101
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Makaloski V, Tsilimparis N, Rohlffs F, Heidemann F, Debus ES, Kölbel T. Endovascular total arch replacement techniques and early results. Ann Cardiothorac Surg 2018; 7:380-388. [PMID: 30155417 DOI: 10.21037/acs.2018.04.02] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
During the last 20 years, a clear shift has been observed towards thoracic endovascular aortic repair for different aortic pathologies. However, total endovascular repair of the aortic arch remains technically demanding. Simultaneous perfusion of all supra-aortic arteries without longer cerebral ischemia time, whilst trying to avoid cerebral embolization, labels endovascular aortic arch repair with highest level of technical difficulty and surgical expertise. The aim of this article is to present an overview of the current technical options for endovascular aortic arch repair and their early results. Currently, early results are reported from four endovascular arch replacement techniques: hybrid repair, total endovascular approach, chimney grafts and in-situ fenestration. The early results of these different arch replacement techniques are promising, especially the total arch replacement with custom-made fenestrated or branched stent-grafts. Long-term results are unknown, and larger series results and comparative studies are needed to determine safety and efficacy.
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Affiliation(s)
- Vladimir Makaloski
- Department of Vascular Medicine, German Aortic Center, University Heart Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nikolaos Tsilimparis
- Department of Vascular Medicine, German Aortic Center, University Heart Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fiona Rohlffs
- Department of Vascular Medicine, German Aortic Center, University Heart Center Hamburg-Eppendorf, Hamburg, Germany
| | - Franziska Heidemann
- Department of Vascular Medicine, German Aortic Center, University Heart Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eike Sebastian Debus
- Department of Vascular Medicine, German Aortic Center, University Heart Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tilo Kölbel
- Department of Vascular Medicine, German Aortic Center, University Heart Center Hamburg-Eppendorf, Hamburg, Germany
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102
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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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Affiliation(s)
- R. E. Clough
- Aortic Centre, Hôpital Cardiologique, Centre Hospitalier Régional Universitaire (CHRU) de Lille, Lille Cedex, France
| | - R. Spear
- Aortic Centre, Hôpital Cardiologique, Centre Hospitalier Régional Universitaire (CHRU) de Lille, Lille Cedex, France
| | - K. Van Calster
- Aortic Centre, Hôpital Cardiologique, Centre Hospitalier Régional Universitaire (CHRU) de Lille, Lille Cedex, France
| | - A. Hertault
- Aortic Centre, Hôpital Cardiologique, Centre Hospitalier Régional Universitaire (CHRU) de Lille, Lille Cedex, France
| | - R. Azzaoui
- Aortic Centre, Hôpital Cardiologique, Centre Hospitalier Régional Universitaire (CHRU) de Lille, Lille Cedex, France
| | - J. Sobocinski
- Aortic Centre, Hôpital Cardiologique, Centre Hospitalier Régional Universitaire (CHRU) de Lille, Lille Cedex, France
| | - D. Fabre
- Department of Aortic and Vascular Surgery, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - S. Haulon
- Aortic Centre, Hôpital Cardiologique, Centre Hospitalier Régional Universitaire (CHRU) de Lille, Lille Cedex, France
- Department of Aortic and Vascular Surgery, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
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103
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Endovascular Chimney Technique for Aortic Arch Pathologies Treatment: A Systematic Review and Meta-Analysis. Ann Vasc Surg 2018; 47:305-315. [DOI: 10.1016/j.avsg.2017.09.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Revised: 07/04/2017] [Accepted: 09/05/2017] [Indexed: 11/19/2022]
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104
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Zhu J, Zhao L, Dai X, Luo Y, Fan H, Feng Z, Zhang Y, Hu F. Fenestrated Thoracic Endovascular Aortic Repair Using Physician Modified Stent Grafts for Acute Type B Aortic Dissection with Unfavourable Landing Zone. Eur J Vasc Endovasc Surg 2018; 55:170-176. [DOI: 10.1016/j.ejvs.2017.11.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 11/10/2017] [Indexed: 12/23/2022]
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105
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Tan GWL, Quek L, Tan BP, Pua U. Early Experience and Lessons Learnt with Customized Fenestrated Thoracic Endovascular Aortic Reconstruction for Aortic Arch Pathology in an Asian Population. Cardiovasc Intervent Radiol 2017; 41:544-553. [DOI: 10.1007/s00270-017-1858-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 12/05/2017] [Indexed: 12/17/2022]
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106
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Sarkar A, Kalsi R, Ayers JD, Drucker CB, Kaushal V, Sutton W, Crawford RS. Continuous Flow Perfused Cadaver Model for Endovascular Training, Research, and Development. Ann Vasc Surg 2017; 48:174-181. [PMID: 29197602 DOI: 10.1016/j.avsg.2017.11.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 10/22/2017] [Accepted: 11/12/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Endovascular simulation employing computer, animal, and static models are common and useful adjuncts for teaching endovascular procedures and developing novel, complex endovascular techniques. Unfortunately, these models lack realistic haptic feedback and thus do not faithfully replicate many of the technical challenges associated with clinical endovascular procedures (e.g., arterial calcification, rigidity, and stenosis). We sought to develop a realistic and reproducible perfused cadaver model for endovascular training, device development, and research. METHODS Fresh frozen, elderly (age 50-80 years) male cadavers were thawed and prepared for open dissection. The entire arterial tree (ascending aorta to femoral arteries) was dissected free and major branch vessels exposed. Sheaths were placed to allow outflow from selected vessels. A Dacron conduit was sewn to the ascending aorta to generate arterial inflow, which was provided by a centrifugal pump. Aortic aneurysms were created in the descending thoracic and abdominal aorta. Digital subtraction arteriography and various endovascular interventions were performed, including stent grafts and EndoAnchors deployment. RESULTS Continuous antegrade flow was achieved in the thoracic, abdominal, iliac, and femoral segments. Open and percutaneous access at the femoral region was obtained with realistic back-bleeding and tactile feedback. Adequate, fluoroscopically documented flow was observed in both cannulated major and noncannulated smaller branches. We performed angiography with standard techniques via a pigtail catheter and contrast injector throughout the arterial system. Abdominal and thoracic endografts were deployed with appropriate angiographic guidance and realistic haptic feedback for both guidewire and stent grafts. Additional applications, including selective cannulation, aorto-iliac occlusive disease interventions, and anchor placement, were also successfully simulated. Finally, the model was used as a platform to test investigational devices. CONCLUSIONS Our pressurized cadaver flow model successfully replicated multiple aspects of advanced endovascular procedures with haptic feedback. This novel human cadaver model allows for training and device development under clinically realistic conditions.
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Affiliation(s)
- Amrita Sarkar
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD.
| | - Richa Kalsi
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Joseph D Ayers
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Charles B Drucker
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Vaidehi Kaushal
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | | | - Robert S Crawford
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
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107
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Kölbel T, Bosaeus L, Tsilimparis N, Heidemann F, Rohlffs F, Liungman K. Fenestrated TEVAR Using a Guidewire Fixator for Anchoring in Aortic Arch Target Vessels. J Endovasc Ther 2017; 25:40-46. [DOI: 10.1177/1526602817744344] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To report a new facilitated method for securing target vessel access during single fenestrated and branched thoracic endovascular repair using a guidewire fixator. Technique: The Liungman Guidewire Fixator (LGF) includes a 0.035-inch guidewire that is fitted with a stopper close to the distal end and a self-expanding anchoring element that is freely movable over the guidewire to the point of the stopper. The technique of using a LGF for anchoring in a target vessel is described in a 75-year-old woman with a 53-mm saccular arch aneurysm. She was treated with a fenestrated Zenith stent-graft that had a catheter-preloaded fenestration for the left subclavian artery (LSA) and a scallop for the left common carotid artery. To avoid through-and-through wire and brachial access, the LGF was used to secure the guidewire in the LSA during stent-graft deployment. Conclusion: The use of an LGF for anchoring in the target LSA during fenestrated arch endografting was feasible and safe.
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Affiliation(s)
- Tilo Kölbel
- German Aortic Center, Department of Vascular Medicine, University Heart Center, Hamburg, Germany
| | | | - Nikolaos Tsilimparis
- German Aortic Center, Department of Vascular Medicine, University Heart Center, Hamburg, Germany
| | - Franziska Heidemann
- German Aortic Center, Department of Vascular Medicine, University Heart Center, Hamburg, Germany
| | - Fiona Rohlffs
- German Aortic Center, Department of Vascular Medicine, University Heart Center, Hamburg, Germany
| | - Krister Liungman
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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108
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Hori D, Okamura H, Yamamoto T, Nishi S, Yuri K, Kimura N, Yamaguchi A, Adachi H. Early and mid-term outcomes of endovascular and open surgical repair of non-dissected aortic arch aneurysm†. Interact Cardiovasc Thorac Surg 2017; 24:944-950. [PMID: 28329032 DOI: 10.1093/icvts/ivx031] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 01/03/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES With the introduction of endovascular stent graft technology, a variety of surgical options are available for patients with aortic aneurysms. We sought to evaluate early-term and mid-term outcomes of patients undergoing endovascular and open surgical repair for non-dissected aortic arch aneurysm. METHODS Overall, 200 patients underwent treatment for isolated non-dissected aortic arch aneurysm between January 2008 and February 2016: 133 patients had open surgery and 67, endovascular repair. Early-term and mid-term outcomes were compared. RESULTS Seventy percent ( n = 47) needing endovascular repair underwent fenestrated stent graft and 30% ( n = 20) underwent the debranched technique. Patients in the open surgery group were younger (71 vs 75 years, P < 0.001) and had a lower prevalence of ischaemic heart disease (11% vs 35%, P < 0.001). Intensive care unit stay (1 vs 3 days, P < 0.001), hospital stay (11 vs 17 days, P < 0.001) and surgical time (208 vs 390 min, P < 0.001) were lower in the endovascular repair group than in the open surgery group. There were 3 in-hospital deaths each in the open surgery and endovascular groups (2% vs 5%, respectively, P = 0.40). Mid-term survival ( P < 0.001) and freedom from reintervention ( P = 0.009) were better in the open surgery than in the endovascular repair group. No aneurysm-related deaths were observed. The propensity-matched comparison ( n = 58) demonstrated that survival was better in the open surgery group ( P = 0.011); no significant difference was seen in the reintervention rate ( P = 0.28). CONCLUSIONS Close follow-up for re-intervention may reduce the risk for aneurysm-related deaths and provide acceptable outcomes in patients undergoing endovascular repair.
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Affiliation(s)
- Daijiro Hori
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Homare Okamura
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Takahiro Yamamoto
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Satoshi Nishi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Koichi Yuri
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Naoyuki Kimura
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Atsushi Yamaguchi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hideo Adachi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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109
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Fernández-Alonso L, Fernández Alonso S, Martínez Aguilar E, Santamarta Fariña E, Alegret Solé J, López San Martín M, Atienza Pascual M, Fernández-Domper L, Centeno Vallepuga R. Endovascular Treatment of Aortic Arch Lesions Using Scalloped Endografts. Vasc Endovascular Surg 2017; 52:22-26. [DOI: 10.1177/1538574417740056] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To present our early and midterm results using thoracic endovascular aortic repair (TEVAR) with a custom-made proximal scalloped stent graft to accommodate left common carotid artery (LCCA) and innominate artery (IA) in treating aortic lesions involving the arch. Materials and Methods: Between February 2014 and April 2017, select patients presenting with aortic arch lesions and short proximal landing zone were treated by proximal scalloped Relay Plus stent grafts. Patient demographics, operative details, clinical outcomes, and complications were analyzed. Results: Six patients (50% male) with a median age of 71 years (range, 60-82) underwent scalloped TEVAR using thoracic custom-made Relay Plus stent graft to preserve flow in the proximal supra-aortic trunks. Target vessels for the scallop were LCCA in 5 cases and IA in 1 case. The technical success rate was 100%, and proximal seal was achieved in all cases with no type I endoleaks on completion angiography. The median follow-up period was 20 (7-32) months. No conversion to open surgical repair and no aortic rupture occurred. One patient had a distal type I endoleak on the 6-month computed tomography (CT) scan, and 1 patient had a proximal type I endoleak on the 12-month CT scan. There was no stroke, paraplegia, retrograde type A dissection, or other aortic-related complication. We routinely used temporary rapid right ventricular pacing to obtain a near-zero blood pressure level during the graft deployment. No complications were observed related to the use of rapid pacing. Conclusion: When anatomy allows, proximal scalloped stent graft to accommodate LCCA and IA is a viable therapeutic option in treating aortic lesions involving the arch with short proximal landing zones. In addition, these findings represent a strong argument for the use of temporary rapid pacing during graft deployment.
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Affiliation(s)
| | | | | | | | - Jordi Alegret Solé
- Division of Vascular Surgery, Complejo Hospitalario of Navarra, Pamplona, Spain
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110
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Fallatah R, Elasfar AA, Alzubaidi S, Alraddadi M, Abuelatta R. Endovascular repair of a leaking aortic-arch pseudoaneurysm using graft stent combined with chimney protection to left common carotid artery: Case report and review of literature. J Saudi Heart Assoc 2017; 30:254-259. [PMID: 29983500 PMCID: PMC6026385 DOI: 10.1016/j.jsha.2017.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 10/13/2017] [Indexed: 11/17/2022] Open
Abstract
Aortic pseudoaneurysm (PsA) is a rare but serious condition that has high mortality and morbidity rates if untreated. We report a rare case of leaking aortic-arch PsA repaired by thoracic endovascular aortic repair using graft stent with the chimney technique to protect the left common carotid artery. Unlike other cases in the literature, our case was unique, having leaking PsA not related to previous cardiac surgery or aortic dissection. The successful management of this patient using thoracic endovascular aortic repair combined with the chimney technique suggests that this approach may be an attractive therapeutic alternative to treat aortic-arch PsA.
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Affiliation(s)
- Raneem Fallatah
- Madina Cardiac Center, Madina, Saudi Arabia
- King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdelfatah A. Elasfar
- Madina Cardiac Center, Madina, Saudi Arabia
- Cardiology Department, Tanta University, Egypt
- Corresponding author at: Madina Cardiac Center, Madina, Saudi Arabia.
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111
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Wang T, Shu C, Li QM, Li M, Li X, He H, Dardik A, Qiu J. First experience with the double chimney technique in the treatment of aortic arch diseases. J Vasc Surg 2017; 66:1018-1027. [DOI: 10.1016/j.jvs.2017.02.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 02/23/2017] [Indexed: 11/25/2022]
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112
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Experimental Assessment of Physician Modified Proximal Scalloped Stent Graft to Extend Proximal Landing Zone in the Aortic Arch. Eur J Vasc Endovasc Surg 2017; 54:150-156. [DOI: 10.1016/j.ejvs.2017.04.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 04/24/2017] [Indexed: 11/24/2022]
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113
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Andrási TB, Grossmann M, Zenker D, Danner BC, Schöndube FA. Supra-aortic interventions for endovascular exclusion of the entire aortic arch. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2017.04.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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114
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Kolvenbach RR, Karmeli R. Commentary: Impressive Midterm Results of Parallel Grafts in the Aortic Arch. J Endovasc Ther 2017; 24:394-396. [PMID: 28387581 DOI: 10.1177/1526602817698893] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ralf R Kolvenbach
- 1 Vascular Centre, Augusta Hospital and Catholic Hospital Group, Düsseldorf, Germany
| | - Ron Karmeli
- 2 Department of Vascular Surgery, Carmel Medical Center, Haifa, Israel
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115
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Wang T, Shu C, Li M, Li QM, Li X, Qiu J, Fang K, Dardik A, Yang CZ. Thoracic Endovascular Aortic Repair With Single/Double Chimney Technique for Aortic Arch Pathologies. J Endovasc Ther 2017; 24:383-393. [PMID: 28387611 DOI: 10.1177/1526602817698702] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To summarize a single-center experience using the single/double chimney technique in association with thoracic endovascular aortic repairs (TEVAR) for aortic arch pathologies. Methods: From November 2007 to March 2016, 122 patients (mean age 50.4±12.7 years, range 29–80; 92 men) with aortic arch pathologies underwent TEVAR combined with single (n=101) or double (n=21) chimney grafts to reconstruct the supra-aortic branches: 21 innominate arteries, 114 left common carotid arteries, and 8 left subclavian arteries (LSA). Pathologies included type B aortic dissection (n=47), aortic arch dissection (n=49), retrograde type A aortic dissection (n=8), thoracic aortic aneurysm (n=7), penetrating aortic arch ulcer (n=9), and post-TEVAR type I endoleak (n=2). Follow-up examinations included computed tomography at 0.5, 3, 6, and 12 months and yearly thereafter. Results: The aortic stent-grafts were deployed in zone 0 (n=21), zone 1 (n=93), and zone 2 (n=8). One (0.8%) of the 122 patients died at 4 days due to a perforated peptic ulcer. Type Ia endoleaks were found intraoperatively in 13 (10.7%) patients, including 3 with the double chimney technique. Type II endoleaks occurred in 6 (4.9%) patients; 3 were treated with duct occluders in the LSA. Postoperative chimney graft migration occurred in 1 (0.8%) patient with double chimneys; additional stent-grafts were deployed in both chimneys. Median follow-up was 32.3 months, during which 1 (0.8%) patient died after a stroke at 3 months. Chimney stent-graft patency was observed in the remaining 120 patients. Two (1.7%) secondary TEVARs were performed for distal aortic dissection. Nine asymptomatic type Ia endoleaks and 1 type II endoleak persisted in follow-up; a type II endoleak in 1 patient with Marfan syndrome sealed in 52 months. Conclusion: TEVAR with the chimney technique provides a safe, minimally invasive alternative with good chimney graft patency and low postoperative mortality during midterm follow-up. The double chimney technique should be used judiciously owing to its potential complications.
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Affiliation(s)
- Tun Wang
- Department of Vascular Surgery, The 2nd Xiang-ya Hospital, Changsha, Hunan, China
- Angiopathy Institute, Central South University, Changsha, Hunan, China
| | - Chang Shu
- Department of Vascular Surgery, The 2nd Xiang-ya Hospital, Changsha, Hunan, China
- Angiopathy Institute, Central South University, Changsha, Hunan, China
- Department of Cardiovascular Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, Xicheng District, Beijing, China
| | - Ming Li
- Department of Vascular Surgery, The 2nd Xiang-ya Hospital, Changsha, Hunan, China
- Angiopathy Institute, Central South University, Changsha, Hunan, China
| | - Quan-ming Li
- Department of Vascular Surgery, The 2nd Xiang-ya Hospital, Changsha, Hunan, China
- Angiopathy Institute, Central South University, Changsha, Hunan, China
| | - Xin Li
- Department of Vascular Surgery, The 2nd Xiang-ya Hospital, Changsha, Hunan, China
- Angiopathy Institute, Central South University, Changsha, Hunan, China
| | - Jian Qiu
- Department of Vascular Surgery, The 2nd Xiang-ya Hospital, Changsha, Hunan, China
- Angiopathy Institute, Central South University, Changsha, Hunan, China
| | - Kun Fang
- Department of Cardiovascular Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, Xicheng District, Beijing, China
| | - Alan Dardik
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Chen-zi Yang
- Department of Vascular Surgery, The 2nd Xiang-ya Hospital, Changsha, Hunan, China
- Angiopathy Institute, Central South University, Changsha, Hunan, China
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116
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Sibille JA, Harding JP, Ballast JK, Hooshmand M, Madjarov JM, Arko FR. Endovascular repair of an innominate artery pseudoaneurysm using the Valiant Mona LSA branched graft device. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2016; 3:1-3. [PMID: 29349361 PMCID: PMC5757800 DOI: 10.1016/j.jvscit.2016.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 09/26/2016] [Indexed: 10/31/2022]
Abstract
A 60-year-old woman involved in a motor vehicle collision presented with a traumatic pseudoaneurysm of the innominate artery origin in addition to multiple concomitant injuries. She was classified as a high-risk candidate for open repair. An experimental thoracic branched graft device was used for coverage of the injury with the addition of a right carotid-to-left carotid-to-left subclavian artery bypass. Follow-up imaging showed resolution of the pseudoaneurysm and patency of her bypass grafts. This is the first described use of the Mona LSA Branch Thoracic Stent Graft System (Medtronic, Minneapolis, Minn) in the innominate artery.
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Affiliation(s)
- Josh A Sibille
- Department of Vascular Surgery, Sanger Heart and Vascular Institute, Charlotte, NC
| | - Joel P Harding
- Department of Vascular Surgery, Sanger Heart and Vascular Institute, Charlotte, NC
| | - Jocelyn K Ballast
- Department of Vascular Surgery, Sanger Heart and Vascular Institute, Charlotte, NC
| | - Mohammad Hooshmand
- Department of Vascular Surgery, Sanger Heart and Vascular Institute, Charlotte, NC
| | - Jeko M Madjarov
- Department of Vascular Surgery, Sanger Heart and Vascular Institute, Charlotte, NC
| | - Frank R Arko
- Department of Vascular Surgery, Sanger Heart and Vascular Institute, Charlotte, NC
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