Zenith AAA endovascular graft suprarenal bare metal stent separation with graft migration and type IA endoleak

Background The Zenith endovascular graft (Cook Medical, Bloomington, IN, USA) is a well-recognised device used in endovascular repair of abdominal aortic aneurysms (EVAR). After a small number of reported cases of suprarenal stent separation from the main body of the graft, modifications were made to the strength and durability of the suture line attachment of the proximal bare metal component prior to release in 2003. This report describes a further case of suprarenal stent separation and type IA endoleak in a patient who underwent an EVAR using the Zenith device in 2012. Methods We present a case report of a 77-year-old male with incidental finding of type IA endoleak on a background of elective endovascular repair for 50.4-mm infrarenal abdominal aortic aneurysm (AAA), with a Cook Zenith endograft. Computed tomography (CT) demonstrated separation of the suprarenal bare metal stent from the main body of the endograft, with resultant graft migration and increase in native aneurysm sac size. Results The patient underwent semi-urgent surgery with successful placement of a bridging thoracic stent graft between the lowest renal artery and main body of the pre-existing graft. Conclusions This case report describes a rare complication of Zenith devices, additionally emphasising the importance of regular surveillance imaging following EVAR.

Reoperation after Implanting a Triple-Branched Stent Graft: Case Report

Acute type A aortic dissection (ATAAD) is an aortic catastrophe with high mortality, requiring immediate surgical intervention. Recently, placement of a triple-branch stent graft has emerged as an effective technique for total arch reconstruction. Indications for this approach, however, are limited by various complications, such as endoleak, stent graft migration or kinking, and spontaneous thrombosis. Here, we report a case of Marfan syndrome in which the patient underwent a reoperation owing to frame fractures (or degradation of graft material) in a triple-branched stent graft implanted 5 years earlier.

Osseous Healing With Nonrigid Suture Fixation in the Arthroscopic Latarjet Procedure

Background: The Latarjet procedure is a popular means to surgically address anterior glenohumeral joint instability. Although the Latarjet procedure is becoming increasingly common, challenges persist and include postoperative complications secondary to use of the conventional 2 bicortical fixation screws. Recently, a novel surgical technique using a guided surgical approach for graft positioning with nonrigid fixation via a suture suspensory system has been described. Purpose: To evaluate healing rates and stability of the grafts in patients who underwent this new Latarjet technique. Study Design: Case series; Level of evidence, 4. Methods: We retrospectively gathered anonymized computed tomography (CT) data sets from a total of 107 patients who underwent nonrigid suture fixation using a cortical button fixation for anterior glenohumeral instability. Of the 107 patients, 45 had CT scans performed at 2 different time periods. The CT scans of each patient were compared by 2 fellowship-trained musculoskeletal radiologists. Data recorded included age, sex, date of scan, initial graft position on the glenoid, presence and degree of graft migration relative to the equator on follow-up scan, and percentage of osseous healing (as assessed by osseous bridging) on the follow-up scan. Descriptive statistics were calculated to evaluate the average migration and average percentage of healing at both time points. Results: Our population (n = 45) consisted of 38 men (84.4%) and 7 women (15.6%). The mean age was 27.1 ± 1.1 years. The mean time between initial CT scan (2 weeks postoperatively) and follow-up CT scan was 26 ± 2 weeks. On follow-up scan, reviewer 1 found 75.6% of patients had greater than 75% healing, and reviewer 2 found 70.2% of patients had greater than 75% healing. The center of the graft was measured at or below the equator on follow-up examination in 43 of 45 (95.6%) patients by reviewer 1 and 44 of 45 (97.8%) patients by reviewer 2. Conclusion: Based on these findings, nonrigid suture fixation using a cortical button device offers an effective alternative to traditional screw fixation for the Latarjet procedure with a high level of osseous healing and minimal graft migration.

An External Iliac Artery Pseudoaneurysm Resulting From Stent Graft Migration

The case of an 80-year-old male with claudication of his left foot who was referred to our hospital for evaluation and treatment. Computed tomography (CT) angiography revealed occlusion of left common and external iliac (EIA) arteries. Recanalization of the EIA lesion under intravascular ultrasound (IVUS) guidance and placement of 2 stent grafts was completed successfully. Nine months later, 27 × 29 mm pseudoaneurysm of the left EIA was identified that appeared to have developed secondary to migration of the original stent graft. A new stent graft was placed.

Spatial Configuration of Abdominal Aortic Aneurysm Analysis as a Useful Tool for the Estimation of Stent-Graft Migration

The aim of this study was to prepare a self-made mathematical algorithm for the estimation of risk of stent-graft migration with the use of data on abdominal aortic aneurysm (AAA) size and geometry of blood flow through aneurysm sac before or after stent-graft implantation. AngioCT data from 20 patients aged 50–60 years, before and after stent-graft placement in the AAA was analyzed. In order to estimate the risk of stent-graft migration for each patient we prepared an opposite spatial configuration of virtually reconstructed stent-graft with long body or short body. Thus, three groups of 3D geometries were analyzed: 20 geometries representing 3D models of aneurysm, 20 geometries representing 3D models of long body stent-grafts, and 20 geometries representing 3D models of short body stent-graft. The proposed self-made algorithm demonstrated its efficiency and usefulness in estimating wall shear stress (WSS) values. Comparison of the long or short type of stent-graft with AAA geometries allowed to analyze the implants’ spatial configuration. Our study indicated that short stent-graft, after placement in the AAA sac, generated lower drug forces compare to the long stent-graft. Each time shape factor was higher for short stent-graft compare to long stent-graft.