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Jin J, Bai J, Wu Y, Zhi K, Wang X, Wen X, Wu J, Qu L. A Novel Reverse Branch Technique for Reconstruction of a Renal Artery Perfused by the False Lumen After Thoracic Endovascular Aortic Repair. J Endovasc Ther 2017; 24:814-818. [PMID: 28814170 DOI: 10.1177/1526602817725265] [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: 11/15/2022]
Abstract
PURPOSE To describe an innovative endovascular technique that successfully reconstructs a renal artery completely perfused by the false lumen after thoracic endovascular aortic repair (TEVAR). CASE REPORT A 65-year-old patient diagnosed with acute Stanford type B aortic dissection underwent successful TEVAR 4 years ago. Regular follow-up found that the thoracic aorta was well repaired, but the false lumen in the abdominal aorta had enlarged year by year. The left renal artery was supplied entirely by the false lumen, which caused kidney hypoperfusion. The abdominal aorta was successfully remodeled using endovascular aneurysm repair with reconstruction of the left renal artery using Viabahn stent-grafts inserted through the patent false lumen. At 6 months, computed tomography showed false lumen thrombosis and patent Viabahn stent-grafts in the false lumen. CONCLUSION The false lumen reverse branch technique was feasible in our case, which provides a new idea for dealing with distal dissection involving the renovisceral arteries after TEVAR.
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Affiliation(s)
- Jie Jin
- 1 Department of Vascular and Endovascular Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jun Bai
- 1 Department of Vascular and Endovascular Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yongfa Wu
- 1 Department of Vascular and Endovascular Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Kangkang Zhi
- 1 Department of Vascular and Endovascular Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Xiaomin Wang
- 1 Department of Vascular and Endovascular Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Xingzhu Wen
- 1 Department of Vascular and Endovascular Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jianjin Wu
- 1 Department of Vascular and Endovascular Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Lefeng Qu
- 1 Department of Vascular and Endovascular Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
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Dzsinich C, Vaszily M, Vallus G, Dzsinich M, Berek P, Barta L, Darabos G, Nyiri G, Teknős D. ["Debranching" -- a new surgical option for the aortic arch and thoracoabdominal aorta hybrid interventions]. Magy Seb 2014; 67:353-61. [PMID: 25500642 DOI: 10.1556/maseb.67.2014.6.5] [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: 11/19/2022]
Abstract
INTRODUCTION Endovascular techniques in vascular surgery are frequently applied to treat aortic diseases. These minimally invasive procedures changed aortic interventions remarkably. We have to be familiar with new terminology and methods. METHOD New and old surgical procedures gained new role in preparation of endograft implantations. Transforming anatomy of aortic branches - "debranching" - is aimed to create a sufficient fixation of the endografts at safe "landing zones". CONCLUSIONS Knowing the option of hybrid procedures is a fundamental requirement for the vascular surgeon. Equally important is to know the biomechanical characteristics of the available endografts, the possible complications during and after implantation and the treatment options. We have to be aware of the limitations of these new methods and the role of traditional open surgery in the new era. Our intention in this paper is to summarize methods of debranching.
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Affiliation(s)
- Csaba Dzsinich
- MH Egészségügyi Központ Szív-, Ér- és Mellkassebészeti Osztály 1134 Budapest Róbert Károly körút 44
| | - Miklós Vaszily
- MH Egészségügyi Központ Szív-, Ér- és Mellkassebészeti Osztály 1134 Budapest Róbert Károly körút 44
| | - Gábor Vallus
- MH Egészségügyi Központ Szív-, Ér- és Mellkassebészeti Osztály 1134 Budapest Róbert Károly körút 44
| | - Máté Dzsinich
- MH Egészségügyi Központ Szív-, Ér- és Mellkassebészeti Osztály 1134 Budapest Róbert Károly körút 44
| | - Péter Berek
- MH Egészségügyi Központ Szív-, Ér- és Mellkassebészeti Osztály 1134 Budapest Róbert Károly körút 44
| | - László Barta
- MH Egészségügyi Központ Szív-, Ér- és Mellkassebészeti Osztály 1134 Budapest Róbert Károly körút 44
| | - Gábor Darabos
- MH Egészségügyi Központ Szív-, Ér- és Mellkassebészeti Osztály 1134 Budapest Róbert Károly körút 44
| | - Gabriella Nyiri
- MH Egészségügyi Központ Szív-, Ér- és Mellkassebészeti Osztály 1134 Budapest Róbert Károly körút 44
| | - Dániel Teknős
- MH Egészségügyi Központ Szív-, Ér- és Mellkassebészeti Osztály 1134 Budapest Róbert Károly körút 44
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Chung C, Malik R, Marin M, Faries P, Ellozy S. Staged hybrid open and endovascular exclusion of a symptomatic thoracoabdominal aortic aneurysm in a high-risk patient. Vascular 2013; 22:280-5. [PMID: 23929424 DOI: 10.1177/1708538113492515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Thoracoabdominal aortic aneurysms have a higher prevalence in the elderly, who are often poor surgical candidates. These extensive aneurysms may be lethal if left untreated. Conventional open repair has proven to be a major task, involving cardiopulmonary bypass, aortic cross-clamping and expeditious repair of an inaccessible structure involving two body cavities. Endovascular repair has become a viable option to treat isolated descending thoracic aneurysms and infrarenal abdominal aortic aneurysms. However, endovascular techniques alone have been less applicable for treating complex aortic aneurysms, including those involving visceral vessels. Therefore, a hybrid open and endovascular approach with visceral debranching has become an increasingly favorable alternative for patients with these complex conditions. We report a case in which a staged hybrid approach was used for successful exclusion of an extensive thoracoabdominal aortic aneurysm in a symptomatic, high-risk patient who would not have been an appropriate candidate for open surgical repair.
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Affiliation(s)
- Christine Chung
- Division of Vascular Surgery, Mount Sinai School of Medicine, New York, NY, USA
| | - Rajesh Malik
- Division of Vascular Surgery, Mount Sinai School of Medicine, New York, NY, USA
| | - Michael Marin
- Division of Vascular Surgery, Mount Sinai School of Medicine, New York, NY, USA
| | - Peter Faries
- Division of Vascular Surgery, Mount Sinai School of Medicine, New York, NY, USA
| | - Sharif Ellozy
- Division of Vascular Surgery, Mount Sinai School of Medicine, New York, NY, USA
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Moulakakis KG, Mylonas SN, Avgerinos ED, Kakisis JD, Brunkwall J, Liapis CD. Hybrid Open Endovascular Technique for Aortic Thoracoabdominal Pathologies. Circulation 2011; 124:2670-80. [DOI: 10.1161/circulationaha.111.041582] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Many authors using a hybrid debranching strategy for the treatment of thoracoabdominal pathologies have reported disappointing results and the initial enthusiasm for the technique has given way to criticism and ambiguity. The aim of the present meta-analysis study was to assess the safety and efficacy of the technique in patients with thoracoabdominal aortic aneurysms or other aortic pathologies.
Methods and Results—
A multiple electronic search was performed on all articles describing hybrid open endovascular repair. Separate meta-analyses were conducted for technical success, visceral graft patency, spinal cord ischemia symptoms, renal insufficiency, and other complications as well as 30-day/in-hospital mortality.
Nineteen publications with a total of 507 patients were analyzed. The pooled estimates for primary technical success and visceral graft patency were 96.2% (95% CI, 93.5%–98.2%) and 96.5% (95% CI, 95.2%–97.8%) respectively. A pooled rate of 7.5% (95% CI, 5.0%–11.0%) for overall spinal cord ischemia symptoms was observed; whereas for irreversible paraplegia the pooled rate was 4.5% (95% CI, 2.5%–7.0%). The pooled estimate for renal failure was 8.8% (95% CI, 3.9%–15.5%). The pooled 30-day/in-hospital mortality rate was 12.8% (95% CI, 8.6%–17.0%). During the mean follow-up period of 34.5 (95% CI, 31.5–37.5) months, a total of 119 endoleaks were identified in 111 patients (22.7%).
Conclusions—
The repair of thoracoabdominal pathologies by means of hybrid procedures in patients who are poor surgical candidates is still associated with significant morbidity and mortality rates. Future studies may substantiate whether the technique is amenable to amelioration and improvement.
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Affiliation(s)
- Konstantinos G. Moulakakis
- From the Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece (K.G.M., S.N.M., E.D.A., J.D.K., C.D.L.); and Department of Vascular Surgery, University Hospital, University of Cologne, Cologne, Germany (J.B.)
| | - Spyridon N. Mylonas
- From the Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece (K.G.M., S.N.M., E.D.A., J.D.K., C.D.L.); and Department of Vascular Surgery, University Hospital, University of Cologne, Cologne, Germany (J.B.)
| | - Efthimios D. Avgerinos
- From the Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece (K.G.M., S.N.M., E.D.A., J.D.K., C.D.L.); and Department of Vascular Surgery, University Hospital, University of Cologne, Cologne, Germany (J.B.)
| | - John D. Kakisis
- From the Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece (K.G.M., S.N.M., E.D.A., J.D.K., C.D.L.); and Department of Vascular Surgery, University Hospital, University of Cologne, Cologne, Germany (J.B.)
| | - Jan Brunkwall
- From the Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece (K.G.M., S.N.M., E.D.A., J.D.K., C.D.L.); and Department of Vascular Surgery, University Hospital, University of Cologne, Cologne, Germany (J.B.)
| | - Christos D. Liapis
- From the Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece (K.G.M., S.N.M., E.D.A., J.D.K., C.D.L.); and Department of Vascular Surgery, University Hospital, University of Cologne, Cologne, Germany (J.B.)
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