Ala Elhelali

Computational fluid analysis of symptomatic chronic type B aortic dissections managed with the Streamliner Multilayer Flow Modulator.

Objective: Managing symptomatic chronic type B aortic dissection (SCTBAD) by the Streamliner Multilayer Flow Modulator (SMFM) stent (Cardiatis, Isnes, Belgium) is akin to provisional structural support to induce complete attachment of the dissection flap, but with the ability of aortic remolding. This study investigated the SMFMs capability to enact healing of SCTBAD. Methods: Clinical data for 12 cases comprising preoperative and postoperative treatment of SCTBAD were obtained from a multicenter database hosted by the Multilayer Flow Modulator Global Registry, Ireland. A biomechanical analysis, by means of computational fluid dynamics modeling, of the hemodynamic effects and branch patency associated with the use of the SMFM was performed for all cases. The mean length of the dissections was 30.23 ± 13.3 cm. There were 30 SMFMs used, which covered 69 aortic branches. Results: At 1‐year follow‐up, the true lumen volume increased from 175.74 ± 98.83 cm3 to 209.87 ± 128.79 cm3; the false lumen decreased from 135.2 ± 92.03 cm3 to 123.19 ± 110.11 cm3. The false lumen index decreased from 0.29 ± 0.13 (preoperatively) to 0.21 ± 0.15 (postoperatively). The primary SMFM treatment of SCTBAD increased carotid perfusion by 35% ± 21% (P = .0216) and suprarenal perfusion by 78% ± 32% (P = .001). The wall pressure distribution blended along the newly enlarged true lumen, whereas the false lumen wall pressure decreased by 6.23% ± 4.81% for the primary group (cases 1–7) and by 3.84% ± 2.59% for the secondary group (cases 8–12). Conclusions: SMFM reduces the false lumen wall pressure through flow modulation. It preserves patency of all branches, minimizing the incidence of short‐term complications. The SMFM is a valuable option in managing primary SCTBAD, without midterm complications.

Long-Term Outcomes of Open Repair of Inflammatory and Atherosclerotic Abdominal Aortic Aneurysms

Background: Abdominal aortic aneurysms (AAA) are a common vascular disease mostly affecting those over the age of 65 years. Open surgical repair (OSR) is considered the gold standard for the treatment of AAA, however longterm mortality and morbidity still remain high in patients with inflammatory AAA, when compared to atherosclerotic AAA. The aim of this study was to evaluate long-term outcomes of both inflammatory and atherosclerotic AAA after OSR. Methods: Out of 837 aortic interventions, 149 patients were identified as having undergone open surgical repair for AAA between 2003 and 2013. Of the 149 patients, histopathological data was available for 92 patients with open AAA repair. Kaplan-Meier curves were analysed to evaluate probability of survival. Results: Patients with inflammatory AAA were younger (70 years) by an average of 2 years compared to atherosclerotic AAA (72 years). Morbidity and length of intensive care stay were insignificantly different in both groups. Inflammatory AAA were associated with higher all cause survival rate (82%) compared to atherosclerotic AAA (68%) (P=0.008) after ten years. Conclusion: There was no difference in clinical outcomes between both atherosclerotic AAA and inflammatory AAA, which is due to the technique used. IAAA were associated with lower mortality rates and improved all cause survival at ten years post open surgical repair.

TCT-810 “The Phantom Streamlinear” as a Therapeutic Option in the Management of Total Body Thoraco-abdominal Aortic Pathology[TAAA]. Early Results.

RESULTS A total of 15 studies (3 prospective studies, 3 observational reviews and 9 case reports) were included. The mean age of patients was 68.85years (þ/-12.34 years), mean aneurysm diameter was 6.67cm ( 1.57cm). Technical success reported in 15 studies was 77.2 %. Aneurysm related survival at one year was 78.7% ( 3.92%). One year all-cause survival was 53.7 % ( 3.94%). There were no reported cases of spinal cord ischemia or renal insult.

Endovascular Repair of a Type III Renal Artery Aneurysm using the MultilayerFlow Modulator: A Clinical Case Report

Background: Our aim was to describe our experience of the multilayer flow modulator (Cardiatis, Isnes, Belgium) used in the treatment of renal artery aneurysms. Case report: A female patient, aged 42 years underwent treatment of a renal artery aneurysm using the multilayer flow modulator. Contrast-enhanced computed tomography revealed a 23.9 mm type III renal artery aneurysm at the bifurcation of the upper and lower pole vessels, with four side branches. Follow up was assessed by postoperative computed tomography scan at 6 and 19 months postoperatively. There were no immediate postoperative complications or mortality. A normal estimated glomerular filtration rate of > 90 ml/min, which was recorded preoperatively, decreased to 77 ml/min on the day of surgery, and returned to > 90 ml/min 1 day postoperatively. The aneurysm initial decreased in size by 23% at 6 months, and by 16% at 19 months. Overall aneurysm shrinkage was 36% (8.6 mm), with all four side-branches remaining patent throughout follow up. Conclusion: The MFM may provide less operative trauma for patients where complex surgical intervention is the only other feasible treatment option. Longer follow-up, a larger sample size, and comparative studies are required to prove the efficacy of this emerging technology.