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Clinical application and technical details of cook zenith devices modification to treat urgent and elective complex aortic aneurysms
PURPOSE: To describe technical details of modifying four different Cook Zenith devices to treat complex aortic aneurysms. MATERIAL: In the first three cases, the modification process involved complete stent graft deployment on a sterile back table. Fenestrations were created using an ophthalmologic...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer International Publishing
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8167926/ https://www.ncbi.nlm.nih.gov/pubmed/34061297 http://dx.doi.org/10.1186/s42155-021-00233-7 |
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author | Manunga, Jesse Jordano, Lia Mirza, Aleem K. Teng, Xiaoyi Skeik, Nedaa Eisenmenger, Laura |
author_facet | Manunga, Jesse Jordano, Lia Mirza, Aleem K. Teng, Xiaoyi Skeik, Nedaa Eisenmenger, Laura |
author_sort | Manunga, Jesse |
collection | PubMed |
description | PURPOSE: To describe technical details of modifying four different Cook Zenith devices to treat complex aortic aneurysms. MATERIAL: In the first three cases, the modification process involved complete stent graft deployment on a sterile back table. Fenestrations were created using an ophthalmologic cautery and reinforced with a radiopaque snare using a double-armed 4–0 Ethibond locking suture based on measurements obtained on centerline of flow. In each instance, a nitinol wire was withdrawn and redirected through and through the fabric and used as a constraining wire. In the fourth patient, modification involved partial stent graft deployment and creation of additional two fenestrations to accommodate renal arteries. The devices are resheathed and implanted in the standard fashion. RESULTS: Four patients underwent exclusion of their aneurysms, including thoracoabdominal aneurysms (n = 2), a contained ruptured juxtarenal aneurysm (n = 1), and a ruptured failed previous endovascular repair (n = 1). Fifteen fenestrations were successfully bridged with Atrium iCAST stent grafts. Average graft modification time, operative time, contrast volume, radiation dose, estimated blood loss, and hospital length of stay were 89 min, 155.25 min, 58.8 mL, 2451 mGy, 175 mL, and 4.3 days, respectively. One patient required a secondary intervention to treat a type Ib endoleak. During an average follow-up of 25 months, aneurysm sacs progressively shrank without additional intervention. CONCLUSION: Physician-modified fenestrated/branched endografts are a safe alternative to custom made devices, especially in urgent cases and should be part of the armamentarium of any complex aortic program. |
format | Online Article Text |
id | pubmed-8167926 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-81679262021-06-17 Clinical application and technical details of cook zenith devices modification to treat urgent and elective complex aortic aneurysms Manunga, Jesse Jordano, Lia Mirza, Aleem K. Teng, Xiaoyi Skeik, Nedaa Eisenmenger, Laura CVIR Endovasc New Technologies PURPOSE: To describe technical details of modifying four different Cook Zenith devices to treat complex aortic aneurysms. MATERIAL: In the first three cases, the modification process involved complete stent graft deployment on a sterile back table. Fenestrations were created using an ophthalmologic cautery and reinforced with a radiopaque snare using a double-armed 4–0 Ethibond locking suture based on measurements obtained on centerline of flow. In each instance, a nitinol wire was withdrawn and redirected through and through the fabric and used as a constraining wire. In the fourth patient, modification involved partial stent graft deployment and creation of additional two fenestrations to accommodate renal arteries. The devices are resheathed and implanted in the standard fashion. RESULTS: Four patients underwent exclusion of their aneurysms, including thoracoabdominal aneurysms (n = 2), a contained ruptured juxtarenal aneurysm (n = 1), and a ruptured failed previous endovascular repair (n = 1). Fifteen fenestrations were successfully bridged with Atrium iCAST stent grafts. Average graft modification time, operative time, contrast volume, radiation dose, estimated blood loss, and hospital length of stay were 89 min, 155.25 min, 58.8 mL, 2451 mGy, 175 mL, and 4.3 days, respectively. One patient required a secondary intervention to treat a type Ib endoleak. During an average follow-up of 25 months, aneurysm sacs progressively shrank without additional intervention. CONCLUSION: Physician-modified fenestrated/branched endografts are a safe alternative to custom made devices, especially in urgent cases and should be part of the armamentarium of any complex aortic program. Springer International Publishing 2021-06-01 /pmc/articles/PMC8167926/ /pubmed/34061297 http://dx.doi.org/10.1186/s42155-021-00233-7 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | New Technologies Manunga, Jesse Jordano, Lia Mirza, Aleem K. Teng, Xiaoyi Skeik, Nedaa Eisenmenger, Laura Clinical application and technical details of cook zenith devices modification to treat urgent and elective complex aortic aneurysms |
title | Clinical application and technical details of cook zenith devices modification to treat urgent and elective complex aortic aneurysms |
title_full | Clinical application and technical details of cook zenith devices modification to treat urgent and elective complex aortic aneurysms |
title_fullStr | Clinical application and technical details of cook zenith devices modification to treat urgent and elective complex aortic aneurysms |
title_full_unstemmed | Clinical application and technical details of cook zenith devices modification to treat urgent and elective complex aortic aneurysms |
title_short | Clinical application and technical details of cook zenith devices modification to treat urgent and elective complex aortic aneurysms |
title_sort | clinical application and technical details of cook zenith devices modification to treat urgent and elective complex aortic aneurysms |
topic | New Technologies |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8167926/ https://www.ncbi.nlm.nih.gov/pubmed/34061297 http://dx.doi.org/10.1186/s42155-021-00233-7 |
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