Development of a method to achieve antegrade in situ fenestration of endovascular stent grafts in abdominal aortic aneurysms
Abdominal aortic aneurysm (AAA) is the focal dilation of the terminal aorta, which can lead to rupture if left untreated. Traditional endovascular aneurysm repair techniques are minimally invasive and pose low mortality rates compared with open surgical repair; however, endovascular aneurysm repair...
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| Format: | Article |
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Elsevier
2025-02-01
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| Series: | Journal of Vascular Surgery Cases and Innovative Techniques |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2468428724002454 |
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| author | Cyrus J. Darvish, BS Nicholas P. Lagerman, MS Oldrich Virag, BS Hannah Parks, BS Yash K. Pandya, MD Mohammad H. Eslami, MD David A. Vorp, PhD Timothy K. Chung, PhD |
| author_facet | Cyrus J. Darvish, BS Nicholas P. Lagerman, MS Oldrich Virag, BS Hannah Parks, BS Yash K. Pandya, MD Mohammad H. Eslami, MD David A. Vorp, PhD Timothy K. Chung, PhD |
| author_sort | Cyrus J. Darvish, BS |
| collection | DOAJ |
| description | Abdominal aortic aneurysm (AAA) is the focal dilation of the terminal aorta, which can lead to rupture if left untreated. Traditional endovascular aneurysm repair techniques are minimally invasive and pose low mortality rates compared with open surgical repair; however, endovascular aneurysm repair procedures face challenges in accommodating variations in the patient's anatomy. Complex aneurysms are defined when the sac extends past the renal arteries or has an insufficient neck landing zone to deploy a traditional endograft. Fenestrated endografts were introduced to enable the repair of complex aneurysms by the creation of fenestrations to enable blood flow into the visceral arteries. This study investigates proof of concept for creating antegrade in situ fenestrations of off-the-shelf endografts using a novel endovascular orifice detection device. Our technique enables the precise location of the visceral artery orifices using fiber optic cables and an infrared light source. The endovascular orifice detection device was tested rigorously in precisely locating an artery opening in blood and a custom AAA phantom model. The study also explored the safest means of creating a fenestration using mechanical puncture and a laser. This innovative approach offers a viable alternative for patients with complex AAAs. |
| format | Article |
| id | doaj-art-5691e6cfa1194ff28db599f491f54641 |
| institution | Kabale University |
| issn | 2468-4287 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Vascular Surgery Cases and Innovative Techniques |
| spelling | doaj-art-5691e6cfa1194ff28db599f491f546412025-01-20T04:17:42ZengElsevierJournal of Vascular Surgery Cases and Innovative Techniques2468-42872025-02-01111101661Development of a method to achieve antegrade in situ fenestration of endovascular stent grafts in abdominal aortic aneurysmsCyrus J. Darvish, BS0Nicholas P. Lagerman, MS1Oldrich Virag, BS2Hannah Parks, BS3Yash K. Pandya, MD4Mohammad H. Eslami, MD5David A. Vorp, PhD6Timothy K. Chung, PhD7Department of Bioengineering, University of Pittsburgh, Pittsburgh, PADepartment of Bioengineering, University of Pittsburgh, Pittsburgh, PADepartment of Bioengineering, University of Pittsburgh, Pittsburgh, PADepartment of Bioengineering, University of Pittsburgh, Pittsburgh, PASchool of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PADivision of Vascular and Endovascular Surgery, Charleston Area Medical Center, Charleston, WVDepartment of Bioengineering, University of Pittsburgh, Pittsburgh, PA; Department of Surgery, University of Pittsburgh, Pittsburgh, PA; McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA; Department of Chemical and Petroleum Engineering, University of Pittsburgh, Pittsburgh, PA; Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA; Clinical & Translational Sciences Institute, University of Pittsburgh, Pittsburgh, PA; Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, PA; Center for Vascular Remodeling and Regeneration, University of Pittsburgh, Pittsburgh, PA; Magee Women’s Research Institute, University of Pittsburgh, Pittsburgh, PADepartment of Bioengineering, University of Pittsburgh, Pittsburgh, PA; Clinical & Translational Sciences Institute, University of Pittsburgh, Pittsburgh, PA; Correspondence: Timothy K. Chung, PhD, Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Research Assistant Professor, 300 Technology Dr, Ste 413, Center for Bioengineering, Pittsburgh, PA 15213Abdominal aortic aneurysm (AAA) is the focal dilation of the terminal aorta, which can lead to rupture if left untreated. Traditional endovascular aneurysm repair techniques are minimally invasive and pose low mortality rates compared with open surgical repair; however, endovascular aneurysm repair procedures face challenges in accommodating variations in the patient's anatomy. Complex aneurysms are defined when the sac extends past the renal arteries or has an insufficient neck landing zone to deploy a traditional endograft. Fenestrated endografts were introduced to enable the repair of complex aneurysms by the creation of fenestrations to enable blood flow into the visceral arteries. This study investigates proof of concept for creating antegrade in situ fenestrations of off-the-shelf endografts using a novel endovascular orifice detection device. Our technique enables the precise location of the visceral artery orifices using fiber optic cables and an infrared light source. The endovascular orifice detection device was tested rigorously in precisely locating an artery opening in blood and a custom AAA phantom model. The study also explored the safest means of creating a fenestration using mechanical puncture and a laser. This innovative approach offers a viable alternative for patients with complex AAAs.http://www.sciencedirect.com/science/article/pii/S2468428724002454Abdominal aortic aneurysmComplex abdominal aortic aneurysmEndovascular repairFEVARLaser fenestrationIn-situ fenestration of endografts |
| spellingShingle | Cyrus J. Darvish, BS Nicholas P. Lagerman, MS Oldrich Virag, BS Hannah Parks, BS Yash K. Pandya, MD Mohammad H. Eslami, MD David A. Vorp, PhD Timothy K. Chung, PhD Development of a method to achieve antegrade in situ fenestration of endovascular stent grafts in abdominal aortic aneurysms Journal of Vascular Surgery Cases and Innovative Techniques Abdominal aortic aneurysm Complex abdominal aortic aneurysm Endovascular repair FEVAR Laser fenestration In-situ fenestration of endografts |
| title | Development of a method to achieve antegrade in situ fenestration of endovascular stent grafts in abdominal aortic aneurysms |
| title_full | Development of a method to achieve antegrade in situ fenestration of endovascular stent grafts in abdominal aortic aneurysms |
| title_fullStr | Development of a method to achieve antegrade in situ fenestration of endovascular stent grafts in abdominal aortic aneurysms |
| title_full_unstemmed | Development of a method to achieve antegrade in situ fenestration of endovascular stent grafts in abdominal aortic aneurysms |
| title_short | Development of a method to achieve antegrade in situ fenestration of endovascular stent grafts in abdominal aortic aneurysms |
| title_sort | development of a method to achieve antegrade in situ fenestration of endovascular stent grafts in abdominal aortic aneurysms |
| topic | Abdominal aortic aneurysm Complex abdominal aortic aneurysm Endovascular repair FEVAR Laser fenestration In-situ fenestration of endografts |
| url | http://www.sciencedirect.com/science/article/pii/S2468428724002454 |
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