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Marumoto A, Yoneda K, Tanaka K, Kitabayashi K. Hybrid Repair with Reversed Sequence Supra-aortic Debranching in Ruptured Arch Aneurysm. Int J Angiol 2022; 31:56-60. [PMID: 35221854 DOI: 10.1055/s-0041-1736441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Aortic arch pathology in a high-risk patient in whom the resternotomy approach is unfeasible due to treated mediastinitis after ascending aortic replacement presents a unique challenge for hybrid arch repair (HAR) because of the need for supra-aortic debranching from unusual inflow sites other than the ascending aorta. This report describes a "reversed sequence" extra-anatomical supra-aortic debranching procedure as a salvage technique performed to enable HAR. An 83-year-old woman with a history of ascending aortic replacement for type A aortic dissection, mediastinitis complicated by sternal osteomyelitis, and a chest wall reconstructed with a rectus abdominis myocutaneous flap presented with chest pain because of a contained dissecting arch aneurysm rupture. The patient underwent supra-aortic debranching from the bilateral common femoral arteries and thoracic endovascular aortic repair to the ascending aorta under cerebral near-infrared spectroscopy (NIRS) monitoring. Completion imaging by angiography demonstrated successful exclusion of the ruptured aneurysm. The regional cerebral oxygen saturation level, monitored by NIRS, did not change markedly during surgery. The patient was neurologically intact with adequate cerebral blood flow assessed postoperatively by 123 I-IMP single photon emission computed tomography. Total debranching of the supra-aortic vessels from the common femoral artery for inflow is feasible and provides adequate cerebral perfusion. This procedure may offer an alternative treatment option in patients with complex conditions involving aortic arch pathology.
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Affiliation(s)
- Akira Marumoto
- Department of Cardiovascular Surgery, Japan Community Healthcare Organization Osaka Hospital, Fukushima, Fukushima-ku, Osaka, Japan
| | - Kazuhiro Yoneda
- Department of Cardiovascular Surgery, Japan Community Healthcare Organization Osaka Hospital, Fukushima, Fukushima-ku, Osaka, Japan
| | - Kenji Tanaka
- Department of Cardiovascular Surgery, Japan Community Healthcare Organization Osaka Hospital, Fukushima, Fukushima-ku, Osaka, Japan
| | - Katsukiyo Kitabayashi
- Department of Cardiovascular Surgery, Japan Community Healthcare Organization Osaka Hospital, Fukushima, Fukushima-ku, Osaka, Japan
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Madathipat U, Nair H, Pitchai S, Kumar V. Distalization of left subclavian artery for cerebral revascularization during hybrid repair of complex and contained rupture of aortic arch aneurysm. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2019. [DOI: 10.4103/ijves.ijves_5_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Inaba Y, Ito T, Hayashi S, Takahashi T, Misumi T, Hachiya T, Shimizu H. Thoracic Endovascular Aortic Repair Including Total Debranching on Femoral Artery for Arch Rupture. Ann Thorac Surg 2017; 104:e123-e125. [PMID: 28734431 DOI: 10.1016/j.athoracsur.2017.02.087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 02/22/2017] [Indexed: 11/27/2022]
Abstract
A 94-year-old woman with rupture of a thoracic aortic aneurysm (rTAA) was referred to us. She previously underwent thoracic endovascular aortic repair and was considered to be at high risk for a conventional open operation. Therefore an endovascular procedure was planned. The proximal landing zone needed to be placed at the ascending aorta to seal a type 1a endoleak. A hybrid operation consisting of supraaortic total debranching on the common femoral artery and endovascular repair was performed. All debranched bypasses were patent and the aneurysm was excluded. The patient regained sufficient ambulatory strength and showed no symptoms of syncope.
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Affiliation(s)
- Yu Inaba
- Department of Cardiovascular Surgery, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan.
| | - Tsutomu Ito
- Department of Cardiovascular Surgery, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan
| | - Sachiko Hayashi
- Department of Cardiovascular Surgery, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan
| | - Tatsuo Takahashi
- Department of Cardiovascular Surgery, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan
| | - Takahiko Misumi
- Department of Cardiovascular Surgery, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan
| | - Takashi Hachiya
- Department of Cardiovascular Surgery, Kawasaki Municipal Hospital, Kanagawa, Japan
| | - Hideyuki Shimizu
- Department of Cardiovascular Surgery, Keio University Hospital, Tokyo, Japan
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Munehiro S, Keiji Y, Naoya S, Shigeru H, Gaku U, Takuya K, Yasufumi F, Kunikazu H, Hideo Y. A novel technique of total debranching TEVAR with inflow from the descending aorta. Gen Thorac Cardiovasc Surg 2017; 66:108-110. [PMID: 28386812 DOI: 10.1007/s11748-017-0770-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 03/19/2017] [Indexed: 11/25/2022]
Abstract
An 82-year-old male with TAA was considered high risk for conventional surgery because of previous CABG. Therefore, a hybrid repair was performed. First, the arch vessels were debranched extra-anatomical bypass. Second, left thoracotomy was performed. The proximal side of a bifurcated graft was anastomosed to the descending aorta. To arch vessels' debranch graft, two bifurcated graft distal limbs were anastomosed with a 10-mm distance. Two stentgrafts were deployed from the ascending to descending aorta. Postoperative CT did not reveal any endoleak, and all debranch grafts were patent.
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Affiliation(s)
- Saiki Munehiro
- Department of Cardiovascular Surgery, Hiroshima City Hiroshima Citizens Hospital, 7-33, Motomachi, Naka-ku, Hiroshima, 730-8518, Japan.
| | - Yunoki Keiji
- Department of Cardiovascular Surgery, Hiroshima City Hiroshima Citizens Hospital, 7-33, Motomachi, Naka-ku, Hiroshima, 730-8518, Japan
| | - Sakoda Naoya
- Department of Cardiovascular Surgery, Hiroshima City Hiroshima Citizens Hospital, 7-33, Motomachi, Naka-ku, Hiroshima, 730-8518, Japan
| | - Hattori Shigeru
- Department of Cardiovascular Surgery, Hiroshima City Hiroshima Citizens Hospital, 7-33, Motomachi, Naka-ku, Hiroshima, 730-8518, Japan
| | - Uchino Gaku
- Department of Cardiovascular Surgery, Hiroshima City Hiroshima Citizens Hospital, 7-33, Motomachi, Naka-ku, Hiroshima, 730-8518, Japan
| | - Kawabata Takuya
- Department of Cardiovascular Surgery, Hiroshima City Hiroshima Citizens Hospital, 7-33, Motomachi, Naka-ku, Hiroshima, 730-8518, Japan
| | - Fujita Yasufumi
- Department of Cardiovascular Surgery, Hiroshima City Hiroshima Citizens Hospital, 7-33, Motomachi, Naka-ku, Hiroshima, 730-8518, Japan
| | - Hisamochi Kunikazu
- Department of Cardiovascular Surgery, Hiroshima City Hiroshima Citizens Hospital, 7-33, Motomachi, Naka-ku, Hiroshima, 730-8518, Japan
| | - Yoshida Hideo
- Department of Cardiovascular Surgery, Hiroshima City Hiroshima Citizens Hospital, 7-33, Motomachi, Naka-ku, Hiroshima, 730-8518, Japan
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Tsai CL, Yang CC, Fujikawa T, Hsieh SR. Hybrid Repair of Ruptured Arch Aneurysm Without Sternotomy Through an Unusual Extraanatomic Bypass. Ann Thorac Surg 2017; 103:e209-e211. [PMID: 28109395 DOI: 10.1016/j.athoracsur.2016.08.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 08/11/2016] [Accepted: 08/13/2016] [Indexed: 11/19/2022]
Abstract
A 42-year-old man experienced a complex aortic arch aneurysm rupture. He had previously undergone an operation for type A dissection and had extremely poor cardiac performance as well as deep sternal infection after the first procedure. The conventional open repair was considered to be a high risk for this patient. We therefore performed an alternative hybrid aortic procedure. The supraarch vessels were perfused through an extraanatomic bypass from an unusual and remote route, namely, the abdominal aorta. Then, stent grafts were implanted in the previously replaced aortic prostheses to exclude the aortic aneurysm. The patient recovered uneventfully with no neurologic adverse events.
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Affiliation(s)
- Chung-Lin Tsai
- Section of Cardiovascular Surgery, Taichung Veterans General Hospital, Taichung, Taiwan.
| | - Chih-Chun Yang
- Section of Cardiovascular Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Takuya Fujikawa
- Section of Cardiovascular Surgery, Kawasaki Aortic Center, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Shih-Rong Hsieh
- Section of Cardiovascular Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
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Zanow J, Breuer M, Lopatta E, Schelenz C, Settmacher U. Hybrid Procedure with Debranching from the Descending Aorta for Aortic Arch Aneurysm after Previous Open Repair. Ann Vasc Surg 2016; 38:319.e7-319.e10. [PMID: 27554687 DOI: 10.1016/j.avsg.2016.05.131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 05/24/2016] [Accepted: 05/26/2016] [Indexed: 10/21/2022]
Abstract
Aortic arch aneurysms can be treated with hybrid procedures by endovascular exclusion and prior debranching of supra-aortic arteries. We report on a case of symptomatic arch aneurysm following previous supracoronary ascending aorta and hemiarch replacement with a very short proximal landing zone. A successful reconstruction was performed by retrograde revascularization of supra-aortic vessels from the descending aorta and subsequent endovascular repair deploying a proximal stent graft directly above the sinotubular junction with good results in the 4-year follow-up. Retrograde supra-aortic debranching may constitute a suitable approach for hybrid endovascular repair of aneurysms of the aortic arch and the ascending aorta in selected cases.
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Affiliation(s)
- Juergen Zanow
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Jena, Germany.
| | - Martin Breuer
- Department of Heart and Thoracic Surgery, Jena University Hospital, Jena, Germany
| | - Eric Lopatta
- Institute of Diagnostic and Interventional Radiology, Jena University Hospital, Jena, Germany
| | | | - Utz Settmacher
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Jena, Germany
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A Simplified Arch Debranching Technique for Hybrid Repair of Complicated Type B Aortic Dissection. Ann Thorac Surg 2016; 102:e69-72. [PMID: 27343539 DOI: 10.1016/j.athoracsur.2016.02.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 02/07/2016] [Accepted: 02/10/2016] [Indexed: 02/05/2023]
Abstract
Convenient procedures and fewer postoperative adverse events of an arch debranching technique are important factors that need to be considered for assured outcomes of hybrid repair. In this report we describe our hybrid repair with a simplified arch debranching technique. It was used for patients with complicated type B aortic dissection who had undergone previous operations for type A aortic dissection. With this technique, the treatment for complicated type B aortic dissection becomes easier and less invasive, which is especially advantageous for patients with high surgical risk for conventional open repair.
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Iida Y, Ito T, Misumi T, Shimizu H. Total debranching thoracic endovascular aortic arch repair with inflow from the descending thoracic aorta. J Vasc Surg 2016; 63:527-8. [PMID: 26804219 DOI: 10.1016/j.jvs.2014.10.095] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 10/23/2014] [Indexed: 11/25/2022]
Affiliation(s)
- Yasunori Iida
- Department of Cardiovascular Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Kanagawa, Japan.
| | - Tsutomu Ito
- Department of Cardiovascular Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Kanagawa, Japan
| | - Takahiko Misumi
- Department of Cardiovascular Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Kanagawa, Japan
| | - Hideyuki Shimizu
- Department of Cardiovascular Surgery, Keio University, Shinjuku-ku, Tokyo, Japan
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Gomibuchi T, Kono T, Takahashi K, Wada Y, Fukui D, Amano J. Hybrid thoracic endovascular aortic repair of ascending aortic pseudoaneurysm. J Vasc Surg 2014; 59:1695-7. [PMID: 24836766 DOI: 10.1016/j.jvs.2013.05.090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 05/13/2013] [Accepted: 05/13/2013] [Indexed: 11/17/2022]
Abstract
We report the successful thoracic endovascular aortic repair of an ascending aortic pseudoaneurysm. Because the risk of resternotomy after conventional surgery was very high, endovascular repair with extra-anatomic reconstruction of the supra-aortic vessels was performed using the femoral artery as the donor artery. Complete exclusion of the pseudoaneurysm was achieved, with no postoperative complications or neurologic sequelae.
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Affiliation(s)
| | - Tetsuya Kono
- Department of Cardiovascular Surgery, Suwa Red Cross Hospital, Suwa, Japan.
| | - Kouhei Takahashi
- Department of Cardiovascular Surgery, Suwa Red Cross Hospital, Suwa, Japan
| | - Yuko Wada
- Department of Cardiovascular Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Daisuke Fukui
- Department of Cardiovascular Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Jun Amano
- Department of Cardiovascular Surgery, Shinshu University School of Medicine, Matsumoto, Japan
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Shimizu H, Nakahara T, Ohkuma K, Kawaguchi S, Yoshitake A, Yozu R. Cerebral blood flow after hybrid distal hemiarch repair. Interact Cardiovasc Thorac Surg 2013; 17:73-8. [PMID: 23513003 DOI: 10.1093/icvts/ivt100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Aortic arch disease can be treated with hybrid repair (extra-anatomic bypass plus placement of aortic endoprostheses), but there is controversy about whether a bypass from one relatively small vessel will provide adequate blood flow to the entire brachiocephalic system. We, therefore, compared flow volumes before and after hybrid repair. METHODS We reviewed the records of 16 patients who underwent a hybrid distal hemiarch repair between October 2010 and May 2012. The procedure consisted of debranching of the left subclavian and left common carotid arteries, creation of a bypass to these vessels from the right subclavian artery by using a T-shaped synthetic graft, and placement of a stent graft. Preoperative and postoperative measurements of blood flow volume in the carotid and vertebral arteries and of regional cerebral blood flow were performed in ~70% of the patients. RESULTS Perioperative complications were one new-onset, fatal acute aortic dissection and two minor strokes. No major endoleaks occurred. Postoperatively, mean flow volumes in the right and left common carotid arteries, right and left internal carotid arteries, and right and left vertebral arteries were 423 and 393, 271 and 189, and 87 and 80 ml/min, respectively. Regional cerebral blood flow in the territories of the anterior, middle and posterior cerebral arteries was not significantly different from preoperative levels, as assessed both with and without administration of acetazolamide. CONCLUSIONS Hybrid distal hemiarch repair preserved regional cerebral blood flow and vasoreactivity, although flow in the common and internal carotid arteries was right-side dominant postoperatively.
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Affiliation(s)
- Hideyuki Shimizu
- Department of Cardiovascular Surgery, Keio University, Shinjuku-ku, Tokyo, Japan.
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Shimizu H, Yoshitake A, Kawaguchi S, Kawaguchi S, Takaki H, Yozu R. Thoracic endovascular aortic repair in patients with prior open aortic surgery. Ann Vasc Dis 2013; 6:80-3. [PMID: 23641289 DOI: 10.3400/avd.oa.12.00082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 01/24/2012] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To review our experience of thoracic endovascular aortic repair (TEVAR) in patients with prior open aortic repair (OAR). MATERIALS AND METHODS Stent-grafts were deployed in the arch, descending thoracic and thoracoabdominal aortae of 39, 13 and 5 patients, respectively, and in a deteriorated extra-anatomical prosthesis in one. The access route was the femoral artery in 10 of 23 patients with, and in 30 of 35 patients without a prior abdominal prosthesis. Prior prostheses and elephant trunks comprised 57 of 116 landing zones and 23 proximal landing zones, respectively. RESULTS Three patients died before discharge. Type II endoleaks developed in six patients, and Types I and III developed in one patient each. Type I endoleaks were not found at landing zones comprising prosthetic grafts. The overall actuarial three-year survival rate including early mortality was 86.5%. CONCLUSION The clinical outcomes of TEVAR were excellent, even in patients with prior OAR. Prosthetic grafts, including elephant trunks, provided good landing zones for TEVAR. Prostheses with larger-caliber designs are recommended for iliac artery reconstruction in future TEVAR.
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Affiliation(s)
- Hideyuki Shimizu
- Department of Cardiovascular Surgery, Keio University, Tokyo, Japan
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