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Multiple overlapping uncovered stents as an alternative flow-diverting strategy in the management of peripheral and visceral aneurysms  Yongxue Zhang,

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Presentation on theme: "Multiple overlapping uncovered stents as an alternative flow-diverting strategy in the management of peripheral and visceral aneurysms  Yongxue Zhang,"— Presentation transcript:

1 Multiple overlapping uncovered stents as an alternative flow-diverting strategy in the management of peripheral and visceral aneurysms  Yongxue Zhang, MD, Qingsheng Lu, MD, Zhiqing Zhao, MD, Junmin Bao, MD, Xiang Feng, MD, Rui Feng, MD, Zaiping Jing, MD  Journal of Vascular Surgery  Volume 60, Issue 5, Pages (November 2014) DOI: /j.jvs Copyright © 2014 Society for Vascular Surgery Terms and Conditions

2 Fig 1 Procedure details of using multiple overlapping uncovered stents (MOUSs) to treat peripheral and visceral aneurysms. A, A left renal artery aneurysm (arrow) was detected using computed tomography (CT) angiography. B-D, Preoperative angiogram confirmed the size and location of the aneurysm, and the stent diameter was oversized by 1 mm referring to the aneurysm neck (B). D, A stiff wire was placed bridging the aneurysm (arrow heads), following which the stents were advanced and deployed to cover the aneurysm (arrow), leaving at least 10 mm lesion-free proximal and distal to the landing zone. C, An angiogram was made after each stent deployment to evaluate the flow velocity change within the aneurysm sac until it was significantly decreased on fluoroscope. E and F, CT angiography at 3-month follow-up (F) demonstrated complete thrombosis and shrinkage of the aneurysm sac compared with preoperative measurements (E). Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

3 Fig 2 Follow-up imaging and parameters measurement. Computed tomography (CT) angiography was used to follow up the evolution of the aneurysm. Three-dimensional reconstruction of the aneurysm was conducted with dedicated CT image processing software (A-C). Aneurysm maximum diameter was measured on the cross-sectional slices perpendicular to the diseased artery (D-F); the area of sac residual perfusion (RP) was measured on each slice, then put together to calculate the sac thrombosis ratio (STR) (G-I). Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

4 Fig 3 Change in aneurysm maximum diameter and sac thrombosis ratio (STR) during regular follow-up. A, Statistical significance was demonstrated in terms of aneurysm maximal diameter decrease (DD) (n = 37) and (B) aneurysm thrombosis ratio at each follow-up point (n = 37) compared with baseline level. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

5 Fig 4 Preservation of side branches arising directly from the aneurysm (An) wall. A and B, A left subclavian artery An involving the left vertebral artery (VA) was treated using 3 layers of bare stents (Sts). C, At 6-month follow-up, an anatomic path was observed to form inside the An sac, providing blood supply to the VA, and the rest of the sac was totally thrombosed (TT) and significantly shrunken. D and E, Possible hemodynamic mechanism involved in the formation process of the special anatomic flow path. The blood flow was redirected by the bare Sts toward the side branch, and thrombus began to grow in the rest of the sac. Ao, Aorta; BA, brachial artery. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

6 Fig 5 Differences in aneurysm evolution during follow-up between saccular and fusiform aneurysms. Aneurysm sac thrombosis speed was faster in saccular aneurysms at 3 and 6 months compared with fusiform aneurysm (A). The difference became less significant over time. B, The maximum diameter decrease (DD) ratio between the two groups was not significant at each follow-up point. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2014 Society for Vascular Surgery Terms and Conditions

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