Acute Insulin Resistance and Rapid Alterations in Neuronal Derived Blood Exosome Concentration After Branched Endovascular Aortic Aneurysm Repair.

Objective: Hyperglycaemia following branched endovascular repair (BEVAR) of extensive aortic aneurysms is associated with post-operative lower extremity weakness (LEW). Insulin administration to maintain euglycaemia appears to decrease LEW rates. The purpose of this study was to examine changes in insulin receptor content of neuron derived blood exosomes (NDEs) after BEVAR.

Low-profile versus standard-profile multibranched thoracoabdominal aortic stent grafts.

Objective: This study compared midterm results using low-profile stent grafts (LPSGs; 18F) and standard-profile stent grafts (SPSGs; 22F-24F) for endovascular pararenal and thoracoabdominal aortic aneurysm (TAAA) repair.

Methods: From July 2005 to March 2015, 134 asymptomatic patients underwent endovascular repair of a pararenal or TAAA using multibranched aortic stent grafts. In March 2011, we started using a LPSG with nitinol stents and thin-walled polyester fabric.

Standard off-the-shelf versus custom-made multibranched thoracoabdominal aortic stent grafts.

Objective: The complex aortic branch anatomy in thoracoabdominal aortic aneurysms (TAAAs) and pararenal aortic aneurysms (PRAAs) presents a challenge for endovascular repair. The multibranched endovascular device has durable midterm results with use of a custom branch stent graft (CSG) configuration. The midterm results with use of the standard branch stent graft (SSG) configuration are unknown, but it has the advantage of off-the-shelf technology.

Endovascular rescue after inadvertent false lumen stent graft implantation.

We report a case of a 58-year-old patient with a complicated type B aortic dissection who developed acute visceral malperfusion after placement of a thoracic aortic stent graft from the true to the false lumen. He underwent an urgent endovascular revision that involved septal fenestration and distal extension of the stent graft into the true lumen.

Visceral branch occlusion following aneurysm repair using multibranched thoracoabdominal stent-grafts.

Purpose: To identify risk factors for late-occurring branch occlusion following multibranched endovascular repair of thoracoabdominal and pararenal aortic aneurysm.

Method: Out of 120 patients who underwent multibranched endovascular aneurysm repair between September 2005 and May 2013, 100 (78 men; mean age 72.4 ± 7.

Assessing the anatomic applicability of the multibranched endovascular repair of thoracoabdominal aortic aneurysm technique.

Background: Multibranched endovascular aneurysm repair (MBEVAR) has the potential to lower the morbidity and mortality rates of thoracoabdominal aneurysm repair, but the applicability of the technique is unknown. Our aim was to estimate the prevalence of anatomic suitability for MBEVAR.

Methods: Retrospective review of patients referred for a prospective trial of MBEVAR between November 2005 and July 2012.

Efficacy and durability of endovascular thoracoabdominal aortic aneurysm repair using the caudally directed cuff technique.

Objective: This study determined early and intermediate results of multibranched endovascular thoracoabdominal (TAAA) and pararenal aortic aneurysm (PRAA) repair using a uniform operative technique.

Methods: Eighty-one patients (mean age, 73 ± 8 years, 19 [23.5%] women) underwent endovascular TAAA repair in a prospective trial using self-expanding covered stents connecting axially oriented, caudally directed cuffs to target aortic branches.

The transition from custom-made to standardized multibranched thoracoabdominal aortic stent grafts.

Objective: The purpose of this study was to compare the branch morphology and short-term outcome of endovascular aneurysm repair using multibranched thoracoabdominal custom-made stent grafts (CSGs) vs standard stent grafts (SSGs).

Methods: Data on patient demographics, aortic morphology, component use, and outcome were collected prospectively. Final branch length (cuff to target artery orifice) and branch angle (cuff orientation to target artery orientation) were determined using 3-D reconstruction of computed tomographic angiograms (CTAs).

Valve-in-valve hemodynamics of 20-mm transcatheter aortic valves in small bioprostheses.

Background: Transcatheter aortic valve (TAV) implantation is a treatment for selected patients with failing bioprostheses. We previously showed that currently available SAPIEN (Edwards Lifesciences, Irvine, CA) TAV sizes did not yield acceptable valve-in-valve (VIV) hemodynamics in small degenerated bioprostheses because optimal TAV function requires full stent expansion to its nominal size. The study objective was to determine (1) if 20-mm TAVs provide acceptable hemodynamics in small degenerated bioprostheses and (2) the effect of TAV spatial orientation on valvular hemodynamics and coronary flows.

Long-term follow-up of neck expansion after endovascular aortic aneurysm repair.

Objective: This study determined the rate, extent, and clinical significance of neck dilatation after endovascular aneurysm repair (EVAR).

Methods: The study included 46 patients who underwent elective EVAR using bifurcated Zenith stent grafts (Cook, Bloomington, Ind) and had at least 48 months of clinical and radiographic follow-up. Computed tomography images were analyzed on a 3-dimensional workstation (TeraRecon, San Mateo, Calif).

Transcatheter aortic valves inadequately relieve stenosis in small degenerated bioprostheses.

Objectives: Transcatheter aortic valves (TAVs) are a promising treatment for high risk surgical patients suffering from degeneration of previously implanted bioprostheses (valve-in-valve therapy). However, unlike native stenosed aortic valves which have accommodated Edwards SAPIEN transcatheter valves after valvuloplasty, rigid bioprostheses may prevent full TAV stent expansion and disrupt leaflet function. We hypothesized that current 23 mm TAVs would not completely relieve severe stenosis in small bioprosthetic valves.

Reversal of fortune: induced endoleak to resolve neurological deficit after endovascular repair of thoracoabdominal aortic aneurysm.

Purpose: To describe a direct anatomical treatment approach using an induced type Ib endoleak to increase spinal cord perfusion and reverse paraplegia occurring after endovascular exclusion of a type 2 thoracoabdominal aortic aneurysm (TAAA).

Technique: The approach is illustrated in an 82-year-old woman who underwent branched endovascular repair of an asymptomatic, 6.8-cm-diameter type 2 TAAA.

Variation in the shape and length of the branches of a thoracoabdominal aortic stent graft: implications for the role of standard off-the-shelf components.

Purpose: To describe variations in the shape, orientation, and length of the branches of multi-branched thoracoabdominal stent grafts.

Method: The branches were constructed in situ by attaching a covered stent (Fluency Plus Tracheobronchial Stent Graft; Bard Peripheral Vascular, Tempe, Ariz) to each of four caudally-oriented cuffs on custom-made stent grafts. Pre- and postoperative computed tomography (CT) scans of 38 consecutively treated patients were analyzed using a three-dimensional work station to give the orientation of celiac, superior mesenteric, and right renal and left renal orifices relative to the centerline of the aorta (planned cuff orientation [PCO]) and relative to the centerline of the stent graft (actual vessel orientation [AVO]).

Valve-in-valve implantation using a novel supravalvular transcatheter aortic valve: proof of concept.

Background: Transcatheter valve implantation within degenerated bioprostheses is a potentially promising treatment for high-risk surgical patients. Clinical experience is limited; however, we have shown in vitro that currently available transcatheter aortic valve sizes did not provide acceptable hemodynamics in small bioprostheses. The objective of this study was to develop a new transcatheter valve that would provide good hemodynamics within degenerated bioprostheses.

Energy loss due to paravalvular leak with transcatheter aortic valve implantation.

Background: Mild to moderate paravalvular leaks commonly occur after transcatheter aortic valve (TAV) implantation. Current TAVs match and may exceed hemodynamic performance of surgically implanted bioprostheses based on pressure gradient and effective orifice area. However, these hemodynamic criteria do not account for paravalvular leaks.

Aortic valve-in-valve implantation: impact of transcatheter- bioprosthesis size mismatch.

Background And Aim Of The Study: Transcatheter aortic valves (TAVs) provide minimally invasive treatment for high-risk patients with severe native aortic stenosis. While the off-label application of TAV for degenerative bioprosthetic stenosis (valve-in-valve therapy) is attractive, few cases have been reported. If the rigid annulus and stent posts of bioprostheses prevent full expansion of the TAV, the hemodynamic performance may be compromised.

A standardized multi-branched thoracoabdominal stent-graft for endovascular aneurysm repair.

Purpose: To assess the feasibility of endovascular thoracoabdominal aortic aneurysm (TAAA) repair using a standard off-the-shelf multi-branched stent-graft.

Methods: The aortic anatomy of 66 patients (45 men; mean age 74 years, range 57-87) referred for endovascular repair of TAAA was measured using 3-dimensional reconstructed images from computed tomographic angiograms. In particular, the orientation and longitudinal position of the orifice of each celiac artery, right renal artery, and left renal artery were measured relative to the location of the superior mesenteric artery (SMA) orifice.