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Routine use of an aortic balloon to resolve possible inflow stenosis induced by the inflatable ring fixation mechanism of the Ovation endograft

  • VASCULAR AND INTERVENTIONAL RADIOLOGY
  • Published:
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Abstract

Purpose

To investigate if the routine use of an aortic balloon within 15–30 min after Ovation stent graft ring inflation would resolve any inflow stenosis, which may reach 60 %, at the level of the sealing rings. Moreover, we estimated the potential hemodynamic compromise in these patients during rest and exercise.

Methods

Following 3-dimensional reconstruction of AAA models, cross-sectional area of the infrarenal aorta just proximal the sealing mechanism (A aort, R aort, respectively) and internal area at the site of stenosis (A int, R int, respectively) were measured for 83. Forty-nine patients were managed without and 34 with an aortic balloon use. Pressure drop during rest and exercise was estimated.

Results

Technical success was 98 % and there were no perioperative deaths, one type-I endoleak, and 12 (14.5 %) type-II endoleaks. Median A int and R int were significantly reduced compared to A aort [55 % reduction, 143 (range 28–380) mm2 vs 314 (range 177–531) mm2, P value <0.001] and R aort [42 % reduction, 6.75 (range 3–11) mm vs 10 (range 7.5–13) mm, P value <0.001]. The observed stenosis was significantly less for patients in whom an aortic balloon was used intraoperatively (area reduction 36 vs 59 %, P value = 0.009). This stenosis caused a statistically significant, but clinically insignificant ΔP in both groups during rest (0.13 vs 0.06 mmHg, P value = 0.02) and exercise (1 vs 0.5 mmHg, P value = 0.02).

Conclusion

The advantages of the unique sealing mechanism of the Ovation device seem to be accompanied by an inflow stenosis which is significantly reduced when neck molding with an aortic balloon is used. Overall, the hemodynamic impact of this abnormality seems to be clinically insignificant at 1-month follow-up.

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Authors and Affiliations

  1. Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, University of Crete Medical School, PO Box 1352, 711 10, Heraklion, Greece

    Christos V. Ioannou, Nikolaos Kontopodis & Stella Lioudaki

  2. Vascular Surgery Department, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece

    Efstratios Georgakarakos

  3. Interventional Radiology Unit, Department of Radiology, University of Crete Medical School, Heraklion, Crete, Greece

    Elias Kehagias & Dimitrios Tsetis

  4. Institute of Applied and Computational Mathematics, Foundation for Research and Technology-Hellas, Heraklion, Greece

    Eleni Metaxa & Yannis Papaharilaou

Authors
  1. Christos V. Ioannou
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  2. Nikolaos Kontopodis
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  3. Efstratios Georgakarakos
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  4. Elias Kehagias
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  5. Eleni Metaxa
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  6. Stella Lioudaki
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  7. Yannis Papaharilaou
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  8. Dimitrios Tsetis
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Correspondence to Christos V. Ioannou.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Ioannou, C.V., Kontopodis, N., Georgakarakos, E. et al. Routine use of an aortic balloon to resolve possible inflow stenosis induced by the inflatable ring fixation mechanism of the Ovation endograft. Radiol med 121, 882–889 (2016). https://doi.org/10.1007/s11547-016-0671-0

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  • DOI: https://doi.org/10.1007/s11547-016-0671-0

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