Davide Colombi1, Flavio Cesare Bodini2, Margherita Bossalini2, Beatrice Rossi2, Emanuele Michieletti2. 1. Department of Radiological Functions, Radiology Unit, "Guglielmo da Saliceto" Hospital, Piacenza, Italy. Electronic address: colombidavide@gmail.com. 2. Department of Radiological Functions, Radiology Unit, "Guglielmo da Saliceto" Hospital, Piacenza, Italy.
Abstract
BACKGROUND: Recently, there has been a shift toward elective endovascular repair of visceral artery aneurysms (VAAs). Transcatheter embolization (TE) and covered stenting (CS) represent the 2 most used endovascular techniques; however, TE carries the potential risk of end-organ ischemia, while CS is challenging when the parent arteries are tortuous. Flow diverter devices (FDDs) developed for cerebral aneurysms maintain distal flow and are characterized by high navigability in tortuous arteries. This report describes our initial experience in using FDD developed for cerebral aneurysms to treat extracranial VAAs/pseudoaneurysm (VAP). METHODS: The study was conducted on patients affected by VAP, who underwent endovascular repair using FDD, between January 2015 and April 2017. All patients underwent preinterventional computed tomography angiography (CTA) for diagnosis and procedural planning. VAP features (type, location, size) and the diameter of both the proximal and distal parent arteries were recorded. Since TE or CS was contraindicated or failed in the previous attempt, VAPs were repaired through an elective endovascular procedure with FDD (Surpass; Stryker Neurovascular, Fremont, CA). Follow-up CTAs were performed within 6 months and at 24 months after the endovascular repair, evaluating patency and proper position of the FDD, the maximum diameter of the VAP, any perfusion of the sac, and adequacy of end-organ perfusion. RESULTS: Four VAPs were repaired by FDD in 4 patients (2 females; median age: 72 years, range: 64-80 years). One patient suffered from cervical arterial anastomotic pseudoaneurysm, whereas the remaining VAPs were 2 splenic artery aneurysms and 1 common hepatic aneurysm. VAPs median size was 20 mm (range: 13-26 mm) with median parent artery caliber of 5 mm (range: 3-5 mm). The correct deployment of the device was obtained in all cases; 2/4 VAPs showed endoleak at the end of the procedure. At follow-up CTAs performed after the procedure in a median time of 25 months (range: 4-28 months), all devices were patent and not migrated. All VAPs showed shrinkage of the sac without endoleak or signs of end-organ ischemia. CONCLUSIONS: When high tortuosity and small caliber of the parent arteries prevent CS and the necessity to maintain vessel patency contraindicates TE, FDD could represent an option for the treatment of VAP; however, high costs and the off-label use in extracranial vessels demand an accurate selection of the patients suitable for the VAP treatment with FDD.
BACKGROUND: Recently, there has been a shift toward elective endovascular repair of visceral artery aneurysms (VAAs). Transcatheter embolization (TE) and covered stenting (CS) represent the 2 most used endovascular techniques; however, TE carries the potential risk of end-organ ischemia, while CS is challenging when the parent arteries are tortuous. Flow diverter devices (FDDs) developed for cerebral aneurysms maintain distal flow and are characterized by high navigability in tortuous arteries. This report describes our initial experience in using FDD developed for cerebral aneurysms to treat extracranial VAAs/pseudoaneurysm (VAP). METHODS: The study was conducted on patients affected by VAP, who underwent endovascular repair using FDD, between January 2015 and April 2017. All patients underwent preinterventional computed tomography angiography (CTA) for diagnosis and procedural planning. VAP features (type, location, size) and the diameter of both the proximal and distal parent arteries were recorded. Since TE or CS was contraindicated or failed in the previous attempt, VAPs were repaired through an elective endovascular procedure with FDD (Surpass; Stryker Neurovascular, Fremont, CA). Follow-up CTAs were performed within 6 months and at 24 months after the endovascular repair, evaluating patency and proper position of the FDD, the maximum diameter of the VAP, any perfusion of the sac, and adequacy of end-organ perfusion. RESULTS: Four VAPs were repaired by FDD in 4 patients (2 females; median age: 72 years, range: 64-80 years). One patient suffered from cervical arterial anastomotic pseudoaneurysm, whereas the remaining VAPs were 2 splenic artery aneurysms and 1 common hepatic aneurysm. VAPs median size was 20 mm (range: 13-26 mm) with median parent artery caliber of 5 mm (range: 3-5 mm). The correct deployment of the device was obtained in all cases; 2/4 VAPs showed endoleak at the end of the procedure. At follow-up CTAs performed after the procedure in a median time of 25 months (range: 4-28 months), all devices were patent and not migrated. All VAPs showed shrinkage of the sac without endoleak or signs of end-organ ischemia. CONCLUSIONS: When high tortuosity and small caliber of the parent arteries prevent CS and the necessity to maintain vessel patency contraindicates TE, FDD could represent an option for the treatment of VAP; however, high costs and the off-label use in extracranial vessels demand an accurate selection of the patients suitable for the VAP treatment with FDD.
Authors: Penelope van Veenendaal; Julian Maingard; Hong Kuan Kok; Dinesh Ranatunga; Tim Buckenham; Ronil V Chandra; Michael J Lee; Duncan Mark Brooks; Hamed Asadi Journal: CVIR Endovasc Date: 2020-06-28