Publications by authors named "C Gronert"

5 Publications

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One-Year Results of ZBIS Iliac Branch Device With an Off-Label Connection Limb.

J Endovasc Ther 2021 Oct 28:15266028211054760. Epub 2021 Oct 28.

Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Purpose: The purpose of this article is to study 1-year results of Zenith branch iliac endovascular graft (ZBIS) with the off-label use of a 13 mm spiral Z limb to connect to the aortic main body.

Materials And Methods: A retrospective review from 2015 to 2019 of all iliac branch devices (IBDs) was performed at 1 institution that were connected to an aortic main body with a 13 mm spiral Z limb and had at least 1-year follow-up with computed tomography (CT). Primary endpoints are freedom from ZBIS separation from the connection limb, endoleak (EL), or reintervention at 1 year. Secondary endpoints are primary and secondary ZBIS patency, presence of any EL, and aortic reinterventions.

Results: Of 149 IBDs implanted in this period, 45 ZBIS in 35 patients were connected with a 13 mm limb and had a 1-year CT; 97% of patients had common iliac artery (CIA) aneurysms, 7% of patients had hypogastric artery (HA) aneurysms, and 30% of patients had bilateral ZBIS implantation. Technical success was 98%. In 84% of cases, the Advanta V12 was used as the HA mating stent; 56% of patients had an EL, mostly type II, which resolved spontaneously in 70% at 1 year, and 9% of ZBIS required reinterventions at 1 year (2 for thrombosis, 2 for type Ic EL from HA mating stent). One-year ZBIS primary patency and secondary patency were 96% and 100%, respectively. No EL was noted to be related to the 13 mm connection limb. No migration or separation of the devices occurred.

Conclusions: The use of 13 mm spiral Z limb to connect a ZBIS with the main body in our series yields a high technical success rate and good 12-month outcomes without device separation or migration.
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http://dx.doi.org/10.1177/15266028211054760DOI Listing
October 2021

Feasibility and Preliminary Patency of Prophylactic Hypogastric Artery Stenting for Prevention of Spinal Cord Ischemia in Complex Endovascular Aortic Repair.

Ann Vasc Surg 2021 Oct 13. Epub 2021 Oct 13.

Department of Vascular Medicine, University Heart & Vascular Center Hamburg, Hamburg, Germany.

Background: To report early results of feasibility and patency of prophylactic hypogastric artery (HA) stenting during complex endovascular aortic repair.

Methods: This is a single centre retrospective non comparative cohort study of all consecutive patients undergoing prophylactic HA stenting during fenestrated and/or branched EVAR (F/B EVAR) in order to prevent spinal cord ischemia (SCI). Endpoints included technical success and early outcomes in terms of morbidity, mortality and patency of the implanted stents.

Results: Between May 2014 and June 2019 prophylactic HA stenting was performed in 36 consecutive patients with significant HA stenosis during F/B EVAR to prevent SCI. 69.4% of patients presented with asymptomatic, 25% with symptomatic and 5.6% with ruptured aortic aneurysms. 55.6% were treated for thoracoabdominal aortic aneurysms, 44.4% for pararenal abdominal aortic aneurysms. In 13.9% aortic coverage was limited to the abdominal aorta. In 86.1% the aortic coverage was in the thoracoabdominal aortic segment. Unilateral HA stenting was performed in 91.7%, whereas 8.3% underwent bilateral stenting. Technical success was 100%. The primary patency of the implanted stents after a median follow-up time of 9.5 months was 97.5%. One intraprocedural bleeding from an HA branch occurred and was successfully treated by coil embolization. No further procedure-related complications occurred. 11.1% of the patients developed SCI.

Conclusions: HA stenting is feasible and safe with high rates of technical success and short-term patency.
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http://dx.doi.org/10.1016/j.avsg.2021.07.053DOI Listing
October 2021

Acute Hemispheric Stroke: Full Remission Following Surgical Thrombectomy.

EJVES Vasc Forum 2020 8;47:31-34. Epub 2020 Apr 8.

Department for Vascular Medicine, Vascular Surgery, Angiology and Endovascular Therapy, University Heart and Vascular Centre, Hamburg-Eppendorf, Hamburg, Germany.

Introduction: Carotid occlusion because of embolisation or as a distal extension of thrombus formation in an ulcerated plaque can be the cause of a devastating stroke, caused by sudden occlusion of the internal carotid artery (ICA). Often, invasive treatments are not an option because of the limited time frame. In rare situations of acute stroke onset and admission to therapy within six hours however, aggressive recanalisation may be considered. This technical note demonstrates surgical transcatheter embolectomy of intra-extra cranial ICA by reducing inflow by placing a clamp on the common carotid artery (CCA) before puncture cranial to the clamp.

Patient And Technique: A 67 year old man was admitted as an emergency seven hours after an acute hemispheric stroke with paraplegia of his left arm and full consciousness. An immediate duplex scan showed more than 90% stenosis of the carotid bifurcation with low echolucent plaque material extending proximally up to the intracranial ICA. CT angiography confirmed the stenosis and a sub-occlusive thrombosis of the ICA up to the M1 segment of the middle cerebral artery (MCA). Because the onset of clinical symptoms was more than six hours previously, the patient was not within the clinical window for endovascular therapy. Following interdisciplinary consensus, surgical over the wire thrombectomy with endarterectomy with complete removal of the thrombus and subsequent thrombo-endarterectomy of the carotid bifurcation and bovine patch plasty was performed. The patient was discharged with statin and antiplatelet treatment on the second post-operative day with full remission of symptoms.

Conclusions: Immediate surgical transcatheter recanalisation of acute intra-extracerebral ICA thrombus with inflow reduction can be a valid procedure to improve cerebral circulation, leading to full remission of stroke symptoms.
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http://dx.doi.org/10.1016/j.ejvsvf.2020.03.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8074627PMC
April 2020

Hypogastric Artery Stenting for Chronic Intermittent Spinal Cord Ischemia After Thoracic Endovascular Aortic Repair.

J Endovasc Ther 2020 Oct 20;27(5):801-804. Epub 2020 May 20.

German Aortic Center Hamburg, Department of Vascular Medicine, University Heart & Vascular Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.

Purpose: To report a case of chronic intermittent spinal cord ischemia (SCI) after thoracic endovascular aortic repair (TEVAR) and its successful treatment using hypogastric artery stenting.

Case Report: A 79-year-old patient presented in May 2013 with a thoracic aortic aneurysm (TAA) and a contained rupture. He urgently underwent TEVAR that covered 274 mm of descending thoracic aorta without immediate postoperative signs of acute SCI. At 3-month follow-up, he reported repeating incidents of sudden lower extremity weakness leading to a fall with a humerus fracture. A neurological consultation revealed the tentative diagnosis of intermittent SCI caused by TEVAR and initially recommended a conservative approach. During the following year there was no clinical improvement of the symptoms. Computed tomography angiography showed a high-grade stenosis of the right hypogastric artery, which was stented in November 2014 to improve the collateral network of spinal cord perfusion. Following treatment, the patient had no further neurological symptoms; at 32 months after the reintervention, the imaging follow-up documented a patent stent and continued exclusion of the TAA.

Conclusion: Intermittent neurological symptoms after TEVAR should be suspected as chronic intermittent SCI. The improvement of collateral networks of the spinal cord by revascularization of the hypogastric artery is a viable treatment option.
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http://dx.doi.org/10.1177/1526602820925445DOI Listing
October 2020

Endovascular Repair Using a 7-Branch Stent-Graft for a Thoracoabdominal Aortic Aneurysm With Variant Renovisceral Artery Anatomy.

J Endovasc Ther 2020 04 9;27(2):231-236. Epub 2019 Dec 9.

German Aortic Center, Department of Vascular Medicine, University Heart & Vascular Center Hamburg, University Hospital Hamburg-Eppendorf, Hamburg, Germany.

To present a case of endovascular repair using a custom-made 7-branch stent-graft for a thoracoabdominal aortic aneurysm (TAAA) in a patient with variations in the renovisceral artery anatomy. A 70-year-old asymptomatic man presented with a 60-mm-diameter type IV TAAA. Due to severe coronary artery disease, an endovascular approach was elected. In the preoperative computed tomography angiography (CTA) scans, variations in the renovisceral artery anatomy included the common hepatic and splenic arteries deriving separately from the aorta and bilateral double renal arteries (RAs). A custom-made 7-branch stent-graft was manufactured to preserve all renovisceral arteries. The 7 branches were catheterized and connected with a steerable sheath from a femoral access. All branches were bridged to the target vessel (TV) with a self-expanding covered stent; 4 TVs also had balloon-expandable covered stents implanted. Final angiography and predischarge CTA showed patency of all 7 target vessels and corresponding visceral organs, with no endoleak. The patient was discharged on postoperative day 8 without complications. Six-month follow-up CTA demonstrated exclusion of the TAAA and patency of all 7 target vessels. Successful treatment of a TAAA in a patient with multiple variant renovisceral arteries was feasible with a custom-made 7-branch stent-graft, achieving a good early outcome.
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http://dx.doi.org/10.1177/1526602819892557DOI Listing
April 2020
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