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Erkul S, Alptekin Erkul GS. Retrograde ascending aortic dissection in the midterm period after thoracic endovascular aortic repair: a case report and literature review. Acta Chir Belg 2022; 122:211-214. [PMID: 32674719 DOI: 10.1080/00015458.2020.1794340] [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: 10/23/2022]
Abstract
Retrograde ascending aortic dissection (rAAD) is a catastrophic complication of thoracic endovascular aortic repair (TEVAR). A 56 year-old male patient who had undergone TEVAR for Stanford type B aortic dissection 6-month ago was admitted to our clinic with uncontrolled hypertension for the last twelve hours and history of a syncopal attack three days ago. Retrograde ascending aortic dissection was detected in computed tomography angiography. Ascending aorta and hemiarch replacement with a Dacron graft was safely performed via hypothermic circulatory arrest and antegrade cerebral perfusion for the treatment of rAAD after TEVAR.
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Affiliation(s)
- Sinan Erkul
- Cardiovascular Surgery Department, Kutahya University of Health Sciences Evliya Celebi Training and Research Hospital, Kutahya, Turkey
| | - Gulen Sezer Alptekin Erkul
- Cardiovascular Surgery Department, Kutahya University of Health Sciences Evliya Celebi Training and Research Hospital, Kutahya, Turkey
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2
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Hybrid Approach in Acute and Chronic Aortic Disease. Medicina (B Aires) 2021; 58:medicina58010049. [PMID: 35056357 PMCID: PMC8777634 DOI: 10.3390/medicina58010049] [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: 11/10/2021] [Revised: 12/20/2021] [Accepted: 12/23/2021] [Indexed: 11/26/2022] Open
Abstract
The management of patients with aortic disease that involves the ascending aorta, the aortic arch, and the descending aorta represent a surgical challenge. Open surgical repair remains the gold standard for aortic arch pathologies. However, this operation requires a cardiopulmonary bypass and a period of profound hypothermia and circulatory arrest, which carries a substantial rate of mortality and morbidity. For these reasons, hybrid arch repair that involves a combination of open surgery with endovascular aortic stent graft placement has been introduced as a therapeutic alternative for those patients deemed unfit for open surgical procedures. Hybrid repair requires varying degrees of invasiveness and can be performed as a single-stage procedure or as a two-stage procedure. The choice of the technique is multifactorial, depending on the characteristics of the diseased arch with regard to position of the stent graft proximal landing zone, patient fitness and comorbid status, as well as surgical expertise and hospital facilities. Among the evolving hybrid procedures is the so-called “frozen” or stented elephant trunk technique. Adapted from the classical elephant trunk technique, this approach facilitates the repair of a concomitant aortic arch and proximal descending aortic aneurysms in a single stage under circulatory arrest. This technique is increasingly being used to treat extensive thoracic aortic disease and has shown promising results.
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3
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Chatterjee S, Preventza O, Orozco-Sevilla V, Coselli JS. Perioperative management of patients undergoing thoracic endovascular repair. Ann Cardiothorac Surg 2021; 10:768-777. [PMID: 34926179 DOI: 10.21037/acs-2021-taes-74] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 09/25/2021] [Indexed: 11/06/2022]
Abstract
Thoracic endovascular aortic repair (TEVAR) is a less invasive method for treating thoracic and some thoracoabdominal aortic aneurysms, dissections of the thoracic aorta and blunt traumatic aortic injury, compared with conventional open surgery. Maximizing the likelihood of a successful outcome requires diligent multidisciplinary (surgical, critical care, nursing, pharmacy, nutrition and physical therapy) perioperative care. In this article, we discuss fundamentals for managing patients after endovascular aortic aneurysm repair. These principles focus on the transition between the operating room and the intensive care unit, prevention and management of spinal cord deficits (SCD), and vital neurological, respiratory, cardiovascular, renal, gastrointestinal and hematological concerns. The better the care team understands the expected postoperative course, the earlier that deviations can be recognized and the more likely that successful rescue can be achieved to reduce the incidence and severity of adverse outcomes. Achieving optimal results after TEVAR requires attention to detail across the preoperative, intraoperative and postoperative phases of care.
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Affiliation(s)
- Subhasis Chatterjee
- Division of General Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.,Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.,Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas, USA
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.,Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas, USA.,Department of Cardiovascular Surgery, CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Texas, USA
| | - Vicente Orozco-Sevilla
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.,Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas, USA.,Department of Cardiovascular Surgery, CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Texas, USA
| | - Joseph S Coselli
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.,Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas, USA.,Department of Cardiovascular Surgery, CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Texas, USA
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4
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Le Huu A, Preventza O. Endovascular repair of acute type B thoracic aortic dissection. Ann Cardiothorac Surg 2021; 10:793-800. [PMID: 34926184 DOI: 10.21037/acs-2021-taes-26] [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: 09/22/2021] [Accepted: 10/24/2021] [Indexed: 11/06/2022]
Abstract
Approximately one-third of patients with acute Stanford type B or DeBakey type III aortic dissection (TBAD) will develop complications, including persistent symptoms, malperfusion, enlarging aneurysms and impending rupture. In these cases, TBAD becomes a surgical emergency that requires endovascular intervention to complement the medical therapy. The immediate goal of endovascular therapy is to reestablish flow to the true lumen, stabilize the aneurysm and prevent rupture. Long-term goals are the remodeling of the descending thoracic aorta and the prevention of further surgeries in the thoracoabdominal aorta. In this report, we describe our step-by-step endovascular approach to TBAD repair.
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Affiliation(s)
- Alice Le Huu
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.,Section of Adult Cardiac Surgery, Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas, USA
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5
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Hong JC, Le Huu A, Preventza O. Medical or endovascular management of acute type B aortic dissection. J Thorac Cardiovasc Surg 2021; 164:1058-1065. [PMID: 34024613 DOI: 10.1016/j.jtcvs.2021.03.127] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/17/2021] [Accepted: 03/17/2021] [Indexed: 01/12/2023]
Affiliation(s)
- Jonathan C Hong
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Alice Le Huu
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex.
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6
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Azizzadeh A, Desai N, Arko FR, Panneton JM, Thaveau F, Hayes P, Dagenais F, Lei L, Verzini F. Pivotal results for the Valiant Navion stent graft system in the Valiant EVO global clinical trial. J Vasc Surg 2019; 70:1399-1408.e1. [DOI: 10.1016/j.jvs.2019.01.067] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 01/22/2019] [Indexed: 10/26/2022]
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7
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Hu W, Zhang Y, Guo L, Fan J, Lu Y, Ma L. A graft inversion technique for retrograde type A aortic dissection after thoracic endovascular repair for type B aortic dissection. J Cardiothorac Surg 2019; 14:29. [PMID: 30717782 PMCID: PMC6360802 DOI: 10.1186/s13019-019-0851-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 01/28/2019] [Indexed: 12/01/2022] Open
Abstract
Background Retrograde type A aortic dissection (RTAD) is a rare but life-threatening complication after thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD). A graft inversion technique was applied to distal anastomosis in total arch replacement for this complicated dissection. We reviewed our results of the processing for this serious complication. The aim is to evaluate the feasibility of this technology. Methods From January 2013 to December 2017, 20 patients (80% male, mean age 50.9 ± 9.5 years) with retrograde type A aortic dissection after thoracic endovascular aortic repair for type B aortic dissection were scheduled for surgical treatment at our center. All patients underwent an ascending aorta and total aortic arch replacement procedure. The 20 patients were divided into two groups, 1 group involved 9 patients underwent surgery using stepwise technique; the graft inversion technique was performed in the other group containing the remaining 11 patients. The postoperative variables, including cardiopulmonary bypass time, the circulatory arrest time, the aortic cross clamp time, were analyzed. Meanwhile we also analyzed the postoperative mortality and complications to evaluate the early and mid-term outcomes of surgical treatment for RTAD after TEVAR. Results In-hospital mortality was 10% (2 of 20 patients). No patient developed postoperative paraplegia, renal failure, stroke, or distal anastomotic bleeding. Two patients developed renal insufficiency, one developed neurologic insufficiency, and one developed pulmonary infection, all of which were managed accordingly. Cardiopulmonary bypass (CPB) time, and circulatory arrest time were significantly shorter in the graft inversion group than in the stepwise group (165.8 ± 37.9 min versus 206.1 ± 46.8 min, p<0.05; 34.5 ± 5.6 min versus 42.4 ± 9.5 min, p<0.05, respectively). The 18 survivors had a mean follow-up of 25.8 ± 18.2 months, and all patients remained alive and well. Conclusion Graft inversion can enable a secure distal anastomosis under good surgical exposure, resulting in reduced durations of CPB, and circulatory arrest for RTAD after TEVAR. Surgical treatment could be a safe alternative for treatment of this patients. Electronic supplementary material The online version of this article (10.1186/s13019-019-0851-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wenbin Hu
- Department of Cardiothoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, No.79 Qinqchun Road, Hangzhou, 310003, Zhejiang, China.,Department of Cardiothoracic Surgery, Affiliated Hospital of Shaoxing University (The Shaoxing Municipal Hospital), Shaoxing, China
| | - Yiran Zhang
- Department of Cardiothoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, No.79 Qinqchun Road, Hangzhou, 310003, Zhejiang, China
| | - Lei Guo
- Department of Cardiothoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, No.79 Qinqchun Road, Hangzhou, 310003, Zhejiang, China
| | - Jingya Fan
- Department of Cardiothoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, No.79 Qinqchun Road, Hangzhou, 310003, Zhejiang, China
| | - Yuan Lu
- Department of Cardiothoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, No.79 Qinqchun Road, Hangzhou, 310003, Zhejiang, China
| | - Liang Ma
- Department of Cardiothoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, No.79 Qinqchun Road, Hangzhou, 310003, Zhejiang, China.
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8
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Zhu J, Dai X, Noiniyom P, Luo Y, Fan H, Feng Z, Zhang Y, Hu F. Fenestrated Thoracic Endovascular Aortic Repair Using Physician-Modified Stent Grafts (PMSGs) in Zone 0 and Zone 1 for Aortic Arch Diseases. Cardiovasc Intervent Radiol 2018; 42:19-27. [PMID: 30327926 DOI: 10.1007/s00270-018-2079-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 09/14/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE To evaluate the outcomes of fenestrated thoracic endovascular aortic repair (f-TEVAR) using physician-modified stent grafts (PMSGs) in zone 0 and zone 1 for aortic arch diseases. METHODS f-TEVAR using PMSGs in Z0 and Z1 was performed on ten high-risk patients for open surgery from November 2015 to September 2017. Indications were complicated acute type B dissection (ABAD) with retrograde dissection involving the mid-arch (n = 1), distal arch aneurysms (n = 3), mid-arch aneurysms of the inner arch curvature (n = 3) and penetrating aortic ulcer located in the mid- or proximal arch (n = 3). Pre-, intra- and postoperative clinical data were recorded. RESULTS The median patient age was 61 (range 45-81) years, and 9 (90%) patients were men. Ten PMSGs (Medtronic Valiant stent grafts, n = 1; Relay thoracic stent grafts, n = 4; Cook TX2 device, n = 5) were deployed. PMSGs were deployed from Z0 and Z1 in 5 and 5 patients, respectively. Double small fenestrations for the left subclavian artery (LSA) and the left common carotid artery (LCCA), respectively, were created in 3 patients. Triple small fenestrations for the innominate artery (IA), the LCCA and the LSA, respectively, were created in 2 patients. One large fenestration for both the IA and the LCCA combined with one small fenestration for the LSA was created in 3 patients. One large fenestration for the LCCA combined with one small fenestration for the LSA was created in 2 patients. Posterior diameter-reducing ties were added to all the devices except to one Valiant stent graft. All but 2 patients underwent elective procedure. Median duration for stent graft modifications was 105 (range 90-125) min. The technical success rate was 90%. Overall mortality was 10% (1/10). One patient died of sudden cardiac arrest intraoperatively after the deployment of the PMSG and all the supra-aortic branch stents. Mean operative time was 106.0 ± 43.0 min, and fluoroscopy time was 30.6 ± 22.9 min. There were no type I or type III endoleaks, perioperative neurological complications or spinal cord ischemia. Median length of stay was 8 (range 4-35) days. Nine patients survived at mean 13.3 (range 6.0-19.0) months follow-up. Retrograde dissection occurred in one patient of Z0 group 40 days post-f-TEVAR and resolved after open repair. During follow-up, all target vessels remained patent without fenestration-related type I or III endoleaks. CONCLUSIONS f-TEVAR using PMSGs in Z0 and Z1 for the treatment of aortic arch diseases in high-risk patients is feasible in the hands of experienced operators.
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Affiliation(s)
- Jiechang Zhu
- Department of Vascular Surgery, General Hospital of Tianjin Medical University, Tianjin, 300052, People's Republic of China
| | - Xiangchen Dai
- Department of Vascular Surgery, General Hospital of Tianjin Medical University, Tianjin, 300052, People's Republic of China.
| | - Phasakorn Noiniyom
- Department of Vascular Surgery, Yala Medical Center Hospital, Yala, 95000, Thailand
| | - Yudong Luo
- Department of Vascular Surgery, General Hospital of Tianjin Medical University, Tianjin, 300052, People's Republic of China
| | - Hailun Fan
- Department of Vascular Surgery, General Hospital of Tianjin Medical University, Tianjin, 300052, People's Republic of China
| | - Zhou Feng
- Department of Vascular Surgery, General Hospital of Tianjin Medical University, Tianjin, 300052, People's Republic of China
| | - Yiwei Zhang
- Department of Vascular Surgery, General Hospital of Tianjin Medical University, Tianjin, 300052, People's Republic of China
| | - Fanguo Hu
- Department of Vascular Surgery, General Hospital of Tianjin Medical University, Tianjin, 300052, People's Republic of China
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9
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Al-kalei AMA, Wu Z, Zhang H. Influence of Primary Intimal Tear Location in Type B Aortic Dissection as a Factor Portending Retrograde Type A Aortic Dissection after Endovascular Repair. J Vasc Interv Radiol 2018; 29:833-840.e2. [DOI: 10.1016/j.jvir.2018.02.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 02/22/2018] [Accepted: 02/23/2018] [Indexed: 11/30/2022] Open
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10
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Kouchoukos NT, Kulik A, Castner CF. Clinical outcomes and rates of aortic growth and reoperation after 1-stage repair of extensive chronic thoracic aortic dissection. J Thorac Cardiovasc Surg 2018; 155:1926-1935. [DOI: 10.1016/j.jtcvs.2017.10.158] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 10/12/2017] [Accepted: 10/27/2017] [Indexed: 10/18/2022]
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11
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Mylonas SN, Barkans A, Ante M, Wippermann J, Böckler D, Brunkwall JS. Prevalence of Bovine Aortic Arch Variant in Patients with Aortic Dissection and its Implications in the Outcome of Patients with Acute Type B Aortic Dissection. Eur J Vasc Endovasc Surg 2018; 55:385-391. [PMID: 29338980 DOI: 10.1016/j.ejvs.2017.12.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 12/01/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVE/BACKGROUND To investigate the prevalence of bovine arch (BA) among patients with type A and B aortic dissection, and to provide insight into the implication of this variation on the outcome of patients with acute or subacute type B aortic dissection (a/sTBAD). METHODS This retrospective cohort analysis includes patients with a/sTBAD admitted between January 2006 and December 2016. Computed tomographic angiograms (CTAs) of patients referred because of type A aortic dissection were also re-evaluated with regard to the presence of BA. As a control group, 110 oncological patients who had undergone a chest CTA for disease staging during the study period were enrolled. A total of 154 patients with a/sTBAD and 168 with type A aortic dissection were identified during the study period. RESULTS An overall prevalence of 17.6% for BA variants was revealed. The comparison between patients with aortic dissection and the control group showed no statistically significant difference in BA prevalence (17.7% vs. 17.3%; p = 1.0). No statistically significant difference in BA prevalence was observed when comparing patients with type A aortic dissection with those with type B aortic dissection (16.6% vs. 18.8%; p = .66). During a median follow-up period of 27.8 months, 30 patients died. The mortality rate among patients presenting a BA variant was 34.5%, whereas among patients without, it was 16.0% (p = .04). Multivariate analysis revealed the presence of a BA as an independent predictor of mortality (adjusted odds ratio 3.4, 95% confidence interval 1.2-9.8). CONCLUSION The BA should be considered as a predictor of the outcome for patients with type B aortic dissection.
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Affiliation(s)
- Spyridon N Mylonas
- Department of Vascular and Endovascular Surgery, University of Cologne, Cologne, Germany.
| | - Arthurs Barkans
- Department of Vascular and Endovascular Surgery, University of Cologne, Cologne, Germany
| | - Marius Ante
- Department of Vascular and Endovascular Surgery, University of Heidelberg, Heidelberg, Germany
| | - Jens Wippermann
- Department of Cardiac and Thoracic Surgery, University of Cologne, Cologne, Germany
| | - Dietmar Böckler
- Department of Vascular and Endovascular Surgery, University of Heidelberg, Heidelberg, Germany
| | - Jan Sigge Brunkwall
- Department of Vascular and Endovascular Surgery, University of Cologne, Cologne, Germany
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12
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Piffaretti G, Lomazzi C, Benedetto F, Pipitò N, Castelli P, Trimarchi S, Dorigo W, Tozzi M. Best Medical Treatment and Selective Stent-GraftRepair for Acute Type B Aortic Intramural Hematoma. Semin Thorac Cardiovasc Surg 2018; 30:279-287. [DOI: 10.1053/j.semtcvs.2018.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2018] [Indexed: 12/15/2022]
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13
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Ma T, Dong ZH, Fu WG, Guo DQ, Xu X, Chen B, Jiang JH, Yang J, Shi ZY, Zhu T, Shi Y, Jiang BH, Xu XY. Incidence and risk factors for retrograde type A dissection and stent graft-induced new entry after thoracic endovascular aortic repair. J Vasc Surg 2017; 67:1026-1033.e2. [PMID: 29097043 DOI: 10.1016/j.jvs.2017.08.070] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 08/06/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Stent graft (SG)-induced new entry (SINE) and retrograde type A dissection (RTAD) are serious device-related complications occurring after thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection (TBAD) and may lead to endograft-related complications including retrograde dissection and death. The purpose of this study was to investigate the incidence and risk factors for the development of RTAD and SINE after TEVAR for TBAD and to identify the complications associated with this. METHODS From April 2005 to October 2013, there were 997 patients who underwent TEVAR for TBAD; 852 were followed up (0-6 years; mean, 2.6 years), and 59 SINEs developed in 53 patients. The oversizing ratio and incidence of RTAD and SINE were compared between proximal bare stent (PBS) and non-PBS groups and RTAD and SINE and non-RTAD and non-SINE groups. The baseline characteristics and SG configurational factors potentially affecting both RTAD and distal SINE were analyzed. RESULTS There was no significant difference between PBS and non-PBS groups in the incidence of RTAD. A greater oversizing ratio was related to a higher distal SINE rate. SINE was seen more frequently in smokers and in patients with hypertension, Marfan syndrome, and TEVAR in the chronic phase and less frequently in complicated dissection cases. Device-related factors for SINE were SG with a connecting bar and SG length <165 mm. The SG length <165 mm increased the overall proximal and distal SINE incidence in multivariate analysis. CONCLUSIONS The presence of a PBS is not associated with a higher RTAD rate, whereas the use of an SG with a connecting bar and length <165 mm increases the risk of RTAD and SINE after TEVAR.
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Affiliation(s)
- Tao Ma
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhi Hui Dong
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei Guo Fu
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Da Qiao Guo
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xin Xu
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Bin Chen
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jun Hao Jiang
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jue Yang
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhen Yu Shi
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ting Zhu
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yun Shi
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Bao Hong Jiang
- Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, China
| | - Xiao Yun Xu
- Department of Chemical Engineering, Imperial College London, London, United Kingdom
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14
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Shahverdyan R, Mylonas S, Gawenda M, Brunkwall J. Single-center mid-term experience with chimney-graft technique for the preservation of flow to the supra-aortic branches. Vascular 2017; 26:175-182. [DOI: 10.1177/1708538117723200] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives To investigate the feasibility and the mid-term outcomes of the chimney-graft technique for the revascularization of supra-aortic branches in patients with thoracic aortic pathologies involving the aortic arch. Methods A retrospective analysis of a prospectively maintained database between January 2010 and July 2016 was performed. Primary endpoints were 30-day and overall mortality. Secondary endpoints were technical success, target vessel patency, stroke/transitory ischemic attack and type I/III endoleak rate. Results A total of 30 patients (80% male, median age 70.0 years) were treated using the chimney-graft technique for the supra-aortic branches. The indication was a degenerative aneurysm in nine patients (32%) and a type B Stanford aortic dissection and a penetrating aortic ulcer in the descending aorta in seven patients (23%), respectively. In six patients (20.0%), the indication was an type Ia endoleak after previous endovascular thoracic repair, whereas a pseudoaneurysm after previous open repair of the descending aorta was the indication in one patient (3%). Twenty-three patients (77%) were treated electively, five (17%) emergently and two (7%) urgently because of free rupture. Technical success was achieved in 90% of patients. The 30-day/in-hospital mortality was 17% (5/30). A retrograde dissection was presented in five patients. Four patients experienced a cerebrovascular event. Eight patients had type Ia endoleak and 10 had type II. During the median follow-up of 16 months (range: 0–56), four further patients died: one in respiratory insufficiency, one due to a ruptured abdominal aortic aneurysm, one in meningitis and the last one for unknown reason. The chimney-graft patency was 100%. According to the Kaplan–Meier curve, the estimated survival at one year was 66 ± 9%. Conclusions The chimney-graft technique, despite a technically demanding strategy, is a useful tool as bailout procedure in our armamentarium for high-risk patients, unsuitable for open or hybrid repair.
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Affiliation(s)
- Robert Shahverdyan
- Department of Vascular Surgery, University Hospital of Cologne, Cologne, Germany
- The first two authors have equally contributed and share the first authorship
| | - Spyridon Mylonas
- Department of Vascular Surgery, University Hospital of Cologne, Cologne, Germany
- The first two authors have equally contributed and share the first authorship
| | - Michael Gawenda
- Department of Vascular Surgery, University Hospital of Cologne, Cologne, Germany
- The first two authors have equally contributed and share the first authorship
| | - Jan Brunkwall
- Department of Vascular Surgery, University Hospital of Cologne, Cologne, Germany
- The first two authors have equally contributed and share the first authorship
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15
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Preventza O, Coselli JS. Differential aspects of ascending thoracic aortic dissection and its treatment: the North American experience. Ann Cardiothorac Surg 2016; 5:352-9. [PMID: 27563548 DOI: 10.21037/acs.2016.07.01] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Acute type A aortic dissection is a deadly disease with significant morbidity and mortality. We describe the differential aspects of the disease and the North American experience with its treatment.
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Affiliation(s)
- Ourania Preventza
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Texas, USA;; Division of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas, USA
| | - Joseph S Coselli
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Texas, USA;; Division of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas, USA
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Liu L, Zhang S, Lu Q, Jing Z, Zhang S, Xu B. Impact of Oversizing on the Risk of Retrograde Dissection After TEVAR for Acute and Chronic Type B Dissection. J Endovasc Ther 2016; 23:620-5. [PMID: 27170148 DOI: 10.1177/1526602816647939] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To find a suitable rate of thoracic stent-graft oversizing by exploring its association with the occurrence of retrograde type A dissection (RTAD) after thoracic endovascular aortic repair (TEVAR) for type B aortic dissection. Methods: From January 2013 to June 2014, 203 patients (mean age 55 years; 167 men) with type B aortic dissection underwent TEVAR. The mean rate of oversizing at the proximal landing zone was 10% (range 0%–32%). Patients were stratified into 2 groups based on the degree of oversizing: ≤5% (n=105, mean 1.2%±1.5%) and >5% (n=98, mean 18.5%±2.8%). TEVAR-related complications, including RTAD, stent migration, and type I endoleaks, were analyzed. Results: There were no significant differences in the preoperative proximal landing zone diameters between the groups (31.1 mm for the ≤5% group vs 31.8 mm for the >5% group, p=0.229). The incidence of type I endoleaks over a mean follow-up 15.1±6.4 months was 5.4% [6 (5.7%) in the ≤5% group vs 5 (5.1%) in the >5% group, p=0.847]. The stent migration rate was low in both groups (1% vs 2%, respectively; p=0.521). The occurrence of RTAD [0 in the ≤5% group vs 11 (11.2%) in the >5% group] was significantly associated with the rate of oversizing (p<0.001). Conclusion: The early and midterm outcomes of this study demonstrate that ≤5% oversizing may be a suitable option for thoracic endografts used to treat type B dissection. The smaller rate of oversizing can lower the incidence of RTAD without increasing stent migration or type I endoleak rates.
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Affiliation(s)
- Lei Liu
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, P.R. China
| | - Simeng Zhang
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, P.R. China
| | - Qingsheng Lu
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, P.R. China
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, P.R. China
| | - Suming Zhang
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, P.R. China
| | - Bing Xu
- Department of Imaging, Changhai Hospital, Second Military Medical University, Shanghai, P.R. China
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Results of Open Surgical Repair in Patients With Marfan Syndrome and Distal Aortic Dissection. Ann Thorac Surg 2016; 101:2193-201. [DOI: 10.1016/j.athoracsur.2015.11.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 11/03/2015] [Accepted: 11/04/2015] [Indexed: 12/16/2022]
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Bibiloni Lage I, Calsina Juscafresa L, Delgado Domínguez C, Bilbao Jaureguizar JI, Bastarrika G, Rábago Juan-Aracil G. Hybrid Repair of Aortic Arch Aneurysms with Endografting of the Ascending Aorta. J Card Surg 2016; 31:341-7. [PMID: 27005830 DOI: 10.1111/jocs.12735] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Different "hybrid" techniques that combine open debranching of the supra-aortic vessels with endografting of the aortic arch have emerged as alternatives to the open arch repair in high-risk patients. This study aims to review the early and mid-term results of single-stage hybrid arch repair with ascending aorta stent graft deployment for aortic arch aneurysms and dissections. METHODS Between June 2006 and May 2015, five consecutive patients, with an age range of 54-78 years, with complex aortic arch diseases, were treated with a hybrid approach in which the endograft had a proximal landing zone in the ascending aorta. Indications included: acute and chronic type A aortic dissections and three arch aneurysms associated with distal aortic pathology. Length of postoperative clinical and imaging follow-up ranged from 10 to 121 months and was completed in all patients. RESULTS Technical success of the endografting was achieved in all cases. There was one in-hospital mortality secondary to pulmonary embolism, one case of retrograde type A aortic dissection (RTAD) detected before discharge and one case of late type Ib endoleak that required an endografting procedure. No postoperative stroke or transient or permanent spinal cord ischemia occurred. CONCLUSION Hybrid arch repair with endograft landing in zone 0 may decrease mortality and morbidity in high-risk patients. doi: 10.1111/jocs.12735 (J Card Surg 2016;31:341-347).
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Affiliation(s)
| | | | | | | | - Gorka Bastarrika
- Department of Radiology, Clínica Universidad de Navarra, Pamplona, Spain
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