A Revolutionary Device for Endovascular Aortic Repair of Abdominal Aortic Aneurysm: A Pilot Study [version 2; peer review: 2 approved]
Bambang Widyantoro,
Yoga Yuniadi,
Muhammad Rafli Iqbal,
Macmilliac Lam,
Melani Limenco Benly,
Renan Sukmawan,
Rendra Mahardika Putra,
Bagus Herlambang,
Ruth Grace Aurora,
Sung Gwon Kang,
Bagas Adhimurda Marsudi,
Suci Indriani,
Suko Adiarto,
Iwan Dakota,
Taofan Taofan
Affiliations
Bambang Widyantoro
Department of Cardiology and Vascular Medicine, Faculty of Medicine University of Indonesia, University of Indonesia Academic Hospital, National Cardiovascular Center Harapan Kita, Jakarta, Jakarta, 11420, Indonesia
Yoga Yuniadi
Department of Cardiology and Vascular Medicine, Faculty of Medicine University of Indonesia, University of Indonesia Academic Hospital, National Cardiovascular Center Harapan Kita, Jakarta, Jakarta, 11420, Indonesia
Muhammad Rafli Iqbal
Research Assistant of Vascular Division, Department of Cardiology and Vascular Medicine, Faculty of Medicine University of Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Jakarta, 11420, Indonesia
Research Assistant of Vascular Division, Department of Cardiology and Vascular Medicine, Faculty of Medicine University of Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Jakarta, 11420, Indonesia
Melani Limenco Benly
Research Assistant of Vascular Division, Department of Cardiology and Vascular Medicine, Faculty of Medicine University of Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Jakarta, 11420, Indonesia
Renan Sukmawan
Department of Cardiology and Vascular Medicine, Faculty of Medicine University of Indonesia, University of Indonesia Academic Hospital, National Cardiovascular Center Harapan Kita, Jakarta, Jakarta, 11420, Indonesia
Rendra Mahardika Putra
Department of Cardiology and Vascular Medicine, Faculty of Medicine University of Indonesia, University of Indonesia Academic Hospital, National Cardiovascular Center Harapan Kita, Jakarta, Jakarta, 11420, Indonesia
Bagus Herlambang
Department of Thorax and Cardiovascular Surgeon, Faculty of Medicine University of Indonesia, University of Indonesia Academic Hospital, National Cardiovascular Center Harapan Kita, Jakarta, Jakarta, 11420, Indonesia
Ruth Grace Aurora
Department of Cardiology and Vascular Medicine, Faculty of Medicine University of Indonesia, University of Indonesia Academic Hospital, National Cardiovascular Center Harapan Kita, Jakarta, Jakarta, 11420, Indonesia
Sung Gwon Kang
Department of Radiology, Chosun University, Gwangju-Si, Gwangju-Si, 61452, South Korea
Bagas Adhimurda Marsudi
Department of Cardiology and Vascular Medicine, Faculty of Medicine University of Indonesia, University of Indonesia Academic Hospital, National Cardiovascular Center Harapan Kita, Jakarta, Jakarta, 11420, Indonesia
Department of Cardiology and Vascular Medicine, Faculty of Medicine University of Indonesia, University of Indonesia Academic Hospital, National Cardiovascular Center Harapan Kita, Jakarta, Jakarta, 11420, Indonesia
Department of Cardiology and Vascular Medicine, Faculty of Medicine University of Indonesia, University of Indonesia Academic Hospital, National Cardiovascular Center Harapan Kita, Jakarta, Jakarta, 11420, Indonesia
Department of Cardiology and Vascular Medicine, Faculty of Medicine University of Indonesia, University of Indonesia Academic Hospital, National Cardiovascular Center Harapan Kita, Jakarta, Jakarta, 11420, Indonesia
Department of Cardiology and Vascular Medicine, Faculty of Medicine University of Indonesia, University of Indonesia Academic Hospital, National Cardiovascular Center Harapan Kita, Jakarta, Jakarta, 11420, Indonesia
Background Endovascular repair for abdominal aortic aneurysms (AAA) has been the gold standard since it was established in 1991. Various graft configurations have been developed to overcome the limitations of endovascular aortic repair (EVAR), including contralateral gate cannulation (CGC). We propose a new device and technique intended to simplify endovascular AAA repair, along with reports of its application in six patients. Intervention The Taofan and Kang (T&K) bidirectional endovascular aortic repair (B-EVAR (B-EVAR) device uses a main-body stent graft, two-limb extensions, and bare metal stent. The procedure involved accessing the right and left femoral arteries, followed by standard aortography evaluation using a pigtail catheter through the contralateral femoral access. The main body stent graft is deployed through ipsilateral femoral access using a balloon catheter, while the contralateral gate is cannulated with a hydrophilic coated wire. Both balloons were inflated simultaneously to ensure that the wires were in different lumens. Contralateral and ipsilateral extensions were deployed using a limb extension stent graft. Standard aortography evaluation was repeated. Result T&K B-EVAR pilot procedures proved successful in various cases, from simple to complex anatomy, and even with varied graft stent deployment strategies. None of the patients had complications or prolonged length of stay (LOS). Follow-up CT did not reveal any high-pressure endoleaks. Conclusion T&K B-EVAR has been proven to simplify endovascular AAA repair in six patients with excellent results. It is also reproducible, potentially universally applicable, and can offer operators ease of use, faster procedure times, reduced fluoroscopy times, and reduced contrast usage.
