401
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Thompson M, Youssef M, Jacob R, Zerwes S, Reijnen M, Szopinski P, Berg P, Oszkinis G, Holden A. Early Experience With Endovascular Aneurysm Sealing in Combination With Parallel Grafts for the Treatment of Complex Abdominal Aneurysms: The ASCEND Registry. J Endovasc Ther 2017; 24:764-772. [DOI: 10.1177/1526602817731103] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
| | - Marwan Youssef
- Department of Vascular Surgery, University Hospital, Mainz, Germany
| | - Rudolf Jacob
- Department of Vascular Surgery, Augsburg Hospital, Augsburg, Germany
| | - Sebastian Zerwes
- Department of Vascular Surgery, Augsburg Hospital, Augsburg, Germany
| | - Michel Reijnen
- Department of Vascular Surgery, Rijnstate Hospital, Arnhem, the Netherlands
| | | | - Patrick Berg
- Department of Vascular Surgery, Marienhospital Kevelaer, Germany
| | | | - Andrew Holden
- Department of Interventional Radiology, Auckland City Hospital, Auckland, New Zealand
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402
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Yang Y, Ma Z, Yang G, Wan J, Li G, Du L, Lu P. Alginate oligosaccharide indirectly affects toll-like receptor signaling via the inhibition of microRNA-29b in aneurysm patients after endovascular aortic repair. DRUG DESIGN DEVELOPMENT AND THERAPY 2017; 11:2565-2579. [PMID: 28919708 PMCID: PMC5590761 DOI: 10.2147/dddt.s140206] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Endovascular aortic repair (EVAR) is often followed by aneurysm recurrence. Alginate oligosaccharide (AOS) has potential antitumor properties as a natural product while the related mechanisms remain unclear. Toll-like receptor (TLR) signaling is associated with inflammatory activity of aneurysm and may be affected by miR-29b. Thus, inhibitory function of AOS on aneurysms was explored by measuring the important molecules in TLR4 signaling. After EVAR, a total of 248 aortic aneurysm patients were recruited and randomly assigned into two groups: AOS group (AG, oral administration 10-mg AOS daily) and control group (CG, placebo daily). The size of residual aneurysms, aneurysm recurrence, and side effects were investigated. Aneurysm recurrence was determined by Kaplan-Meier analysis. After 2 years, eight and two patients died in the CG and AG, respectively. The sizes of residual aneurysms were significantly larger in the CG than in the AG (P<0.05). The incidence of aneurysm recurrence was also significantly higher in the CG than in the AG (P<0.05). AOS treatment reduced the levels of miR-29b, TLR4, mitogen-activated protein kinase (MAPK), nuclear factor kappa B (NF-kappa B), interleukin 1 (IL-1) beta, and interleukin 6 (IL-6). Overexpression and silence of miR-29b increased and reduced the level of TLR4, phospho-p65 NF-kappa B, phospho-p38 MAPK, IL-1 beta, and IL-6. Spearman's rank correlation analysis shows that the level of miR-29b is positively related to the levels of TLR4, NF-kappa B, IL-1 beta, and IL-6 (P<0.05). Thus, AOS represses aneurysm recurrence by indirectly affecting TLR signaling via miR-29b.
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Affiliation(s)
- Yong Yang
- Department of Vascular Surgery, The Second People's Hospital of Yunnan Province, Kunming, China.,Department of Vascular Surgery, The Fourth Affiliated Hospital of Kunming Medical University, Kunming, China.,Department of Vascular Surgery, Vascular Surgery Centre in Yunnan Province, Kunming, China.,Department of Vascular Surgery, Abdominal Surgery Centre in Yunnan Province, Kunming, China
| | - Zhenhuan Ma
- Department of Vascular Surgery, The Second People's Hospital of Yunnan Province, Kunming, China.,Department of Vascular Surgery, The Fourth Affiliated Hospital of Kunming Medical University, Kunming, China.,Department of Vascular Surgery, Vascular Surgery Centre in Yunnan Province, Kunming, China.,Department of Vascular Surgery, Abdominal Surgery Centre in Yunnan Province, Kunming, China
| | - Guokai Yang
- Department of Vascular Surgery, The Second People's Hospital of Yunnan Province, Kunming, China.,Department of Vascular Surgery, The Fourth Affiliated Hospital of Kunming Medical University, Kunming, China.,Department of Vascular Surgery, Vascular Surgery Centre in Yunnan Province, Kunming, China.,Department of Vascular Surgery, Abdominal Surgery Centre in Yunnan Province, Kunming, China
| | - Jia Wan
- Department of Vascular Surgery, The Second People's Hospital of Yunnan Province, Kunming, China.,Department of Vascular Surgery, The Fourth Affiliated Hospital of Kunming Medical University, Kunming, China.,Department of Vascular Surgery, Vascular Surgery Centre in Yunnan Province, Kunming, China.,Department of Vascular Surgery, Abdominal Surgery Centre in Yunnan Province, Kunming, China
| | - Guojian Li
- Department of Vascular Surgery, The Second People's Hospital of Yunnan Province, Kunming, China.,Department of Vascular Surgery, The Fourth Affiliated Hospital of Kunming Medical University, Kunming, China.,Department of Vascular Surgery, Vascular Surgery Centre in Yunnan Province, Kunming, China.,Department of Vascular Surgery, Abdominal Surgery Centre in Yunnan Province, Kunming, China
| | - Lingjuan Du
- Department of Vascular Surgery, The Second People's Hospital of Yunnan Province, Kunming, China.,Department of Vascular Surgery, The Fourth Affiliated Hospital of Kunming Medical University, Kunming, China.,Department of Vascular Surgery, Vascular Surgery Centre in Yunnan Province, Kunming, China.,Department of Vascular Surgery, Abdominal Surgery Centre in Yunnan Province, Kunming, China
| | - Ping Lu
- Department of Vascular Surgery, The Second People's Hospital of Yunnan Province, Kunming, China.,Department of Vascular Surgery, The Fourth Affiliated Hospital of Kunming Medical University, Kunming, China.,Department of Vascular Surgery, Vascular Surgery Centre in Yunnan Province, Kunming, China.,Department of Vascular Surgery, Abdominal Surgery Centre in Yunnan Province, Kunming, China
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403
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Pecoraro F, Lachat M, Cayne N, Pakeliani D, Rancic Z, Puippe G, Criado F, Pfammatter T, Veith F, Krüger B, Neff T. Mid-term Results of Chimney and Periscope Grafts in Supra-aortic Branches in High Risk Patients. Eur J Vasc Endovasc Surg 2017; 54:295-302. [DOI: 10.1016/j.ejvs.2017.06.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 06/20/2017] [Indexed: 01/16/2023]
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404
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405
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Voskresensky I, Scali ST, Feezor RJ, Fatima J, Giles KA, Tricarico R, Berceli SA, Beck AW. Outcomes of thoracic endovascular aortic repair using aortic arch chimney stents in high-risk patients. J Vasc Surg 2017; 66:9-20.e3. [PMID: 28216358 DOI: 10.1016/j.jvs.2016.11.063] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 11/29/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Aortic arch disease is a challenging clinical problem, especially in high-risk patients, in whom open repair can have morbidity and mortality rates of 30% to 40% and 2% to 20%, respectively. Aortic arch chimney (AAC) stents used during thoracic endovascular aortic repair (TEVAR) are a less invasive treatment strategy than open repair, but the current literature is inconclusive about the role of this technology. The focus of this analysis is on our experience with TEVAR and AAC stents. METHODS All TEVAR procedures performed from 2002 to 2015 were reviewed to identify those with AAC stents. Primary end points were technical success and 30-day and 1-year mortality. Secondary end points included complications, reintervention, and endoleak. Technical success was defined as a patient's surviving the index operation with deployment of the AAC stent at the intended treatment zone with no evidence of type I or type III endoleak on initial postoperative imaging. The Kaplan-Meier method was used to estimate survival. RESULTS Twenty-seven patients (age, 69 ± 12 years; male, 70%) were identified, and all were described as being at prohibitive risk for open repair by the treating team. Relevant comorbidity rates were as follows: coronary artery disease/myocardial infarction, 59%; oxygen-dependent emphysema, 30%; preoperative creatinine concentration >1.8 mg/dL, 19%; and congestive heart failure, 15%. Presentations included elective (67%; n = 18), symptomatic (26%; n = 7), and ruptured (7%; n = 2). Eleven patients (41%) had prior endovascular or open arch/descending thoracic repair. Indications were degenerative aneurysm (49%), chronic residual type A dissection with aneurysm (15%), type Ia endoleak after TEVAR (11%), postsurgical pseudoaneurysm (11%), penetrating ulcer (7%), and acute type B dissection (7%). Thirty-two brachiocephalic vessels were treated: innominate (n = 7), left common carotid artery (LCCA; n = 24), and left subclavian artery (n = 1). Five patients (19%) had simultaneous innominate-LCCA chimneys. Brachiocephalic chimney stents were planned in 75% (n = 24), with the remainder placed for either LCCA or innominate artery encroachment (n = 8). Overall technical success was 89% (one intraoperative death, two persistent type Ia endoleaks in follow-up). The 30-day mortality was 4% (n = 1; intraoperative death of a patient with a ruptured arch aneurysm), and median length of stay was 6 (interquartile range, 4-9) days. Seven (26%) patients experienced a major complication (stroke, three [all with unplanned brachiocephalic chimney]; respiratory failure, three; and death, one). Nine (33%) patients underwent aorta-related reintervention, and no chimney occlusion events occurred during follow-up (median follow-up, 9 [interquartile range, 1-23] months). The 1-year and 3-year survival is estimated to be 88% ± 6% and 69% ± 9%, respectively. CONCLUSIONS TEVAR with AAC can be performed with high technical success and acceptable morbidity and mortality in high-risk patients. Unplanned AAC placement during TEVAR results in an elevated stroke risk, which may be related to the branch vessel coverage necessitating AAC placement. Acceptable midterm survival can be anticipated, but aorta-related reintervention is not uncommon, and diligent follow-up is needed.
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Affiliation(s)
- Igor Voskresensky
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, Fla
| | - Salvatore T Scali
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, Fla.
| | - Robert J Feezor
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, Fla
| | - Javairiah Fatima
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, Fla
| | - Kristina A Giles
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, Fla
| | - Rosamaria Tricarico
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, Fla
| | - Scott A Berceli
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, Fla
| | - Adam W Beck
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, Fla
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406
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Caradu C, Morin J, Midy D, Lepidi S, Ducasse E. Combination of Chimneys and Fenestrated Endografts in the Treatment of Complex Aortic Aneurysms. J Endovasc Ther 2017; 24:575-583. [PMID: 28602114 DOI: 10.1177/1526602817713472] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To present early results of fenestrated endovascular aneurysm repair (FEVAR) combined with chimney grafts in a high-volume center. METHODS From July 2011 to July 2016, 45 patients (mean age 73.0±8.8 years; 39 men) with complex aneurysms who were poor candidates for open repair and anatomically ineligible for standard or custom-made FEVAR were treated with chimney FEVAR (chFEVAR). Eight (18%) cases were treated in emergency. In all, 130 target vessels (2.9/patient) were addressed using 21 scallops, 42 open/18 covered chimneys, and 27 custom-made/22 homemade fenestrations. RESULTS Successful aneurysm exclusion, successful reconstruction, and technical success rates were 97.8% (44/45), 98.2% (107/109 vessels excluding the scallops), and 93.3% (42/45). Six (13.3%) patients died within 30 days (5 in hospital). Estimated overall survival, freedom from aneurysm-related death, and freedom from aneurysm-related reintervention were 85.9%, 88.5%, and 59.2%, respectively, at 12 months. The target vessel patency rate was 96.0%. At latest follow-up, 1 type Ia and 3 type II endoleaks were present. Sac shrinkage occurred in 18 (54%) patients. CONCLUSION Combined chFEVAR showed good technical feasibility and could be an effective approach in emergent settings and highly selective cases when FEVAR is not feasible. Thirty-day mortality, target vessel patency, and type Ia endoleak rates were acceptable.
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Affiliation(s)
- Caroline Caradu
- 1 Department of Vascular Surgery, Université de Bordeaux, CHU de Bordeaux, France
| | - Julien Morin
- 1 Department of Vascular Surgery, Université de Bordeaux, CHU de Bordeaux, France
| | - Dominique Midy
- 1 Department of Vascular Surgery, Université de Bordeaux, CHU de Bordeaux, France
| | - Sandro Lepidi
- 2 Department of Vascular Surgery, University of Padua, Italy
| | - Eric Ducasse
- 1 Department of Vascular Surgery, Université de Bordeaux, CHU de Bordeaux, France
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407
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Torsello GF, Inchingolo M, Austermann M, Torsello GB, Panuccio G, Bisdas T. Durability of a low-profile stent graft for thoracic endovascular aneurysm repair. J Vasc Surg 2017; 66:1638-1643. [PMID: 28602624 DOI: 10.1016/j.jvs.2017.04.042] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 04/16/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The introduction of lower profile endografts expanded the application of aortic endovascular repair. However, evidence about their durability is still scarce. The objective of this study was to assess longer term durability of the Zenith Alpha Thoracic Stent Graft (Cook Inc, Bloomington, Ind) after thoracic endovascular aortic repair. METHODS Prospectively collected data of all patients treated for thoracic aortic aneurysms or penetrating aortic ulcers and having computed tomography angiography-based follow-up of ≥12 months were retrospectively analyzed. The primary end point was ongoing clinical success. Among the secondary end points, stent graft migration and fracture were analyzed. RESULTS Between August 2010 and October 2015, 70 consecutive patients were treated in a single center with the Zenith Alpha stent graft. With computed tomography angiography-based follow-up of 22.3 ± 15.9 months, ongoing clinical success was 87.1%. There were three cases of type IA endoleak (4.3%), two cases of type IB endoleak (2.9%), and one case of aneurysm sac enlargement (1.4%). Five patients died postoperatively (7.1%). No type III or type IV endoleak was detected; there was one case of distal stent graft migration and no stent fracture. Reintervention was necessary in one case (1.4%) of a combined type IA and type II endoleak. There were no conversions to open repair and no ruptures or intraoperative deaths. All-cause mortality was 17.1% at 76 months. CONCLUSIONS The Zenith Alpha Thoracic Stent Graft appears to maintain favorable results in a longer time frame with a low incidence of aneurysm sac growth and migration. Results from multicenter prospective trials are needed to validate these data.
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Affiliation(s)
- Giovanni F Torsello
- Department of Vascular Surgery, St. Franziskus Hospital, Münster, Germany; Westphalian Center for Radiology, Münster, Germany.
| | - Mirjam Inchingolo
- Department of Vascular and Endovascular Surgery, University Clinic of Münster, Münster, Germany
| | - Martin Austermann
- Department of Vascular Surgery, St. Franziskus Hospital, Münster, Germany
| | - Giovanni B Torsello
- Department of Vascular Surgery, St. Franziskus Hospital, Münster, Germany; Department of Vascular and Endovascular Surgery, University Clinic of Münster, Münster, Germany
| | - Giuseppe Panuccio
- Department of Vascular and Endovascular Surgery, University Clinic of Münster, Münster, Germany
| | - Theodosios Bisdas
- Department of Vascular and Endovascular Surgery, University Clinic of Münster, Münster, Germany
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408
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Marrocco-Trischitta MM, de Beaufort HW, Secchi F, van Bakel TM, Ranucci M, van Herwaarden JA, Moll FL, Trimarchi S. A geometric reappraisal of proximal landing zones for thoracic endovascular aortic repair according to aortic arch types. J Vasc Surg 2017; 65:1584-1590. [DOI: 10.1016/j.jvs.2016.10.113] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 10/30/2016] [Indexed: 01/16/2023]
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409
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Piffaretti G, Ottavi P, Lomazzi C, Franchin M, Micheli R, Ferilli F, Dorigo W, Marrocco-Trischitta M, Castelli P, Trimarchi S. Thoracic Endovascular Aortic Repair for Type B Acute Aortic Dissection Complicated by Descending Thoracic Aneurysm. Eur J Vasc Endovasc Surg 2017; 53:793-801. [DOI: 10.1016/j.ejvs.2017.02.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 02/21/2017] [Indexed: 01/03/2023]
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410
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Iafrancesco M, Goebel N, Mascaro J, Franke UF, Pacini D, Di Bartolomeo R, Weiss G, Grabenwöger M, Leontyev SA, Mohr FW, Sioris T, Jakob H, Tsagakis K. Aortic diameter remodelling after the frozen elephant trunk technique in aortic dissection: results from an international multicentre registry†. Eur J Cardiothorac Surg 2017; 52:310-318. [PMID: 28575324 DOI: 10.1093/ejcts/ezx131] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 12/20/2016] [Indexed: 11/14/2022] Open
Affiliation(s)
- Mauro Iafrancesco
- Department of Cardiothoracic Surgery, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Nora Goebel
- Department of Cardiac and Vascular Surgery, Robert Bosch Hospital, Stuttgart, Germany
| | - Jorge Mascaro
- Department of Cardiothoracic Surgery, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ulrich F.W. Franke
- Department of Cardiac and Vascular Surgery, Robert Bosch Hospital, Stuttgart, Germany
| | - Davide Pacini
- Department of Cardiac Surgery, Sant’Orsola-Malpighi Hospital, Bologna, Italy
| | | | - Gabriel Weiss
- Department of Cardiovascular Surgery, Hospital Hietzing, Vienna, Austria
| | - Martin Grabenwöger
- Department of Cardiovascular Surgery, Hospital Hietzing, Vienna, Austria
| | - Sergey A. Leontyev
- Department of Cardiac Surgery, Leipzig Heart Center, University of Leipzig, Leipzig, Germany
| | - Friedrich-Wilhelm Mohr
- Department of Cardiac Surgery, Leipzig Heart Center, University of Leipzig, Leipzig, Germany
| | - Thanos Sioris
- Tampere University Hospital Heart Center, Tampere, Finland
| | - Heinz Jakob
- Department of Thoracic and Cardiovascular Surgery, West German Heart Centre Essen, University Hospital Essen, Essen, Germany
| | - Konstantinos Tsagakis
- Department of Thoracic and Cardiovascular Surgery, West German Heart Centre Essen, University Hospital Essen, Essen, Germany
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411
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Sultan S, Kavanagh EP, Stefanov F, Sultan M, Elhelali A, Costache V, Diethrich E, Hynes N. Endovascular management of chronic symptomatic aortic dissection with the Streamliner Multilayer Flow Modulator: Twelve-month outcomes from the global registry. J Vasc Surg 2017; 65:940-950. [PMID: 28342521 DOI: 10.1016/j.jvs.2016.09.059] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 09/04/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Reported are initial 12-month outcomes of patients with chronic symptomatic aortic dissection managed by the Streamliner Multilayer Flow Modulator (SMFM; Cardiatis, Isnes, Belgium). Primary end points were freedom from rupture- and aortic-related death, and reduction in false lumen index. Secondary end points were patency of great vessels and visceral branches, and freedom of stroke, paraplegia, and renal failure. METHODS Out of 876 SMFM implanted globally, we have knowledge of 542. To date, 312 patients are maintained in the global registry, of which 38 patients were identified as having an aortic dissection (12.2%). Indications included 35 Stanford type B dissections, two Stanford type A and B dissections, and one mycotic Stanford type B dissection. RESULTS There were no reported ruptures or aortic-related deaths. All cause survival was 85.3% Twelve-month freedom from neurologic events was 100%, and there were no incidences of end-organ ischemia, paraplegia or renal insult. Morphologic analysis exhibited dissection remodeling by a reduction in longitudinal length of the dissected aorta, and false lumen volume. A statistically significant reduction in false lumen index (P = .016) at 12 months, and a borderline significant increase in true lumen volume (P = .053) confirmed dissection remodeling. CONCLUSIONS The SMFM is an option in management of complex pan-aortic dissection. Results highlight SMFM implantation leads to dissection stabilization with no further aneurysm progression, and no retrograde type A dissection. Thoracic endovascular aneurysm repair by SMFM ensued in freedom from aortic rupture, neurologic stroke, paraplegia and renal failure. Further analysis of the global registry data will inform long-term outcomes.
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Affiliation(s)
- Sherif Sultan
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, Galway University Hospital, National University of Ireland, Galway, Ireland; Department of Vascular and Endovascular Surgery, Galway Clinic, Doughiska, Galway, Ireland.
| | - Edel P Kavanagh
- Department of Vascular and Endovascular Surgery, Galway Clinic, Doughiska, Galway, Ireland
| | - Florian Stefanov
- Department of Mechanical and Industrial Engineering, Galway Medical Technologies Center (GMedTech), Galway Mayo Institute of Technology, Galway, Ireland
| | - Mohamed Sultan
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, Galway University Hospital, National University of Ireland, Galway, Ireland
| | - Ala Elhelali
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, Galway University Hospital, National University of Ireland, Galway, Ireland; Department of Mechanical and Industrial Engineering, Galway Medical Technologies Center (GMedTech), Galway Mayo Institute of Technology, Galway, Ireland
| | - Victor Costache
- Department of Cardio-Vascular Surgery, European Clinic Polisano Hospital, Sibiu, Romania
| | | | - Niamh Hynes
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, Galway University Hospital, National University of Ireland, Galway, Ireland; Department of Vascular and Endovascular Surgery, Galway Clinic, Doughiska, Galway, Ireland
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412
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Results of the French Multicentric Study of ANACONDA™ Fenestrated Endografts in the Treatment of Complex Aortic Pathologies (EFEFA Registry). Ann Vasc Surg 2017; 43:151-165. [PMID: 28495540 DOI: 10.1016/j.avsg.2017.03.171] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 03/28/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Most of the experience on fenestrated endovascular aneurysm repair involves the custom-made Zenith® endograft (Cook). The fenestrated Anaconda® endograft (Vascutek) was introduced with the potential advantages of complete repositioning and lack of stent material on the main aortic body for more versatility. However, few data are available. Our objective was to assess its mid-term results in the treatment of complex aortic aneurysms. METHODS Consecutive patients treated with the custom-made fenestrated Anaconda endograft in France and the Principality of Monaco, from December 2010 to October 2015, were included. RESULTS Eighty-six patients were included over 16 centers (82 men, mean age 73.4 ± 8.1 years, 16 (18.6%) symptomatic aneurysms). The repositioning system was used in 68 cases (79.1%). Two hundred ninety-two visceral/renal vessels were targeted, with a mean number of 3.4 ± 0.6 target vessels/patient and a successful reconstruction in 99.3% of the cases (290/292 vessels). Perioperative technical success was achieved in 86.0% (74/86 patients). In-hospital and 30-day mortality rates were 3.5% (3 patients) and 7.0% (6 patients), respectively. At 12 and 24 months, estimated overall survival rate was 88.3% and 85.2%, target vessel's patency rate was 97.2% and 96.3%, and freedom from aneurysm-related reintervention rate was 96.3% and 88.0%, respectively. At 24 months, there were 7 type II endoleaks (12.7%) and a significant reduction in aneurysm maximum transverse diameter in 70.4%. Five limb occlusions occurred at 1-year and 1 at 2-year follow-up (7.0%). CONCLUSIONS The fenestrated Anaconda stent-graft system offers acceptable technical success rates, mid-term efficacy, and durability with respect to aneurysm sac regression, target vessel patency, overall mortality, and reintervention rates. Long-term results are still awaited, until then, the rate of graft limb occlusion is of concern and should be further investigated, especially in case of particularly complex aortic anatomies.
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413
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Zhu C, Huang B, Zhao J, Ma Y, Yuan D, Yang Y, Xiong F, Wang T. Influence of distal entry tears in acute type B aortic dissection after thoracic endovascular aortic repair. J Vasc Surg 2017; 66:375-385. [PMID: 28438361 DOI: 10.1016/j.jvs.2016.12.142] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 12/21/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This study evaluated the clinical influence of distal entry tears in acute type B aortic dissection (ATBAD) after thoracic endovascular aortic repair (TEVAR). METHODS From August 2009 to December 2014, the clinical outcomes of 130 patients who underwent TEVAR for ATBAD were retrospectively analyzed. According to whether distal entry tears existed after TEVAR, patients were divided into group A (n = 25, absence of distal entry tears) and group B (n = 105, presence of distal entry tears). We evaluated clinical outcomes, including mortality and morbidity in early and late follow-up, as well as aortic remolding. Late aortic events were defined as aortic dissection-related events occurring >30 days from the initial TEVAR procedures, which consisted of endoleak, retrograde type A aortic dissection, aortic enlargement, late rupture, repeat dissection, and stent-induced new entry tear. RESULTS The study comprised 130 patients (114 men [87.7%] and 16 women [12.3%)] with a mean age of 53.71 years. The 30-day mortality was 3.1%, and early morbidity included type I endoleak, 3.1%, organ failure, 3.8%; stroke, 3.1%; spinal cord ischemia, 0%; and early rupture 1.5%. The overall survival rate by Kaplan-Meier analysis at 1, 3, and 5 years was 93.8%, 89.5%, and 79.2%, respectively. There were no significant differences in early morbidity and 30-day mortality and late survival between group A and group B. However, group A had a significantly lower rate of late aortic events than group B (P = .028 by log-rank test). Meanwhile, group A had better aortic remolding than group B in complete thrombosis of the thoracic aorta at 12 months postoperatively (100% vs 83.5%; P = .029). CONCLUSIONS This study demonstrated that TEVAR for ATBAD had low perioperative morbidity and mortality and satisfactory midterm outcome. Distal entry tears increase the occurrence of late aortic events and inhibit aortic remolding but do not have a significantly negative effect on late survival. Repairing all entry tears to restore single-lumen blood flow and enhance false lumen thrombosis might benefit selected patients.
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Affiliation(s)
- Chenmou Zhu
- West China Medical School of Sichuan University, Chengdu, China
| | - Bin Huang
- Department of Vascular Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Jichun Zhao
- Department of Vascular Surgery, West China Hospital of Sichuan University, Chengdu, China.
| | - Yukui Ma
- Department of Vascular Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Ding Yuan
- Department of Vascular Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Yi Yang
- Department of Vascular Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Fei Xiong
- Department of Vascular Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Tiehao Wang
- Department of Vascular Surgery, West China Hospital of Sichuan University, Chengdu, China
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414
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Maurel B, Resch T, Spear R, Roeder B, Bracale UM, Haulon S, Mastracci TM. Early experience with a modified preloaded system for fenestrated endovascular aortic repair. J Vasc Surg 2017; 65:972-980. [DOI: 10.1016/j.jvs.2016.09.045] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 09/27/2016] [Indexed: 10/19/2022]
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415
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Caradu C, Bérard X, Midy D, Ducasse E. Influence of Anatomic Angulations in Chimney and Fenestrated Endovascular Aneurysm Repair. Ann Vasc Surg 2017; 43:104-114. [PMID: 28258015 DOI: 10.1016/j.avsg.2017.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 01/11/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND The lack of widespread availability of Fenestrated endovascular aneurysm repair (F-EVAR) encouraged alternative strategies. Hence, Chimney graft (CG)-EVAR spread when costs, manufacturing delays, or anatomy preclude F-EVAR. Our objective is to evaluate CG- and F-EVAR outcomes depending on the angulation of target renal arteries and hostility of iliac accesses in order to determine the potential impact of a choice made between both techniques on the basis of preoperative anatomic criteria. METHODS Consecutive patients treated by CG-EVAR or F-EVAR, from January 2010 to January 2015, were considered for inclusion. Anatomic parameters were defined by preoperative computed tomography angiography. A subgroup analysis was performed depending on renal arteries' angulation (cut-off: -30°) and iliac arteries' hostility (cut-off: diameter <6 mm, tortuosity index = 3). RESULTS Twenty-six patients were included the CG group (mean age 74.7 ± 6.9 years, 30 target vessels) and 66 in the F-EVAR group (71.7 ± 7.9 years, 133 target vessels). Infrarenal aortic neck length was significantly longer for CG-EVAR (3.3 ± 3.7 vs. 1.8 ± 3.2 mm, P = 0.04), while the distance between the superior mesenteric artery and highest renal artery was shorter in the CG group (11.7 ± 6.2 mm vs. 14.1 ± 5.9 mm, P = 0.06). Longitudinal angulation of the right renal artery was not statistically different between both groups, while the left renal artery presented with a significantly more downward angulation in the CG group (-32.0 ± 15.3 vs. -19.0 ± 19.6, P = 0.003). There were significantly more grade 3 iliac tortuosity indexes for CG-EVAR (P = 0.03) with significantly smaller external iliac diameters (7.8 ± 1.7 vs. 8.8 ± 1.6 mm, P = 0.0009). There was 1 renal artery early occlusion in the <-30° CG subgroup and 2 in the <-30° F-EVAR subgroup where severe downward angulation crushed the stents, with a tendency toward higher early occlusions compared with the ≥-30° F-EVAR subgroup (P = 0.054). Mean follow-up duration was 20 months in the CG group and 14 in the F-EVAR group. Kaplan-Meier estimates showed no significant difference in terms of overall survival, freedom from reintervention, freedom from type I or III endoleak, or patency. In the CG group, 14 patients (53.8%) presented with hostile iliac accesses without any significant difference in terms of limb events. CONCLUSIONS CG-EVAR is a complementary strategy to F-EVAR, and understanding which technique is applicable to which patient is important to improve outcomes. Our results suggest that considering renal artery angulation and diameter, iliac artery hostility, and aortic neck length among other parameters may help the surgeon make a decision toward the endovascular strategy that seems best suited for each specific patient.
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Affiliation(s)
- Caroline Caradu
- Unit of Vascular Surgery, Université de Bordeaux, CHU de Bordeaux, Bordeaux, France
| | - Xavier Bérard
- Unit of Vascular Surgery, Université de Bordeaux, CHU de Bordeaux, Bordeaux, France
| | - Dominique Midy
- Unit of Vascular Surgery, Université de Bordeaux, CHU de Bordeaux, Bordeaux, France
| | - Eric Ducasse
- Unit of Vascular Surgery, Université de Bordeaux, CHU de Bordeaux, Bordeaux, France.
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416
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Durable outcomes of thoracic endovascular aortic repair with Zenith TX1 and TX2 devices. J Vasc Surg 2017; 65:1287-1296. [PMID: 28216363 DOI: 10.1016/j.jvs.2016.11.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 11/09/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Long-term data regarding the safety and durability of thoracic endovascular aortic repair (TEVAR) are limited. The study objective was to evaluate the long-term outcomes of TEVAR in high-risk patients with descending thoracic aortic pathology. METHODS High-risk patients were treated with thoracic endografts (2001-2011) under a prospective, physician-sponsored, investigational device exemption trial. Three-dimensional reconstructions and measurements were performed on computed tomography scans acquired before discharge, at 1, 6, and 12 months, and then yearly thereafter. RESULTS The study included 200 patients, of whom 171 were treated for thoracic aneurysm, 28 for chronic dissection, and 1 for aortobronchial fistula. Patients were monitored for an average of 4.8 ± 3.3 years, and 93 (46.5%) were monitored for >5 years. Operative mortality was 6.5%. Survival at 30 days and at 1, 5, and 9 years was 94.0%, 85.8%, 55.6%, and 31.4%, and freedom from aneurysm-related death was 94.0%, 92.4%, 91.7%, 91.7%, respectively. Sixty-one endoleaks occurred in 54 patients (28%). Sixty-seven reinterventions were performed in 50 patients. Overall freedom from reintervention at 30 days, 1, 5, and 9 years was 87.9%, 82.9%, 75.5%, and 64.0%, respectively. Forty-seven reinterventions (70%) were thoracic aneurysm-related, 35 (74%) of which were endovascular procedures. Thirty of these were to correct endoleaks at a median of 1.4 years (interquartile range, 0.2-5.0 years). CONCLUSIONS TEVAR is durable and associated with high long-term aneurysm-related survival. Long-term imaging follow-up remains critical to identify endoleaks or rare device durability issues, most of which can be monitored or managed with endovascular therapies.
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417
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Caradu C, Morin J, Poirier M, Midy D, Ducasse E. Monocentric Evaluation of Chimney Versus Fenestrated Endovascular Aortic Repair for Juxtarenal Abdominal Aortic Aneurysm. Ann Vasc Surg 2017; 40:28-38. [PMID: 28161566 DOI: 10.1016/j.avsg.2016.09.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 09/07/2016] [Accepted: 09/19/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND With approval of on-label fenestrated (F-) endovascular aortic repair (EVAR), concerns regarding long-term patency and endoleaks (ELs) after chimney graft (CG)-EVAR were raised. To add supportive data on the value of this technique, we chose to report the midterm results of CG-EVAR in a single center with standardized methods and to compare them to F-EVAR. METHODS A retrospective analysis of prospectively gathered data from January 2010 to January 2015 was conducted, and patients with excessive comorbidities for open repair treated by CG-EVAR or F-EVAR were included. RESULTS Ninety patients were treated by F-EVAR (88 men, 198 targets vessels) and 31 by CG-EVAR (26 men, 39 targets vessels, 12.9% treated in emergency; P = 0.001). Mean age was significantly higher in the CG group (71.3 ± 8.2 years in the FG group vs. 75.3 ± 6.6; P = 0.02), and there were significantly more patients suffering from preoperative chronic kidney disease (CKD) (13 [14.4%] treated by F-EVAR vs. 12 [38.7%]; P = 0.009). Target vessels were successfully reconstructed in 99.0% (196/198 target vessels) vs. 97.4% (38/39 target vessels) of cases (P = 0.3). In-hospital mortality was significantly higher after CG-EVAR (3.3% vs. 16.1%; P = 0.03). Incidence of acute kidney injury and CKD did not differ significantly between both groups. At 12 and 24 months, overall survival was 91.4% after F-EVAR vs. 82.1% and 81.8% vs. 69.0% (P = 0.4), estimated freedom from aneurysm related reintervention was 93.3% vs. 82.1% and 84.9% vs. 82.1% (P = 0.6), and target vessel's primary patency rate was 97.5% vs. 89.9% (P = 0.06), respectively. Freedom from type I EL's survival was significantly higher after F-EVAR at 12 and 24 months (100% vs. 89.0% and 97.7% vs. 89.0%; P = 0.01), but aneurysm maximum transverse diameter decrease did not differ significantly. CONCLUSIONS There are potential advantages to CG-EVAR with off-the-shelf availability, versatility, and low-profile devices. In this series, patients treated by CG-EVAR showed promising and durable midterm results compared with F-EVAR. CG-EVAR and F-EVAR should not be apprehended as opposed strategies but more as complementary ones, while the best indications for CG-EVAR are clarified.
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Affiliation(s)
- Caroline Caradu
- Unit of Vascular surgery, Université de Bordeaux, CHU de Bordeaux, Bordeaux, France
| | - Julien Morin
- Unit of Vascular surgery, Université de Bordeaux, CHU de Bordeaux, Bordeaux, France
| | - Mathieu Poirier
- Unit of Vascular Surgery, CH de Mont-de-Marsan, Mont-de-Marsan, France
| | - Dominique Midy
- Unit of Vascular surgery, Université de Bordeaux, CHU de Bordeaux, Bordeaux, France
| | - Eric Ducasse
- Unit of Vascular surgery, Université de Bordeaux, CHU de Bordeaux, Bordeaux, France.
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418
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de Beaufort H, Nauta F, Conti M, Cellitti E, Trentin C, Faggiano E, van Bogerijen G, Figueroa C, Moll F, van Herwaarden J, Auricchio F, Trimarchi S. Extensibility and Distensibility of the Thoracic Aorta in Patients with Aneurysm. Eur J Vasc Endovasc Surg 2017; 53:199-205. [DOI: 10.1016/j.ejvs.2016.11.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 11/15/2016] [Indexed: 12/31/2022]
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419
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Oderich GS, Ribeiro M, Reis de Souza L, Hofer J, Wigham J, Cha S. Endovascular repair of thoracoabdominal aortic aneurysms using fenestrated and branched endografts. J Thorac Cardiovasc Surg 2017; 153:S32-S41.e7. [DOI: 10.1016/j.jtcvs.2016.10.008] [Citation(s) in RCA: 166] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/24/2016] [Accepted: 10/06/2016] [Indexed: 01/04/2023]
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420
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Inducing false lumen thrombosis for retrograde type A aortic dissection. J Thorac Cardiovasc Surg 2017; 153:57-65. [DOI: 10.1016/j.jtcvs.2016.09.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 08/16/2016] [Accepted: 09/02/2016] [Indexed: 11/18/2022]
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421
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Oderich GS, Ribeiro M, Hofer J, Wigham J, Cha S, Chini J, Macedo TA, Gloviczki P. Prospective, nonrandomized study to evaluate endovascular repair of pararenal and thoracoabdominal aortic aneurysms using fenestrated-branched endografts based on supraceliac sealing zones. J Vasc Surg 2016; 65:1249-1259.e10. [PMID: 27986479 DOI: 10.1016/j.jvs.2016.09.038] [Citation(s) in RCA: 194] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 09/11/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE To investigate outcomes of manufactured fenestrated and branched endovascular aortic repair (F-BEVAR) endografts based on supraceliac sealing zones to treat pararenal aortic aneurysms and thoracoabdominal aortic aneurysms (TAAAs). METHODS A total of 127 patients (91 male; mean age, 75 ± 10 years old) were enrolled in a prospective, nonrandomized single-center study using manufactured F-BEVAR (November 2013-March 2015). Stent design was based on supraceliac sealing zone in all patients with ≥ four vessels in 111 (89%). Follow-up included clinical examination, laboratory studies, duplex ultrasound, and computed tomography imaging at discharge, 1 month, 6 months, and yearly. End points adjudicated by independent clinical event committee included mortality, major adverse events (any mortality, myocardial infarction, stroke, paraplegia, acute kidney injury, respiratory failure, bowel ischemia, blood loss >1 L), freedom from reintervention, and branch-related instability (occlusion, stenosis, endoleak or disconnection requiring reintervention), target vessel patency, sac aneurysm enlargement, and aneurysm rupture. RESULTS There were 47 pararenal, 42 type IV, and 38 type I-III TAAAs with mean diameter of 59 ± 17 mm. A total of 496 renal-mesenteric arteries were incorporated by 352 fenestrations, 125 directional branches, and 19 celiac scallops, with a mean of 3.9 ± 0.5 vessels per patient. Technical success of target vessel incorporation was 99.6% (n = 493/496). There were no 30-day or in-hospital deaths, dialysis, ruptures or conversions to open surgical repair. Major adverse events occurred in 27 patients (21%). Paraplegia occurred in two patients (one type IV, one type II TAAAs). Follow-up was >30 days in all patients, >6 months in 79, and >12 months in 34. No patients were lost to follow-up. After a mean follow-up of 9.2 ± 7 months, 23 patients (18%) had reinterventions (15 aortic, 8 nonaortic), 4 renal artery stents were occluded, five patients had type Ia or III endoleaks, and none had aneurysm sac enlargement. Primary and secondary target vessel patency was 96% ± 1% and 98% ± 0.7% at 1 year. Freedom from any branch instability and any reintervention was 93% ± 2% and 93% ± 2% at 1 year, respectively. Patient survival was 96% ± 2% at 1 year for the entire cohort. CONCLUSIONS Endovascular repair of pararenal aortic aneurysms and TAAAs, using manufactured F-BEVAR with supraceliac sealing zones, is safe and efficacious. Long-term follow-up is needed to assess the impact of four-vessel designs on device-related complications and progression of aortic disease.
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MESH Headings
- Aged
- Aged, 80 and over
- Aortic Aneurysm, Abdominal/diagnostic imaging
- Aortic Aneurysm, Abdominal/mortality
- Aortic Aneurysm, Abdominal/physiopathology
- Aortic Aneurysm, Abdominal/surgery
- Aortic Aneurysm, Thoracic/diagnostic imaging
- Aortic Aneurysm, Thoracic/mortality
- Aortic Aneurysm, Thoracic/physiopathology
- Aortic Aneurysm, Thoracic/surgery
- Aortography/methods
- Blood Vessel Prosthesis
- Blood Vessel Prosthesis Implantation/adverse effects
- Blood Vessel Prosthesis Implantation/instrumentation
- Blood Vessel Prosthesis Implantation/mortality
- Computed Tomography Angiography
- Endovascular Procedures/adverse effects
- Endovascular Procedures/instrumentation
- Endovascular Procedures/mortality
- Female
- Humans
- Kaplan-Meier Estimate
- Male
- Minnesota
- Postoperative Complications/etiology
- Postoperative Complications/physiopathology
- Postoperative Complications/therapy
- Prosthesis Design
- Retreatment
- Risk Factors
- Stents
- Time Factors
- Treatment Outcome
- Ultrasonography, Doppler, Duplex
- Vascular Patency
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Affiliation(s)
- Gustavo S Oderich
- Advanced Endovascular Aortic Research Program, Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn.
| | - Mauricio Ribeiro
- Advanced Endovascular Aortic Research Program, Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn; Division of Vascular and Endovascular Surgery, Department of Surgery and Anatomy, University of São Paulo School of Medicine of Ribeirão Preto, Ribeirão Preto, Brazil
| | - Jan Hofer
- Advanced Endovascular Aortic Research Program, Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Jean Wigham
- Advanced Endovascular Aortic Research Program, Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Stephen Cha
- Department of Epidemiology and Biostatistics, Mayo Clinic, Rochester, Minn
| | - Julia Chini
- Advanced Endovascular Aortic Research Program, Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
| | | | - Peter Gloviczki
- Advanced Endovascular Aortic Research Program, Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
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422
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Bischoff MS, Meisenbacher K, Wehrmeister M, Böckler D, Kotelis D. Treatment indications for and outcome of endovascular repair of type B intramural aortic hematoma. J Vasc Surg 2016; 64:1569-1579.e2. [DOI: 10.1016/j.jvs.2016.05.078] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 05/10/2016] [Indexed: 01/16/2023]
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423
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Drudi L, Phung K, Ades M, Zuckerman J, Mullie L, Steinmetz O, Obrand D, Afilalo J. Psoas Muscle Area Predicts All-Cause Mortality After Endovascular and Open Aortic Aneurysm Repair. Eur J Vasc Endovasc Surg 2016; 52:764-769. [DOI: 10.1016/j.ejvs.2016.09.011] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 09/20/2016] [Indexed: 12/20/2022]
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424
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Introduction of a Team Based Approach to Radiation Dose Reduction in the Enhancement of the Overall Radiation Safety Profile of FEVAR. Eur J Vasc Endovasc Surg 2016; 52:451-457. [DOI: 10.1016/j.ejvs.2016.05.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 05/15/2016] [Indexed: 11/23/2022]
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425
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Remodeling of abdominal aortic branch perfusion after thoracic endovascular aortic repair for aortic dissections. J Vasc Surg 2016; 64:902-11. [DOI: 10.1016/j.jvs.2016.03.441] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 03/15/2016] [Indexed: 12/31/2022]
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426
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Ammar CP, Larion S, Ahanchi SS, Lavingia KS, Dexter DJ, Panneton JM. Anatomic severity grading score for primary descending thoracic aneurysms predicts procedural difficulty and aortic-related reinterventions after thoracic endovascular aortic repair. J Vasc Surg 2016; 64:912-920.e1. [DOI: 10.1016/j.jvs.2016.03.451] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 03/22/2016] [Indexed: 10/21/2022]
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427
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Sweet MP. Anatomic features of the distal aortic arch that influence endovascular aneurysm repair. J Vasc Surg 2016; 64:891-5. [DOI: 10.1016/j.jvs.2016.03.424] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 03/12/2016] [Indexed: 10/21/2022]
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428
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Mid-term Outcomes of Renal Branches Versus Renal Fenestrations for Thoraco-abdominal Aneurysm Repair. Eur J Vasc Endovasc Surg 2016; 52:141-8. [DOI: 10.1016/j.ejvs.2016.03.018] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 03/13/2016] [Indexed: 11/18/2022]
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429
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Benjelloun A, Henry M, Taberkant M, Berrado A, Houati RE, Semlali A. Multilayer Flow Modulator Treatment of Abdominal and Thoracoabdominal Aortic Aneurysms With Side Branch Coverage: Outcomes From a Prospective Single-Center Moroccan Registry. J Endovasc Ther 2016; 23:773-82. [PMID: 27381934 DOI: 10.1177/1526602816657087] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate endovascular repair of thoracoabdominal aortic aneurysms (TAAA) and abdominal aortic aneurysms (AAA) using the Multilayer Flow Modulator (MFM) in high-surgical-risk patients with at least one covered branch vessel. METHODS In this prospective single-center nonrandomized trial, 18 patients (mean age 61.1 years; 16 men) with TAAA (n=10, mean diameter 74.4 mm) and AAA (n=8, mean diameter 67.8 mm) were treated with the MFM between June 2009 and September 2012. The primary safety endpoints were all-cause mortality at 30 days and 12 months and neurological complications. The primary efficacy endpoint was overall procedure success, defined as patency of covered branch vessels, reductions in aneurysm diameter, and sac thrombus formation. RESULTS The technical success rate was 100% (53 study devices implanted, mean stented length 273 mm). Through mean follow-up of 13.4 months, all 61 covered branch vessels remained patent; there were no neurologic complications, ruptures, or instances of device migration, kinking, or fracture. Three patients died, 2 of unrelated causes and one of an undetermined cause. Only one reintervention with an additional MFM implanted at 5 years was required for a type I endoleak in a young patient with natural growth. Carefully planned and executed diameter and volume measurements demonstrated aneurysm shrinkage and progressive sac thrombus formation for both patient groups. CONCLUSION Through midterm follow-up, treatment of high-surgical-risk TAAA and AAA patients with the MFM appears to be safe and effective, maintaining branch vessel patency and reducing rupture risk through reduction of aneurysm diameter and modulation of flow dynamics. Longer term follow-up is needed.
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Affiliation(s)
| | - Michel Henry
- Global Research Institute, Apollo Clinic, Hyderabad, India
| | - Mustapha Taberkant
- Service de Chirurgie Vasculaire, Hôpital Militaire Med V, Rabat, Morocco
| | - Abdelaziz Berrado
- Ecole Mohammadia d'Ingenieurs, Equipe de Recherche AMIPS, Université Med V, Agdal-Rabat, Morocco
| | - Rachid El Houati
- Service de Chirurgie Cardiovasculaire Hôpital Med VI, Marrakech, Morocco
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430
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The Gore Hybrid Vascular Graft in renovisceral debranching for complex aortic aneurysm repair. J Vasc Surg 2016; 64:33-8. [DOI: 10.1016/j.jvs.2015.12.059] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 12/30/2015] [Indexed: 11/22/2022]
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431
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Faure EM, Canaud L, Marty-Ané C, Alric P. Hybrid aortic arch repair for dissecting aneurysm. J Thorac Cardiovasc Surg 2016; 152:162-8. [DOI: 10.1016/j.jtcvs.2016.03.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 02/12/2016] [Accepted: 03/01/2016] [Indexed: 10/22/2022]
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432
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Boufi M, Guivier-Curien C, Dona B, Loundou A, Deplano V, Boiron O, Hartung O, Alimi Y. Risk Factor Analysis for the Mal-Positioning of Thoracic Aortic Stent Grafts. Eur J Vasc Endovasc Surg 2016; 52:56-63. [DOI: 10.1016/j.ejvs.2016.03.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 03/19/2016] [Indexed: 10/21/2022]
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433
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Ziza V, Canaud L, Molinari N, Branchereau P, Marty-Ané C, Alric P. Thoracic endovascular aortic repair: A single center's 15-year experience. J Thorac Cardiovasc Surg 2016; 151:1595-1603.e7. [DOI: 10.1016/j.jtcvs.2015.12.030] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 11/22/2015] [Accepted: 12/12/2015] [Indexed: 11/26/2022]
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434
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Piffaretti G, Galli M, Lomazzi C, Franchin M, Castelli P, Mariscalco G, Trimarchi S. Endograft repair for pseudoaneurysms and penetrating ulcers of the ascending aorta. J Thorac Cardiovasc Surg 2016; 151:1606-14. [DOI: 10.1016/j.jtcvs.2015.12.055] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 12/18/2015] [Accepted: 12/24/2015] [Indexed: 11/30/2022]
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435
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Böckler D, Brunkwall J, Taylor P, Mangialardi N, Hüsing J, Larzon T, Hyhlik-Dürr A, Gawenda M, Clough R, Ronchey S, Örman L. Thoracic Endovascular Aortic Repair of Aortic Arch Pathologies with the Conformable Thoracic Aortic Graft: Early and 2 year Results from a European Multicentre Registry. Eur J Vasc Endovasc Surg 2016; 51:791-800. [DOI: 10.1016/j.ejvs.2016.02.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 02/05/2016] [Indexed: 10/21/2022]
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436
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The effects of combining fusion imaging, low-frequency pulsed fluoroscopy, and low-concentration contrast agent during endovascular aneurysm repair. J Vasc Surg 2016; 63:1147-55. [DOI: 10.1016/j.jvs.2015.11.033] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 11/03/2015] [Indexed: 11/22/2022]
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437
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Bischoff MS, Ante M, Meisenbacher K, Böckler D. Outcome of thoracic endovascular aortic repair in patients with thoracic and thoracoabdominal aortic aneurysms. J Vasc Surg 2016; 63:1170-1181.e1. [DOI: 10.1016/j.jvs.2015.11.045] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 11/12/2015] [Indexed: 01/16/2023]
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438
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Sobocinski J, Patterson BO, Vidal-Diez A, Brownrigg JR, Thompson MM, Holt PJ. Preoperative morphology influences thoracic aortic aneurysm sac expansion after endovascular repair. Br J Surg 2016; 103:819-29. [DOI: 10.1002/bjs.10138] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 12/02/2015] [Accepted: 01/06/2016] [Indexed: 11/12/2022]
Abstract
Abstract
Background
The fate of the aneurysm sac after thoracic endovascular aortic repair (TEVAR) remains poorly defined. The aim of this study was to characterize the incidence of aneurysm sac expansion after TEVAR, and to determine the effect of aneurysm morphology on postoperative sac behaviour.
Methods
Preoperative and postoperative CT angiography (CTA) images were analysed from a proprietary database (M2S). TEVARs undertaken for thoracic aortic aneurysms from 2004 to 2013 were included. Preoperative aortic morphology was available for each patient. Post-TEVAR sac expansion was defined as an increase in aortic diameter of at least 5 mm. The influence of aortic morphological variables on sac expansion was assessed using Cox regression and Kaplan–Meier analysis.
Results
CTA images were available for 899 patients who underwent TEVAR. Median follow-up was 2·1 (i.q.r. 1·7–2·4) years. Some 46·0 per cent had a maximum aneurysm diameter of 55 mm or more at the time of repair. The 5-year rate of freedom from sac expansion of at least 5 mm was 60·9 per cent. The sac expansion rate after 3 years was higher when the proximal sealing zone was over 38 mm in diameter (freedom from expansion 51·2 per cent versus 76·6 per cent for diameter 38 mm or less; P < 0·001), or 20 mm or less in length (freedom from expansion 67·3 per cent versus 77·1 per cent for length exceeding 20 mm; P = 0·022). Findings for the distal sealing zone were similar. The risk of sac expansion increased according to the number of adverse morphological risk factors (freedom from expansion rate 79·1 per cent at 3 years in patients with 2 or fewer risk factors versus 45·7 per cent in those with more than 2; P < 0·001).
Conclusion
Sac expansion was common in this cohort of patients undergoing TEVAR for thoracic aortic aneurysm. Aneurysm sac expansion was significantly influenced by adverse morphological features in the aortic stent-graft sealing zones.
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Affiliation(s)
- J Sobocinski
- St George's Vascular Institute NHS Trust, University of London, London, UK
- Aortic Centre, Vascular Surgery, Hôpital Cardiologique, Centre Hospitalier Universitaire (CHU) de Lille, Institut National de la Santé et de la Recherche Médicale (INSERM) U1008, University of Lille, Lille, France
| | - B O Patterson
- St George's Vascular Institute NHS Trust, University of London, London, UK
| | - A Vidal-Diez
- St George's Vascular Institute NHS Trust, University of London, London, UK
| | - J R Brownrigg
- St George's Vascular Institute NHS Trust, University of London, London, UK
| | - M M Thompson
- St George's Vascular Institute NHS Trust, University of London, London, UK
| | - P J Holt
- St George's Vascular Institute NHS Trust, University of London, London, UK
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439
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Georgiadis GS, van Herwaarden JA, Antoniou GA, Giannoukas AD, Lazarides MK, Moll FL. Fenestrated stent grafts for the treatment of complex aortic aneurysm disease: A mature treatment paradigm. Vasc Med 2016; 21:223-38. [DOI: 10.1177/1358863x16631841] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The introduction of fenestrated stent grafts (SGs) to treat abdominal aortic aneurysms (AAAs) with short proximal necks began in 1999. Nowadays, the whole visceral aorta can be treated totally by endovascular means. The established use of fenestrated devices to treat complex AAAs as a first-line management option has been previously reported. An up-to-date evaluation of the literature was performed including all types of publications regarding the use of fenestrated technology to repair complex AAAs. Fenestrated repair is now an established alternative to hybrid/chimney/snorkel repairs. However, specific criteria and prerequisites are required for the use and improvement of this method. Multiple device morphologies have been used incorporating the visceral arteries in various combinations. This modular strategy connects different devices (bridging covered stents and bifurcated SGs) with the aortic main body, thus excluding the aneurysm from the circulation. Precise deployment of the fenestrated SG is mandatory for successful visceral vessel revascularization. Accurate SG sizing and customization, a high level of technical skill, and facilities with modern imaging techniques including 3D road mapping and dedicated hybrid rooms are required. Most experience has been with the custom-made Zenith Cook platform, although off-the-shelf devices have been recently implanted. More complex repairs have been performed over the last few years, but device complexity has also increased. Perioperative, mid-term, and a few recently reported long-term results are encouraging. Secondary interventions remain the main problem, similar to that observed after traditional endovascular abdominal aortic aneurysm repair (EVAR).
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Affiliation(s)
- George S Georgiadis
- Department of Vascular Surgery, University Medical Center, Utrecht, The Netherlands
- Department of Vascular Surgery, ‘Demokritus’ University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | | | - George A Antoniou
- Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, UK
| | | | - Miltos K Lazarides
- Department of Vascular Surgery, ‘Demokritus’ University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Frans L Moll
- Department of Vascular Surgery, University Medical Center, Utrecht, The Netherlands
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440
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Hynes N, Sultan S, Elhelali A, Diethrich EB, Kavanagh EP, Sultan M, Stefanov F, Delassus P, Morris L. Systematic Review and Patient-Level Meta-analysis of the Streamliner Multilayer Flow Modulator in the Management of Complex Thoracoabdominal Aortic Pathology. J Endovasc Ther 2016; 23:501-12. [DOI: 10.1177/1526602816636891] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Purpose: To examine the safety and short-term efficacy of the Streamliner Multilayer Flow Modulator (SMFM) in the management of patients with complex thoracoabdominal aortic pathology who are unfit for alternative interventions. Methods: Biomedical databases were systematically searched for articles published between 2008 and 2015 on the SMFM. A patient-level meta-analysis was used to evaluate aneurysm-related survival. Secondary outcomes were all-cause survival, stroke, spinal cord ischemia, renal impairment, and branch vessel patency. Other considerations were the impact of compliance with the instructions for use (IFU) on clinical outcome. Mean values and Kaplan-Meier estimates are presented with the 95% confidence interval (CI). Results: Fifteen articles (3 multicenter cohort studies, 3 observational cohort studies, and 9 case reports) were included, presenting 171 patients (mean age 68.8±12.3 years; 139 men). The mean aneurysm diameter was 6.7±1.6 cm (95% CI 6.4 to 6.9 cm). Technical success reported in 15 studies was 77.2%. Aneurysm-related survival at 1 year was 78.7% (95% CI 71.7% to 84.4%). One-year all-cause survival was 53.7% (95% CI 46.0% to 61.3%). There were no reported cases of spinal cord ischemia, renal insult, or stroke. Conclusion: The SMFM can be safely utilized in some patients with complex thoracoabdominal pathologies provided operators adhere to the IFU. The SMFM is a novel technology with no long-term published data on its sustained effectiveness and a lack of comparative studies. Randomized clinical trials, registries, and continued assessment are essential before this flow-modulating technology can be widely disseminated.
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Affiliation(s)
- Niamh Hynes
- Western Vascular Institute, Department of Vascular and Endovascular Surgery, University Hospital Galway, National University of Ireland, Galway, Ireland
- Galway Clinic, Royal College of Surgeons of Ireland Affiliated Hospital, Doughiska, Galway, Ireland
| | - Sherif Sultan
- Western Vascular Institute, Department of Vascular and Endovascular Surgery, University Hospital Galway, National University of Ireland, Galway, Ireland
- Galway Clinic, Royal College of Surgeons of Ireland Affiliated Hospital, Doughiska, Galway, Ireland
| | - Ala Elhelali
- Western Vascular Institute, Department of Vascular and Endovascular Surgery, University Hospital Galway, National University of Ireland, Galway, Ireland
- GMedTech, Department of Biomedical Engineering, Galway Mayo Institute of Technology, Galway, Ireland
| | | | - Edel P. Kavanagh
- Western Vascular Institute, Department of Vascular and Endovascular Surgery, University Hospital Galway, National University of Ireland, Galway, Ireland
| | - Mohamed Sultan
- Western Vascular Institute, Department of Vascular and Endovascular Surgery, University Hospital Galway, National University of Ireland, Galway, Ireland
| | - Florian Stefanov
- Western Vascular Institute, Department of Vascular and Endovascular Surgery, University Hospital Galway, National University of Ireland, Galway, Ireland
- GMedTech, Department of Biomedical Engineering, Galway Mayo Institute of Technology, Galway, Ireland
| | - Patrick Delassus
- GMedTech, Department of Biomedical Engineering, Galway Mayo Institute of Technology, Galway, Ireland
| | - Liam Morris
- GMedTech, Department of Biomedical Engineering, Galway Mayo Institute of Technology, Galway, Ireland
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441
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Editor's Choice – Subsequent Results for Arch Aneurysm Repair with Inner Branched Endografts,. Eur J Vasc Endovasc Surg 2016; 51:380-5. [DOI: 10.1016/j.ejvs.2015.12.002] [Citation(s) in RCA: 138] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 12/08/2015] [Indexed: 11/19/2022]
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442
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Khashram M, He Q, Oh TH, Khanafer A, Wright IA, Vasudevan TM, Lo ASN, Roake JA, Civil I. Late Radiological and Clinical Outcomes of Traumatic Thoracic Aortic Injury Managed with Thoracic Endovascular Aortic Repair. World J Surg 2016; 40:1763-70. [DOI: 10.1007/s00268-016-3457-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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443
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Open versus Endovascular Repair of Arch and Descending Thoracic Aneurysms: A Retrospective Comparison. Ann Vasc Surg 2016; 31:30-8. [DOI: 10.1016/j.avsg.2015.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 08/02/2015] [Accepted: 08/04/2015] [Indexed: 11/21/2022]
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444
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Sobocinski J, Patterson BO, Karthikesalingam A, Thompson MM. The Effect of Left Subclavian Artery Coverage in Thoracic Endovascular Aortic Repair. Ann Thorac Surg 2016; 101:810-7. [DOI: 10.1016/j.athoracsur.2015.08.069] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 07/08/2015] [Accepted: 08/26/2015] [Indexed: 10/22/2022]
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445
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Bischoff MS, Müller-Eschner M, Meisenbacher K, Peters AS, Böckler D. Device Conformability and Morphological Assessment After TEVAR for Aortic Type B Dissection: A Single-Centre Experience with a Conformable Thoracic Stent-Graft Design. Med Sci Monit Basic Res 2015; 21:262-70. [PMID: 26718893 PMCID: PMC4725445 DOI: 10.12659/msmbr.897010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background The aim of this study was to analyze device conformability in TEVAR of acute and chronic (a/c) type B aortic dissections (TBAD) using the Gore Conformable Thoracic Aortic Stent-graft (CTAG). Material/Methods From January 1997 to February 2014, a total of 90 out of 405 patients in our center received TEVAR for TBAD. Since November 2009, 23 patients (16 men; median age: 62 years) were treated with the CTAG. Indications were complicated aTBAD in 15 (65%) and expanding cTBAD in 8 (35%) patients. Primary endpoints were the assessment of device conformability by measuring the distance (D) from the radiopaque gold band marker (GM) at the proximal CTAG end to the inner curvature (IC) of the arch on parasagittal multiplanar reformations of CT angiography, as well as the evaluation of aortic diameter changes following TEVAR. Median follow-up was 13.3 months (range: 2 days to 35 months). Results Primary and secondary success rates were 91.3% (21/23) and 95.6% (22/23), respectively. There was 1 type Ia endoleak, retrograde dissection or primary conversion was not observed. Median GM-IC-D was 0 mm (range: 0 mm to 10 mm). GM-IC-D was associated with zone 2 placement compared to zone 3 (P=0.036). There was no association between GM-IC-D formation and arch type. In aTBAD cases the true lumen significantly increased after TEVAR (P=0.017) and the false lumen underwent shrinkage (P=0.025). In cTBAD patients the false lumen decreased after TEVAR (P=0.036). Conclusions The CTAG shows favorable conformability and wall apposition in challenging arch pathologies such as TBAD.
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Affiliation(s)
- Moritz S Bischoff
- Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Matthias Müller-Eschner
- Department of Radiodiagnostics and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Katrin Meisenbacher
- Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas S Peters
- Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Dittmar Böckler
- Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Heidelberg, Germany
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446
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Long-Term Changes in Aortic Length after Thoracic Endovascular Aortic Repair. J Vasc Interv Radiol 2015; 27:181-7. [PMID: 26686422 DOI: 10.1016/j.jvir.2015.10.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 10/20/2015] [Accepted: 10/22/2015] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To study long-term changes to the thoracic aorta following thoracic endovascular aortic repair (TEVAR) for treatment of different aortic pathologic conditions. MATERIALS AND METHODS This retrospective study included 53 consecutive patients (mean age, 58.8 y ± 14; 13 female and 40 male) in whom TEVAR was performed between October 2002 and May 2010. The mean duration of follow-up was 21.1 months (range, 0.5-96 mo). Statistical analysis was performed with the Friedman test and Conover-Iman test. RESULTS Nineteen patients with aortic aneurysm (group 1), 25 patients with type B dissection (group 2), and 9 patients with other pathologic conditions (group 3) were treated with TEVAR. The mean overall aortic lengths (from the origin of the left subclavian artery to the origin of the celiac trunk) before TEVAR were 271.4 mm, 268.6 mm, and 233.6 mm in groups 1, 2, and 3, respectively. At 12-month follow-up, the lengths were 282.8 mm, 294.4 mm, and 237.5 mm in groups 1, 2, and 3, respectively. The changes in aortic lengths following TEVAR were statistically significant (P < .001). A second intervention was required in 14 patients, and 6 patients died during follow-up. CONCLUSIONS A significant change in the overall aortic length was observed following TEVAR. The changes in aortic length reached statistical significance after 12 months.
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447
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He X, Liu W, Li Z, Liu X, Wang T, Ding C, Zeng H. Hybrid Approach to Management of Complex Aortic Arch Pathologies: A Single-Center Experience in China. Ann Vasc Surg 2015; 31:23-9. [PMID: 26675146 DOI: 10.1016/j.avsg.2015.09.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 09/13/2015] [Accepted: 09/18/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND The purpose of this study is to summarize a single-center experience and midterm outcomes of a combined supra-aortic debranching and thoracic endovascular aortic repair (TEVAR) for hybrid operation on patients with complex aortic arch disease. METHODS From 2012 to 2015, 43 consecutive patients (37 male and 6 females) who underwent a hybrid operation for complex aortic arch disease were retrospectively analyzed. Of the 43 patients, 12 were diagnosed with type A aortic dissection (AD), 27 with complicated type B AD involving the aortic arch, 2 with aortic arch aneurysm, and 2 with type A penetrating atherosclerosis ulcer. RESULTS The patients' mean age was 52.3 ± 11.3 years. Hybrid operation was technically successful in all patients. The overall 30-day mortality and in-hospital mortality rates were 2.3% (1 of 43), with 1 patient dying at days 18 of severe aspiration pneumonia after procedure. Thirty-day paraplegia and stroke were 0%. Complication included 1 newly onset renal insufficiency and type II endoleak. After a median follow-up of 15 months (range, 6-26 months), the overall mortality was 7.1% (3 of 42), with Kaplan-Meier survival estimate of 91% at 1 year. Only one late death was considered aorta-related. computed tomography (CT) scanning was performed at 6 months and annually thereafter, and 2 patients were observed with type Ib endoleak and type II endoleak, respectively. For the patient with type Ib endoleak, distal extension was performed successfully. No late extra-anatomic bypass occlusion and stent-graft migration were found on CT scans or ultrasound. CONCLUSIONS These initial results suggest that hybrid operation with supra-aortic debranching, and TEVAR is an acceptable treatment option for patients with complex aortic arch disease. Short-term and midterm outcomes are acceptable. Further research with large sample size and long-term follow-up is needed.
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Affiliation(s)
- Xingwei He
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wanjun Liu
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhuxi Li
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xintian Liu
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tao Wang
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Cheng Ding
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hesong Zeng
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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448
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de Souza LR, Oderich GS, Banga PV, Hofer JM, Wigham JR, Cha S, Gloviczki P. Outcomes of total percutaneous endovascular aortic repair for thoracic, fenestrated, and branched endografts. J Vasc Surg 2015; 62:1442-9.e3. [DOI: 10.1016/j.jvs.2015.07.072] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 07/14/2015] [Indexed: 12/17/2022]
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449
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Osman E, Tan KT, Tse L, Jaskolka J, Roche-Nagle G, Oreopoulos G, Rubin B, Lindsay T. The in-hospital costs of treating high-risk patients with fenestrated and branched endografts. J Vasc Surg 2015; 62:1457-64. [DOI: 10.1016/j.jvs.2015.07.040] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 07/07/2015] [Indexed: 01/22/2023]
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450
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Iwakoshi S, Ichihashi S, Itoh H, Tabayashi N, Sakaguchi S, Yoshida T, Nakao Y, Kichikawa K. Clinical outcomes of thoracic endovascular aneurysm repair using commercially available fenestrated stent graft (Najuta endograft). J Vasc Surg 2015; 62:1473-8. [DOI: 10.1016/j.jvs.2015.06.224] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 06/26/2015] [Indexed: 10/23/2022]
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