Customized and in situ fenestrated stent-grafts:A reinforced poly-ε-caprolactone branch cuff designed to prevent type III endoleaks and enhance hemodynamics

Superior long-term anchorage of the bridging stent-grafts from the fenestrated main body endograft could be achieved with the addition of a flared cuff,capable of preventing the previously observed fabric fraying around the fenestration as a result of the balloon angioplasty of the seal zone.This novel stent cuff design will also facilitate more complete biointegration of the devices,eliminate the hemodynamic variation as well as significantly reduce the possibility of a Type III endoleak.The feasibility of this concept is demonstrated by observations made from in-situ tests performed in a Beta endograft design.Flared cuffs made of poly(ε-caprolactone)supported with a weft-knitted polyester structure can be manufactured with various configurations to optimize the transition from the main body of the endograft,thus preventing the currently marketed designs’hemodynamic perturbation while also promoting endograft biointegration.This concept represents an evolution in branch graft design,which may enhance the long-term durability of customized fenestrations and open new applications for in-vivo graft fenestration in the near future.Further ongoing investigation to optimize its structure,X-ray opacity,fixation to the flared stent,and material biocompatibility are still required to build upon this concept’s proof.

Fenestrated endovascular aortic repair for juxtarenal abdominal aortic aneurysm

Background Endovascular stent-graft with fenestration can improve proximal sealing in patients with juxtarenal abdominal aortic aneurysm （JAAA）. The purpose of this study was to describe our primary experience and evaluate the safety and efficacy of fenestrated device for JAAA in high-risk patients. Methods Between March 2011 and May 2012, nine male patients （mean age, （79.6±8.6） years） with asymptomatic JAAAs underwent elective deployment of the Zenith fenestrated stent-grafts at a single institution. All patients were treated in the hybrid operating room under general anesthesia. Follow-up computed tomography angiography （CTA） was routinely performed before discharge, at 3, 6, and 12 months and annually thereafter. Results Procedural success was achieved in all cases. Total sixteen small fenestrations, two large fenestrations and eight scallops were used. Intra-operative complications occurred in four patients, which included one proximal type I endoleak, two type II endoleaks, and one renal artery dissection. The mean hospital stay was （8.9±1.4） days, mean blood loss was （360.5±46.8） ml, and mean iodinated contrast volume was （230.6±58.3） ml. The mean follow-up time was （7.6±4.2） months. The visceral graft patency was 100% until now. One patient had an increase of serum creatinine of more than 30%, but did not require dialysis. No patients died, no stent fractured, and migration were diagnosed during the follow-up. Conclusions The early results of fenestrated device for high-risk patients with complex JAAAs are satisfactory. However, long-term fenestrated graft durability and branch vessel patency remain to be determined.