title: Routine use of an aortic balloon to resolve possible inflow stenosis induced by the inflatable ring fixation mechanism of the Ovation endograft.
abstract: OBJECTIVE
  To investigate if the routine use of an aortic balloon within 15-30 min after Ovation stent graft ring inflation would resolve any inflow stenosis, which may reach 60 %, at the level of the sealing rings. Moreover, we estimated the potential hemodynamic compromise in these patients during rest and exercise.
  
  
  METHODS
  Following 3-dimensional reconstruction of AAA models, cross-sectional area of the infrarenal aorta just proximal the sealing mechanism (Aaort, Raort, respectively) and internal area at the site of stenosis (Aint, Rint, respectively) were measured for 83. Forty-nine patients were managed without and 34 with an aortic balloon use. Pressure drop during rest and exercise was estimated.
  
  
  RESULTS
  Technical success was 98 % and there were no perioperative deaths, one type-I endoleak, and 12 (14.5 %) type-II endoleaks. Median Aintand Rintwere significantly reduced compared to Aaort[55 % reduction, 143 (range 28-380) mm2vs 314 (range 177-531) mm2, P value <0.001] and Raort[42 % reduction, 6.75 (range 3-11) mm vs 10 (range 7.5-13) mm, P value <0.001]. The observed stenosis was significantly less for patients in whom an aortic balloon was used intraoperatively (area reduction 36 vs 59 %, P value = 0.009). This stenosis caused a statistically significant, but clinically insignificant ΔP in both groups during rest (0.13 vs 0.06 mmHg, P value = 0.02) and exercise (1 vs 0.5 mmHg, P value = 0.02).
  
  
  CONCLUSIONS
  The advantages of the unique sealing mechanism of the Ovation device seem to be accompanied by an inflow stenosis which is significantly reduced when neck molding with an aortic balloon is used. Overall, the hemodynamic impact of this abnormality seems to be clinically insignificant at 1-month follow-up.
authors.affiliation: Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, University of Crete Medical School, PO Box 1352, 711 10, Heraklion, Greece. ioannou@med.uoc.gr.
authors.forename: Christos V
authors.initials: CV
authors.lastname: Ioannou
authors.affiliation: Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, University of Crete Medical School, PO Box 1352, 711 10, Heraklion, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Kontopodis
authors.affiliation: Vascular Surgery Department, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece.
authors.forename: Efstratios
authors.initials: E
authors.lastname: Georgakarakos
authors.affiliation: Interventional Radiology Unit, Department of Radiology, University of Crete Medical School, Heraklion, Crete, Greece.
authors.forename: Elias
authors.initials: E
authors.lastname: Kehagias
authors.affiliation: Institute of Applied and Computational Mathematics, Foundation for Research and Technology-Hellas, Heraklion, Greece.
authors.forename: Eleni
authors.initials: E
authors.lastname: Metaxa
authors.affiliation: Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, University of Crete Medical School, PO Box 1352, 711 10, Heraklion, Greece.
authors.forename: Stella
authors.initials: S
authors.lastname: Lioudaki
authors.affiliation: Institute of Applied and Computational Mathematics, Foundation for Research and Technology-Hellas, Heraklion, Greece.
authors.forename: Yannis
authors.initials: Y
authors.lastname: Papaharilaou
authors.affiliation: Interventional Radiology Unit, Department of Radiology, University of Crete Medical School, Heraklion, Crete, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Tsetis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging* / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000628:therapy*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D057510:Endovascular Procedures; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging* / Q000628:therapy*; D006439:Hemodynamics; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Abdominal aortic aneurysm; Aortic hemodynamics; Aortic stenosis; Endograft oversizing; Endograft planning; Endovascular aneurysm repair (EVAR); Low-profile endograft