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Kato M. Interventions in Acute or Subacute Phase for Type B Aortic Dissection. Ann Vasc Dis 2024; 17:120-127. [PMID: 38919329 PMCID: PMC11196166 DOI: 10.3400/avd.ra.24-00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 02/07/2024] [Indexed: 06/27/2024] Open
Abstract
The treatment strategy for acute and subacute Stanford type B aortic dissection has changed significantly since the advent of thoracic endovascular aortic repair (TEVAR). Indication for invasive treatment: In addition to the conventional complicated cases (rupture or malperfusion case), the indication for invasive treatment now includes cases with refractory hypertension, persistent or recurrent pain, large aortic diameter, and other conditions that are considered to have a poor prognosis with conservative treatment. Treatment methods: TEVAR is the first choice for acute, subacute, and early chronic-stage treatment, and when this is not possible, other techniques (fenestration and graft replacement) are chosen. Treatment timing: The timing of invasive treatment should be emergent in life-threatening conditions (for rupture or malperfusion case) and immediate in symptomatic cases, while in other cases, preemptive TEVAR is considered appropriate on a scheduled timing within 6 months of onset. (This is a translation of Jpn J Vasc Surg 2023; 32: 157-163.).
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Affiliation(s)
- Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital, Osaka, Osaka, Japan
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Berger T, Maier A, Kletzer J, Schlett CL, Kondov S, Czerny M, Rylski B, Kreibich M. Radiographic complicated and uncomplicated descending aortic dissections: aortic morphological differences by CT angiography and risk factor analysis. Eur Heart J Cardiovasc Imaging 2024; 25:867-877. [PMID: 38269622 DOI: 10.1093/ehjci/jeae030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/16/2024] [Accepted: 01/21/2024] [Indexed: 01/26/2024] Open
Abstract
AIMS To identify radiographic differences between patients with uncomplicated and complicated descending aortic dissections. METHODS AND RESULTS Between April 2009 and July 2021, 209 patients with acute descending aortic dissections were analysed as complicated (malperfusion, rupture, diameter progress, and diameter ≥ 55 mm) or uncomplicated. Detailed CTA measurements (slice thickness ≤ 3 mm) were taken in multiplanar reconstruction. A composite endpoint (early aortic failure) was defined as reoperation, diameter progression, and early mortality. Seventy-seven patients were female (36.8%) [complicated n = 27 (36.5%); uncomplicated n = 50 (37.0%) P = 1.00]. Seventy-four (35%) patients were categorized as morphologically complicated, and 135 (65%) as uncomplicated. In patients with complicated dissections, the dissection extended more frequently to the aortic bifurcation (P = 0.044), the coeliac trunk (P = 0.003), the superior mesenteric artery (P = 0.007), and both iliac arteries (P < 0.001) originated less frequently from the true lumen. The length of the most proximal communication (entry) in type B aortic dissection was longer, 14.0 mm [12.0 mm; 27.0 mm] vs. 6.0 mm [4,0 mm; 13.0 mm] in complicated cases (P = 0.005). Identified risk factors for adverse aortic events were connective tissue disease [HR 8.0 (1.9-33.7 95% CI HR)], length of the aortic arch [HR 4.7 (1.5-15.1 95% CI HR)], a false lumen diameter > 19.38 mm [HR 3.389 (1.1-10.2 95% CI HR)], and origin of the inferior mesenteric artery from the false lumen [HR 4.2 (1.0-5.5 95% CI HR)]. CONCLUSION We identified significant morphological differences and predictors for adverse events in patients presenting complicated and uncomplicated descending dissections. Our morphological findings will help guide future aortic therapies, taking a tailored patient approach.
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Affiliation(s)
- Tim Berger
- Department of Cardiovascular Surgery, University Heart Centre Freiburg, University Medical Centre Freiburg, Südring 15, 79189 Bad Krozingen, Freiburg, Germany
- Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Breisacher Strasse 153, 79110 Freiburg, Germany
| | - Annika Maier
- Department of Cardiovascular Surgery, University Heart Centre Freiburg, University Medical Centre Freiburg, Südring 15, 79189 Bad Krozingen, Freiburg, Germany
- Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Breisacher Strasse 153, 79110 Freiburg, Germany
| | - Joseph Kletzer
- Department of Cardiovascular Surgery, University Heart Centre Freiburg, University Medical Centre Freiburg, Südring 15, 79189 Bad Krozingen, Freiburg, Germany
- Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Breisacher Strasse 153, 79110 Freiburg, Germany
| | - Christopher L Schlett
- Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Breisacher Strasse 153, 79110 Freiburg, Germany
- Department of Diagnostic and Interventional Radiology, University Medical Centre Freiburg, Freiburg, Germany
| | - Stoyan Kondov
- Department of Cardiovascular Surgery, University Heart Centre Freiburg, University Medical Centre Freiburg, Südring 15, 79189 Bad Krozingen, Freiburg, Germany
- Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Breisacher Strasse 153, 79110 Freiburg, Germany
| | - Martin Czerny
- Department of Cardiovascular Surgery, University Heart Centre Freiburg, University Medical Centre Freiburg, Südring 15, 79189 Bad Krozingen, Freiburg, Germany
- Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Breisacher Strasse 153, 79110 Freiburg, Germany
| | - Bartosz Rylski
- Department of Cardiovascular Surgery, University Heart Centre Freiburg, University Medical Centre Freiburg, Südring 15, 79189 Bad Krozingen, Freiburg, Germany
- Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Breisacher Strasse 153, 79110 Freiburg, Germany
| | - Maximilian Kreibich
- Department of Cardiovascular Surgery, University Heart Centre Freiburg, University Medical Centre Freiburg, Südring 15, 79189 Bad Krozingen, Freiburg, Germany
- Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Breisacher Strasse 153, 79110 Freiburg, Germany
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D'Oria M, Wanhainen A, Kolbel T, Yoon W, Mani K. Novel insights into thoracic endografts technology for prevention of distal stent-graft induced new entry (dSINE) following endovascular repair of type B aortic dissections: from bench to bedside. Expert Rev Med Devices 2024; 21:391-398. [PMID: 38629872 DOI: 10.1080/17434440.2024.2343824] [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] [Received: 12/18/2023] [Accepted: 04/12/2024] [Indexed: 04/19/2024]
Abstract
INTRODUCTION Endovascular treatment of type B aortic dissections (TBAD) has currently acquired a primary therapeutic role when anatomically feasible. The main issue with thoracic endovascular aortic repair (TEVAR) for aortic dissection is the actual nature of the aortic wall, which is structurally compromised and more fragile. Indeed, a wealth of data have shown that TEVAR for TBAD will lead, in a substantial proportion of cases, to a device-related adverse event named distal stent-graft induced new entry (dSINE). AREAS COVERED Currently available aortic stent-grafts have not been specifically devised for the treatment of aortic dissection. A novel dissection specific stent-graft (DSSG) was developed, which is a custom-made device based on the Zenith Alpha Thoracic platform (Cook Medical). The DSSG has several unique properties that, in principle, make its use optimal in TBAD patients. EXPERT OPINION TEVAR in the setting of aortic dissections remains technically challenging. The occurrence of dSINE represents a unique complication in this scenario and may lead to high rates of aortic-related adverse events and need for secondary interventions. The use of a novel custom-made DSSG in the setting of chronic TBAD has been proven to be safe, feasible and effective. However, even this approach may fail to completely prevent dSINE formation.
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Affiliation(s)
- Mario D'Oria
- Division of Vascular and Endovascular Surgery, Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Anders Wanhainen
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - Tilo Kolbel
- German Aortic Center Hamburg, University Heart Center, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - William Yoon
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Kevin Mani
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden
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Alanezi T, Altoijry A, AlSheikh S, Al-Mubarak H, Alhamzah M, Alomran F, Abdulrahim O, Aljabri B, Greco E, Hussain MA, Al-Omran M. Predicting the need for subclavian artery revascularization in thoracic endovascular aortic repair: A systematic review and meta-analysis. J Vasc Surg 2024:S0741-5214(24)00985-6. [PMID: 38621636 DOI: 10.1016/j.jvs.2024.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/21/2024] [Accepted: 04/09/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVE This systematic review and meta-analysis aims to investigate the effectiveness of left subclavian artery revascularization compared with non-revascularization in thoracic endovascular aortic repair, and to summarize the current evidence on its indications. METHODS A computerized search was conducted across multiple databases, including MEDLINE, SCOPUS, Cochrane Library, and Web of Science, for studies published up to November 2023. Study selection, data abstraction, and quality assessment (using the Newcastle-Ottawa Scale) were independently conducted by two reviewers, with a third author resolving discrepancies. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random-effects models and publication bias was assessed using funnel plots. RESULTS In the 76 included studies, left subclavian artery revascularization was associated with reduced risks of stroke (OR, 0.67; 95% CI, 0.45-0.98; n = 15,331), spinal cord ischemia (OR, 0.75; 95% CI, 0.56-0.99; n = 11,995), and arm ischemia (OR, 0.09; 95% CI, 0.01-0.59; n = 8438). No significant reduction in paraplegia (OR, 0.56; 95% CI, 0.21-1.47; n = 1802) or mortality (OR, 0.77; 95% CI, 0.53-1.12; n = 11,831) was observed. Moreover, the risk of endoleak was comparable in both groups (OR, 1.25; 95% CI, 0.55-2.84; P = .60; n = 793), whereas the risk of reintervention was significantly higher in the revascularization group (OR, 1.98; 95% CI, 1.03-3.83; P = .04; n = 272). Both groups had similar risks of major (OR, 0.45; 95% CI, 0.19-1.09; P = .08; n = 1113), minor (OR, 0.21; 95% CI, 0.01-3.45; P = .27; n = 183), renal (OR, 0.61; 95% CI, 0.12-3.06; P = .55; n = 310), and pulmonary (OR, 0.59; 95% CI, 0.16-2.15; P = .42; n = 8083) complications. The most frequent indications for left subclavian artery revascularization were primary prevention of spinal cord ischemia, augmentation of the landing zone, and primary stroke prevention. CONCLUSIONS Left subclavian artery revascularization in thoracic endovascular aortic repair was associated with reduced neurological complications but was not found to impact mortality. The study highlights important indications for revascularization as well as significant predictors of complications, providing a basis for clinical decision-making and future research.
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Affiliation(s)
- Tariq Alanezi
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulmajeed Altoijry
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Sultan AlSheikh
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Husain Al-Mubarak
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Musaad Alhamzah
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Faris Alomran
- Department of Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Omer Abdulrahim
- Department of Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Badr Aljabri
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Elisa Greco
- Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Mohamad A Hussain
- Harvard Medical School, Boston, MA; Division of Vascular and Endovascular Surgery and the Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston
| | - Mohammed Al-Omran
- Department of Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia; Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.
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Lopes A, Gouveia E Melo R, Amorim P, Fernandes E Fernandes R, Mendes Pedro L. Current perspectives in acute type B aortic dissections: a literature review. THE JOURNAL OF CARDIOVASCULAR SURGERY 2024; 65:132-138. [PMID: 37255494 DOI: 10.23736/s0021-9509.23.12636-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In this new millennial, endovascular strategies have revolutionized the treatment of acute type B aortic dissection (aTBAD). With reduced in-hospital mortality and good long-term outcomes TEVAR has become the gold standard for the treatment of complicated dissection and is gaining increasing support for its preventive applicability in some uncomplicated dissections. With this new paradigm came a shift of the treatment goal where just covering the entry tear is not enough and instead achieving long-term positive thoracoabdominal remodeling is needed. More extensive approaches with composite device designs (covered stent graft and bare metal stent) emerged to answer this aortic conundrum. At 5-year of follow-up, "Provisional ExTension To Induce COmplete Attachment technique" (PETTICOAT) and its evolution "Stent assisted balloon induced intimal disruption and relamination in aortic dissection repair" (STABILISE) seem to be safe techniques that can allow, when anatomically feasible, excellent aortic remodeling and, in some cases, even the healing of the dissection. Nevertheless, STABILISE results, although promising, are mostly based on small series and therefore need to be validated by analyzing medium-long-term results from the international registry. Given the plethora of new data and the disparity of expert opinions on the best treatment to adopt, in this review we aim to summarize the current knowledge on the results of these different strategies for acute TBAD.
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Affiliation(s)
- Alice Lopes
- Division of Heart and Vessels, Department of Vascular Surgery, Saint Mary's Hospital, Lisbon, Portugal -
- Faculty of Medicine, University of Lisbon, Lisbon, Portugal -
- Cardiovascular Center of the University of Lisbon (CCUL), Lisbon, Portugal -
| | - Ryan Gouveia E Melo
- Division of Heart and Vessels, Department of Vascular Surgery, Saint Mary's Hospital, Lisbon, Portugal
- Faculty of Medicine, University of Lisbon, Lisbon, Portugal
- Cardiovascular Center of the University of Lisbon (CCUL), Lisbon, Portugal
| | - Pedro Amorim
- Division of Heart and Vessels, Department of Vascular Surgery, Saint Mary's Hospital, Lisbon, Portugal
- Cardiovascular Center of the University of Lisbon (CCUL), Lisbon, Portugal
| | - Ruy Fernandes E Fernandes
- Division of Heart and Vessels, Department of Vascular Surgery, Saint Mary's Hospital, Lisbon, Portugal
- Faculty of Medicine, University of Lisbon, Lisbon, Portugal
- Cardiovascular Center of the University of Lisbon (CCUL), Lisbon, Portugal
| | - Luís Mendes Pedro
- Division of Heart and Vessels, Department of Vascular Surgery, Saint Mary's Hospital, Lisbon, Portugal
- Faculty of Medicine, University of Lisbon, Lisbon, Portugal
- Cardiovascular Center of the University of Lisbon (CCUL), Lisbon, Portugal
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Karaolanis GI, Georgakarakos E, Karakosta A, Glantzounis GK, Moulakakis KG, Dorweiler B, Mylonas SN. Long-term outcomes of thoracic endovascular aortic repair for the treatment of descending thoracic aortic aneurysms: a systematic review and meta-analysis. THE JOURNAL OF CARDIOVASCULAR SURGERY 2024; 65:139-146. [PMID: 37335279 DOI: 10.23736/s0021-9509.23.12648-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
INTRODUCTION We undertook a systematic review of the currently published literature on TEVAR for DTAAs and we combined the eligible studies into a meta-analysis with the intention of evaluating the efficacy and the long-term durability of this treatment option. EVIDENCE ACQUISITION A systematic search of the literature from January 2015 up to December 2022 was performed according to the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines. For events during follow-up we calculated the incidence rates (IRs) with 95% confidence intervals (95% CIs) per 100 patient-years (p-ys) as the number of patients with outcome events occurring during the specific time period divided by the total number of p-ys. EVIDENCE SYNTHESIS A total of 4127 study titles were identified by the initial search strategy, of which 12 were considered eligible for inclusion in the meta-analysis. A Total of 1976 patients (62% male) were identified among the eligible studies. One-year survival was 90.1% (95% CI 86.3% to 93.0%), 3-year survival was estimated at 80.5% (95% CI 69.2% to 88.4%) and the 5-year survival was estimated at 73.2% (95%CI 64.3% to 80.5%) with significant heterogeneity among studies regarding these outcomes. Regarding freedom from reintervention analysis for 1 year and 5 years was 96.5% (95% CI 94.5% to 97.8%) and 85.4% (95% CI 56.7% to 96.3%) respectively. The pooled late complications IR per 100 p-ys was 55.0 (95% CI 39.1 to 70.9), whereas the pooled IR for late reinterventions per 100 p-ys was 21.2 (95% CI 26.0 to 87.5). Late type I endoleak was reported with a pooled IR of 26.7 per 100 p-ys (95% CI 19.8 to 33.6) and late type III endoleak with a pooled IR of 7.6 per 100 p-ys (95% CI 5.5 to 9.7). CONCLUSIONS TEVAR presents a safe and feasible solution for the treatment of DTAA with sustained long-term effectivity. Current evidence supports a satisfactory 5-year survival with low rates of reinterventions.
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Affiliation(s)
- Georgios I Karaolanis
- Vascular Unit, Department of Surgery, University Hospital of Ioannina and School of Medicine, Ioannina, Greece -
| | - Efstratios Georgakarakos
- Department of Vascular Surgery, "Democritus" University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Agathi Karakosta
- Department of Anesthesia and Postoperative Intensive Care, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Georgios K Glantzounis
- Department of Surgery, School of Health Sciences, University Hospital of Ioannina and Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | | | - Bernhard Dorweiler
- Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Cologne, Germany
| | - Spyridon N Mylonas
- Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Cologne, Germany
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Reutersberg B, Gleason T, Desai N, Ehrlich M, Evangelista A, Braverman A, Myrmel T, Chen EP, Estrera A, Schermerhorn M, Bossone E, Pai CW, Eagle K, Sundt T, Patel H, Trimarchi S, Eckstein HH. Neurological event rates and associated risk factors in acute type B aortic dissections treated by thoracic aortic endovascular repair. J Thorac Cardiovasc Surg 2024; 167:52-62.e5. [PMID: 35260280 DOI: 10.1016/j.jtcvs.2022.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 01/14/2022] [Accepted: 02/01/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Thoracic endovascular aortic repair is the method of choice in patients with complicated type B acute aortic dissection. However, thoracic endovascular aortic repair carries a risk of periprocedural neurological events including stroke and spinal cord ischemia. We aimed to look at procedure-related neurological complications within a large cohort of patients with type B acute aortic dissection treated by thoracic endovascular aortic repair. METHODS Between 1996 and 2021, the International Registry of Acute Aortic Dissection collected data on 3783 patients with type B acute aortic dissection. For this analysis, 648 patients with type B acute aortic dissection treated by thoracic endovascular aortic repair were included (69.4% male, mean age 62.7 ± 13.4 years). Patients were excluded who presented with a preexisting neurologic deficit or received adjunctive procedures. Demographics, clinical symptoms, and outcomes were analyzed. The primary end point was the periprocedural incidence of neurological events (defined as stroke, spinal cord ischemia, transient neurological deficit, or coma). Predictors for perioperative neurological events and follow-up outcomes were considered as secondary end points. RESULTS Periprocedure neurological events were noted in 72 patients (11.1%) and included strokes (n = 29, 4.6%), spinal cord ischemias (n = 21, 3.3%), transient neurological deficits (n = 16, 2.6%), or coma (n = 6, 1.0%). The group with neurological events had a significantly higher in-hospital mortality (20.8% vs 4.3%, P < .001). Patients with neurological events were more likely to be female (40.3% vs 29.3%, P = .077), and aortic rupture was more often cited as an indication for thoracic endovascular aortic repair (38.8% vs 16.5%, P < .001). In patients with neurological events, more stent grafts were used (2 vs 1 stent graft, P = .002). Multivariable logistic regression analysis showed that aortic rupture (odds ratio, 3.12, 95% confidence interval, 1.44-6.78, P = .004) and female sex (odds ratio, 1.984, 95% confidence interval, 1.031-3.817, P = .040) were significantly associated with perioperative neurological events. CONCLUSIONS In this highly selected group from dedicated aortic centers, more than 1 in 10 patients with type B acute aortic dissection treated by thoracic endovascular aortic repair had neurological events, in particular women. Further research is needed to identify the causes and presentation of these events after thoracic endovascular aortic repair, especially among women.
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Affiliation(s)
- Benedikt Reutersberg
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Thomas Gleason
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Nimesh Desai
- Division of Cardiovascular Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pa
| | - Marek Ehrlich
- Department of Cardiothoracic Surgery, University of Vienna, Vienna, Austria
| | | | - Alan Braverman
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St Louis, Mo
| | | | - Edward P Chen
- Division of Cardiovascular Surgery, Duke University School of Medicine, Durham, NC
| | - Anthony Estrera
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Tex
| | - Marc Schermerhorn
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Eduardo Bossone
- Department of Cardiology, San Giovanni e Ruggi, Salerno, Italy
| | - Chih-Wen Pai
- Department of Medicine and Department of Cardiac Surgery, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Mich
| | - Kim Eagle
- Department of Medicine and Department of Cardiac Surgery, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Mich
| | - Thoralf Sundt
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass
| | - Himanshu Patel
- Cardiac Surgery, University of Michigan Health System, Ann Arbor, Mich
| | - Santi Trimarchi
- Department of Clinical and Community Sciences, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
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Ribieras AJ, Challa AS, Kang N, Kenel-Pierre S, Rey J, Velazquez OC, Milner R, Bornak A. Race-based outcomes of thoracic aortic aneurysms and dissections in the Global Registry for Endovascular Aortic Treatment. J Vasc Surg 2023; 78:1190-1197.e2. [PMID: 37454953 DOI: 10.1016/j.jvs.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 07/01/2023] [Accepted: 07/08/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE This study characterizes racial differences in presentation, as well as short- and long-term outcomes after endovascular treatment of thoracic aortic aneurysm (TAA) and type B aortic dissection (TBAD). METHODS We queried the Gore Global Registry for Endovascular Aortic Treatment for thoracic endovascular aortic repairs (TEVARs) performed between 2010 and 2016 and followed through 2022. Pathologies represented were descending TAA, complicated TBAD, and uncomplicated TBAD. Using standard statistical tests, we compared overall and pathology-specific demographics, procedural factors, and outcomes among Black and White patients undergoing TEVAR. RESULTS We identified 438 TEVAR cases, including 236 descending TAA, 121 complicated TBAD, and 74 uncomplicated TBAD. Overall, Black patients were younger and had a higher incidence of renal insufficiency (P = .001), whereas White patients had more chronic obstructive pulmonary disease (P = .003) and cardiac arrhythmias (P = .037). In patients treated for descending TAA, Black patients had increased device- and procedure-related complications (34.3% vs 17.4%; P = .014), conversion to open repair (2.9% vs 0%; P = .011) and type II endoleak (5.7% vs 1.0%; P = .040), but no differences in mortality, length of hospital stay, or major adverse cardiovascular events. Whereas outcomes of TEVAR for uncomplicated TBAD were comparable, Black patients more frequently presented with complicated TBAD than White patients (Black, 40.5% vs White, 24.8%; P = .008) and had subsequently greater reintervention rates (28.1% vs 12.4%; P = .012), all-cause mortality (hazard ratio, 4.28; 95% confidence interval, 1.74-10.5; P = .002) and aortic-related mortality (hazard ratio, 16.7; 95% confidence interval, 1.49-186; P = .022). CONCLUSIONS Despite increased device- and procedure-related complications, similar short- and long-term outcomes are achieved in Black and White patients undergoing TEVAR for descending TAA and uncomplicated TBAD. However, Black patients are more likely to present with, require reintervention for, and suffer mortality from complicated TBAD.
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Affiliation(s)
- Antoine J Ribieras
- Division of Vascular and Endovascular Surgery, University of Miami Miller School of Medicine, Miami, FL
| | - Akshara S Challa
- Division of Vascular and Endovascular Surgery, University of Miami Miller School of Medicine, Miami, FL
| | - Naixin Kang
- Division of Vascular and Endovascular Surgery, University of Miami Miller School of Medicine, Miami, FL
| | - Stefan Kenel-Pierre
- Division of Vascular and Endovascular Surgery, University of Miami Miller School of Medicine, Miami, FL
| | - Jorge Rey
- Division of Vascular and Endovascular Surgery, University of Miami Miller School of Medicine, Miami, FL
| | - Omaida C Velazquez
- Division of Vascular and Endovascular Surgery, University of Miami Miller School of Medicine, Miami, FL
| | - Ross Milner
- Division of Vascular Surgery and Endovascular Therapy, University of Chicago Pritzker School of Medicine, Chicago, IL
| | - Arash Bornak
- Division of Vascular and Endovascular Surgery, University of Miami Miller School of Medicine, Miami, FL.
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9
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Oh AR, Lim SK, Sung K, Lee SM, Lee JH. Outcomes of open repair for descending thoracic and thoracoabdominal aortic aneurysm in recent 10 years: experience of a high-volume centre in Korea. Eur J Cardiothorac Surg 2023; 64:ezad338. [PMID: 37847652 DOI: 10.1093/ejcts/ezad338] [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: 07/03/2023] [Revised: 09/13/2023] [Indexed: 10/19/2023] Open
Abstract
OBJECTIVES Although recent studies and guidelines suggest the preferred outcomes after surgical repair of thoracic aortic aneurysm (TAA) and thoracoabdominal aortic aneurysm (TAAA), published results are limited to those from high-volume hospitals and based on old data gathered before optimal management was established. Here, we analysed our outcomes over the previous 10 years from cases of open TAA and TAAA repair to offer updated and real-world results of those complex procedures performed in a high-volume centre. METHODS From November 2013 to April 2022, 212 consecutive adult patients who underwent open TAA and TAAA repair were enrolled. We analysed early and late outcomes after surgery, including postoperative complications and mortality. RESULTS There were 154 (73%) men, and the median age at surgery was 61 years. Intraoperative death occurred in 1 patient due to uncontrolled bleeding. Nine patients (4%) died during follow-up, and the survival estimates at 5 years were 94 ± 3% and 95 ± 3% after descending TAA and TAAA repair, respectively. Ten patients (4%) suffered from spinal cord ischaemic injury (9 with paraplegia and 1 with paresthesia), but permanent paraplegia persisted in only 1 case. CONCLUSIONS We report very low postoperative complication rates and excellent early and late survival rates after open TAA and TAAA repair from our recent 10-year data analysis. These findings may assist when choosing treatment options for these complicated diseases.
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Affiliation(s)
- Ah Ran Oh
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Suk Kyung Lim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kiick Sung
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sangmin Maria Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jong-Hwan Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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10
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Ogino H, Iida O, Akutsu K, Chiba Y, Hayashi H, Ishibashi-Ueda H, Kaji S, Kato M, Komori K, Matsuda H, Minatoya K, Morisaki H, Ohki T, Saiki Y, Shigematsu K, Shiiya N, Shimizu H, Azuma N, Higami H, Ichihashi S, Iwahashi T, Kamiya K, Katsumata T, Kawaharada N, Kinoshita Y, Matsumoto T, Miyamoto S, Morisaki T, Morota T, Nanto K, Nishibe T, Okada K, Orihashi K, Tazaki J, Toma M, Tsukube T, Uchida K, Ueda T, Usui A, Yamanaka K, Yamauchi H, Yoshioka K, Kimura T, Miyata T, Okita Y, Ono M, Ueda Y. JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection. Circ J 2023; 87:1410-1621. [PMID: 37661428 DOI: 10.1253/circj.cj-22-0794] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | - Koichi Akutsu
- Cardiovascular Medicine, Nippon Medical School Hospital
| | - Yoshiro Chiba
- Department of Cardiology, Mito Saiseikai General Hospital
| | | | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University
| | | | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | - Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine
| | | | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
| | - Hirooki Higami
- Department of Cardiology, Japanese Red Cross Otsu Hospital
| | | | - Toru Iwahashi
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kentaro Kamiya
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine
| | | | - Takuya Matsumoto
- Department of Vascular Surgery, International University of Health and Welfare
| | | | - Takayuki Morisaki
- Department of General Medicine, IMSUT Hospital, the Institute of Medical Science, the University of Tokyo
| | - Tetsuro Morota
- Department of Cardiovascular Surgery, Nippon Medical School Hospital
| | | | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kenji Okada
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | | | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Masanao Toma
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Takuro Tsukube
- Department of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center
| | - Tatsuo Ueda
- Department of Radiology, Nippon Medical School
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kazuo Yamanaka
- Cardiovascular Center, Nara Prefecture General Medical Center
| | - Haruo Yamauchi
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Yutaka Okita
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
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11
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Capoccia M, Sherif MA, Nassef A, Shaw D, Walker P, Evans B, Kaul P, Elmahdy W. Aortic arch surgery for type B aortic dissection: How far should we go? The value of a hybrid approach. Clin Case Rep 2023; 11:e6742. [PMID: 36619481 PMCID: PMC9810843 DOI: 10.1002/ccr3.6742] [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: 08/30/2022] [Revised: 11/21/2022] [Accepted: 12/04/2022] [Indexed: 01/05/2023] Open
Abstract
Traditionally, the management of type B aortic dissection has been the domain of the vascular surgeons. Timing and type of intervention still generate debate. We sought to review our early experience with the treatment of this condition based on a hybrid approach following an aortic multi-disciplinary team meeting involving close cooperation between cardiac surgeons, vascular surgeons, interventional radiologists, vascular anesthetists, and cardiac anesthetists. Four patients (age 41-56 years; 3 males; 1 female) with type B aortic dissection underwent aortic arch surgery through a hybrid approach: one elective procedure consisting of ascending aorta and hemi-arch replacement with debranching followed by thoracic endovascular aortic repair (TEVAR); one redo procedure requiring aortic arch replacement with hybrid frozen elephant trunk; two acute presentations (aortic arch replacement and debranching followed by TEVAR; AVR with ascending aorta, arch, and proximal descending thoracic aorta replacement with conventional elephant trunk and debranching). Deep hypothermic circulatory arrest was required in three patients. Despite respiratory complications and slightly prolonged postoperative course, all patients survived without onset of stroke, paraplegia, malperfusion, endoleak, or need for re-exploration. Follow-up remains satisfactory. Different factors may affect outcome following complex aortic procedures. Nevertheless, close cooperation between cardiac surgeons, vascular surgeons, and interventional radiologists may reduce potential for complications and address aspects that may not be completely within the domain of individual specialists.
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Affiliation(s)
- Massimo Capoccia
- Cardiac Surgery, Yorkshire Heart CentreLeeds Teaching Hospitals NHS TrustLeedsUK
| | - Mohamed Ashur Sherif
- Cardiac Surgery, Yorkshire Heart CentreLeeds Teaching Hospitals NHS TrustLeedsUK
| | - Ahmed Nassef
- Vascular SurgeryLeeds Teaching Hospitals NHS TrustLeedsUK
| | - David Shaw
- Interventional RadiologyLeeds Teaching Hospitals NHS TrustLeedsUK
| | - Paul Walker
- Interventional RadiologyLeeds Teaching Hospitals NHS TrustLeedsUK
| | - Betsy Evans
- Cardiac Surgery, Yorkshire Heart CentreLeeds Teaching Hospitals NHS TrustLeedsUK
| | - Pankaj Kaul
- Cardiac Surgery, Yorkshire Heart CentreLeeds Teaching Hospitals NHS TrustLeedsUK
| | - Walid Elmahdy
- Cardiac Surgery, Yorkshire Heart CentreLeeds Teaching Hospitals NHS TrustLeedsUK
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12
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Matsuda H. Current management of acute type B dissection in 2021. Asian Cardiovasc Thorac Ann 2023; 31:37-41. [PMID: 35473408 DOI: 10.1177/02184923221097172] [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: 11/16/2022]
Abstract
The rationale for thoracic endovascular aortic repair (TEVAR) for type B aortic dissection depends on the phase of disease: acute phase, which is 'complicated', subacute to early chronic phase, which requires 'preemptive TEVAR' and chronic phase, which entails 'prevention of further dilatation and rupture'. Low operative mortality and morbidity after TEVAR for complicated acute type B aortic dissection have been reported with significant improvement during midterm survival. 'Retrograde' type A dissection, which can be described as type B0,X (X>3) according to a new reporting standard, has reportedly been treated with TEVAR with less invasiveness. TEVAR is the first and possibly the only effective strategy for acute type B dissection, so that expansion of indications for type B0,X, as described in the new reporting standard has been validated.
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Affiliation(s)
- Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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13
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Spinelli D, Weaver FA, Azizzadeh A, Magee GA, Piffaretti G, Benedetto F, Miller CC, Sandhu HK, Gable DR, Trimarchi S. Endovascular treatment of complicated versus uncomplicated acute type B aortic dissection. J Thorac Cardiovasc Surg 2023; 165:4-13.e1. [PMID: 33612294 DOI: 10.1016/j.jtcvs.2021.01.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 12/12/2020] [Accepted: 01/02/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The study objective was to analyze the outcomes of thoracic endovascular aortic repair performed for complicated and uncomplicated acute type B aortic dissections. METHODS Patients from WL Gore's Global Registry for Endovascular Aortic Treatment who underwent thoracic endovascular aortic repair for acute type B aortic dissections were included, and data were retrospectively analyzed. RESULTS Of 5014 patients enrolled in the Global Registry for Endovascular Aortic Treatment, 172 underwent thoracic endovascular aortic repair for acute type B aortic dissections. Of these repairs, 102 were for complicated acute type B aortic dissections and 70 were for uncomplicated acute type B aortic dissections. There were 46 (45.1%) procedures related to aortic branch vessels versus 15 (21.4%) in complicated type B aortic dissections and uncomplicated type B aortic dissections (P = .002). The mean length of stay was 14.3 ± 10.6 days (median, 11; range, 2-75) versus 9.8 ± 7.9 days (median, 8; range, 0-42) in those with complicated type B aortic dissections versus those with uncomplicated acute type B aortic dissections (P < .001). Thirty-day mortality was not different between groups (complicated type B aortic dissections 2.9% vs uncomplicated acute type B aortic dissections 1.4%, P = .647), as well as aortic complications (8.8% vs 5.7%, P = .449). Aortic event-free survival was 62.9% ± 37.1% versus 70.6% ± 29.3% at 3 years (P = .696). CONCLUSIONS In the Global Registry for Endovascular Aortic Treatment, thoracic endovascular aortic repair results for complicated type B aortic dissections versus uncomplicated acute type B aortic dissections showed that 30-day mortality and perioperative complications were equally low for both. The midterm outcome was positive. These data confirm that thoracic endovascular aortic repair as the first-line strategy for treating complicated type B dissections is associated with a low risk of complications. Further studies with longer follow-up are necessary to define the role of thoracic endovascular aortic repair in uncomplicated acute type B dissections compared with medical therapy. However, in the absence of level A evidence from randomized trials, results of the uncomplicated acute type B aortic dissection patient cohort treated with thoracic endovascular aortic repair from registries are important to understand the related risk and benefit.
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Affiliation(s)
- Domenico Spinelli
- Unit of Vascular Surgery, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Policlinico G. Martino, University of Messina, Messina, Italy.
| | - Fred A Weaver
- Division of Vascular Surgery and Endovascular Therapy, University of South California, Los Angeles, Calif
| | - Ali Azizzadeh
- Division of Vascular Surgery, Heart Institute for Vascular Therapeutics, Cedars Sinai, Los Angeles, Calif
| | - Gregory A Magee
- Division of Vascular Surgery and Endovascular Therapy, University of South California, Los Angeles, Calif
| | - Gabriele Piffaretti
- Vascular Surgery, Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
| | - Filippo Benedetto
- Unit of Vascular Surgery, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Policlinico G. Martino, University of Messina, Messina, Italy
| | - Charles C Miller
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School, University of Texas Health Science Center, Houston, Tex
| | - Harleen K Sandhu
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School, University of Texas Health Science Center, Houston, Tex
| | - Dennis R Gable
- Department of General and Vascular Surgery, Baylor Plano Heart Hospital, Plano, Tex
| | - Santi Trimarchi
- Department of Clinical and Community Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
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14
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Gao HQ, Li G, Zhang HK, Zhang LL, Xu SD. A retrospective study of thoracic endovascular aortic repair timing in patients with uncomplicated type B dissection who have a smoking history. Front Cardiovasc Med 2022; 9:1035971. [PMID: 36505364 PMCID: PMC9726749 DOI: 10.3389/fcvm.2022.1035971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 11/02/2022] [Indexed: 11/24/2022] Open
Abstract
Objective To determine the optimal timing of thoracic endovascular aortic repair (TEVAR) for patients with uncomplicated type B dissections who have a smoking history. Methods Data from 308 consecutive patients with uncomplicated type B dissections, who have a smoking history and onset-to-TEVAR time within 90 days, were analyzed. The patients were divided into two groups: Acute and subacute phases. Univariate and multivariate regression analyses were performed. Smooth curve fitting and threshold analysis were performed to characterize the relationship between the onset-to-TEVAR time and follow-up deaths. Results There were no significant differences between the two groups. Smooth curve fitting and threshold effect analysis showed that if early TEVAR was performed within 9.4 days from onset, there was better long-term survival and there was no significant difference after 9.4 days. Conclusion By studying the relationship between onset-to-TEVAR time and all-cause mortality, we found that early TEVAR may have a lower all-cause mortality rate during follow-up in uncomplicated type B dissection patients who have a smoking history and within 90 days from onset.
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Affiliation(s)
- Hui-Qiang Gao
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China,Hui-Qiang Gao,
| | - Guoqi Li
- Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hong-Kai Zhang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lan-Lin Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China
| | - Shang-Dong Xu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Beijing Institute of Heart Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China,*Correspondence: Shang-Dong Xu,
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15
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Lombardi JV, Gleason TG, Panneton JM, Starnes BW, Dake MD, Haulon S, Mossop PJ, Segbefia E, Bharadwaj P. Five-year results of the STABLE II study for the endovascular treatment of complicated, acute type B aortic dissection with a composite device design. J Vasc Surg 2022; 76:1189-1197.e3. [PMID: 35809819 DOI: 10.1016/j.jvs.2022.06.092] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/20/2022] [Accepted: 06/30/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To provide the five-year outcomes of the use of a composite device (proximal covered stent-graft + distal bare stent) for endovascular repair of patients with acute, type B aortic dissection complicated by aortic rupture and/or malperfusion. METHODS STABLE II was a prospective, multicenter study of the Zenith Dissection Endovascular System (William Cook Europe, Denmark). Patients were enrolled between August 2012 and January 2015 at sites in the United States and Japan. Five-year follow-up was completed by January 2020. RESULTS In total, 73 patients (mean age 60.7±10.9 years; 65.8% male) with acute type B dissection complicated by malperfusion (72.6%), rupture (21.9%), or both (5.5%) were enrolled. Patients were treated with either a composite device (79.5%) or the proximal stent-graft alone (no distal bare stent, 20.5%). Dissections were more extensive in patients who received the composite device (408.9±121.3 mm) than in patients who did not receive a bare stent (315.9±100.1 mm). Mean follow-up was 1209.4±754.6 days. Freedom from all-cause mortality was 80.3%±4.7% at one year and 68.9%± 7.3% at five years. Freedom from dissection-related mortality remained at 97.1%±2.1% from one-year through five-year follow-up. Within the stent-graft region, the rate of either complete thrombosis or elimination of the false lumen increased over time (82.1% of all patients at five years vs. 55.7% at first post-procedure CT), with a higher rate at five years in patients who received the composite device (90.5%) compared with patients without the bare stent (57.1%). Throughout follow-up, overall true lumen diameter increased within the stent-graft region, and overall false lumen diameter decreased. At five years, 20.7% of patients experienced a decrease in maximum transaortic diameter within the stent-graft region, 17.2% experienced an increase, and 62.1% experienced no change. Distal to the treated segment (but within the dissected aorta), 23.1% of patients experience no change in transaortic diameter at five years; a bare stent was deployed in all these patients at the procedure. Five-year freedom from all secondary intervention was 70.7%±7.2%. CONCLUSIONS These five-year outcomes indicate a low rate of dissection-related mortality for the Zenith Dissection Endovascular System in the treatment of patients with acute, complicated type B aortic dissection. Further, these data suggest a positive influence of composite device use on false lumen thrombosis. Continuous monitoring for distal aortic growth is necessary in all patients.
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Affiliation(s)
- Joseph V Lombardi
- Division of Vascular Surgery, Cooper University Hospital, Camden, NJ.
| | - Thomas G Gleason
- Division of Cardiothoracic Surgery, University of Maryland Medical Center, Baltimore, MD
| | - Jean M Panneton
- Division of Vascular Surgery, Eastern Virginia Medical School, Norfolk, VA
| | - Benjamin W Starnes
- Division of Vascular Surgery, Harborview Medical Center, University of Washington, Seattle, WA
| | | | - Stephan Haulon
- Division of Vascular Surgery, Aortic Centre, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris-Saclay, Paris, France
| | - Peter J Mossop
- Division of Interventional Radiology, St. Vincent's Hospital, Melbourne, Australia
| | - Edem Segbefia
- Research Division, Cook Research Incorporated, West Lafayette, IN
| | - Priya Bharadwaj
- Research Division, Cook Research Incorporated, West Lafayette, IN
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16
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Grigorian A, Lewis M, Wlodarczyk JR, Chien CY, Park T, Demetriades D. Left subclavian artery coverage during endovascular repair of thoracic aorta injury in trauma and non-trauma patients. Eur J Trauma Emerg Surg 2022; 48:4425-4429. [PMID: 35713681 DOI: 10.1007/s00068-022-02027-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/28/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE In thoracic endovascular aortic repair (TEVAR), the left subclavian artery (LSA) is often occluded. Although most patients tolerate this, some develop ischemic symptoms to the brain or left upper extremity (LUE). A revascularization procedure may be associated with significant complications. The purpose of this review was to assess the incidence of LSA occlusion, resulting ischemic symptoms, and complications related to revascularization operations in trauma patients compared to non-trauma patients. METHODS Studies from 2010 to 2020 were fully reviewed if they discussed incidence of LSA coverage, LUE ischemia, carotid-subclavian bypass, or complications associated with carotid-subclavian bypass. RESULTS Seventeen articles were included in this analysis. A total of 167 patients were identified as trauma cases. Incidence of LSA occlusion in trauma was 91/167 (54%) compared to 281/1446 (19%) in the population exclusive of trauma (p < 0.001). Following LSA occlusion, the rate of LUE claudication/ischemia was 21/56 (38%) for trauma, compared to 12/193 (6%) in non-trauma cases (p < 0.001). The overall complication rate after carotid-subclavian rescue bypass was 29.2% (33/112), with phrenic nerve palsy (24%), recurrent laryngeal nerve palsy (5%), and pseudoaneurysm (1.7%) being the most common. CONCLUSION LSA coverage following TEVAR is common and associated with significant complications, often requiring operative management. The incidence of ischemic complications after occlusion of the LSA is significantly higher in the trauma population. Revascularization procedures to correct the occlusion have a high rate of complications.
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Affiliation(s)
- Areg Grigorian
- Division of Trauma and Surgical Critical Care, University of Southern California, 2051 Marengo Street, Los Angeles, CA, 90033, USA.
| | - Meghan Lewis
- Division of Trauma and Surgical Critical Care, University of Southern California, 2051 Marengo Street, Los Angeles, CA, 90033, USA
| | - Jordan R Wlodarczyk
- Division of Trauma and Surgical Critical Care, University of Southern California, 2051 Marengo Street, Los Angeles, CA, 90033, USA
| | - Chih Ying Chien
- Division of Trauma and Surgical Critical Care, University of Southern California, 2051 Marengo Street, Los Angeles, CA, 90033, USA
| | - Timothy Park
- Division of Trauma and Surgical Critical Care, University of Southern California, 2051 Marengo Street, Los Angeles, CA, 90033, USA
| | - Demetrios Demetriades
- Division of Trauma and Surgical Critical Care, University of Southern California, 2051 Marengo Street, Los Angeles, CA, 90033, USA
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17
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Wilson-Smith AR, Muston B, Kamalanathan H, Yung A, Chen CHJ, Sahai P, Eranki A. Endovascular repair of acute complicated type B aortic dissection-systematic review and meta-analysis of long-term survival and reintervention. Ann Cardiothorac Surg 2021; 10:723-730. [PMID: 34926176 DOI: 10.21037/acs-2021-taes-17] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 10/29/2021] [Indexed: 11/06/2022]
Abstract
Background Thoracic endovascular repair (TEVAR) is considered the first-line therapy in the repair of acute complicated type B aortic dissection (AC-BAD). Given the difficulty of designing randomized trials in this surgical cohort, long-term outcome data is limited. This systematic review and meta-analysis provide a complete aggregation of reported long-term survival and freedom from reintervention of AC-BAD patients based on the existing literature. Methods Three databases were searched from date of database inception to January 2021. The relevant references were identified and baseline cohort characteristics, survival and freedom from reintervention were extracted. The primary endpoints were survival and freedom from reintervention, whilst secondary endpoints were post-operative outcomes such as cord ischemia and endoleak. Kaplan-Meier curves were digitized and aggregated as per established procedure. Results A total of 2,812 references were identified in the literature search for review, with 46 selected for inclusion. A total of 2,565 patients were identified, of which 1,920 (75%) were male. The mean age of the cohort was 59.8±5.8. Actuarial survival at 2, 4, 6 and 10 years was 87.5%, 83.2%, 78.5% and 69.7%, respectively. Freedom from all secondary reintervention at 2, 4, 6, 8 and 10 years was 74.7%, 69.1%, 65.7%, 63.9% and 60.9%, respectively. When accounting for study quality, actuarial survival at 2, 4, 6 and 8 years was 85.4%, 79.1%, 69.8% and 63.1%, respectively. Freedom from all secondary reintervention at 2, 4, 6 and 8 years was 73.2%, 67.6%, 63.7% (maintained), respectively. Conclusions TEVAR is associated with promising long-term survival extended to 10 years, though rates of freedom from reintervention remain an ongoing point for improvement. Randomized controlled trials comparing endovascular with open repair in the setting of acute, complicated type B aortic dissection are needed.
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Affiliation(s)
- Ashley R Wilson-Smith
- Department of Thoracic Surgery, The Chris O'Brien Lifehouse Center, Sydney, Australia.,Department of Thoracic Surgery, The Collaborative Research Group (CORE), Sydney, Australia.,Department of Surgery, The University of Sydney, Sydney, Australia.,Department of Surgery, The John Hunter Hospital, Newcastle, Australia.,Department of Surgery, The Hunter Medical Research Institute (HMRI), Newcastle, Australia
| | - Benjamin Muston
- Department of Thoracic Surgery, The Collaborative Research Group (CORE), Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | | | - Amanda Yung
- Department of Thoracic Surgery, The Collaborative Research Group (CORE), Sydney, Australia.,Department of Surgery, The University of Sydney, Sydney, Australia
| | - Cheng-Hao Jacky Chen
- Department of Thoracic Surgery, The Collaborative Research Group (CORE), Sydney, Australia.,Department of Surgery, The University of Sydney, Sydney, Australia
| | - Prachi Sahai
- Department of Surgery, The John Hunter Hospital, Newcastle, Australia
| | - Aditya Eranki
- Department of Surgery, The John Hunter Hospital, Newcastle, Australia
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18
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Singh S, Nassiri N, Vallabhajosyula P. All type B aortic dissections should undergo thoracic endovascular aneurysm repair. JTCVS Tech 2021; 9:17-24. [PMID: 34647046 PMCID: PMC8501243 DOI: 10.1016/j.xjtc.2021.05.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 05/25/2021] [Indexed: 12/26/2022] Open
Affiliation(s)
- Saket Singh
- Division of Cardiac 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
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19
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Gao Z, Qin Z, Qian D, Pan W, Zhou G, An Z, Hou C, Wang L, Zhang L, Gu T, Jin J. Risk factors for incomplete thrombosis in false lumen in sub-acute type B aortic dissection post-TEVAR. Heart Vessels 2021; 37:505-512. [PMID: 34417627 DOI: 10.1007/s00380-021-01926-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 08/13/2021] [Indexed: 11/30/2022]
Abstract
There is scarce information about the risk factors for incomplete false lumen thrombosis (FLT) among type B aortic dissection (AD) patients, particularly in the sub-acute phase following thoracic endovascular aortic repair (TEVAR). We enrolled consecutive sub-acute type B AD patients at Xinqiao Hospital (Chongqing, China) from May 2010 to December 2019. Patients with severe heart failure, cancer, and myocardial infarction were excluded. The postoperative computed tomography angiography (CTA) data were extracted from the most recent follow-up aortic CTA. Multivariate logistic regressions were applied to identify the association between FLT and clinical or imaging factors. Fifty-five subjects were enrolled in our study. Twelve participants showed complete FLT, and 2 of these died during the follow-up, while 8 patients died in incomplete FLT group. In the multivariate analysis, maximum abdominal aorta diameter (OR 1.20, 95% CI 1.016-1.417 p = 0.032) and the number of branches arising from the false lumen (FL) (OR 15.062, 95% 1.681-134.982 p = 0.015) were significantly associated with incomplete FLT. The C-statistics was 0.873 (95% CI 0.773-0.972) for the model. The FL diameter (p < 0.001) was significantly shorter following TEVAR, while the true lumen diameter (p < 0.001) and maximum abdominal aorta diameter (p = 0.011) were larger after the aortic repair. There were 21.8% of sub-acute type B AD patients presented complete FLT post-TEVAR. Maximum abdominal aorta diameter and the number of branches arising from the FL were independent risk factors for incomplete FLT. The true lumen diameter, maximum abdominal aorta diameter, and FL diameter changed notably following TEVAR.
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Affiliation(s)
- Zhichun Gao
- Institute of Cardiovascular Diseases of PLA, PLA, Xinqiao Street, Chongqing, 400038, China.,Department of Cardiology, Xinqiao Hospital, Army Medical University (Third Military Medical University), Xinqiao Street, Shapingba District, Chongqing, 400038, China
| | - Zhexue Qin
- Institute of Cardiovascular Diseases of PLA, PLA, Xinqiao Street, Chongqing, 400038, China.,Department of Cardiology, Xinqiao Hospital, Army Medical University (Third Military Medical University), Xinqiao Street, Shapingba District, Chongqing, 400038, China
| | - Dehui Qian
- Institute of Cardiovascular Diseases of PLA, PLA, Xinqiao Street, Chongqing, 400038, China.,Department of Cardiology, Xinqiao Hospital, Army Medical University (Third Military Medical University), Xinqiao Street, Shapingba District, Chongqing, 400038, China
| | - Wenxu Pan
- Institute of Cardiovascular Diseases of PLA, PLA, Xinqiao Street, Chongqing, 400038, China.,Department of Cardiology, Xinqiao Hospital, Army Medical University (Third Military Medical University), Xinqiao Street, Shapingba District, Chongqing, 400038, China
| | - Guiquan Zhou
- Institute of Cardiovascular Diseases of PLA, PLA, Xinqiao Street, Chongqing, 400038, China.,Department of Cardiology, Xinqiao Hospital, Army Medical University (Third Military Medical University), Xinqiao Street, Shapingba District, Chongqing, 400038, China
| | - Zhixia An
- Institute of Cardiovascular Diseases of PLA, PLA, Xinqiao Street, Chongqing, 400038, China.,Department of Cardiology, Xinqiao Hospital, Army Medical University (Third Military Medical University), Xinqiao Street, Shapingba District, Chongqing, 400038, China
| | - Changchun Hou
- Institute of Cardiovascular Diseases of PLA, PLA, Xinqiao Street, Chongqing, 400038, China.,Department of Cardiology, Xinqiao Hospital, Army Medical University (Third Military Medical University), Xinqiao Street, Shapingba District, Chongqing, 400038, China
| | - Luyu Wang
- Institute of Cardiovascular Diseases of PLA, PLA, Xinqiao Street, Chongqing, 400038, China.,Department of Cardiology, Xinqiao Hospital, Army Medical University (Third Military Medical University), Xinqiao Street, Shapingba District, Chongqing, 400038, China
| | - Liying Zhang
- Institute of Cardiovascular Diseases of PLA, PLA, Xinqiao Street, Chongqing, 400038, China.,Department of Cardiology, Xinqiao Hospital, Army Medical University (Third Military Medical University), Xinqiao Street, Shapingba District, Chongqing, 400038, China
| | - Tao Gu
- Department of Radiology, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Jun Jin
- Institute of Cardiovascular Diseases of PLA, PLA, Xinqiao Street, Chongqing, 400038, China. .,Department of Cardiology, Xinqiao Hospital, Army Medical University (Third Military Medical University), Xinqiao Street, Shapingba District, Chongqing, 400038, China.
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20
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Howard C, Sheridan J, Picca L, Reza S, Smith T, Ponnapalli A, Calow R, Cross O, Iddawela S, George M, Livra Dias D, Srinivasan A, Munir W, Bashir M, Idhrees M. TEVAR for complicated and uncomplicated type B aortic dissection-Systematic review and meta-analysis. J Card Surg 2021; 36:3820-3830. [PMID: 34310731 DOI: 10.1111/jocs.15827] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 06/23/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Type B aortic dissection (TBAD), is defined as a dissection involving the aorta distal to left subclavian artery with the ascending aorta and the aortic arch not affected. TBAD is classified due to the time frame and presence of complications. Complicated TBAD (co-TBAD) patients have a greater mortality rate than uncomplicated TBAD (un-TBAD) and thoracic endovascular aortic repair (TEVAR) is considered the gold-standard intervention for these clinical challenges. METHODS We undertook a systematic review of the literature regarding TEVAR intervention in co-TBAD and un-TBAD. A comprehensive search was undertaken across four major databases and was evaluated and assessed until June 2020. RESULTS A total of 16,104 patients were included in the study (7772 patients co-TBAD and 8352 un-TBAD). A significantly higher proportion of comorbidities were seen in co-TBAD patients compared with un-TBAD. Acute dissection was more frequent in the co-TBAD group (73.55% vs. 66.91%), while chronic dissection was more common in un-TBAD patients (33.8% vs. 70.73%). Postprocedure stroke was higher in co-TBAD (5.85% vs. 3.92%; p < .01), while postprocedural renal failure was higher in un-TBAD patients (7.23 vs. 11.38%; p < .01). No difference was observed in in-hospital mortality however the 30 days mortality was higher in the co-TBAD group. One-year survival was higher in the uncomplicated group but this difference was not observed in the 5-year survival. CONCLUSION In our analysis we can appreciate that despite significantly higher comorbidities in the co-TBAD cohort, there was no difference in in-hospital mortality between the two groups and the 5-year survival did not have any difference.
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Affiliation(s)
- Callum Howard
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Jonathan Sheridan
- Academic Unit of Medical Education, The University of Sheffield, Sheffield, UK
| | - Leonardo Picca
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Sihab Reza
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Tristan Smith
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Anuradha Ponnapalli
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Rachel Calow
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Olivia Cross
- School of Medicine, Keele University, Staffordshire, UK
| | - Sashini Iddawela
- Department of Respiratory Medicine, University Hospitals Birmingham, Birmingham, UK
| | - Melvin George
- Clinical Pharmacology, SRM Medical College Hospital, Kancheepuram, Tamil Nadu, India
| | - Deidre Livra Dias
- Senior Medical Reviewer, Cognizant Technology Solutions, Pune, India
| | - Anand Srinivasan
- Department of Pharmacology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Wahaj Munir
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Mohammad Bashir
- Vascular and Endovascular Surgery, NHS Wales Health Education and Improvement, Cardiff, UK
| | - Mohammed Idhrees
- Institute of Cardiac and Aortic Disorders (ICAD), SRM Institutes for Medical Science (SIMS Hospital), Vadapalani, Chennai, India
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21
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Miri R, Mleyhi S, Ben Mrad M, Derbel B, Souid A, Boukriba S, Ziadi J, Denguir R. Endovascular repair of ruptured Type B aortic dissection. JOURNAL DE MÉDECINE VASCULAIRE 2021; 46:186-189. [PMID: 34238514 DOI: 10.1016/j.jdmv.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 05/15/2021] [Indexed: 10/21/2022]
Affiliation(s)
- R Miri
- Cardiovascular surgery department, La Rabta Teaching Hospital, Faculty of medicine of Tunis, University of Tunis El Manar, Jabbari Street, 1007 Tunis, Tunisia.
| | - S Mleyhi
- Cardiovascular surgery department, La Rabta Teaching Hospital, Faculty of medicine of Tunis, University of Tunis El Manar, Jabbari Street, 1007 Tunis, Tunisia
| | - M Ben Mrad
- Cardiovascular surgery department, La Rabta Teaching Hospital, Faculty of medicine of Tunis, University of Tunis El Manar, Jabbari Street, 1007 Tunis, Tunisia
| | - B Derbel
- Cardiovascular surgery department, La Rabta Teaching Hospital, Faculty of medicine of Tunis, University of Tunis El Manar, Jabbari Street, 1007 Tunis, Tunisia
| | - A Souid
- Radiology department, La Rabta Teaching Hospital, Faculty of medicine of Tunis, University of Tunis El Manar, Tunisia
| | - S Boukriba
- Radiology department, La Rabta Teaching Hospital, Faculty of medicine of Tunis, University of Tunis El Manar, Tunisia
| | - J Ziadi
- Cardiovascular surgery department, La Rabta Teaching Hospital, Faculty of medicine of Tunis, University of Tunis El Manar, Jabbari Street, 1007 Tunis, Tunisia
| | - R Denguir
- Cardiovascular surgery department, La Rabta Teaching Hospital, Faculty of medicine of Tunis, University of Tunis El Manar, Jabbari Street, 1007 Tunis, Tunisia
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22
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White RD, Moore KS, Salahia MG, Thomas WR, Gordon AC, Williams IM, Wood AM, Zealley IA. Renal Arteries Revisited: Anatomy, Pathologic Entities, and Implications for Endovascular Management. Radiographics 2021; 41:909-928. [PMID: 33939544 DOI: 10.1148/rg.2021200162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The renal arteries (RAs) are important vessels that usually arise from the abdominal aorta and supply the kidneys; thus, these arteries play a vital role in physiologic functions such as hemofiltration and blood pressure regulation. An understanding of the basis for embryologic development and the frequently variable anatomy of the RAs is necessary to fully appreciate the range of diseases and the implications for procedural planning. Hemorrhage from an RA is relatively common and is typically traumatic or spontaneous, with the latter form often seen in association with underlying tumors or arteriopathy. Accurate diagnostic evaluation of RA disease due to conditions such as atherosclerosis, fibromuscular dysplasia, vasculitis, aneurysm, arteriovenous shunt, embolic disease, and dissection is dependent on the use of multimodality imaging and is essential for selecting appropriate clinical management, with endovascular therapy having a key role in treatment. Surgical considerations include extra-anatomic renal bypass, which remains an important treatment option even in this era of endovascular therapy, and RA embolization as an adjunct to tumor surgery. A novel area of research interest is the potential role of RA denervation in the management of refractory hypertension. ©RSNA, 2021.
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Affiliation(s)
- Richard D White
- From the Departments of Radiology (R.D.W., K.S.M., M.G.S., W.R.T., A.C.G., A.M.W.) and Vascular Surgery (I.M.W.), University Hospital of Wales, Heath Park, Cardiff CF14 4XW, Wales; and Department of Radiology, Ninewells Hospital and Medical School, Dundee, Scotland (I.A.Z.)
| | - Katherine S Moore
- From the Departments of Radiology (R.D.W., K.S.M., M.G.S., W.R.T., A.C.G., A.M.W.) and Vascular Surgery (I.M.W.), University Hospital of Wales, Heath Park, Cardiff CF14 4XW, Wales; and Department of Radiology, Ninewells Hospital and Medical School, Dundee, Scotland (I.A.Z.)
| | - M Ghali Salahia
- From the Departments of Radiology (R.D.W., K.S.M., M.G.S., W.R.T., A.C.G., A.M.W.) and Vascular Surgery (I.M.W.), University Hospital of Wales, Heath Park, Cardiff CF14 4XW, Wales; and Department of Radiology, Ninewells Hospital and Medical School, Dundee, Scotland (I.A.Z.)
| | - W Rhodri Thomas
- From the Departments of Radiology (R.D.W., K.S.M., M.G.S., W.R.T., A.C.G., A.M.W.) and Vascular Surgery (I.M.W.), University Hospital of Wales, Heath Park, Cardiff CF14 4XW, Wales; and Department of Radiology, Ninewells Hospital and Medical School, Dundee, Scotland (I.A.Z.)
| | - Andrew C Gordon
- From the Departments of Radiology (R.D.W., K.S.M., M.G.S., W.R.T., A.C.G., A.M.W.) and Vascular Surgery (I.M.W.), University Hospital of Wales, Heath Park, Cardiff CF14 4XW, Wales; and Department of Radiology, Ninewells Hospital and Medical School, Dundee, Scotland (I.A.Z.)
| | - Ian M Williams
- From the Departments of Radiology (R.D.W., K.S.M., M.G.S., W.R.T., A.C.G., A.M.W.) and Vascular Surgery (I.M.W.), University Hospital of Wales, Heath Park, Cardiff CF14 4XW, Wales; and Department of Radiology, Ninewells Hospital and Medical School, Dundee, Scotland (I.A.Z.)
| | - Andrew M Wood
- From the Departments of Radiology (R.D.W., K.S.M., M.G.S., W.R.T., A.C.G., A.M.W.) and Vascular Surgery (I.M.W.), University Hospital of Wales, Heath Park, Cardiff CF14 4XW, Wales; and Department of Radiology, Ninewells Hospital and Medical School, Dundee, Scotland (I.A.Z.)
| | - Ian A Zealley
- From the Departments of Radiology (R.D.W., K.S.M., M.G.S., W.R.T., A.C.G., A.M.W.) and Vascular Surgery (I.M.W.), University Hospital of Wales, Heath Park, Cardiff CF14 4XW, Wales; and Department of Radiology, Ninewells Hospital and Medical School, Dundee, Scotland (I.A.Z.)
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23
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Zaidan L, Qannita A, Abbarah S, Koussayer B, Koussayer S. TEVAR Stent to the False Lumen of a Chronic Type B Aortic Dissection With Aneurysmal Dilatation, When no Other Options Are Left. Ann Vasc Surg 2021; 74:523.e19-523.e25. [PMID: 33831528 DOI: 10.1016/j.avsg.2021.01.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/26/2021] [Accepted: 01/30/2021] [Indexed: 10/21/2022]
Abstract
We report a case of a 72 years-old male referred to us with a 2-year history of an enlarging aortic aneurysm secondary to a chronic Type B aortic dissection and a complete occlusion of the true lumen in the thoracic and abdominal aorta except at the level of visceral arteries origins. Several attempts to recanalize the true lumen was not successful. Because of the patient's high risk for an open repair and the normal size of his thoracic aorta proximal to the celiac artery, we deployed the TEVAR stent to the false lumen to prevent aneurysmal enlargement and rupture. The operation was successful, and the patient recovered without complications and with complete exclusion of the aneurysm on two years follow up.
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Affiliation(s)
- Louai Zaidan
- Alfaisal University, Riyadh, Saudi Arabia; Vascular Surgery Department, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Ahmed Qannita
- Alfaisal University, Riyadh, Saudi Arabia; Vascular Surgery Department, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Shaher Abbarah
- Vascular Surgery Department, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Bilal Koussayer
- Vascular Surgery Department, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Samer Koussayer
- Alfaisal University, Riyadh, Saudi Arabia; Vascular Surgery Department, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia; Section Head, Vascular Surgery Department, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.
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24
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Zhong J, Osman A, Tingerides C, Puppala S, Shaw D, McPherson S, Darwood R, Walker P. Technique-Based Evaluation of Clinical Outcomes and Aortic Remodelling Following TEVAR in Acute and Subacute Type B Aortic Dissection. Cardiovasc Intervent Radiol 2021; 44:537-547. [PMID: 33388868 DOI: 10.1007/s00270-020-02749-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 12/09/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION To evaluate the clinical outcomes and aortic remodelling rates following thoracic endovascular aortic repair (TEVAR) for acute or subacute type B aortic dissection (TBAD) based on technique. MATERIAL AND METHODS All TEVARs for acute/subacute TBAD between 01/01/2008 and 01/06/2020 were included. TEVARS were grouped by technique (TEVAR only, PETTICOAT and STABILISE). Aortic remodelling was assessed at three aortic levels on follow-up CT. Thirty-day technical/clinical success rates, re-intervention rates and complications were recorded. RESULTS A total of 29 patients were included. The median age was 55 years (31-82). The median duration from initial presentation to TEVAR was 7 days (0-84). Intra-procedural complications included one aortic rupture from balloon moulding in a STABILISE case. Thirty-day mortality, stroke, spinal cord ischaemia and visceral ischaemia were 3% (n = 1), 3% (n = 1), 3% (n = 1) and 3% (n = 1), respectively. (All occurred in acute TBAD.) Overall survival was 50.5 months (18-115). Median follow-up was 31 months (1-115). Six patients (21%) required re-intervention, with a median time of 5 months (5-46) from first TEVAR. Overall complete aortic remodelling rates were: 89% at the proximal descending thoracic aorta, 78% at the distal thoracic aorta and 50% at the infra-renal abdominal aorta. At the infra-renal aorta, the STABILISE group (n = 11) had a higher complete aortic remodelling rate (82%) compared to TEVAR alone (n = 12) (20%). CONCLUSION Endovascular intervention for acute and subacute TBAD is safe with a high rate of technical success. STABILISE results in higher aortic remodelling at the infra-renal aorta (82%) compared to TEVAR alone (20%) but risks aortic rupture from balloon moulding.
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Affiliation(s)
- Jim Zhong
- Department of Diagnostic and Interventional Radiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, LS1 3EX, UK.,University of Leeds, Leeds, UK
| | - Ahmed Osman
- Department of Diagnostic and Interventional Radiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, LS1 3EX, UK
| | - Costa Tingerides
- Department of Diagnostic and Interventional Radiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, LS1 3EX, UK.,University of Leeds, Leeds, UK
| | - Sapna Puppala
- Department of Diagnostic and Interventional Radiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, LS1 3EX, UK.,University of Leeds, Leeds, UK
| | - David Shaw
- Department of Diagnostic and Interventional Radiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, LS1 3EX, UK.,University of Leeds, Leeds, UK
| | - Simon McPherson
- Department of Diagnostic and Interventional Radiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, LS1 3EX, UK.,University of Leeds, Leeds, UK
| | - Rosemary Darwood
- University of Leeds, Leeds, UK.,Department of Vascular Surgery, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, LS1 3EX, UK
| | - Paul Walker
- Department of Diagnostic and Interventional Radiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, LS1 3EX, UK. .,University of Leeds, Leeds, UK.
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25
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Sahin AA, Guner A, Demir AR, Uzun N, Onan B, Topel C, Çelik Ö. Comparison between PeRcutanEous and surgical femoral aCcess for endovascuLar aOrtic repair in patientS with typE III aortic Dissection (PRECLOSE Trial). Vascular 2020; 29:616-623. [PMID: 33054676 DOI: 10.1177/1708538120965310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Aortic dissections are cardiovascular events with high mortality and morbidity rates. Management might be either with medical or interventional approach. Recently, thoracic endovascular intervention (TEVAR) becomes the first treatment of choice because of its better results and lower rates of complications in patients with type III aortic dissections. The intervention might be performed via femoral artery either with percutaneous or with surgical approach. Because of large sheath insertion to femoral artery, Pre-close technique is described in literature. The aim of this study was to investigate and compare the outcomes and safety of 'Pre-close technique' to surgical approach in patients with type III aortic dissections who underwent TEVAR with femoral access ≥22 F. METHODS A total of 96 patients whom had type III aortic dissection and was performed TEVAR were retrospectively included in the study. Fifty-six patients had TEVAR with percutaneous approach and these patients are named as P-TEVAR group, and 40 patients had TEVAR with surgical approach and these patients are named as S-TEVAR group. Pre- and post-procedural data with complications and procedural data during TEVAR were evaluated for both groups and compared in between. RESULTS The main finding was that there was no significant difference between S-TEVAR and P-TEVAR groups in terms of complications and technical success. Operating room time was significantly decreased in P-TEVAR group (P < 0.001). Overall success rate for femoral approach in patients with Pre-close technique was 94.6% and was 100% for surgical approach. P-TEVAR group had post-operative complications in three patients and S-TEVAR group had in four patients. CONCLUSIONS Total percutaneous approach with Pre-close technique using Pro-Glide device is a safe and feasible method of femoral access in patients with type III aortic dissections.
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Affiliation(s)
- Ahmet A Sahin
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ahmet Guner
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ali R Demir
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Nedim Uzun
- Department of Emergency Medicine, Gaziosmanpasa Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Burak Onan
- Department of Cardiovascular Surgery, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Cagdas Topel
- Department of Radiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ömer Çelik
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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26
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Kuo HS, Huang JH, Chen JS. Handmade fenestrated stent grafts to preserve all supra-aortic branches in thoracic endovascular aortic repair. J Thorac Cardiovasc Surg 2020; 160:629-639.e1. [DOI: 10.1016/j.jtcvs.2019.07.096] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/16/2019] [Accepted: 07/16/2019] [Indexed: 11/16/2022]
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27
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Bavaria JE, Brinkman WT, Hughes GC, Shah AS, Charlton-Ouw KM, Azizzadeh A, White RA. Five-year outcomes of endovascular repair of complicated acute type B aortic dissections. J Thorac Cardiovasc Surg 2020; 163:539-548.e2. [DOI: 10.1016/j.jtcvs.2020.03.162] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 03/05/2020] [Accepted: 03/16/2020] [Indexed: 11/28/2022]
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28
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Li DL, He YJ, Wang XH, He YY, Wu ZH, Zhu QQ, Shang T, Zhang HK. Long-term Results of Thoracic Endovascular Aortic Repair for Type B Aortic Dissection and Risk Factors for Survival. J Endovasc Ther 2020; 27:358-367. [PMID: 32166999 DOI: 10.1177/1526602820910135] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To compare characteristics of acute, subacute, and chronic type B aortic dissection and their influence on long-term results of thoracic endovascular aortic repair (TEVAR). Materials and Methods: In a single-center, retrospective cohort study, 314 patients (median age 52 years; 244 men) with acute (n=165), subacute (n=115), or chronic (n=34) type B aortic dissection underwent TEVAR between January 2009 and December 2013. Patient demographics, risk factors, and imaging characteristics were compared among the groups. Univariable and multivariable Cox regression analyses were performed to identify any factors influencing survival. Results: The acute and subacute patients exhibited more complications at presentation than chronic patients. However, the chronic patients exhibited more aneurysmal dilatation (p<0.001) and true lumen collapse (p<0.001). Over a mean follow-up of 68.1±22.9 months (range 2–108), subacute patients showed a lower reintervention rate (3.6% vs 12.1% vs 12.1%, p=0.045), a lower major complication rate (14.4% vs 33.1% vs 27.3%, p=0.002), and better cumulative overall survival (p=0.03) than the acute and chronic groups, respectively. Furthermore, acute patients developed more stent-graft–induced distal erosion (p=0.017) and retrograde type A dissection (RTAD) (p=0.036), whereas chronic patients had less aortic remodeling in the stented segment (p<0.001), distal thoracic aorta (p<0.001), and abdominal aorta (p=0.047). Finally, multivariable analysis demonstrated age >52 years, visceral malperfusion, and RTAD as independent factors influencing overall survival; aneurysmal dilatation, rupture/impending rupture, and RTAD were independent factors influencing aorta-specific survival. Conclusion: Acute and subacute patients had increased risks of rupture and complications at presentation, whereas chronic patients had increased risks for aneurysmal dilatation. From a long-term perspective, the subacute phase might be an optimal time for TEVAR in cases of type B aortic dissection that do not need emergent interventions. The risk factors influencing survival should be identified, carefully managed, and possibly prevented.
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Affiliation(s)
- Dong-lin Li
- Department of Vascular Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yun-jun He
- Department of Vascular Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiao-hui Wang
- Department of Vascular Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yang-yan He
- Department of Vascular Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Zi-heng Wu
- Department of Vascular Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Qian-qian Zhu
- Department of Vascular Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Tao Shang
- Department of Vascular Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Hong-kun Zhang
- Department of Vascular Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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Alhaizaey A, Aljabri B, Alghamdi M, AlAhmary A, karmota AG, Asiry M, Al-Omran M, Alhazmi B, Abulyazied A, Abbass M, Azazy A. Left subclavian artery occlusion during endovascular repair of traumatic thoracic aortic injury, cohort study. INTERNATIONAL JOURNAL OF SURGERY OPEN 2020. [DOI: 10.1016/j.ijso.2019.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Matsuzaki Y, Yamasaki T, Hohri Y, Hiramatsu T. Surgical Strategies for Type B Aortic Dissection by Frozen Elephant Trunk. Ann Vasc Dis 2019; 12:473-479. [PMID: 31942204 PMCID: PMC6957904 DOI: 10.3400/avd.oa.19-00094] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The timing and choice of surgical method for type B aortic dissection, is still a topic of much debate. We performed total arch replacement using frozen elephant trunk (TAR-FET) as a means of preventing distant aortic events, such as retrograde type A aortic dissection (RTAD). We conducted analysis of 142 patients with acute type B dissection who were admitted between January of 2010 and July of 2017. Fifty-five cases required surgical intervention to treat enlargement of the false lumen diameter and ULP formation 2 weeks after the onset of symptoms. 17 TAR-FET were performed with a mean of 42±26 days period from onset to surgery. There were no complications of RTAD or paraplegic, and 90% of patient demonstrated aortic event free survival (5 years) and false lumen reduction ratio of 35%. Based on our analysis, using TAR-FET properly avoids serious complications like RTAD, and is a viable treatment option for type B dissection. (This is a translation of J Jpn Coll Angiol 2018; 58: 151-157.).
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Affiliation(s)
- Yuichi Matsuzaki
- Department of Cardiovascular Surgery, Kyoto Daini Red Cross Hospital, Kyoto, Kyoto, Japan
| | - Takuma Yamasaki
- Department of Cardiovascular Surgery, Kyoto Daini Red Cross Hospital, Kyoto, Kyoto, Japan
| | - Yu Hohri
- Department of Cardiovascular Surgery, Kyoto Daini Red Cross Hospital, Kyoto, Kyoto, Japan
| | - Takeshi Hiramatsu
- Department of Cardiovascular Surgery, Kyoto Daini Red Cross Hospital, Kyoto, Kyoto, Japan
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Mansukhani NA, Haleem MS, Eskandari MK. Thoracic Endovascular Aortic Repair Adverse Events Reported In The Food And Drug Administration Manufacturer And User Facility Device Experience Database. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2019; 12:461-467. [PMID: 31814779 PMCID: PMC6861529 DOI: 10.2147/mder.s206269] [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: 02/21/2019] [Accepted: 06/13/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of this study is to identify adverse events (device- and patient-related) associated with thoracic aortic stent graft systems and their timing post-procedure. Materials and methods The Food and Drug Administration’s Manufacturer and User Facility Device Experience (FDA-MAUDE) voluntary database was searched for Thoracic Aortic Endovascular Repair (TEVAR) devices reported over the course of 1 year (January 1, 2014 to December 31, 2014). The data abstracted included the indication for treatment, device used, and adverse events. Results During 2014, there were 334 original submissions to the FDA-MAUDE database describing 371 adverse events regarding TEVAR devices that met inclusion criteria for this study. All submissions were from manufacturers, and none were from physicians. The most common pathologies treated were thoracic aortic aneurysm (67.6%) and type B aortic dissection (25.1%). The most frequently reported intraoperative, early postoperative (<30 days), and late postoperative (>30 days) events overall were technical device failure, neurologic complications (stroke, paraplegia), and endoleak, respectively. Of note, there were descriptions of retained deployment materials, late graft infections, and aorto-visceral fistula formation up to 3 years postoperatively. Conclusion The MAUDE database is a valuable repository for complications and device failures that are not otherwise in the published literature and submitted by manufacturers relating to this relatively new technology.
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Affiliation(s)
- Neel A Mansukhani
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Meraaj S Haleem
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Mark K Eskandari
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
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Retrograde stenting of the superior mesenteric artery is the procedure of choice for dissection of the aorta with mesenteric compromise. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2019; 5:431-434. [PMID: 31660466 PMCID: PMC6806652 DOI: 10.1016/j.jvscit.2019.06.014] [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: 04/18/2019] [Accepted: 06/19/2019] [Indexed: 11/23/2022]
Abstract
Acute mesenteric ischemia secondary to aortic dissection in type A and type B is a true vascular surgical emergency. Presentation can be subtle or dramatic, and time to revascularization is limited before irreversible changes occur. The literature recognizes the catastrophic consequences of acute superior mesenteric artery occlusion and the need for urgent revascularization, often before central aortic repair in type A. There is no optimal revascularization technique described in this scenario. We present a case of type A aortic dissection with acute dynamic and static superior mesenteric artery occlusion and describe treatment that resulted in successful salvage of the bowel and the patient's life.
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Chassin-Trubert L, Mandelli M, Ozdemir BA, Alric P, Gandet T, Canaud L. Midterm Follow-up of Fenestrated and Scalloped Physician-Modified Endovascular Grafts for Zone 2 TEVAR. J Endovasc Ther 2019; 27:377-384. [PMID: 31645219 DOI: 10.1177/1526602819881128] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To investigate the midterm outcomes of scalloped or fenestrated physician-modified endovascular grafts (PMEGs) for zone 2 thoracic endovascular aortic repairs (TEVAR). Materials and Methods: Between November 2013 and May 2019, 54 consecutive patients (mean age 63 years; 41 men) were treated with thoracic PMEGs modified with 7 scallops or 47 fenestrations for the left subclavian artery (LSA). Indications for aortic repair were acute complicated type B aortic dissection (17, 31%), degenerative aneurysm (13, 24%), acute traumatic rupture of the aortic isthmus (9, 16%), post chronic dissection aneurysmal evolution (8, 15%), penetrating aortic ulcer (3, 6%), intramural hematoma (2, 4%), and floating thrombus (2, 4%). Results: Technical success was 94%; 3 (6%) LSAs were unintentionally covered. An intraoperative type Ia endoleak was treated during the index procedure. One (2%) patient suffered spinal cord ischemia, with irreversible bilateral paraplegia. Three (6%) patients experience postoperative minor strokes with full neurological recovery. Four (7%) patients died in the perioperative period; 2 (2%) were due to aneurysm rupture. Mean follow-up was 26±16 months; 15 (28%) patients had at least 3 years of follow-up. Two (4%) type II endoleaks were identified and successfully treated (4% reintervention rate); no other endoleaks were identified. All the LSAs remained clinically and radiologically patent. There were no conversions to open repair, ruptures, retrograde dissection, stent fracture, migrations, or other aortic complications. Conclusion: Scalloped or single-fenestrated PMEGs for the LSA appear to be durable and safe in the midterm. Combined with low periprocedural morbidity and mortality, these results suggest that this approach can be considered as an off-label alternative to extend proximal seal to zone 2 for TEVAR. Further studies with a larger number of patients and long-term outcomes are needed to fully validate this approach.
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Affiliation(s)
- Lucien Chassin-Trubert
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France
| | - Marcello Mandelli
- Department of Vascular Surgery, Santa Helena Hospital, Florianopolis, Brazil
| | - Baris Ata Ozdemir
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France
| | - Pierre Alric
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France
| | - Thomas Gandet
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France
| | - Ludovic Canaud
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France
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Lombardi JV, Cambria RP, Nienaber CA, Chiesa R, Mossop P, Haulon S, Zhou Q. Five-year results from the Study of Thoracic Aortic Type B Dissection Using Endoluminal Repair (STABLE I) study of endovascular treatment of complicated type B aortic dissection using a composite device design. J Vasc Surg 2019; 70:1072-1081.e2. [DOI: 10.1016/j.jvs.2019.01.089] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 01/09/2019] [Indexed: 01/16/2023]
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Norton EL, Williams DM, Kim KM, Khaja MS, Wu X, Patel HJ, Deeb GM, Yang B. Management of acute type B aortic dissection with malperfusion via endovascular fenestration/stenting. J Thorac Cardiovasc Surg 2019; 160:1151-1161.e1. [PMID: 31669033 DOI: 10.1016/j.jtcvs.2019.09.065] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 08/30/2019] [Accepted: 09/03/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The study objective was to evaluate the management of malperfusion in acute type B aortic dissection with endovascular fenestration/stenting. METHODS From 1996 to 2018, 182 patients with an acute type B aortic dissection underwent fenestration/stenting for suspected malperfusion based on imaging, clinical manifestations, and laboratory findings. Data were obtained from medical record review and the National Death Index database. RESULTS The median age of patients was 55 years. Signs of malperfusion included abdominal pain (61%), lower-extremity weakness (27%), nonpalpable lower-extremity pulses (24%), and abnormal lactate, creatinine, liver enzymes, and creatine kinase levels. Confirmed hemodynamically significant malperfusion affected the spinal cord (2.7%), celiac (24%), superior mesenteric (40%), renal (51%), and iliofemoral (43%) arterial distributions. Of the 182 patients, 99 (54%) underwent aortic fenestration/stenting, 108 (59%) had 1 or multi-branch vessel fenestration/stenting, 5 (2.7%) had concomitant thoracic endovascular aortic repair, 17 (9.3%) had additional thrombolysis or thromboembolectomy, and 48 (26%) received no intervention. After fenestration/stenting, 24 patients (13%) required additional procedures for necrotic bowel or limb and 9 patients (4.9%) had subsequent aortic repair (thoracic endovascular aortic repair, open repair) before discharge. The new-onset paraplegia was 0%. The in-hospital mortality was 7.7% over 20+ years and 0% in the last 8 years. The 5- and 10-year survivals were 72% and 49%, respectively. The significant risk factors for late mortality were age and acute paralysis (hazard ratio, 3.5; both P < .0001). Given death as a competing factor, the 5- and 10-year cumulative incidence of reintervention was 21% and 31% for distal aortic pathology, respectively. CONCLUSIONS Patients with acute type B aortic dissection with malperfusion can be managed with endovascular fenestration/stenting with excellent short- and long-term outcomes. This approach is particularly helpful to patients with static malperfusion of aortic branch vessels.
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Affiliation(s)
| | | | - Karen M Kim
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - Minhaj S Khaja
- Department of Radiology, Michigan Medicine, Ann Arbor, Mich
| | - Xiaoting Wu
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - Himanshu J Patel
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - G Michael Deeb
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - Bo Yang
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich.
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Fan W, Li C, Zheng G, Pan Z, Rong J. Thoracic endovascular aortic repair in penetrating aortic ulcer combined with isolated left vertebral artery: A case report. Medicine (Baltimore) 2019; 98:e17159. [PMID: 31517864 PMCID: PMC6750286 DOI: 10.1097/md.0000000000017159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 07/19/2019] [Accepted: 08/20/2019] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Penetrating aorta ulcer (PAU) with isolated left vertebral artery (ILVA) is a rare condition, accounting for no more than 1% of all kinds of aorta diseases. And traditional treatment was open surgery with total arch replacement by elephant trunk. Here, we report a case of PAU combined with ILVA managed by thoracic endovascular aortic repair (TEVAR) technique. PATIENT CONCERNS A 65-year-old male with chronic hypertension and Nicotine abuse underwent intermittent back pain for 2 years and aggravated a bit for 1 week. DIAGNOSES Preoperative computed tomography angiogram (CTA) indicated PAU combined with ILVA. INTERVENTIONS TEVAR was performed for PAU following with retrograde in situ fenestration and chimney technique for revascularization of ILVA and left subclavian artery (LSA), respectively. OUTCOMES The operation was successfully and the patient was discharged from hospital after 1 week of treatment. Postoperatively, the images of CTA illustrated the patency of aorta, ILVA, and LSA without obvious endoleak. Besides, no ischemia attack or other relative syndromes were detected at 6-months follow-up. LESSONS This case demonstrates that TEVAR is an alternative to elephant trunk especially for PAU with ILVA. And it also showed the precise exposure of ILVA and necessity to reconstruct ILVA during TEVAR operation in order to reduce the occurrence of ischemia attack.
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Kim N, Choi SJ, Yoo BH, Lee S, Kim KM, Yon JH, Lee WY, Kim MC. Risk factors of 30-day mortality following endovascular thoracic and abdominal aortic repair with general anesthesia. Anesth Pain Med (Seoul) 2019. [DOI: 10.17085/apm.2019.14.3.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Nari Kim
- Department of Anesthesiology and Pain Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Si Jin Choi
- Department of Anesthesiology and Pain Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Byung Hoon Yoo
- Department of Anesthesiology and Pain Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Sangseok Lee
- Department of Anesthesiology and Pain Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Kye-Min Kim
- Department of Anesthesiology and Pain Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Jun Heum Yon
- Department of Anesthesiology and Pain Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Woo Yong Lee
- Department of Anesthesiology and Pain Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Mun-Cheol Kim
- Department of Anesthesiology and Pain Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
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Son SA, Lee DH, Oh TH, Cho JY, Lee YO, Kim YE, Kim JW, Kim GJ. Risk Factors Associated With Reintervention After Thoracic Endovascular Aortic Repair for Descending Aortic Pathologies. Vasc Endovascular Surg 2019; 53:181-188. [PMID: 30866751 DOI: 10.1177/1538574418814989] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND: Thoracic endovascular aortic repair (TEVAR) is associated with several short-term benefits, including reduced morbidity and mortality; however, the long-term durability of TEVAR and the need for secondary aortic reintervention remain unclear. We aimed to determine the adverse outcomes, including aortic reintervention, after TEVAR for thoracic aortic aneurysms and dissection. METHODS: Between October 2009 and July 2016, 130 patients underwent TEVAR at Kyungpook National University Hospital. We excluded 35 patients with traumatic injury and included the remaining 95 patients in our study after TEVAR. The patients included in this study were categorized into 2 groups (reintervention [R] and nonintervention [N] groups) according to the need for reintervention. The mean follow-up period for all 95 patients was 22.4 (20.6) months. RESULTS: The overall actuarial survival rates were 83.7% (4.1%) and 63.6% (8.8%) at 1 and 5 years, respectively. The rates of freedom from aortic reintervention after TEVAR were 94.0% (3.5%), 72.8% (8.2%), and 48.9% (10.5%) at 2, 3, and 5 years, respectively. The independent risk factors for aortic reintervention were endoleaks after TEVAR (odds ratio [OR] 6.13, P = .017), increase in aortic size by over 5% per year (OR 20.40, P = .001), and peripheral vascular occlusive disease (PVOD; OR 13.62, P = .007). Patients with preoperative hemoptysis tended to show a greater need for aortic reintervention ( P = .059). Increase in aortic size by over 5% per year and PVOD were the primary risk factors for endoleaks (OR 3.82, P = .013 and OR 4.37, P = .021, respectively). CONCLUSION: Survival after TEVAR for thoracic aortic pathologies was satisfactory in most of the patients chosen as candidates for the procedure. However, the occurrence of endoleaks, increase in aortic size by over 5% per year, and PVOD were the primary causes of aortic reintervention.
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Affiliation(s)
- Shin-Ah Son
- 1 Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Deok Heon Lee
- 1 Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Tak-Hyuk Oh
- 1 Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Joon Yong Cho
- 1 Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Young Ok Lee
- 1 Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Young Eun Kim
- 1 Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Jung Won Kim
- 1 Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Gun-Jik Kim
- 1 Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
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Zhou W, Yu W, Wang Y, Li Y, Sheng W, Wang Q, Xu W. Assessing Aortic Remodeling after Thoracic Endovascular Aortic Repair (TEVAR) in DeBakey IIIb Aortic Dissection: A Retrospective Study. Ann Thorac Cardiovasc Surg 2019; 25:46-55. [PMID: 30305479 PMCID: PMC6388301 DOI: 10.5761/atcs.oa.18-00167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
PURPOSE This study analyzed the different levels of aortic remodeling in patients with DeBakey IIIb aortic dissection (AD) after thoracic endovascular aortic repair (TEVAR) at a single center. METHODS In all, 66 patients with DeBakey IIIb AD who underwent TEVAR in the acute (Group A) or subacute phase (Group SA) from January 2012 to October 2016 were included in the study. The change in aortic lumen (A), true lumen (TL), false lumen (FL), and true lumen index (TLi) at different levels were analyzed. RESULTS There was no statistically significant difference in the clinical information and morphologic imaging findings in Groups A and SA. At proximal levels (levels A-C), there was no difference in aortic remodeling parameters, that is, increased TL, decreased FL, and increased TLi at levels B and C and stable A at levels A-C, in both groups. Moreover, the above parameters were illustrated using a box-and-whisker plot, which revealed the unstable acute phase by the larger distribution interval and the median and abnormal values of the right skew distribution in Group A. CONCLUSION Postoperative surveillance is important for patients of both acute and subacute AD.
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Affiliation(s)
- Wei Zhou
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.,Department of Radiology, Qingdao Municipal Hospital, Qingdao University, Qingdao, Shandong, China
| | - Wanjiang Yu
- Department of Radiology, Qingdao Municipal Hospital, Qingdao University, Qingdao, Shandong, China
| | - Yunying Wang
- Department of Medical Genetics, Qingdao Municipal Hospital, Qingdao University, Qingdao, Shandong, China
| | - Ying Li
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Wei Sheng
- Department of Cardiovascular Surgery, Qingdao Municipal Hospital, Qingdao University, Qingdao, Shandong, China
| | - Qingjiang Wang
- Department of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Wenjian Xu
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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Wojciechowski J, Znaniecki L, Kaszubowski M, Rogowski J. Late Aortic Remodeling after Endovascular Repair of Complicated Type B Aortic Dissection—TEVAR Protects Only the Covered Segment of Thoracic Aorta. Ann Vasc Surg 2019; 55:148-156. [DOI: 10.1016/j.avsg.2018.05.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/02/2018] [Accepted: 05/10/2018] [Indexed: 11/28/2022]
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Systematic review and meta-analysis of acute type B thoracic aortic dissection, open, or endovascular repair. J Vasc Surg 2018; 69:1599-1609.e2. [PMID: 30598351 DOI: 10.1016/j.jvs.2018.08.187] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 08/07/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The purpose of this study was to compare perioperative and mortality outcomes of endovascular aortic repair against open repair in acute type B thoracic aortic dissection. METHODS A comprehensive search was undertaken among the four major databases (PubMed, Embase, Scopus, and Ovid) to identify all published data comparing open vs endovascular repair in management of acute type B aortic dissection. Databases where evaluated and assessed to July 2017. The 95% confidence intervals were analyzed from the extracted data using relevant statistical methods. RESULTS Overall, 18,193 patients were found in a combination of nine studies. Patients undergoing open repair were younger (mean, 61.3 ± 9.3 years vs 66.6 ± 12.5 years; P < .00001). Postoperative stroke and paraplegia were similar in both groups (P = .71 and P = .81 respectively); however, the rate of all neurologic complications were more common in the traditional open repair group (6.9% vs 4.8%; P = .006). The all-cause operative and 1-year death was reported as higher in the open repair group (18.6% vs 7.4% [P < .0001] and 24.3% vs 14.3% [P < .0001], respectively); however, at 5 years this rate is almost similar between both groups (46.7% vs 49.7%; P = .21). At 1 year, the rate of reintervention was reported to be higher in endovascular repair group of patients (15.4% vs 5.5%; P = .004). CONCLUSIONS This study concludes that endovascular repair, in the setting of acute type B thoracic aortic dissection, provides an early surgical benefit; however, this finding has not yet been supported by long-term data. There seems to be a benefit with respect to all-neurologic events in favor of endovascular repair. Long-term comparative data and studies are required to give a better understanding of these two approaches.
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Yu PS, Fujikawa T, Underwood MJ, Wong RH. Current management of acute aortic syndrome. SURGICAL PRACTICE 2018. [DOI: 10.1111/1744-1633.12340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Peter S.Y. Yu
- Department of Surgery; The Chinese University of Hong Kong, Prince of Wales Hospital; Hong Kong
| | - Takuya Fujikawa
- Department of Surgery; The Chinese University of Hong Kong, Prince of Wales Hospital; Hong Kong
| | - Malcolm J. Underwood
- Department of Surgery; The Chinese University of Hong Kong, Prince of Wales Hospital; Hong Kong
| | - Randolph H.L. Wong
- Department of Surgery; The Chinese University of Hong Kong, Prince of Wales Hospital; Hong Kong
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Zierler RE, Jordan WD, Lal BK, Mussa F, Leers S, Fulton J, Pevec W, Hill A, Murad MH. The Society for Vascular Surgery practice guidelines on follow-up after vascular surgery arterial procedures. J Vasc Surg 2018; 68:256-284. [PMID: 29937033 DOI: 10.1016/j.jvs.2018.04.018] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 04/11/2018] [Indexed: 12/20/2022]
Abstract
Although follow-up after open surgical and endovascular procedures is generally regarded as an important part of the care provided by vascular surgeons, there are no detailed or comprehensive guidelines that specify the optimal approaches with regard to testing methods, indications for reintervention, and follow-up intervals. To provide guidance to the vascular surgeon, the Clinical Practice Council of the Society for Vascular Surgery appointed an expert panel and a methodologist to review the current clinical evidence and to develop recommendations for follow-up after vascular surgery procedures. For those procedures for which high-quality evidence was not available, recommendations were based on observational studies, committee consensus, and indirect evidence. Recognizing that there are numerous published reports on the role of duplex ultrasound for surveillance of infrainguinal vein bypass grafts, the Society commissioned a systematic review and meta-analysis on this topic. The panel classified the strength of each recommendation and the corresponding quality of evidence on the basis of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system: recommendations were graded either strong or weak, and the quality of evidence was graded high, moderate, or low. The resulting recommendations represent a wide variety of open surgical and endovascular procedures involving the extracranial carotid artery, thoracic and abdominal aorta, mesenteric and renal arteries, and lower extremity arterial revascularization. The panel also identified many areas in which there was a lack of high-quality evidence to support their recommendations. This suggests that there are opportunities for further clinical research on testing methods, threshold criteria, and the role of surveillance as well as on the modes of failure and indications for reintervention after vascular surgery procedures.
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Affiliation(s)
| | | | - Brajesh K Lal
- Department of Surgery, University of Maryland, Baltimore, Md
| | - Firas Mussa
- Department of Surgery Palmetto Health/University of South Carolina School of Medicine, Columbia, SC
| | - Steven Leers
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Joseph Fulton
- Department of Surgery, Westchester Medical Center, Poughkeepsie, NY
| | - William Pevec
- Division of Vascular Surgery, University of California, Davis, Sacramento, Calif
| | - Andrew Hill
- Division of Vascular & Endovascular Surgery, The Ottawa Hospital & University of Ottawa, Ottawa, Ontario, Canada
| | - M Hassan Murad
- Division of Preventive Medicine, Mayo Clinic, Rochester, Minn
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Ethnic disparities in outcomes of patients with complicated type B aortic dissection. J Vasc Surg 2018; 68:36-45. [DOI: 10.1016/j.jvs.2017.10.083] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 10/24/2017] [Indexed: 11/23/2022]
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Al Adas Z, Shepard AD, Weaver MR, Miller DJ, Nypaver TJ, Modi S, Affan M, Nour K, Balraj P, Kabbani LS. Cerebrovascular injuries found in acute type B aortic dissections are associated with blood pressure derangements and poor outcome. J Vasc Surg 2018; 68:1308-1313. [PMID: 29945839 DOI: 10.1016/j.jvs.2018.01.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 01/29/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Cerebrovascular injury (CVI) is a recognized but underappreciated complication of acute type B aortic dissection (ATBAD). This study was performed to determine risk factors for CVI associated with ATBAD and, in particular, the possible contributory role of aggressive anti-impulse therapy. METHODS A retrospective review of all patients presenting to a tertiary medical center with an ATBAD between January 2003 and October 2012 was conducted. All CVIs were adjudicated by a vascular neurologist and assigned a probable cause. The initial intensity of anti-impulse therapy was defined as the difference in mean arterial pressure (ΔMAP) from presentation to subsequent admission to the intensive care unit. RESULTS A total of 112 patients were identified. The average age was 61 years; 64% were male, and 59% were African American. Twenty patients required operative intervention (14 thoracic endovascular aortic repairs and 6 open). CVI occurred in 13 patients (11.6%): 9 were hypoperfusion related (6 diffuse hypoxic brain injuries and 3 watershed infarcts), 2 were procedure related (both thoracic endovascular aortic repairs), 1 was an intracranial hemorrhage on presentation, and 1 was a probable embolic stroke on presentation. CVI patients had demographics and comorbidities comparable to those of the non-CVI patients. CVI was associated with operative intervention (54% vs 13%; P = .002). Thirty-day mortality was significantly higher in CVI patients (54% vs 6%; P < .001). Patients who suffered a hypoperfusion brain injury had a higher MAP on presentation to the emergency department (142 mm Hg vs 120 mm Hg; P = .034) and a significantly greater reduction in MAP (ΔMAP 49 mm Hg vs 15 mm Hg; P < .001) by the time they reached the intensive care unit compared with the non-CVI patients. CONCLUSIONS In our series, CVI in ATBAD is more frequent than previously reported and is associated with increased mortality. The most common causes are related to cerebral hypoperfusion. Higher MAP on presentation and greater decline in MAP are associated risk factors for hypoperfusion-related CVI. A less aggressive approach to lowering MAP in ATBAD warrants further study in an attempt to reduce CVI in ATBAD.
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Affiliation(s)
- Ziad Al Adas
- Division of Vascular Surgery, Henry Ford Hospital, Detroit, Mich
| | | | | | | | | | - Sumul Modi
- Division of Neurology, Henry Ford Hospital, Detroit, Mich
| | - Muhammad Affan
- Division of Neurology, Henry Ford Hospital, Detroit, Mich
| | - Khaled Nour
- Division of Cardiology, Henry Ford Hospital, Detroit, Mich
| | - Praveen Balraj
- Division of Vascular Surgery, Henry Ford Hospital, Detroit, Mich
| | - Loay S Kabbani
- Division of Vascular Surgery, Henry Ford Hospital, Detroit, Mich.
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Qiao F, Su C, Han Q, Tan M, Wang J, Liu Y, Lu F, Han L, Xu Z. Hybrid Reconstruction of the Aortic Arch Using a Double-Branched Stent-Graft in a Canine Model. J INVEST SURG 2018; 32:491-500. [PMID: 29469632 DOI: 10.1080/08941939.2018.1436206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Purpose: To report the results of a hybrid approach to aortic arch repair using an innovative unibody double-branched stent graft in a canine model.Materials and methods: The stent-graft system consists of two parts: the main body and two branches for reconstruction of the supra-arch branches. There is a 2-cm-long suturing portion at the proximal end of the main body. Twenty adult German sheep dogs underwent a hybrid surgical treatment to place the stent-grafts into the proximal descending aorta and the supra-arch branches. Outcomes were assessed by operative mortality, complications, imaging studies, and histomorphometric analyses.Results: Placement of the stent-graft was performed successfully in all dogs without complications. One dog died of respiratory failure due to early extubation. The other dogs survived to 6 months without complications, at which time they were sacrificed. The mean cardiopulmonary bypass time was 80.3 ± 7.3 mins and hypothermic circulatory arrest time was 10.7 ± 1.9 min. The average blood loss was 373.5 mL. At 6 months, postoperative aortic imaging indicated that the main body and branches of the stent-graft were fully open and in satisfactory position. No migration, deformation, or endovascular leakage was observed. Histomorphometric results showed normal arrangement of medial and adventitial elastic fibers, moderately proliferated intima, with or without neo-microvessels, and microscopic morphological changes in internal elastic lamina.Conclusions: These results demonstrate that it is possible and safe to reconstruct the aortic arch with the novel open-branched stent-graft placement.
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Affiliation(s)
- Fan Qiao
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Cunhua Su
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.,Department of Cardiothoracic Surgery, Nanjing First Hospital, Nanjing, Jiangsu Province, China
| | - Qingqi Han
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Mengwei Tan
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Jun Wang
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yang Liu
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Fanglin Lu
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Lin Han
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zhiyun Xu
- Department of Cardiovascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
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Ranney DN, Cox ML, Yerokun BA, Benrashid E, McCann RL, Hughes GC. Long-term results of endovascular repair for descending thoracic aortic aneurysms. J Vasc Surg 2018; 67:363-368. [PMID: 28847657 PMCID: PMC9799071 DOI: 10.1016/j.jvs.2017.06.094] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 06/15/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Since thoracic endovascular aortic repair (TEVAR) received U.S. Food and Drug Administration approval for the treatment of descending thoracic aneurysms in March 2005, excellent 30-day and midterm outcomes have been described. However, data on long-term outcomes are lacking with Medicare data suggesting that TEVAR has worse late survival compared with open descending repair. As such, the purpose of this study was to examine the long-term outcomes for on-label use of TEVAR for repair of descending thoracic aneurysms. METHODS Of 579 patients undergoing TEVAR between March 2005 and April 2016 at a single referral center for aortic surgery, 192 (33.2%) were performed for a descending thoracic aneurysm indication in accordance with the device instructions for use, including 106 fusiform (55.2%), 80 saccular (41.7%), and 6 with both saccular and fusiform (3.1%) aneurysms. All aneurysms were located distal to the left subclavian artery and proximal to the celiac axis, and hybrid procedures including arch or visceral debranching were excluded with the exception of left carotid-subclavian artery bypass. Aortic dissection and intramural hematoma as indications for TEVAR were also excluded. Primary 30-day and in-hospital outcomes included mortality, stroke, need for new permanent dialysis, and permanent paraparesis or paraplegia. Primary long-term outcomes included survival and rate of reintervention secondary to endoleak. The Kaplan-Meier method was used to estimate long-term overall and aorta-specific survivals. RESULTS The mean age was 71.1 ± 10.4 years. All aneurysms in this series were degenerative in nature and no patients with a connective tissue disorder were included. The mean aortic diameter was 5.9 ± 1.5 cm at time of intervention. Rates of 30-day and in-hospital mortality, stroke, permanent dialysis, and permanent paraparesis and paraplegia were 4.7%, 2.1%, 0.5%, and 0.5%, respectively. At a mean follow-up of 69 ± 44 months (range, 3-141 months), there were 68 late deaths (35.4%), two of which were due to aortic rupture. Overall and aorta-specific survivals at 141 months (11.8 years) were 45.7% and 96.2%, respectively. Endovascular reintervention was required in 14 patients (7.3%) owing to type I (n = 10), type II (n = 2), and type III (n = 2) endoleak, all of which subsequently resolved. No patient required open reintervention for any cause. CONCLUSIONS Long-term (12-year) aorta-specific survival after on-label endovascular repair of degenerative descending thoracic aneurysms in nonsyndromic patients is excellent (96%) with sustained protection from rupture, and a low rate of reintervention owing to endoleak (7%). Endovascular repair should be considered the treatment of choice for this pathology.
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Affiliation(s)
- David N Ranney
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Morgan L Cox
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Babatunde A Yerokun
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Ehsan Benrashid
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Richard L McCann
- Division of Vascular Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - G Chad Hughes
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.
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Zhu J, Zhao L, Dai X, Luo Y, Fan H, Feng Z, Zhang Y, Hu F. Fenestrated Thoracic Endovascular Aortic Repair Using Physician Modified Stent Grafts for Acute Type B Aortic Dissection with Unfavourable Landing Zone. Eur J Vasc Endovasc Surg 2018; 55:170-176. [DOI: 10.1016/j.ejvs.2017.11.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 11/10/2017] [Indexed: 12/23/2022]
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van der Weijde E, Bakker OJ, Kamman AV, van Herwaarden JA, Trimarchi S, Vos JA, Heijmen RH. A Feasibility Study of Off-the-Shelf Scalloped Stent-Grafts in Acute Type B Aortic Dissection. J Endovasc Ther 2017; 24:819-824. [DOI: 10.1177/1526602817726329] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Emma van der Weijde
- Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Olaf J. Bakker
- Department of Vascular & Endovascular Surgery, University Medical Center Utrecht, the Netherlands
| | - Arnoud V. Kamman
- Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, San Donato Milanese, Milan, Italy
| | - Joost A. van Herwaarden
- Department of Vascular & Endovascular Surgery, University Medical Center Utrecht, the Netherlands
| | - Santi Trimarchi
- Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, San Donato Milanese, Milan, Italy
| | - Jan Albert Vos
- Department of Interventional Radiology, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Robin H. Heijmen
- Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
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Hellgren T, Wanhainen A, Steuer J, Mani K. Outcome of endovascular repair for intact and ruptured thoracic aortic aneurysms. J Vasc Surg 2017; 66:21-28. [DOI: 10.1016/j.jvs.2016.12.101] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 12/05/2016] [Indexed: 10/20/2022]
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