Endovascular Therapy

To evaluate the displacement forces acting on an aortic endograft when the iliac limbs are crossed ("ballerina" position). An endograft model was computationally reconstructed based on data from a patient whose infrarenal aortic aneurysm had an endovascular stent-graft implanted with the iliac limbs crossed. Computational fluid dynamics analysis determined the maximum displacement force on the endograft and separately on the bifurcation and iliac limbs. Its analogue model was reconstructed for comparison, assuming the neck, main body, and total length constant but considering the iliac limbs to be deployed in the usual bifurcated mode. Calculations were repeated after developing "idealized" models of both the bifurcated and crossed-limbs endografts with straight main bodies and no neck angulation or curved iliac segments. The vector of the total force was directed anterocaudal for both the typical bifurcated and the crossed-limbs configurations, with the forces in the latter slightly reduced and the vertical component accounting for most of the force in both configurations. Idealized crossed-limbs and bifurcated configurations differed only in the force on the iliac limbs, but this difference disappeared in the realistic models. Crossing of the iliac limbs can slightly affect the direction of the displacement forces. Although this configuration can exert larger forces on the limbs than in the bifurcated mode, this effect can be blunted by concomitant modifications in the geometry of the main body and other parts of the endograft, making its hemodynamic behavior resemble that of a typically positioned endograft.

Compared with the coronary setting, knowledge about antithrombotic therapies after endovascular treatment (EVT) is inadequate in patients with peripheral artery disease (PAD). Based on a review of trials and guidelines, which is summarized in this article, there is scant evidence that antithrombotic drugs improve outcome after peripheral EVT. To address this knowledge gap, the randomized, open-label, multinational edoxaban in patients with Peripheral Artery Disease (ePAD) study (ClinicalTrials.gov identifier NCT01802775) was designed to explore the safety and efficacy of a combined regimen of antiplatelet therapy with clopidogrel and anticoagulation with edoxaban, a selective and direct factor Xa inhibitor, both combined with aspirin. As of July 2014, 203 patients (144 men; mean age 67 years) from 7 countries have been enrolled. These patients have been allocated to once-daily edoxaban [60 mg for 3 months (or 30 mg in the presence of factors associated with increased exposure)] or c...

Endovascular treatment of brain aneurysms with flow diverter device can be technically difficult. Obtaining distal access through the wide neck of a large or giant aneurysm may be challenging and sometimes the microcatheter needs to be looped inside the aneurysm. However, the inability to resolve this loop and to straighten the microcatheter can preclude flow diverter placement. This brief report presents four cases of large/giant aneurysms treated with flow diverter device, in which our innovative stent-retriever anchor technique was used to obtain the distal access of the parent artery. All procedures were technically successful, and no complications were recorded.

To compare the immediate suprarenal neck angulation change between the Ovation stent-graft, with its inflatable sealing rings, and a stent-graft with a conventional sealing mechanism. A case-control study was conducted in which 30 consecutive patients (mean age 67 years; all men) with abdominal aortic aneurysm (AAA) treated with the Ovation stent-graft (group O) were retrospectively compared with 24 patients (mean age 77 years; all men) contemporaneously treated with the Endurant stent-graft (group E) at 3 high-volume tertiary vascular centers. The variables recorded were the aortic neck length, preoperative and postoperative angulation, minimum and maximum diameters of the infrarenal neck, as well as the maximum AAA diameter. All patients had undergone preoperative and postoperative (within 30 days) computed tomographic angiography. Multiple regression analysis compared the relative contribution to neck angulation change of each geometric parameter and the type of endograft. Data a...