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Queiroz AB, Lopes JB, Santos VP, Cruz PBAF, Fidelis RJR, Filho JSA, Passos LCS. Physician-Modified Endovascular Grafts for Zone-2 Thoracic Endovascular Aortic Repair. AORTA (STAMFORD, CONN.) 2022; 10:13-19. [PMID: 35640582 PMCID: PMC9179216 DOI: 10.1055/s-0042-1742696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 07/02/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVE This study aims to describe our technique and early experience with physician-modified endovascular grafts (PMEGs) for aortic arch diseases in zone 2. We used a total endovascular technique based on a single fenestrated endograft to preserve left subclavian artery (LSA) patency. METHODS From December 2019 to August 2020, six consecutive patients with a variety of thoracic aortic diseases were treated with handmade fenestrated thoracic aortic grafts: four aortic dissections, one penetrating aortic ulcer, and one intramural hematoma. The planning, endograft modification, surgical technique, and follow-up of the patients were described. We evaluated immediate technical success and after 30 days, the LSA patency, Type-1 endoleak, and postoperative complications. RESULTS Thoracic endovascular aortic repair (TEVAR) was performed for zone 2 in all cases. Immediate technical success, defined as successful alignment of the LSA with a covered stent and no Type-1 endoleak, was achieved in all cases. Patients had a 30-day follow-up computed tomography, which demonstrated LSA patency and no Type-I endoleaks. To date, no strokes, left arm ischemia, paraplegia, or conversions to open surgery have been reported; one patient operated for acute Type B dissection died during the early follow-up. CONCLUSION TEVAR for zone 2 with a PMEG to maintain LSA patency achieved technical success and early durability. It is expected that with longer follow-up and a larger number of cases, these results will be confirmed.
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Affiliation(s)
- André B. Queiroz
- Centro de Doenças da Aorta - CDA, Division of Vascular and Endovascular Surgery, Cardiac Surgery, Cardiology and Anesthesia, Universidade Federal da Bahia, Hospital Ana Nery, Salvador-Bahia, Brazil
- Division of Vascular Surgery, Universidade Federal da Bahia, Hospital Universitário Professor Edgar Santos, Salvador-Bahia, Brazil
| | - Jackson B. Lopes
- Centro de Doenças da Aorta - CDA, Division of Vascular and Endovascular Surgery, Cardiac Surgery, Cardiology and Anesthesia, Universidade Federal da Bahia, Hospital Ana Nery, Salvador-Bahia, Brazil
| | - Vanessa P. Santos
- Division of Vascular Surgery, Universidade Federal da Bahia, Hospital Universitário Professor Edgar Santos, Salvador-Bahia, Brazil
| | - Pedro B. A. F. Cruz
- Centro de Doenças da Aorta - CDA, Division of Vascular and Endovascular Surgery, Cardiac Surgery, Cardiology and Anesthesia, Universidade Federal da Bahia, Hospital Ana Nery, Salvador-Bahia, Brazil
| | - Ronald J. R. Fidelis
- Division of Vascular Surgery, Universidade Federal da Bahia, Hospital Universitário Professor Edgar Santos, Salvador-Bahia, Brazil
| | - José S. Araújo Filho
- Centro de Doenças da Aorta - CDA, Division of Vascular and Endovascular Surgery, Cardiac Surgery, Cardiology and Anesthesia, Universidade Federal da Bahia, Hospital Ana Nery, Salvador-Bahia, Brazil
- Division of Vascular Surgery, Universidade Federal da Bahia, Hospital Universitário Professor Edgar Santos, Salvador-Bahia, Brazil
| | - Luiz C. S. Passos
- Centro de Doenças da Aorta - CDA, Division of Vascular and Endovascular Surgery, Cardiac Surgery, Cardiology and Anesthesia, Universidade Federal da Bahia, Hospital Ana Nery, Salvador-Bahia, Brazil
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Angelos P. Double-edged sword of surgical innovation: ethical issues of early and late adoption of novel techniques. Br J Surg 2021; 108:107-108. [PMID: 33711150 DOI: 10.1093/bjs/znaa162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 12/08/2020] [Indexed: 11/12/2022]
Affiliation(s)
- P Angelos
- Department of Surgery, MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois, USA
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Committees, editors and reviewers. Greyhounds or hounds. ANGIOLOGIA 2020. [DOI: 10.20960/angiologia.00148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Gloviczki P, Lawrence PF. The road to medical innovations. J Vasc Surg 2019; 71:1. [PMID: 31864640 DOI: 10.1016/j.jvs.2019.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 10/17/2019] [Indexed: 11/28/2022]
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