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Antegrade Hybrid Chimney TEVAR Endograft in a Patient with Blunt Aortic Injury: A Challenging Case with Technical Success but Unfavorable Result. Case Rep Vasc Med 2021; 2021:6380428. [PMID: 33954006 PMCID: PMC8057905 DOI: 10.1155/2021/6380428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 11/03/2020] [Accepted: 03/31/2021] [Indexed: 11/22/2022] Open
Abstract
Thoracic Endovascular Aortic Repair (TEVAR) has modified aortic medicine, particularly in patients with traumatic aortic injury (TAI). Conventional repair of TAI in the aortic arch is technically demanding as it requires cardiopulmonary bypass and deep hypothermic arrest with still a significant number of complications. Despite recent improvements in endovascular techniques, many patients have been excluded from endovascular repair due to unfavorable anatomy. To increase the feasibility of endovascular repair, adjunctive open extra-anatomical bypasses may be required to provide an adequate proximal landing zone. Several methods, for instance, chimney technique, hybrid technique, and fenestrated or branched stent-grafts, have been proposed as options to preserve the supra-aortic branches, each with its own advantages and disadvantages. We herein present a patient with complex anatomical features and blunt aortic injury, who underwent antegrade chimney stent-graft deployment through the ascending aorta, not otherwise amenable to standard retrograde delivery because of severe peripheral artery disease. The remarkable aspect, in this case, is that both stents were placed antegrade, through the ascending aorta.
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2
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de Beaufort HW, van den Heuvel DA, Heijmen RH. A challenging double bubble thoracic aortic and proximal subclavian aneurysm treated via transapical access. J Vasc Surg Cases Innov Tech 2020; 6:80-83. [PMID: 32095661 PMCID: PMC7033591 DOI: 10.1016/j.jvscit.2019.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/16/2019] [Indexed: 11/26/2022] Open
Abstract
This case report describes a patient with a distal aortic arch and left subclavian artery aneurysm who was considered unsuitable for open surgical repair because of comorbidities and previous bypass surgery. Inadequate peripheral access precluded standard transfemoral thoracic endovascular aortic repair. Nonetheless, successful endovascular repair was possible via transapical access using the new Gore cTAG deployment mechanism, which allowed precise antegrade stent graft deployment in a short proximal neck.
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Affiliation(s)
- Hector W. de Beaufort
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Robin H. Heijmen
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
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3
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Nogami E, Yunoki J, Kitsuka T, Itoh M, Tanaka A, Nishida T. Transapical thoracic endovascular aortic repair in aortic arch aneurysm through a pre-existent bioprosthetic aortic valve. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2018; 4:265-267. [PMID: 30533573 PMCID: PMC6260461 DOI: 10.1016/j.jvscit.2018.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 07/17/2018] [Indexed: 10/27/2022]
Abstract
An 80-year-old man had undergone Y-graft replacement for ruptured abdominal aortic aneurysm followed by bioprosthetic aortic valve replacement. Follow-up computed tomography revealed a 65-mm aneurysm at the distal aortic arch. We selected endovascular surgery because of the patient's high-risk condition, and the extreme curvature of the 8-mm artificial blood vessels led us to adopt a transapical approach. No signs of deterioration of the bioprosthesis were noted, and the patient's hemodynamic condition remained stable during surgery. Transapical thoracic endovascular aortic repair through a pre-existent aortic bioprosthesis is an efficient alternative approach for treating aortic aneurysm, even after bioprosthetic aortic valve replacement.
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Affiliation(s)
- Eijiro Nogami
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga, Japan
| | - Junji Yunoki
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga, Japan
| | - Takahiro Kitsuka
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga, Japan
| | - Manabu Itoh
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga, Japan
| | - Atsuhisa Tanaka
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga, Japan
| | - Takahiro Nishida
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga, Japan
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Sattah AP, Secrist MH, Sarin S. Complications and Perioperative Management of Patients Undergoing Thoracic Endovascular Aortic Repair. J Intensive Care Med 2017; 33:394-406. [PMID: 28946776 DOI: 10.1177/0885066617730571] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Endovascular treatments have become increasingly common for patients with a variety of thoracic aortic pathologies. Although considered less invasive than traditional open surgical approaches, they are nonetheless complex procedures. Patients undergo manipulation of an often calcified aorta near the origin of the carotid and subclavian vessels and have stents placed in a curved vessel adjacent to a perpetually beating heart. These stents can obstruct blood flow to the spinal cord, induce an inflammatory response, and in rare cases erode into the adjacent trachea or esophagus. Renal complications range from contrast-induced nephropathy to hypotension and ischemia to dissection. Emboli can lead to strokes and mesenteric ischemia. These patients have complex medical histories, and skilled perioperative management is critical to achieving the best clinical outcomes. Here, we review the medical management of the most common complications in these patients including stroke, spinal cord ischemia, renal injury, retrograde dissections, aortoesophageal and aortobronchial fistulas, postimplantation syndrome, mesenteric ischemia, and endograft failure.
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Affiliation(s)
- Anna P Sattah
- 1 School of Arts and Sciences, Duke University, Durham, NC, USA.,2 School of Medicine and Department of Surgery, University of Virginia, Charlottesville, VA, USA.,3 Department of Anesthesia and Critical Care, George Washington University Medical Center, Washington, DC, USA.,4 Holy Cross Hospital, Silver Spring, MD, USA
| | - Michael H Secrist
- 5 College of Humanities, Brigham Young University, Provo, UT, USA.,6 Doctor of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.,7 Department of Interventional Radiology, University of California, Irvine, CA, USA.,8 Department of Radiology, George Washington University Medical Center, Washington, DC, USA
| | - Shawn Sarin
- 2 School of Medicine and Department of Surgery, University of Virginia, Charlottesville, VA, USA.,9 Kasturba Medical College, Karnataka, India.,10 Northeast Ohio Medical Universities, Rootstown, OH, USA.,11 Department of Interventional Radiology, National Institutes of Health, Stapleton, New York City, NY, USA.,12 Department of Interventional Radiology, George Washington University Medical Center, Washington, DC, USA
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5
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Murakami T, Nishimura S, Hosono M, Nakamura Y, Sohgawa E, Sakai Y, Shibata T. Transapical Endovascular Repair of Thoracic Aortic Pathology. Ann Vasc Surg 2017; 43:56-64. [DOI: 10.1016/j.avsg.2016.10.054] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 06/23/2016] [Accepted: 10/13/2016] [Indexed: 10/20/2022]
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6
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Heinisch PP, Winkler B, Weidenhagen R, Klaws R, Carrel T, Khoynezhad A, Bombien R. Type A aortic dissection model to improve endovascular research and technologies. Asian Cardiovasc Thorac Ann 2016; 24:337-43. [PMID: 27002099 DOI: 10.1177/0218492316641288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Type A aortic dissection is a life-threatening disease requiring immediate surgical treatment. With emerging catheter-based technologies, endovascular stent-graft implantation to treat aneurysms and dissections has become a standardized procedure. However, endovascular treatment of the ascending aorta remains challenging. Thus we designed an ascending aortic dissection model to allow simulation of endovascular treatment. METHODS Five formalin-fixed human aortas were prepared. The ascending aorta was opened semicircularly in the middle portion and the medial layer was separated from the intima. The intimal tube was readapted using running monofilament sutures. The preparations were assessed by 128-slice computed tomography. A bare-metal stent was implanted for thoracic endovascular aortic repair in 4 of the aortic dissection models. RESULTS Separation of the intimal and medial layer of the aorta was considered to be sufficient because computed tomography showed a clear image of the dissection membrane in each aorta. The dissection was located 3.9 ± 1.4 cm proximally from the aortic annulus, with a length of 4.6 ± 0.9 cm. Before stent implantation, the mean distance from the intimal flap to the aortic wall was measured as 0.63 ± 0.163 cm in the ascending aorta. After stent implantation, this distance decreased to 0.26 ± 0.12 cm. CONCLUSION This model of aortic dissection of the ascending human aorta was reproducible with a comparable pathological and morphological appearance. The technique and model can be used to evaluate new stent-graft technologies to treat type A dissection and facilitate training for surgeons.
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Affiliation(s)
| | - Bernhard Winkler
- Department of Cardiovascular Surgery, Inselspital, University of Bern, Switzerland
| | - Rolf Weidenhagen
- Department of Vascular Surgery, Klinikum Neuperlach, Munich, Germany
| | - Rolf Klaws
- Institute of Anatomy, Christian-Albrechts University of Kiel, Kiel, Germany
| | - Thierry Carrel
- Department of Cardiovascular Surgery, Inselspital, University of Bern, Switzerland
| | - Ali Khoynezhad
- Division of Cardiothoracic Surgery, Cedars-Sinai Medical Canter, Los Angeles, CA, USA
| | - Rene Bombien
- Department of Vascular Surgery, Klinikum Neuperlach, Munich, Germany Division of Cardiothoracic Surgery, Cedars-Sinai Medical Canter, Los Angeles, CA, USA
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Allen KB, Johnson LM, Borkon AM, Aggarwal S, Davis JR, Cohen DJ, Chhatriwalla AK, Grantham A, Hart A. Combined Transcatheter Aortic Valve Replacement and Thoracic Endovascular Aortic Repair Using Transapical Access. Ann Thorac Surg 2015; 100:723-7. [PMID: 26234852 DOI: 10.1016/j.athoracsur.2014.10.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Revised: 08/23/2014] [Accepted: 10/10/2014] [Indexed: 11/18/2022]
Abstract
Vascular complications remain an important consideration when selecting access for delivery of large endovascular devices. With the advent of transcatheter aortic valve replacement, transapical access has become an acceptable technique when transfemoral or direct transaortic access is contraindicated. We report the use of the transapical approach during thoracic aortic endovascular repair in 2 patients, one of which included concomitant delivery of a transcatheter aortic valve replacement device. To our knowledge, this is the first reported case of a hybrid single-stage transcatheter aortic valve replacement and thoracic aortic endovascular repair using transapical access.
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Affiliation(s)
- Keith B Allen
- Department of Cardiothoracic/Vascular Surgery, St. Luke's Mid America Heart & Vascular Institute, Kansas City, Missouri.
| | - Lesley M Johnson
- Department of Cardiothoracic/Vascular Surgery, St. Luke's Mid America Heart & Vascular Institute, Kansas City, Missouri
| | - A Michael Borkon
- Department of Cardiothoracic/Vascular Surgery, St. Luke's Mid America Heart & Vascular Institute, Kansas City, Missouri
| | - Sanjeev Aggarwal
- Department of Cardiothoracic/Vascular Surgery, St. Luke's Mid America Heart & Vascular Institute, Kansas City, Missouri
| | - J Russell Davis
- Department of Cardiothoracic/Vascular Surgery, St. Luke's Mid America Heart & Vascular Institute, Kansas City, Missouri
| | - David J Cohen
- Department of Cardiology, St. Luke's Mid America Heart & Vascular Institute, Kansas City, Missouri
| | - Adnan K Chhatriwalla
- Department of Cardiology, St. Luke's Mid America Heart & Vascular Institute, Kansas City, Missouri
| | - Aaron Grantham
- Department of Cardiology, St. Luke's Mid America Heart & Vascular Institute, Kansas City, Missouri
| | - Anthony Hart
- Department of Cardiology, St. Luke's Mid America Heart & Vascular Institute, Kansas City, Missouri
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Murakami T, Kawatani Y, Nakamura Y, Hori T. Transapical Endovascular Aortic Aneurysm Repair in a Patient with Shaggy Aorta Syndrome. Ann Vasc Surg 2015; 29:838.e7-9. [DOI: 10.1016/j.avsg.2014.11.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 10/27/2014] [Accepted: 11/06/2014] [Indexed: 10/24/2022]
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9
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Affiliation(s)
- George Joseph
- Department of Cardiology, Christian Medical College, Vellore, India
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10
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Thoracic Aorta Stent Grafting through Transapical Access. Ann Vasc Surg 2015; 29:362.e5-9. [DOI: 10.1016/j.avsg.2014.09.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 09/09/2014] [Accepted: 09/14/2014] [Indexed: 11/20/2022]
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11
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Luo C, Wang S, Chi N, Wu I. Transapical Endovascular Repair with a Table‐Tailored Endograft to Treat Ascending Aortic Dissection. J Card Surg 2014; 29:824-6. [DOI: 10.1111/jocs.12449] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Chien‐Ming Luo
- Cardiovascular Surgical Division, Department of SurgeryNational Taiwan University HospitalHsin‐Chu BranchHsin‐Chu CountyTaiwan
| | - Shoei‐Shen Wang
- Cardiovascular Surgical DivisionDepartment of Surgery, National Taiwan University HospitalTaipeiTaiwan
| | - Nai‐Hsin Chi
- Cardiovascular Surgical DivisionDepartment of Surgery, National Taiwan University HospitalTaipeiTaiwan
| | - I‐Hui Wu
- Cardiovascular Surgical DivisionDepartment of Surgery, National Taiwan University HospitalTaipeiTaiwan
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12
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Shah A, Bombien R, Khoynezhad A. Thoracic endovascular aortic repair: are we approaching total endovascular solutions for thoracic aortic disease? Multimed Man Cardiothorac Surg 2014; 2014:mmu009. [PMID: 25012992 DOI: 10.1093/mmcts/mmu009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Thoracic endovascular aortic repair (TEVAR) has become an attractive alternative treatment option for thoracic aortic disease. New devices and advanced image-guided procedures are continuously expanding the indications. This article focuses on currently available endovascular solutions for thoracic aortic disease and future 'all endovascular' directions of TEVAR. Currently available endovascular solutions, such as hybrid operations, chimney stent grafting and transapical stent graft deployment, for ascending aortic pathologies are presented. Additionally, the impact of upcoming new technologies, such as endovascular treatment of Stanford Type A dissections of the ascending aorta, is elaborated. With improving device technology, diverse available stent grafts and imaging modalities, TEVAR has become safer and holds promising potential to expand treatment options, especially for the ascending aorta and the aortic arch.
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Affiliation(s)
- Aamir Shah
- Division of Cardio-Thoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, USA
| | - René Bombien
- Division of Cardio-Thoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Ali Khoynezhad
- Division of Cardio-Thoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, USA
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13
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Kumpati GS, Gray R, Patel A, Bull DA. Endovascular Repair of Acute Ascending Aortic Disruption via the Right Axillary Artery. Ann Thorac Surg 2014; 97:700-3. [DOI: 10.1016/j.athoracsur.2013.05.114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Revised: 05/08/2013] [Accepted: 05/15/2013] [Indexed: 10/25/2022]
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Beller CJ. Transapical aortic valve implantation - What have we learnt? Quo vadis? Cardiovasc Diagn Ther 2013; 2:E1-3. [PMID: 24282734 DOI: 10.3978/j.issn.2223-3652.2012.10.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 10/30/2012] [Indexed: 11/14/2022]
Affiliation(s)
- Carsten J Beller
- Clinic for Cardiac Surgery, Heart Centre Heidelberg, University of Heidelberg, Heidelberg, Germany
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15
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Shults C, Gunter R, Thourani VH. The versatility of transapical access: Will it lead to a completely new approach to valvular therapy? Ann Cardiothorac Surg 2013; 1:220-3. [PMID: 23977498 DOI: 10.3978/j.issn.2225-319x.2012.06.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 06/27/2012] [Indexed: 11/14/2022]
Affiliation(s)
- Christian Shults
- Joseph B. Whitehead Department of Surgery, Division of Cardiothoracic Surgery, Emory University School of Medicine Atlanta, GA, USA
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Ramponi F, Stephen MS, Wilson MK, Vallely MP. Think differently: trans-apical platform for TEVAR. Ann Cardiothorac Surg 2013; 1:412-6. [PMID: 23977530 DOI: 10.3978/j.issn.2225-319x.2012.08.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 08/24/2012] [Indexed: 11/14/2022]
Affiliation(s)
- Fabio Ramponi
- Department of Cardiothoracic, Royal Prince Alfred Hospital, The University of Sydney, Sydney, Australia ; The Baird Research Institute for Applied Heart and Lung Surgical Research, Royal Prince Alfred Hospital, The University of Sydney, Sydney, Australia
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Shahverdyan R, Madershahian N, Gawenda M. A novel technique of antegrade transapical arch and thoracic aortic endovascular repair with a triple-barrel graft. J Thorac Cardiovasc Surg 2013; 145:1670-1. [DOI: 10.1016/j.jtcvs.2013.02.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 10/16/2012] [Accepted: 02/12/2013] [Indexed: 10/27/2022]
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Krankenberg H, Bader R, Sixt S, Tübler T, Schwencke C, Kivelitz D, Rad A, Caspary M, Zeller T. Endovascular Repair of Ascending Aortic Aneurysm by Transapical Approach and Periscope Technique. J Endovasc Ther 2013; 20:13-7. [DOI: 10.1583/12-4082.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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