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Ali-Hasan-Al-Saegh S, Halloum N, Scali S, Kriege M, Abualia M, Stamenovic D, Bashar Izzat M, Bohan P, Kloeckner R, Oezkur M, Dorweiler B, Treede H, El Beyrouti H. A systematic review and meta-analysis of retrograde type A aortic dissection after thoracic endovascular aortic repair in patients with type B aortic dissection. Medicine (Baltimore) 2023; 102:e32944. [PMID: 37058052 PMCID: PMC10101253 DOI: 10.1097/md.0000000000032944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 01/23/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Retrograde type A dissection (RTAD) is a devastating complication of thoracic endovascular repair (TEVAR) with low incidence but high mortality. The objective of this study is to report the incidence, mortality, potential risk factors, clinical manifestation and diagnostic modalities, and medical and surgical treatments. METHODS A systematic review and single-arm and two-arm meta-analyses evaluated all published reports of RTAD post-TEVAR through January 2021. All study types were included, except study protocols and animal studies, without time restrictions. Outcomes of interest were procedural data (implanted stent-grafts type, and proximal stent-graft oversizing), the incidence of RTAD, associated mortality rate, clinical manifestations, diagnostic workouts and therapeutic management. RESULTS RTAD occurred in 285 out of 10,600 patients: an estimated RTAD incidence of 2.3% (95% CI: 1.9-2.8); incidence of early RTAD was approximately 1.8 times higher than late. Wilcoxon signed-rank testing showed that the proportion of RTAD patients with acute type B aortic dissection (TBAD) was significantly higher than those with chronic TBAD (P = .008). Pooled meta-analysis showed that the incidence of RTAD with proximal bare stent TEVAR was 2.1-fold higher than with non-bare stents: risk ratio was 1.55 (95% CI: 0.87-2.75; P = .13). Single arm meta-analysis estimated a mortality rate of 42.2% (95% CI: 32.5-51.8), with an I2 heterogeneity of 70.11% (P < .001). CONCLUSION RTAD is rare after TEVAR but with high mortality, especially in the first month post-TEVAR with acute TBAD patients at greater risk as well as those treated with proximal bare stent endografts.
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Affiliation(s)
- Sadeq Ali-Hasan-Al-Saegh
- Department of Cardiac and Vascular Surgery, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Nancy Halloum
- Department of Cardiac and Vascular Surgery, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Salvatore Scali
- Division Vascular Surgery, University of Florida College of Medicine, Gainesville, FL
| | - Marc Kriege
- Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Mohannad Abualia
- Department of Cardiac and Vascular Surgery, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Davor Stamenovic
- Division of Thoracic Surgery, Academic Thoracic Center Mainz, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | | | | | - Roman Kloeckner
- Department of Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Mehmet Oezkur
- Department of Cardiac and Vascular Surgery, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Bernhard Dorweiler
- Department of Vascular Surgery, Faculty of Medicine, University of Cologne, Koln, Germany
| | - Hendrik Treede
- Department of Cardiac and Vascular Surgery, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Hazem El Beyrouti
- Department of Cardiac and Vascular Surgery, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
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Karaolanis GI, Antonopoulos CN, Charbonneau P, Georgakarakos E, Moris D, Scali S, Kotelis D, Donas K. A systematic review and meta-analysis of stroke rates in patients undergoing Thoracic Endovascular Aortic Repair for descending thoracic aortic aneurysm and type B dissection. J Vasc Surg 2022; 76:292-301.e3. [DOI: 10.1016/j.jvs.2022.02.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 02/15/2022] [Indexed: 01/28/2023]
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Chen Y, Zhang S, Liu L, Lu Q, Zhang T, Jing Z. Retrograde Type A Aortic Dissection After Thoracic Endovascular Aortic Repair: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2017; 6:JAHA.116.004649. [PMID: 28939705 PMCID: PMC5634245 DOI: 10.1161/jaha.116.004649] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Retrograde type A aortic dissection (RTAD) is a potentially lethal complication after thoracic endovascular aortic repair (TEVAR). However, data are limited regarding the development of RTAD post‐TEVAR. This systematic review aims to define the incidence, mortality, and potential risk factors of RTAD post‐TEVAR. Methods and Results Multiple electronic searches were performed. Fifty publications with a total of 8969 patients were analyzed. Pooled estimates for incidence and mortality of RTAD were 2.5% (95% confidence interval [CI], 2.0–3.1) and 37.1% (95% CI, 23.7–51.6), respectively. Metaregression analysis evidenced that RTAD rate was associated with hypertension (P=0.043), history of vascular surgery (P=0.042), and American Surgical Association (P=0.044). The relative risk of RTAD was 1.81 (95% CI, 1.04–3.14) for acute dissection (relative to chronic dissection) and 5.33 (95% CI, 2.70–10.51) for aortic dissection (relative to a degenerative aneurysm). Incidence of RTAD was significantly different in patients with proximal bare stent and nonbare stent endografts (relative risk [RR]=2.06; 95% CI, 1.22–3.50). RTAD occurrence rate in zone 0 was higher than other landing zones. Conclusions The pooled RTAD rate after TEVAR was calculated at 2.5% with a high mortality rate (37.1%). Incidence of RTAD is significantly more frequent in patients treated for dissection than those with an aneurysm (especially for acute dissection), and when the proximal bare stent was used. Rate of RTAD after TEVAR varied significantly according to the proximal Ishimaru landing zone. The more‐experienced centers tend to have lower RTAD incidences.
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Affiliation(s)
- Yanqing Chen
- Division of Vascular Surgery, Changhai Hospital, Shanghai, China.,Military Institute of Vascular Disease, The First Affiliated Hospital of the Second Military Medical University, Shanghai, China
| | - Simeng Zhang
- Division of Vascular Surgery, Changhai Hospital, Shanghai, China.,Military Institute of Vascular Disease, The First Affiliated Hospital of the Second Military Medical University, Shanghai, China
| | - Lei Liu
- Division of Vascular Surgery, Changhai Hospital, Shanghai, China.,Military Institute of Vascular Disease, The First Affiliated Hospital of the Second Military Medical University, Shanghai, China
| | - Qingsheng Lu
- Division of Vascular Surgery, Changhai Hospital, Shanghai, China .,Military Institute of Vascular Disease, The First Affiliated Hospital of the Second Military Medical University, Shanghai, China
| | - Tianyi Zhang
- Department of statistics, The Second Military Medical University, Shanghai, China
| | - Zaiping Jing
- Division of Vascular Surgery, Changhai Hospital, Shanghai, China .,Military Institute of Vascular Disease, The First Affiliated Hospital of the Second Military Medical University, Shanghai, China
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Gambardella I, Antoniou GA, Torella F, Spadaccio C, Oo AY, Gaudino M, Nappi F, Shaw MA, Girardi LN. Secondary Open Aortic Procedure Following Thoracic Endovascular Aortic Repair: Meta-Analytic State of the Art. J Am Heart Assoc 2017; 6:e006618. [PMID: 28903940 PMCID: PMC5634303 DOI: 10.1161/jaha.117.006618] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 07/28/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND Thoracic endovascular aortic repair is characterized by a substantial need for reintervention. Secondary open aortic procedure becomes necessary when further endoluminal options are exhausted. This synopsis and quantitative analysis of available evidence aims to overcome the limitations of institutional cohort reports on secondary open aortic procedure. METHODS AND RESULTS Electronic databases were searched from 1994 to the present date with a prospectively registered protocol. Pooled quantification of pre/intraoperative variables, and proportional meta-analysis with random effect model of early and midterm outcomes were performed. Subgroup analysis was conducted for patients who had early mortality. Fifteen studies were elected for final analysis, encompassing 330 patients. The following values are expressed as "pooled mean, 95% confidence interval." Type B dissection was the most common pathology at index thoracic endovascular aortic repair (51.2%, 44.4-57.9). The most frequent indication for secondary open aortic procedure was endoleak (39.7%, 34.6-45.1). More than half of patients had surgery on the descending aorta (51.2%, 45.8-56.6), and one fourth on the arch (25.2%, 20.8-30.1). Operative mortality was 10.6% (7.4-14.9). Neurological morbidity was substantial between stroke (5.1%, 2.8-9.1) and paraplegia (8.3%, 5.2-13.1). At 2-year follow-up, mortality (20.4%, 11.5-33.5) and aortic adverse event (aortic death 7.7%, 4.3-13.3, tertiary aortic open procedure 7.4%, 4.0-13.2) were not negligible. CONCLUSIONS In the secondary open aortic procedure population, type B dissection was both the most common pathology and the one associated with the lowest early mortality, whereas aortic infection and extra-anatomical bypass were associated with the most ominous prognosis.
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Affiliation(s)
- Ivancarmine Gambardella
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - George A Antoniou
- Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Manchester, United Kingdom
| | - Francesco Torella
- Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - Cristiano Spadaccio
- Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Aung Y Oo
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Francesco Nappi
- Cardiac Surgery Center, Cardiologique du Nord de Saint-Denis, Paris, France
| | - Matthew A Shaw
- Information Department, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Leonard N Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
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Pantaleo A, Jafrancesco G, Buia F, Leone A, Lovato L, Russo V, Di Marco L, Di Bartolomeo R, Pacini D. Distal Stent Graft-Induced New Entry: An Emerging Complication of Endovascular Treatment in Aortic Dissection. Ann Thorac Surg 2016; 102:527-32. [DOI: 10.1016/j.athoracsur.2016.02.001] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 01/01/2016] [Accepted: 02/01/2016] [Indexed: 11/16/2022]
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Nauta FJH, Conti M, Kamman AV, van Bogerijen GHW, Tolenaar JL, Auricchio F, Figueroa CA, van Herwaarden JA, Moll FL, Trimarchi S. Biomechanical Changes After Thoracic Endovascular Aortic Repair in Type B Dissection. J Endovasc Ther 2015; 22:918-33. [DOI: 10.1177/1526602815608848] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Thoracic endovascular aortic repair (TEVAR) has evolved into an established treatment option for type B aortic dissection (TBAD) since it was first introduced 2 decades ago. Morbidity and mortality have decreased due to the minimally invasive character of TEVAR, with adequate stabilization of the dissection, restoration of true lumen perfusion, and subsequent positive aortic remodeling. However, several studies have reported severe setbacks of this technique. Indeed, little is known about the biomechanical behavior of implanted thoracic stent-grafts and the impact on the vascular system. This study sought to systematically review the performance and behavior of implanted thoracic stent-grafts and related biomechanical aortic changes in TBAD patients in order to update current knowledge and future perspectives.
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Affiliation(s)
- Foeke J. H. Nauta
- Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Italy
- Departments of Surgery and Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
- Department of Vascular Surgery, University Medical Center Utrecht, the Netherlands
| | - Michele Conti
- Department of Civil Engineering and Architecture, University of Pavia, Italy
| | - Arnoud V. Kamman
- Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Italy
- Departments of Surgery and Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
- Department of Vascular Surgery, University Medical Center Utrecht, the Netherlands
| | | | - Jip L. Tolenaar
- Department of General Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
| | | | - C. Alberto Figueroa
- Departments of Surgery and Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | | | - Frans L. Moll
- Department of Vascular Surgery, University Medical Center Utrecht, the Netherlands
| | - Santi Trimarchi
- Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Italy
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Comparison of attachment site endoleak rates in Dacron versus native aorta landing zones after thoracic endovascular aortic repair. J Vasc Surg 2014; 59:921-9. [DOI: 10.1016/j.jvs.2013.10.086] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 10/17/2013] [Accepted: 10/17/2013] [Indexed: 11/20/2022]
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Zipfel B, Hetzer R. „Aortenbogen-Debranching“ mit Implantation von Stent-Prothesen. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2013. [DOI: 10.1007/s00398-013-1021-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Zipfel B, Buz S, Redlin M, Hullmeine D, Hammerschmidt R, Hetzer R. Spinal Cord Ischemia After Thoracic Stent-Grafting: Causes Apart From Intercostal Artery Coverage. Ann Thorac Surg 2013; 96:31-8. [DOI: 10.1016/j.athoracsur.2013.03.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 03/01/2013] [Accepted: 03/04/2013] [Indexed: 11/15/2022]
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Restrictive bare stent for prevention of stent graft-induced distal redissection after thoracic endovascular aortic repair for type B aortic dissection. J Vasc Surg 2013; 57:44S-52S. [PMID: 23336855 DOI: 10.1016/j.jvs.2012.06.117] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 06/20/2012] [Accepted: 06/29/2012] [Indexed: 11/21/2022]
Abstract
BACKGROUND Stent graft-induced distal redissection (SIDR) is one of the major concerns in the durability of endovascular repair for complicated Stanford type B aortic dissection. The characteristics and means of prevention of this complication remain unknown. METHODS From April 1997 to March 2010, 674 patients with type B aortic dissections were treated primarily by thoracic endovascular aortic repair (TEVAR) at our center. Criteria for inclusion in this study were treatment primarily with TEVAR and an estimated mismatch rate (ratio of distal diameter of stent graft to long diameter of true lumen) greater than 120%. By this protocol, 465 patients were included in this study and were retrospectively analyzed. Among them, 266 patients were treated in the acute phase, and 199 were treated in the chronic phase. RESULTS A total of 311 patients were treated with standard TEVAR and 154 patients with TEVAR + restrictive bare stent (RBS). The preoperative mismatch rate (measured as the preoperative long diameter of the true lumen at the level of the intended distal end of the stent graft) of the SIDR was significantly higher than that of the non-SIDR (192.7 ± 54.9% vs 131.9 ± 10.4%; P < .05). The follow-up mismatch rate of the SIDR was significantly higher than that of the non-SIDR (145.4 ± 34.6 vs 120.3 ± 16.1; P < .05). Compared with the standard TEVAR, TEVAR + RBS was associated with a lower incidence of SIDR (0% vs 2.9%; P = .033) and less secondary intervention (3.9% vs 9.3%; P = .040). Placement of the RBS significantly expanded the true lumen at the level of the descending aorta with the narrowest true lumen and at the level of the distal end of the stent graft. CONCLUSIONS The mismatch between the distal diameter of the stent graft and the diameter of the compressed true lumen seems to be the major factor in the occurrence of SIDR. Placement of an RBS, as an adjunctive technique to TEVAR, could reduce the incidence of SIDR. On the basis of early- to midterm observations, RBSs may improve morphological remodeling of the dissected aorta at certain levels.
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Systematic review of clinical outcomes in hybrid procedures for aortic arch dissections and other arch diseases. J Thorac Cardiovasc Surg 2012; 144:1286-300, 1300.e1-2. [DOI: 10.1016/j.jtcvs.2012.06.013] [Citation(s) in RCA: 141] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 05/20/2012] [Accepted: 06/08/2012] [Indexed: 11/21/2022]
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Vendramin I, Piccoli G, Gasparini D, Livi U. Surgical techniques and early experience of endovascular treatment of complex thoracic aortic disease via minithoracotomy. J Vasc Surg 2012; 57:268-71. [PMID: 23127985 DOI: 10.1016/j.jvs.2012.07.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 06/04/2012] [Accepted: 07/29/2012] [Indexed: 10/27/2022]
Affiliation(s)
- Igor Vendramin
- Cardiothoracic Department, University Hospital, S. Maria della Misericordia, Udine, Italy.
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Murad H, Murad FF. [The endovascular surgery and hybrid rooms?]. Rev Col Bras Cir 2012; 39:1-2. [PMID: 22481697 DOI: 10.1590/s0100-69912012000100001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Surgical conversion after thoracic endovascular aortic repair. J Thorac Cardiovasc Surg 2011; 142:1027-31. [DOI: 10.1016/j.jtcvs.2011.01.060] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2010] [Revised: 01/06/2011] [Accepted: 01/25/2011] [Indexed: 12/23/2022]
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Thoracic endovascular aortic repair with homemade stent grafts: early and mid-term outcomes. Surg Today 2011; 41:1054-61. [PMID: 21773893 DOI: 10.1007/s00595-010-4489-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Accepted: 05/25/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE We reviewed our experience with homemade stent grafts in the repair of a variety of thoracic aortic lesions. The objective of this study was to assess the early and mid-term outcomes of this therapy. METHODS From 1999 to 2007, homemade stent grafts were inserted in 88 patients with an atherosclerotic aneurysm, dissection, pseudoaneurysm, trauma, or rupture in the thoracic aorta. The endoprostheses were stainless steel Z-stents covered by a polyester graft, and were custom-designed for each patient. RESULTS Placement of stent grafts was technically successful in 81 of the 88 patients (92%). Within 30 days after treatment, 3 patients died, 3 had a cerebral infarction, and 3 had onset of paraplegia or paraparesis. Primary endoleaks were observed in 8 patients (9%). During the mean follow-up period of 32 ± 26 months, 7 patients had persistent endoleaks and 7 had stent-graft migration. The aneurysm-related mortality rate was 7%. The rate of freedom from open-surgery conversion at 32 months was 89.0%. CONCLUSIONS Our early experience with elective and emergency thoracic endovascular aortic repair using homemade stent grafts provided therapeutic benefits to high-risk patients. Endoleaks and stent-graft migrations were the factors most commonly responsible for secondary intervention in the mid-term period. Careful follow-up of patients treated with this approach is needed to avoid major complications in the long term.
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Management of the Left Subclavian Artery during Endovascular Stent Grafting for Traumatic Aortic Injury – A Systematic Review. Eur J Vasc Endovasc Surg 2011; 41:758-69. [DOI: 10.1016/j.ejvs.2011.01.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Accepted: 01/04/2011] [Indexed: 11/19/2022]
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Chocron S, Vaislic C, Kaili D, Bonneville JF. Multilayer stents in the treatment of thoraco-abdominal residual type B dissection. Interact Cardiovasc Thorac Surg 2011; 12:1057-9. [DOI: 10.1510/icvts.2010.257394] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Zipfel B, Czerny M, Funovics M, Coppi G, Ferro C, Rousseau H, Berti S, Tealdi DG, Riambau V, Mangialardi N, Sassi C. Endovascular Treatment of Patients With Types A and B Thoracic Aortic Dissection Using Relay Thoracic Stent-Grafts: Results From the RESTORE Patient Registry. J Endovasc Ther 2011; 18:131-43. [DOI: 10.1583/10-3233mr.1] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Muhammad K, Helton T, Theodos G, Kapadia S, Tuzcu EM. Hybrid cardiovascular therapy: interventional (and surgical) procedures in high-risk patients. Interv Cardiol 2011. [DOI: 10.2217/ica.11.6] [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] Open
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Riambau V, Zipfel B, Coppi G, Czerny M, Tealdi DG, Ferro C, Chiesa R, Sassi C, Rousseau H, Berti S. Final operative and midterm results of the European experience in the RELAY Endovascular Registry for Thoracic Disease (RESTORE) study. J Vasc Surg 2011; 53:565-73. [DOI: 10.1016/j.jvs.2010.09.050] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 09/14/2010] [Accepted: 09/15/2010] [Indexed: 11/28/2022]
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Nishida Y, Ohtake H, Kiuchi R, Sanada J, Matsui O, Watanabe G. Emergent thoracic endovascular aortic repair for acute type-B aortic dissection with malperfusion by matsui-kitamura stent graft. Ann Vasc Dis 2011; 4:344-7. [PMID: 23555477 DOI: 10.3400/avd.cr.11.00048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Accepted: 09/12/2011] [Indexed: 11/13/2022] Open
Abstract
Acute type-B aortic dissection with malperfusion is a serious cardiovascular condition associated with high morbidity and mortality. Recent studies have investigated the efficacy of thoracic endovascular aortic repair (TEVAR) as treatment for acute aortic dissection. In this report, we present a case of acute type-B aortic dissection complicated with malperfusion, which was successfully treated with emergent TEVAR for entry closure by a Matsui-Kitamura stent graft (MKSG). MKSG is a flexible custom-made curved stent graft. The main advantages of MKSG for emergent TEVAR include flexibility, shape, and small profile when compressed.
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Affiliation(s)
- Yuji Nishida
- Departments of General and Cardiothoracic Surgery, Kanazawa University, Kanazawa, Ishikawa, Japan
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Zipfel B, Ewert P, Buz S, El Al AA, Hammerschmidt R, Hetzer R. Endovascular Stent-Graft Repair of Late Pseudoaneurysms After Surgery for Aortic Coarctation. Ann Thorac Surg 2011; 91:85-91. [DOI: 10.1016/j.athoracsur.2010.08.053] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Revised: 08/25/2010] [Accepted: 08/30/2010] [Indexed: 10/18/2022]
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Murad MH, Rizvi AZ, Malgor R, Carey J, Alkatib AA, Erwin PJ, Lee WA, Fairman RM. Comparative effectiveness of the treatments for thoracic aortic transaction. J Vasc Surg 2011; 53:193-199.e1-21. [DOI: 10.1016/j.jvs.2010.08.028] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2010] [Revised: 08/10/2010] [Accepted: 08/10/2010] [Indexed: 11/15/2022]
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Ohtake H, Kimura K, Sanada J, Matsui O, Watanabe G. Risk factor analysis of thoracic endovascular repair using the Matsui-Kitamura stent graft for acute aortic emergencies in the descending thoracic aorta. J Vasc Surg 2010; 52:1464-70. [DOI: 10.1016/j.jvs.2010.07.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2009] [Revised: 07/09/2010] [Accepted: 07/09/2010] [Indexed: 11/26/2022]
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Koullias GJ, Wheatley GH. State-of-the-Art of Hybrid Procedures for the Aortic Arch: A Meta-Analysis. Ann Thorac Surg 2010; 90:689-97. [DOI: 10.1016/j.athoracsur.2009.12.016] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2009] [Revised: 12/06/2009] [Accepted: 12/09/2009] [Indexed: 10/19/2022]
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Kirkwood ML, Pochettino A, Fairman RM, Jackson BM, Woo EY, Wang GJ. Thoracic Aortic Endograft Explant: A Single-Center Experience. Vasc Endovascular Surg 2010; 44:440-5. [DOI: 10.1177/1538574410371525] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: We report our experience following thoracic aortic endovascular repair (TEVAR) explant. Methods: A total of 500 TEVARs were performed from 1999 to 2009, with 4 requiring explant. Chart review was performed to identify the indications of explant, operative technique, and perioperative morbidity and mortality. Results: Indications of graft removal included device maldeployment, type I endoleak, aortoenteric fistula, and retrograde type A dissection necessitating aortic root replacement. Reconstruction was achieved with aortic homograft, Dacron, or explant of the proximal component with incorporation of the distal stent into the suture line. Mean follow-up was 13 months (0-50 months). Paraplegia and perioperative death occurred in 1 patient who underwent intraoperative conversion to open repair. There were no other major complications, and graft removal was achieved in all patients. Conclusions: Although rare, familiarity with TEVAR explant is imperative as it is increasingly performed for broader indications. Our limited data suggest that explant can be performed successfully albeit with morbidity.
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Affiliation(s)
- Melissa L. Kirkwood
- Department of Vascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA,
| | - Alberto Pochettino
- Department of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Ronald M. Fairman
- Department of Vascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Benjamin M. Jackson
- Department of Vascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Edward Y. Woo
- Department of Vascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Grace J. Wang
- Department of Vascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Coartación aórtica en el adulto. CIRUGIA CARDIOVASCULAR 2009. [DOI: 10.1016/s1134-0096(09)70134-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Cirugía híbrida de la enfermedad del cayado aórtico: un abordaje sistemático. CIRUGIA CARDIOVASCULAR 2009. [DOI: 10.1016/s1134-0096(09)70133-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Occlusion of the left subclavian artery with stent grafts is safer with protective reconstruction. Ann Thorac Surg 2009; 88:498-504. [PMID: 19632400 DOI: 10.1016/j.athoracsur.2009.04.042] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Revised: 04/09/2009] [Accepted: 04/13/2009] [Indexed: 12/20/2022]
Abstract
BACKGROUND Safe fixation of endovascular stent grafts in thoracic aortic disease often requires covering of the left subclavian artery (LSA) with the stent graft. It is controversial whether this occlusion can be done without additional risk of ischemic complications. METHODS In 102 patients treated with endovascular stent grafts, the LSA was covered. In a nonrandomized clinical practice, unprotected occlusion of the LSA was performed in 63 patients (61%), whereas 39 patients underwent extrathoracic subclavian to carotid artery revascularization before (n = 28) or concomitantly with (n = 11) the endovascular procedure. RESULTS Left cerebral ischemia occurred in 11% of the unprotected group and in 5% of the protected group. The difference was not statistically significant. The difference in spinal cord ischemia was insignificant owing to the low incidence in general, but the covered length of the aorta was significantly longer in the protected group. Arm ischemia after unprotected LSA occlusion occurred in 25%. CONCLUSIONS The interpretation of the results remains speculative because many factors contribute to left cerebral ischemia. However, in terms of overall complications, there is a significant difference in favor of the group protected by revascularization of the LSA either before or simultaneously with stent grafting. Arm ischemia is mostly mild and can be managed secondarily. Subclavian revascularization is associated with relatively low risk and should be considered in advance, at least when extended covering of the thoracic aorta is intended.
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Karmy-Jones R, Kouchoukos NT. Endovascular credentialing and assembling the endovascular team. J Card Surg 2009; 24:334-42. [PMID: 19438793 DOI: 10.1111/j.1540-8191.2009.00839.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Riyad Karmy-Jones
- Department of Thoracic and Vascular Surgery, Southwest Washington Medical Center, Vancouver, Washington, USA
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Zipfel B, Buz S, Laube H, Hetzer R. Type A Dissection After Implantation of a Stent-Graft Triggered by an Intramural Hematoma. J Endovasc Ther 2009; 16:243-50. [DOI: 10.1583/08-2540.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
In 2005, the findings of the multicenter Gore Tag study led to United States Food and Drug Administration approval for endovascular repair of thoracic aortic aneurysms (TEVAR). TEVAR provides a therapeutic option for patients who have thoracic aortic aneurysm and for the treatment of type B aortic dissection with malperfusion. Spinal cord ischemia and stroke are recognized neurologic complications of TEVAR. Identification of high-risk patients combined with targeted anesthetic and perioperative management may decrease the risk of neurologic complications after TEVAR.
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Surgical correction of failed thoracic endovascular aortic repair. J Vasc Surg 2008; 47:1195-202. [DOI: 10.1016/j.jvs.2008.01.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2007] [Revised: 12/12/2007] [Accepted: 01/02/2008] [Indexed: 11/21/2022]
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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.
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Right minithoracotomy as an alternative approach for endovascular repair of thoracic aortic aneurysm. J Thorac Cardiovasc Surg 2007; 134:1589-91. [DOI: 10.1016/j.jtcvs.2007.06.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2007] [Accepted: 06/22/2007] [Indexed: 11/22/2022]
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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.
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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.
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Bonatti J, Vassiliades T, Nifong W, Jakob H, Erbel R, Fosse E, Werkkala K, Sutlic Z, Bartel T, Friedrich G, Kiaii B. How to Build a Cath-Lab Operating Room. Heart Surg Forum 2007; 10:E344-8. [PMID: 17650462 DOI: 10.1532/hsf98.20070709] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Recent developments in cardiac surgery and interventional cardiology have led to the installation of integrated operating rooms that allow both surgical and endovascular procedures. These units offer surgical as well as angiographic equipment and personnel and therefore require special planning and design. A variety of integrated procedures can be performed. Hybrid coronary revascularization, percutaneous valve repair, and aortic stent-graft placement are current developments that are ideally performed in a cath-lab operating room. This review by an international working group of cardiac surgeons and cardiologists outlines the challenges involved with implementation of an integrated operating suite and suggests general planning and construction guidelines.
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Affiliation(s)
- Johannes Bonatti
- Department of Cardiac Surgery and Cardiology, Innsbruck Medical University, Innsbruck, Austria.
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