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At least 145 records · Page 8Linked to original sources
PubMed2006

The fate of target visceral vessels after fenestrated endovascular aortic repair--general considerations and mid-term results.

OBJECTIVE: To carry out a retrospective analysis of the short and mid-term target vessels (TV) patency following fenestrated endovascular aortic repair (f-EVAR) of abdominal aneurysm (AAA). PATIENTS AND METHODS: Seventeen f-EVAR patients were analysed. The Zenith (Cook) fenestrated graft was used in all cases. Bare renal stents were used where good apposition existed between the stent graft and the aortic wall, and covered stents were chosen when this apposition appeared deficient. RESULTS: A total of 35 TV were treated: twenty with small fenestration and 15 with a scallop. Procedural technical success was achieved in 16 out of 17 patients. All TV were perfused at the completion angiography. Access to TV through small fenestrations was achieved in 18 out of 20 vessels. After a mean follow-up of 20.5 months no type I endoleaks were detected. No late complications were observed in any of the stented TV. One patient with perioperative bilateral renal artery occlusion remains on haemodialysis. One non-target renal artery, opposite a scallop was unintentionally covered. One kidney, initially perfused via a un-stented scallop fenestration, was atrophied 14 months post surgery. One patient died from heart failure. CONCLUSIONS: f-EVAR is a valid and safe treatment option. Our series and the world literature demonstrates a >90% TV preservation rate. Long-term intensive surveillance is required.

Aortic Aneurysm, Abdominal↗
PubMed2002

The feasibility of office-based laser-assisted tympanic membrane fenestration with tympanostomy tube insertion: the duPont Hospital experience.

OBJECTIVE: To determine the feasibility of inserting tympanostomy tubes in children using office-based laser-assisted tympanic membrane fenestration. METHODS AND MATERIALS: Study consisted of a retrospective review of the charts of all children who underwent office-based laser-assisted tympanic membrane fenestration with tympanostomy tube insertion from July 1, 1998 to August 31, 2000. Tetracaine eardrops were used for topical anesthesia. Fenestration was achieved with the OtoLAM flashscanner laser (ESC Sharplan, Yokneam, Israel). RESULTS: Of the 127 patients (185 ears) who underwent laser-assisted tympanic membrane fenestration, 61 ears underwent tympanostomy tube insertion. Ten ears were treated for otitis media with effusion, 43 for recurrent acute otitis media, and eight for acute otitis media not responding to antibiotics. Fifteen ears had purulent effusion, five had a serous effusion, and 23 had mucoid middle ear fluid. Eighteen ears had no middle ear fluid. At the first follow-up visit, all tested ears had hearing of 20 dB or better. Two children had tubes that were blocked. Blockage occurred in ears that required more than one laser firing to penetrate the tympanic membrane. Otorrhea was present in 13 ears (21%). Otorrhea occurred exclusively in ears with purulent or mucoid middle ear fluid. CONCLUSIONS: Office-based laser-assisted tympanic membrane fenestration with tympanostomy tube insertion is a safe and effective alternative to tube placement in the operating room. The outcome compares favorably with previously published data.

Ambulatory Surgical Procedures↗
PubMedDate not supplied

Creation of reentry tears in aortic dissection by means of percutaneous balloon fenestration: gross anatomic and histologic considerations.

PURPOSE: To study the safety and efficacy of percutaneous fenestration in aortic dissection, transmural tears in canine and human aortae were created with conventional angioplasty balloons. MATERIALS AND METHODS: Tears created in the aortae of five living dogs were compared with tears created in postmortem specimens. Percutaneous fenestration was performed in a woman with acute type I dissection and ischemic hepatitis who died in multisystem failure, and the balloon tear was documented at autopsy. Additional tears in the human aorta were studied in necropsy specimens of normal, Marfanoid, atherosclerotic, and acutely and chronically dissected thoracic and abdominal aortae. RESULTS: In the canine aorta, transmural balloon tears resulted in rapid death of all five animals, and the tears were approximately 10% longer than tears created post mortem with the same balloon. In human aortic specimens, most transmural and all transseptal tears were linear and were oriented nearly perpendicular to the longitudinal axis of the aorta. Tears that were initiated near calcified plaques or large aortic branches extended in unpredictable directions. The transverse orientation of the tears coincided with the long axis of smooth muscle cells in the media of the intact aorta or the dissection septum. CONCLUSION: Percutaneous balloon fenestration, when performed in areas of the aorta relatively free of atherosclerosis, results in transverse tears in the aortic dissection septum. Percutaneous fenestration of the aortic dissection septum appears feasible and should be considered as a treatment option in carefully selected cases of aortic dissection with ischemic complications. A final conclusion regarding the safety and efficacy of percutaneous fenestration undertaken to relieve organ ischemia requires further clinical experience.

Aged↗
PubMedDate not supplied

[Surgical technic in femur shaft fenestration within the scope of revision operations following hip joint total endoprostheses].

In revision arthroplasty the loss of stability secondary to fenestration of the proximal femur reduces the loading capacity of the limb and increases the risk of postoperative fractures. Trying to improve the fenestration technique we tested the usual fenestration procedure experimentally. Besides pure axial load we investigated the torsional forces of the proximal femur in the bended hip position. We recorded the deformation under increasing load and analysed the fracture pattern. The results shows an unwarantable loss of stability in lateral or complete ventral fenestration procedures. Ventral fenestration procedures with smooth edges and intact proximal bony ring having additional prosthesis stem support presented the best mechanical results. According to the tolerated load it is possible to give guide-lines for the postoperative treatment in the cemented and cementless arthroplasty of the hip joint.

Adult↗
PubMedDate not supplied

Fenestrated and branched stent-grafting: a 5-years experience.

Fenestrated stent-grafts aim at treating short-necked aneurysms. As a result of customized fenestrations, patency of vital side branches such as the renal arteries and the superior mesenteric artery can be maintained, whilst positioning the graft over these aortic side branches. Over the years, the technique has been refined. Results in a few experienced centers are good, with excellent patency rates of targeted side branches. Suprarenal and thoraco-abdominal aneurysms can only be treated by endovascular means with branched grafts. This can be achieved with fenestrated grafts, but with the use of covered stents through the fenestrations, or by fully branched grafts. Both options are feasible and present with specific advantages and disadvantages. This report gives an overview of our 5-years experience with fenestrated and branched grafts, and discusses the following aspects of the technique: indications, technical principles, results, and limitations.

Aortic Aneurysm↗
PubMed1990

Treatment of highly symptomatic polycystic liver disease. Preliminary experience with a combined hepatic resection-fenestration procedure.

Polycystic liver disease (PLD) associated with autosomal dominant polycystic kidney disease is usually well tolerated. However there is a small subset of patients who become incapacitated by massive liver enlargement and for whom effective nonsurgical therapy is limited. Recent surgical advances in the treatment of PLD have raised uncertainties regarding proper management of these highly symptomatic patients. We have reviewed our recent experience with a combined hepatic resection-fenestration procedure to assess its efficacy in nine patients. All patients underwent resection of two or more liver segments and extensive fenestration of residual cysts in the remnant liver. Symptomatic relief and reduction in abdominal girth were obtained in eight surviving patients, persisting for an average follow-up period of 17 months. No progression of cystic disease has been observed clinically or by computed tomography and hepatic function was preserved. Three patients had no complications. Five patients had complications including transient right pleural effusion (3) and thrombosis of an arteriovenous fistula (2). One patient who had a previous hepatic cyst fenestration and a cadaveric renal transplantation died after operation of an intracerebral hemorrhage after experiencing coagulopathy, hyperbilirubinemia, and sepsis. Our results suggest (1) some highly symptomatic patients with massive PLD may benefit from combined hepatic resection and fenestration with acceptable risk, and (2) previous liver surgery and immunosuppressive therapy may increase the risk of such surgery. Longer follow-up is needed in a larger number of patients to determine the duration of benefit from the combined resection-fenestration procedure for highly symptomatic PLD.

Adult↗
PubMed2002

Tube fenestrations in Baerveldt Glaucoma Implant surgery: 1-year results compared with standard implant surgery.

PURPOSE: To evaluate the efficacy and safety of tube fenestrations in eyes undergoing polyglactin suture-ligated Baerveldt Glaucoma Implant surgery. PATIENTS AND METHODS: The authors performed a retrospective nonrandomized comparative interventional study of consecutive cases of 111 eyes of 111 patients with refractory glaucoma who received polyglactin (Vicryl) suture-ligated Baerveldt 350 implants as a single procedure. In 69 of these cases (group 1), fenestrations were placed anterior to the ligature using a suture needle. In 42 cases (group 2), no fenestrations were performed. Main outcome measures included intraocular pressure, visual acuity, and complications. RESULTS: Mean (+/- SD) preoperative intraocular pressure was 36.7 +/- 10.2 mm Hg in group 1 and 28.3 +/- 10.3 mm Hg in group 2 (P <0.001). Postoperative mean intraocular pressure was lower in group 1 than in group 2 at day 1 (20.2 +/- 12.8 vs. 29.3 +/- 1.9 mm Hg, P <0.001) and week 1 (18.3 +/- 10.4 vs. 23.7 +/- 8.6 mm Hg, P = 0.006), but was virtually identical at 1 year (12.7 +/- 4.9 vs. 12.6 +/- 4.4 mm Hg, P = 0.95). Number of glaucoma medications used by group 1 patients was significantly lower up to 3 months (P </=0.05). Complication rates were similar in both groups. After tube opening at a mean of 36 +/- 4.7 days, there was an equal and sustained intraocular pressure reduction in both groups in patients taking a similar number of glaucoma medicines up to 12 months after surgery. CONCLUSION: Tube fenestrations provide safe and effective short-term intraocular pressure control with fewer glaucoma medications in a ligated nonvalved glaucoma drainage implant, with comparable intraocular pressure control and medications required at 1 year. However, not all patients have sustained reduction of intraocular pressure in the immediate postoperative period with fenestrations, making the effect somewhat unpredictable.

Aged↗
PubMed2005

Role of fenestration and resection for symptomatic solitary liver cysts.

BACKGROUND: Symptomatic liver cysts can be managed surgically by fenestration or by hepatic resection. The present study was designed to investigate the current role of each surgical technique in the management of this benign condition. METHODS: Forty consecutive patients with symptomatic liver cyst (non-parasitic and non-malignant) surgically treated by fenestration or resection were identified from a prospectively collected database. An analysis of primary outcome measures including operative parameters, morbidity and mortality rates, length of postoperative stay and recurrence rates in months was carried out. RESULTS: The laparoscopic fenestration group had the best perioperative outcome. At median follow up of 20 months, there were no recurrences in the resection group but recurrence occurred in 6/27 (22%) in the fenestration group. Four of these recurrences were asymptomatic and were managed conservatively while two symptomatic recurrences required a resection. CONCLUSION: Laparoscopic fenestration is the best treatment for symptomatic liver cysts as the primary operation. It is associated with the lowest blood loss, lowest morbidity and shortest hospital stay. Liver resection is best reserved for recurrent symptomatic cysts and cystic lesions suspicious of tumours where it can be safely performed and associated with a zero recurrence rate.

Adult↗
PubMed2005

Use of stents to maintain atrial defects and fontan fenestrations in congenital heart disease.

Maintaining patent atrial septal communications or fenestrations can be vital in conditions requiring adequate decompression of the atria or Fontan baffle. We have recently deployed stents for this purpose, and the aim of this retrospective analysis is to describe our experience. All 26 patients undergoing such stent placement were retrospectively studied and for neonates with hypoplastic left heart syndrome (HLHS) and patients with Fontan fenestrations, their data were compared to controls undergoing transseptal static balloon dilation during the same time period. All 7 stented neonates with HLHS survived to their Norwood procedure and 57% survived to hospital discharge, similar to those who had static balloon dilation. Complications occurred in both HLHS groups but transient complete heart block was only seen in the control group, which also had larger balloons used (10.3 mm vs 7 mm, P=0.002). The success rate for patients undergoing stent placement in Fontan fenestrations was 64% compared to 76% with dilation alone. Complications were seen in 64% of the Fontan stented group compared to 39% for controls. There were 5 other patients with complex lesions (3 of whom were on the Extracorporeal Membrane Oxygenator) in whom stent placement successfully maintained atrial communication patency. Atrial septal stent placement in neonates with HLHS with restrictive defects is effective and appears at least as safe as static balloon dilation. On the other hand, initial fenestration stent placement is indicated only after extracardiac Fontan procedures in which the previous fenestration location cannot be found.

Adolescent↗
PubMed1990

A comparison of the size of fenestrations in the internal elastic lamina of young and old porcine aortas as seen with the scanning electron microscope.

The size of the fenestrations (windows) in the internal elastic lamina (IEL) of arteries may be important in the functioning of the blood vessel wall. The fenestrations are filled with collagen, muscle, and (or) ground substance, which must be removed to make the fenestration visible with the scanning electron microscope. All of the nonelastic components are removed with a hot alkali solution. Our experiments were designed to compare the fenestration size in the IEL of the thoracic aorta of young (6-8 weeks) and old (6-9 months) pigs. A protocol for digestion of young pig tissue was developed and showed that fresh young aortas should be digested in 0.1 M NaOH at 75 degrees C for 2 h and fixed tissue should be digested for 5 h. The average area of the fenestrations for young pig thoracic aortas digested for 2 h was 1.8 +/- 0.29 (SE) microns 2 and for the old pig aortas digested for 2 h was 1.7 +/- 0.11 (SE) microns 2. These values were not significantly different (p greater than 0.05), but the IEL from young pigs appeared rougher than the previously reported smooth IEL of the adult pigs.

Aging↗
PubMed1991

Analysis of the appearance of fenestrations in the blood vessels of the fetal sheep pituitary.

Using electron microscopy, the appearance of fenestrations within blood vessels of the fetal sheep pituitary gland was studied at 40, 80 and 122 days of gestation (term = 150 days). While fenestrations were extremely rare at 40 days of gestation, blood vessels contained characteristic regions of narrow endothelium, termed attenuations. There was an increase in the frequency of fenestrations with increasing gestational age, while there was a decrease in the number of attenuations, to the extent that the latter were not observed at 122 days of gestation. In order to examine the 'leakiness' of vessels with relatively few fenestrations, the fate of intracardially injected horseradish peroxidase (HRP) was studied in 50- and 51-day fetuses. Flocculant HRP reaction product was observed in the lumen of pituitary blood vessels, within endothelial cells, as well as within perivascular spaces and intercellular spaces between pituitary glandular cells. HRP was also observed in internalised vesicles within pituitary cells. These results indicate that even though fenestrations are scarce at early gestational ages, blood-borne substances can leave the portal network to interact with pituitary cells. The previously reported patency of the portal vascular system in the immature fetus is supported by our observations.

Animals↗
PubMed2000

Clinical outcome of fenestrated Fontan patients after closure: the first 10 years.

BACKGROUND: The late clinical status of Fontan patients after fenestration closure is unknown. Data are now available on all patients who underwent closure from 1989 to 1999. METHODS AND RESULTS: All patients who underwent catheter closure of a Fontan fenestration were enrolled in either the Clamshell (1989 to 1994) or CardioSEAL (1996 to 1999) regulatory trials. Physiological values obtained at catheterization helped assess the hemodynamic effects of fenestration occlusion. In addition to survival, outcomes assessed included O(2) saturations, medication use, significant clinical findings (eg, heart failure, protein-losing enteropathy, or new arrhythmias), and somatic growth. Of 181 patients who underwent closure, 27 had additional significant leaks. The remaining 154 patients constituted the study group. Median time from closure to latest follow-up was 3.4 years (range 0.4 to 10.3 years). Fenestration closure increased O(2) saturation 9.4% on average (P:<0. 001). The numbers of patients receiving digoxin or diuretics decreased at the most recent follow-up compared with baseline (P:<0. 001), but use of antiarrhythmic agents increased marginally (P:=0. 05). Height and weight percentiles rose (medians of 2 and 4, respectively; P:<0.001). Clinical decompensation during follow-up of 154 patients was rare (4.5%), with 2 deaths, 3 Fontan revisions, and 1 patient each with protein-losing enteropathy and ascites. No other patient developed chronic congestive symptoms; 21 patients developed new arrhythmias, and 2 had a stroke or transient ischemic attack. CONCLUSIONS: Fenestration closure in Fontan patients was followed by improved oxygenation, reduced need for anticongestive medication, and improved somatic growth at latest follow-up. Death (1.3%) or chronic decompensation (3.2%) was rare.

Adolescent↗
PubMed2001

Endoluminal aortic grafting with renal and superior mesenteric artery incorporation by graft fenestration.

PURPOSE: To explore the use of juxta- and suprarenal aortic segments for endograft fixation in abdominal aortic aneurysm (AAA) patients and to develop methods of graft implantation that use endograft fenestrations to preserve renal and visceral vessel perfusion. METHODS: From August 1998 to May 2000, 13 AAA patients with unsuitable infrarenal aortic necks were treated with custom-designed endovascular grafts employing the juxta- and suprarenal aortic segments for proximal sealing. Flow to 33 renal and superior mesenteric arteries was maintained via graft fenestrations that were aligned by use of radiopaque graft markers. The fenestration-orifice interface for renal arteries was secured with modified balloon-expandable stents. RESULTS: All fenestrated grafts were deployed as planned, and all target vessels (33/33) were preserved. Two patients did not receive any stents, one being the first in the series and another who had incorporation of a renal accessory artery only. Without the use of transgraft stenting, 5 renal arteries would have been occluded by the endograft or poorly perfused. Procedural success was 100%. No conversion to open operation or graft-related complications occurred. There was no primary endoleak in any patient by angiographic criteria. Two patients required additional surgical procedures related to access vessels. Periprocedural mortality at 30 days was nil. Follow-up ranging from 3 to 24 months on all patients has not demonstrated any proximal or distal endoleaks. One stented renal vessel has occluded; all other arteries remain patent at last examination. CONCLUSIONS: This study has demonstrated the ability to successfully place a multifenestrated endoluminal graft in an aortic aneurysm using juxta- and suprarenal aortic segments to obtain a satisfactory seal. Stenting of the fenestration-renal ostium junction has helped to maintain renal patency.

Aortic Aneurysm, Abdominal↗
PubMed2003

Retrograde fenestration of endoluminal grafts from target vessels: feasibility, technique, and potential usage.

PURPOSE: To report initial experiments involving a new method for percutaneous intraprocedural stent-graft fenestration from the target vessel. TECHNIQUE: In bench and canine models, the fabric of an implanted Zenith endograft was punctured easily using the stiff end of a coronary 0.014-inch guidewire delivered through the target vessel (e.g., renal or iliac artery). A 20-G cutting needle was passed over the coronary wire to enlarge the puncture site, followed by a cutting balloon to create a fenestration that was of sufficient size to allow deployment of a stent. CONCLUSIONS: In vivo endograft fenestration of a Zenith endograft is feasible. In addition to providing a percutaneous means of intentionally fenestrating a stent-graft from the artery to be perfused, the technique has potential application as a bailout maneuver after inadvertent side branch occlusion. Although the time to achieve successful fenestration in the experimental model was long, refinement may achieve performance times adequate to maintain viability of the end organ.

Animals↗
PubMed1993

A retrospective study of ventral fenestration for disk diseases in dogs.

Sixty-six dogs suffering from intervertebral disk diseases on cervical and/or thoracolumbar disks were treated by a ventral fenestration. The breeds affected with disk diseases were Dachshund (65.1%), Beagle (15.2%), Shih Tsu (4.5%), Pekingese (4.5%), and others (18.2%). Sites suffered from disk diseases and received disk fenestration most frequently were from T10-11 to L2-3. However, other disks were also needed the operation in some cases. An average number of disks received fenestration was 6.0. Days to walk after the fenestration in 51 cases varied 1 to 120 days (average: 14.9 +/- 22.0 days, mean +/- S.D.) depending on their severity. The recovery rates from the follow-up study were as follows: In grade I (3 cases, able to walk with back pain) and grade II (14 cases, slight ataxia and paresis) it was 100%, respectively. The rates in grade III (23 cases, paraplegia with positive deep pain) and grade IV (26 cases, paraplegia with lack of deep pain) were 73.9% and 65.4%, respectively. A few recurrence after the operation were observed in this study. As a result, the ventral fenestration was extremely effective as a treatment for disk diseases in the dog.

Animals↗
PubMed2004

In situ stent-graft fenestration to preserve the left subclavian artery.

PURPOSE: To report our first clinical application of a new technique for in situ fenestration of a thoracic stent-graft. CASE REPORT: After completing a series of in vitro and in vivo experiments, in situ stent-graft fenestration was employed during endograft repair of a saccular thoracic aortic aneurysm in a 77-year-old woman. Because the stent-graft would have covered the left subclavian artery ostium, a modified Zenith TX1 thoracic stent-graft was deployed then fenestrated transluminally using a guidewire followed by serial cutting balloons, which created a fenestration over the LSA sufficiently large to accommodate a Jomed covered stent on an 8-mm balloon. Completion angiography showed exclusion of the aneurysm and brisk flow into the LSA. Following the procedure, the arm pressures were nearly equal. The 6-month CT scan showed no endoleak and a patent subclavian artery stent. CONCLUSIONS: In situ graft fenestration to preserve the left subclavian artery after deliberate coverage during endovascular repair of a thoracic aortic aneurysm appears feasible in this initial clinical application. There are uncertainties regarding the long-term stability of the fabric tears that are an inherent part of this technique.

Aged↗
PubMed2005

Fenestrated and branched endografts: assessment of proximal aortic neck fixation.

PURPOSE: To investigate proximal fixation characteristics of different aortic endograft designs: a suprarenally placed fenestrated endograft, a modular branched endograft, an infrarenal endograft with suprarenal bare stent fixation, and the gold standard, a conventional hand-sewn anastomosis. METHODS: Ten human cadaveric aortas were obtained at autopsy and transected 20 mm below the renal arteries to mimic an infrarenal aneurysm neck. In random order, the infrarenal, fenestrated, and branched endografts were deployed into the aorta. Using a hydraulic material testing machine, longitudinal load was applied to the distal end of each endograft until migration occurred, thus defining the displacement force (DF). Subsequently, a hand-sewn infrarenal anastomosis was tested in a similar manner. RESULTS: The median DF was 4.67 N (3.82-6.37) for the infrarenal endograft, 9.17 N (8.03- 10.81) for the fenestrated endograft, and 16.95 N (14.78-19.67) for the branched endograft. The differences in DF between the infrarenal and fenestrated endografts and between the fenestrated and branched designs were statistically significant (both p=0.005). The median force to dislodge the graft from the conventional anastomosis was 89.16 N (71.24-105.23). CONCLUSIONS: Suprarenally placed endografts, especially with additional branch grafts, provide improved proximal fixation compared to an infrarenal endograft with suprarenal bare stent fixation. However, none of the tested endografts approached the optimal, time-proven fixation, the hand-sewn anastomosis.

Aorta, Abdominal↗
PubMed1994

Carbonic anhydrase is abundant in fenestrated capillaries of cherry hemangioma.

A strong correlation has been found between carbonic anhydrase (CA) activity and fenestrations in juxtaepithelial capillaries of several tissues, including psoriatic lesions of human skin. In the present study we demonstrate that the majority of the capillaries in cherry hemangiomas are fenestrated and histochemically react CA positively. Obviously the occurrence of CA in these capillaries corresponds to the fenestrations of venous capillaries, which are numerously revealed by electron microscopy. In normal undiseased skin no capillary staining for CA was observed. Therefore in a large proportion of the capillaries of cherry hemangiomas the correlation between fenestrations and CA activity also exists. We suggest that the histochemical demonstration of CA activity might serve as a sensitive and simple marker for fenestrated capillaries in skin tissue.

Adult↗