich R, Alden P, Alexander J, Skeik N, et al. Single-center experience with complex abdominal aortic aneurysms treated by open or endovascular repair using fenestrated/branched endografts. J Vasc Surg. 2018. https://doi.org/10.1016/j.jvs.2017.11.093.CrossRefPubMed

27.

Wang SK, Gutwein AR, Gupta AK, Lemmon GW, Sawchuk AP, Motaganahalli RL, et al. Institutional experience with the Zenith Fenestrated aortic stent graft. J Vasc Surg. 2018. https://doi.org/10.1016/j.jvs.2017.11.063.CrossRefPubMedPubMedCentral

28.

Kieffer E, Chiche L, Godet G, Koskas F, Bahnini A, Bertrand M, et al. Type IV thoracoabdominal aneurysm repair: predictors of postoperative mortality, spinal cord injury, and acute intestinal ischemia. Ann Vasc Surg. 2008;22(6):822–8. https://doi.org/10.1016/j.avsg.2008.07.002.CrossRefPubMed

29.

Youssef M, Deglise S, Szopinski P, Jost-Philipp S, Jomha A, Vahl CF, et al. A Multicenter experience with a new fenestrated-branched device for endovascular repair of thoracoabdominal aortic aneurysms. J Endovasc Ther. 2018;25(2):209–19. https://doi.org/10.1177/1526602817752147.CrossRefPubMed

30.

Khashram M, Williman JA, Hider PN, Jones GT, Roake JA. Systematic review and meta-analysis of factors influencing survival following abdominal aortic aneurysm repair. Eur J Vasc Endovasc Surg Off J Eur Soc Vasc Surg. 2016;51(2):203–15. https://doi.org/10.1016/j.ejvs.2015.09.007.CrossRef

31.

Crawford SA, Sanford RM, Forbes TL, Amon CH, Doyle MG. Clinical outcomes and material properties of in situ fenestration of endovascular stent grafts. J Vasc Surg. 2016;64(1):244–50. https://doi.org/10.1016/j.jvs.2016.03.445.CrossRefPubMed

32.

Verscheure D, Garcia AC, Brenot P, Angel C, Haulon S, Mercier O, et al. In vitro study of anterograde laser fenestration of aortic stentgrafts. Ann Vasc Surg. 2017;44:4–5.CrossRef

Titel: Image Fusion Guidance for In Situ Laser Fenestration of Aortic Stent graft for Endovascular Repair of Complex Aortic Aneurysm: Feasibility, Efficacy and Overall Functional Success
verfasst von: Thomas Leger
Vania Tacher
Marek Majewski
Joseph Touma
Pascal Desgranges
Hicham Kobeiter
Publikationsdatum: 13.05.2019
Verlag: Springer US
Erschienen in: CardioVascular and Interventional Radiology / Ausgabe 10/2019
Print ISSN: 0174-1551
Elektronische ISSN: 1432-086X
DOI: https://doi.org/10.1007/s00270-019-02231-8

Update Radiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Die Highlights vom Kongress des American College of Cardiology 2024

Springer Medizin

Image Fusion Guidance for In Situ Laser Fenestration of Aortic Stent graft for Endovascular Repair of Complex Aortic Aneurysm: Feasibility, Efficacy and Overall Functional Success