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Management of Complicated Aortic Aneurysms Using Multiple Overlapping Uncovered Stents: Mid-Term Outcome From a Cohort Study

This study sought to report the mid-term outcome of a modified flow-diverting strategy in the treatment of complicated aortic aneurysms of different morphology. Historical data suggested aortic aneurysm expansion and rupture after endovascular treatment with current commercial flow-diverters, indica...

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Autores principales: Zhang, Yongxue, Teng, Zhongzhao, Lu, Qingsheng, Zhao, Zhiqing, Bao, Junmin, Feng, Xiang, Feng, Rui, Chen, Zengsheng, Huang, Yuan, Sadat, Umar, Gillard, Jonathan H, Jing, Zaiping
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4602789/
https://www.ncbi.nlm.nih.gov/pubmed/25501077
http://dx.doi.org/10.1097/MD.0000000000000209
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author Zhang, Yongxue
Teng, Zhongzhao
Lu, Qingsheng
Zhao, Zhiqing
Bao, Junmin
Feng, Xiang
Feng, Rui
Chen, Zengsheng
Huang, Yuan
Sadat, Umar
Gillard, Jonathan H
Jing, Zaiping
author_facet Zhang, Yongxue
Teng, Zhongzhao
Lu, Qingsheng
Zhao, Zhiqing
Bao, Junmin
Feng, Xiang
Feng, Rui
Chen, Zengsheng
Huang, Yuan
Sadat, Umar
Gillard, Jonathan H
Jing, Zaiping
author_sort Zhang, Yongxue
collection PubMed
description This study sought to report the mid-term outcome of a modified flow-diverting strategy in the treatment of complicated aortic aneurysms of different morphology. Historical data suggested aortic aneurysm expansion and rupture after endovascular treatment with current commercial flow-diverters, indicating the essentiality of further investigation of this technique prior to its large-scale clinical application. An alternative flow-diverting strategy using layer-by-layer assembled multiple overlapping uncovered stents was employed in this study. The treatment outcome in aneurysms of different morphology (saccular, fusiform, and dissecting) was assessed during a mid-term follow-up period. Of 42 patients enrolled in this study (30 male, mean age: 63.3 years), technical success was achieved in 40 cases. During an average follow-up period of 20.9 months, mean aneurysm diameter shrunk from 53.4 ± 13.6 mm to 48.8 ± 13.9 mm (P < 0.001), while stent-induced sac thrombosis ratio increased significantly (18.1 ± 14.9% to 93.6 ± 9.5%, P < 0.001). The majority of side branches (74/76 major visceral branches, 237/244 minor segmental arteries), covered by 3.3 stents on average, maintained their patency after stenting. Saccular aneurysms manifested the highest thrombus deposition speed (18/20 were totally thrombosed within 12 months) and most significant shrinkage (51.4 ± 13.3 mm pre-operatively vs 43.5 ± 10.2 mm during follow-up, P < 0.001) compared with fusiform and dissecting aneurysms. This modified flow-diverting strategy could be a feasible alternative in the management of complicated aortic aneurysms where vital branches need to be preserved. The treatment outcome may depend on the aneurysm type. Further studies with larger patient cohort and longer follow-up are required to substantiate these results.
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spelling pubmed-46027892015-10-27 Management of Complicated Aortic Aneurysms Using Multiple Overlapping Uncovered Stents: Mid-Term Outcome From a Cohort Study Zhang, Yongxue Teng, Zhongzhao Lu, Qingsheng Zhao, Zhiqing Bao, Junmin Feng, Xiang Feng, Rui Chen, Zengsheng Huang, Yuan Sadat, Umar Gillard, Jonathan H Jing, Zaiping Medicine (Baltimore) 3400 This study sought to report the mid-term outcome of a modified flow-diverting strategy in the treatment of complicated aortic aneurysms of different morphology. Historical data suggested aortic aneurysm expansion and rupture after endovascular treatment with current commercial flow-diverters, indicating the essentiality of further investigation of this technique prior to its large-scale clinical application. An alternative flow-diverting strategy using layer-by-layer assembled multiple overlapping uncovered stents was employed in this study. The treatment outcome in aneurysms of different morphology (saccular, fusiform, and dissecting) was assessed during a mid-term follow-up period. Of 42 patients enrolled in this study (30 male, mean age: 63.3 years), technical success was achieved in 40 cases. During an average follow-up period of 20.9 months, mean aneurysm diameter shrunk from 53.4 ± 13.6 mm to 48.8 ± 13.9 mm (P < 0.001), while stent-induced sac thrombosis ratio increased significantly (18.1 ± 14.9% to 93.6 ± 9.5%, P < 0.001). The majority of side branches (74/76 major visceral branches, 237/244 minor segmental arteries), covered by 3.3 stents on average, maintained their patency after stenting. Saccular aneurysms manifested the highest thrombus deposition speed (18/20 were totally thrombosed within 12 months) and most significant shrinkage (51.4 ± 13.3 mm pre-operatively vs 43.5 ± 10.2 mm during follow-up, P < 0.001) compared with fusiform and dissecting aneurysms. This modified flow-diverting strategy could be a feasible alternative in the management of complicated aortic aneurysms where vital branches need to be preserved. The treatment outcome may depend on the aneurysm type. Further studies with larger patient cohort and longer follow-up are required to substantiate these results. Wolters Kluwer Health 2014-12-12 /pmc/articles/PMC4602789/ /pubmed/25501077 http://dx.doi.org/10.1097/MD.0000000000000209 Text en Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins http://creativecommons.org/licenses/by-nc-nd/4.0 This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0, where it is permissible to download, share and reproduce the work in any medium, provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/4.0
spellingShingle 3400
Zhang, Yongxue
Teng, Zhongzhao
Lu, Qingsheng
Zhao, Zhiqing
Bao, Junmin
Feng, Xiang
Feng, Rui
Chen, Zengsheng
Huang, Yuan
Sadat, Umar
Gillard, Jonathan H
Jing, Zaiping
Management of Complicated Aortic Aneurysms Using Multiple Overlapping Uncovered Stents: Mid-Term Outcome From a Cohort Study
title Management of Complicated Aortic Aneurysms Using Multiple Overlapping Uncovered Stents: Mid-Term Outcome From a Cohort Study
title_full Management of Complicated Aortic Aneurysms Using Multiple Overlapping Uncovered Stents: Mid-Term Outcome From a Cohort Study
title_fullStr Management of Complicated Aortic Aneurysms Using Multiple Overlapping Uncovered Stents: Mid-Term Outcome From a Cohort Study
title_full_unstemmed Management of Complicated Aortic Aneurysms Using Multiple Overlapping Uncovered Stents: Mid-Term Outcome From a Cohort Study
title_short Management of Complicated Aortic Aneurysms Using Multiple Overlapping Uncovered Stents: Mid-Term Outcome From a Cohort Study
title_sort management of complicated aortic aneurysms using multiple overlapping uncovered stents: mid-term outcome from a cohort study
topic 3400
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4602789/
https://www.ncbi.nlm.nih.gov/pubmed/25501077
http://dx.doi.org/10.1097/MD.0000000000000209
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