1
|
Acharya MN, Mariscalco G. Hybrid zone 0 aortic arch repair: Have we reached the final frontier? J Card Surg 2021; 36:3817-3819. [PMID: 34260767 DOI: 10.1111/jocs.15815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 07/05/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Metesh N Acharya
- Department of Cardiac Surgery, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Giovanni Mariscalco
- Department of Cardiac Surgery, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| |
Collapse
|
2
|
Aru RG, Tyagi SC, Minion DJ, Orr NT, Bounds MC. Carotid-Carotid Transposition for Zone 1 Thoracic Endovascular Aortic Repair. Ann Vasc Surg 2021; 76:325-329. [PMID: 33951527 DOI: 10.1016/j.avsg.2021.04.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/05/2021] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Carotid-carotid bypass is the standard technique for cervical aortic arch debranching to maintain left common carotid artery perfusion with zone I thoracic endovascular aortic repair (TEVAR), while left-to-right carotid-carotid transposition (CCT) has been described as an autologous alternative. We report on our center's experience with CCT in the setting of zone I TEVAR. This is the only published series of this technique. METHODS All patients who underwent CCT, defined by CPT code 35509, between 2017 and 2020 were identified at our tertiary care center. Patient demographics, indications for CCT, complications specific to CCT, operative details, post-operative course, and outcomes were retrospectively reviewed. RESULTS A total of 13 patients underwent CCT prior to zone 1 TEVAR. The indications for intervention were thoracic or thoracoabdominal aortic aneurysms and dissections secondary to hypertension (n = 10), Marfan syndrome (n = 2), and Turner syndrome with aneurysmal degeneration of previous coarctation repair (n = 1). There was a high incidence of preexisting hypertension (92%), malnutrition (69%), and smoking (61%) in this cohort. Operative intervention was performed on both an elective (n = 7, 54%) and an urgent (n = 6, 46%) basis. Complications directly related to CCT included transient unilateral recurrent laryngeal nerve deficit (n = 1, 7.7%). There were no cerebrovascular events, surgical site infections, or procedure-related mortalities. All transpositions with follow-up imaging were patent without stenosis or thrombosis (average 7.2 months, n = 10). There were no late complications related to CCT. CONCLUSIONS CCT is a safe and autologous alternative to carotid-carotid bypass for left common carotid artery revascularization with zone I TEVAR.
Collapse
Affiliation(s)
- Roberto G Aru
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, KY.
| | - Sam C Tyagi
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, KY
| | - David J Minion
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, KY
| | - Nathan T Orr
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, KY
| | - Michael C Bounds
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, KY
| |
Collapse
|
3
|
Choi SHJ, Yang GK, Baxter K, Gagnon J. Evaluation of Aortic Zone 2 Proximal Landing Accuracy During Thoracic Endovascular Aortic Repair Following Carotid-Subclavian Revascularization. Vasc Endovascular Surg 2021; 55:355-360. [PMID: 33535904 DOI: 10.1177/1538574421989851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Adequate seal for thoracic endovascular aortic repair (TEVAR) commonly requires landing in zone 2, but can prove to be challenging due to the tortuous and angulated anatomy of the region. OBJECTIVES Our objective was to determine the proximal landing accuracy of zone 2-targeted TEVARs following carotid-subclavian revascularization (CSR) and its impact on clinical outcomes. METHODS Retrospective review of patients that underwent CSR for zone 2 endograft delivery at a tertiary institute between January 2008 and March 2018 was conducted. Technical outcomes were assessed by examining the incidence of intraoperative corrective maneuvers, 1a endoleaks and reinterventions. Distance to target and incidence of LSA stump filling were examined as radiographic markers of landing accuracy. RESULTS Zone 2-targeted TEVAR with CSR was performed in 53 patients for treatment of dissections (49%), aneurysms (30%) or trauma (21%). Nine (17%) cases required intraoperative corrective procedures: 5 (9%) proximal cuffs due to type 1a endoleak and 4 (8%) left common carotid artery (LCCA) stenting due to inadvertent coverage. Cases performed using higher resolution hybrid fluoroscopy machine compared to mobile C-arm were associated with increased proximal cuff use (OR 8.8; 95% CI 1.2-62.4). Average distance between the proximal edge of the covered graft to LCCA was 8 ± 1 mm and larger distances were not associated with higher rates of 1a endoleak. Twenty-eight (53%) cases of antegrade LSA stump filling were noted on follow-up imaging, but were not associated with higher rates of reinterventions (OR 0.8, 95% CI [0.2-4.6]). Three (6%) patients had a stroke within 30 days and 4 (8%) patients expired within 1 month. Intraoperative corrective maneuvers, post-operative 1a endoleak and reinterventions were not associated with higher rates of stroke or mortality. CONCLUSION Using current endografts and imaging modalities, zone 2-targeted TEVARs have suboptimal technical accuracy.
Collapse
Affiliation(s)
- Sally H J Choi
- Division of Vascular Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gary K Yang
- Division of Vascular Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Keith Baxter
- Division of Vascular Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joel Gagnon
- Division of Vascular Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
4
|
Spadaccio C, Hu H, Li C, Qiao Z, Ge Y, Tie Z, Zhu J, Moon MR, Danton M, Sun L, Gaudino MF. Thoracic aortic surgery: status and upcoming novelties. Minerva Cardioangiol 2020; 68:518-531. [PMID: 32319269 DOI: 10.23736/s0026-4725.20.05263-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Several novel technological developments and surgical approaches have characterized the field of aortic surgery in the recent decade. The progressive introduction of endovascular procedures, minimally invasive surgical techniques and hybrid approaches have changed the practice in aortic surgery and generated new trends and questions. Also, the advancements in the manufacturing of tissue engineered vascular grafts as substitutes for aortic replacements are enlightening new avenues in the treatment of aortic disease. This review will provide an overview of the current novel perspectives, debates and trends in major thoracic aortic surgery.
Collapse
Affiliation(s)
- Cristiano Spadaccio
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK - .,Department of Cardiac Surgery, Golden Jubilee National Hospital, Glasgow, UK - .,Department of Cardiovascular Surgery, Beijing Aortic Disease Centre, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Centre for Vascular Prostheses, Capital Medical University, Beijing, China -
| | - Haiou Hu
- Department of Cardiovascular Surgery, Beijing Aortic Disease Centre, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Centre for Vascular Prostheses, Capital Medical University, Beijing, China
| | - Chengnan Li
- Department of Cardiovascular Surgery, Beijing Aortic Disease Centre, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Centre for Vascular Prostheses, Capital Medical University, Beijing, China
| | - Zhiyu Qiao
- Department of Cardiovascular Surgery, Beijing Aortic Disease Centre, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Centre for Vascular Prostheses, Capital Medical University, Beijing, China
| | - Yipeng Ge
- Department of Cardiovascular Surgery, Beijing Aortic Disease Centre, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Centre for Vascular Prostheses, Capital Medical University, Beijing, China
| | - Zheng Tie
- Department of Cardiovascular Surgery, Beijing Aortic Disease Centre, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Centre for Vascular Prostheses, Capital Medical University, Beijing, China
| | - Junming Zhu
- Department of Cardiovascular Surgery, Beijing Aortic Disease Centre, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Centre for Vascular Prostheses, Capital Medical University, Beijing, China
| | - Marc R Moon
- School of Medicine, Washington University, St Louis, MI, USA
| | - Mark Danton
- Department of Cardiac Surgery, Scottish Pediatric Cardiac Services, Royal Hospital for Children, Glasgow, UK
| | - Lizhong Sun
- Department of Cardiovascular Surgery, Beijing Aortic Disease Centre, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Centre for Vascular Prostheses, Capital Medical University, Beijing, China
| | - Mario F Gaudino
- Department of Cardiothoracic Surgery Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
| |
Collapse
|
5
|
Bianco V, Sultan I, Kilic A, Aranda-Michel E, Cuddy RJ, Srivastava A, Navid F, Gleason TG. Concomitant left subclavian artery revascularization with carotid-subclavian transposition during zone 2 thoracic endovascular aortic repair. J Thorac Cardiovasc Surg 2020; 159:1222-1227. [DOI: 10.1016/j.jtcvs.2019.03.060] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 03/02/2019] [Accepted: 03/26/2019] [Indexed: 12/18/2022]
|
6
|
Srivastava S, Bhan A. Aortic arch aneurysms and dissection-open repair is the gold standard. Indian J Thorac Cardiovasc Surg 2019; 35:136-155. [PMID: 33061079 DOI: 10.1007/s12055-019-00819-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 03/08/2019] [Accepted: 03/13/2019] [Indexed: 10/26/2022] Open
Abstract
The aortic arch repair is one of the most complex surgeries and carries a high risk of complications as well as mortality. Since 1975, when the arch repair was first done by Randall B. Griepp using hypothermic circulatory arrest, many new technologies were introduced. But even with the use of antegrade and retrograde perfusion techniques and improvement of surgical techniques and grafts, the rate of mortality, cerebral, spinal, and visceral damage was much higher as compared to any other cardiac surgeries. With further developments aimed at less invasive approaches, thoracic endovascular aortic repair (TEVAR) along with de-branching of supra-aortic vessels or the frozen elephant trunk was introduced. Here, in this article, we review the myriad of approaches to the aortic arch and have come to a conclusion that while traditional open surgery is considered as the gold standard for treatment of extensive aortic arch pathologies, one school of thought suggests hybrid techniques such as the frozen elephant trunk and aortic arch vessel de-branching as more appropriate procedures for high-risk patients, where co-morbidities may contraindicate cardiopulmonary bypass and longer operative times required for traditional repair. No randomized trials are present to compare between open and hybrid or endovascular procedure in normal or high-risk patients. The meta-analysis of most of the studies defines open surgery as the gold standard for arch pathology because the hybrid procedures did not provide any proven survival benefits or decrease in stroke rate and spinal ischemia when compared to open surgery in early, mid, or long-term results.
Collapse
Affiliation(s)
- Swarnika Srivastava
- Department of cardiothoracic surgery, Medanta The Medicity hospital, Gurugram, India.,Noida, India
| | - Anil Bhan
- Department of cardiothoracic surgery, Medanta The Medicity hospital, Gurugram, India
| |
Collapse
|
7
|
Tan GJS, Khoo PLZ, Chan KMJ. A review of endovascular treatment of thoracic aorta disease. Ann R Coll Surg Engl 2018; 100:1-6. [PMID: 30286634 PMCID: PMC6204499 DOI: 10.1308/rcsann.2018.0143] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2018] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION The development of thoracic endovascular aortic repair has altered the approach and reduced the risk of treating the majority of descending thoracic aortic conditions. Primarily developed for the exclusion of thoracic aortic aneurysms, it is now used in place of open repair surgery for most descending thoracic aortic diseases, and has also been used to treat aortic arch diseases in selected cases. METHODS A literature search was conducted of Medline and Embase databases from January 2007 to February 2017, using the key words 'aortic disease', 'thoracic aorta' and 'endovascular repair'; 205 articles were identified, of which 25 studies were selected for review based on their relevance. FINDINGS The key findings of the indications, techniques, outcomes, complications and comparisons with open surgical repair were extracted from the published studies and are summarised in this review. Thoracic endovascular aortic repair is the preferred choice of intervention for patients with descending thoracic aortic disease. With time, it has improved to be safer and has the potential to expand aortic treatment choices in future.
Collapse
Affiliation(s)
- GJS Tan
- Faculty of Medical Sciences, Newcastle University Medical School, Newcastle Upon Tyne, UK
| | - PLZ Khoo
- Faculty of Medical Sciences, Newcastle University Medical School, Newcastle Upon Tyne, UK
| | - KMJ Chan
- National Heart and Lung Institute, Imperial College London, London, UK
- Cardiac Vascular Sentral Kuala Lumpur (CVSKL) Hospital, Kuala Lumpur, Malaysia
| |
Collapse
|
8
|
Joo HC, Youn YN, Ko YG, Choi D, Won JY, Lee DY, Yoo KJ. Comparison of open surgical versus hybrid endovascular repair for descending thoracic aortic aneurysms with distal arch involvement. J Thorac Dis 2018; 10:3548-3557. [PMID: 30069352 DOI: 10.21037/jtd.2018.05.127] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Our aim was to compare the efficacies of conventional open thoracotomy and hybrid endovascular technique in patients with descending thoracic aortic aneurysms involving the distal arch. Methods Between January 2005 and December 2015, 125 consecutive patients with descending aneurysms involving distal arch underwent open repair via thoracotomy (n=79) or zone 1/2 hybrid endovascular repair (n=46). Surgeries entailing total arch replacement by elephant trunk technique (with sternotomy) and Zone 0 hybrid arch repairs were excluded. Early and late outcomes were compared using propensity scores and inverse-probability-of-treatment weighting (IPTW). Results In-hospital mortality rates for open repair (10.1%) and hybrid repair (6.5%) did not differ significantly (P=0.49). Major adverse outcomes included stroke (11.4% vs. 8.7%), paraplegia (2.5% vs. 0.0%) and lung complications (19.0% vs. 6.5%). Once adjusted by IPTW, hospital mortality risk for conventional open repair (OR =4.396; P=0.086) tended to be higher, and there was significant risk of lung complications (OR =4.372; P=0.025). However, both techniques were similar in terms of 30-day mortality (OR =2.745; P=0.257), stroke (OR =2.134; P=0.217), paraplegia (OR =3.639; P=0.407), and midterm survival (OR =1.05; P=0.90). Freedom from reintervention at 10 years was significantly better for open repair (85.2%±7.1%) compared with the hybrid approach (46.3%±11.0%; OR =0.13; P<0.01). Conclusions Hybrid arch repair conferred a significantly lower incidence of pulmonary complications, without benefitting perioperative mortality and stroke. However, open repair proved more reliable, showing greater durability. Long-term investigations are needed to confirm the viability and safety of hybrid repair as an alternative treatment in this setting.
Collapse
Affiliation(s)
- Hyun-Chel Joo
- Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young-Nam Youn
- Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young-Guk Ko
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong Yun Won
- Division of Radiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Do Yun Lee
- Division of Radiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyung-Jong Yoo
- Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
9
|
Abstract
Conventional arch replacement can be carried out in a great majority of patients. Hybrid procedures are often as invasive and technically difficult as conventional ones. Moreover, their immediate results are, in many reported experiences, not better and their long-term results less favourable than the ones observed with conventional methods. So, yes, the open conventional arch replacement is still "the gold standard".
Collapse
|
10
|
Teixeira PGR, Woo K, Beck AW, Scali ST, Weaver FA. Association of left subclavian artery coverage without revascularization and spinal cord ischemia in patients undergoing thoracic endovascular aortic repair: A Vascular Quality Initiative® analysis. Vascular 2017; 25:587-597. [DOI: 10.1177/1708538116681910] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives Investigate the impact of left subclavian artery coverage without revascularization on spinal cord ischemia development in patients undergoing thoracic endovascular aortic repair. Methods The Vascular Quality Initiative thoracic endovascular aortic repair module (April 2011–July 2014) was analyzed. Patients undergoing left subclavian artery coverage were divided into two groups according to revascularization status. The association between left subclavian artery revascularization with the primary outcome of spinal cord ischemia and the secondary outcome of stroke was assessed with multivariable analysis adjusting for between-group baseline differences. Results The left subclavian artery was covered in 508 (24.6%) of the 2063 thoracic endovascular aortic repairs performed. Among patients with left subclavian artery coverage, 58.9% underwent revascularization. Spinal cord ischemia incidence was 12.1% in the group without revascularization compared to 8.5% in the group undergoing left subclavian artery revascularization (odds ratio (95%CI): 1.48(0.82–2.68), P = 0.189). Multivariable analysis adjustment identified an independent association between left subclavian artery coverage without revascularization and the incidence of spinal cord ischemia (adjusted odds ratio (95%CI): 2.29(1.03–5.14), P = 0.043). Although the incidence of stroke was also higher for the group with a covered and nonrevascularized left subclavian artery (12.1% versus 8.5%), this difference was not statistically significant after multivariable analysis (adjusted odds ratio (95%CI): 1.55(0.74–3.26), P = 0.244). Conclusion For patients undergoing left subclavian artery coverage during thoracic endovascular aortic repair, the addition of a revascularization procedure was associated with a significantly lower incidence of spinal cord ischemia.
Collapse
Affiliation(s)
- Pedro GR Teixeira
- Department of Surgery and Perioperative Care, University of Texas at Austin, Austin, USA
| | - Karen Woo
- Division of Vascular Surgery, University of California, Los Angeles, Los Angeles, USA
| | | | | | - Fred A Weaver
- Division of Vascular Surgery and Endovascular Therapy, University of Southern California, Los Angeles, USA
| | | |
Collapse
|
11
|
Tokuda Y, Oshima H, Narita Y, Abe T, Araki Y, Mutsuga M, Fujimoto K, Terazawa S, Yagami K, Ito H, Yamamoto K, Komori K, Usui A. Hybrid versus open repair of aortic arch aneurysms: comparison of postoperative and mid-term outcomes with a propensity score-matching analysis. Eur J Cardiothorac Surg 2015; 49:149-56. [DOI: 10.1093/ejcts/ezv063] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 01/23/2015] [Indexed: 11/14/2022] Open
|
12
|
Castrovinci S, Murana G, de Maat GE, Smith T, Schepens MA, Heijmen RH, Morshuis WJ. The classic elephant trunk technique for staged thoracic and thoracoabdominal aortic repair: Long-term results. J Thorac Cardiovasc Surg 2015; 149:416-22. [DOI: 10.1016/j.jtcvs.2014.09.078] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 09/04/2014] [Accepted: 09/23/2014] [Indexed: 10/24/2022]
|
13
|
|
14
|
Hybrid arch debranching and proximal endograft extension to repair a type I endoleak after endovascular thoracic aneurysm repair. Ann Vasc Surg 2014; 28:740.e7-12. [PMID: 24378243 DOI: 10.1016/j.avsg.2013.06.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 06/12/2013] [Accepted: 06/12/2013] [Indexed: 11/20/2022]
Abstract
Endovascular repair of complex aortic disease has emerged over the past decade as an alternative to traditional open repair, especially for patients with significant medical comorbidities and/or anatomic challenges, such as reoperative fields. However, the possibility of graft migration and endoleak mandates long-term follow-up of these grafts. We present a patient who underwent hybrid repair after stent graft migration and proximal type I endoleak after thoracic endovascular aneurysm repair. This approach allowed us to avoid extensive surgery that would also necessitate circulatory arrest.
Collapse
|
15
|
Czerny M, Schmidli J, Carrel T, Grimm M. Hybrid aortic arch repair. Ann Cardiothorac Surg 2013; 2:372-7. [PMID: 23977610 DOI: 10.3978/j.issn.2225-319x.2013.03.05] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 03/15/2013] [Indexed: 11/14/2022]
Abstract
The successes of thoracic endovascular aortic repair (TEVAR) have spurned new approaches to addressing thoracic aortic pathologies. These hybrid techniques offer an alternative in patients with multi-segmental thoracic aortic pathologies which would have otherwise required a two-step arch replacement and open descending arch repair. The following article offers a clinical insight to the available hybrid approaches, such as rerouting of supra-aortic vessels. Unique complications to endovascular repairs, and technical risks and issues, are also presented along with management options and strategies to minimize such concerns.
Collapse
Affiliation(s)
- Martin Czerny
- Department of Cardiovascular Surgery, Inselspital, University Hospital Berne, Switzerland
| | | | | | | |
Collapse
|
16
|
Michler RE, Lipsitz E, Neragi-Miandoab S. A Case Series of a Hybrid Approach to Aortic Arch Disease. Heart Surg Forum 2013; 16:E225-31. [DOI: 10.1532/hsf98.20131022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
<p><b>Objective:</b> Debranching of the aortic arch and endovascular stent placement as a combination therapy for complex aortic arch pathology has emerged over the past few years as an alternative to traditional repair. This hybrid approach is a viable option for patients who would not tolerate conventional arch replacement, as well as for patients with a failed stent graft of the descending aorta and a subsequent type I endoleak.</p><p><b>Methods:</b> We retrospectively reviewed the preoperative characteristics and postoperative outcomes of 5 patients who underwent debranching of the aortic arch and implantation of an endovascular stent across the aortic arch between 2008 and 2011. Data were analyzed with the Student t test and the Kaplan-Meyer method.</p><p><b>Results:</b> The mean age was 70.6 � 18 years; 4 men and 1 woman were evaluated. One patient had previous aortic surgery for dissection. The preoperative morbidities included arrhythmia (1 patient), chronic obstructive pulmonary disease (2 patients), cerebrovascular accident (1 patient), diabetes mellitus (2 patients), coronary artery disease (2 patients), and active angina (1 patient). One patient had a myocardial infarction 3 weeks before surgery. The primary technical-success rate was 100%, and none of the patients died in the perioperative phase. The mean follow-up time was 22 � 18.4 months, and the median follow-up time was 13.8 months (range, 7.13-50.7 months). Two patients died during follow-up. The pathology of the aorta in the patients who died was arch aneurysm; the 3 remaining patients are alive and regularly followed at our institution.</p><p><b>Conclusion:</b> The combination of surgery and simultaneous endovascular stenting in the operating room is an alternative approach for patients who are poor candidates for traditional arch repair under circulatory arrest.</p>
Collapse
|
17
|
Kang WC, Shin EK, Park CH, Kang JM, Ko YG, Choi D, Youn YN, Shim WH. Hybrid endovascular repair for aortic arch pathology: Intermediate outcomes and complications. Catheter Cardiovasc Interv 2013; 82:275-82. [DOI: 10.1002/ccd.24384] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Revised: 02/01/2012] [Accepted: 02/20/2012] [Indexed: 12/19/2022]
Affiliation(s)
- Woong Chol Kang
- Department of Cardiology; Gil Hospital; Gachon University; Incheon Korea
| | - Eak Kyun Shin
- Department of Cardiology; Gil Hospital; Gachon University; Incheon Korea
| | - Chul-Hyun Park
- Department of Cardiovascular Surgery; Gil Hospital; Gachon University; Incheon Korea
| | - Jin Mo Kang
- Department of and Vascular Surgery; Gil Hospital; Gachon University; Incheon Korea
| | - Young-Guk Ko
- Department of Cardiology; Yonsei Cardiovascular Hospital; Yonsei University College of Medicine; Seoul Korea
| | - Donghoon Choi
- Department of Cardiology; Yonsei Cardiovascular Hospital; Yonsei University College of Medicine; Seoul Korea
| | - Young Nam Youn
- Department of Cardiovascular Surgery; Yonsei Cardiovascular Hospital; Yonsei University College of Medicine; Seoul Korea
| | - Won-Heum Shim
- Department of Cardiology; Yonsei Cardiovascular Hospital; Yonsei University College of Medicine; Seoul Korea
| |
Collapse
|
18
|
Transposition of the supra-aortic vessels before stent grafting the aortic arch and descending aorta. J Thorac Cardiovasc Surg 2013; 145:S91-7. [DOI: 10.1016/j.jtcvs.2012.11.056] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 08/06/2012] [Accepted: 11/28/2012] [Indexed: 11/18/2022]
|
19
|
Murashita T, Matsuda H, Domae K, Iba Y, Tanaka H, Sasaki H, Ogino H. Less invasive surgical treatment for aortic arch aneurysms in high-risk patients: A comparative study of hybrid thoracic endovascular aortic repair and conventional total arch replacement. J Thorac Cardiovasc Surg 2012; 143:1007-13. [PMID: 21783209 DOI: 10.1016/j.jtcvs.2011.06.024] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 05/16/2011] [Accepted: 06/27/2011] [Indexed: 11/26/2022]
|
20
|
|
21
|
Onorati F, Santini F, Telesca M, Faggian G, Mazzucco A. Spontaneous rupture of the right sinus of valsalva mimicking an ascending aortic intramural hematoma. J Card Surg 2011; 26:204-7. [PMID: 21299622 DOI: 10.1111/j.1540-8191.2011.01196.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Spontaneous ruptures of the ascending aorta are extremely rare and require emergent surgical intervention. We report a case of a delayed diagnosis of a spontaneous, localized periostial rupture of a nondilated right sinus of Valsalva, which mimicked an intramural hematoma of the ascending aorta. The diagnosis and surgical management of this unusual pathology is the subject of this case report.
Collapse
Affiliation(s)
- Francesco Onorati
- Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy.
| | | | | | | | | |
Collapse
|
22
|
Czerny M, Pfannmüller B, Borger MA, Schmidt A, Mohr FW, Grabenwöger M. Hybrid debranching technique for aortic arch replacement. Multimed Man Cardiothorac Surg 2011; 2011:mmcts.2011.005108. [PMID: 24413422 DOI: 10.1510/mmcts.2011.005108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We present the case of a 64-year-old female with a multisegmental thoracic aortic aneurysm extending from the sinu-tubular junction to the mid-descending aorta. The patient was treated by a combined vascular and endovascular approach containing an ascending aortic replacement, rerouting of the supraaortic branches by autologous double transposition followed by endovascular stent-graft placement.
Collapse
Affiliation(s)
- Martin Czerny
- Department of Cardiovascular Surgery, Inselspital, University Hospital Berne, Freiburgstrasse, 3010 Berne, Switzerland
| | | | | | | | | | | |
Collapse
|
23
|
Bavaria J, Milewski RK, Baker J, Moeller P, Szeto W, Pochettino A. Classic hybrid evolving approach to distal arch aneurysms: Toward the zone zero solution. J Thorac Cardiovasc Surg 2010; 140:S77-80; discussion S86-91. [PMID: 21092802 DOI: 10.1016/j.jtcvs.2010.07.031] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Accepted: 07/12/2010] [Indexed: 10/18/2022]
|
24
|
Ricotta JJ. Endoleak management and postoperative surveillance following endovascular repair of thoracic aortic aneurysms. J Vasc Surg 2010; 52:91S-9S. [DOI: 10.1016/j.jvs.2010.06.149] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Revised: 06/17/2010] [Accepted: 06/17/2010] [Indexed: 11/24/2022]
|
25
|
Have hybrid procedures replaced open aortic arch reconstruction in high-risk patients? A comparative study of elective open arch debranching with endovascular stent graft placement and conventional elective open total and distal aortic arch reconstruction. J Thorac Cardiovasc Surg 2010; 140:590-7. [DOI: 10.1016/j.jtcvs.2010.02.055] [Citation(s) in RCA: 158] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Revised: 02/01/2010] [Accepted: 02/20/2010] [Indexed: 11/23/2022]
|
26
|
Kang WC, Shin EK, Ahn TH, Lee KH, Moon CI, Han SH, Park CH, Park KY, Kang JM, Kim JH. Combined open and endovascular repair for aortic arch pathology. Korean Circ J 2010; 40:399-404. [PMID: 20830254 PMCID: PMC2933465 DOI: 10.4070/kcj.2010.40.8.399] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Accepted: 04/01/2010] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives We describe our experience with combined open and endovascular repair in patients who have aortic arch pathology. Subjects and Methods This study is a retrospective analysis of 7 patients who underwent combined open and endovascular repair for aortic arch pathology. Medical records and radiographic information were reviewed. Results A total of 7 consecutive patients (5 men, 71.4%) underwent thoracic stent graft implantation. The mean age was 59.9±16.7 years. The indication for endovascular repair was aneurysmal degeneration in 5 patients, and rupture or impending rupture in 2 patients. In all 7 cases, supra-aortic transposition of the great vessels was performed successfully. Stent graft implantation was achieved in all cases. Surgical exposure of the access vessel was necessary in 2 patients. A total of 9 stent grafts were implanted (3 stent grafts in one patient). The Seal thoracic and the Valiant endovascular stent graft were implanted in 6 patients and 1 patient, respectively. There were no post-procedure deaths or neurologic complications. In 2 patients, bleeding and injury of access vessel were noted after the procedure. Postoperative endoleak was noted in 1 patient. One patient died at 10 months after the procedure due to a newly developed ascending aortic dissection. No patients required secondary intervention during the follow-up period. The aortic diameter decreased in 4 patients. In 3 patients, including 1 patient with endoleak, there was no change in aortic diameter. Conclusion Our experience suggests that combined open and endovascular repair for aortic arch pathology is safe and effective, with few complications.
Collapse
Affiliation(s)
- Woong Chol Kang
- Department of Cardiology, Gil Medical Center, Gachon University of Medicine and Science, Incheon, Korea
| | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Antoniou G, El Sakka K, Hamady M, Wolfe J. Hybrid Treatment of Complex Aortic Arch Disease with Supra-aortic Debranching and Endovascular Stent Graft Repair. Eur J Vasc Endovasc Surg 2010; 39:683-90. [PMID: 20227895 DOI: 10.1016/j.ejvs.2010.02.002] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Accepted: 02/03/2010] [Indexed: 10/19/2022]
|
28
|
Contemporary Indications and own Results of Surgical Treatment of occlusions of the initial section of the Left subclavian artery. POLISH JOURNAL OF SURGERY 2010. [DOI: 10.2478/v10035-010-0038-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
29
|
Dumfarth J, Gottardi R, Holfeld J, Schoder M, Dziodzio T, Juraszek A, Hoebartner M, Laufer G, Grimm M, Czerny M. Translocation of the supra-aortic vessels and stent grafting of the aortic arch. Multimed Man Cardiothorac Surg 2010; 2010:mmcts.2008.003871. [PMID: 24412927 DOI: 10.1510/mmcts.2008.003871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This is a report on the combined surgical and endovascular treatment of a very large aortic arch aneurysm. In the first step, total arch rerouting was performed with an inversed bifurcated Dacron prosthesis. Brachiocephalic trunk and left subclavian artery were inserted into the two branches of the prosthesis via an end-to-end anastomosis and left common carotid was reinserted into the branch to the left subclavian. In the second step, thoracic endovascular aortic repair was performed. By this combined concept a stable and durable result could be achieved.
Collapse
Affiliation(s)
- Julia Dumfarth
- Department of Cardiothoracic Surgery, University of Vienna Medical School, Vienna, Austria
| | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Hybrid Procedure for Proximal Arch and Descending Aortic Aneurysms. Ann Thorac Surg 2008; 86:1989-91. [DOI: 10.1016/j.athoracsur.2008.04.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2008] [Revised: 04/16/2008] [Accepted: 04/25/2008] [Indexed: 11/22/2022]
|
31
|
Gottardi R, Funovics M, Eggers N, Hirner A, Dorfmeister M, Holfeld J, Zimpfer D, Schoder M, Donas K, Weigang E, Lammer J, Grimm M, Czerny M. Supra-aortic Transposition for Combined Vascular and Endovascular Repair of Aortic Arch Pathology. Ann Thorac Surg 2008; 86:1524-9. [PMID: 19049743 DOI: 10.1016/j.athoracsur.2008.06.075] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Revised: 06/13/2008] [Accepted: 06/13/2008] [Indexed: 02/08/2023]
|
32
|
Kische S, Akin I, Ince H, Rehders TC, Schneider H, Ortak J, Nienaber CA. Reparación mediante implantación de stents en enfermedades agudas y crónicas de la aorta torácica. Rev Esp Cardiol 2008. [DOI: 10.1157/13126047] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
|
33
|
Lentini S, Gaeta R, Tancredi F, Savasta M, La Monaca M, Ciuffreda F, Monaco F. Transposition of the left carotid artery to the ascending aorta to repair aortic arch injury. J Card Surg 2008; 24:57-8. [PMID: 18793235 DOI: 10.1111/j.1540-8191.2008.00722.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We present a case where we repaired the aortic arch, by the transposition of the left carotid artery to the ascending aorta. A 52-year-old man presented to our department with a penetrating chest wound by a gunshot in the attempt of suicide. The aortic arch and the insertion of the left carotid artery were involved in the lesion. Through sternotomic approach, the aortic arch was repaired in extracorporeal circulation. Left carotid artery was transected to allow easier repair of the arch posterior wall involved in the lesion, and to reduce the danger of residual stenosis. Then, it was translocated to the ascending aorta by interposing a 7-mm Gore-Tex (W.L. Gore & Associates, Flagstaff, AZ, USA) conduit. The patient complicated renal failure and pneumonia in the postoperative period, but eventually he was discharged in good general conditions.
Collapse
Affiliation(s)
- Salvatore Lentini
- Cardiac Surgery Unit, Policlinico G. Martino University of Messina, Messina, Italy
| | | | | | | | | | | | | |
Collapse
|
34
|
|
35
|
Can the Left Subclavian Artery be Safely Covered during Endovascular Repair of the Descending Thoracic Aorta? INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2008; 3:147-50. [DOI: 10.1097/imi.0b013e31817793f8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective Routine preoperative carotid-subclavian bypass or transposition is frequently recommended in patients undergoing endovascular repair of the descending thoracic aorta (DTA). We reviewed our comprehensive thoracic endografting experience with regards to coverage of the left subclavian artery (LSA) to assess whether mandatory preoperative carotid-subclavian bypass or transposition is necessary. Methods Between February 2000 and November 2005, 255 patients were successfully treated with an endoluminal graft (ELG) to the DTA. Indications for intervention included atherosclerotic aneurysms (109/255, 42.7%), acute and chronic dissections (75/255, 29.4%), miscellaneous (41/255, 16.1%), and penetrating aortic ulcers (30/255, 11.8%). There were 151 males (151/255, 59.2%) and 104 females (104/255, 40.8%) with a mean age of 71 years (range, 23–91 years). Results The LSA was completely covered with an ELG in 71 patients (71/255, 27.8%) and partially covered in 47 patients (47/255, 18.4%). In patients who had complete coverage of the LSA, 30 patients (30/71, 42.3%) had acute or chronic Type B dissections, 26 patients (26/71, 36.6%) had aneurysms, 11 patients (11/71, 15.5%) had miscellaneous aortic pathologies, and 4 patients (4/71, 5.6%) had pseudoaneurysms associated with prior coarctation repair. Fifteen patients (15/255, 5.9%) underwent preoperative carotid-subclavian bypass or transposition and subsequently underwent complete coverage of the LSA with an ELG. One patient (1/56, 1.8%) with complete coverage of the LSA required elective postoperative carotid-subclavian bypass secondary to left arm claudication. Conclusions Routine preoperative carotid-subclavian bypass is not necessary, except in select patients with a patent left internal mammary artery to the left anterior descending artery bypass graft or contralateral vertebral artery disease.
Collapse
|
36
|
Domenig C, Linni K, Mader N, Kretschmer G, Magometschnigg H, Hölzenbein T. Subclavian to Carotid Artery Transposition: Medial versus Lateral Approach. Eur J Vasc Endovasc Surg 2008; 35:551-7. [DOI: 10.1016/j.ejvs.2007.12.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2007] [Accepted: 12/03/2007] [Indexed: 10/22/2022]
|
37
|
Preventza O, Wheatley GH, Williams J, Chaugle H, Hughes K, Ramaiah V, Rodriguez-Lopez J, Olsen D, Diethrich EB. Can the Left Subclavian Artery be Safely Covered during Endovascular Repair of the Descending Thoracic Aorta? INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2008. [DOI: 10.1177/155698450800300307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Ourania Preventza
- Department of Cardiovascular and Endovascular Surgery, Arizona Heart Institute, Phoenix, AZ
| | - Grayson H. Wheatley
- Department of Cardiovascular and Endovascular Surgery, Arizona Heart Institute, Phoenix, AZ
| | - James Williams
- Department of Cardiovascular and Endovascular Surgery, Arizona Heart Institute, Phoenix, AZ
| | - Hannan Chaugle
- Department of Cardiovascular and Endovascular Surgery, Arizona Heart Institute, Phoenix, AZ
| | - Kakra Hughes
- Department of Cardiovascular and Endovascular Surgery, Arizona Heart Institute, Phoenix, AZ
| | - Venkatesh Ramaiah
- Department of Cardiovascular and Endovascular Surgery, Arizona Heart Institute, Phoenix, AZ
| | - Julio Rodriguez-Lopez
- Department of Cardiovascular and Endovascular Surgery, Arizona Heart Institute, Phoenix, AZ
| | - Dawn Olsen
- Department of Cardiovascular and Endovascular Surgery, Arizona Heart Institute, Phoenix, AZ
| | - Edward B. Diethrich
- Department of Cardiovascular and Endovascular Surgery, Arizona Heart Institute, Phoenix, AZ
| |
Collapse
|
38
|
|
39
|
Svensson LG, Kouchoukos NT, Miller DC, Bavaria JE, Coselli JS, Curi MA, Eggebrecht H, Elefteriades JA, Erbel R, Gleason TG, Lytle BW, Mitchell RS, Nienaber CA, Roselli EE, Safi HJ, Shemin RJ, Sicard GA, Sundt TM, Szeto WY, Wheatley GH. Expert Consensus Document on the Treatment of Descending Thoracic Aortic Disease Using Endovascular Stent-Grafts⁎⁎Expert Consensus Document on the Treatment of Descending Thoracic Aortic Disease Using Endovascular Stent-Grafts has been supported by Unrestricted Educational Grants from Cook, Inc and Medtronic, Inc. Ann Thorac Surg 2008; 85:S1-41. [PMID: 18083364 DOI: 10.1016/j.athoracsur.2007.10.099] [Citation(s) in RCA: 546] [Impact Index Per Article: 34.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2007] [Revised: 10/17/2007] [Accepted: 10/18/2007] [Indexed: 01/15/2023]
Affiliation(s)
- Lars G Svensson
- Center for Aortic Surgery and Marfan Syndrome Clinic, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio 44195, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Endangered Cerebral Blood Supply After Closure of Left Subclavian Artery: Postmortem and Clinical Imaging Studies. Ann Thorac Surg 2008; 85:120-5. [DOI: 10.1016/j.athoracsur.2007.08.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2007] [Revised: 08/14/2007] [Accepted: 08/14/2007] [Indexed: 11/20/2022]
|
41
|
Chabrot P, Chahid T, Azarnoush K, Cassagnes L, Garcier JM, Camilleri L, Boyer L. [Type III endoleaks at follow-up of covered descending thoracic aortic stent-grafts: report of 3 patients]. ACTA ACUST UNITED AC 2007; 88:1709-15. [PMID: 18065931 DOI: 10.1016/s0221-0363(07)74050-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To describe the imaging work-up and management of type III endoleaks detected after covered stent-graft treatment of descending thoracic aortic aneurysms. PATIENTS AND METHODS Retrospective study of circumstances surrounding the diagnosis, management and outcome type III endoleaks occuring in 3 of 18 patients following covered stent-graft treatment of descending thoracic aortic aneurysms between April 1998 and July 2005. The endoleaks were detected at a mean follow-up of 22 months (19-24 months) after stent-graft placement. RESULTS The type III endoleaks were detected on scheduled follow-up CT examinations in asymptomatic patients. Endovascular management was proposed at a mean interval time of 4.4 months (1 week - 11 months) after diagnosis of the endoleak, and was successful in all 3 cases. One patient died 1 month after endovascular repeai of the leak, 1 patient required surgical management at 14 months for new recurrence, and 1 patient had a favorable outcome at 2 months. CONCLUSION Follow-up of patients after covered stent-graft treatment of descending thoracic aortic aneurysms is required. Prompt endovascular repair of delayed complications may be possible, but surgical management may become necessary.
Collapse
Affiliation(s)
- P Chabrot
- Service de Radiologie B, CHU Clermont-Ferrand, Hôpital G Montpied, 58, rue Montalembert, BP 69, 63003 Clermont-Ferrand
| | | | | | | | | | | | | |
Collapse
|
42
|
Karmy-Jones R, Simeone A, Meissner M, Granvall B, Nicholls S. Descending thoracic aortic dissections. Surg Clin North Am 2007; 87:1047-86, viii-ix. [PMID: 17936475 DOI: 10.1016/j.suc.2007.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Type B dissection has traditionally been managed medically if uncomplicated and surgically if associated with complications. This practice has resulted in most centers reporting significant morbidity and mortality if open repair is required. In the setting of malperfusion, operative repair has been conjoined with fenestration or visceral stenting to improve outcomes. Endovascular stent grafts seem to offer an attractive alternative in the acute complicated type B dissection, with reduced mortality and morbidity, particularly paralysis, compared with open repair. It is reasonable to consider endovascular stent grafts as another tool in managing dissection, but to recognize that open surgical repair still plays an important role, and that the data that define indications and outcomes are still emerging.
Collapse
Affiliation(s)
- Riyad Karmy-Jones
- Division of Thoracic Surgery, Heart and Vascular Institute, Southwest Washington Medical Center, P.O. Box 1600 Vancouver, WA 98668, USA.
| | | | | | | | | |
Collapse
|
43
|
Reece TB, Gazoni LM, Cherry KJ, Peeler BB, Dake M, Matsumoto AH, Angle J, Kron IL, Tribble CG, Kern JA. Reevaluating the Need for Left Subclavian Artery Revascularization With Thoracic Endovascular Aortic Repair. Ann Thorac Surg 2007; 84:1201-5; discussion 1205. [PMID: 17888970 DOI: 10.1016/j.athoracsur.2007.05.020] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2007] [Revised: 05/06/2007] [Accepted: 05/07/2007] [Indexed: 11/23/2022]
Abstract
BACKGROUND With increased utilization of thoracic endovascular aortic repair (TEVAR), the anatomic limitations of proximal device landing zones are being challenged. As our experience has grown with TEVAR involving exclusion of the left subclavian artery (LSA), the need for selective revascularization of the LSA appeared to be more common than we initially anticipated. We hypothesize that for patients undergoing TEVAR requiring coverage of the LSA, the need for LSA revascularization is higher than reported in the literature. METHODS The charts of all patients undergoing TEVAR performed at a single tertiary care center from 1999 to 2006 were reviewed. The review included the preoperative radiographic evaluations, the assessment of comorbidities, the anatomic position of the proximal and distal landing zones, outcomes, complications, and the need for preoperative or postoperative subclavian artery revascularization. RESULTS Sixty-four patients underwent TEVAR and 27 (42%) of these patients required exclusion of the LSA from the thoracic aorta. Seven of these 27 patients (25.9%) required preoperative LSA revascularization. Four patients developed late symptoms, necessitating LSA revascularization. No patients died or developed paraplegia, but three adverse neurological events occurred unrelated to the posterior fossa circulation. No patient developed any left arm disability. CONCLUSIONS The TEVAR coverage of the LSA with selective revascularization was safe for patients, but greater than 11 of 27 (40.7%) required either preoperative or postoperative LSA revascularization. Although this study represents our early experience with TEVAR, these data suggest that selective revascularization after TEVAR exclusion of the origin of the LSA may be required more frequently than previously reported.
Collapse
Affiliation(s)
- T Brett Reece
- Department of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Kische S, Rehders TC, Akin I, Ince H, Nienaber CA. Role of interventional repair in the thoracic aorta. Future Cardiol 2007; 3:399-412. [PMID: 19804231 DOI: 10.2217/14796678.3.4.399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Endovascular treatment of chronic aneurysmatic diseases of the descending thoracic aorta has demonstrated encouraging peri-interventional mortality and morbidity and is accepted as a preferred strategy in experienced centers. The emergence of endovascular strategies for acute thoracic aortic pathologies is an even more exciting new territory for nonsurgical interventions considering the sobering results of open surgery. Although it is apparent that patients at high risk for open surgery will benefit from endovascular strategies, the exact role of stent-graft placement remains to be defined, as the community awaits solid long-term data and as devices and techniques continue to improve. While some indications and scenarios, such as acute type B dissection with associated malperfusion syndrome or imminent aortic rupture, have been shown to benefit from stent-graft treatment, others are less settled. The current paper discusses both the established and emerging indications, as well as technical and anatomical aspects of this fascinating therapeutic option.
Collapse
Affiliation(s)
- Stephan Kische
- Rostock School of Medicine, Division of Cardiology at the University Hospital Rostock, Ernst-Heydemann-Str. 6, 18057 Rostock, Germany.
| | | | | | | | | |
Collapse
|
45
|
Moon MC, Morales JP, Greenberg RK. The Aortic Arch and Ascending Aorta: Are They Within the Endovascular Realm? Semin Vasc Surg 2007; 20:97-107. [PMID: 17580247 DOI: 10.1053/j.semvascsurg.2007.04.007] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Aneurysms involving the ascending aorta and arch have been historically treated with open surgical techniques requiring cardiopulmonary bypass and, in cases involving the aortic arch, utilizing deep hypothermic circulatory arrest. The reported rates of mortality range from 0% to 16.5% for surgery addressing ascending aorta and arch pathology, and stroke rates of 2% to 18%. These statistics highlight the invasiveness of these procedures. Continued development and evolution of endovascular stent-grafts has allowed for the application of endovascular interventions in the proximal descending thoracic aorta and visceral aortic segments. Based on early experiences, attention has been focused on the ascending aorta and aortic arch, where unique challenges exist and have been addressed by both extra-anatomic bypass and novel methods incorporating branched and fenestrated devices. Device evolution, coupled with increased experience by the aortic interventionalist, has resulted in successful cases of endovascular management of every section of the aorta, including aortic valve replacement. However, these experiences have also been accompanied by significant complications. In this light, new endovascular endeavors must be considered in the context of conventional treatment options, hybrid procedures, and novel branched devices. Patient factors, such as specific anatomic issues, comorbid diseases, and functional levels must play an important role in the determination of therapeutic options. Ultimately, a clinician who understands the disease and is familiar with all treatment options (interventional, medical, and open surgical) will be best suited to provide care for the aortic patient. Finally, as with any assessment of interventional strategies, rigorous follow-up and serial imaging are essential.
Collapse
MESH Headings
- Aortic Dissection/diagnostic imaging
- Aortic Dissection/pathology
- Aortic Dissection/surgery
- Aorta/pathology
- Aorta/surgery
- Aorta, Thoracic/diagnostic imaging
- Aorta, Thoracic/pathology
- Aorta, Thoracic/surgery
- Aortic Aneurysm/diagnostic imaging
- Aortic Aneurysm/pathology
- Aortic Aneurysm/surgery
- Aortic Aneurysm, Thoracic/diagnostic imaging
- Aortic Aneurysm, Thoracic/pathology
- Aortic Aneurysm, Thoracic/surgery
- Aortography
- Blood Vessel Prosthesis
- Blood Vessel Prosthesis Implantation/adverse effects
- Blood Vessel Prosthesis Implantation/instrumentation
- Humans
- Imaging, Three-Dimensional
- Patient Selection
- Prosthesis Design
- Radiographic Image Interpretation, Computer-Assisted
- Radiography, Interventional
- Stents
- Tomography, X-Ray Computed
- Treatment Outcome
Collapse
Affiliation(s)
- M C Moon
- Department of Vascular Surgery, Cleveland Clinic, Cleveland, OH 44195, USA
| | | | | |
Collapse
|
46
|
Ferreira M, Monteiro M, Lanziotti L, Abuhadba G, Capotorto L. Deliberate Subclavian Artery Occlusion during Aortic Endovascular Repair: Is it Really that Safe? Eur J Vasc Endovasc Surg 2007; 33:664-7. [PMID: 17293132 DOI: 10.1016/j.ejvs.2006.12.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2006] [Accepted: 12/13/2006] [Indexed: 11/16/2022]
Abstract
PURPOSE To report a series of cases in which deliberate occlusion of the left Subclavian Artery (SA) caused the Subclavian Steal Syndrome (SSS). METHODS Between January 2001 and August 2006, we performed 81 endovascular repairs of the Thoracic Aorta. 21 patients required left SA occlusion for an adequate proximal landing zone. 17 of these patients were treated by deliberate SA occlusion. Four patients (23.5%) developed a SSS, of which three were treated by a secondary Subclavian-to-carotid transposition, with complete remission of the SSS. RESULTS The subclavian-to-carotid transposition was successful in the treatment of the 3 patients selected. One patient refused to be operated, and had only partial remission of the SSS symptoms. Mean follow-up was 28 months (range 2-48). CONCLUSION In this series deliberate occlusion of the SA led to SSS in a significant number of patients. Consideration should be given to primary subclavian transposition in some patients requiring subclavian occlusion.
Collapse
Affiliation(s)
- M Ferreira
- SITE - Serviço Integrado de Técnicas Endovasculares, Brazil.
| | | | | | | | | |
Collapse
|
47
|
Czerny M, Zimpfer D, Rodler S, Funovics M, Dorfmeister M, Schoder M, Marta G, Weigang E, Gottardi R, Lammer J, Wolner E, Grimm M. Endovascular Stent-Graft Placement of Aneurysms Involving the Descending Aorta Originating From Chronic Type B Dissections. Ann Thorac Surg 2007; 83:1635-9. [PMID: 17462371 DOI: 10.1016/j.athoracsur.2006.12.041] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2006] [Revised: 12/13/2006] [Accepted: 12/18/2006] [Indexed: 11/16/2022]
Abstract
BACKGROUND The performance of endovascular stent-graft placement in patients suffering from aneurysms involving the descending aorta originating from chronic type B dissections is unclear. METHODS Within a 2-year period, we treated 6 patients with this pathology. Four patients required extension of the proximal landing zone (autologous double transposition, n = 2; subclavian-to-carotid artery transposition, n = 2) before stent-graft placement. RESULTS Supra-aortic rerouting procedures and endovascular stent-graft placement were performed successfully in all patients. Closure of the primary entry tear, full expansion of the stent-graft, and eventually, thrombosis of the false lumen was achieved in 5 patients. In 1 patient with a short proximal landing zone, a persisting type Ia endoleak was observed. In all patients with successful primary entry closure, a reduction in aneurysm diameter occurred. Mean follow-up is 16 months (range, 4 to 25). CONCLUSIONS Endovascular stent-graft placement of aneurysms involving the descending aorta originating from chronic type B dissections may serve as a valuable treatment option in this complex pathology. The chronic dissection membrane can be successfully compressed against large areas of the native aortic wall. A sufficient proximal landing zone is mandatory for early and late success.
Collapse
Affiliation(s)
- Martin Czerny
- Department of Cardiothoracic Surgery, University of Vienna Medical School, Vienna, Austria.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Jackson BM, Carpenter JP, Fairman RM, Moser GW, Pochettino A, Woo EY, Bavaria JE. Anatomic exclusion from endovascular repair of thoracic aortic aneurysm. J Vasc Surg 2007; 45:662-6. [PMID: 17350215 DOI: 10.1016/j.jvs.2006.12.062] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2006] [Accepted: 12/22/2006] [Indexed: 11/20/2022]
Abstract
OBJECTIVES We sought to define the current anatomic barriers to thoracic aortic aneurysm (TAA) stent grafting to guide future device development. METHODS All patients presenting with TAA requiring repair were evaluated for endovascular repair during a 4-year period (2000 to 2004). The TAAs evaluated were those beginning distal to the left common carotid artery (LCCA) and ending proximal to the celiac artery. All patients in whom endovascular repair was indicated underwent cross-sectional imaging by computed tomography angiography and three-dimensional modeling of their thoracic and abdominal arterial anatomy. Patients were evaluated for endovascular TAA repair in the context of the inclusion/exclusion criteria of pivotal United States Food and Drug Administration trials of the Gore TAG and Medtronic Talent devices. Anatomic requirements included >or=20 mm of suitable proximal and distal neck length, and proximal and distal neck diameters of 20 to 42 mm. These trials allowed the use of femoral or iliac access, including the use of conduits, and permitted stent graft coverage of the left subclavian artery (LSA) after preliminary carotid-subclavian bypass. Patients rejected for medical reasons or who died during evaluation were not included in the review. RESULTS A total of 126 patients (73 men, 53 women) with TAA located between the LCCA and celiac artery were screened for endovascular repair, and 33 (26%) were rejected for anatomic reasons. The remaining 93 patients underwent endografting (59 Talent, 34 TAG). Rejection was not significantly different by gender (16/73 men, 17/53 women, P = .22, NS). Most patients (28/33) were rejected for more than one criterion. Hostile proximal neck characteristics were the most prevalent reason for disqualification, despite the ability to cover the LSA to extend the proximal seal zone. Many of these patients (16/28) also had distal neck anatomy unsuitable for grafting. Overall, 19 patients had hostile distal necks. Difficulties with vascular access (diseased or tortuous iliac arteries, or a small caliber aorta) that could not be overcome even by use of conduits occurred in a significant fraction of patients (10/33). CONCLUSIONS Most patients with a TAA located between the LCCA and the celiac artery can be treated by endovascular repair. Patients excluded from TAA stent graft protocols for anatomic reasons most commonly have hostile proximal neck features that preclude endovascular repair with currently available devices. Transposition of arch vessels to facilitate greater use of existing stent grafts or development of new stent graft designs are needed to expand the applicability of TAA endovascular repair.
Collapse
Affiliation(s)
- Benjamin M Jackson
- Division of Vascular Surgery, University of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, USA.
| | | | | | | | | | | | | |
Collapse
|
49
|
Czerny M, Gottardi R, Zimpfer D, Schoder M, Grabenwoger M, Lammer J, Wolner E, Grimm M. Mid-term results of supraaortic transpositions for extended endovascular repair of aortic arch pathologies. Eur J Cardiothorac Surg 2007; 31:623-7. [PMID: 17239613 DOI: 10.1016/j.ejcts.2006.12.030] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2006] [Revised: 12/08/2006] [Accepted: 12/13/2006] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To evaluate mid-term results of supraaortic transpositions for extended endovascular repair of aortic arch pathologies. METHODS From October 2002 to July 2006, 27 patients (mean age 72 years) with aortic arch diseases were treated (arch aneurysms n=18, type B dissections n=5, perforating ulcers n=4). Strategy for distal arch disease was autologous sequential transposition of the left carotid artery and of the left subclavian artery in 17 patients. Strategy for entire arch disease was total supraaortic rerouting using a reversed bifurcated prosthesis in 10 patients. Endovascular stent-graft placement was performed metachronously thereafter. RESULTS Two in-hospital deaths occurred (myocardial infarction on the day prior to discharge n=1, rupture while waiting for stent-graft placement n=1). At completion angiography, all reconstructions were fully patent. Four patients had small type Ia endoleaks, two of them resolving spontaneously. Mean follow-up is 15 months (1-43 months). Three late deaths occurred (myocardial infarction n=2, sudden unknown death n=1). One-year survival was 83% and 3-year survival was 72%, respectively. Redo stent-graft placement was performed in one patient after 25 months (type III endoleak). The remaining patients had normal CT scans with regular perfusion of the supraaortic branches without any signs of endoleaks. CONCLUSIONS Mid-term results of alternative treatment approaches in elderly patients with aortic arch pathologies are satisfying. Extended applications provide safe and effective treatment in patients at high risk for conventional repair.
Collapse
Affiliation(s)
- Martin Czerny
- Department of Cardiothoracic Surgery, University of Vienna Medical School, Vienna, Austria.
| | | | | | | | | | | | | | | |
Collapse
|
50
|
Szeto WY, Bavaria JE, Bowen FW, Woo EY, Fairman RM, Pochettino A. The Hybrid Total Arch Repair: Brachiocephalic Bypass and Concomitant Endovascular Aortic Arch Stent Graft Placement. J Card Surg 2007; 22:97-102; discussion 103-4. [PMID: 17338740 DOI: 10.1111/j.1540-8191.2007.00376.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Repair of aortic arch aneurysm is technically demanding, requiring complex circulatory management. Very large atherosclerotic saccular aneurysms of the arch are grave markers of extensive arch and brachiocephalic atheromatous disease and represent high surgical risks for perioperative neurologic complications. Operative morbidity and mortality may be prohibitive with traditional surgical intervention. We described our experience with a hybrid procedure for total arch repair with a brachiocephalic bypass with a trifurcated graft followed by concomitant placement of a stent graft in the arch. METHODS Since June 2005, we have performed the hybrid total arch repair in eight patients. A retrospective review was performed to evaluate the new technique. RESULTS The mean age of the patients was 67 years with a mean aneurysm size of 8 cm (range, 4.4 to 10 cm). Significant comorbidities included carotid stenosis, chronic renal insufficiency, peripheral vascular disease, hypertension, and coronary artery disease. Two patients had previous Abdominal aortic aneurysm (AAA) repairs. Three patients had previous sternotomy for type A dissection, ascending aortic aneurysm repair, and coronary artery bypass grafting. Transesophageal echocardiogram demonstrated grade IV or V atheromatous disease in the arch and ascending aorta. Stent grafts were deployed antegrade directly into the ascending aorta in three patients and retrograde from the femoral artery in five patients. Technical success with complete aneurysmal exclusion was achieved in all patients (100%). At a mean follow-up period of 11.7 months, there was no incidence of endoleak. There was one death resulting from a perioperative myocardial infarction (first patient). Documented perioperative neurologic events (stroke) occurred in two patients, with both patients demonstrating no residual deficit at the time of discharge. CONCLUSIONS Saccular arch aneurysms can be technically treated by total arch repair with brachiocephalic bypass and concomitant aortic arch stent graft placement. Hybrid arch repair provides an alternative to patients otherwise considered prohibitively high risk for traditional open arch repair.
Collapse
Affiliation(s)
- Wilson Y Szeto
- Division of Cardiac Surgery, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania 19104, USA.
| | | | | | | | | | | |
Collapse
|