• Yongxue Zhang, Zhongzhao Teng, Qingsheng Lu, Zhiqing Zhao, Junmin Bao, Xiang Feng, Rui Feng, Zengsheng Chen, Yuan Huang, Umar Sadat, Jonathan H Gillard, and Zaiping Jing.
• From the Division of Vascular Surgery, Changhai Hospital, Shanghai, China (YZ, QL, ZZ, JB, XF, RF); University Department of Radiology, University of Cambridge, UK (YZ, ZT, YH, JHG); Department of Engineering, University of Cambridge, UK (ZT); School of Aerospace, Tsinghua University, Beijing, China (ZC); Cambridge Vascular Unit, Addenbrooke's Hospital, Cambridge, UK (US); and Military Institute of Vascular Disease, the First Affiliated Hospital of Second Military Medical University, Shanghai, China (ZJ).
• Medicine (Baltimore). 2014 Dec 1; 93 (27): e209e209.

AbstractThis study sought to report the mid-term outcome of a modified flow-diverting strategy in the treatment of complicated aortic aneurysms of different morphology. Historical data suggested aortic aneurysm expansion and rupture after endovascular treatment with current commercial flow-diverters, indicating the essentiality of further investigation of this technique prior to its large-scale clinical application. An alternative flow-diverting strategy using layer-by-layer assembled multiple overlapping uncovered stents was employed in this study. The treatment outcome in aneurysms of different morphology (saccular, fusiform, and dissecting) was assessed during a mid-term follow-up period.Of 42 patients enrolled in this study (30 male, mean age: 63.3 years), technical success was achieved in 40 cases. During an average follow-up period of 20.9 months, mean aneurysm diameter shrunk from 53.4 ± 13.6 mm to 48.8 ± 13.9 mm (P < 0.001), while stent-induced sac thrombosis ratio increased significantly (18.1 ± 14.9% to 93.6 ± 9.5%, P < 0.001). The majority of side branches (74/76 major visceral branches, 237/244 minor segmental arteries), covered by 3.3 stents on average, maintained their patency after stenting. Saccular aneurysms manifested the highest thrombus deposition speed (18/20 were totally thrombosed within 12 months) and most significant shrinkage (51.4 ± 13.3 mm pre-operatively vs 43.5 ± 10.2 mm during follow-up, P < 0.001) compared with fusiform and dissecting aneurysms. This modified flow-diverting strategy could be a feasible alternative in the management of complicated aortic aneurysms where vital branches need to be preserved. The treatment outcome may depend on the aneurysm type. Further studies with larger patient cohort and longer follow-up are required to substantiate these results.

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