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Aortic arch replacement for degenerative aneurysms: advances during the last decade. Gen Thorac Cardiovasc Surg 2012; 61:191-6. [DOI: 10.1007/s11748-012-0166-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Indexed: 10/27/2022]
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Janczak D, Garcarek J, Bogdanik R, Szydelko T, Chabowski M, Wojtanowski M. Eight-year follow-up of a high-risk patient treated for Crawford Type II thoracoabdominal aortic aneurysm (TAAA) with a multistage hybrid open-endovascular repair. Ann Thorac Cardiovasc Surg 2012; 19:166-9. [PMID: 22971708 DOI: 10.5761/atcs.cr.12.01924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The case of a patient with type II TAAA (thoracoabdominal aortic aneurysm), who underwent multistage hybrid procedure, is presented. This high-risk patient was excluded as ineligible for conventional open repair. At first, the bypass between both common carotid arteries was inserted. Then, the transperitoneal viscerorenal revascularization was performed to ensure blood perfusion. At the end, the stent graft from the aorta arch to its bifurcation was deployed with endovascular techniques. This stent graft covered left common carotid artery, left subclavian artery, visceral trunk, superior mesenteric artery and both renal arteries. The patient had been observed for eight years with relatively low complication rate. The hybrid open-endovascular repair (HOER) shows promising results in patients at prohibitive risk for classic reconstruction.
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Affiliation(s)
- Dariusz Janczak
- Department of Clinical Proceedings, Faculty of Health Science, Medical University Wroclaw, 5 Weigla Street, Wroclaw, Poland
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Roselli EE, Qureshi A, Idrees J, Lima B, Greenberg RK, Svensson LG, Pettersson G. Open, hybrid, and endovascular treatment for aortic coarctation and postrepair aneurysm in adolescents and adults. Ann Thorac Surg 2012; 94:751-6; discussion 757-8. [PMID: 22704801 DOI: 10.1016/j.athoracsur.2012.04.033] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2011] [Revised: 03/31/2012] [Accepted: 04/04/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Open, hybrid, and endovascular procedures are used for grown-up patients with aortic coarctation and complications after repair, an expanding population. We sought to characterize patients and procedures, assess early and late outcomes, and describe indications to guide treatment of these complex patients. METHODS Between May 1999 and January 2011, 110 patients underwent open (n=40), hybrid (n=11), or endovascular (n=59) repair of coarctation (n=43), recurrent aortic coarctation (n=42), or postrepair aneurysm (n=25). Mean age was 38±14 years. Sixty-eight had previous repairs (median 27 years earlier; range, 1 to 50). Twenty-two had prior cardiovascular operations other than coarctation and 50% had bicuspid valve. Fifty-nine concomitant procedures were performed in 45 patients (40%). Data were from the prospective database, chart review, and Social Security Death Index. RESULTS Technical success was achieved in 100%, with no hospital deaths, no strokes, and no paraplegia. Complications were uncommon and included respiratory failure (n=2, 1.8%), and temporary renal failure (n=2, 1.8%). Twenty-two patients required reinterventions, but half of those were planned. There was no difference in occurrence of unplanned reintervention between approaches (endovascular 12%, hybrid 18%, open 12.5%). Length of stay was 4.8±4.8 days. Transcoarct gradient fell from 37.6±18 mm Hg preoperatively to 7.0±6.9 mm Hg in coarctation patients. Postrepair aneurysm patients had no late ruptures, and maximum diameter shrunk from 5.9±1.3 cm preoperatively to 4.8±1.3 cm. Estimated survival at 1, 5, and 8 years was 95%, 95%, and 90%, respectively. CONCLUSIONS Coarctation, recurrent coarctation, and postrepair aneurysm/pseudoaneurysm in adolescent and adult patients can be safely and effectively managed with open, hybrid, or endovascular techniques. Optimal results are achievable in this complex population of patients with a multimodality approach tailored to surgical indication and anatomy. All survivors of coarctation repair require lifelong surveillance.
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Affiliation(s)
- Eric E Roselli
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio 44195-5108, USA.
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Rusults of classical crawford and hybrid operations in thoracic-abdominal aorta aneurysms treatment--comparative assessment. POLISH JOURNAL OF SURGERY 2012; 84:126-35. [PMID: 22659355 DOI: 10.2478/v10035-012-0021-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
UNLABELLED Thoracic-abdominal aortic aneurysms (TAAA) are still serious medical problem. Classical procedure requires two cavities approach and implantation of vascular prosthetic in the place of aneurysm--Crawford's procedure. Significant progress was made during last years by using endovascular procedures (stentgrafts). Alternative is hybrid procedure--prosthetic appliance of visceral and kidney arteries and then stentgraft implantation in whole thoracic-abdominal aorta. THE AIM OF THE STUDY was comparative analysis of classical and hybrid procedures in thoracic-abdominal aneurysms treatment. MATERIAL AND METHODS Between 1989-2011 in Department of Vascular, General and Transplantological Surgery Medical University in Wrocław and Surgical Department of 4th Military Clinical Hospital in Wrocław 53 patients were operated due to thoracic-abdominal aortic aneurysms. Classical Crawford's procedure was performed in 41 patients (group I) and hybrid procedure was performed in 12 patients (group II). Additionally 7 patients required aortic arc branches reconstruction due to achieve optimal conditions to stentgraft amplantation. Procedures were performed at one or two stages. RESULTS Mortality in patients treated classically (group I) depended on type of aneurysm in Crawford's classification. In type I-II mortality rate was 54% ((7 deaths/12 patients), in type III do V 17% (5 deaths/ 29 patients). In the group after hybrid procedure (group II) mortality rate was 28% (2 deaths/ 7 patients) in type I-II and 20% (1 death/5 patients) in type III to V. Observed serious perioperative complications. CONCLUSIONS 1. Endovascular procedures development enabled introducing of new methods in thoracic-abdominal aortic aneurysms treatment (hybrid procedures) and allowed to get better results. 2. Clear advantage of hybrid procedures above classical Crawford's procedure is observed in type I and II of TAAA. 3. Mortality and morbidity rates recommend hybrid procedure in type I and II of TAAA. 4. Surgical results of classical and hybrid procedures in type III-V TAAA treatment are comparative, with indication on classical approach.
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Lioupis C, Corriveau MM, MacKenzie K, Obrand D, Steinmetz O, Abraham C. Treatment of Aortic Arch Aneurysms with a Modular Transfemoral Multibranched Stent Graft: Initial Experience. Eur J Vasc Endovasc Surg 2012; 43:525-32. [DOI: 10.1016/j.ejvs.2012.01.031] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Accepted: 01/29/2012] [Indexed: 10/28/2022]
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Endovascular Therapy for Thoracic Aortic Aneurysms: State of the Art in 2012. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2012; 14:149-63. [DOI: 10.1007/s11936-012-0169-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Hybrid repair of thoracic aortic lesions for zone 0 and 1 in high-risk patients. J Vasc Surg 2012; 55:318-25. [DOI: 10.1016/j.jvs.2011.08.042] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Revised: 08/24/2011] [Accepted: 08/24/2011] [Indexed: 11/20/2022]
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Kanaoka Y, Ohki T, Toya N, Ishida A, Tachihara H, Hirayama S, Kurosawa K, Sumi M, Ohta H, Kaneko K. Technical challenges in endovascular repair of complex thoracic aortic aneurysms. Ann Vasc Dis 2012; 5:21-9. [PMID: 23555482 DOI: 10.3400/avd.oa.11.01011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 12/06/2011] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Endovascular aneurysm repair has gained widespread acceptance, and there has been a significant increase in the number of aneurysms treated with stent grafts. However, the endovascular technique alone is often not appropriate for anatomically complex aneurysms involving the neck branches. We used the TAG stent for thoracic aortic aneurysms (TAA), and report our initial results. PATIENTS AND RESULTS We deployed 80 TAG stents in 65 patients electively treated with TAA between June 2006 and June 2008. Thoracic endovascular aneurysm repair (TEVAR) was performed in 45 cases of descending aortic aneurysm with no morbidity or mortality. A combination of open surgery and TEVAR was performed in 11 out of 20 cases with aneurysms of the aortic arch. The prior total arch replacement and elephant trunk procedure was performed in 3 cases with dilated ascending aorta, total debranching from ascending aorta with sternotomy in 5, and carotid-carotid artery crossover bypass in 3 cases. Meanwhile, TEVAR with coverage of the left subclavian artery was performed in the remaining 9 distal arch cases. In 3 cases with extremely short necks, a 0.018" guide wire was inserted percutaneously in a retrograde manner through the common carotid artery (CCA) into the ascending aorta to place the stent graft in close proximity to the CCA (wire protection). In 1 of these 3 cases, the TAG stent was deployed through the CCA, and the 0.018" guide wire was used to deliver a balloon-expandable stent in order to restore the patency of the CCA. In arch and distal arch aneurysm cases, perioperative mortality and the incidence of stroke were both 5.0%; dissection of the ascending aorta was seen in one case (5.0%). CONCLUSION As treatment for descending aortic aneurysms, TEVAR can replace conventional open repair. However, TEVAR for arch aneurysms has some problems, and further improvement is necessary. (English Translation of Jpn J Vasc Surg 2010; 19: 547-555.).
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Affiliation(s)
- Yuji Kanaoka
- Department of Surgery, Division of Vascular Surgery, Jikei University School of Medicine, Tokyo, Japan
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Vallabhajosyula P, Bavaria JE, Szeto WY. Hybrid Approaches to Complex Aortic Arch Aneurysms. ACTA ACUST UNITED AC 2012. [DOI: 10.1053/j.optechstcvs.2012.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Mavroudis CD, Molina E, Stewart A. Cerebral protection for aortic arch surgery: hybrid approach. Semin Thorac Cardiovasc Surg 2012; 24:302-4. [PMID: 23465679 DOI: 10.1053/j.semtcvs.2012.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2012] [Indexed: 11/11/2022]
Affiliation(s)
- Constantine D Mavroudis
- Department of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York, New York, USA
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61
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Distal Landing Zone Open Fenestration Facilitates Endovascular Elephant Trunk Completion and False Lumen Thrombosis. Ann Thorac Surg 2011; 92:2078-84. [DOI: 10.1016/j.athoracsur.2011.08.018] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Revised: 08/04/2011] [Accepted: 08/08/2011] [Indexed: 11/19/2022]
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Kang WC, Greenberg RK, Mastracci TM, Eagleton MJ, Hernandez AV, Pujara AC, Roselli EE. Endovascular repair of complicated chronic distal aortic dissections: Intermediate outcomes and complications. J Thorac Cardiovasc Surg 2011; 142:1074-83. [DOI: 10.1016/j.jtcvs.2011.03.008] [Citation(s) in RCA: 122] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Revised: 09/17/2010] [Accepted: 03/14/2011] [Indexed: 10/18/2022]
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Anaya-Ayala JE, Cheema ZF, Davies MG, Bismuth J, Ramlawi B, Lumsden AB, Reardon MJ. Hybrid thoracic endovascular aortic repair via right anterior minithoracotomy. J Thorac Cardiovasc Surg 2011; 142:314-8. [DOI: 10.1016/j.jtcvs.2010.10.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Revised: 09/07/2010] [Accepted: 10/16/2010] [Indexed: 11/29/2022]
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Obitsu Y, Koizumi N, Takahashi S, Iida Y, Saiki N, Watanabe Y, Kawaguchi S, Shigematsu H. Hybrid procedures combining conventional and thoracic endovascular aortic repair for thoracic aortic aneurysms. Surg Today 2011; 41:922-7. [PMID: 21748607 DOI: 10.1007/s00595-010-4377-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Accepted: 02/08/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE To minimize surgical invasiveness for extensive aortic aneurysms and expand the indications for thoracic endovascular aortic repair (TEVAR), we evaluated outcomes of hybrid procedures combining conventional surgical aortic repair and TEVAR for thoracic aortic aneurysms. METHODS The following hybrid procedures were performed: second-stage TEVAR after total aortic arch replacement using the elephant trunk as the landing zone in 17 patients; and for multiple aortic aneurysms, vascular graft replacement and TEVAR in 13 patients, vascular graft replacement and TEVAR with bypass in 2 patients, and TEVAR with bypass in 23 patients. RESULTS There were three (5.3%) hospital deaths, from serious complications including stroke, paraplegia, paraparesis, and aspiration pneumonia; and eight late deaths. There was only one aneurysm-related death, of a patient who underwent emergency surgery for an esophageal fistula resulting from enlargement of a residual false lumen of a thoracoabdominal aorta after second-stage TEVAR. CONCLUSION Hybrid procedures minimize surgical invasiveness in thoracic aortic aneurysm repair, but further evaluation of a larger number of patients is necessary.
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Affiliation(s)
- Yukio Obitsu
- Department of Vascular Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
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Yu Z, Ogasawara T, Daitoku K, Fukuda I. Combined valve-sparing root replacement and total arch replacement with frozen elephant trunk. Interact Cardiovasc Thorac Surg 2011; 13:421-3. [PMID: 21737539 DOI: 10.1510/icvts.2011.273144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report a case of simultaneous repair of an extensive thoracic aortic aneurysm from the aortic root to the distal aortic arch. A 54-year-old male had annuloaortic ectasia and a transverse aortic and distal arch aneurysm. Aneurysms of the descending aorta and the abdominal aorta were also demonstrated. The patient underwent aortic valve-sparing root reconstruction, replacement of the aortic arch and placement of a frozen elephant trunk stent-graft concomitantly through a median sternotomy incision. Because a complicated procedure was necessary, root reconstruction was performed first and coronary perfusion was resumed. This case suggests that the surgical procedure should be determined on the bases of the situation of thoracic aortic aneurysm and the general condition of the patient. Treatment for extensive diseased aorta from the aortic root to the distal aortic arch is a surgical challenge. Although single-stage repair is one of the options for this condition, it is very invasive. Total arch replacement with the frozen elephant trunk technique is efficacious to exclude distal arch aneurysm or descending aortic aneurysm through median sternotomy. An aortic valve-sparing operation was developed to preserve the native aortic valve function in order to improve the patient's quality of life. We herein report a case of concomitant total arch replacement using a frozen elephant trunk and aortic valve-sparing operation for extensive thoracic aortic aneurysm.
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Affiliation(s)
- Zaiqiang Yu
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
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Jim J, Moon MR, Rubin BG, Sicard GA, Sanchez LA. Hybrid Repair of Distal Arch Aortic Aneurysms: Endovascular Elephant Trunk Completion. Ann Vasc Surg 2011; 25:598-604. [DOI: 10.1016/j.avsg.2010.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2010] [Revised: 10/05/2010] [Accepted: 10/06/2010] [Indexed: 11/24/2022]
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67
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Elephant trunk procedure 27 years after Borst: what remains and what is new? Eur J Cardiothorac Surg 2011; 40:1-11. [PMID: 21388822 DOI: 10.1016/j.ejcts.2011.01.062] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 01/24/2011] [Accepted: 01/27/2011] [Indexed: 11/21/2022] Open
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Graft-to-endograft anastomosis for emergency treatment of distal aortic arch aneurysm after endovascular stenting of thoracoabdominal type B dissection. Ann Vasc Surg 2011; 25:557.e11-3. [PMID: 21549930 DOI: 10.1016/j.avsg.2010.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2010] [Revised: 09/27/2010] [Accepted: 11/09/2010] [Indexed: 11/22/2022]
Abstract
Emergency aortic arch surgery still remains a challenge, especially in elderly patients. We report a case about the open surgical management by graft-to-endograft anastomosis of a complicated aortic arch aneurysm because of a type I endoleak after thoracic endovascular aortic repair of a chronic type B aortic dissection.
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69
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Shah AA, Bhattacharya SD, McCann RL, Hughes GC. Pan-aortic hybrid treatment of mega-aorta syndrome. J Vasc Surg 2011; 53:1398-401. [DOI: 10.1016/j.jvs.2010.11.115] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 11/22/2010] [Accepted: 11/24/2010] [Indexed: 10/18/2022]
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Lee CW, Beaver TM, Klodell CT, Hess PJ, Martin TD, Feezor RJ, Lee WA. Arch debranching versus elephant trunk procedures for hybrid repair of thoracic aortic pathologies. Ann Thorac Surg 2011; 91:465-71. [PMID: 21256293 DOI: 10.1016/j.athoracsur.2010.10.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Revised: 09/30/2010] [Accepted: 10/04/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND We compared outcomes of arch debranching (AD) and elephant trunk (ET) techniques when used with thoracic endovascular aortic repair. METHODS A review was performed of consecutive patients with proximal thoracic aortic pathologies repaired with a hybrid approach. RESULTS Between 2005 and 2009, 58 patients underwent first-stage ET (n = 21) or AD (n = 37). Cardiopulmonary bypass was utilized in 100% of ET procedures and 68% of AD procedures (p < 0.01). Circulatory arrest was used in 86% of ET and 27% of AD cases (p < 0.01). The second stage was completed in 76% of ET and 76% of AD patients. Rates of spinal cord ischemia (ET 0 of 21, AD 0 of 37, p = 1.0), stroke (ET 2 of 21, AD 4 of 37, p = 1.0), and 30-day mortality (ET 4 of 21, AD 6 of 37, p = 1.0) were similar. Each group had one major aortic complication between the two stages. Type Ia endovascular leak at 1 and 12 months occurred in 13% ET patients and 4% AD patients at 1 month (p = 0.54) and in 0% ET patients and 4% AD patients at 12 months (p = 1.0). Kaplan-Meier estimates of survival at 1 and 12 months were 90.5% ± 6.4% and 73.1% ± 10% in the ET group, and 86.5% ± 5.6 and 71.6% ± 8.5 in the AD group, respectively (p = 0.68). The risk of a secondary procedure at 1 and 12 months was 76.2% ± 9.3% and 58.7% ± 12% in the ET group, and 71.0% ± 7.8% and 52.8% ± 10% in the AD group, respectively (p = 0.86). CONCLUSIONS Arch debranching achieves equivalent results to standard elephant trunk repair but with a decreased need for cardiopulmonary bypass and circulatory arrest.
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Affiliation(s)
- Constance W Lee
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, Florida, USA.
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71
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Di Eusanio M, Berretta P, Bissoni L, Petridis FD, Di Marco L, Di Bartolomeo R. Re-operations on the proximal thoracic aorta: results and predictors of short- and long-term mortality in a series of 174 patients. Eur J Cardiothorac Surg 2011; 40:1072-6. [DOI: 10.1016/j.ejcts.2011.02.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Revised: 02/03/2011] [Accepted: 02/07/2011] [Indexed: 10/18/2022] Open
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Staged hybrid repair using telescoped stent graft fixation for aortic arch and descending aortic aneurysms. J Vasc Surg 2011; 54:507-10. [PMID: 21367559 DOI: 10.1016/j.jvs.2010.12.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Revised: 12/07/2010] [Accepted: 12/07/2010] [Indexed: 11/20/2022]
Abstract
Staged repair of extensive thoracic aortic aneurysms is complicated, with a high incidence of interval rupture between stages. We describe the systematic staged hybrid procedure of a previous endovascular repair of a descending aortic aneurysm and open surgical repair of an aortic arch aneurysm. In the second-stage arch repair, the stent graft was easily retracted and fixed, without dissection, around the aortic arch aneurysm distal side. Extensive thoracic aortic aneurysms were managed without interim rupture or neurologic deficits. This approach avoided the potential for interim rupture because recovery from the first-stage endovascular repair was shorter than that from open repair.
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Marullo AG, Bichi S, Pennetta RA, Di Matteo G, Cricco AM, Specchia L, Castriota F, Esposito G. Hybrid Aortic Arch Debranching With Staged Endovascular Completion in DeBakey Type I Aortic Dissection. Ann Thorac Surg 2010; 90:1847-53. [PMID: 21095323 DOI: 10.1016/j.athoracsur.2010.07.077] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Revised: 07/23/2010] [Accepted: 07/26/2010] [Indexed: 10/18/2022]
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Schoenhagen P, Numburi U, Halliburton SS, Aulbach P, von Roden M, Desai MY, Rodriguez LL, Kapadia SR, Tuzcu EM, Lytle BW. Three-dimensional imaging in the context of minimally invasive and transcatheter cardiovascular interventions using multi-detector computed tomography: from pre-operative planning to intra-operative guidance. Eur Heart J 2010; 31:2727-2740. [DOI: 10.1093/eurheartj/ehq302] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
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Long-term results of second-stage thoracic endovascular aortic repair following total aortic arch replacement. Gen Thorac Cardiovasc Surg 2010; 58:501-5. [PMID: 20941562 DOI: 10.1007/s11748-010-0627-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Accepted: 04/04/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE We investigated the surgical results of secondary thoracic endovascular aneurysm repair (TEVAR) using the elephant trunk graft after total aortic arch replacement (TAR) for extensive thoracic aortic lesions. METHODS The subjects comprised 16 patients who underwent TEVAR as a staged procedure following TAR at our institution between 1997 and 2007. Long-term results were retrospectively surveyed (mean observation period 68.4 months). We performed TEVAR with the elephant trunk graft as a proximal landing zone for the descending thoracic repair, the mean duration between TAR and TEVAR was 4.7 weeks for the staged operations and 18.3 months for the nonstaged operations. RESULTS Early results were good in all cases, with no deaths and no noteworthy complications. For the seven patients without dissection, long-term results were also good. Among the nine patients with dissection, the false lumen in the thoracoabdominal area enlarged in three during follow-up. We performed thoracoabdominal repair in two, but one died of an aneurysm-esophageal fistula. There was only one long-term aneurysm-related death. CONCLUSION Second-stage TEVAR using the elephant trunk graft after TAR allows less invasive surgery for extensive aortic lesions and achieves good long-term results. However, enlargement of the false lumen was a long-term concern in patients with aortic dissection, and careful follow-up is essential.
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Open techniques for arch vessel reconstruction during thoracic endovascular aneurysm repair (TEVAR). J Vasc Surg 2010; 52:71S-6S. [DOI: 10.1016/j.jvs.2010.06.146] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2010] [Revised: 06/14/2010] [Accepted: 06/17/2010] [Indexed: 11/23/2022]
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Sun T, Wang G, Zhang K, Liang H, Jiang X. Hybrid procedure for thoracic aortic disease. JOURNAL OF HUAZHONG UNIVERSITY OF SCIENCE AND TECHNOLOGY. MEDICAL SCIENCES = HUA ZHONG KE JI DA XUE XUE BAO. YI XUE YING DE WEN BAN = HUAZHONG KEJI DAXUE XUEBAO. YIXUE YINGDEWEN BAN 2010; 30:666-668. [PMID: 21063853 DOI: 10.1007/s11596-010-0567-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Indexed: 05/30/2023]
Abstract
Form 2008 to 2009, four patients with complex thoracic aortic disease, including aortic aneurysms and dissections, were successfully treated in our department with a new treatment approach: hybrid procedure. Combined open surgery and endovascular repair were performed in these patients without deep hypothermia or circulatory arrest. Compared to those who underwent traditional open surgery in the same period, time of mechanical ventilation and ICU stay was decreased in these four patients. All of them were discharged soon after operation without postoperative complications or death. The result suggests that this new approach could be an option for thoracic aortic disease, but long-term and large-population studies are still required to demonstrate the safety and validity.
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Affiliation(s)
- Tucheng Sun
- Department of Cardiovascular Surgery, Huazhong University of Science and Technology, Wuhan, China.
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Reporting standards for thoracic endovascular aortic repair (TEVAR). J Vasc Surg 2010; 52:1022-33, 1033.e15. [DOI: 10.1016/j.jvs.2010.07.008] [Citation(s) in RCA: 480] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2010] [Revised: 07/11/2010] [Accepted: 07/14/2010] [Indexed: 11/22/2022]
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79
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McKay C, Allen P, Jones PM, Chu MWA. Aortic arch replacement and elephant trunk procedure: an interdisciplinary approach to surgical reconstruction, perfusion strategies and blood management. Perfusion 2010; 25:369-79. [PMID: 20739351 DOI: 10.1177/0267659110381664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Surgical treatment of patients who present with large aneurysms of the ascending aorta, transverse arch and descending aorta, including the thoracic and abdominal aorta typically consists of a two-staged elephant trunk procedure. Typically, these operations are lengthy, requiring long cardiopulmonary bypass times, deep hypothermic circulatory arrest and multiple anastamotic suture lines, which increases the risks for coagulopathic bleeding and the need for massive transfusions. The purpose of this report is to describe our approach, involving advanced surgical techniques and the innovative perfusion considerations as well as modified blood management strategies to minimize perioperative blood loss and the need for transfusions. All of the above will highlight critical cardiac team communications. An ever-evolving case requires forward thinking, revised judgments, open discussion and the continued involvement of all team members. In turn, this ensures evidence-based medical and perfusion practices that lead to achieving a positive peri-operative course, with optimal blood conservation.
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Affiliation(s)
- Christine McKay
- Clinical Perfusion Services, London Health Sciences Centre, London, Ontario, Canada
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80
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Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE, Eagle KA, Hermann LK, Isselbacher EM, Kazerooni EA, Kouchoukos NT, Lytle BW, Milewicz DM, Reich DL, Sen S, Shinn JA, Svensson LG, Williams DM. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the diagnosis and management of patients with thoracic aortic disease. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology,American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons,and Society for Vascular Medicine. J Am Coll Cardiol 2010; 55:e27-e129. [PMID: 20359588 DOI: 10.1016/j.jacc.2010.02.015] [Citation(s) in RCA: 1002] [Impact Index Per Article: 71.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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81
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Obitsu Y, Koizumi N, Saiki N, Kawaguchi S, Shigematsu H. Long-term result of hybrid procedure for an extensive thoracic aortic aneurysm in Takayasu arteritis: a case report. J Cardiothorac Surg 2010; 5:28. [PMID: 20406457 PMCID: PMC2873360 DOI: 10.1186/1749-8090-5-28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2010] [Accepted: 04/20/2010] [Indexed: 11/30/2022] Open
Abstract
We herein present a 60 years old woman with Takayasu arteritis and an extensive thoracic aortic aneurysm who initially underwent a total aortic arch replacement. Then, in the second stage, thoracic endovascular aortic repair was performed using the elephant trunk graft as the proximal landing zone at four weeks after aortic arch repair. The postoperative course was relatively uncomplicated, but a type II endoleak was noted. Currently, about 5 years postoperatively, the slight type II endoleak from intercostal artery persists, but aneurism dilatation has not been noted, so the patient is being followed up.
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Affiliation(s)
- Yukio Obitsu
- Department of Vascular Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan.
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82
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Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE, Eagle KA, Hermann LK, Isselbacher EM, Kazerooni EA, Kouchoukos NT, Lytle BW, Milewicz DM, Reich DL, Sen S, Shinn JA, Svensson LG, Williams DM. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease: Executive Summary. Circulation 2010. [DOI: 10.1161/cir.0b013e3181d47d48] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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83
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2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease: Executive Summary. J Am Coll Cardiol 2010. [DOI: 10.1016/j.jacc.2010.02.010] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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84
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Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE, Eagle KA, Hermann LK, Isselbacher EM, Kazerooni EA, Kouchoukos NT, Lytle BW, Milewicz DM, Reich DL, Sen S, Shinn JA, Svensson LG, Williams DM. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation 2010; 121:e266-369. [PMID: 20233780 DOI: 10.1161/cir.0b013e3181d4739e] [Citation(s) in RCA: 1182] [Impact Index Per Article: 84.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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85
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Xydas S, Wei B, Takayama H, Russo M, Bacchetta M, Smith CR, Stewart A. Use of carotid–subclavian arterial bypass and thoracic endovascular aortic repair to minimize cerebral ischemia in total aortic arch reconstruction. J Thorac Cardiovasc Surg 2010; 139:717-22; discussion 722. [DOI: 10.1016/j.jtcvs.2009.10.040] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2009] [Revised: 09/28/2009] [Accepted: 10/25/2009] [Indexed: 10/19/2022]
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86
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Combined Open and Endovascular Treatment of Thoracoabdominal Aneurysms and Secondary Expanding Aortic Dissections: Early and Mid-Term Results From a Single-Center Series. Ann Vasc Surg 2010; 24:167-77. [DOI: 10.1016/j.avsg.2009.10.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2009] [Revised: 09/22/2009] [Accepted: 10/07/2009] [Indexed: 11/23/2022]
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87
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Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE, Eagle KA, Hermann LK, Isselbacher EM, Kazerooni EA, Kouchoukos NT, Lytle BW, Milewicz DM, Reich DL, Sen S, Shinn JA, Svensson LG, Williams DM, Jacobs AK, Smith SC, Anderson JL, Adams CD, Buller CE, Creager MA, Ettinger SM, Guyton RA, Halperin JL, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura R, Page RL, Riegel B, Stevenson WG, Tarkington LG, Yancy CW. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease: Executive Summary. Catheter Cardiovasc Interv 2010; 76:E43-86. [DOI: 10.1002/ccd.22537] [Citation(s) in RCA: 225] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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88
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Szeto WY, Bavaria JE. Hybrid Repair of Aortic Arch Aneurysms: Combined Open Arch Reconstruction and Endovascular Repair. Semin Thorac Cardiovasc Surg 2009; 21:347-54. [DOI: 10.1053/j.semtcvs.2009.11.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2009] [Indexed: 11/11/2022]
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89
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Desai ND, Szeto WY. Complex aortic arch aneurysm and dissections: hybrid techniques for surgical and endovascular therapy. Curr Opin Cardiol 2009; 24:521-7. [DOI: 10.1097/hco.0b013e3283317c91] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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90
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Da Rocha MFM, Miranda S, Adriani D, Urgnani F, Riambau VA, Mulet J. Hybrid procedures for complex aortic pathology: initial experience at a single center. Rev Esp Cardiol 2009; 62:896-902. [PMID: 19706245 DOI: 10.1016/s1885-5857(09)72654-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION AND OBJECTIVES To review experience at our center with the use of hybrid techniques for treating complex aneurysms of the thoracic aorta. METHODS The medical records of 41 patients (40 male) with complex aortic aneurysms affecting supra-aortic or visceral vessels who underwent hybrid procedures between 1998 and 2007 were reviewed retrospectively. All patients were in American Society of Anesthesiologists category IV. They were divided in two groups: group A comprised 32 patients with aneurysms involving the aortic arch and its branches (2 ascending aorta replacements, 1 arch repair, 13 carotid-carotid bypasses, 12 carotid-subclavian bypasses, and 4 with total arch debranching); and group B comprised 9 patients with thoracoabdominal aneurysms and visceral vessel transpositions (4 partial and 5 total debranching). The mean age in group A was 69.3+/-1.3 (range, 62-73) years and in group B, 71.5+/-5.0 (range, 68-74) years. RESULTS The mean hospital stay was 18+/-7.1 days (range, 5-35) and 12+/-8.2 days (range, 2-15) in groups A and B, respectively. Overall mortality was 12.2% (3.4% and 44.4% in groups A and B, respectively) and neurological morbidity was 3.4% and 11.1% in the two groups, respectively. CONCLUSIONS The results obtained with hybrid treatment of the aortic arch area were comparable with those of conventional surgery. However, thoracoabdominal repair with complete revascularization of the visceral branches was associated with high mortality. Consequently, hybrid treatment is a valid option for high-risk patients who do not require complete revascularization in the visceral area.
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Affiliation(s)
- Marcio F Maciel Da Rocha
- División de Cirugía Vascular, Instituto del Tórax, Hospital Clínic, Universidad de Barcelona, Barcelona, Spain
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91
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Endovascular Aortic Arch Repair: Hopes and Certainties. Eur J Vasc Endovasc Surg 2009; 38:255-61. [DOI: 10.1016/j.ejvs.2009.06.007] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Accepted: 06/11/2009] [Indexed: 11/22/2022]
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92
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93
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Yamamoto H, Yamamoto F, Ishibashi K, Noishiki Y. Vascular prosthesis rupture caused by contact with rib stump after thoracic aorta replacement. J Vasc Surg 2009; 50:195-7. [PMID: 19563969 DOI: 10.1016/j.jvs.2009.01.064] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Revised: 01/26/2009] [Accepted: 01/28/2009] [Indexed: 11/16/2022]
Abstract
A 42-year-old male with Marfan syndrome, who had undergone aortic root and total arch replacement for type-A acute aortic dissection at the age of 40, underwent descending aorta replacement with woven Dacron (Vascutek Ltd., Renfrewshire, Scotland) because of pseudoaneurysm at the site of the distal anastomosis and an enlarged pseudolumen of the dissecting descending aorta. The fourth and eighth ribs were cut at their anterior and posterior sites to allow wide exposure of the entire descending aorta. Postoperative computed tomographic scanning showed that the vascular prosthesis posteriorly contacted the eighth rib stump. On the postoperative day 25, the patient collapsed and developed severe hypotension. Emergency thoracotomy revealed a 6 mm in diameter hole on the posterior side of the vascular prosthesis. One day later, the patient died of cardiac dysfunction resulting from sustained hypotension. Electron microscopic examination of the vascular prosthesis showed that the hole was caused by frayed fabric and disrupted polyester fibers. Our experience warns that a woven polyester vascular prosthesis could rupture within 3 weeks of contacting a rib stump.
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Affiliation(s)
- Hiroshi Yamamoto
- Department of Cardiovascular Surgery, Akita University School of Medicine, Akita, Japan.
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94
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Toda K, Taniguchi K, Masai T, Takahashi T, Kuki S, Sawa Y. Arch Aneurysm Repair With Long Elephant Trunk: A 10-Year Experience in 111 Patients. Ann Thorac Surg 2009; 88:16-22. [DOI: 10.1016/j.athoracsur.2009.03.092] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Revised: 03/27/2009] [Accepted: 03/31/2009] [Indexed: 10/20/2022]
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95
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Slovut DP, Sullivan TM. Combined Endovascular and Open Revascularization. Ann Vasc Surg 2009; 23:414-24. [DOI: 10.1016/j.avsg.2008.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2008] [Accepted: 12/05/2008] [Indexed: 11/29/2022]
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96
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Kurra V, Schoenhagen P, Roselli EE, Kapadia SR, Tuzcu EM, Greenberg R, Akhtar M, Desai MY, Flamm SD, Halliburton SS, Svensson LG, Sola S. Prevalence of significant peripheral artery disease in patients evaluated for percutaneous aortic valve insertion: Preprocedural assessment with multidetector computed tomography. J Thorac Cardiovasc Surg 2009; 137:1258-64. [PMID: 19380001 DOI: 10.1016/j.jtcvs.2008.12.013] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2008] [Revised: 11/14/2008] [Accepted: 12/19/2008] [Indexed: 11/29/2022]
Affiliation(s)
- Vikram Kurra
- Heart & Vascular Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
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97
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Kim T, Martin TD, Lee WA, Hess PJ, Klodell CT, Tribble CG, Feezor RJ, Beaver TM. Evolution in the management of the total thoracic aorta. J Thorac Cardiovasc Surg 2009; 137:627-34. [DOI: 10.1016/j.jtcvs.2008.11.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Revised: 10/06/2008] [Accepted: 11/15/2008] [Indexed: 11/26/2022]
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98
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Fehrenbacher JW, McCready RA. Erosion of elephant trunk Dacron graft limb by thoracic endograft causing acute aneurysm expansion. J Vasc Surg 2009; 49:491-3. [PMID: 19216967 DOI: 10.1016/j.jvs.2008.08.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Revised: 08/28/2008] [Accepted: 08/31/2008] [Indexed: 11/28/2022]
Abstract
We recently treated a patient in whom a Gore TAG thoracic endograft (W.L. Gore and Assoc, Flagstaff, Arix) had been used to repair a descending thoracic aneurysm as the second stage of a hybrid procedure. This patient had previously undergone repair of ascending and aortic arch aneurysms, with an elephant trunk graft limb placed in the descending thoracic aorta for subsequent repair of the descending thoracic aneurysm. Eight months after placement of the thoracic endograft, the patient presented with an acutely expanding and symptomatic thoracic aneurysm. The patient was operated on urgently. The proximal portion of the endograft had eroded into the previously placed Dacron elephant trunk limb. The proximal portion of the endograft was removed and was replaced with a Dacron graft. The management of this patient forms the basis of this report.
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Affiliation(s)
- John W Fehrenbacher
- Department of Cardiovascular Surgery, Methodist Hospital, Clarian Health Partners, Indianapolis, Indiana, USA.
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99
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A staged replacement of the entire aorta from the ascending arch to the hypogastric arteries using a hybrid approach. J Vasc Surg 2008; 48:1593-6. [DOI: 10.1016/j.jvs.2008.06.055] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2008] [Revised: 06/20/2008] [Accepted: 06/23/2008] [Indexed: 11/23/2022]
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100
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Xu SD, Fan ZM, Li Y, Huang FJ. Endovascular repair after stent elephant trunk procedure for extensive thoracic aortic aneurysm. Interact Cardiovasc Thorac Surg 2008; 7:1189-90. [DOI: 10.1510/icvts.2008.184051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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