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DiBartolomeo AD, Miranda E, Han SM, Magee GA. In situ laser fenestration of aortic septum to bridge false and true lumen during endovascular repair of aortic dissection. J Vasc Surg Cases Innov Tech 2024; 10:101312. [PMID: 38559376 PMCID: PMC10981118 DOI: 10.1016/j.jvscit.2023.101312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/14/2023] [Indexed: 04/04/2024] Open
Abstract
Fenestration of the septum between the true and false lumen might be necessary after aortic dissection. We report the technical aspects of in situ laser fenestration of the aortic dissection septum. Two illustrative cases are provided: a 56-year-old man with false lumen deployment of a frozen elephant trunk graft, and a 67-year-old man who underwent fenestrated endovascular aortic repair with a target branch vessel off the false lumen. In both cases, the septum was crossed using in situ laser fenestration. This technique is a precise option to enable passage between true and false lumens during endovascular repair of an aortic dissection.
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Affiliation(s)
- Alexander D. DiBartolomeo
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA
| | - Elizabeth Miranda
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA
| | - Sukgu M. Han
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA
| | - Gregory A. Magee
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA
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2
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Massmann A, Giebels C, Buecker A, Schäfers HJ, Fries P. Endovascular Rescue Aortic Fenestration After Accidental False Lumen TEVAR in Type B Dissection. J Endovasc Ther 2024; 31:151-156. [PMID: 35861466 DOI: 10.1177/15266028221112259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Unintended false-lumen thoracic endovascular aortic repair (TEVAR) is under-reported and often fatal. We present percutaneous endovascular rescue techniques for true-lumen reperfusion with strategies to address the peripheral artery perfusion needs unique to each case. CASE REPORT Two patients deteriorated 24 hours after uncomplicated and complicated acute aortic type-B dissection TEVAR treatment at a tertiary community hospital. Reevaluation of index and repeated imaging studies revealed inadvertent false-lumen TEVAR with severe visceral and peripheral ischemia. Stepwise subtraction angiography was used to confirm continuous true-lumen catheterization from femoral puncture into the thoracic aorta. Retrograde fenestration distal to the misplaced TEVAR from the true- into the false-lumen allowed for snorkeling by distal stent-extension across the dissection membrane. In one case, TEVAR stent graft extension resulted in true-lumen re-expansion and in the other case, bare-metal stent-extension for stabilization of the dissection membrane resulted in true-lumen re-expansion in addition to preservation of visceral and peripheral perfusion via the false-lumen. Despite excellent acute hemodynamic results and initial signs of recovery, both patients eventually died (multiorgan failure; cerebral hemorrhagic infarction). CONCLUSION Correct indication and prompt recognition of potential inadvertent false-lumen stenting is critical to avoid disastrous sequelae, for example, malperfusion. Endovascular salvage is feasible for restoration of correct perfusion and must be performed in a timely manner. CLINICAL IMPACT Clinically apparent, complicated type-B dissection necessitates instantaneous treatment. Prerequisite for an endovascular approach is a true-lumen guidewire continuously from access to the ascending aorta. DSA after TEVAR and prompt clinical re-evaluation are to verify effective visceral and peripheral restoration of blood flow. Despite these measures, inadvertent false-lumen TEVAR may occur rarely. Immediate recognition may allow for timely true-lumen re-expansion using percutaneous endovascular salvage techniques e.g. retrograde fenestration from the true- into the false-lumen for distal snorkeling of the misplaced TEVAR across the dissection membrane. However, morbidity and mortality are very high, if erroneous stent graft placement is not identified early.
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Affiliation(s)
- Alexander Massmann
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg, Germany
| | - Christian Giebels
- Clinic for Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg, Germany
| | - Arno Buecker
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg, Germany
| | - Hans-Joachim Schäfers
- Clinic for Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg, Germany
| | - Peter Fries
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg, Germany
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Witcher AC, Meers B, Lewis CT, Beck AW, Eudailey KW. Rescue of False Lumen Frozen Elephant Trunk Deployment Intraoperatively. Ann Thorac Surg 2023; 116:e5-e7. [PMID: 35932792 DOI: 10.1016/j.athoracsur.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 05/21/2022] [Accepted: 07/16/2022] [Indexed: 11/30/2022]
Abstract
Endovascular devices have become increasingly available, which has led to an increase in use of frozen elephant trunk stents for extended repair during type A aortic dissection. Frozen elephant trunk deployment is usually done under direct visualization of both the true and false lumen but rarely, the endograft can inadvertently end in the false lumen. This can lead to false lumen pressurization and end-organ malperfusion. Herein we describe a novel intraoperative rescue technique for misplaced frozen elephant trunk into the false lumen, easily executed in a standard operating room using transesophageal echocardiography and intravascular ultrasound guidance.
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Affiliation(s)
- Adam C Witcher
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Brad Meers
- Department of Anesthesiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Clifton T Lewis
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Adam W Beck
- Division of Vascular Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kyle W Eudailey
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
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4
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Fereydooni S, Amabile A, Nassiri N, Vallabhajosyula P. Trans-sternotomy, snare-assisted thoracic endovascular aortic repair for redirection of a migrated elephant trunk. J Vasc Surg Cases Innov Tech 2023; 9:101095. [PMID: 36852324 PMCID: PMC9958475 DOI: 10.1016/j.jvscit.2023.101095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/15/2022] [Indexed: 01/13/2023] Open
Abstract
The two-stage elephant trunk (ET) and thoracic endovascular aortic repair technique for type A and B aortic dissection can result in complications between the two stages. We have presented the case of a patient with an acute-on-chronic type B aortic dissection complicated by ET kinking and migration into the false lumen. We used a hybrid approach consisting of a first stage (retrograde thoracic endovascular aortic repair) and a second stage ("body floss" with antegrade thoracic endovascular aortic repair) to successfully reposition the ET back into the true lumen.
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Affiliation(s)
- Soraya Fereydooni
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
- Correspondence: Soraya Fereydooni, BS, Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, 333 Cedar St, New Haven, CT 06510
| | - Andrea Amabile
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Naiem Nassiri
- Division of Vascular and Endovascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
- The Aortic Institute at Yale-New Haven Hospital, New Haven, CT
| | - Prashanth Vallabhajosyula
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
- The Aortic Institute at Yale-New Haven Hospital, New Haven, CT
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5
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Okugi S, Koide M, Kunii Y, Tateishi M, Shimbori R, Moriuchi H, Hayashi M. Endovascular treatment after the fenestrated frozen elephant trunk technique. Clin Case Rep 2022; 10:e6595. [PMID: 36397854 PMCID: PMC9664544 DOI: 10.1002/ccr3.6595] [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: 08/24/2022] [Revised: 09/28/2022] [Accepted: 10/29/2022] [Indexed: 11/16/2022] Open
Abstract
Recently, several centers have performed total arch replacement using the fenestrated frozen elephant trunk technique for acute Stanford type‐A aortic dissection. However, the long‐term results and need for additional treatment following this procedure are unclear. We report a case of a 54‐year‐old man who underwent endovascular therapy for endoleaks after total arch replacement using the fenestrated frozen elephant trunk technique for acute type‐A aortic dissection with an isolated left vertebral artery. After the surgery, the endoleak was resolved, and the patient was asymptomatic with no neurological deficits. This strategy might be effective in similar cases. When endoleak occur after TAR using the fenestrated frozen elephant trunk technique in patients with rare anatomical subtypes, collaboration with other experts facilitates additional treatment.
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Affiliation(s)
- Satoshi Okugi
- Department of Cardiovascular Surgery Seirei Hamamatsu General Hospital Shizuoka Japan
| | - Masaaki Koide
- Department of Cardiovascular Surgery Seirei Hamamatsu General Hospital Shizuoka Japan
| | - Yoshifumi Kunii
- Department of Cardiovascular Surgery Seirei Hamamatsu General Hospital Shizuoka Japan
| | - Minori Tateishi
- Department of Cardiovascular Surgery Seirei Hamamatsu General Hospital Shizuoka Japan
| | - Risa Shimbori
- Department of Cardiovascular Surgery Seirei Hamamatsu General Hospital Shizuoka Japan
| | - Hiroki Moriuchi
- Department of Cardiovascular Surgery Seirei Hamamatsu General Hospital Shizuoka Japan
| | - Masataka Hayashi
- Department of Neurosurgery Seirei Hamamatsu General Hospital Shizuoka Japan
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6
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Takagi D, Wada T, Igarashi W, Kadohama T, Kiryu K, Arai T, Yamamoto H. Endovascular rescue for malpositioned frozen elephant trunk into the false lumen. J Card Surg 2021; 36:3948-3951. [PMID: 34310739 DOI: 10.1111/jocs.15846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/10/2021] [Accepted: 07/17/2021] [Indexed: 12/01/2022]
Abstract
We describe a case of frozen elephant trunk deployment unintentionally malpositioned into the false lumen. An 83-year-old man underwent total arch repair with a frozen elephant trunk for type A acute aortic dissection complicated by mesenteric malperfusion. However, intraoperative transesophageal echocardiography showed expansion of the false lumen in the descending aorta, suggesting a malpositioned frozen elephant trunk into the false lumen. Endovascular fenestration of the dissecting flap and subsequent endograft deployment from the inside of the malpositioned frozen elephant trunk graft to the true lumen of the descending aorta was successfully performed under intravascular ultrasound guidance.
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Affiliation(s)
- Daichi Takagi
- Department of Cardiovascular Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Takuya Wada
- Department of Cardiovascular Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Wataru Igarashi
- Department of Cardiovascular Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Takayuki Kadohama
- Department of Cardiovascular Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Kentaro Kiryu
- Department of Cardiovascular Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Takeshi Arai
- Department of Cardiovascular Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Hiroshi Yamamoto
- Department of Cardiovascular Surgery, Akita University Graduate School of Medicine, Akita, Japan
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7
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Ho JYK, Bashir M, Teh G, Jakob H, Wong RHL. Launching the E-vita Open Neo amid COVID-Challenges and strategies. J Card Surg 2021; 36:793-795. [PMID: 33554356 PMCID: PMC8014468 DOI: 10.1111/jocs.15197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 11/04/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Jacky Y K Ho
- Department of Surgery, Division of Cardiothoracic Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Mohamad Bashir
- Vascular & Endovascular Surgery, Royal Blackburn Teaching Hospital, Blackburn, UK
| | - Gloria Teh
- CryoLife, Inc, Asia-Pacific Region, Singapore
| | - Heinz Jakob
- Department of Thoracic and Cardiovascular Surgery, West German Heart Center Essen, University Hospital Essen, Essen, Germany
| | - Randolph H L Wong
- Department of Surgery, Division of Cardiothoracic Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
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8
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Ho JY, Chow SC, Kwok MW, Fujikawa T, Wong RH. Total Aortic Arch Replacement and Frozen Elephant Trunk. Semin Thorac Cardiovasc Surg 2021; 33:656-662. [DOI: 10.1053/j.semtcvs.2020.11.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 11/06/2020] [Indexed: 11/11/2022]
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9
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Chen JF, Mangi A, Vallabhajosyula P, Nassiri N. Snare-assisted thoracic endovascular aortic repair for redirection of a false lumen elephant trunk. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:566-570. [PMID: 33134644 PMCID: PMC7588806 DOI: 10.1016/j.jvscit.2020.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 08/05/2020] [Indexed: 11/25/2022]
Abstract
In recent years, a hybrid approach to the classic two-stage elephant trunk technique has come into favor for treatment of thoracic aortic dissection. During the first stage, inadvertent intraoperative placement of the elephant trunk into the false lumen can occur on rare occasions, resulting in untoward difficulties during the second stage of the procedure. We describe here a snare-assisted technique for endovascular salvage of an elephant trunk that had inadvertently been placed in the false lumen of a chronic aortic dissection.
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Affiliation(s)
- Julia Fayanne Chen
- Division of Vascular and Endovascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn.,Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine, New Haven, Conn
| | - Abeel Mangi
- Division of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Prashanth Vallabhajosyula
- Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine, New Haven, Conn.,Division of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Naiem Nassiri
- Division of Vascular and Endovascular Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn.,Aortic Institute at Yale New Haven Hospital, Yale University School of Medicine, New Haven, Conn
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10
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Raupach J, Chovanec V, Kozakova V, Vojacek J. Endovascular fenestration of aortic dissection membrane after failed frozen elephant trunk procedure. Eur J Cardiothorac Surg 2020; 57:598-600. [PMID: 31593219 DOI: 10.1093/ejcts/ezz251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/15/2019] [Accepted: 08/22/2019] [Indexed: 12/28/2022] Open
Abstract
We report a case of a 51-year-old male with complicated acute type A aortic dissection who initially underwent a supracoronary and aortic arch replacement using frozen elephant trunk technique. False-lumen perfusion was revealed later which resulted in the collapse of the true lumen. Endovascular fenestration of the dissection flap was performed. True-lumen reperfusion with false-lumen regression was achieved. Endovascular fenestration using a re-entry catheter represents an efficient and safe treatment approach for this rare but serious complication.
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Affiliation(s)
- Jan Raupach
- Department of Radiology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Vendelin Chovanec
- Department of Radiology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Veronika Kozakova
- Charles University Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Jan Vojacek
- Department of Cardiac Surgery, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
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11
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Tamai K, Hori D, Yuri K, Yamaguchi A. Additional frozen elephant trunk as a bailout for a misdeployed frozen elephant trunk in the false lumen in a patient with acute aortic dissection. Eur J Cardiothorac Surg 2020; 57:399-401. [PMID: 31364695 DOI: 10.1093/ejcts/ezz213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 06/21/2019] [Accepted: 06/28/2019] [Indexed: 11/13/2022] Open
Abstract
Using a frozen elephant trunk (FET) in patients with acute aortic dissection is an effective method to induce aortic remodelling after surgery. A 40-year-old man with Stanford type A acute aortic dissection underwent emergency total arch replacement with FET. The FET was inserted into the descending aorta under direct vision. However, transoesophageal echocardiography after the deployment of the FET revealed that it was misdeployed in the false lumen. An additional FET was deployed in the true lumen to redirect the blood flow to the true lumen. The patient was discharged from the hospital without any major complications. Computed tomography 6 months after surgery revealed enhanced aortic remodelling without any signs of stent graft-induced new entry. Additional deployment of a FET into the true lumen could be an option for a misdeployed FET in the false lumen.
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Affiliation(s)
- Koichi Tamai
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Daijiro Hori
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Koichi Yuri
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Atsushi Yamaguchi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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12
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Plotkin A, Hanks SE, Han SM, Fleischman F, Weaver FA, Magee GA. Endovascular septal fenestration using a radiofrequency wire to salvage inadvertent false lumen deployment of a frozen elephant trunk stent graft. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2019; 5:553-556. [PMID: 31799483 PMCID: PMC6883310 DOI: 10.1016/j.jvscit.2019.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 07/26/2019] [Indexed: 11/19/2022]
Abstract
We report a case of a frozen elephant trunk arch repair, where the stent graft was unintentionally placed into the false lumen. Postoperative imaging demonstrated an enlarged false lumen with no thoracic aorta fenestrations that could be traversed to place another thoracic endovascular aortic repair endograft into the true lumen. An atraumatic radiofrequency wire (PowerWire, Baylis Medical, Montreal, Quebec, Canada) was used to create a new septal fenestration, enabling thoracic endovascular aortic repair endograft extension into the thoracic true lumen. This novel use of a radiofrequency wire can enable safe and controlled endovascular septal fenestration even in chronic dissections to redirect flow into the true lumen.
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Affiliation(s)
- Anastasia Plotkin
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck Medical Center of USC, Los Angeles, Calif
| | - Sue E. Hanks
- Department of Radiology, University of Southern California, Keck Hospital, Los Angeles, Calif
| | - Sukgu M. Han
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck Medical Center of USC, Los Angeles, Calif
| | - Fernando Fleischman
- Division of Cardiothoracic Surgery, Department of Surgery, University of Southern California, Keck Hospital, Los Angeles, Calif
| | - Fred A. Weaver
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck Medical Center of USC, Los Angeles, Calif
| | - Gregory A. Magee
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck Medical Center of USC, Los Angeles, Calif
- Correspondence: Gregory A. Magee, MD, MSc, Assistant Professor of Surgery, Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck Hospital, 1520 San Pablo St, Ste 4300, Los Angeles, CA 90033
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13
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Fujikawa T, Yamamoto S, Oshima S, Ozaki K, Shimamura J, Asada H, Wong RHL. Open surgery for descending thoracic aorta in an endovascular era. J Thorac Cardiovasc Surg 2018; 157:2168-2174. [PMID: 30448162 DOI: 10.1016/j.jtcvs.2018.08.094] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 08/02/2018] [Accepted: 08/11/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Thoracic endovascular aortic repair has become the preferred treatment for a variety of descending thoracic aortic pathologies. However, there are unresolved issues such as morphologic appearance of chronic dissection, persistent false lumen perfusion, and adequacy of landing zone. Enthusiasm for improving the technique of open aortic repair and perioperative management is fading. In this study, we would like to demonstrate how we improve our surgical outcomes by establishing a dedicated aortic multidisciplinary team at the Kawasaki Aortic Center. METHOD We performed a single-center retrospective study from January 2015 to December 2016. All patients with open descending thoracic aortic replacement were recruited. Preoperative patient demographic data, bypass strategies, operative details, and postoperative outcomes were reviewed. RESULT From January 2015 to December 2016, we treated 168 cases of descending thoracic aortic repair using a left thoracotomy. Median age was 69.0 ± 21.8 years old, and 63.1% were aortic dissection (acute, 4.8%; chronic, 58.3%); 81.3% patients underwent elective operations. Left heart bypass, deep hypothermic circulatory arrest, and partial cardiopulmonary bypass were performed in 88.6%, 9.0%, and 2.4% of patients, respectively. Mean operative time was 312 ± 94 minutes. In-hospital mortality in total was 0.6%. The rate of transient spinal cord injury was 4.7%. CONCLUSIONS Under a dedicated aortic multidisciplinary team, we demonstrated that open descending thoracic aorta replacement can be performed with excellent early outcomes with low reintervention rates, regardless of the nature of the aortic pathologies.
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Affiliation(s)
- Takuya Fujikawa
- Kawasaki Aortic Center, Kawasaki Saiwai Hospital, Kawasaki, Japan; Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Shin Yamamoto
- Kawasaki Aortic Center, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Susumu Oshima
- Kawasaki Aortic Center, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Kensuke Ozaki
- Kawasaki Aortic Center, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | | | - Hiroaki Asada
- Kawasaki Aortic Center, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Randolph H L Wong
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China.
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14
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Aortic remodeling with frozen elephant trunk technique for Stanford type A aortic dissection using Japanese J-graft open stent graft. Heart Vessels 2018; 34:307-315. [PMID: 30191318 PMCID: PMC6510868 DOI: 10.1007/s00380-018-1246-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/17/2018] [Indexed: 10/29/2022]
Abstract
The frozen elephant trunk (FET) technique allows single-stage extended surgical repair of Stanford type A aortic dissection and has shown promotion of aortic remodeling by maintaining the true lumen flow and facilitating its expansion and by promoting false lumen thrombosis. However, few studies have compared the effectiveness of FET technique, in terms of the downstream aortic remodeling. Between 2005 and 2017, 50 patients underwent total arch replacement for Stanford type A aortic dissection, including that with (n = 22) and without FET technique (n = 28). We compared distal aortic remodeling in patients who underwent total arch replacement with (using a J-Graft open stent graft) or without the technique. The false lumen complete thrombosis rate and the ratio of true lumen area at three levels of the descending aorta were evaluated post operation. In FET group, the diameter and length of the stent graft were 29.0 ± 3.9 mm and 70.9 ± 17.4 mm, respectively. The in-hospital death with and without the FET technique was 0 and 3, respectively, with no late death in both groups. Eight patients (28.6%) only in the non-FET group required additional surgical treatment for downstream aorta. In the FET group, the ratio of true lumen area at the level of bronchial carina and false lumen complete thrombosis rate at the levels of bronchial carina and aortic valve were significantly higher than non-FET group. A more favorable remodeling in the descending aorta was observed in patients who underwent FET associated with a total arch replacement compared to those who underwent total arch replacement alone.
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15
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Experimental Evaluation of Endovascular Fenestration Scissors in an Ovine Model of Aortic Dissection. Eur J Vasc Endovasc Surg 2018; 56:373-380. [DOI: 10.1016/j.ejvs.2018.05.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 05/23/2018] [Indexed: 11/21/2022]
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