Multilayer Flow Modulator (MFM) Stent Insertion at Saccular Aneurysm in Peri-visceral Aorta: A Case Report.

Introduction: To manage abdominal aorta aneurysm, especially supra-renal, open repair aorta surgery or EVAR with Chimney technique seemed evident until now. Multilayer Flow Modulator (MFM) is an effective and safe solution to achieve this problem and is the newest procedure for high-surgical-risk patients. We report our experience with MFM device for peri-visceral aorta aneurysm patient. Methods: A 67-year-old female with focal significant stenosis at right renal artery affected by 2.4 x 1cm saccular aneurysm in the peri-visceral aorta. Branched and fenestrated endovascular options were excluded because it is impossible in Korea, while the chimney technique was excluded due to its unattainability. Before the deployment of MFM stent, right renal artery angioplasty with 5mm x 19mm stent was done and the angiogram showed improved blood flow. Along with 3D reconstructed CT images, AneurysmFlowSM (Philips) angiogram was done in our Hybrid operating room. Then we successfully deployed a 25mm x 100mm MFM stent into the aorta and post-procedure AneurysmFlowSM angiogram was done. Results: Before the MFM deployment, AneurysmFlowSM angiogram showed complex turbulence of contrast dye along the aorta and this indicates that vorticity is presenting in the aneurysmal sac. Post-deployment AneurysmFlowSM showed slight but improved turbulent flow which is achieved by flow lamination. Renal arteries, including the one with a stent, show excellent blood flow without any defects. Post-operative complications like infection, stent thrombus and migration were not noted with 100% technical success. The patient showed a pre-operative eGFR of 74.7 mL/min and 96 mL/min postoperatively. Other laboratory findings remained normal and she was discharged 5 days after the procedure. [Formula presented] Conclusion: The MFM can be utilized in high-surgical-risk patients with peri-visceral aortic as well as thoracoabdominal aortic aneurysms with safety. MFM is an alternative treatment approach to current devices with no long-term comparative data. Its effectiveness and ability to preserve collateral branches are an important aspect and randomized clinical trials are essential to becoming a viable alternative endovascular treatment. References 1. Arnaoutakis, G. J. and W. Y. Szeto (2016). "Can the Streamliner multilayer flow modulator really streamline the solution to complex arch and thoracoabdominal aortic pathology?" J Thorac Cardiovasc Surg 152(5): 1319-1320 2. Bozzani, A., et al. (2015). "Descending thoracic aorta remodeling after multilayer stent release." Ann Vasc Surg 29(5): 1018-1011. 3. Ferrero, E., et al. (2014). "Aortic arch rupture after multiple multilayer stent treatment of a thoracoabdominal aneurysm." J Vasc Surg 60(5): 1348-1352. Morris, L., et al. (2016). "An Experimental Evaluation of Device/Arterial Wall Compliance Mismatch for Four Stent-Graft Devices and a Multi-layer Flow Modulator Device for the Treatment of Abdominal Aortic Aneurysms." Eur J Vasc Endovasc Surg 51(1): 44-55. Oderich, G. S. (2017). "Evidence of use of multilayer flow modulator stents in treatment of thoracoabdominal aortic aneurysms and dissections." J Vasc Surg 65(4): 935-937. Pane, B., et al. (2016). "A Single-Center Experience of Aortic and Iliac Artery Aneurysm Treated with Multilayer Flow Modulator." Ann Vasc Surg 30: 166-174. Ruffino, M. and C. Rabbia (2011). "Endovascular treatment of visceral artery aneurysms with Cardiatis multilayer flow modulator: preliminary results at six-month follow-up." J Cardiovasc Surg (Torino) 52(3): 311-321. Stefanov, F., et al. (2017). "Computational fluid analysis of symptomatic chronic type B aortic dissections managed with the Streamliner Multilayer Flow Modulator." J Vasc Surg 65(4): 951-963. Sultan, S., et al. (2014). "How does the multilayer flow modulator work? The science behind the technical innovation." J Endovasc Ther 21(6): 814-821. Xiong, Y., et al. (2016). "Hemodynamics study of a multilayer stent for the treatment of aneurysms." Biomed Eng Online 15(Suppl 2): 134.