Treatment of a Thoracoabdominal Aneurysm With the Cardiatis Multilayer Flow Modulator

Yıl 2021, Cilt: 16 Sayı: 1, 113 - 116, 08.02.2021

Çağlar Özmen Arzu Shahverenova Mustafa Demirtaş

https://doi.org/10.17517/ksutfd.683218

Öz

Percutaneous treatment of thoracoabdominal aortic aneurysms have been increasingly used recent years. The Cardiatis multilayer flow modulator stents have been used for aneurysms threatment. We report our case and the results of the 2 years follow-up with thoracoabdominal aortic aneurysms treated with the Cardiatis multilayer flow modulator.
A 78-year-old female patient was admitted to the hospital with abdominal pain. A computed tomography scan showed an aneurysm of the abdominal aorta with a maximal diameter of 50 mm. The patient refused open surgery, so we decided to treat the patient with a flow-diverting stent. In an angiography, 16x40, 16x80 and 16x80 mm three Cardiatis multilayer stent were successively implanted with an overlap of 1 cm from the distal thoracic aorta. A control angiography showed a good position of the stent and completely close the aneurysmal segment. A CT scan showed regression of the aneurysm with developing partial thrombus after the 6 month and 24 month follow-up process.
The use of CMFM for complex aneurysms will remain a matter of debate as long as their efficacy and safety have not been completely elucidated. In conclusion, despite the successful and life-saving treatment of our patient, the use of flow-diverting stents for complex aneurysms should be limited only to those compassionate-use cases without treatment alternatives.

Anahtar Kelimeler

Cardiatis multilayer flow modulator, Complex aneurysms, Endovascular theraphy

Torakoabdominal Anevrizmanın Cardiatis Çok Katmanlı Akış Modülatörü ile Tedavisi

Öz

Torakoabdominal aort anevrizmalarının perkütan tedavisi son yıllarda giderek daha fazla kullanılmaktadır. Anevrizma tehdidi için Cardiatis çok katmanlı akış modülatör stentleri son yıllarda gittikçe artan sıklıkta kullanılmaktadır. Cardiatis çok katmanlı akış modülatörü ile tedavi edilen torakoabdominal aort anevrizmalı olgumuzu sunuyoruz.
78 yaşında bayan hasta karın ağrısı şikayeti ile hastaneye başvurdu. Bilgisayarlı tomografide maksimum 50 mm çapında abdominal aort anevrizması gösterdi. Hasta cerrahiyi reddetti, bu yüzden hastayı Cardiatis ile tedavi etmeye karar verdik. Anjiyografide, 16x40, 16x80 ve 16x80 mm'lik üç Cardiatis çok katmanlı stent arka arkaya distal torasik aorttan 1 cm'lik bir over-lap olacak şekilde implante edildi. Kontrol anjiyografisinde stentin iyi bir pozisyonu olduğu ve anevrizmal segmentin tamamen kapatıldığı görüldü. BT taraması, 6 ay ve 24 ay takip sürecinden sonra anevrizmanın gerilediğini gösterdi.
Cardiatisin karmaşık anevrizmalar için kullanımı, etkinlikleri ve güvenlikleri tam olarak aydınlatılmadığı sürece tartışma konusu olmaya devam edecektir. Sonuç olarak, hastamızın başarılı ve hayat kurtarıcı tedavisine rağmen, karmaşık anevrizmalar için akış yönelimli stent kullanımı sadece tedavi alternatifi olmayan karmaşık anatomili vakalarla sınırlandırılmalıdır.

Anahtar Kelimeler

Cardiatis çok katmanlı akış modülatörü, Endovasküler Tedavi, Karmaşık Anevrizmalar

Kaynakça

• 1. Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H, et al; ESC Committee for Practice Guidelines. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J 2014; 35: 2873-926.
• 2. Swerdlow NJ, Wu WW, Schermerhorn ML. Open and Endovascular Management of Aortic Aneurysms. Circ Res. 2019 Feb 15;124(4):647-661. doi: 10.1161/CIRCRESAHA.118.313186.
• 3. Dubost C, Allary M, Oeconomos N. Resection of an aneurysm of the abdominal aorta:reestablishment of the continuity by a preserved human arterial graft, with result after five months. AMA Arch Surg. 1952;64:405–8.
• 4. Makaroun MS, Dillavou ED, Wheatley GH, Cambria RP Gore TAG Investigators. Five-year results of endovascular treatment with the Gore TAG device compared with open repair of thoracic aortic aneurysms. J Vasc Surg. 2008;47:912–8.
• 5. Reijnen MM, van Sterkenburg SM. Treatment of a Salmonella-induced rapidly expanding aortic pseudoaneurysm involving the visceral arteries using the Cardiatis multilayer stent. J Vasc Surg. 2014 Oct;60(4):1056-8. doi: 10.1016/j.jvs.2013.07.102.
• 6. De Vries JP. Treatment of complex thoracoabdominal or juxtarenal aortic aneurysms with a Multilayer stent. J Endovasc Ther. 2012 Feb;19(1):125-7. doi: 10.1583/11-3398C.1.
• 7. Zhang Y, Lu Q, Jing Z. Multilayer stents, a new progress in the endovascular treatment of aneurysm. Chin Med J 2013;126: 536e41.
• 8. Greenhalgh RM, Brown LC, Powell JT, Thompson SG, Epstein D. United Kingdom EVAR Trial Investigators. Endovascular versus open repair of abdominal aortic aneurysm. N Engl J Med 2010;362:1863e71.
• 9. De Bruin JL, Baas AF, Buth J, Prinssen M, Verhoeven EL, Cuypers PW, et al. Dream Study Group. Long-term outcome of open or endovascular repair of abdominal aortic aneurysm. N Engl J Med 2010;362:1881e9.
• 10. Lederle FA, Freischlag JA, Kyriakides TC, Padberg Jr FT, Matsumura JS, Kohler TR, et al. Open Versus Endovascular Repair (OVER) Veterans Affairs Cooperative Study Group. Outcomes following endovascular vs open repair of abdominal aortic aneurysm: a randomized trial. JAMA 2009;302:1535e42.
• 11. Bavaria JE, Appoo JJ, Makaroun MS, Verter J, Yu ZF, Mitchell RS, et al. Endovascular stent grafting versus open surgical repair of descending thoracic aortic aneurysms in low-risk patients: a multicenter comparative trial. J Thorac Cardiovasc Surg 2007;133(2):369e77.
• 12. Augsburger L, Farhat M, Asakura F, et al. Hemodynamical effects of Cardiatis braided stents in sidewall aneurysm silicone models using PIV. Available at: http://www.cardiatis.com/images/ stories/info/etude%20luca%20in%20vitro.pdf. Last accessed October 30, 2011.
• 13. Bonneau M, Kang C. Assessment of peripheral multilayer stent technology in pig-model aneurysm. Available at: http://www.cardiatis.com/ images/stories/info/06-aortic-vein-pig-model.pdf. Last accessed October 30, 2011.
• 14. Wailliez C, Coussement G. CFD study of multilayer stent haemodinamics effects in abdominal aortic aneurysms. Available at: http://www.cardiatis.com/images/stories/info/fluid-19%28105%29_c. wailliez_g.coussement_fpms.pdf. Last accessed October 30, 2011.
• 15. Balderi A, Antonietti A, Pedrazzini F, Sortino D, Vinay C, Grosso M. Treatment of a hepatic artery aneurysm by endovascular exclusion using the multilayer Cardiatis stent. Cardiovasc Intervent Radiol. 2010;33:1282–1286.
• 16. Meyer C, Verrel F, Weyer G, Wilhelm K.et al. Endovascular management of complex renal artery aneurysms using the multilayer stent. Cardiovasc Intervent Radiol. 2011;34:637–641.