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PubMed2005

Repair of juxtarenal para-anastomotic aortic aneurysms after previous open repair with fenestrated and branched endovascular stent grafts.

Three patients with juxtarenal para-anastomotic aortic aneurysms after previous open abdominal aortic aneurysm repair were treated with custom-designed fenestrated and branched Zenith endovascular stent grafts. Six renal arteries and two superior mesenteric arteries were targeted for incorporation by graft fenestrations and branches. The fenestration/renal ostium interface was secured with balloon-expandable Genesis stents (n = 5) or Jostent stent grafts (n = 1). Completion angiography demonstrated no endoleaks and antegrade perfusion in all target vessels. During follow-up, one patient developed asymptomatic renal artery occlusion and underwent further endovascular intervention for type I distal endoleak. Computed tomography at 12 months demonstrated complete aneurysm exclusion in all patients with antegrade perfusion in the remaining target vessels. Fenestrated and branched endovascular stent grafts may be an acceptable alternative to conventional open repair in this group of patients.

Aged↗

PubMed1998

Fontan fenestration closure in the catheterization laboratory--echocardiographic evaluation of residual right to left shunts.

This study is a retrospective review using transthoracic echocardiography to assess the success of fenestration closure as well as residual right to left shunts in 35 patients who underwent Fontan fenestration closure in the catheterization laboratory. There is a high rate of closure of the Fontan fenestration; however, other residual right to left shunts are common.

Adolescent↗

PubMed2004

Inhibition of vascular endothelial growth factor (VEGF) signaling in cancer causes loss of endothelial fenestrations, regression of tumor vessels, and appearance of basement membrane ghosts.

Angiogenesis inhibitors are receiving increased attention as cancer therapeutics, but little is known of the cellular effects of these inhibitors on tumor vessels. We sought to determine whether two agents, AG013736 and VEGF-Trap, that inhibit vascular endothelial growth factor (VEGF) signaling, merely stop angiogenesis or cause regression of existing tumor vessels. Here, we report that treatment with these inhibitors caused robust and early changes in endothelial cells, pericytes, and basement membrane of vessels in spontaneous islet-cell tumors of RIP-Tag2 transgenic mice and in subcutaneously implanted Lewis lung carcinomas. Strikingly, within 24 hours, endothelial fenestrations in RIP-Tag2 tumors disappeared, vascular sprouting was suppressed, and patency and blood flow ceased in some vessels. By 7 days, vascular density decreased more than 70%, and VEGFR-2 and VEGFR-3 expression was reduced in surviving endothelial cells. Vessels in Lewis lung tumors, which lacked endothelial fenestrations, showed less regression. In both tumors, pericytes did not degenerate to the same extent as endothelial cells, and those on surviving tumor vessels acquired a more normal phenotype. Vascular basement membrane persisted after endothelial cells degenerated, providing a ghost-like record of pretreatment vessel number and location and a potential scaffold for vessel regrowth. The potent anti-vascular action observed is evidence that VEGF signaling inhibitors do more than stop angiogenesis. Early loss of endothelial fenestrations in RIP-Tag2 tumors is a clue that vessel phenotype may be predictive of exceptional sensitivity to these inhibitors.

Animals↗

PubMed2004

Total extracardiac cavopulmonary connection: an alternative technique of fenestration.

Fenestrating an extracardiac conduit used for total cavopulmonary connection normally requires an additional incision on the right-sided atrium and is time consuming. Herein we describe an alternative technique that may be used to facilitate this process, which consists of creating the fenestration by using part of the atrial incision resulting from the disconnection of the inferior vena cava from the right atrium. The advantages of this technique are avoidance of an extra incision and suture line on the atrium, and the ease of construction. This may be especially useful in patients with heterotaxy syndromes with mesocardia or dextrocardia, in whom the atrial mass is displaced posteriorly and can be difficult to reach. Closure of the fenestration can be easily performed at a later stage in the cardiac catheterization laboratory by using a septal occluding device.

Anastomosis, Surgical↗

PubMed1998

Catastrophic transcatheter baffle fenestration for failing Fontan physiology.

Transcatheter fenestration and balloon dilation of an atrial baffle created from native atrial tissue was attempted in a 15-year-old girl with failing Fontan physiology and protein-losing enteropathy. After transseptal puncture, initial dilations with a 10-mm and 12-mm diameter balloon resulted in an inadequate fenestration, with no significant decrease of right atrial pressure or systemic arterial saturation. Dilation of the fenestration with a 16-mm-diameter balloon produced a tear of the atrial septum and subsequent death. Balloon dilation of native atrial tissue may result in uncontrolled tears of the atrial septum.

Abnormalities, Multiple↗

PubMed2006

[Terminovertebral aneurysm arising from basilar artery fenestration].

A case of ruptured middle saccular aneurysm arising from basilar artery fenestration is reported. Defects of the medial wall at the junctures of the fenestrated segments explain the association between vertebrobasilar aneurysms and basilar artery fenestration. A 47 year-old woman had a perimesencephalic subarachnoid hemorrhage. Immediate angiography revealed a ventral vertebrobasilar aneurysm and an endovascular coil occlusion was performed. Embryological development, pathogenesis and therapeutic difficulties are discussed.

Adult↗

PubMed1994

Choroidal infarction after optic nerve sheath fenestration.

PURPOSE: To describe a visual complication of optic nerve sheath fenestration. METHODS: Case review of two patients who underwent seemingly uncomplicated optic nerve sheath fenestration. FINDINGS: Both patients had a surgical complication that resulted in significant depression of their temporal visual field and development of a wedge-shaped region of subretinal pigmentation in the nasal fundus. CONCLUSIONS: Both patients had choroidal infarctions as a complication of optic nerve sheath fenestration. Choroidal infarction should be considered in cases of unexpected loss of visual field after this type of surgery, although the funduscopic signs that assist in making the diagnosis may not be evident for several weeks after surgery.

Adult↗

PubMed1987

Fenestrated medial patella plica.

Fenestrated medial patellar plicae are unusual. In a review of 1,000 consecutive knee arthroscopies, the incidence of this finding was 1.8%. These fenestrations may vary in size and shape from being small, circular, and only 5 mm in diameter to being lengthwise openings 3-4 cm long. There is a high prevalence of associated medial knee symptoms (80%) that are relieved by complete resection. Since the plical fenestration does not appear to abrade the articular cartilage, symptoms are probably the result of medial wall inflammation.

Adolescent↗

PubMedDate not supplied

Acute aortic regurgitation due to spontaneous rupture of a fenestrated cusp: report in a 65-year-old man and review of seven additional cases.

A 65-year-old man with chronic hypertension developed dyspnea, a cough, and a new diastolic murmur. Two-dimensional echocardiography showed severe aortic regurgitation. No valvular vegetations were identified and blood cultures were negative. Surgical intervention was recommended, but the patient died of an acute intracranial hemorrhage two weeks later. At autopsy, the posterior aortic cusp was flail, due to rupture of the residual cord above two large fenestrations. There was no acute or healed endocarditis. To our knowledge, this is the eighth reported case of aortic valve incompetence due to spontaneous rupture of a fenestrated cusp. Patients ranged in age from 31-67 years (mean, 54), and 4 (50%) were older than 60 years. Seven (88%) of the 8 were men, and 4 (57%) of 7 had chronic hypertension. Analogously, in another four reported cases, aortic insufficiency developed following spontaneous rupture of the fenestrated raphe of an atypical congenitally bicuspid aortic valve. Noninfective and nontraumatic rupture of cord-like aortic valve structures may result in severe acute aortic regurgitation, particularly in men with chronic hypertension.

Acute Disease↗

PubMed1987

Fenestration of the supraclinoid internal carotid artery.

A twenty-eight year old woman presenting with subarachnoid hemorrhage was found at angiography to have a left anterior cerebral-anterior communicating artery aneurysm. Also identified was a fenestration of the right supraclinoid internal carotid artery with an associated accessory middle cerebral artery. This appears to be the second reported case of fenestration of the intracranial internal carotid artery. Fenestrations of cerebral vessels and their possible embryologic origins are briefly reviewed.

Adult↗

PubMed2006

Can we do without routine fenestration in extracardiac total cavopulmonary connections? Report on 84 consecutive patients.

Fenestration is still widely used in right heart bypass operations. Our study was conducted to assess its need in the most recent modification, the completion of a total cavopulmonary connection with an extracardiac tube. The extracardiac approach was introduced at our institution in January, 1999. Since June of 2000, no patient had a fenestration. If more than 1 risk factor amongst ventricular function being more than moderately impaired, atrioventricular valvar regurgitation more than moderate, mean pulmonary arterial pressure more than 15 millimetres of mercury, mean atrial pressure higher than 12 millimetres of mercury, pulmonary arterial distortion, or other than sinus rhythm was present preoperatively, the patient was considered a "high risk" candidate. Postoperatively elevated pulmonary arterial pressure higher than 16 millimetres of mercury, prolonged effusions and requirement for drainage longer than 7 days, and death were considered endpoints in the statistical analysis. Our study group included 84 patients who underwent surgery up to August, 2004. A previous bidirectional cavopulmonary anastomosis had been accomplished in 73 patients at a mean age of 27.01 plus or minus 32.60 months, with a median of 11.5 months, without creating an additional source of flow of blood to the lungs. At the time of the total cavopulmonary connection, the mean age was 66.4 plus or minus 60.1 months, with a median of 37.1 months, and a range from 17.3 to 251.2 months, with 50 patients being younger than 48 months. We deemed 16 patients to be at "high risk". These patients were older at the time of bidirectional cavopulmonary anstomosis (p smaller than 0.016), at the time of completion (p smaller than 0.019), and also differed in size at time of completion (p smaller than 0.020). They required a longer time on cardiopulmonary bypass (p smaller than 0.015), and reached higher early postoperative pulmonary arterial pressures after completion (p smaller than 0.025). There were no differences between groups of patients having up to 1 or more risk factors in regard to need for intubation (p smaller than 0.511), pulmonary arterial pressures after extubation (p smaller than 0.817), and duration of chest drainage (p smaller than 0.650). Three patients died, one in the group deemed at high risk. There was no death in the last 38 patients. We conclude that a total cavopulmonary connection with an extracardiac tube can be performed without fenestration, even if the patients are deemed to be at increased risk. Early staging of patients with functionally univentricular physiology might be one of the keys for these findings.

Adolescent↗

PubMed2002

Does laparoscopic fenestration provide long-term alleviation for symptomatic cystic disease of the liver?

BACKGROUND: The use of laparoscopic technique for management of symptomatic liver cysts is documented to be a feasible and safe procedure with good short-term symptomatic relief. However, it cannot be recommended as the standard of care as long-term results are scarce. The present study was initiated to review the long-term results of this approach in the management of symptomatic liver cysts. METHODS: A retrospective review of all patients with symptomatic liver cysts that were treated by laparoscopic fenestration in our department over an 8-year period from 1993 to 2001. The clinical and radiographical data were analysed at follow-up to assess the -outcome. RESULTS: Eleven patients were treated using a laparoscopic approach; 10 patients with solitary cysts and one with adult polycystic liver disease. All patients achieved short-term alleviation of symptoms and an uneventful postoperative course. The mean hospital stay was 3 days. Long-term follow up was available for 9 patients with a mean of 44 months. Histologically, one of the patients was diagnosed with a biliary cystadenoma and she had a symptomatic recurrence and a liver resection at 20 months. In the other seven patients, there was no clinical recurrence but a radiographical recurrence of 28.5%. The patient with adult polycystic liver disease had two symptomatic recurrences: at 26 months where he underwent a repeat laparoscopic fenestration and at 43 months where he underwent an open fenestration. CONCLUSION: The present study confirms that with adequate patients election, long-term alleviation of symptoms can be achieved with the laparoscopic approach for solitary simple liver cysts but not for polycystic liver disease or cystic tumours of the liver.

Adult↗

PubMed1998

Neuroendoscopic fenestration of arachnoid cysts.

The authors report 6 patients with arachnoid cysts treated endoscopically. The series includes 6 patients with temporobasal arachnoid cysts. The age of the patients at the time of diagnosis ranged from 5 to 71 years. The patients' symptoms included headache, seizures, vomiting, nausea, dizziness, and problems with balance. The authors performed cystocisternostomies via burr holes with the aid of a universal neuroendoscopic system. In 4 cases the endoscopic fenestration was a unique treatment which enabled the avoidance of a definitive cystoperitoneal shunt. In the two cases treated subsequently, cystoperitoneal shunts were performed. The surgical endoscopic technique and the postoperative radiological findings which indirectly confirm the patency of the fenestration are discussed. The authors conclude that endoscopic fenestration of intracranial fluid cysts represents the treatment of preference. In cases where the endoscopic procedure fails a microneurosurgical procedure or cystoperitoneal shunting is recommended to avoid exposing the patient to additional risk.

Adolescent↗

PubMed1994

Endoscopic fenestration of the 3rd ventricular floor in aqueductal stenosis.

Six endoscopic fenestrations of the 3rd ventricular floor have been performed in patients with stenosis (SAS) of the aqueduct of Sylvius in our institute during the last two years. The endoscopic intraventricular landmarks were the Monro's foramen followed by the mamillary bodies. The fenestration instrument was a monopolar coagulation wire, the dilatation instrument was a balloon catheter. The patients included two newborns and four adults. The two newborns developed a recurrent hydrocephalus after 2 months. The four adults remained well after the operation. The only complication was edema (SIADH syndrome) in one case for 24 hours. Flow sensitised phase MRI showed a mirroring in the prestenotic CSF pulsation curve preoperatively. This, in combination with an increased intraventricular pulsation, is a sign of reduced capacity of the subarachnoid space at the cerebral surface. The postoperative patency of the fenestration with diminished intraventricular pulsation can be demonstrated with ECG retrogated phase MRI. There was a slow and incomplete decrease of the preoperative enlarged ventricular size. This operative method is a low-risk, minimal invasive alternative method to shunt implantation in adults with SAS.

Adult↗

PubMed2000

Transcatheter closure of fenestrations and excluded hepatic veins after fontan: versatility of the Amplatzer device.

BACKGROUND: The aim of this study was to evaluate the Amplatzer septal occluder (ASO) for transcatheter closure of fenestrations and excluded hepatic veins in patients after modified Fontan operations. Residual right-to-left shunts have improved surgical results of the Fontan operation. Shunt closure may eventually be desirable to eliminate hypoxemia and reduce risk of embolic complications. METHODS AND RESULTS: Ten patients with hypoxemia caused by residual shunts after Fontan procedures were evaluated for closure. After favorable results of test occlusion, all shunts were closed with the use of the ASO. Eight ASOs were used to close fenestrations in 7 patients with 6F transvenous sheaths. Three ASOs were used to close excluded hepatic veins in 3 patients with 6F venous sheaths and transbaffle punctures. Fluoroscopy and transesophageal echocardiography were used to guide device placement. Device placement in all patients was successful. All shunts were closed by angiography after device placement. While breathing room air, systemic oxygen saturation rose from 87.9% +/- 3.0% to 96.3% +/- 0. 9% (P <.001) in the patients. There were no complications of the implant procedures and none noted in outpatient follow-up. CONCLUSIONS: This experience suggests that the ASO is safe and effective for closing surgical shunts after Fontan procedures. The ASO design allows closure of excluded hepatic veins and has advantages over other devices in closure of fenestrations.

Adolescent↗

PubMed2001

Transesophageal echocardiography in intimal flap fenestration.

In selected patients with descending aortic dissection, percutaneous intimal flap fenestration is a less-invasive alternative to surgery. We describe a patient with decreased renal and mesenteric blood flow as a result of descending aortic dissection. Percutaneous balloon intimal fenestration was performed under guidance of transesophageal echocardiography. Transesophageal echocardiography provided crucial information about the intimal flap puncture site and true- and false-lumen blood flow. After the flap fenestration, false-lumen blood flow increased, and the patient improved clinically.

Aortic Dissection↗

PubMed1985

The formation of fenestrations and channels by capillary endothelium in vitro.

Microvascular endothelial cells isolated from fenestrated capillaries have been shown to form tubes in vitro, thereby demonstrating that they retain the ability to express some degree of their in vivo differentiated phenotype. However, some of their physiologically important structural features, such as transendothelial openings (i. e., diaphragmed fenestrations and transendothelial channels) are lost or are greatly reduced in number. In this study, cloned bovine adrenal cortex endothelial cells were cultured on plastic or on a basal lamina produced by Madin-Darby canine kidney (MDCK) cells for up to 17 days postconfluence. All cultures were then routinely fixed and processed for electron microscopic morphometry. For cells grown on plastic for 17 days postconfluence, the linear density of transendothelial openings in endothelial profiles less than 400 nm thick was found to be 0.007 openings per micron. On MDCK matrix, however, the linear density of transendothelial openings in endothelial profiles less than 400 nm thick was found to be 0.157 per micron. Occasionally some cells formed "tube-like" structures that also contained diaphragmed fenestrations and transendothelial channels on both sides of the tubes. These findings suggest that the substrate on which endothelial cells are grown can affect their differentiation.

Animals↗

PubMed2004

Effects of Arg-Gly-Asp sequence peptide and hyperosmolarity on the permeability of interstitial matrix and fenestrated endothelium in joints.

OBJECTIVES: The aims were to assess the contribution of arg-gly-asp (RGD) mediated cell integrin-matrix bonds to interstitial hydraulic resistance and to fenestrated endothelial permeability in joints. Joint fluid is generated by filtration from fenestrated capillaries and drains through a fibronectin-rich synovial intercellular matrix. The role of parenchymal cell-matrix bonding in determining tissue hydraulic resistance is unknown. METHODS: The knee cavity of anesthetized rabbits was infused with saline or the competitive hexapeptide blocker GRGDTP, with or without added osmotic stress (600 mosm saline). Intra-articular pressure Pj, net trans-synovial drainage rate s, and the permeation of Evans blue-labeled albumin (EVA) from plasma into the joint cavity were measured. RESULTS: GRGDTP increased the hydraulic conductance of the synovial drainage pathway, ds/dPj, by 71% (p =.02, paired t test, n = 6 animals). Synovial plasma EVA clearance (control 7.1 +/- 0.8 microL h-1, mean +/- SEM, n = 15) was unaffected by GRGDTP (7.0 +/- 2.3 microL h(-1), n = 6) or hyperosmolarity (4.9 +/- 1.5 microL h(-1), n = 8) but was increased by GRGDTP and hyperosmolarity together (15.9 +/- 4.8 microL h(-1), n = 5) (p =.01, ANOVA). Changes in dPj/dt evoked by GRGDTP plus hyperosmolarity, but neither alone, demonstrated increased microvascular filtration into the joint cavity (p <.001, ANOVA), as did changes in fluid absorption from the infusion system at fixed Pj. CONCLUSIONS: RGD-mediated bonds between the parenchymal cells and interstitial polymers reduce the interstitial hydraulic conductance by 42%. This helps to retain the lubricating fluid inside a joint cavity. RGD-mediated bonds also support the macromolecular barrier function of fenestrated endothelium, but in vivo this is evident only in stressed endothelium (cf. in vitro).

Albumins↗