Midterm Results with the Open Chimney Technique during Endovascular Aneurysm Repair.

PURPOSE: To report the midterm experience with chimney-endovascular aneurysm repair (Ch-EVAR) with the use of open self-expending stents for branch vessel preservation. MATERIALS AND METHODS: From July 2010 to May 2017, 67 patients underwent open Ch-EVAR because their proximal landing zones were adjacent to, or covered, the renal or mesenteric arteries (Zones 7-9), and they were not suitable for standard or fenestrated endovascular aneurysm repair. The proximal landing zone was relocated below the highest renal artery in 46 cases, the superior mesenteric artery in 17 cases, and the celiac artery in 4 cases, using 84 open chimneys (131 stents). A subgroup analysis was performed between an early (2010-2014) and a later (2015-2017) time period. Thirty-two patients were treated during the early period, and 35 were treated during the later period. In the later period, open chimneys were strengthened by a second self-expanding stent. RESULTS: The primary technical success rate was 89.6%; the early mortality rate was 9.0%; and the median follow-up duration was 13 months (range, 1-76 months). The estimated actuarial survival rate was 85.7% in year 1 and 79.2% in year 2, and the estimated patency rate of open chimneys reached 95.2% at 2 years. Aneurysm sac regression >5 mm and sac stability rates were 39.0% and 57.6%, respectively. Freedom from aneurysm-related reintervention was lower in the later period (log-rank P = .04), while type Ia endoleaks tended to be twice as likely. CONCLUSIONS: Midterm results of open Ch-EVAR show high technical success with acceptable midterm patency and lack of endoleak in appropriately selected patients. The advantages over covered stents are lower-profile delivery systems and maintenance of branch vessel patency in early bifurcations and overlying visceral vessels.

Early cannulation of the Flixene™ arteriovenous graft.

PURPOSE: The aim of this review was to search for evidence of the efficiency of early cannulation of the Flixene™ (Maquet-Atrium Medical, Hudson, NH, USA) arteriovenous graft (AVG) in the current literature and to assess its patency and complication rates. METHODS: Searches in Pubmed, Medline, Embase and the Cochrane Library were performed using the following specific search terms: early cannulation AVG and/or Flixene™ graft. The primary outcomes were mean time to first cannulation and patency rates at 12 months. Secondary outcomes were complications. RESULTS: Six studies reporting outcomes in a total of 260 procedures were included in this review. The median delay from intervention to first cannulation was documented in four studies and was less than 3 days. Primary assisted patency at 12 months ranged from 45% to 53% in the four documented series. In five studies, documented secondary patency at 12 months ranged from 63% to 92%. Two studies compared outcomes between traditional and Flixene™ grafts: one study reported significantly (p<0.01) improved one-year patency using the Flixene™ graft, the two studies did not report significant differences in complication rates between both groups. The rate of infection and pseudo-aneurysm formation ranged from 0 to 11% and 0 to 6%, respectively. CONCLUSIONS: This review shows that early cannulation of the Flixene™ graft within 3 days following its implantation is feasible with one-year patency and complication rates equivalent to those of conventional grafts which can be cannulated only after 2 weeks.

Use of the Flixene vascular access graft as an early cannulation solution.

OBJECTIVE: The primary end points of this study were safety and efficacy of early cannulation of the Flixene graft (Maquet-Atrium Medical, Hudson, NH). Secondary end points were complications and patency. METHODS: This is a prospective single-center nonrandomized study. Study data included patient characteristics; history of vascular access; operative technique; interval between implantation and initial cannulation; complications; and patency at 1 month, 3 months, and every 6 months. Patency rates were estimated by the Kaplan-Meier method. RESULTS: Between January 2011 and September 2013, a total of 46 Flixene grafts were implanted in 44 patients (27 men) with a mean age of 63 years. The implantation site was the upper arm in 67% of cases, the forearm in 11%, and the thigh in 22%. Seven grafts were never cannulated during the study period. Of the remaining 39 grafts, 32 (82%) were successfully cannulated within the first week after implantation, including 16 (41%) on the first day. The median interval from implantation to initial cannulation was 2 days (interquartile range, 1-3 days). The median follow-up was 223.5 days (interquartile range, 97-600 days). Five hematomas occurred, but only one required surgical revision. Primary assisted and secondary patency rates were 65% and 86%, respectively, at 6 months and 56% and 86%, respectively, at 1 year. CONCLUSIONS: This study suggests that cannulation of the Flixene graft within 1 week after implantation is safe and effective. Early cannulation avoids or shortens the need for a temporary catheter. One-year patency rates appeared to be comparable to those achieved with conventional grafts, but long-term follow-up and randomized controlled studies will be needed to confirm this finding.

Acute thrombosis of external iliac artery secondary to endofibrosis.

Iliac endofibrosis is a rare condition caused by chronic wall stress and a subsequent progressive fibrosis that usually affects the external iliac artery. It can present with intermittent claudication and is most commonly found in young athletes without significant risk factors for peripheral arterial disease. We present a case of acute thrombosis of the external iliac artery secondary to endofibrosis in a 38-year-old cyclist and describe the treatment options. For symptomatic patients and in case of long arterial occlusion, the treatment of choice is the surgical resection with autologous vein interposition.