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Mougin J, Schwein A, Postiglione TJ, Guihaire J, Fabre D, Haulon S. Management of the False Lumen in Post Type A Aortic Dissection Arch Aneurysms Treated With Branched Endografts. J Endovasc Ther 2023:15266028221149912. [PMID: 36632664 DOI: 10.1177/15266028221149912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION The treatment of chronic postdissection aneurysms of the aortic arch is a challenge. This study aims to describe false lumen management after aortic arch endovascular repair of post-type A dissection aneurysms treated with a branched endograft. METHODS In this single-center retrospective observational study, all consecutive patients undergoing endovascular treatment of aneurysmal degeneration of chronic type A aortic dissections following open repair were enrolled. The primary endpoint was maximal aortic diameter evolution measured on computed tomography angiography (CTA) performed during follow-up. Secondary endpoints included procedural success, aortic re intervention, and remodeling during follow-up. RESULTS Between January 2017 and June 2020, 22 patients underwent endovascular branched arch repair for post type A dissection aneurysms. Technical success was 100%. Thirteen patients (59%) had dissection involvement of at least 1 supra-aortic vessel. Midterm follow-up CTA was performed for 20 patients, 23.1 (±13.3) months after the procedure. Maximal aortic diameter at the level of the repair was decreasing in 13 (65%) patients, increasing in 2 (10%) patients, and no change was observed in 5 (25%) patients. During follow-up, 7 patients (35%) required aortic reintervention. Thoracic candy plugs were implanted for distal false lumen occlusion in 15 patients and associated with a high rate of complete remodeling (6/15 patients, 40%). CONCLUSION Arch branch endografting of aneurysmal evolution of a post type A dissection aortic arch is a safe and feasible option in experienced hands. Candy plug use in favorable anatomies seems to be associated with accelerated remodeling of the aorta. CLINICAL IMPACT There are currently no recommendations on dissected supra- aortic vessels management and the use of thoracic aorta false lumen occlusion devices during endovascular repair of chronic post dissection aneurysm of the aortic arch with branched endografts. Based on our clinical experience reported in the current manuscript, we propose a treatment algorithm for the management of the false lumen in this setting.
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Mesnard T, Patterson BO, Azzaoui R, Pruvot L, Haulon S, Sobocinski J. Iliac branch device to treat type IB endoleak with a brachial access or an "up-and-over" transfemoral technique. J Vasc Surg 2022; 76:1537-1547.e2. [PMID: 35760243 DOI: 10.1016/j.jvs.2022.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/12/2022] [Accepted: 06/19/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE This study aimed to review the results of secondary IBD (iliac branch device) implantation in patients with type IB endoleak after prior fenestrated and/or branched or infrarenal endovascular aortic repair (F/B-EVAR or EVAR), using either brachial access or an "up-and-over" transfemoral technique. METHODS A retrospective single centre analysis was conducted between Jan 2016 and Oct 2021 including consecutive patients that underwent IBD to correct a type IB endoleak after prior EVAR or F/B-EVAR. Groups were defined by arterial access which was either brachial (group 1) or transfemoral (group 2). All IBD implanted were manufactured by Cook Medical (INC, Bloomington, IN, USA). Demographics, anatomical features, technical success, and 30-day major adverse events (MAE) were recorded according to the current SVS standards. Survival curves according to Kaplan-Meier were calculated. Branch instability was a composite endpoint of any IIA branch-related complication or reintervention indicated to treat endoleak, kink, disconnection, stenosis, occlusion or rupture. RESULTS Overall, 28 patients (93% male, median age 74 years) receiving 32 IBDs were included, with 14 patients in each group. Prior endovascular aortic repairs were 23 EVAR and 5 F/B-EVAR, with time from initial repair being 58 months [48, 70]. Median pre-IBD maximal aneurysm diameter was 63.5 mm [59.0, 78.0]. Patients' baseline characteristics were similar in both groups except for pulmonary status. All procedures were performed in a hybrid operative room. Median total operating time, fluoroscopy time and dose area product were 120 min [86, 167], 23 min [15, 32] and 54 Gy.cm2 [40, 62], respectively. Total operating time was shorter in group 2 (p=0.006). Technical success rate was 100% and no early death reported. One 30-day MAE occurred including a medically treated colonic ischemia (group 2). Aortic-related secondary interventions were required in 7 patients (5 in group 1 and 2 in group 2) including 3 surgical explantations. Median follow-up was 31 months [24, 42] and 6 months [3, 10] in group 1 and 2, respectively. In group 1, 2-year freedom from aortic-related secondary intervention and IIA branch instability were 84.6% [67.1-100] and 92.3% [78.9-100], respectively. In group 2, 6-month freedom from aortic-related secondary intervention and IIA branch instability were 87.5% [67.3-100] and 91.7% [77.3-100], respectively. CONCLUSION The secondary implantation of IBD to correct distal type I endoleak of previous aortic stent-graft is safe with a high technical success rate. The "up-and-over" technique could be considered as an alternative to the brachial access in patients with suitable anatomy.
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Adam C, Fabre D, Mougin J, Zins M, Azarine A, Ardon R, d’Assignies G, Haulon S. Pre-surgical and Post-surgical Aortic Aneurysm Maximum Diameter Measurement: Full Automation by Artificial Intelligence. J Vasc Surg 2022. [DOI: 10.1016/j.jvs.2021.11.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Karelis A, Haulon S, Sonesson B, Adam D, Kölbel T, Oderich G, Cieri E, Mesnard T, Verhoeven E, Dias N, Marqués P, Tenorio E, Claridge M, Casali F, Tsilimparis N, Sobocinski J, Katsargyris A. Multicentre Outcomes of Redo Fenestrated/Branched Endovascular Aneurysm Repair to Rescue Failed Fenestrated Endografts. J Vasc Surg 2021. [DOI: 10.1016/j.jvs.2021.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Charbonneau P, Kölbel T, Rohlffs F, Eilenberg W, Planche O, Bechstein M, Ristl R, Greenhalgh R, Haulon S. Silent Brain Infarction After Endovascular Arch Procedures: Preliminary Results from the STEP Registry. J Vasc Surg 2021. [DOI: 10.1016/j.jvs.2021.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Loftus I, Haulon S, Boyle J. NICE Abdominal Aortic Aneurysm Guidelines Finally Published: How Will They Influence Aortic Practice in the UK and Beyond? Eur J Vasc Endovasc Surg 2020; 59:697-698. [DOI: 10.1016/j.ejvs.2020.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Monnet P, Zehou O, Khemri M, Hirsch G, Rakotonarivo L, Jankovic M, Thomas E, Fromentin I, Haulon S, Henry O, Bouillanne O, Motamed G, Schwald-Adam N, David JP, Mezière A, Picou Y, Schonheit C, Jannic A, Gautier MS, Lestang P, Plaquet JL, Charpentier C, Ostojic A, Wolkenstein P, Duong TA. Prise en charge des tumeurs cutanées par télédermatologie : quel parcours de soins dans une filière gériatrique ? Ann Dermatol Venereol 2019. [DOI: 10.1016/j.annder.2019.09.244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Clough R, Barillà D, Delsart P, Ledieu G, Spear R, Crichton S, Mounier Vehier C, Peacock J, Sobocinski J, Haulon S. Long-term Survival and Risk Analysis in 136 Consecutive Patients With Type B Aortic Dissection Presenting to a Single Centre Over an 11 Year Period. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.04.453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Hascoët S, Karsenty C, Tortigue M, Watkins A, Riou J, Boet A, Houyel L, Tahhan N, Fabre D, Haulon S, Brenot P, Petit J. A modified procedure for percutaneous pulmonary valve implantation of the Edwards SAPIEN 3 transcatheter heart valve. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2019. [DOI: 10.1016/j.acvdsp.2018.10.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hirsch G, Thomas E, Fromentin I, Haulon S, Henry O, Bouillanne O, Motamed G, Schwald-Adam N, David JP, Hua C, Zehou O, Thion P, Chosidow O, Wolkenstein P, Duong TA. TELDERM : télé-expertise en dermatologie : évolution sur 21 mois dans un établissement gériatrique. Ann Dermatol Venereol 2018. [DOI: 10.1016/j.annder.2018.09.388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Moussa MD, Lamer A, Mass G, Louvel P, Lecaitel S, Hertault A, Gantois G, Leroy G, Ait-Ouarab S, Brandt C, Kipnis E, Sobocinski J, Tavernier B, Haulon S, Robin E. P2662Prognostic value of postoperative high-sensitivity troponin among patients undergoing fenestrated and/or branched endovascular aortic aneurysm repair. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Clough RE, Spear R, Van Calster K, Hertault A, Azzaoui R, Sobocinski J, Fabre D, Haulon S. Case series of aortic arch disease treated with branched stent-grafts. Br J Surg 2018; 105:358-365. [DOI: 10.1002/bjs.10681] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 07/15/2017] [Accepted: 07/20/2017] [Indexed: 01/16/2023]
Abstract
Abstract
Background
Surgical repair of aortic arch pathology is complex and associated with significant morbidity and mortality. Alternative approaches have been developed to reduce these risks, including the use of thoracic stent-grafts with fenestrations or in combination with bypass procedures to maintain supra-aortic trunk blood flow. Branched stent-grafts are a novel approach to treat aortic arch pathology.
Methods
Consecutive patients with aortic arch disease presenting to a single university hospital vascular centre were considered for branched stent-graft repair (October 2010 to January 2017). Patients were assessed in a multidisciplinary setting including a cardiologist, cardiac surgeon and vascular surgeon. All patients were considered prohibitively high risk for standard open surgical repair. The study used reporting standards for endovascular aortic repair and PROCESS (Preferred Reporting of Case Series in Surgery) guidelines.
Results
Some 30 patients (25 men) underwent attempted branch stent-graft repair. Mean age was 68 (range 37–84) years. Eighteen patients had chronic aortic dissection, 11 patients had an aneurysm and one had a penetrating ulcer. Fourteen patients had disease in aortic arch zone 0, six in zone 1 and ten in zone 2. Twenty-five patients had undergone previous aortic surgery and 24 required surgical revascularization of the left subclavian artery. Technical success was achieved in 27 of 30 patients. Four patients had an endoleak (type Ia, 1; type II, 3). The in-hospital mortality rate was three of 30. Mean length of follow-up was 12·0 (range 1·0–67·8) months, during which time 12 patients required an aortic-related reintervention.
Conclusion
Repair of aortic arch pathology using branched stent-grafting appears feasible. Before widespread adoption of this technology, further studies are required to standardize the technique and identify which patients are most likely to benefit.
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Tinelli G, Hertault A, Martin Gonzalez T, Spear R, Azzaoui R, Sobocinski J, Clough RE, Haulon S. Evaluation of a new imaging software for aortic endograft planning. EUROPEAN REVIEW FOR MEDICAL AND PHARMACOLOGICAL SCIENCES 2017; 21:2717-2724. [PMID: 28678313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate a new 3D Workstation workflow (EVAR Assist, Advantage Windows, GE Healthcare, Chalfont, UK) (EA-AW) designed to simplify complex EVAR planning. PATIENTS AND METHODS All pre-operative computed tomography (CT) scans of patients who underwent repair at our institution of a complex aortic aneurysm using fenestrated endovascular repair (f-EVAR) between January and September 2014, were reviewed. For each patient, imaging analysis (12 measures: aortic diameters and length and "clock position" of visceral artery) was performed on two different workstations: Aquarius (TeraRecon, San Mateo, CA, USA) and EA-AW. According to a standardized protocol, three endovascular surgeons experienced in aortic endograft planning, performed image analyses and data collection independently. We analyzed an internal assessment between observers (on the Aquarius 3DWS) and an external assessment comparing these results with the planning center (PC) data used to custom the fenestrated endograft of the patients enrolled in this study. Finally, we compared both 3DWS data to determine the accuracy and the reproducibility. A p-value < .05 was considered as statistically significant. Complete agreement between operators was defined as 1.0. RESULTS Intra- and inter-observer variability (interclass correlation coefficients - ICC: 0.81-.091) was very low and confirmed the reliability of our planners. The ICC comparison between EA-AW and Aquarius was excellent (> 0.8 for both), thus confirming the reproducibility and reliability of the new EA-AW application. Aortic and iliac necks diameters and lengths were similarly reported with both workstations. In our study, the mean difference in distance and orientation evaluation of target vessels evaluated by the two workstations was marginal and has no impact on clinical practice in term of device manufacturing. CONCLUSIONS We showed that complex EVAR planning can be performed with this new dedicated 3D workstation workflow with a good reproducibility.
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de Souza L, Oderich G, Farber M, Haulon S, Banga P, Pereira A, Gloviczki P, Textor S, Jia F. Comparison of Renal Outcomes in Patients Treated by Zenith® Fenestrated and Zenith® Abdominal Aortic Aneurysm Stent grafts in US Prospective Pivotal Trials. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2017.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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de Souza LR, Oderich GS, Farber MA, Haulon S, Banga PV, Pereira AH, Gloviczki P, Textor SC, Jia F. Editor's Choice - Comparison of Renal Outcomes in Patients Treated by Zenith ® Fenestrated and Zenith ® Abdominal Aortic Aneurysm Stent grafts in US Prospective Pivotal Trials. Eur J Vasc Endovasc Surg 2017; 53:648-655. [PMID: 28285957 DOI: 10.1016/j.ejvs.2017.02.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 02/03/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE/BACKGROUND Fenestrated endovascular repair (FEVAR) has been used to treat complex abdominal aortic aneurysms (AAAs). The risk of renal function deterioration compared with infrarenal endovascular aortic repair (EVAR) has not been determined. METHODS Patients with preserved renal function (estimated glomerular filtration rate [eGFR] > 45 mL/minute) enrolled in two prospective, non-randomised studies evaluating Zenith fenestrated and AAA stent grafts were matched (1:2) by propensity scores for age, sex, hypertension, diabetes, and pre-operative eGFR. Sixty-seven patients were treated by FEVAR and 134 matched controls treated by EVAR. Mean follow-up was 30 ± 20 months. Outcomes included acute kidney injury (AKI) defined by RIFLE and changes in serum creatinine (sCr), eGFR, and chronic kidney disease (CKD) staging up to 5 years. RESULTS AKI at 1 month was similar between groups, with > 25% decline in eGFR observed in 5% of FEVAR and 9% of EVAR patients (p = .39). There were no significant differences in > 25% decline in eGFR at 2 years (FEVAR 20% vs. EVAR 20%; p > .99) or 5 years (FEVAR 27% vs. EVAR 50%; p = .50). Progression to stage IV-V CKD was similar at 2 years (FEVAR 2% vs. EVAR 3%; p > .99) and 5 years (FEVAR 7% vs. EVAR 8%; p > .99), with similar sCr and eGFR up to 5 years. During follow-up, there were more renal artery stenosis/occlusions (15/67 [22%] vs. 3/134 [2%]; p < .001) and renal related re-interventions (12/67 [18%] vs. 4/134 [3%]; p < .001) in patients treated by FEVAR. Rate of progression to renal failure requiring dialysis was low and identical in both groups (1.5% vs. 1.5%; p > .99). CONCLUSION Aortic repair with FEVAR and EVAR was associated with similar rates of renal function deterioration in patients with preserved pre-operative renal function. Renal related re-interventions were higher following FEVAR, although net changes in renal function were similar in both groups.
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Riambau V, Böckler D, Brunkwall J, Cao P, Chiesa R, Coppi G, Czerny M, Fraedrich G, Haulon S, Jacobs M, Lachat M, Moll F, Setacci C, Taylor P, Thompson M, Trimarchi S, Verhagen H, Verhoeven E, ESVS Guidelines Committee, Kolh P, de Borst G, Chakfé N, Debus E, Hinchliffe R, Kakkos S, Koncar I, Lindholt J, Vega de Ceniga M, Vermassen F, Verzini F, Document Reviewers, Kolh P, Black J, Busund R, Björck M, Dake M, Dick F, Eggebrecht H, Evangelista A, Grabenwöger M, Milner R, Naylor A, Ricco JB, Rousseau H, Schmidli J. Editor's Choice – Management of Descending Thoracic Aorta Diseases. Eur J Vasc Endovasc Surg 2017; 53:4-52. [DOI: 10.1016/j.ejvs.2016.06.005] [Citation(s) in RCA: 598] [Impact Index Per Article: 85.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Raybaud G, Lambert M, Douillard C, Dessein A, Morell-Dubois S, Guillou M, Haulon S, Hatron PY. Thrombose artérielle aiguë dans un contexte d’hyperhomocystéinémie : à propos d’un cas et revue de la littérature. Rev Med Interne 2016; 37:849-853. [DOI: 10.1016/j.revmed.2016.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 06/03/2016] [Accepted: 10/06/2016] [Indexed: 11/29/2022]
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Martin-Gonzalez T, Mastracci T, Carrell T, Constantinou J, Dias N, Katsargyris A, Modarai B, Resch T, Verhoeven E, Haulon S. Mid-term Outcomes of Renal Branches Versus Renal Fenestrations for Thoraco-abdominal Aneurysm Repair. J Vasc Surg 2016. [DOI: 10.1016/j.jvs.2016.07.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Maurel B, Lounes Y, Amako M, Fabre D, Hertault A, Sobocinski J, Spear R, Azzaoui R, Mastracci T, Haulon S. Changes in Renal Anatomy after Fenestrated Endovascular Aneurysm Repair. Eur J Vasc Endovasc Surg 2016. [DOI: 10.1016/j.ejvs.2016.07.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Clough RE, Haulon S. Commentary on 'Morphological Differences in the Aorto-iliac Segment in AAA Patients of Caucasian and Asian Origin'. Eur J Vasc Endovasc Surg 2016; 51:790. [PMID: 27150799 DOI: 10.1016/j.ejvs.2016.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 03/13/2016] [Indexed: 10/22/2022]
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Mastracci T, Carrell T, Constantinou J, Dias N, Martin-Gonzalez T, Katsargyris A, Modarai B, Resch T, Verhoeven E, Burnell M, Haulon S. Effect of Branch Stent Choice on Branch-related Outcomes in Complex Aortic Repair. J Vasc Surg 2016. [DOI: 10.1016/j.jvs.2016.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Mastracci T, Carrell T, Constantinou J, Dias N, Martin-Gonzalez T, Katsargyris A, Modarai B, Resch T, Verhoeven E, Burnell M, Haulon S. Editor's Choice – Effect of Branch Stent Choice on Branch-related Outcomes in Complex Aortic Repair. Eur J Vasc Endovasc Surg 2016; 51:536-42. [DOI: 10.1016/j.ejvs.2015.12.046] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 12/29/2015] [Indexed: 11/29/2022]
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Spear R, Haulon S, Ohki T, Tsilimparis N, Kanaoka Y, Milne C, Debus S, Takizawa R, Kölbel T. Subsequent Results for Arch Aneurysm Repair with Inner Branched Endografts. J Vasc Surg 2016. [DOI: 10.1016/j.jvs.2016.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Maurel B, Haulon S. Re: ‘The Impact of Early Pelvic and Lower Limb Reperfusion and Attentive Peri-operative Management on the Incidence of Spinal Cord Ischemia During Thoraco-abdominal Aortic Aneurysm Endovascular Repair’. Eur J Vasc Endovasc Surg 2016; 51:316. [DOI: 10.1016/j.ejvs.2015.10.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 10/26/2015] [Indexed: 11/28/2022]
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Spear R, Sobocinski J, Settembre N, Tyrrell MR, Malikov S, Maurel B, Haulon S. Early Experience of Endovascular Repair of Post-dissection Aneurysms Involving the Thoraco-abdominal Aorta and the Arch. Eur J Vasc Endovasc Surg 2015; 51:488-97. [PMID: 26680449 DOI: 10.1016/j.ejvs.2015.10.012] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 10/18/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Outcomes are reported in management of post-dissection aneurysms involving the aortic arch and/or thoraco-abdominal segment (TAAA) treated with fenestrated and branched (complex) endografts. METHODS This report includes all patients with chronic post-dissection aneurysms >55 mm in diameter, deemed unfit for open surgery, treated using complex endografts between October 2011 and March 2015. When appropriate, staged management strategies including left subclavian artery revascularization, thoracic endografting, dissection flap fenestration or tear enlargement, and other endovascular procedures were performed at least 3 weeks prior to definitive complex endovascular repair. The following outcome data were collected prospectively at discharge, 12 months and annually thereafter: technical success, endoleaks, target vessel patency, false lumen patency, aneurysm diameter, major and minor complications, re-interventions, and mortality. RESULTS The cohort comprised 23 patients with a median age of 65 years. Staged procedures were performed in 14 patients (61%). Seven patients with dissections involving the arch were treated with inner branched endografts, and 16 TAAA patients were treated with fenestrated or branched endografts. The technical success rate was 71% following arch repair and 100% following TAAA repair. During early follow up, one of the arch group patients died and one in the TAAA group suffered spinal cord ischemia. The median follow up was 12 months (range 3-48), during which time one patient died of causes unrelated to aneurysm or treatment. Two early re-interventions were performed in the arch group to correct access vessel complications and there were a further two late re-interventions in the TAAA group to treat endoleaks. All target vessels (n = 72) remained patent. CONCLUSIONS This experience indicates that complex endovascular repair of post-dissection aneurysms is a viable alternative to open repair in patients deemed unfit for open surgery. There are insufficient data to allow comparison with the outcome of open surgery in anatomically similar, but fit, patients.
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