1
|
Kolvenbach R, Karmeli R, Rabin A, Lica R. Endovascular Hybrid Repair of True Ascending Aortic Aneurysms Using Double Graft Wrapping to Prepare a Landing Zone for Ascending Aortic Stent-Graft Placement: A Cohort Study. J Endovasc Ther 2019; 26:658-664. [PMID: 31198085 DOI: 10.1177/1526602819856075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To describe a hybrid procedure that avoids cardiopulmonary bypass to treat patients with true ascending aortic aneurysms without a suitable proximal landing zone for endovascular repair. Material and Methods: Thirteen consecutive patients (mean age 75.9±6.5 years; 8 women) with true ascending aortic aneurysms were treated with the endovascular hybrid repair of true aortic aneurysms (EHTA) approach, which consists of a conventional sternotomy with double wrapping of the ascending aorta followed by staged stent-graft placement. Via sternotomy, a polypropylene mesh trimmed to downsize the aneurysm is placed around the dilated ascending aorta and sutured to the adventitia. A similarly trimmed polytetrafluoroethylene graft is placed loosely around the first wrap to avoid adhesions and secure the proximal landing zone. There is no need for cardiopulmonary bypass. A few days later, a standard thoracic stent-graft is deployed via either a transaxillary or transfemoral access; chimney or bypass grafts are used as needed to revascularize the supra-aortic vessels. Results: The ascending aortic diameter was reduced from a mean 5.7 cm (range 4.8-6.5) to 3.9 cm (range 3.2-4.3) after wrapping. The mean interval between surgery and stent-graft placement was 5 days. In this interval, 2 patients with significant reduction in the diameter of the ascending aorta elected to forego placement of a stent-graft. Of the 11 patients who underwent the full hybrid EHTA procedure, the ascending aortic stent-graft was combined with a chimney graft in the innominate artery in 4 cases. In 1 patient, a supra-aortic debranching procedure using a bifurcated Dacron graft to the innominate and left common carotid arteries was performed after wrapping with the polypropylene mesh. There was no mortality or neurological complication. A sternal wound infection required a prolonged hospital stay. At a mean follow-up of 13.8 months (range 3-24), there has been no death, type I endoleak, or sign of aneurysm enlargement on imaging. Conclusion: This technique permits complete endovascular exclusion of an ascending aortic aneurysm in a less invasive approach than standard open repair. Although this is only a small cohort of patients without long-term follow-up, it seems that this hybrid procedure is associated with low morbidity and mortality. It offers a beating-heart approach to treat true ascending aortic aneurysms in selected high-risk patients.
Collapse
Affiliation(s)
- Ralf Kolvenbach
- Department of Vascular Surgery and Endovascular Therapy, Augusta Hospital, Catholic Hospital Group, Düsseldorf, Germany
| | | | | | - Raluca Lica
- Department of Vascular Surgery and Endovascular Therapy, Augusta Hospital, Catholic Hospital Group, Düsseldorf, Germany
| |
Collapse
|
2
|
Moriarty JM, Shah R, Hage AN, Srinivasa RN, Aboulhosn JA. Back-table Modified Aortic Endograft Deployed via "Innominate Bounce" Technique for Management of a Zone 0 Ascending Aortic Pseudoaneurysm. Ann Vasc Surg 2019; 59:307.e1-307.e5. [PMID: 31075458 DOI: 10.1016/j.avsg.2019.02.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 02/10/2019] [Accepted: 02/13/2019] [Indexed: 11/24/2022]
Abstract
Ascending aortic pseudoaneurysms pose a difficult therapeutic dilemma. Surgical repair carries high morbidity and mortality risk and may be challenging in patients with unfavorable anatomy or prior aortic surgery. Endovascular repair is difficult due to short landing zones, need for precise delivery, and the lack of adequately sized commercially available devices. This report describes a case of back-table modification of a thoracic aortic stent graft successfully deployed using an "innominate bounce" technique.
Collapse
Affiliation(s)
- John M Moriarty
- Department of Radiology, Division of Interventional Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Raj Shah
- University of Arizona College of Medicine, Tucson, AZ.
| | - Anthony N Hage
- Department of Radiology, Division of Interventional Radiology, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Ravi N Srinivasa
- Department of Radiology, Division of Interventional Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Jamil A Aboulhosn
- Department of Medicine, Division of Interventional Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| |
Collapse
|
3
|
Hsu HL, Huang CY, Chen PL, Chen YY, Hsu CP, Chen IM, Shih CC. Efficacy of ascending aortic banding technique concomitant with type I hybrid aortic arch repair in high-risk patients. Heart Vessels 2019; 34:1524-1532. [PMID: 30911784 DOI: 10.1007/s00380-019-01384-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 03/15/2019] [Indexed: 11/26/2022]
Abstract
Banding of the ascending aorta has been introduced as a less complex procedure to optimize the proximal landing zone of the stent graft in hybrid aortic arch surgery. However, data about the long-term results and effects of this technique are still limited. We aimed to study the efficacy of banding of the ascending aorta in hybrid aortic arch repair. The study included 11 high-risk patients with dilated ascending aorta (wider than 38 mm in diameter) undergoing ascending aortic banding for hybrid arch repair. Clinical outcomes, including technical success, endoleaks, perioperative mortality and morbidity, and sequential remodeling of the ascending aorta were investigated. The average diameter of the ascending aorta had been reduced (p = 0.02) from 42.1 mm (range = 39.0-46.4) to 37.2 mm (range = 35.6-38.6) after banding procedure. The technical success rate was 100.0%. No type I endoleak occurred, but 2 cases of distal stent graft-induced new entry required re-interventions. The 5-year survival and freedom from aortic events rates both were 81.8%. The ascending aortic diameter remained stable and no proximal migration of the stent graft was observed during the study period. The 5-year results validated the durability of this therapeutic modality, especially in high-risk patients.
Collapse
Affiliation(s)
- Hung-Lung Hsu
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Cardiovascular Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Surgery, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Chun-Yang Huang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, #201, Section 2, Shipai Road, Taipei, Taiwan
| | - Po-Lin Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, #201, Section 2, Shipai Road, Taipei, Taiwan
| | - Yin-Yin Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Surgery, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Chiao-Po Hsu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, #201, Section 2, Shipai Road, Taipei, Taiwan
| | - I-Ming Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, #201, Section 2, Shipai Road, Taipei, Taiwan
| | - Chun-Che Shih
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, #201, Section 2, Shipai Road, Taipei, Taiwan.
| |
Collapse
|
4
|
Takei Y, Hori T, Kanno Y, Shibasaki I, Fukuda H. Modified Total Arch Debranching TEVAR with Aberrant Left Vertebral Artery. Ann Vasc Dis 2018; 11:545-548. [PMID: 30637013 PMCID: PMC6326058 DOI: 10.3400/avd.cr.18-00043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Total arch debranching and thoracic endovascular repair of an aortic arch aneurysm with a left aberrant vertebral artery are rare procedures. A small artery is difficult to reconstruct and anastomose in a narrow thoracic space with a large aneurysm. We describe an 85-year-old man with a fusiform aortic arch aneurysm and left aberrant vertebral artery who underwent a hybrid procedure with reconstruction of the left aberrant vertebral artery at a surgical site in the neck. Postoperative computed tomography images confirmed exclusion of the aneurysm and patency of all arch vessels, including the left vertebral artery.
Collapse
Affiliation(s)
- Yusuke Takei
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Takayuki Hori
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Yasuyuki Kanno
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Ikuko Shibasaki
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Hirotsugu Fukuda
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan
| |
Collapse
|
5
|
Narita H, Komori K, Usui A, Yamamoto K, Banno H, Kodama A, Sugimoto M. Postoperative Outcomes of Hybrid Repair in the Treatment of Aortic Arch Aneurysms. Ann Vasc Surg 2016; 34:55-61. [DOI: 10.1016/j.avsg.2015.11.041] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 10/31/2015] [Accepted: 11/24/2015] [Indexed: 11/25/2022]
|
6
|
Chiang CH, Yeh ML, Chen WL, Kan CD. Apparatus for Comparison of Pullout Forces for Various Thoracic Stent Grafts at Varying Neck Angulations and Oversizes. Ann Vasc Surg 2015; 31:196-204. [PMID: 26597245 DOI: 10.1016/j.avsg.2015.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 10/07/2015] [Accepted: 10/11/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND The purpose of this study is to provide an apparatus for comparison of pullout forces for various thoracic stent grafts at varying neck angulations and oversizes. METHODS An in vitro platform capable of performing pullout tests was used on stent grafts in angulated silicone tubes designed for this study (0°, 45°, 90°, and 135° with a 32-mm inner diameter) in a temperature-controlled chamber (37 ± 2°C). Three commercial stent grafts with sizes commonly used in Taiwan (Valiant: 34, 36, 38, and 40 mm; Zenith TX2: 34, 36, 38, and 40 mm; and TAG: 34, 37, and 40 mm) were used, and each size was tested 8 times for each angulation condition. RESULTS The mean dislodgement forces (DFs) at 0° angulation within 10-20% oversize were approximately 22.7, 9.6, and 9.0 N for the Valiant, Zenith TX2, and TAG devices, respectively, whereas the mean DFs decreased by 46%, 38%, and 50% to 12.3, 5.9, and 4.5 N when the angulation reached 135°. Regression analysis shows that neck angulation was a significant factor for the Valiant and Zenith TX2 devices (P < 0.0001 and P < 0.0001, respectively) but not for the TAG device (P = 0.483). In addition, oversize and interactions between variables (angulation × oversize) exhibited significant effects on the DFs for all devices (P < 0.0001). CONCLUSIONS We successfully built up an apparatus for comparison of pullout forces for various thoracic stent grafts at varying neck angulations and oversizes. With the empirical comparative data of different brand stent grafts under various conditions shown and compared, our findings suggest that aortic neck angulation has a negative correlation with stent-graft fixation. To have better stent-graft fixation and seal in the aortic arch for thoracic endovascular aortic repair, a longer landing zone with cautiously selected oversize is a more suitable selection.
Collapse
Affiliation(s)
- Cheng-Hsien Chiang
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Ming-Long Yeh
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Ling Chen
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Chung-Dann Kan
- Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| |
Collapse
|
7
|
Ohira S, Watanabe T, Yaku H. Layered wrapping technique combined with oxidized cellulose and vascular prosthesis for effective haemostasis in aortic surgery. Interact Cardiovasc Thorac Surg 2014; 20:276-7. [PMID: 25415316 DOI: 10.1093/icvts/ivu396] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Bleeding from anastomotic sites is one of the major complications of aortic surgery. We describe a novel double-layer wrapping technique using a combination of oxidized cellulose and a vascular prosthesis to effectively achieve haemostasis. The anastomotic site is surrounded by a prosthetic graft inlaid with a strip of Nu-Knit. These are fixed by horizontal mattress and over-and-over sutures. Nu-Knit acts as an ideal cushion to achieve haemostasis, because it has a haemostatic effect and fills the space between the anastomotic site and wrapping graft. This technique is simple, and facilitates adequate haemostasis without complications.
Collapse
Affiliation(s)
- Suguru Ohira
- Division of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Taiji Watanabe
- Division of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hitoshi Yaku
- Division of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| |
Collapse
|
8
|
Dzsinich C, Vaszily M, Vallus G, Berek P, Barta L, Dzsinich M, Darabos G, Nyiri G, Szentpétery L, Pataki T, Nagy G. [Penetrating atheromatous ulcer of the thoracic aorta. Treatment options]. Orv Hetil 2014; 155:461-8. [PMID: 24631934 DOI: 10.1556/oh.2014.29846] [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: 11/19/2022]
Abstract
INTRODUCTIONS Atherosclerosis is a generalized degenerative disease of arteries. A rare manifestation of that is the penetrating atheromatous aortic ulceration of the aortic wall which may be complicated by subintimal hematoma, dissection, false aneurysm and rupture (acute aortic syndrome). AIM The aim of the authors was to analyse their experience with this rare disease. METHOD In the department of the authors 10,212 patients underwent surgery for cardiovascular diseases. Among these, 18 patients were diagnosed with penetrating atheromatous aortic ulceration located in the thoracic aorta (ascending aorta 2, aortic arch 8, descending aorta 6 and thoracoabdominal aorta 2 patients). Severe comorbidities were present in the majority of patients. RESULTS Depending on the localisation the authors used various treatment options such as open surgery (4 patients), hybrid techniques (7 patients) and pure endografting (7 patients). One patient died on postoperative day 3. Two patients had late complications due to endoleaks treated successfully by open surgery. CONCLUSIONS The authors conclude that when this dangerous condition detected in time, a wide variety of open, hybrid and endovascular methods can be applied with good results.
Collapse
Affiliation(s)
- Csaba Dzsinich
- MH Egészségügyi Központ Szív-, Ér- és Mellkas-Sebészeti Osztály Budapest Róbert Károly krt. 44. 1133
| | - Miklós Vaszily
- MH Egészségügyi Központ Szív-, Ér- és Mellkas-Sebészeti Osztály Budapest Róbert Károly krt. 44. 1133
| | - Gábor Vallus
- MH Egészségügyi Központ Szív-, Ér- és Mellkas-Sebészeti Osztály Budapest Róbert Károly krt. 44. 1133
| | - Péter Berek
- MH Egészségügyi Központ Szív-, Ér- és Mellkas-Sebészeti Osztály Budapest Róbert Károly krt. 44. 1133
| | - László Barta
- MH Egészségügyi Központ Szív-, Ér- és Mellkas-Sebészeti Osztály Budapest Róbert Károly krt. 44. 1133
| | - Máté Dzsinich
- MH Egészségügyi Központ Szív-, Ér- és Mellkas-Sebészeti Osztály Budapest Róbert Károly krt. 44. 1133
| | - Gábor Darabos
- MH Egészségügyi Központ Szív-, Ér- és Mellkas-Sebészeti Osztály Budapest Róbert Károly krt. 44. 1133
| | - Gabriella Nyiri
- MH Egészségügyi Központ Szív-, Ér- és Mellkas-Sebészeti Osztály Budapest Róbert Károly krt. 44. 1133
| | - László Szentpétery
- MH Egészségügyi Központ Szív-, Ér- és Mellkas-Sebészeti Osztály Budapest Róbert Károly krt. 44. 1133
| | - Tibor Pataki
- MH Egészségügyi Központ Szív-, Ér- és Mellkas-Sebészeti Osztály Budapest Róbert Károly krt. 44. 1133
| | - Gabriella Nagy
- MH Egészségügyi Központ Szív-, Ér- és Mellkas-Sebészeti Osztály Budapest Róbert Károly krt. 44. 1133
| |
Collapse
|