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Milligan JM, Dayama A, El Sayed HF, Panneton JM. Current technology for endovascular repair of the aortic arch. ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2020. [DOI: 10.23736/s1824-4777.20.01451-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Oishi Y, Sonoda H, Ushijima T, Kimura S, Tatewaki H, Tanoue Y, Shiose A. Single-stage hybrid total arch replacement for extended arch aneurysms. J Vasc Surg 2019; 69:1719-1725. [DOI: 10.1016/j.jvs.2018.08.184] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 08/07/2018] [Indexed: 11/16/2022]
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Yu B, Liu Z, Xue C, Liu J, Yang J, Jin Z, Yu S, Duan W. Total arch repair with open placement of a novel double-branched stent graft for acute Type A aortic dissection: a single-centre experience with 21 consecutive patients. Interact Cardiovasc Thorac Surg 2018; 28:262-269. [PMID: 30084994 DOI: 10.1093/icvts/ivy243] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 06/27/2018] [Indexed: 01/12/2023] Open
Affiliation(s)
- Bo Yu
- Department of Cardiovascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, China
| | - ZhenHua Liu
- Department of Cardiovascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Chao Xue
- Department of Cardiovascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, China
| | - JinCheng Liu
- Department of Cardiovascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Jian Yang
- Department of Cardiovascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, China
| | - ZhenXiao Jin
- Department of Cardiovascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, China
| | - ShiQiang Yu
- Department of Cardiovascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, China
| | - WeiXun Duan
- Department of Cardiovascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, China
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Early results of total arch replacement under partial sternotomy. Gen Thorac Cardiovasc Surg 2018; 66:327-333. [PMID: 29600320 DOI: 10.1007/s11748-018-0913-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 03/26/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Partial sternotomy with limited skin incision has been utilized for cardiac surgery. We, therefore, started to apply the partial sternotomy for total arch replacement since 2013 in selected cases. The aim of this study reported the results of our early experiences. METHODS Between July 2013 and December 2015, we retrospectively reviewed 15 cases (median age 72, range 67-84, 15 male) who underwent total arch replacement thorough partial sternotomy. All procedures were performed under hypothermic circulatory arrest with selective cerebral perfusion. RESULTS Median skin incision was 9 cm (range 7-15 cm, 5.3% of height) and partial sternotomy consisted of 14 upper and 1 lower partial sternotomy (L shape 8 and T shape 7 cases). Median operation time, cardiopulmonary bypass time, ischemic heart time, selective cerebral perfusion time and hypothermic circulatory arrest time were 485 [360-770], 223 [1174-270], 146 [100-163], 154 [116-189], and 69 [45-90] minutes, respectively. Median duration of mechanical ventilator dependent time was 12 h [5-38]. Median length of ICU stay and hospital stay were 3 [1-7], and 18 [13-76] days, respectively. Thirty days and in-hospital mortality were 0% without any neurological complications. There are two aorta-related reoperation due to graft inducing hemolytic anemia and no aorta-related death during follow-up (median 954, range 702-1462 days). CONCLUSION The early results of total arch replacement through partial sternotomy were satisfactory. The partial sternotomy could be a good option for total arch replacement in selected patients.
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Andrási TB, Grossmann M, Zenker D, Danner BC, Schöndube FA. Supra-aortic interventions for endovascular exclusion of the entire aortic arch. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2017.04.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Yoshitake A, Okamoto K, Yamazaki M, Kimura N, Hirano A, Iida Y, Abe T, Shimizu H. Comparison of aortic arch repair using the endovascular technique, total arch replacement and staged surgery†. Eur J Cardiothorac Surg 2017; 51:1142-1148. [DOI: 10.1093/ejcts/ezx028] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 01/10/2017] [Indexed: 11/12/2022] Open
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Der Aortenbogen – was ist bei der endovaskulären Versorgung zu beachten? GEFASSCHIRURGIE 2016. [DOI: 10.1007/s00772-016-0164-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Liebrich M, Voth V, Hupp T, Richter GM, Doll KN, Hemmer W. Aortenbogenchirurgie. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2016. [DOI: 10.1007/s00398-016-0084-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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9
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Goldfinger JZ, Halperin JL, Marin ML, Stewart AS, Eagle KA, Fuster V. Thoracic aortic aneurysm and dissection. J Am Coll Cardiol 2015; 64:1725-39. [PMID: 25323262 DOI: 10.1016/j.jacc.2014.08.025] [Citation(s) in RCA: 230] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 08/26/2014] [Accepted: 08/26/2014] [Indexed: 11/27/2022]
Abstract
Aortic dissection is the most devastating complication of thoracic aortic disease. In the more than 250 years since thoracic aortic dissection was first described, much has been learned about diseases of the thoracic aorta. In this review, we describe normal thoracic aortic size; risk factors for dissection, including genetic and inflammatory conditions; the underpinnings of genetic diseases associated with aneurysm and dissection, including Marfan syndrome and the role of transforming growth factor beta signaling; data on the role for medical therapies in aneurysmal disease, including beta-blockers, angiotensin receptor blockers, and angiotensin-converting enzyme inhibitors; prophylactic surgery for aneurysm; surgical techniques for the aortic root; and surgical and endovascular management of aneurysm and dissection for different aortic segments.
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Affiliation(s)
- Judith Z Goldfinger
- Department of Medicine, Division of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jonathan L Halperin
- Department of Medicine, Division of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michael L Marin
- Department of Surgery, Division of Vascular Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Allan S Stewart
- Department of Cardiothoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kim A Eagle
- Department of Medicine, Samuel and Jean A. Frankel Cardiovascular Center, University of Michigan Health System and Medical School, Ann Arbor, Michigan
| | - Valentin Fuster
- Department of Medicine, Division of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, New York.
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Sim HT, Beom MS, Kim SR, Ryu SW. Acute thrombotic occlusion of left internal jugular vein compressed by bypass graft for thoracic endovascular aortic repair debranching procedure. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2015; 47:552-5. [PMID: 25551080 PMCID: PMC4279840 DOI: 10.5090/kjtcs.2014.47.6.552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 02/11/2014] [Accepted: 02/17/2014] [Indexed: 11/25/2022]
Abstract
Thoracic endovascular aortic repair has become a widespread alternative treatment option for thoracic aortic aneurysm. The debranching of arch vessels may be required to provide an acceptable landing zone for an endovascular stent graft. We report a case where the bypass graft used in the thoracic endovascular aortic repair procedure compressed the left internal jugular vein, causing acute thrombotic occlusion.
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Affiliation(s)
- Hyung Tae Sim
- Department of Thoracic and Cardiovascular Surgery, Saint Carollo General Hospital
| | - Min Sun Beom
- Department of Thoracic and Cardiovascular Surgery, Saint Carollo General Hospital
| | - Sung Ryong Kim
- Department of Thoracic and Cardiovascular Surgery, Saint Carollo General Hospital
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Abstract
BACKGROUND The treatment of patients with aneurysms of the ascending aorta and aortic arch often represents a challenge due to their complexity. The clinical picture is characterized by further progression of the disease and severe complications, such as acute aortic dissection or even aortic rupture are not uncommon. OBJECTIVES This article gives a review of definitions, etiology and indications for operative treatment of patients with aneurysms of the ascending aorta and aortic arch. RESULTS AND DISCUSSION An aortic aneurysm of the ascending aorta is defined as a dilatation of all wall layers of the aorta of more than 50 % in comparison to the normal diameter. This is dependent on age, sex, body surface area and the underlying diseases. In most cases the cause is the presence of atherosclerosis. Connective tissue diseases, bicuspid or monocuspid aortic valves and aortitis represent additional risk factors. Surgical treatment of the ascending aorta, aortic root and aortic arch is carried out in patients without connective tissue diseases and a diameter of ≥ 55 mm and for patients with Marfan syndrome and bicuspid aortic valves with a diameter of ≥ 50 mm. Earlier indications for surgery are present with an aortic diameter of ≥ 45 mm in patients with the following risk factors: familial disposition for aortic dissection (often unrecognized as sudden cardiac death), annual growth rate of the aortic diameter of > 2 mm, comorbid severe aortic valve or mitral valve insufficiency and female patients with a desire to have children. The standard surgical procedures include aortic root replacement, aortic valve reconstruction with aortic root or ascending aorta replacement and partial or total aortic arch replacement depending on the extent of the aneurysm. The so-called hybrid procedures for aortic arch surgery include frozen elephant trunk (ET) techniques and debranching procedures. Good perioperative and postoperative results can be achieved by early diagnostics and an assessment of the indications depending on the individual etiology. Individual and valve-preserving treatment strategies have a favorable influence on the operative outcome.
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Affiliation(s)
- S Leontyev
- Klinik für Herzchirurgie, Herzzentrum, Universität Leipzig, Strümpellstr. 39, 04289, Leipzig, Deutschland,
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Chen LW, Wu XJ, Dai XF, Lu L, Liao DS, Li C, Li QZ. Total arch repair for acute type A aortic dissection with open placement of a modified triple-branched stent graft and the arch open technique. J Cardiothorac Surg 2014; 9:135. [PMID: 25085259 PMCID: PMC4445643 DOI: 10.1186/s13019-014-0135-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 07/17/2014] [Indexed: 11/12/2022] Open
Abstract
Background In total arch repair with open placement of a triple-branched stent graft for acute type A aortic dissection, the diameters of the native arch vessels and the distances between 2 neighboring arch vessels did not always match the available sizes of the triple-branched stent grafts, and insertion of the triple-branched stent graft through the distal ascending aortic incision was not easy in some cases. To reduce those two problems, we modified the triple-branched stent graft and developed the arch open technique. Methods and results Total arch repair with open placement of a modified triple-branched stent graft and the arch open technique was performed in 25 consecutive patients with acute type A aortic dissection. There was 1 surgical death. Most survivors had an uneventful postoperative course. All implanted stents were in a good position and wide expansion, there was no space or blood flow surrounding the stent graft. Complete thrombus obliteration of the false lumen was found around the modified triple-branched stent graft in all survivors and at the diaphragmatic level in 20 of 24 patients. Conclusions The modified triple-branched stent graft could provide a good match with the different diameters of the native arch vessels and the various distances between 2 neighboring arch vessels, and it’s placement could become much easier by the arch open technique. Consequently, placement of a modified triple-branched stent graft could be easily used in most patients with acute type A aortic dissection for effective total arch repair.
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Affiliation(s)
- Liang-Wan Chen
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, 350001, China.
| | - Xi-Jie Wu
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, 350001, China.
| | - Xiao-Fu Dai
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, 350001, China.
| | - Lin Lu
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, 350001, China.
| | - Dong-Shan Liao
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, 350001, China.
| | - Chao Li
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, 350001, China.
| | - Qian-Zhen Li
- Department of Cardiac Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, 350001, China.
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Chiesa R, Bertoglio L, Rinaldi E, Tshomba Y. Hybrid repair of aortic arch pathology. Multimed Man Cardiothorac Surg 2014; 2014:mmu003. [PMID: 24876520 DOI: 10.1093/mmcts/mmu003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The objective was to evaluate a 13-year single-centre experience of arch endovascular aortic repair using the hybrid approach. Between 1999 and 2013, 491 patients were treated with endografts for thoracic aortic pathologies. The aortic arch was involved in 179 (36.5%) patients (128 men; mean age 70.2 ± 10.8 years, range 27-84). A hybrid approach was performed for all Zone 0 and 1 procedures and in nearly half of Zone 2 procedures. Early and mid-term outcomes were reviewed retrospectively. Overall primary technical success (24 h) was achieved in 162 (90.5%) of the 179 cases; 2 deaths and 15 Type 1 endoleaks were observed. Clinical success at 30 days was achieved in 161 (89.9%) of the 179 patients, with a mortality rate of 4.5% (8/179). Short-term clinical success at 6 months was achieved in 169 (94.4%) of the 179 patients; the rates for the different landing zones did not differ significantly. At a mean follow-up of 27.3 ± 15.7 months (range 1-94), the mid-term clinical success was 165 (92.2%) of the 179 patients; the rates among the different proximal zones did not differ significantly. In selected patients, early and mid-term outcomes of arch endovascular aortic repair using the hybrid approach are promising; however, mortality and morbidity are not negligible. Our results may have practical implications for the ongoing evaluation of the hybrid procedure in the aortic arch, as well as for patients fit for traditional surgery.
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Affiliation(s)
- Roberto Chiesa
- 'Vita-Salute' University, Scientific Institute H. San Raffaele, Milan, Italy
| | - Luca Bertoglio
- 'Vita-Salute' University, Scientific Institute H. San Raffaele, Milan, Italy
| | - Enrico Rinaldi
- 'Vita-Salute' University, Scientific Institute H. San Raffaele, Milan, Italy
| | - Yamume Tshomba
- 'Vita-Salute' University, Scientific Institute H. San Raffaele, Milan, Italy
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Iba Y, Minatoya K, Matsuda H, Sasaki H, Tanaka H, Oda T, Kobayashi J. How should aortic arch aneurysms be treated in the endovascular aortic repair era? A risk-adjusted comparison between open and hybrid arch repair using propensity score-matching analysis. Eur J Cardiothorac Surg 2014; 46:32-9. [DOI: 10.1093/ejcts/ezt615] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kasprzak P, Pfister K, Janotta M, Kopp R. EndoAnchor Placement in Thoracic and Thoracoabdominal Stent-Grafts to Repair Complications of Nonalignment. J Endovasc Ther 2013; 20:471-80. [DOI: 10.1583/12-4125.1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Janczak D, Krajewska M, Garcarek J, Gancarek J, Chabowski M. Hybrid approach in an acute type B aortic dissection in a female patient after having a renal transplant. EXP CLIN TRANSPLANT 2013; 12:156-8. [PMID: 23647485 DOI: 10.6002/ect.2013.0006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This study describes our experiences with a 44-year-old woman who developed acute type B aortic dissection and elected emergency surgery 3 years after a renal transplant. This led to acute ischemia in the right lower extremity. The first stage of surgery was to implant an extra-anatomic (pretracheal) bypass with a GORE-TEX prosthesis from the brachiocephalic trunk to the left common carotid artery. The second stage was implanting a stent graft into the aortic arch that covered the left common carotid artery and the left subclavian artery. The third stage was to insert a stent graft that involved the entire thoracic aorta and proximal segment of the abdominal aorta to the celiac trunk, with the right axillary and left femoral approach. The fourth stage was an extra-anatomic (suprapubic) bypass with the GORE-TEX prosthesis from the left femoral artery to the right femoral artery. Surgery resulted in normal blood supply to the organs and restored renal function.
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Affiliation(s)
- Dariusz Janczak
- Department of Clinical Proceedings, Facilty of Health Science, Wroclaw Medical University, Wroclaw, Poland
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Preventza O, Bakaeen FG, Cervera RD, Coselli JS. Deployment of proximal thoracic endograft in zone 0 of the ascending aorta: treatment options and early outcomes for aortic arch aneurysms in a high-risk population. Eur J Cardiothorac Surg 2013; 44:446-52; discussion 452-3. [PMID: 23515170 DOI: 10.1093/ejcts/ezt068] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Open repair of aortic arch aneurysms can be technically challenging. Hybrid approaches have been developed to facilitate arch repairs and improve their clinical outcomes in high-risk patients. We examined treatment options and early outcomes in patients whose thoracic endografts were deployed to include Zone 0. METHODS Between 2005 and 2011, a hybrid approach in which the endograft was deployed in the ascending aorta was used in 29 patients (median age 67 years, range 32-85 years). The indication for surgery was saccular arch aneurysm in 11 patients (37.9%), fusiform arch aneurysm with or without involvement of the proximal descending aorta in 10 (34.5%), proximal Type I endoleak after endovascular repair of the descending aorta in 5 (17.2%), chronic Type III (Type B) aortic dissection with aneurysmal arch formation in 2 (6.9%) and acute Type I (Type A) dissection with prior repair of an extent I thoracoabdominal aneurysm in 1 (3.4%). Six patients (20.7%) had previously undergone a sternotomy. One-, two- or three-branch aortobrachiocephalic de-branching, with or without concomitant heart surgery, was performed in 28 patients and extra-anatomic bypass in 1. RESULTS Two patients (6.9%) died during postoperative hospitalization. Overall survival during the follow-up period (median 411 days) was 79.3%. Five neurological events occurred: one extensive stroke, two minor strokes (10.3%) and two episodes of paraparesis (6.9%), one with partial recovery and one with full recovery. CONCLUSIONS The hybrid approach enables the treatment of aortic arch disease in high-risk individuals. Long-term follow-up data are needed.
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Affiliation(s)
- Ourania Preventza
- Department of Cardiovascular Surgery, The Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, TX 77030, USA.
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Systematic review of clinical outcomes in hybrid procedures for aortic arch dissections and other arch diseases. J Thorac Cardiovasc Surg 2012; 144:1286-300, 1300.e1-2. [DOI: 10.1016/j.jtcvs.2012.06.013] [Citation(s) in RCA: 141] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 05/20/2012] [Accepted: 06/08/2012] [Indexed: 11/21/2022]
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Shahverdyan R, Gawenda M, Brunkwall J. Triple-barrel graft as a novel strategy to preserve supra-aortic branches in arch-TEVAR procedures: clinical study and systematic review. Eur J Vasc Endovasc Surg 2012; 45:28-35. [PMID: 23123094 DOI: 10.1016/j.ejvs.2012.09.023] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2012] [Accepted: 09/30/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To report our early experience with total endovascular repair of aortic-arch aneurysm using double chimney-grafts and present a literature overview. PATIENTS AND METHODS The double chimney-graft technique was performed in six male patients with contained ruptured aneurysm, dissecting aneurysm, pseudoaneurysm, penetrating aortic ulcer and proximal endoleak after TEVAR. Furthermore, a systematic electronic health database search of available articles was conducted according to PRISMA Guidelines. RESULTS In all cases, all supra-aortic vessels had to be covered with aortic stent-graft to receive a sufficient landing and sealing zone. Chimney-grafts were introduced to the ascending aorta slightly deeper than the thoracic stent-grafts through the cut-down exposure of the common carotid arteries. We deployed aortic stent-grafts and self-expandable chimney-grafts simultaneously and successfully. The patient with contained ruptured aneurysm died due to cardiopulmonary failure on day 19, the others survived. We detected two 'gutter' endoleaks. As a result of literature search, 12 articles met the inclusion criteria. Two articles described the double-chimney technique. CONCLUSIONS The use of double chimney-grafts is possible in high-risk patients where the proximal landing zone of endograft would be in zone 0. The available data is still limited. The long-term follow-up remains to be evaluated with the increased number of patients treated.
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Affiliation(s)
- R Shahverdyan
- Department of Vascular Surgery, University Hospital of Cologne, Kerpener Str. 62, D-50937 Cologne, Germany.
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Behandlung akuter und chronischer Erkrankungen des Aortenbogens. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2012. [DOI: 10.1007/s00398-012-0912-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Roldan CJ. Penetrating Atherosclerotic Ulcerative Disease of the Aorta: Do Emergency Physicians Need to Worry? J Emerg Med 2012; 43:196-203. [DOI: 10.1016/j.jemermed.2011.01.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Revised: 10/08/2010] [Accepted: 01/03/2011] [Indexed: 11/16/2022]
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Murashita T, Matsuda H, Domae K, Iba Y, Tanaka H, Sasaki H, Ogino H. Less invasive surgical treatment for aortic arch aneurysms in high-risk patients: A comparative study of hybrid thoracic endovascular aortic repair and conventional total arch replacement. J Thorac Cardiovasc Surg 2012; 143:1007-13. [PMID: 21783209 DOI: 10.1016/j.jtcvs.2011.06.024] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 05/16/2011] [Accepted: 06/27/2011] [Indexed: 11/26/2022]
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Lotfi S, Clough RE, Ali T, Salter R, Young CP, Bell R, Modarai B, Taylor P. Hybrid Repair of Complex Thoracic Aortic Arch Pathology: Long-Term Outcomes of Extra-anatomic Bypass Grafting of the Supra-aortic Trunk. Cardiovasc Intervent Radiol 2012; 36:46-55. [DOI: 10.1007/s00270-012-0383-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Accepted: 03/25/2012] [Indexed: 10/28/2022]
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Hybrid repair of thoracic aortic lesions for zone 0 and 1 in high-risk patients. J Vasc Surg 2012; 55:318-25. [DOI: 10.1016/j.jvs.2011.08.042] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Revised: 08/24/2011] [Accepted: 08/24/2011] [Indexed: 11/20/2022]
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Own Clinical Observations of Treatment Outcome in Acute Type B Aortic Dissection. POLISH JOURNAL OF SURGERY 2012; 84:23-30. [DOI: 10.2478/v10035-012-0004-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Desai ND, Pochettino A, Szeto WY, Moser GW, Moeller PJ, Sodhi N, Jackson B, Woo E, Fairman RM, Bavaria J. Thoracic endovascular aortic repair: Evolution of therapy, patterns of use, and results in a 10-year experience. J Thorac Cardiovasc Surg 2011; 142:587-94. [DOI: 10.1016/j.jtcvs.2011.02.050] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Revised: 01/03/2011] [Accepted: 02/09/2011] [Indexed: 11/30/2022]
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Kulik A, Castner CF, Kouchoukos NT. Outcomes After Total Aortic Arch Replacement With Right Axillary Artery Cannulation and a Presewn Multibranched Graft. Ann Thorac Surg 2011; 92:889-97. [DOI: 10.1016/j.athoracsur.2011.04.067] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Revised: 04/12/2011] [Accepted: 04/15/2011] [Indexed: 10/17/2022]
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Geisbüsch P, Katzen BT, Moreno N, Benenati JF, Powell A, Tsoukas AI, Garcia L. Simultaneous Complete Supraaortic Debranching and Thoracic Aortic Endografting in an Angiography Suite Setting. J Vasc Interv Radiol 2011; 22:1001-5. [DOI: 10.1016/j.jvir.2011.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Revised: 03/21/2011] [Accepted: 03/23/2011] [Indexed: 11/25/2022] Open
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29
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Double-chimney technology for treating secondary type I endoleak after endovascular repair for complicated thoracic aortic dissection. J Vasc Surg 2011; 54:212-5. [DOI: 10.1016/j.jvs.2010.11.120] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Revised: 11/17/2010] [Accepted: 11/27/2010] [Indexed: 11/19/2022]
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30
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Maleux G, Vaninbroukx J, Heye S. Failed surgical ligation of the proximal left subclavian artery during hybrid thoracic endovascular aortic repair successfully managed by percutaneous plug or coil occlusion: a report of 3 cases. J Cardiothorac Surg 2011; 6:45. [PMID: 21477301 PMCID: PMC3090327 DOI: 10.1186/1749-8090-6-45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Accepted: 04/08/2011] [Indexed: 11/28/2022] Open
Abstract
Open surgical rerouting and proximal ligation of one or more supra-aortic vessels prior to endovascular stent-graft placement has become an alternative to major open thoracic surgery in the treatment of complex thoracic aortic disease. Complications owing to failed surgical ligation of the left subclavian artery are rare. In this report, 3 cases of failed ligation are presented. Diagnosis was made by CT-scan and treatment was performed by transcatheter coil and plug embolization, avoiding redo neck surgery.
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Affiliation(s)
- Geert Maleux
- Department of Radiology, University Hospitals Leuven, Belgium.
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31
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Geisbüsch P, Kotelis D, Müller–Eschner M, Hyhlik-Dürr A, Böckler D. Complications after aortic arch hybrid repair. J Vasc Surg 2011; 53:935-41. [DOI: 10.1016/j.jvs.2010.10.053] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Revised: 10/01/2010] [Accepted: 10/01/2010] [Indexed: 11/27/2022]
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Antoniou G, Mireskandari M, Bicknell C, Cheshire N, Gibbs R, Hamady M, Wolfe J, Jenkins M. Hybrid Repair of the Aortic Arch in Patients with Extensive Aortic Disease. Eur J Vasc Endovasc Surg 2010; 40:715-21. [DOI: 10.1016/j.ejvs.2010.08.024] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Accepted: 08/29/2010] [Indexed: 11/24/2022]
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Ma X, Guo W, Liu X, Yin T, Jia X, Xiong J, Zhang H, Wang L. Hybrid endovascular repair in aortic arch pathologies: a retrospective study. Int J Mol Sci 2010; 11:4687-96. [PMID: 21151464 PMCID: PMC3000108 DOI: 10.3390/ijms11114687] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Revised: 11/07/2010] [Accepted: 11/10/2010] [Indexed: 12/02/2022] Open
Abstract
The aortic arch presents specific challenges to endovascular repair. Hybrid repair is increasingly evolving as an alternative option for selected patients, and promising initial results have been reported. The aim of this study was to introduce our experiences and evaluate mid-term results of supra aortic transpositions for extended endovascular repair of aortic arch pathologies. From December 2002 to January 2008, 25 patients with thoracic aortic aneurysms and dissections involving the aortic arch were treated with hybrid endovascular treatment in our center. Of the 25 cases, 14 were atherosclerotic thoracic aortic aneurysms and 11 were thoracic aortic dissection. The hybrid repair method included total-arch transpositions (15 cases) or hemi-arch transpositions (10 cases), and endovascular procedures. All hybrid endovascular procedures were completed successfully. Three early residual type-I endoleaks and one type-II endoleak were observed. Stroke occurred in three patients (8%) during the in-hospital stage. The perioperative mortality rate was 4%; one patients died post-operatively from catheter related complications. The average follow-up period was 15 ± 5.8 months (range, 1–41 months). The overall crude survival rate at 15 months was 92% (23/25). During follow-up, new late endoleaks and stent-raft related complications were not observed. One case (4%) developed a unilateral lower limb deficit at 17 days and was readmitted to hospital. In conclusion, the results are encouraging for endovascular aortic arch repair in combination with supra-aortic transposition in high risk cases. Aortic endografting offers good mid-term results. Mid-term results of the hybrid approach in elderly patients with aortic arch pathologies are satisfying.
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Affiliation(s)
- Xiaohui Ma
- Department of Vascular Surgery, Clinical Division of Surgery, Chinese People Liberation Army (PLA) General Hospital and Postgraduate Medical School. 28 Fuxing Road, Beijing 100853, China; E-Mails: (X.M.); (X.L.); (T.Y.); (X.J.); (J.X.); (H.Z.); (L.W.)
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34
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Antoniou G, El Sakka K, Hamady M, Wolfe J. Hybrid Treatment of Complex Aortic Arch Disease with Supra-aortic Debranching and Endovascular Stent Graft Repair. Eur J Vasc Endovasc Surg 2010; 39:683-90. [PMID: 20227895 DOI: 10.1016/j.ejvs.2010.02.002] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Accepted: 02/03/2010] [Indexed: 10/19/2022]
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Geisbüsch P, Kotelis D, Hyhlik-Dürr A, Hakimi M, Attigah N, Böckler D. Endografting in the aortic arch - does the proximal landing zone influence outcome? Eur J Vasc Endovasc Surg 2010; 39:693-9. [PMID: 20452789 DOI: 10.1016/j.ejvs.2010.03.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Accepted: 03/12/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To analyse early and midterm results of thoracic aortic endografting (TEVAR) in the aortic arch. METHODS Between January 1997 and February 2009 178 patients received TEVAR in the aortic arch at our institution. This population was subdivided into four groups according to the proximal landing zone (LZ) classification in the aortic arch by Ishimaru et al. and a retrospective analysis regarding perioperative mortality, morbidity and endoleak formation was performed. RESULTS The overall 30-day mortality rate was 14% with no statistical significant difference between LZ's 0-3 (p=0.274). Renal insufficiency (hazard ratio (HR) 2.5; p=0.0119), age >75 years (HR 3.1; p=0.0019) and emergency procedures (HR 8.9; p < 0.0001) were independent predictors of death. There was no significant difference regarding type I (p=0.07) or type III (p=0.49) endoleaks between the proximal LZs, but a significant difference regarding the development of type II endoleaks (p=0.01). CONCLUSIONS The present study showed no influence of the proximal LZ on perioperative mortality and morbidity rate. Furthermore it did not influence relevant (type I/III) endoleak formation.
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Affiliation(s)
- P Geisbüsch
- Department of Vascular and Endovascular Surgery, Ruprecht - Karls University Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
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36
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Kim GS, Lee TY, Kim JB, Lee SH, Kim HJ, Cho WC. Treating a Ruptured Ascending Aorta with an Endovascular Stent Graft. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2010. [DOI: 10.5090/kjtcs.2010.43.1.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Gwan-Sic Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Taek-Yeon Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Joon-Bum Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Seung-Hyun Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Hee-Jung Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Won-Chul Cho
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
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37
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Dumfarth J, Gottardi R, Holfeld J, Schoder M, Dziodzio T, Juraszek A, Hoebartner M, Laufer G, Grimm M, Czerny M. Translocation of the supra-aortic vessels and stent grafting of the aortic arch. Multimed Man Cardiothorac Surg 2010; 2010:mmcts.2008.003871. [PMID: 24412927 DOI: 10.1510/mmcts.2008.003871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This is a report on the combined surgical and endovascular treatment of a very large aortic arch aneurysm. In the first step, total arch rerouting was performed with an inversed bifurcated Dacron prosthesis. Brachiocephalic trunk and left subclavian artery were inserted into the two branches of the prosthesis via an end-to-end anastomosis and left common carotid was reinserted into the branch to the left subclavian. In the second step, thoracic endovascular aortic repair was performed. By this combined concept a stable and durable result could be achieved.
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Affiliation(s)
- Julia Dumfarth
- Department of Cardiothoracic Surgery, University of Vienna Medical School, Vienna, Austria
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Desai ND, Szeto WY. Complex aortic arch aneurysm and dissections: hybrid techniques for surgical and endovascular therapy. Curr Opin Cardiol 2009; 24:521-7. [DOI: 10.1097/hco.0b013e3283317c91] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Da Rocha MFM, Miranda S, Adriani D, Urgnani F, Riambau VA, Mulet J. Hybrid procedures for complex aortic pathology: initial experience at a single center. Rev Esp Cardiol 2009; 62:896-902. [PMID: 19706245 DOI: 10.1016/s1885-5857(09)72654-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION AND OBJECTIVES To review experience at our center with the use of hybrid techniques for treating complex aneurysms of the thoracic aorta. METHODS The medical records of 41 patients (40 male) with complex aortic aneurysms affecting supra-aortic or visceral vessels who underwent hybrid procedures between 1998 and 2007 were reviewed retrospectively. All patients were in American Society of Anesthesiologists category IV. They were divided in two groups: group A comprised 32 patients with aneurysms involving the aortic arch and its branches (2 ascending aorta replacements, 1 arch repair, 13 carotid-carotid bypasses, 12 carotid-subclavian bypasses, and 4 with total arch debranching); and group B comprised 9 patients with thoracoabdominal aneurysms and visceral vessel transpositions (4 partial and 5 total debranching). The mean age in group A was 69.3+/-1.3 (range, 62-73) years and in group B, 71.5+/-5.0 (range, 68-74) years. RESULTS The mean hospital stay was 18+/-7.1 days (range, 5-35) and 12+/-8.2 days (range, 2-15) in groups A and B, respectively. Overall mortality was 12.2% (3.4% and 44.4% in groups A and B, respectively) and neurological morbidity was 3.4% and 11.1% in the two groups, respectively. CONCLUSIONS The results obtained with hybrid treatment of the aortic arch area were comparable with those of conventional surgery. However, thoracoabdominal repair with complete revascularization of the visceral branches was associated with high mortality. Consequently, hybrid treatment is a valid option for high-risk patients who do not require complete revascularization in the visceral area.
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Affiliation(s)
- Marcio F Maciel Da Rocha
- División de Cirugía Vascular, Instituto del Tórax, Hospital Clínic, Universidad de Barcelona, Barcelona, Spain
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40
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Emergency debranching and stent grafting for complex aortic arch injury. Injury 2009; 40:1014-7. [PMID: 19524900 DOI: 10.1016/j.injury.2009.03.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2009] [Accepted: 03/30/2009] [Indexed: 02/02/2023]
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41
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Endovascular Aortic Arch Repair: Hopes and Certainties. Eur J Vasc Endovasc Surg 2009; 38:255-61. [DOI: 10.1016/j.ejvs.2009.06.007] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Accepted: 06/11/2009] [Indexed: 11/22/2022]
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42
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Endovascular repair of the descending aorta and the aortic arch with the Relay stent graft. Ann Thorac Surg 2009; 88:637-40. [PMID: 19632426 DOI: 10.1016/j.athoracsur.2008.12.078] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2008] [Revised: 12/17/2008] [Accepted: 12/18/2008] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim of this study was to evaluate the efficacy and safety of thoracic endovascular aortic repair with a newly designed Relay thoracic stent graft (Bolton Medical, Sunrise, FL). DESCRIPTION Between 2005 and 2007, 22 patients (71.8 +/- 8.5) received 24 stent grafts. Indications were aneurysms (n = 13), penetrating atherosclerotic ulcers (n = 7), and dissections (n = 2). Due to the proximity of the lesions to the aortic arch, rerouting procedures (ie, subclavian transposition [n = 1], double transposition [n = 12], and total arch rerouting [n = 6] were performed pre-interventionally; three patients did not undergo rerouting). All patients were followed-up with a computed tomographic scan of the entire aorta at discharge, 3 months, 6 months, and annually thereafter (mean follow-up, 13 months). EVALUATION Primary technical success was obtained in 20 of 22 patients, with one persisting type I endoleak and one asymptomatic type II endoleak. One patient died due to malignant arrhythmia 3 days after stent-graft placement. During follow-up, 1 nonaortic related death was observed. No additional endoleaks were observed. Finally, all supra-aortic rerouting procedures remained patent. CONCLUSIONS In the treatment of degenerative disease of the descending aorta and the aortic arch, the Bolton Relay stent graft offers acceptable efficacy and safety in short-term follow-up.
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Karmy-Jones R, Kouchoukos NT. Endovascular credentialing and assembling the endovascular team. J Card Surg 2009; 24:334-42. [PMID: 19438793 DOI: 10.1111/j.1540-8191.2009.00839.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Riyad Karmy-Jones
- Department of Thoracic and Vascular Surgery, Southwest Washington Medical Center, Vancouver, Washington, USA
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44
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45
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Shimamura K, Kuratani T, Matsumiya G, Shirakawa Y, Takeuchi M, Takano H, Sawa Y. Hybrid endovascular aortic arch repair using branched endoprosthesis: The second-generation “branched” open stent-grafting technique. J Thorac Cardiovasc Surg 2009; 138:46-52; discussion 52-3. [DOI: 10.1016/j.jtcvs.2009.03.025] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2008] [Revised: 11/18/2008] [Accepted: 03/15/2009] [Indexed: 11/27/2022]
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46
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Ohtake H, Tomita S, Yamaguchi S, Yoshida S, Kimura K, Sanada J, Matsui O, Watanabe G. An Experimental Study of Type I Endoleak Repair With a Suturing Device. Ann Thorac Surg 2009; 88:258-61. [DOI: 10.1016/j.athoracsur.2009.02.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2007] [Revised: 02/15/2009] [Accepted: 02/16/2009] [Indexed: 11/26/2022]
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47
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Zierer A, Sanchez LA, Moon MR. Combined Open Proximal and Stent-Graft Distal Repair for Distal Arch Aneurysms: An Alternative to Total Debranching. Ann Thorac Surg 2009; 88:307-9. [DOI: 10.1016/j.athoracsur.2008.10.061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2008] [Revised: 10/05/2008] [Accepted: 10/08/2008] [Indexed: 10/20/2022]
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48
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Kopp R, Meimarakis G, Strauss T, Hatz R, Walter Jauch K, Waggershauser T. Combined supra-aortic extra-anatomic revascularization and endovascular hybrid procedure for recurrent hemoptysis caused by a symptomatic aneurysm of the right subclavian artery. Vascular 2009; 17:172-5. [PMID: 19476752 DOI: 10.2310/6670.2008.00058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Acute hemoptysis might be caused by aneurysms of the subclavian artery. We report a 75-year-old female patient presenting with recurrent hemoptysis, dyspnea, fever, and episodes of unclear pneumonia. Further examination revealed a large intrathoracic aneurysm of the right subclavian artery. After an initial transfemoral interventional attempt to occlude the entry of the aneurysm, the patient developed persistent thoracic pain. The patient was then treated by a combined extrathoracic hybrid procedure with a left to right carotid-carotid-axillary artery bypass and an endovascular aneurysm exclusion by insertion of two iliac artery occluder stent grafts in the proximal brachiocephalic trunk and the distal right subclavian artery. After this combined intervention, hemoptysis disappeared, and the patient recovered remarkably during a follow-up of 24 months.
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Affiliation(s)
- Reinhard Kopp
- Department of Vascular Surgery, Klinikum Grosshadern, University of Munich, Munich, Germany.
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49
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Cooper DG, Markur S, Walsh SR, Cousins C, Hayes PD, Boyle JR. Hybrid Endovascular Repair of an Aneurysmal Chronic Type B Dissection in a Patient with Marfan Syndrome With an Aberrant Right Subclavian Artery. Vasc Endovascular Surg 2008; 43:271-6. [DOI: 10.1177/1538574408328662] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abnormal aortic arch anatomy is relatively uncommon but most frequently involves an aberrant right subclavian artery. Rarely, it is associated with aneurysmal dilatation of a chronic type B dissection. Under such circumstances, the abnormal anatomy may complicate therapeutics options. Furthermore, controversy exists regarding the use of surgical or endovascular techniques in patients with aortic aneurysms and underlying arteriopathies. The current literature is limited with regard to reporting of the latter. We present a hybrid approach to repair such an aneurysm in a patient with Marfan syndrome. In a 2-stage procedure, involving initial supra-aortic bypass to all aortic arch branches, followed by endovascular stent graft deployment, the aneurysm was successfully excluded. There were no immediate complications and no evidence of endoleak at 3 months postoperatively, with thrombosis of the false lumen in the chest. By adapting hybrid open and endovascular techniques, complex thoracic aneurysms may be successfully treated in the short term in the presence of an underlying arteriopathy.
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Affiliation(s)
- David G. Cooper
- Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom,
| | - Shiraz Markur
- Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
| | - Stewart R. Walsh
- Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
| | - Claire Cousins
- Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
| | - Paul D. Hayes
- Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
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50
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Lentini S, Gaeta R, Tancredi F, Savasta M, La Monaca M, Ciuffreda F, Monaco F. Transposition of the left carotid artery to the ascending aorta to repair aortic arch injury. J Card Surg 2008; 24:57-8. [PMID: 18793235 DOI: 10.1111/j.1540-8191.2008.00722.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We present a case where we repaired the aortic arch, by the transposition of the left carotid artery to the ascending aorta. A 52-year-old man presented to our department with a penetrating chest wound by a gunshot in the attempt of suicide. The aortic arch and the insertion of the left carotid artery were involved in the lesion. Through sternotomic approach, the aortic arch was repaired in extracorporeal circulation. Left carotid artery was transected to allow easier repair of the arch posterior wall involved in the lesion, and to reduce the danger of residual stenosis. Then, it was translocated to the ascending aorta by interposing a 7-mm Gore-Tex (W.L. Gore & Associates, Flagstaff, AZ, USA) conduit. The patient complicated renal failure and pneumonia in the postoperative period, but eventually he was discharged in good general conditions.
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Affiliation(s)
- Salvatore Lentini
- Cardiac Surgery Unit, Policlinico G. Martino University of Messina, Messina, Italy
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