A fenestrated, double-barrel technique for proximal reintervention after open or endovascular abdominal aortic aneurysm repair
Objective: Proximal endovascular reintervention after prior endovascular aortic repair (EVAR) or open abdominal aortic aneurysm repair (OR) can be challenging due to the short distance to the visceral branches. We present a novel solution to allow the use of the commercially available ZFEN device us...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-03-01
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| Series: | Journal of Vascular Surgery Cases and Innovative Techniques |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2468428722002398 |
| _version_ | 1797860135699218432 |
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| author | Jordan R. Stern, MD Kenneth Tran, MD Shernaz S. Dossabhoy, MD Sabina M. Sorondo, MD Jason T. Lee, MD |
| author_facet | Jordan R. Stern, MD Kenneth Tran, MD Shernaz S. Dossabhoy, MD Sabina M. Sorondo, MD Jason T. Lee, MD |
| author_sort | Jordan R. Stern, MD |
| collection | DOAJ |
| description | Objective: Proximal endovascular reintervention after prior endovascular aortic repair (EVAR) or open abdominal aortic aneurysm repair (OR) can be challenging due to the short distance to the visceral branches. We present a novel solution to allow the use of the commercially available ZFEN device using a double-barrel, kissing-limb technique. Methods: Patients who underwent fenestrated repair for proximal failure after EVAR or OR were identified. The ZFEN device is deployed above the prior graft flow divider. Once the visceral branches are secured, kissing limbs are used to connect with the prior graft limbs. The distal diameter of the standard ZFEN is 24 mm, accommodating two 20 mm components according to the formula 2πDLIMB = πDZFEN + 2DZFEN. Results: Of 235 patients who underwent repair using ZFEN from 2012 to 2021 at a single institution, 28 were treated for proximal failure of prior repairs, with 13 treated using the double-barrel technique (8 EVAR, 5 OR). The distance from the flow divider to the lowest renal artery was 67 ± 24.4 mm (range, 39-128 mm), and the distance to the superior mesenteric artery (SMA) was 87 ± 30.5 mm (range, 60-164 mm). Technical success was 100%. Seven patients had standard ZFEN builds (2 renal small fenestrations, SMA large fen/scallop). The minimum distance to the lowest renal artery and SMA to accommodate a standard ZFEN build was 56 and 60 mm, respectively. Four patients required adjunctive snorkel grafts and two required laser fenestrations. Two patients had gutter leaks at 1 month that self-resolved; one patient developed a late type 1a endoleak. Freedom from reintervention was 90%, 72%, and 48% at 1, 2, and 3 years, respectively. Conclusions: This double-barrel technique allows for distal seal of commercial ZFEN devices into prior open or endovascular repairs with good technical success. Long-term outcomes remain to be quantified. |
| first_indexed | 2024-04-09T21:41:56Z |
| format | Article |
| id | doaj.art-222483575bfe4a76822986ea85562265 |
| institution | Directory Open Access Journal |
| issn | 2468-4287 |
| language | English |
| last_indexed | 2024-04-09T21:41:56Z |
| publishDate | 2023-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Vascular Surgery Cases and Innovative Techniques |
| spelling | doaj.art-222483575bfe4a76822986ea855622652023-03-26T05:17:50ZengElsevierJournal of Vascular Surgery Cases and Innovative Techniques2468-42872023-03-0191101091A fenestrated, double-barrel technique for proximal reintervention after open or endovascular abdominal aortic aneurysm repairJordan R. Stern, MD0Kenneth Tran, MD1Shernaz S. Dossabhoy, MD2Sabina M. Sorondo, MD3Jason T. Lee, MD4Correspondence: Jordan R. Stern, MD, Stanford University School of Medicine, 780 Welch Rd, Ste CJ350, Palo Alto, CA 94304; Division of Vascular and Endovascular Surgery, Stanford University School of Medicine, Stanford, CADivision of Vascular and Endovascular Surgery, Stanford University School of Medicine, Stanford, CADivision of Vascular and Endovascular Surgery, Stanford University School of Medicine, Stanford, CADivision of Vascular and Endovascular Surgery, Stanford University School of Medicine, Stanford, CADivision of Vascular and Endovascular Surgery, Stanford University School of Medicine, Stanford, CAObjective: Proximal endovascular reintervention after prior endovascular aortic repair (EVAR) or open abdominal aortic aneurysm repair (OR) can be challenging due to the short distance to the visceral branches. We present a novel solution to allow the use of the commercially available ZFEN device using a double-barrel, kissing-limb technique. Methods: Patients who underwent fenestrated repair for proximal failure after EVAR or OR were identified. The ZFEN device is deployed above the prior graft flow divider. Once the visceral branches are secured, kissing limbs are used to connect with the prior graft limbs. The distal diameter of the standard ZFEN is 24 mm, accommodating two 20 mm components according to the formula 2πDLIMB = πDZFEN + 2DZFEN. Results: Of 235 patients who underwent repair using ZFEN from 2012 to 2021 at a single institution, 28 were treated for proximal failure of prior repairs, with 13 treated using the double-barrel technique (8 EVAR, 5 OR). The distance from the flow divider to the lowest renal artery was 67 ± 24.4 mm (range, 39-128 mm), and the distance to the superior mesenteric artery (SMA) was 87 ± 30.5 mm (range, 60-164 mm). Technical success was 100%. Seven patients had standard ZFEN builds (2 renal small fenestrations, SMA large fen/scallop). The minimum distance to the lowest renal artery and SMA to accommodate a standard ZFEN build was 56 and 60 mm, respectively. Four patients required adjunctive snorkel grafts and two required laser fenestrations. Two patients had gutter leaks at 1 month that self-resolved; one patient developed a late type 1a endoleak. Freedom from reintervention was 90%, 72%, and 48% at 1, 2, and 3 years, respectively. Conclusions: This double-barrel technique allows for distal seal of commercial ZFEN devices into prior open or endovascular repairs with good technical success. Long-term outcomes remain to be quantified.http://www.sciencedirect.com/science/article/pii/S2468428722002398Aortic aneurysmEndovascularFenestrated/branched repair |
| spellingShingle | Jordan R. Stern, MD Kenneth Tran, MD Shernaz S. Dossabhoy, MD Sabina M. Sorondo, MD Jason T. Lee, MD A fenestrated, double-barrel technique for proximal reintervention after open or endovascular abdominal aortic aneurysm repair Journal of Vascular Surgery Cases and Innovative Techniques Aortic aneurysm Endovascular Fenestrated/branched repair |
| title | A fenestrated, double-barrel technique for proximal reintervention after open or endovascular abdominal aortic aneurysm repair |
| title_full | A fenestrated, double-barrel technique for proximal reintervention after open or endovascular abdominal aortic aneurysm repair |
| title_fullStr | A fenestrated, double-barrel technique for proximal reintervention after open or endovascular abdominal aortic aneurysm repair |
| title_full_unstemmed | A fenestrated, double-barrel technique for proximal reintervention after open or endovascular abdominal aortic aneurysm repair |
| title_short | A fenestrated, double-barrel technique for proximal reintervention after open or endovascular abdominal aortic aneurysm repair |
| title_sort | fenestrated double barrel technique for proximal reintervention after open or endovascular abdominal aortic aneurysm repair |
| topic | Aortic aneurysm Endovascular Fenestrated/branched repair |
| url | http://www.sciencedirect.com/science/article/pii/S2468428722002398 |
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