Sukgu M Han1, Emanuel R Tenorio2, Aleem K Mirza2, Louis Zhang1, Salome Weiss3, Gustavo S Oderich4. 1. Division of Vascular Surgery and Endovascular Therapy, University of Southern California, Los Angeles, CA. 2. Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN. 3. Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN; Department of Cardiovascular Surgery, Inselspital, University of Bern, Bern, Switzerland. 4. Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN. Electronic address: oderich.gustavo@mayo.edu.
Abstract
BACKGROUND: The aim of this study is to describe a modification technique using the low-profile Cook Zenith Alpha™ thoracic stent graft, and addition of a preloaded wire system, for urgent repair of pararenal (PRA) and thoracoabdominal (TAAA) aortic aneurysms. METHODS: We analyzed 20 consecutive patients who underwent urgent physician modified endograft repair (PMEG) of PRA and TAAA at 2 institutions. The low-profile Cook Zenith Alpha Thoracic stent graft was modified in accordance with each specific patient anatomic characteristics. End points were technical success, 30-day mortality, and major adverse events (MAEs). RESULTS: Technical success was achieved in all patients (100%). A total of 76 renal-mesenteric arteries were incorporated by fenestrations (70%) or directional branches (30%) with an average of 3.7 ± 0.6 vessels per patient. There were 6 different types of stent configuration. The most common design consisted of 4 fenestrations (9 patients, 45%). The average of modification time was 110 ± 27 minutes. Total procedure time (including the time for open component) was 242 ± 75 minutes. There was no death within the first 30 days or hospital stay. MAEs occurred in 10 patients (50%). The most common MAEs were acute kidney injury (by Risk, Injury, and Failure; and Loss; and End-stage kidney disease criteria) in 6 patients (30%), estimated blood loss >1 L, respiratory failure requiring reintubation in 2 patients (10%) each, and paraplegia and ischemic colitis in 1 patient (5%) each. One patient (5%) required temporary, new-onset dialysis. CONCLUSIONS: PMEG using low-profile Zenith Alpha thoracic stent graft was safe with no early mortality and acceptable early morbidity.
BACKGROUND: The aim of this study is to describe a modification technique using the low-profile Cook Zenith Alpha™ thoracic stent graft, and addition of a preloaded wire system, for urgent repair of pararenal (PRA) and thoracoabdominal (TAAA) aortic aneurysms. METHODS: We analyzed 20 consecutive patients who underwent urgent physician modified endograft repair (PMEG) of PRA and TAAA at 2 institutions. The low-profile Cook Zenith Alpha Thoracic stent graft was modified in accordance with each specific patient anatomic characteristics. End points were technical success, 30-day mortality, and major adverse events (MAEs). RESULTS: Technical success was achieved in all patients (100%). A total of 76 renal-mesenteric arteries were incorporated by fenestrations (70%) or directional branches (30%) with an average of 3.7 ± 0.6 vessels per patient. There were 6 different types of stent configuration. The most common design consisted of 4 fenestrations (9 patients, 45%). The average of modification time was 110 ± 27 minutes. Total procedure time (including the time for open component) was 242 ± 75 minutes. There was no death within the first 30 days or hospital stay. MAEs occurred in 10 patients (50%). The most common MAEs were acute kidney injury (by Risk, Injury, and Failure; and Loss; and End-stage kidney disease criteria) in 6 patients (30%), estimated blood loss >1 L, respiratory failure requiring reintubation in 2 patients (10%) each, and paraplegia and ischemic colitis in 1 patient (5%) each. One patient (5%) required temporary, new-onset dialysis. CONCLUSIONS:PMEG using low-profile Zenith Alpha thoracic stent graft was safe with no early mortality and acceptable early morbidity.
Authors: Aleem K Mirza; Emanuel R Tenorio; Thanila A Macedo; Jussi M Kärkkäinen; Swati Chaparala; Gustavo S Oderich Journal: J Vasc Surg Cases Innov Tech Date: 2020-05-27
Authors: Aleem K Mirza; Jussi M Kärkkäinen; Emanuel R Tenorio; Guilherme B Lima; Giuliana B Marcondes; Gustavo S Oderich Journal: EJVES Vasc Forum Date: 2020-09-06