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Rossi MJ, Ilyas S, Abramowitz SD, De Freitas S, Hockstein MA, Maloni KC, Shults C, Fatima J. A Scoping Review of Definitions of Success in Endovascular Aortic Arch Repair. J Endovasc Ther 2024:15266028241271679. [PMID: 39148208 DOI: 10.1177/15266028241271679] [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: 08/17/2024]
Abstract
INTRODUCTION The present standard of care to treat aortic arch pathologies is open surgical repair with cardiopulmonary bypass and deep hypothermic arrest. With approaches for total endovascular and extra-anatomic cervical debranching hybrid arch repair becoming more diverse, understanding what is considered a successful operation is prerequisite for a rigorous comparison of techniques. This review describes the specific outcomes reported, the rates of success, and the definitions of technical and clinical success in total endovascular and extra-anatomic cervical debranching hybrid aortic arch repair. METHODS A comprehensive search of MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials was performed. Studies with patients undergoing total endovascular or hybrid extra-anatomic cervical debranching repair of the aortic arch were included. Any publications including only patients with Ishimaru zone 2 or distal repairs were excluded from this review. Studies with less than 5 patients were excluded. Data extraction was performed by one author. Data items included were study design, procedure type, procedural details, underlying pathology, type of cervical debranching, type of endograft repair, surgical outcomes, definition of cerebrovascular events, technical success, and the definition of technical success. RESULTS Of 1754 studies screened for review, 85 studies with 5521 patients were included. By frequency, the included studies examined the following interventions: fenestrated devices, branched devices, parallel grafting. Most studies were retrospective single-institution studies. There were no randomized controlled trials. Short-term mortality and cerebrovascular events were nearly universally reported, present in 99% and 95% of studies reviewed, respectively. Only 27% of studies provided an explicit definition for cerebrovascular events. While 75% of studies reported a technical success rate, only 45% of those studies provided explicit criteria. Clinical success rates were infrequently reported, present in only 5.9% of studies reviewed. CONCLUSION The definitions of technical success that were provided fell short of analogous defined reporting standards in nearly all studies, inflating technical success rates. Definitions of cerebrovascular events and technical success require stringent criteria to uniformly compare various methods of endovascular aortic arch repair. A societal consensus document for reporting standards of endovascular aortic arch repair would allow for higher-quality outcomes research. CLINICAL IMPACT Total endovascular and extra-anatomic cervical debranching hybrid operations are being increasingly utilized for complex aortic arch repair. These techniques, however, can be associated with serious complications. Currently, there is no accepted metric to define technical or report clinical outcomes. Due to the paucity of high-quality data, use of these approaches may be limited in clinical practice. This study emphasizes the need for the development of standards for reporting outcomes in endovascular aortic arch repair. Future studies can then utilize these benchmarks, whcih will allow for improved efficacy and safety in these techniques.
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Affiliation(s)
- Matthew J Rossi
- Vascular Surgery Integrated Residency Program, MedStar Health, Washington, DC, USA
| | - Sadia Ilyas
- Department of Vascular Surgery, MedStar Washington Hospital Center, Washington, DC, USA
| | - Steven D Abramowitz
- Department of Vascular Surgery, MedStar Washington Hospital Center, Washington, DC, USA
| | - Simon De Freitas
- West Palm Beach Veteran's Affairs Hospital, West Palm Beach, FL, USA
| | - Maxwell A Hockstein
- Department of Critical Care, MedStar Washington Hospital Center, Washington, DC, USA
| | - Krystal C Maloni
- Department of Vascular Surgery, MedStar Washington Hospital Center, Washington, DC, USA
| | - Christian Shults
- Department of Cardiac Surgery, MedStar Washington Hospital Center, Washington, DC, USA
| | - Javairiah Fatima
- Department of Vascular Surgery, MedStar Washington Hospital Center, Washington, DC, USA
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Luo ZR, Zhu YP, Fang GH. Utilizing Single-Branched Stent in Combination With Fenestration or Chimney for Endovascular Repair of Aortic Arch Lesions With Aberrant Subclavian Artery. J Endovasc Ther 2024:15266028241259391. [PMID: 38887028 DOI: 10.1177/15266028241259391] [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: 06/20/2024]
Abstract
OBJECTIVE The study was to figure out the feasibility, efficacy, and safety of a single-branched stent graft, namely Castor, in combination with fenestration or chimney in the context of aortic arch lesions presenting with aberrant subclavian artery (ASA) and/or Kommerell's diverticulum (KD). METHODS All consecutive patients with aortic arch lesions and ASA and/or KD receiving Castor from June 2018 to June 2023 were investigated. RESULTS Incorporating 18 patients, the study encompassed 11 cases with KD, 3 cases with dysphagia; 2 cases of right-sided aortic arch with left-sided aberrant left subclavian artery (ALSA), and 16 cases of left-sided aortic arch with right-sided aberrant right subclavian artery (ARSA). The mean operation time was 132±23 minutes. The mean measured proximal aortic diameter was 30.9±1.6 mm, and proximal diameter of Castor stent was 34 (32, 34.5) mm, with oversize of 9.1±1.6%; the mean measured branch diameter was 8.8±0.97 mm, and branch diameter of Castor stent was 10 (8, 10) mm, with oversize of 0.86±0.57 mm. Technical success rate was 100%, and no in-hospital mortality, no stroke, and no endoleak were identified. One (5.6%) case with spinal cord ischemia and one (5.6%) case with poor healing of operative site were identified. During the follow-up period, no aortic-related death or secondary intervention was recorded. The maximal aortic diameter was significantly reduced at the sixth postoperative month (padj=0.031); KD diameter was significantly reduced at the third (padj=0.001) and sixth (padj<0.001) postoperative month. CONCLUSION Totally endovascular repair of aortic arch lesions with ASA and KD via Castor stent in combination with fenestration or chimney is feasible, effective, and safe, which can achieve an encouraging medium-term outcome and provide excellent remodeling at the lesions. CLINICAL IMPACT Single branched stent in combination with fenestration or chimney achieved a sufficient proximal landing zone and provided an encouraging medium-term outcome in this retrospective review of 18 patients receiving endovascular treatment of pathological aortic arch with aberrant subclavian artery and/or Kommerell's diverticulum. The authors suggest this time-saving and efficient technique to establish systematic experience for the treatment in this kind of patients.
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Affiliation(s)
- Zeng-Rong Luo
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, P.R. China
- Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fuzhou, China
| | - Yong-Ping Zhu
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, P.R. China
- Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fuzhou, China
| | - Guan-Hua Fang
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, P.R. China
- Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fuzhou, China
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Okamoto T, Yokoi Y, Sato N, Suzuki S, Enomoto T, Onishi R, Nakamura N, Okubo Y, Nagasawa A, Mishima T, Shiraishi S, Tsuchida M. Outcomes of thoracic endovascular aortic repair using fenestrated stent grafts in patients with thoracic aortic distal arch aneurysms. Eur J Cardiothorac Surg 2024; 65:ezae062. [PMID: 38439540 DOI: 10.1093/ejcts/ezae062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/28/2023] [Accepted: 02/06/2024] [Indexed: 03/06/2024] Open
Abstract
OBJECTIVES Thoracic endovascular aortic repair (TEVAR) for aortic arch aneurysms is challenging because of anatomical restrictions and the presence of cervical branches. Revascularization of the cervical branch is required when conventional commercial stent grafts are used. TEVAR using fenestrated stent grafts (FSG) often does not require additional procedures to revascularize cervical branches. This study aimed to evaluate the features and initial and midterm outcomes of TEVAR using fenestrated stent grafts. METHODS From April 2007 to December 2016, 101 consecutive patients underwent TEVAR using fenestrated stent grafts for distal aortic arch aneurysms at a single centre. Technical success, complications, freedom from aneurysm-related death, secondary intervention and aneurysm progression were retrospectively investigated. RESULTS All the patients underwent TEVAR using fenestrated stent grafts. The 30-day mortality rate was zero. Cerebral infarction, access route problems and spinal cord injury occurred in 4, 3 and 2 patients, respectively. Each type of endoleak was observed in 38 of the 101 patients during the course of the study; 20/38 patients had minor type 1 endoleaks at the time of discharge. The endoleak disappeared in 2 patients and showed no significant change in 8 patients; however, the aneurysm expanded over time in 10 patients. Additional treatment was performed in 8 of the 10 patients with type 1 endoleaks and dilatation of the aneurysm. The rate of freedom from aneurysm-related death during the observation period was 98%. CONCLUSIONS TEVAR with FSG is a simple procedure, with few complications. Additional treatment has been observed to reduce aneurysm-related deaths, even in patients with endoleaks and enlarged aneurysms. Based on this study, the outcomes of endovascular repair of aortic arch aneurysms using a fenestrated stent graft seem acceptable.
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Affiliation(s)
- Takeshi Okamoto
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yoshihiko Yokoi
- Division of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Noriaki Sato
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Shuhei Suzuki
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takashi Enomoto
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Ryo Onishi
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Norihito Nakamura
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yuka Okubo
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Ayako Nagasawa
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takehito Mishima
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Shuichi Shiraishi
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masanori Tsuchida
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Luo ZR, Li SL, Chen LW, Huang RD. Utilizing physician modified fenestration on the castor branched stent technique for reconstruction of an isolated left vertebral artery on the aortic arch. Sci Rep 2024; 14:4051. [PMID: 38374192 PMCID: PMC10876643 DOI: 10.1038/s41598-024-54781-8] [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: 11/21/2023] [Accepted: 02/16/2024] [Indexed: 02/21/2024] Open
Abstract
The study aimed to provide physician modified fenestration (PMF) on a single-branched stent for the aortic arch (Castor) to protect the isolated left vertebral artery (ILVA) during thoracic endovascular aortic repair (TEVAR). Patients who underwent TEVAR involving ILVA reconstruction through PMF performing on the Castor branched stent were included in a retrospective, multi-centre study from June 2018 to December 2022. In these patients, all proximal landing zones of "Castor" were positioned in Ishimaru zone 2a. A total of twenty-five patients met the inclusion criteria and the achievement rate showed 25/25 (100%) success in them. The twenty-five patients had a median follow-up length of 28.5 ± 14.6 months. One patient (4.0%) suffered from postoperative ischemic stroke before discharge. One patient (4.0%) died from a hemodialysis-related brain hemorrhage before discharge on the 29th day after the procedure. One patient died of advanced liver cancer in the 33th month after discharge. Aortic rupture, stroke or spinal cord injury did not occur throughout the follow-up period after discharge. Two patients (8.0%) experienced endoleak at the fenestration, however, resulting in only one's necessity for reintervention. Notably, the procedure effectively maintained ILVAs patency for all patients during follow up. According to our preliminary findings, performing a TEVAR under local anaesthesia using PMF on a Castor branched stent for ILVA preservation appeared practical, secure, and effective.
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Affiliation(s)
- Zeng-Rong Luo
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fuzhou, Fujian Province, China
| | - Sai-Lan Li
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fuzhou, Fujian Province, China
| | - Liang-Wan Chen
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fuzhou, Fujian Province, China
| | - Rong-Da Huang
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China.
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fuzhou, Fujian Province, China.
- Department of Cardiovascular Surgery and Cardiac Disease Center, Fujian Medical University Union Hospital, Fuzhou, 350001, China.
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Spath P, Campana F, Tsilimparis N, Gallitto E, Pini R, Faggioli G, Caputo S, Gargiulo M. Outcomes of Fenestrated and Branched Endografts for Partial and Total Endovascular Repair of the Aortic Arch - A Systematic Review and Meta-Analysis. Eur J Vasc Endovasc Surg 2024; 67:106-116. [PMID: 37536517 DOI: 10.1016/j.ejvs.2023.07.048] [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: 11/18/2022] [Revised: 07/01/2023] [Accepted: 07/27/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE Fenestrated and branched thoracic endovascular aortic repair (F/B-TEVAR) of the aortic arch is a viable approach in patients unsuitable for open repair. The aim was to summarise the published results of manufactured F/B-TEVAR devices for partial and total repair of the aortic arch, and to compare fenestrated with branched configurations. DATA SOURCES PubMed, Scopus and The Cochrane Library were searched for articles (2018 - 2021) about patients with elective, urgent, or emergency aortic requiring a proximal landing zone in the aortic arch (zone 0 - 1 - 2) and treated by F/B-TEVAR. REVIEW METHODS The systematic review and meta-analysis were performed according to the PRISMA guidelines. Open repair, supra-aortic trunk (SAT) debranching + standard TEVAR, and in situ physician modified and parallel grafts were excluded. Primary outcomes were technical success and 30 day mortality rate. Secondary outcomes were 30 day major adverse events, and overall survival and procedure related endpoints during follow up. RESULTS Of 458 articles screened, 18 articles involving 571 patients were selected. Indications for intervention were chronic dissections (50.1%), degenerative aneurysms (39.6%), penetrating aortic ulcers (7.4%), and pseudoaneurysms (2%). F-TEVAR, B-TEVAR, and F+B-TEVAR were used in 38.4%, 54.1%, and 7.5% of patients, respectively. Overall, technical success was 95.9% (95% confidence interval [CI] 0.93 - 0.97; I2 = 0%; p for heterogeneity (Het) = .77) and the 30 day mortality rate was 6.7% (95% CI 0.05 - 0.09; I2 = 0%; p Het = .66). No statistical differences were found comparing fenestrated with branched endografts, except for a higher rate of type I - III endoleaks in F-TEVAR (9.8% vs. 2.6%; p = .034). The overall survival rate and freedom from aortic related death at the one year follow up ranged between 82 - 96.4% and 94 - 94.7%, respectively. Thirteen and five studies were considered at moderate and high risk of bias, respectively. CONCLUSION F/B-TEVAR for the treatment of the aortic arch, according to experience in dedicated centres, now enjoys a satisfactory level of technical success together with a progressively reduced early mortality rate. There are several limitations, and further studies are needed to reach clearer conclusions.
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Affiliation(s)
- Paolo Spath
- Vascular Surgery, University of Bologna, DIMEC, Bologna, Italy; Department of Vascular Surgery, Hospital "Infermi" Rimini, AUSL Romagna, Rimini, Italy.
| | | | - Nikolaos Tsilimparis
- Department of Vascular Surgery, Ludwig-Maximillian University Hospital, Munich, Germany
| | - Enrico Gallitto
- Vascular Surgery, University of Bologna, DIMEC, Bologna, Italy; Bologna Metropolitan Vascular Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria S. Orsola, Bologna, Italy
| | - Rodolfo Pini
- Vascular Surgery, University of Bologna, DIMEC, Bologna, Italy; Bologna Metropolitan Vascular Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria S. Orsola, Bologna, Italy
| | - Gianluca Faggioli
- Vascular Surgery, University of Bologna, DIMEC, Bologna, Italy; Bologna Metropolitan Vascular Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria S. Orsola, Bologna, Italy
| | - Stefania Caputo
- Vascular Surgery, University of Bologna, DIMEC, Bologna, Italy
| | - Mauro Gargiulo
- Vascular Surgery, University of Bologna, DIMEC, Bologna, Italy; Bologna Metropolitan Vascular Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria S. Orsola, Bologna, Italy
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Chang H, Jin D, Wang Y, Liu B, Wang W, Li Y. Chimney Technique and Single-Branched Stent Graft for the Left Subclavian Artery Preservation During Zone 2 Thoracic Endovascular Aortic Repair for Type B Acute Aortic Syndromes. J Endovasc Ther 2023; 30:849-858. [PMID: 35678719 DOI: 10.1177/15266028221102657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the efficacy and safety of zone 2 thoracic endovascular aortic repair assisted by the chimney technique or single-branched stent graft for the preservation of the left subclavian artery, and summarize our single-center experience with the techniques. MATERIALS AND METHODS From February 2017 to June 2020, 137 patients who underwent left subclavian artery revascularization during zone 2 thoracic endovascular aortic repair were enrolled. Patients had acute type B aortic dissection and penetrating aortic ulcer associated with intramural hematoma. The chimney technique was performed in 68 patients (group A), and single-branched stent graft was deployed in 69 patients (group B). All procedures were performed during the acute phase. Primary technical success, immediate postoperative endoleak, neurologic complications (stroke or spinal cord ischemia), 30-day mortality, 1-year technical success, all-cause mortality, patency of the left subclavian artery, and reintervention were analyzed. Comparing the occurrence of the Bird-Beak Configuration, defined as a gap between the aortic wall and the sent graft with stent protrusion into the aortic lumen more than 5 mm, was also performed. RESULTS Primary technique success was achieved in 66 and 67 patients in groups A and B, respectively. The incidence of immediate postoperative endoleak, neurologic complications (stroke or spinal cord ischemia), and 30-day mortality were 5.9%, 1.5%, and 4.4% in group A, and 2.9%, 2.9%, and 2.9% in group B, respectively. During follow-up, the 1-year technical success rate was similar in both groups. All-cause mortality was similar in both groups (3.1% in group A and 4.5% in group B). The patency of the left subclavian artery was not significantly different between the 2 groups with 2 and 3 occlusions in groups A and B, respectively. The rate of reintervention was higher in group B (3.1% vs 1.6%, p=0.536), with a non-significant difference. Bird-Beak Configuration was more prominent in group B with the incidence of 59.42%. CONCLUSIONS Acting as minimally invasive alternatives, both techniques are feasible for left subclavian artery preservation during zone 2 thoracic endovascular aortic repair for type B acute aortic syndromes with encouraging mid-term outcomes. Long-term follow-up is required to confirm these findings.
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Affiliation(s)
- Haiyang Chang
- Department of Intervention Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
- Interventional Oncology Institute, Shandong University, Jinan, People's Republic of China
| | - Die Jin
- Department of Intervention Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
- Interventional Oncology Institute, Shandong University, Jinan, People's Republic of China
| | - Yongzheng Wang
- Department of Intervention Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
- Interventional Oncology Institute, Shandong University, Jinan, People's Republic of China
| | - Bin Liu
- Department of Intervention Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
- Interventional Oncology Institute, Shandong University, Jinan, People's Republic of China
| | - Wujie Wang
- Department of Intervention Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
- Interventional Oncology Institute, Shandong University, Jinan, People's Republic of China
| | - Yuliang Li
- Department of Intervention Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
- Interventional Oncology Institute, Shandong University, Jinan, People's Republic of China
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Ye J, Li Y, Lu Y, Wang Y, Liu B, Chang H. Homemade fenestration and chimney techniques for the left subclavian artery revascularization during zone 2 thoracic endovascular aortic repair. Front Cardiovasc Med 2023; 10:1144751. [PMID: 37324627 PMCID: PMC10264814 DOI: 10.3389/fcvm.2023.1144751] [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: 01/15/2023] [Accepted: 04/21/2023] [Indexed: 06/17/2023] Open
Abstract
Background To investigate the safety and efficacy of homemade fenestration and chimney techniques for the left subclavian artery (LSA) revascularization during zone 2 thoracic endovascular aortic repair (TEVAR). Methods From February 2017 to February 2021, 41 patients undergoing fenestration technique (group A) and 42 patients undergoing chimney technique (group B) to preserve the LSA during zone 2 TEVAR were enrolled in the present study. The procedure was indicated for dissections with unsuitable proximal landing zone with refractory pain and hypertension, rupture and malperfusion, and high-risk radiographic features. The baseline characteristics, peri-procedure, and follow-up clinical and radiographic data were recorded and analyzed. The primary endpoint was clinical success, and the secondary endpoints were rupture-free survival, LSA patency, and complications. Aortic remodeling, defined as patency, partial and complete thrombosis of the false lumen, was also analyzed. Results Technical success was achieved in 38 and 41 patients in groups A and B, respectively. Four intervention-related deaths were confirmed, two in each group. Immediate post-procedural endoleaks were detected in two and three patients in group A and B, respectively. No other major complications were found in either group, except for one retrograde type A dissection in group A. During follow-up, the initial clinical success rates were 90.24% and 92.86% in groups A and B, respectively. The primary and secondary mid-term clinical success rates were 87.5% and 90% in group A, and both of them were 92.68% in group B. Rupture-free survival and LSA patency were not significantly different between the two groups. The incidence of complete thrombosis in the aorta distal to the stent graft was 67.65% and 61.11% in groups A and B, respectively. Conclusions Apart from the lower clinical success rate of fenestration technique, both physician-modified techniques are available for LSA revascularization during zone 2 TEVAR and significantly promote favorable aortic remodeling.
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Affiliation(s)
- Jiacheng Ye
- Department of Intervention Medicine, The First Hospital of Nanping Affiliated to Fujian Medical University, Nanping, China
| | - Yuliang Li
- Department of Intervention Medicine, The Second Hospital of Shandong University, Jinan, China
- Interventional Oncology Institute of Shandong University, Jinan, China
| | - Yue Lu
- Department of Intervention Medicine, The Second Hospital of Shandong University, Jinan, China
- Interventional Oncology Institute of Shandong University, Jinan, China
| | - Yongzheng Wang
- Department of Intervention Medicine, The Second Hospital of Shandong University, Jinan, China
- Interventional Oncology Institute of Shandong University, Jinan, China
| | - Bin Liu
- Department of Intervention Medicine, The Second Hospital of Shandong University, Jinan, China
- Interventional Oncology Institute of Shandong University, Jinan, China
| | - Haiyang Chang
- Department of Intervention Medicine, The Second Hospital of Shandong University, Jinan, China
- Interventional Oncology Institute of Shandong University, Jinan, China
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Tian Y, Wang C, Xie P. Mid-term outcomes of left subclavian artery revascularization with Castor stent graft in treatment of type B aortic dissection in left subclavian artery. J Interv Med 2023; 6:74-80. [PMID: 37409064 PMCID: PMC10318335 DOI: 10.1016/j.jimed.2023.04.002] [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: 01/13/2023] [Revised: 04/07/2023] [Accepted: 04/09/2023] [Indexed: 07/07/2023] Open
Abstract
Background Here we analyzed mid-term data of thoracic endovascular aneurysm repair (TEVAR) surgery with Castor single-branched stent graft placement for the management of Stanford type B aortic dissection (STBAD) involving the left subclavian artery (LSA). Methods Between April 2014 and February 2019, 32 patients with STBAD involving a Castor single-branched stent graft were included. We analyzed their outcomes, including technical success rate (TSR), surgical duration (SD), presence of ischemia, perioperative complications, LSA patency, and survival rate (SR), using computed tomography angiography and clinical evaluation during mid-term follow-up. Results The mean patient age was 54.63 ± 12.37 years (range, 36-83 years). The TSR was 96.88% (n = 31/32). The mean SD was 87.44 ± 10.89 with a mean contrast volume of 125.31 ± 19.30 mL. No neurological complications or deaths occurred during the study period. The patients had a mean hospital stay of 7.84 ± 3.20 days. At a mean follow-up of 68.78 ± 11.26 months, four non-aortic deaths (12.5%) were observed. The LSA patency rate was 100% (n = 28/28). There was only one case of type I endoleak immediately after surgery (3.12%) (type I from LSA). However, none of the patients experienced type II endoleaks, and there were no cases of retrograde type A aortic dissection or stent graft-driven new distal entry. Finally, all patients exhibited good LSA patency. Conclusion TEVAR using a Castor single-branched stent graft may be a highly feasible and efficient procedure for the management of STBAD involving the LSA.
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Affiliation(s)
- Yu Tian
- Department of Interventional Therapy, Cancer Hospital Chinese Academy of Medical Science, ShenZhen Center, Guangdong Province, China
| | - Chengjie Wang
- Department of Vascular Surgery, Yuhuangding Hospital, Yantai, Shandong Province, China
| | - Peng Xie
- Department of Orthopedics, The 3rd Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong Province, China
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NEXUS Arch: A Multicenter Study Evaluating the Initial Experience With a Novel Aortic Arch Stent Graft System. Ann Surg 2023; 277:e460-e466. [PMID: 33714965 DOI: 10.1097/sla.0000000000004843] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the initial clinical experience with a novel endograft system (NEXUS Aortic Arch Stent Graft System) designed to treat aortic arch pathologies and address the morphology and hemodynamic challenges of the aortic arch. SUMMARY BACKGROUND DATA The aortic arch remains the most challenging part of the aorta for both open and endovascular repair. Transcatheter aortic arch repair has the potential to significantly reduce surgical risks. METHODS Patients underwent transcatheter aortic arch repair with a single branch, 2 stent graft system, implanted over a through-and-through guidewire from the brachiocephalic trunk, to the descending aorta with an ascending aorta stent graft. The ascending aorta stent graft is deployed into a designated docking sleeve to connect the 2 stent grafts and isolate the aortic arch pathology. Proximal landing zone in all cases was in Zone 0. Anatomical inclusion criteria included adequate landing zone in the ascending aorta, brachiocephalic trunk, and descending thoracic aorta. Preparatory debranching procedure was performed in all patients with carotid-carotid crossover bypass and left carotid to left subclavian bypass, or parallel graft from descending aorta to left subclavian artery. Safety and performance were evaluated through 1 year. Survival analysis used the Kaplan-Meier method. RESULTS Twenty-eight patients, 79% males, with a mean age of 72.2 ± 6.2 years were treated with 100% procedural success. Isolated aortic arch aneurysm was the principle pathology in 17 (60.7%) of patients, while chronic aortic dissection was the principle pathology in 6 (21.4%) of patients. The remaining 5 (17.8%) had combined or other pathologies. At 1 month, the vascular pathology was excluded in 25 of 26 alive patients (96.1%). The 30 days mortality rate was 7.1%, stroke rate was 3.6% (all nondisabling), and combined mortality/stroke rate was 10.7%. One-year mortality was 10.7%, without device or aneurysm-related death. Two patients (7.1%) reported stroke or transient ischemic attack at 1 year that recovered completely. One year combined mortality/stroke rate was 17.8%. There were 3 patients (10.7%) that had device-related unplanned reinterventions through 1 year. CONCLUSIONS The NEXUS Aortic Arch Stent Graft System, a novel single branch, 2 stent graft system used for endovascular aortic arch repair that requires landing in the ascending aorta, demonstrates a high success rate with excellent 1 year safety and performance.
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Seike Y, Fukuda T, Yokawa K, Koizumi S, Masada K, Inoue Y, Sasaki H, Matsuda H. Differences of mid-term outcomes in debranching thoracic endovascular aortic repair between zone 0 and zone 1-2 landing. Gen Thorac Cardiovasc Surg 2023; 71:59-66. [PMID: 35900663 DOI: 10.1007/s11748-022-01852-0] [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: 05/15/2022] [Accepted: 06/27/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Debranching thoracic endovascular aortic repair (d-TEVAR) for zone 0 landing (Z0-TEVAR) remained challenging in aortic arch aneurysms. This study aimed to compare the mid-term outcomes between Z0-TEVAR and Z1/2-TEVAR to assess the appropriateness of Z0-TEVAR as the first-line therapy for aortic arch aneurysms in high-risk patients. METHODS Medical records of 200 patients who underwent d-TEVAR from 2007 to 2019 were retrospectively reviewed. Of these, 40 patients who underwent Z0-TEVAR (70% males; the median age of 82 years) and 160 Z1/2-TEVAR (78% males; the median age of 77 years) were compared. In each group, 39 patients were matched using propensity scores (PS) to adjust for differences in patient backgrounds. RESULTS Freedom from all-cause mortality (p < 0.001), aorta-related mortality (p < 0.001), and stroke (p = 0.001) were significantly lower in Z0-TEVAR than in Z1/2-TEVAR. Freedom from reintervention was similar between the two groups (p = 0.326). Type A dissection post-TEVAR was observed in 3 (7.5%) of Z0-TEVAR, but none in Z1/2-TEVAR (p = 0.006). Pneumonia was also more frequent in Z0-TEVAR (n = 8, 30%) than Z1/2-TEVAR (n = 4, 2.5%) (p < 0.001). PS matching also yielded worse outcomes (all-cause mortality, p = 0.017; aorta-related mortality, p = 0.046; and stroke, p = 0.027) in Z0-TEVAR than Z1/2-TEVAR. CONCLUSIONS Higher mid-term mortality and stroke rates after Z0-TEVAR were confirmed by PS matching. Z0-TEVAR would be an alternative for high-risk patients with arch aneurysms requiring zone 0 landing but not a reliable method.
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Affiliation(s)
- Yoshimasa Seike
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-shinmachi, Suita, Osaka, 564-8565, Japan
| | - Tetsuya Fukuda
- Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Koki Yokawa
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-shinmachi, Suita, Osaka, 564-8565, Japan
| | - Shigeki Koizumi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-shinmachi, Suita, Osaka, 564-8565, Japan
| | - Kenta Masada
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-shinmachi, Suita, Osaka, 564-8565, Japan
| | - Yosuke Inoue
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-shinmachi, Suita, Osaka, 564-8565, Japan
| | - Hiroaki Sasaki
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-shinmachi, Suita, Osaka, 564-8565, Japan
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-shinmachi, Suita, Osaka, 564-8565, Japan.
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Shen P, Li D, Wu Z, He Y, Wang X, Shang T, Zhu Q, Tian L, Li Z, Zhang H. Physician-modified fenestration or in situ fenestration for preservation of isolated left vertebral artery in thoracic endovascular aortic repair. Front Cardiovasc Med 2023; 10:1055549. [PMID: 37063949 PMCID: PMC10098321 DOI: 10.3389/fcvm.2023.1055549] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 03/08/2023] [Indexed: 04/18/2023] Open
Abstract
Objective To present our experience of preserving the isolated left vertebral artery (ILVA) with physician-modified fenestration (PM-F) or in situ fenestration (ISF) during thoracic endovascular aortic repair (TEVAR) for aortic pathologies involving aortic arch. Methods This is a single-center, retrospective, observational cohort study. Between June 2016 and December 2021, 9 patients (8 men; median age 60.0 years old) underwent TEVAR with ILVA reconstruction (PM-F, n = 6; ISF, n = 3) were identified and analyzed. Results The technical success rate was 100%. No early (<30 days) death occurred. No aortic rupture, major stroke or spinal cord injury was observed. The median follow up was 38.0 (rang: 1.0-66.0) months. One death occurred at 56 months, while the reason cannot be identified. No aortic rupture, major stroke or spinal cord injury was observed during follow up. No patient required reintervention. Out of the 22 successfully revascularized target vessels, 2 ILVAs were found occluded in 2 patients at 6 months and 7 months, respectively. However, these two patients were asymptomatic. Conclusions Our initial experience reveals that PM-F or ISF for ILVA preservation was feasible, safe, and effective during TEVAR for complex thoracic aortic pathologies. However, the patency of preserved ILVA should be improved.
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Affiliation(s)
- Peier Shen
- Department of Nursing, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Donglin Li
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ziheng Wu
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yangyan He
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaohui Wang
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Tao Shang
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qianqian Zhu
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lu Tian
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhenjiang Li
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Correspondence: Zhenjiang Li Hongkun Zhang
| | - Hongkun Zhang
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Correspondence: Zhenjiang Li Hongkun Zhang
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Tricarico R, Berceli SA, Tran-Son-Tay R, He Y. Non-invasive estimation of the parameters of a three-element windkessel model of aortic arch arteries in patients undergoing thoracic endovascular aortic repair. Front Bioeng Biotechnol 2023; 11:1127855. [PMID: 36926690 PMCID: PMC10011467 DOI: 10.3389/fbioe.2023.1127855] [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: 12/20/2022] [Accepted: 02/17/2023] [Indexed: 03/08/2023] Open
Abstract
Background: Image-based computational hemodynamic modeling and simulations are important for personalized diagnosis and treatment of cardiovascular diseases. However, the required patient-specific boundary conditions are often not available and need to be estimated. Methods: We propose a pipeline for estimating the parameters of the popular three-element Windkessel (WK3) models (a proximal resistor in series with a parallel combination of a distal resistor and a capacitor) of the aortic arch arteries in patients receiving thoracic endovascular aortic repair of aneurysms. Pre-operative and post-operative 1-week duplex ultrasound scans were performed to obtain blood flow rates, and intra-operative pressure measurements were also performed invasively using a pressure transducer pre- and post-stent graft deployment in arch arteries. The patient-specific WK3 model parameters were derived from the flow rate and pressure waveforms using an optimization algorithm reducing the error between simulated and measured pressure data. The resistors were normalized by total resistance, and the capacitor was normalized by total resistance and heart rate. The normalized WK3 parameters can be combined with readily available vessel diameter, brachial blood pressure, and heart rate data to estimate WK3 parameters of other patients non-invasively. Results: Ten patients were studied. The medians (interquartile range) of the normalized proximal resistor, distal resistor, and capacitor parameters are 0.10 (0.07-0.15), 0.90 (0.84-0.93), and 0.46 (0.33-0.58), respectively, for common carotid artery; 0.03 (0.02-0.04), 0.97 (0.96-0.98), and 1.91 (1.63-2.26) for subclavian artery; 0.18 (0.08-0.41), 0.82 (0.59-0.92), and 0.47 (0.32-0.85) for vertebral artery. The estimated pressure showed fairly high tolerance to patient-specific inlet flow rate waveforms using the WK3 parameters estimated from the medians of the normalized parameters. Conclusion: When patient-specific outflow boundary conditions are not available, our proposed pipeline can be used to estimate the WK3 parameters of arch arteries.
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Affiliation(s)
- Rosamaria Tricarico
- Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States
| | - Scott A Berceli
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Florida, Gainesville, FL, United States.,North Florida/South Georgia Veterans Health System, Gainesville, FL, United States
| | - Roger Tran-Son-Tay
- Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States.,Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, FL, United States
| | - Yong He
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Florida, Gainesville, FL, United States
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Jiménez-Jiménez CE, Randial-Pérez LJ, Héctor Hugo RM, Silva-Restrepo I, Valenzuela-Valenzuela JA. Tratamiento endovascular con técnica de chimenea para patologías del arco aórtico. REVISTA COLOMBIANA DE CIRUGÍA 2022. [DOI: 10.30944/20117582.970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introducción. La patología del arco aórtico se ha tratado principalmente con cirugía por vía abierta, pero con una alta morbimortalidad. Las técnicas endovasculares híbridas y las reconstrucciones en “chimenea” son una técnica válida y segura para disminuir el riesgo y la mortalidad.
Métodos. Se presentan dos pacientes con patología del arco aórtico y contraindicación de manejo quirúrgico abierto, atendidos en el Servicio de Cirugía Vascular, Hospital Universitario Clínica de San Rafael, Bogotá, D.C., Colombia.
Resultados. Se realizaron dos procedimientos endovasculares del arco aórtico para tratar un aneurisma torácico roto y una úlcera aórtica sintomática, con cubrimiento de los troncos supra aórticos con una endoprótesis y canalización de los vasos supra aórticos con prótesis cubiertas y uso de la “técnica de chimenea”, de manera exitosa.
Discusión. La patología del arco aórtico es de alta complejidad y se asocia con una morbimortalidad elevada por lo que, en los últimos 20 años se han desarrollado diferentes técnicas utilizando procedimientos percutáneos.
Conclusión. La “técnica de chimenea” se puede realizar de una manera mínimamente invasiva en pacientes con patología del arco aórtico, no candidatos para cirugía abierta, con resultados exitosos.
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Kong X, Ruan P, Yu J, Chu T, Gao L, Jiang H, Ge J. Single-center experience with a unibody single-branched stent graft for zone 2 thoracic endovascular aortic repair. Front Cardiovasc Med 2022; 9:995173. [PMID: 36158794 PMCID: PMC9500193 DOI: 10.3389/fcvm.2022.995173] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/25/2022] [Indexed: 11/23/2022] Open
Abstract
To provide an adequate proximal landing zone, left subclavian artery (LSA) reconstruction has become an important part of thoracic endovascular aortic repair (TEVAR). This study evaluates the short and medium term efficacy of a novel unibody single-branched stent graft for zone 2 TEVAR. Fifty-two patients (mean age, 56 ± 10.9 years; 42 men) with distal aortic arch lesions requiring LSA reconstruction received unibody single-branched stents from September 2019 to March 2021. Computed tomography angiography was performed 6, 12, and 24 months after surgery to observe stent morphology, branch patency, endoleaks, stent-related adverse events, and changes in the diameter of true and false lumens. All stents were deployed adequately, and the technical success rate was 100%. The mean operation time was 121.8 ± 47.0 min. The mean postoperative hospital stay was 6.2 ± 3.7 days, and the mean follow-up was 16.8 ± 5.2 months (range, 12–24 months). During follow-up, there were no deaths and complications such as stent displacement or fracture, stenosis, fracture, occlusion, and type Ia endoleaks. The patency rate of the branched segment was 100%. In 42 patients with aortic dissection (AD), the true lumen diameter of the aortic isthmus was 29.4 ± 2.9 mm after surgery, significantly larger than before surgery (20.6 ± 5.4 mm, P < 0.05). Postoperative aortic isthmus false lumen diameter was significantly smaller than that before operation (6.1 ± 5.2 mm vs. 16.0 ± 7.6 mm, P < 0.05). The new unibody single-branched stent for zone 2 TEVAR is safe and accurate, and its efficacy is good in the short and medium term.
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Wu M, Zhao Y, Zeng Z, Bao X, Li T, Feng R, Feng J, Jing Z. Mid-term Comparison of One-Piece Branched Stent-Graft and Chimney Technique Treating Aortic Arch Pathologies. Cardiovasc Intervent Radiol 2022; 45:733-743. [PMID: 35355095 DOI: 10.1007/s00270-022-03063-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 01/22/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE We compared the mid-term outcomes of a one-piece branched stent-graft with the chimney technique in the treatment of aortic arch pathologies. METHODS Between August 2012 and December 2017, a retrospective analysis of 279 patients with thoracic aortic dissection (TAD) or aneurysm (TAA) who underwent thoracic endovascular aortic repair with b-TEVAR (n = 69, 58 TAD and 11 TAA) or c-TEVAR (n = 210, 151 TAD and 59 TAA) was performed. RESULTS Forty-five double-chimney for the left subclavian artery (LSA) and left common carotid artery LCCA and 165 single-chimney for the LSA were performed in chimney-TEVAR (c-TEVAR) and 69 branched-TEVAR (b-TEVAR) with 36 single-branched stent-grafts and 33 branched stent-grafts combined with fenestration technique. The c-TEVAR group experienced more in-hospital complications than the b-TEVAR group (19.5 vs. 7.2%, p = 0.017), primarily because the c-TEVAR group experienced more in-hospital cerebral ischemia events (6.2 vs. 0%, p = 0.043) and intra-operative type I endoleaks (31.9 vs. 5.8%, p < 0.01). There were significantly more follow-up type I endoleaks (21.9 vs. 4.3%, p = 0.002), cerebral ischemia events (11.0 vs. 2.9%, p = 0.042), and re-interventions (12.9 vs. 4.3%, p = 0.048) in the c-TEVAR group than in the b-TEVAR group. However, follow-up mortality was not significantly different between the c-TEVAR and b-TEVAR groups (5.2 vs. 2.9%, p = 0.638). CONCLUSION In patients with aortic pathologies involving the arch branches, customized b-TEVAR may result in fewer cerebral ischemia events and endoleaks than c-TEVAR. However, c-TEVAR should be considered an off-the-shelf treatment option for patients in need of emergency treatment. LEVEL OF EVIDENCE Level 4, Case Series.
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Affiliation(s)
- Mingwei Wu
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Yuxi Zhao
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Zhaoxiang Zeng
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Xianhao Bao
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Tao Li
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Rui Feng
- Department of Vascular Surgery, Shanghai General Hospital, Shanghai Jiaotong University, 650 New Song Jiang Road, Shanghai, 201600, People's Republic of China.
| | - Jiaxuan Feng
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China.
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China.
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Hughes GC, Vekstein A. Current state of hybrid solutions for aortic arch aneurysms. Ann Cardiothorac Surg 2021; 10:731-743. [PMID: 34926177 DOI: 10.21037/acs-2021-taes-168] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 10/27/2021] [Indexed: 01/04/2023]
Abstract
Since its inception in the early 2000s, hybrid arch repair (HAR) has evolved from a novel approach to a well-established treatment modality for aortic arch pathology in appropriately selected patients. HAR procedures have been proposed as a means to circumvent the perioperative morbidity and mortality associated with open total arch replacement. These procedures, all of which remain off-label applications of approved endograft technology, combine more conventional open surgical techniques, to create endograft landing zones, with thoracic endovascular aortic repair to exclude the aortic pathology from the circulation. The current classification system for HAR was proposed in 2013 and consists of three types, designated by the Roman numerals I, II and III. The current system has become outdated, however, with the advent of newer technologies, and herein we propose a new, updated classification system that is more encompassing with regards to the broad array of options available to treat aortic arch disease. Likewise, an institutional algorithm to guide patient and operative selection for HAR is presented. Patients are considered for HAR if they have either high-risk comorbidities or high-risk anatomy, with an important feature of the algorithm being that any decisions about repair strategy should be made by a surgical team with expertise in both open and endovascular techniques. Despite being performed for nearly two decades, the evidence around HAR consists mainly of single center series (level B-C evidence) with no randomized controlled trials. The data suggest HAR to be a safe alternative to open repair with acceptable short and mid-term results. As we as aortic surgeons continue to move towards less invasive approaches, both conventional open and hybrid techniques will remain important tools in the toolbox for arch repair, although the advent of multi-branched arch endografts will almost certainly reduce the extent of open or hybrid repair in many patients and eliminate it altogether in others.
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Affiliation(s)
- G Chad Hughes
- Duke University Medical Center, Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University, Durham, NC, USA
| | - Andrew Vekstein
- Duke University Medical Center, Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University, Durham, NC, USA
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Dueppers P, Reutersberg B, Rancic Z, Messmer F, Menges AL, Meuli L, Rychla M, Zimmermann A. Long-term results of total endovascular repair of arch-involving aortic pathologies using parallel grafts for supra-aortic debranching. J Vasc Surg 2021; 75:813-823.e1. [PMID: 34606961 DOI: 10.1016/j.jvs.2021.09.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 09/01/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We evaluated the long-term morphologic and clinical outcomes after thoracic endovascular aortic repair combined with parallel grafts (PG-TEVAR) for arch-involving aortic pathologies. METHODS We performed a retrospective analysis of perioperative and follow-up data of patients who had undergone PG-TEVAR at a single vascular surgery center from November 2010 to April 2018. Patients with prior or simultaneous open chest or cervical debranching procedures or arch repair were excluded. The primary endpoint was freedom from overall PG-TEVAR-related reintervention. The secondary endpoints were parallel graft sealing zone failure (presence of gutter-related type I or Ic endoleak), PG failure (occlusion or reintervention), stroke, and 30-day and overall PG-TEVAR-related and all-cause mortality. Kaplan-Meier curves were used to estimate the freedom from reintervention and survival. Receiver operating characteristics curves were used to find the optimal cutoff to prevent type Ia endoleak-related reintervention. RESULTS A total of 33 patients, including 8 women, with a median age of 74 years (interquartile range, 67-79 years) had undergone PG-TEVAR (chimney, periscope, and sandwich in 20, 15, and 13 patients, respectively) with proximal landing in Ishimaru zone 0, 1, or 2 in 4, 5, and 24 patients, respectively. The aortic pathologies included type B aortic dissection (acute and chronic, eight and six, respectively), degenerative aneurysm (n = 10), type Ia endoleak (n = 3), para-anastomotic/patch aneurysm (n = 4), left subclavian artery aneurysm (n = 1), and traumatic rupture (n = 1). The perioperative stroke rate and 30-day mortality was 6% and 9%, respectively. Direct postoperative computed tomography revealed 28 endoleaks (gutter-related type Ia, 12; gutter-related type Ib, 9; type Ia, 2; type Ic, 2; type III, 1; undetermined, 2) in 27 patients. The technical and clinical success rate was 37% and 30%, respectively. The mean follow-up for survival was 48 ± 31 months. The latest radiologic follow-up demonstrated 12 remaining and 1 new endoleak. The early and overall PG sealing zone failure and PG failure was 73% and 36% and 9% and 18%, respectively. The overall PG-TEVAR-related reintervention rate was 33% (n = 11). The estimated freedom from overall PG-TEVAR-related reintervention was 68% at 60 months. The main graft oversizing and length oversizing rates were not significantly associated statistically with the type Ia endoleak-related reintervention rate. The PG-TEVAR-related and all-cause mortality were 18% and 34%, respectively. CONCLUSIONS PG-TEVAR for total endovascular repair of arch-involving aortic pathologies resulted in a high rate of type I endoleaks and the need for long-term reintervention. Gutter-related endoleaks might be more frequent than reported and should not be underestimated because they can lead to sac enlargement and reintervention. Frequent radiologic surveillance is mandatory. Further studies comparing PG-TEVAR to other total endovascular alternatives are required to confirm these findings.
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Affiliation(s)
- Philip Dueppers
- Department of Vascular Surgery, University Hospital Zurich, Zurich, Switzerland.
| | | | - Zoran Rancic
- Department of Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Florian Messmer
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Anna-Leonie Menges
- Department of Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Lorenz Meuli
- Department of Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Miriam Rychla
- Department of Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
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Endovascular Treatment of Post Type A Chronic Aortic Arch Dissection With a Branched Endograft: Early Results From a Retrospective International Multicenter Study. Ann Surg 2021; 273:997-1003. [PMID: 30973389 DOI: 10.1097/sla.0000000000003310] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate the outcome of endovascular aortic arch repair for chronic dissection with a custom-made branched endograft. BACKGROUND Acute type A aortic dissections are often treated with prosthetic replacement of the ascending aorta. During follow-up, repair of an aneurysmal evolution of the false lumen distal to the ascending prosthesis can be a challenge both for the surgeon and the patient. METHODS We conducted a multicenter, retrospective study of consecutive patients from 14 vascular units treated with a custom-made, inner-branched device (Cook Medical, Bloomington, IN) for chronic aortic arch dissection. Rates of in-hospital mortality and stroke, technical success, early and late complications, reinterventions, and mortality during follow-up were evaluated. RESULTS Seventy consecutive patients were treated between 2011 and 2018. All patients were considered unfit for conventional surgery. In-hospital combined mortality and stroke rate was 4% (n = 3), including 1 minor stroke, 1 major stroke causing death, and 1 death following multiorgan failure. Technical success rate was 94.3%. Twelve (17.1%) patients required early reinterventions: 8 for vascular access complication, 2 for endoleak correction, and 2 for pericardial effusion drainage. Median follow-up was 301 (138-642) days. During follow-up, 20 (29%) patients underwent secondary interventions: 9 endoleak corrections, 1 open repair for prosthetic kink, and 10 distal extensions of the graft to the thoracic or thoracoabdominal aorta. Eight patients (11%) died during follow-up because of nonaortic-related cause in 7 cases. CONCLUSIONS Endovascular treatment of aortic arch chronic dissections with a branched endograft is associated with low mortality and stroke rates but has a high reintervention rate. Further follow-up is required to confirm the benefits of this novel approach.
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Banno H, Mutsuga M, Sugimoto M, Tokuda Y, Kodama A, Usui A, Komori K. Midterm Outcomes of Zone 0 Antegrade Endograft Implantation During Type I Hybrid Aortic Arch Repair. Eur J Vasc Endovasc Surg 2021; 61:938-944. [PMID: 33773906 DOI: 10.1016/j.ejvs.2021.02.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/05/2021] [Accepted: 02/22/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Type I hybrid arch repair has become popular as a procedure that is less invasive than total arch replacement. The major advantage of this technique is that antegrade endograft implantation can be performed during the procedure, thereby avoiding the complications of introducing the endograft from the groin. The aim of this study was to assess the midterm outcomes of type I hybrid aortic arch repair with antegrade endograft implantation. METHODS Thirty consecutive patients who underwent type I hybrid repair with antegrade endograft implantation from 2009 to 2015 were reviewed retrospectively. Patient demographics, and peri-operative and late results were collected from a prospective database and analysed. RESULTS Four patients (13%) were female and the median age was 78 years. Median aneurysm size was 64 mm. Six patients (20%) developed stroke, and the 30 day mortality rate was 3%. Two patients suffered aortic dissection at the site of debranching anastomosis. The median follow up was 5.2 years. All aneurysms remained stable or had decreased in size at three years, and 82% were stable at five years. Overall survival was 79% at three years and 71% at five years. The rates of freedom from aorta related death were 86% at three and five years, respectively. During the follow up period, three additional left subclavian artery embolisations and one endograft relining due to type IIIb endoleak were required. CONCLUSION Midterm outcomes of type I hybrid aortic arch repair with antegrade endograft implantation for aortic arch aneurysms are reported. Although the incidence of peri-operative stroke was high, late sac behaviour was acceptable.
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Affiliation(s)
- Hiroshi Banno
- Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Masato Mutsuga
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masayuki Sugimoto
- Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshiyuki Tokuda
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akio Kodama
- Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kimihiro Komori
- Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Teratani H, Matsumura H, Sukehiro Y, Hayashida Y, Minematsu N, Wada H. Hybrid zone zero debranching thoracic endovascular aortic repair of ascending aortic injury after surgery and radiotherapy for breast cancer. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 7:93-96. [PMID: 33718674 PMCID: PMC7921190 DOI: 10.1016/j.jvscit.2020.12.007] [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: 08/24/2020] [Accepted: 12/15/2020] [Indexed: 11/06/2022]
Abstract
Thoracic endovascular aortic repair of the ascending aorta remains challenging. We have reported the case of an 81-year-old woman with ascending aortic injury who underwent a life-saving hybrid repair. The patient had previously undergone extended radical mastectomy and postoperative radiotherapy for breast cancer, which had resulted in a right thoracic wall defect and bone exposure and osteonecrosis of the sternum. Therefore, the ascending aorta was directly compressed by the sternum at the level of the brachiocephalic artery bifurcation, causing persistent bleeding from the thoracic wall. Hybrid zone 0 debranching thoracic endovascular aortic repair with a left subclavian artery inflow was emergently performed and achieved hemostasis.
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Affiliation(s)
- Hiromitsu Teratani
- Department of Cardiovascular Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Hitoshi Matsumura
- Department of Cardiovascular Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Yuta Sukehiro
- Division of Cardiovascular Surgery, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Yoshio Hayashida
- Department of Cardiovascular Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Noritoshi Minematsu
- Department of Cardiovascular Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Hideichi Wada
- Department of Cardiovascular Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
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21
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Jing Z, Lu Q, Feng J, Zhou J, Feng R, Zhao Z, Bao J, Jiang W, Zhang X, Shu C, Fu W, Liu C, Guo W, Zhang X, Chen Z, Liu C, Han X. Endovascular Repair of Aortic Dissection Involving the Left Subclavian Artery by Castor Stent Graft: A Multicentre Prospective Trial. Eur J Vasc Endovasc Surg 2020; 60:854-861. [PMID: 33183920 DOI: 10.1016/j.ejvs.2020.08.022] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 07/20/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The left subclavian artery (LSA) origin can be intentionally covered by stent grafts, to provide adequate proximal landing zones during thoracic endovascular repair for Stanford type B aortic dissections (TBADs). To preserve the LSA, a novel single branched stent graft, named "Castor" was designed and a clinical trial conducted to investigate its suitability. METHODS From April 2013 to March 2015, 73 patients with TBAD were treated by Castor stent grafts at 11 Chinese tertiary hospitals as part of a single arm prospective clinical trial. There were 50 acute (<2 weeks [68.5%]) and 23 chronic aortic dissections (>2 weeks [31.5%]). RESULTS The technical success rate was 97% (n = 71/73). The two failures were caused by occlusion of the branch section of the stent graft. There were four intra-operative endoleaks (two type Ia, two type B from the LSA). The endoleak rate was 5% (n = 4/73). There was one in hospital death and no major complications. The median follow up time was 61 months (range 48-72 months). The mortality was 5% (n = 4/73) within one year and 7% within six years (n = 5/73). Two deaths were of unknown cause and three were not related to the aorta. Two new entry tears were found on the proximal or distal edge of the stent graft and were retreated endovascularly. Six occlusions of the branch section of the Castor stent graft were found, and the follow up patency rate of the branch section was 93% (n = 63/68). Two intra-operative endoleaks were left during follow up and eventually disappeared according to the latest computed tomography angiograms. CONCLUSION For patients with TBADs needing anchoring proximal to the origin of LSA, the Castor single branched stent graft may provide an easily manipulated, safe, and effective endovascular treatment.
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Affiliation(s)
- Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
| | - Qingsheng Lu
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
| | - Jiaxuan Feng
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Jian Zhou
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Rui Feng
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zhiqing Zhao
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Junmin Bao
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Weiliang Jiang
- Department of Vascular Surgery, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiwei Zhang
- Department of Vascular Surgery, People's Hospital of Jiangsu Province, Jiangsu, China
| | - Chang Shu
- Department of Vascular Surgery, Second Xiangya Hospital of Central South University, Hunan, China
| | - Weiguo Fu
- Department of Vascular Surgery, Zhongshan Affiliated Hospital of Fudan University, Shanghai, China
| | - Changjian Liu
- Department of Vascular Surgery, Gulou Affiliated Hospital of Nanjing University, Jiangsu, China
| | - Wei Guo
- Department of Vascular Surgery, General Hospital of the People's Liberation Army, Beijing, China
| | - Xiaoming Zhang
- Department of Vascular Surgery, People's Affiliated Hospital of Peking University, Beijing, China
| | - Zhong Chen
- Department of Vascular Surgery, Anzhen Affiliated Hospital of Capital Medical University, Beijing, China
| | - Changwei Liu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Xinwei Han
- Department of Vascular Surgery, First Affiliated Hospital of Zhengzhou University, Henan, China
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22
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Dun Y, Shi Y, Guo H, Liu Y, Qian X, Sun X, Yu C. Secondary Open Arch Operation After Prior Thoracic Endovascular Aortic Repair. Ann Thorac Surg 2020; 111:1545-1553. [PMID: 32976838 DOI: 10.1016/j.athoracsur.2020.07.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 06/18/2020] [Accepted: 07/15/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Many patients required secondary open arch operation due to new aortic pathologies or complications after thoracic endovascular aortic repair (TEVAR). In this study, we investigated the outcome of secondary open arch operation after prior TEVAR. METHODS Fifty-seven consecutive patients underwent secondary open arch operation after prior TEVAR. The major indications were retrograde type A aortic dissection (n = 24), proximal new aortic dissection (n = 8), and type Ⅰa endoleak (n = 16). An elective operation was performed in 35 patients and an emergent operation in 22. The survival and freedom from aortic events during the follow-up were evaluated with the Kaplan-Meier survival curve and the log-rank test. The survival was also analyzed with the Cox analysis. RESULTS The in-hospital mortality was 7.0% (4 of 57). The mean follow-up time was 32.2 ± 19.7 months. Five late deaths occurred. The overall survival at 1 year, 3 years, and 6 years was 89.5%, 84.6%, and 79.9%, respectively. Aortic events developed in 7 patients. Freedom from aortic events after the operation at 1 year, 3 years, and 6 years was 94.2%, 83.0%, and 77.8%, respectively. There were no differences in survival and freedom from aortic events between the elective group and the emergent group. The Cox analysis identified additional coronary artery bypass grafting and hypothermic circulatory arrest as independent factors predicting survival. CONCLUSIONS Secondary open arch operation could be performed to treat the arch pathologies after TEVAR with acceptable early and midterm outcomes.
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Affiliation(s)
- Yaojun Dun
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi Shi
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongwei Guo
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yanxiang Liu
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiangyang Qian
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaogang Sun
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Cuntao Yu
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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23
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Zhang J, Liu X, Tian M, Chen H, Wang J, Ji M, Cong L, Yang C, Zhu E, Tan J. Endovascular aortic repairs combined with looping-chimney technique for repairing aortic arch lesions and reconstructing left common carotid artery. J Thorac Dis 2020; 12:2270-2279. [PMID: 32642132 PMCID: PMC7330391 DOI: 10.21037/jtd.2020.04.31] [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] [Indexed: 11/30/2022]
Abstract
Background The aim of this retrospective study was to evaluate the feasibility and efficacy of thoracic endovascular aortic repairs (TEVAR) combined with looping chimney technique (LCT) for repairing aortic arch lesions and reconstructing left common carotid artery. Methods Total of 14 patients (mean age 52.86±14.46 years; range, 27–79; 10 men, 4 women) were included in the study from December 2016 to December 2018. Aortic arch pathologies of all patients with insufficient proximal landing zone (PLZ) were repaired by TEVAR under local anesthesia, before TEVAR, the left common carotid artery (LCCA) was protected by the guiding sheath from the retrograde brachial access, after aortic stent graft deployed, chimney graft was implanted to restore LCCA by LCT if necessary. All patients underwent computed tomography angiograph (CTA) 2 weeks, 3 months, 6 months and 1 year after surgery. Results Pathology results of 14 patients included: type B aortic dissection (n=8), penetrating aortic ulcers (n=1), retrograde type A aortic dissection (n=1), thoracic aortic aneurysm (TAA) (n=2), and thoracic aortic pseudoaneurysm (n=2). In all patients, aortic arch lesions were repaired by TEVAR; while LCCA were successfully reconstructed by the LCT. In one case, the innominate artery (IA) was simultaneously reconstructed through the same percutaneous right brachial artery (RBA) access. Coiling eliminated type Ia endoleak in 3 patients, and type II endoleak vanished by plugging left subclavian artery (LSA) in 2 patients. In four patients, the chimney stent (CG) of LCCA was partially compressed and then another bare stent was implanted to restore patency rate. The mean follow-up duration was 9.77±6.64 months (range, 0–24) and no combinations were observed in 13 patients; except in one patient who died of cerebral hemorrhage due to abnormal coagulation function. Conclusions TEVAR combined with LCT has shown to be suitable surgical approach for aortic arch lesions. Either covered intentionally or inadvertently, the LCCA could be safely and effectively reconstructed via percutaneous RBA access. Short-term follow-up demonstrated satisfactory morbidity and mortality in high-risk patients; however, longer follow-up is required to assess the effectiveness and durability of this innovative endovascular procedure.
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Affiliation(s)
- Jinhui Zhang
- Department of Vascular Surgery, Yan'an Affiliated Hospital of Kunming Medical University, Kunming 650051, China.,Key Laboratory of Cardiovascular Disease of Yunnan Province, Kunming 650051, China
| | - Xunqiang Liu
- Department of Vascular Surgery, Yan'an Affiliated Hospital of Kunming Medical University, Kunming 650051, China.,Key Laboratory of Cardiovascular Disease of Yunnan Province, Kunming 650051, China
| | - Min Tian
- Department of Vascular Surgery, Yan'an Affiliated Hospital of Kunming Medical University, Kunming 650051, China.,Key Laboratory of Cardiovascular Disease of Yunnan Province, Kunming 650051, China
| | - Huanjun Chen
- Department of Vascular Surgery, Yan'an Affiliated Hospital of Kunming Medical University, Kunming 650051, China.,Key Laboratory of Cardiovascular Disease of Yunnan Province, Kunming 650051, China
| | - Jifeng Wang
- Department of Vascular Surgery, Yan'an Affiliated Hospital of Kunming Medical University, Kunming 650051, China.,Key Laboratory of Cardiovascular Disease of Yunnan Province, Kunming 650051, China
| | - Min Ji
- Department of Vascular Surgery, Yan'an Affiliated Hospital of Kunming Medical University, Kunming 650051, China.,Key Laboratory of Cardiovascular Disease of Yunnan Province, Kunming 650051, China
| | - Lei Cong
- Department of Vascular Surgery, Yan'an Affiliated Hospital of Kunming Medical University, Kunming 650051, China
| | - Chunxin Yang
- Department of Vascular Surgery, Yan'an Affiliated Hospital of Kunming Medical University, Kunming 650051, China.,Key Laboratory of Cardiovascular Disease of Yunnan Province, Kunming 650051, China
| | - Enshuai Zhu
- Department of Vascular Surgery, Yan'an Affiliated Hospital of Kunming Medical University, Kunming 650051, China.,Key Laboratory of Cardiovascular Disease of Yunnan Province, Kunming 650051, China
| | - Jing Tan
- Key Laboratory of Cardiovascular Disease of Yunnan Province, Kunming 650051, China.,Yan'an Affiliated Hospital of Kunming Medical University, Kunming 650051, China
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Tricarico R, Laquian L, Allen MB, Tran-Son-Tay R, Scali ST, Lee TC, Beck AW, Berceli SA, He Y. Temporal analysis of arch artery diameter and flow rate in patients undergoing aortic arch endograft procedures. Physiol Meas 2020; 41:035004. [PMID: 32109898 DOI: 10.1088/1361-6579/ab7b40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Rosamaria Tricarico
- Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States of America
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25
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Reyes Valdivia A, Busto Suárez S, Duque Santos Á, Zanabili Al-Sibbai AA, Gandarias Zúñiga C, Chaudhuri A. Evaluation of EndoAnchor Aortic Wall Penetration After Thoracic Endovascular Aortic Repair. J Endovasc Ther 2020; 27:240-247. [DOI: 10.1177/1526602820907564] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To analyze aortic wall penetration of Heli-FX EndoAnchors after use in seal zones in the aortic arch or descending thoracic aorta during thoracic endovascular aortic repair (TEVAR). Materials and Methods: From May 2014 to May 2019, 25 patients (mean age 70.5±10 years; 16 women) were treated with TEVAR and adjunctive use of the Heli-FX device in 3 academic vascular surgery departments. Computed tomography scans were retrospectively reviewed to determine the location [arch or descending thoracic aorta (DTA)] of the EndoAnchors and the adequacy of aortic wall penetration, defined as adequate (≥2 mm), partial (<2 mm), or inadequate wall penetration (including loss). Endoleaks, reinterventions, and mortality were assessed. Results: A total of 161 EndoAnchors were deployed (median 7 per patient, range 4–9). Twenty-two EndoAnchors were place in the arch (zones 0–2) and 139 in the DTA (zones 3–5). A larger proportion of arch deployments (27%) had suboptimal penetration compared with the DTA (6.5%; p<0.005), resulting in a 91% adequate wall penetration rate for the series overall. Three EndoAnchors were lost (and only 1 retrieved) in 3 different patients, with no additional morbidity; thus, an overall deployment success rate of 88% was achieved. At a mean follow-up of 16.6±14 months, 4 patients required 5 (successful) reinterventions, including one for a type Ia endoleak treated with chimney TEVAR. One patient died 10 months after treatment due to endograft infection, without an opportunity for surgical correction. Conclusion: EndoAnchors have a higher risk of maldeployment in the arch, though this may be attributable to the small learning curve experience in this location. The best aortic wall penetration for this series was in the DTA, where EndoAnchors proved useful for distal endograft fixation during TEVAR.
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Affiliation(s)
- Andrés Reyes Valdivia
- Department of Vascular and Endovascular Surgery, Ramón y Cajal’s University Hospital, Madrid, Spain
| | - Sara Busto Suárez
- Department of Vascular Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - África Duque Santos
- Department of Vascular and Endovascular Surgery, Ramón y Cajal’s University Hospital, Madrid, Spain
| | | | - Claudio Gandarias Zúñiga
- Department of Vascular and Endovascular Surgery, Ramón y Cajal’s University Hospital, Madrid, Spain
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Colacchio EC, Coggia M, Salcuni M, Giorgio D, De Robertis G, Colacchio G. Endovascular repair of an abdominal aortic aneurysm associated with crossed fused renal ectopia. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:140-142. [PMID: 32154469 PMCID: PMC7056603 DOI: 10.1016/j.jvscit.2020.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 01/20/2020] [Indexed: 11/30/2022]
Abstract
Chimney/snorkel endovascular aneurysm repair (Ch-EVAR) enables the minimally invasive treatment of abdominal aortic aneurysm in anatomically challenging and high-risk surgical cases. Here, we present the case of a 77-year-old man with an abdominal aortic aneurysm associated with crossed fused renal ectopia and an ectopic renal artery arising directly from the aneurysm sac. After successful implementation of Ch-EVAR, computed tomography angiography at 18 months revealed no endoleaks, patency of the parallel graft, and normal renal vascularization and function. This report underscores the feasibility of Ch-EVAR in a case with high anatomic complexity.
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Affiliation(s)
- Elda Chiara Colacchio
- Department of Cardiac, Thoracic, and Vascular Sciences, Vascular and Endovascular Surgery Section, University of Padua, Padua, Italy
| | - Marc Coggia
- Department of Vascular Surgery, Ambroise Paré University Hospital, Boulogne-Billancourt, and Faculty of Health Sciences Simone Veil, Versailles Saint-Quentin-en-Yvelines University, Paris-Saclay University, Paris, France
| | - Matteo Salcuni
- Department of Radiology and Interventional Radiology, Marrelli Hospital, Crotone, Italy
| | - Donato Giorgio
- Department of Vascular and Endovascular Surgery, General Regional Hospital Ente Ecclesiastico "F.Miulli", Acquaviva delle Fonti, Italy
| | - Gianni De Robertis
- Department of Vascular and Endovascular Surgery, General Regional Hospital Ente Ecclesiastico "F.Miulli", Acquaviva delle Fonti, Italy
| | - Giovanni Colacchio
- Department of Vascular and Endovascular Surgery, General Regional Hospital Ente Ecclesiastico "F.Miulli", Acquaviva delle Fonti, Italy
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27
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Koike Y, Date K, Kiss B. Chimney Endografting for Zone 2 Thoracic Endovascular Aortic Repair Using The Reorientation Technique. INTERVENTIONAL RADIOLOGY 2020; 5:89-93. [PMID: 36284658 PMCID: PMC9550391 DOI: 10.22575/interventionalradiology.2019-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 02/29/2020] [Indexed: 11/15/2022]
Abstract
The purpose of this report was to describe the reorientation of the chimney graft technique to downsize brachial artery access during thoracic endovascular aortic repair and thus preserve left subclavian artery flow. In the case described herein, the chimney graft was advanced not from the brachial or axillary artery, but from the common femoral artery, over a brachiofemoral pull-through wire. The chimney graft was then turned out into the ascending aorta by balloon dilatation via percutaneous brachial access (“reorientation”). Despite the use of a large-diameter chimney graft, the chimney technique with percutaneous brachial access was successfully performed using the reorientation technique.
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Affiliation(s)
- Yuya Koike
- Department of Interventional Radiology, Yokohama Nanbu Hospital
- Department of Interventional Radiology, Yokohama Rosai Hospital
| | - Kazuma Date
- Department of Cardiovascular Surgery, Yokohama Rosai Hospital
| | - Borbala Kiss
- Department of Radiology, Yokohama Rosai Hospital
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28
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Ahmad W, Buse C, Kröger JR, Mylonas S, Majd P, Brunkwall S, Maintz D, Brunkwall JS. A Shorter Aortic Arch Sealing Ring (< 10 mm) Distal to the Most Distal Chimney Seems to Be an Additional Important Factor Contributing to a Gutter Endoleak in Aortic Arch TEVAR. Ann Vasc Surg 2019; 61:116-123. [PMID: 31394247 DOI: 10.1016/j.avsg.2019.05.065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 05/26/2019] [Accepted: 05/29/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND The aim of the present study was to define the possible anatomical and technical parameter that might predict the occurrence of gutter endoleak or type Ia endoleak (EL Ia) in patients treated with the chimney graft (CG) technique for the brachiocephalic trunk (BCT) and left common carotid artery (LCCA) due to aortic arch pathologies. METHODS We reviewed our institutional endovascular aortic database of patients, who between 2010 and 2018 had undergone thoracic endovascular aortic repair (TEVAR) with chimney graft technique (ChTEVAR) as a debranching method of the supraaortic arteries. RESULTS ChTEVAR was performed in 45 patients of whom a chimney in both the LCCA and the BCT was used in 32 patients, only in the LCCA in twelve patients, and only in the BCT in one patient. Eight patients (17.8%) had an EL Ia (based on postoperative computed tomography angiography). No late EL Ia was detected during the follow-up period. All patients with a postoperative EL Ia received 2 CGs with one each for the BCT, and LCCA had either no or a sealing ring distal to the most distal chimney of less than 10 mm versus patients with a longer sealing zone (P = 0.043). Patients with an endoleak did not differ from those without endoleak with respect to stent-graft oversizing, the diameter of the proximal and distal landing zones, or the aortic diameter directly proximal to the pathology. CONCLUSIONS A sealing ring distal to the most distal chimney of more than 10 mm seems to be associated with a reduced risk of an EL Ia. The relatively few patients and the single-center nature require larger studies to verify the present results.
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Affiliation(s)
- Wael Ahmad
- Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Cologne, North Rhine-Westphalia, Germany.
| | - Christian Buse
- Faculty of Medicine, University of Cologne, Cologne, North Rhine-Westphalia, Germany
| | - Jan Robert Kröger
- Department of Radiology, University Hospital of Cologne, Cologne, North Rhine-Westphalia, Germany
| | - Spyridon Mylonas
- Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Cologne, North Rhine-Westphalia, Germany
| | - Payman Majd
- Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Cologne, North Rhine-Westphalia, Germany
| | - Silke Brunkwall
- Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Cologne, North Rhine-Westphalia, Germany
| | - David Maintz
- Chairman, Department of Radiology, University Hospital of Cologne, Cologne, North Rhine-Westphalia, Germany
| | - Jan Sigge Brunkwall
- Chairman, Department of Vascular and Endovascular Surgery, University Hospital of Cologne, Cologne, North Rhine-Westphalia, Germany
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29
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Liu F, Zhang W, Wang G, Yuan T, Shu X, Guo D, Wang L, Fu W. Long-term outcomes of balloon-expandable bare stent as chimney stent in thoracic endovascular aortic repair for supra-aortic branches reconstruction. J Thorac Dis 2019; 11:1261-1268. [PMID: 31179068 DOI: 10.21037/jtd.2019.04.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background To report the long-term outcomes of balloon-expandable bare stent (BEBS) as chimney stent (CS) in thoracic endovascular aortic repair (TEVAR) for supra-aortic branches reconstruction. Methods A total of 33 patients with thoracic aortic diseases underwent TEVAR using BEBSs as CSs for supra-aortic branches reconstruction in our center from 2010 to 2015. The demographics and procedural details were prospectively collected and retrospectively reviewed. All patients were followed up at 1, 3, 6 months and every 1 year thereafter. Postoperative complications and long-term outcomes were recorded. Results The technical success rate was 100%. A total of 36 BEBSs were utilized as CSs to reconstruct the supra-aortic branches during TEVAR. The rate of immediate endoleak was 42.4% (14/33), including 12 (36.4%) type Ia endoleaks and 2 (6.1%) type II endoleaks. Two of type Ia endoleaks were managed by balloon dilation and disappeared, while the rest were left with close follow-up. Two type II endoleaks were embolized by coils and excluded by a plug, respectively. One patient (3.0%) died 2 days after the procedure due to the acute rupture of aortic dissection. The mean follow-up time was 61.8 (ranged from 12 to 102) months. The unmanaged 10 type Ia endoleaks were closely observed during the follow-up, of which 7 disappeared at 1 year and 1 disappeared at 2 years. The rest 2 type Ia endoleaks existed without further dilation of the aorta. One patient (3.0%) was re-intervened for the increased false lumen due to the distal residual tears. The long-term mortality was 9.1% (3/33). All CSs kept patent till the end of follow-up. No other complications were found. Conclusions The balloon-expandable stent (BES) is a feasible choice as CS for supra-aortic branches reconstruction with long-term patency during TEVAR. However, BEBS may be related to a higher rate of early endoleak.
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Affiliation(s)
- Fei Liu
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.,Vascular Surgery Institute of Fudan University, Shanghai 200032, China
| | - Wei Zhang
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.,Vascular Surgery Institute of Fudan University, Shanghai 200032, China
| | - Guili Wang
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.,Vascular Surgery Institute of Fudan University, Shanghai 200032, China
| | - Tong Yuan
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.,Vascular Surgery Institute of Fudan University, Shanghai 200032, China
| | - Xiaolong Shu
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.,Vascular Surgery Institute of Fudan University, Shanghai 200032, China
| | - Daqiao Guo
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.,Vascular Surgery Institute of Fudan University, Shanghai 200032, China
| | - Lixin Wang
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.,Vascular Surgery Institute of Fudan University, Shanghai 200032, China.,Department of Vascular Surgery, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen 361015, China
| | - Weiguo Fu
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.,Vascular Surgery Institute of Fudan University, Shanghai 200032, China.,Department of Vascular Surgery, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen 361015, China
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Law Y, Kölbel T, Detter C, Rohlffs F, von Kodolitsch Y, Makaloski V, Debus ES, Tsilimparis N. Emergency Use of Branched Thoracic Endovascular Repair in the Treatment of Aortic Arch Pathologies. Ann Thorac Surg 2019; 107:1799-1806. [DOI: 10.1016/j.athoracsur.2018.09.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 08/21/2018] [Accepted: 09/10/2018] [Indexed: 10/28/2022]
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Tricarico R, He Y, Tran-Son-Tay R, Laquian L, Beck AW, Berceli SA. Anatomic and hemodynamic investigation of an occluded common carotid chimney stent graft for hybrid thoracic aortic aneurysm repair. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2019; 5:187-194. [PMID: 31193609 PMCID: PMC6536778 DOI: 10.1016/j.jvscit.2019.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 02/11/2019] [Indexed: 11/26/2022]
Abstract
We examined the possible reasons for common carotid artery chimney stent graft occlusion through computational fluid dynamics analyses of follow-up imaging of a patient-specific aortic configuration reconstructed from computed tomography aortography. Anatomic and hemodynamic parameters were extracted for the bilateral common carotid and subclavian arteries before and after endograft placement. Results suggested that postoperative reduction in lumen diameter within the chimney stent graft combined with an increased flow rate led to complex hemodynamics with high wall shear stress, probably resulting in high-shear thrombogenesis and chimney stent graft occlusion 2.6 years after the primary repair. Early postoperative duplex ultrasound imaging might help identify at-risk conditions.
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Affiliation(s)
- Rosamaria Tricarico
- Department of Biomedical Engineering, University of Florida, Gainesville, Fla
| | - Yong He
- North Florida/South Georgia Veterans Health System, Gainesville, Fla.,Department of Surgery, University of Florida, Gainesville, Fla
| | - Roger Tran-Son-Tay
- Department of Biomedical Engineering, University of Florida, Gainesville, Fla.,Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, Fla
| | - Liza Laquian
- Department of Surgery, University of Florida, Gainesville, Fla
| | - Adam W Beck
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Alabama at Birmingham, Birmingham, Ala
| | - Scott A Berceli
- Department of Biomedical Engineering, University of Florida, Gainesville, Fla.,North Florida/South Georgia Veterans Health System, Gainesville, Fla.,Department of Surgery, University of Florida, Gainesville, Fla
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Abstract
Hybrid aortic arch repair (HAAR) consists of thoracic stent-graft repair and procedures to maintain cerebral blood flow. Several hybrid techniques have been used, including arch artery debranching, parallel graft technique, fenestration or branching of endograft, or a combination of these. We provided an overview of HAAR by presenting literature reviews as well as our clinical experience. The experience consisted of 172 patients who had undergone HAAR. The 30-day mortality was 3% (5/172). Persistent neurologic deficits occurred in 7 patients (4%), respiratory failure in 5 (3%), de novo aortic dissection in 3 and spinal cord injury in 2. 17% of the patients experienced type Ia endoleak. Seventeen patients required redo thoracic endovascular aortic repair. Fifty-six late deaths occurred during the follow-up period, including aortic-related death in 9 patients. In conclusion, hybrid arch debranching repair should be performed for elderly or high-surgical-risk patients. However, refining techniques and device technology is likely to reduce late endograft-related events. (This is a translation of Jpn J Vasc Surg 2018; 27: 385-391.).
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Affiliation(s)
- Kiyofumi Morishita
- Department of Cardiovascular Surgery, Hakodate Municipal Hospital, Hakodate, Hokkaido, Japan
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33
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Valdés DC, Karkos CD, Moy Petersen JC, Fernández JR, González RF. Emergency Endovascular Management of a Symptomatic Pseudoaneurysm of the Left Subclavian Artery Ostium Using a Combination of an Abdominal Aortic Stent-Graft Extension Cuff and a Periscope Stent Graft. Ann Vasc Surg 2018; 55:307.e13-307.e17. [PMID: 30217702 DOI: 10.1016/j.avsg.2018.06.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/28/2018] [Accepted: 06/21/2018] [Indexed: 11/30/2022]
Abstract
A pseudoaneurysm located at the subclavian artery ostium is an infrequent but life-threatening pathology that usually requires major thoracic surgery with a high risk of mortality and morbidity. Endovascular therapy applied to the aortic arch branches is a recent alternative technique, which is still in its early stages because dedicated endovascular devices for the aortic arch are lacking. In this article, we present the emergency endovascular management of a symptomatic pseudoaneurysm of the left subclavian artery ostium which was presumably secondary to an atherosclerotic plaque rupture. Endovascular exclusion required a combination of an abdominal aortic stent-graft extension cuff, which was placed via a retroperitoneal iliac access, and a subclavian artery periscope stent graft.
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Affiliation(s)
- Diego Caicedo Valdés
- Angiology and Vascular Surgery Department, Complexo Hospitalario de Pontevedra, Pontevedra, Spain.
| | - Christos D Karkos
- Vascular Surgery Unit, 5th Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Juan Carlos Moy Petersen
- Angiology and Vascular Surgery Department, Hospital Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - Julia Requena Fernández
- Angiology and Vascular Surgery Department, Complexo Hospitalario de Pontevedra, Pontevedra, Spain
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Al-Hakim R, Schenning R. Advanced Techniques in Thoracic Endovascular Aortic Repair: Chimneys/Periscopes, Fenestrated Endografts, and Branched Devices. Tech Vasc Interv Radiol 2018; 21:146-155. [DOI: 10.1053/j.tvir.2018.06.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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35
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Jayet J, Heim F, Coggia M, Chakfe N, Coscas R. An Experimental Study of Laser in situ Fenestration of Current Aortic Endografts. Eur J Vasc Endovasc Surg 2018; 56:68-77. [DOI: 10.1016/j.ejvs.2018.03.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 03/12/2018] [Indexed: 10/17/2022]
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36
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Valentine EA, Zhou EY, Gordon EK, Ochroch EA. The Year in Vascular Anesthesia: Selected Highlights From 2017. J Cardiothorac Vasc Anesth 2018; 32:2043-2053. [PMID: 29784496 DOI: 10.1053/j.jvca.2018.04.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Elizabeth A Valentine
- Department of Anesthesiology and Critical Care, Division of Cardiovascular and Thoracic Anesthesiology, Hospital of the University of Pennsylvania, Philadelphia, PA.
| | - Elizabeth Y Zhou
- Department of Anesthesiology and Critical Care, Division of Cardiovascular and Thoracic Anesthesiology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Emily K Gordon
- Department of Anesthesiology and Critical Care, Division of Cardiovascular and Thoracic Anesthesiology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - E Andrew Ochroch
- Department of Anesthesiology and Critical Care, Division of Cardiovascular and Thoracic Anesthesiology, Hospital of the University of Pennsylvania, Philadelphia, PA
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