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Complication With Medtronic Thoracic Stent Endograft

Introduction and Background The introduction of thoracic stent grafts into clinical practice over the past two decades and the ability to image the thoracic aorta in high definition have offered a paradigm shift in the way we have been able to diagnose and to treat thoracic aortic pathologies. Looking at national registry data from 2002–2012, Wang et al. described a majority shift toward endovascular treatment of…

Terumo Aortic Relay TEVAR

Introduction Bolton Medical (Sunrise, Florida), now owned by Terumo (Tokyo, Japan), introduced the Relay thoracic endovascular aortic repair (TEVAR) endograft in 2005, with Phase II trials for approval in the United States beginning in 2007. In 2009, RelayPlus was introduced, which is now one of Bolton Medical’s main TEVAR endografts. While the endograft itself remained the same, the delivery system was updated. RelayPlus is the company’s…

Device-Specific Issues With EVAR: Cook

Introduction Since the advent of endovascular abdominal aortic aneurysm repair (EVAR) for abdominal aortic aneurysms (AAA), the rate of technical proficiency has reached impressive levels, with modern reports reaching 99%–100% of endografts successfully placed during initial treatment. However, despite technical success and exceedingly low perioperative mortality, the need for reintervention continues to be the crux of EVAR and is most often related to endograft-specific complications. Although…

Complications of TAG and Conformable TAG (CTAG) Thoracic Endoprosthesis

Introduction The Conformable TAG (CTAG) endoprosthesis (WL Gore and Associates, Flagstaff, Arizona) is the third-generation thoracic endograft approved for treatment of aneurysm, traumatic transection, and Type B dissection in the descending thoracic aorta. The second-generation TAG endoprosthesis was the first stent graft approved for thoracic endovascular aortic repair (TEVAR) of descending aortic aneurysm by the US Food and Drug Administration (FDA) in 2005. More than 40,000…

TAA Endoleaks

Introduction Thoracic endovascular aortic repair (TEVAR), first performed in 1992, has become the treatment of choice for the majority of thoracic aortic pathologies, including thoracic aortic aneurysms (TAAs) and complicated Type B aortic dissections (TADs). Presence of an endoleak is one of the most common reasons for early or late reinterventions and/or treatment failure following TEVAR. Endoleaks can be classified into four categories. A fifth category,…

Complications in Endovascular Thoracoabdominal Aortic Aneurysm Repair

Endovascular repair of thoracoabdominal aortic aneurysms requires long segment stent graft coverage with concomitant revascularization of the renovisceral and potentially supraaortic arch segments. Such procedures represent the highest extent of complex endovascular therapy and are associated with increased technical demand, as well as the potential for iatrogenic injury to the target vessels and endoleak formation. Risk factors for intraprocedural loss of branch vessel patency include unstented…

Endoleaks

Overview Endoleaks, or persistent flow into the aneurysm sac, are the most common complication of EVAR, occurring in up to a third of cases. They occur at the time of graft implantation, or arise during followup, with varying implications. The Society for Vascular Surgery classifies endoleaks into five categories ( Fig. 17.1 ) : Type I. Attachment site endoleak IA. Proximal attachment site endoleak IB. Distal…

Complications With Branched Endovascular Devices

Points of Attention in Branched EVAR Branched endovascular aortic aneurysm repair (B-EVAR) was developed for the treatment of thoracoabdominal aortic aneurysms (TAAA). With increasing physician experience and device evolution we can at the moment treat almost all types of aneurysms extending from the aortic arch to the iliac bifurcation. In connective tissue disease, open reconstruction remains the first choice of treatment. There is a multitude of…

Complications of Fenestrated Endovascular Aneurysm Repair

Stent Graft Design Many of the complications of endovascular aneurysm repair result from a mismatch between the demands of the pathology and the capabilities of the device, and many can be avoided by proper patient selection and device selection, based on a thorough understanding of the differences between various alternatives. The first branched stent grafts were of unibody design: inserted whole with the branches already attached.…

Grafts Outside the United States

Introduction The market of aortic endografts is in continuous development. Several endografts that have gained the CE mark are under investigation by the FDA before launching in the U.S. market. This chapter describes their peculiarities and the evidence acquired with the use of these endografts. Since the majority of the devices described in this chapter have been recently introduced, the evidence on the feasibility of their…

Vascutek (Bolton) TREO Endograft

Introduction Bolton Medical was founded in 1998 and is based in Sunrise, Florida, and Barcelona, Spain. The company was acquired in 2017 by Terumo (Tokyo, Japan), with Bolton Medical’s products merged into Terumo’s Vascutek line of vascular grafts. Bolton Medical manufactures Treovance and TREO, its EVAR endografts, with TREO being its newest. The company also manufactures an aorto-uni-iliac endograft and a customized endograft. These endografts have…

Nellix

The Nellix device (Endologix, Irvine, CA) is a novel endovascular aneurysm sealing system (EVAS) designed to address some of the issues with current infrarenal endovascular aneurysm devices. Persistent flow in the aneurysm sac after deployment of a stent graft can lead to aneurysm sac expansion and ultimately rupture. The Nellix device utilizes polymer-filled EndoBags to seal the aneurysm sac space. This is designed to decrease persistent…

Graft-Specific Issues for EVAR: The Aorfix Endograft

Introduction Anatomical characteristics of infrarenal abdominal aortic aneurysms (AAA) are the most critical factors for successful endovascular repair (EVAR). The long-term durability of EVAR is highly dependent on the integrity of the proximal fixation site. Severe proximal aortic neck angulation (i.e., ≥60 degree angulation between the infrarenal aortic neck and the longitudinal axis of the aneurysm) and iliac angulation/tortuosity make it difficult to introduce the delivery…

Endologix AFX

The original Endologix endovascular graft is currently called AFX, mainly to distinguish it from the other Endologix products, Ovation and Nellix (Endologix, Irvine, California). The AFX2 is the third-generation endovascular system after the earlier Powerlink and AFX stent grafts. The AFX is a unibody, bifurcated system consisting of a self-expanding cobalt-chromium alloy stent attached to a fabric cover ( Fig. 8.1 ). The fabric is a…

Endologix Ovation

The Ovation abdominal stent graft system is a unique polymer-based trimodular endoprosthesis that has demonstrated safety and effectiveness in treatment of abdominal aortic aneurysms, especially in patients with challenging neck anatomy and narrow iliac vessels ( Fig. 7.1 ). The stent graft is made of a 32 mm long nitinol suprarenal stent, with radiopaque (RO) markers near the proximal edge of the graft. The main stent…

Complications of the Medtronic Endurant Stent Graft

Background of the Medtronic Endurant Stent Graft Device The Endurant stent graft system is an evolution of previous abdominal stent graft systems to meet the challenges of hostile abdominal aortic aneurysm anatomy. After gaining CE marking in Europe in 2008 and FDA approval in 2010, it has become one of the preeminent endograft systems in the world. It consists of a high-density multifilament polyester graft with…

Gore Excluder

Introduction Endovascular aortic repair (EVAR) has become the standard of care in the treatment of infrarenal abdominal aortic aneurysm (AAA), with low perioperative morbidity and mortality and comparable long-term outcomes to open surgical repair. Successful EVAR requires meticulous intraoperative execution and careful consideration of a variety of anatomic factors during preoperative planning. Of these anatomic features, perhaps the most important are the characteristics of the infrarenal…

General Complications of EVAR

Endovascular aortic aneurysm repair (EVAR) was first performed in 1987 ; however, a more popularized adaptation was introduced in the early 1990s. Since then, EVAR’s popularity and methods have expanded with a constantly evolving and growing list of techniques, devices, and indications. Several large-scale trials have proven the early morbidity and mortality benefit of EVAR over open infrarenal aortic aneurysm repair (OAR) in a variety of…