1
|
Hosseinzadeh A, Tajaddini A, Jafari SH, Mohammadi Z, Dalfardi F, Fatemian H, Shahriarirad R. Computed tomography angiography-guided analysis of morphologic properties of the thoracic aorta and arch branches among the adult population: A cross-sectional study. Health Sci Rep 2024; 7:e70017. [PMID: 39221053 PMCID: PMC11362214 DOI: 10.1002/hsr2.70017] [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: 01/29/2024] [Revised: 07/02/2024] [Accepted: 08/13/2024] [Indexed: 09/04/2024] Open
Abstract
Background and Aims Before performing any surgical or endovascular procedure, the anatomical classification of the patient is essential for treatment planning. Computed Tomographic Angiography (CTA) is a standard method to evaluate thoracic aortic anatomy and associated variations. Methods This cross-sectional, descriptive study was performed among adult participants without any peripheral vascular diseases undergoing thoracic CTA. Demographic data were collected along with factors retrieved from the patients CTA, such as the type of aortic arch, length, and diameter of ascending and descending aorta, the diameter of the main branches and the distance between branches, the angles by which the main arteries rise from their origins, and left anterior oblique angle of the aortic arch. Results 164 patients, with a mean age of 57 ± 19.3 years, entered the study. 53 (33.8%) had a bovine arch, which was mostly observed among males. A decrease in the frequency of type I arch and also an increase in the frequency of type 2 and 3 arches was observed with the increase in age (p < 0.001). The BCT diameter had a direct association with both left common carotid artery diameter (r = 0.478, p < 0.001) and left subclavian artery diameter (r = 0.470, p < 0.001). The length of the descending aorta had a direct correlation (r = 0.294, p < 0.001) with the length of the ascending aorta. Conclusion Complex endovascular interventions are vital method in treating aorta, head, and neck pathologies. Accurate knowledge of thoracic aortic anatomy is becoming crucial for diagnosis and intervention planning.
Collapse
Affiliation(s)
- Ahmad Hosseinzadeh
- Thoracic and Vascular Surgery Research CenterShiraz University of Medical ScienceShirazIran
| | - Ali Tajaddini
- Department of SurgeryShiraz University of Medical SciencesShirazIran
| | - Seyed Hamed Jafari
- Medical imaging research centerShiraz University of medical sciencesShirazIran
| | - Zahra Mohammadi
- School of MedicineShiraz University of Medical SciencesShirazIran
| | - Farzad Dalfardi
- Thoracic and Vascular Surgery Research CenterShiraz University of Medical ScienceShirazIran
| | - Hossein Fatemian
- Thoracic and Vascular Surgery Research CenterShiraz University of Medical ScienceShirazIran
- School of MedicineShiraz University of Medical SciencesShirazIran
| | - Reza Shahriarirad
- Thoracic and Vascular Surgery Research CenterShiraz University of Medical ScienceShirazIran
- School of MedicineShiraz University of Medical SciencesShirazIran
| |
Collapse
|
2
|
Imai A, Mitomi K, Sato M, Matsuzaki K, Konishi T, Watanabe Y. Collapse of zone 0 landing TEVAR (Najuta) and the development of higher brain dysfunction. THE JOURNAL OF CARDIOVASCULAR SURGERY 2024; 65:370-375. [PMID: 38618698 DOI: 10.23736/s0021-9509.24.12982-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
Although thoracic endovascular repair (TEVAR)-specific complications often develop, stent-graft collapse is a rare, but fatal complication that requires attention. A 62-year-old male underwent TEVAR for a saccular distal arch aortic aneurysm. After the placement of the Gore TAG (W. L. Gore & Associates, Inc., Newark, DE, USA) from zones 2 to 4, a Najuta endograft (Kawasumi Laboratories, Inc., Tokyo, Japan) was deployed from zone 0. Neither intraoperative angiography nor postoperative contrast-enhanced computed tomography (CT) showed endoleaks or migration. On day 12 after surgery, the patient suddenly lost consciousness during rehabilitation, and CT revealed the collapse of the Najuta endograft. In emergency surgery, the Najuta endograft was removed and the TAG was sutured to the aorta. Although the patient survived, he developed irreversible higher brain dysfunction. The cause of the collapse was examined by the manufacturer and only a slight bird-beak configuration was noted. There were no other findings to indicate the cause of the collapse. The Najuta endograft is a semi-customized system that is created according to the three-dimensional morphology of each individual aortic arch and, thus, is expected to follow the flexion of this vessel. Nevertheless, the risk of collapse needs to be considered.
Collapse
Affiliation(s)
- Akito Imai
- Department of Cardiovascular Surgery, Hitachi General Hospital, Ibaraki, Japan -
| | - Kisato Mitomi
- Department of Cardiovascular Surgery, Hitachi General Hospital, Ibaraki, Japan
| | - Masataka Sato
- Department of Cardiovascular Surgery, Hitachi General Hospital, Ibaraki, Japan
| | - Kanji Matsuzaki
- Department of Cardiovascular Surgery, Hitachi General Hospital, Ibaraki, Japan
| | - Taisuke Konishi
- Department of Cardiovascular Surgery, Dokkyo Medical University Hospital, Tochigi, Japan
| | - Yasunori Watanabe
- Department of Cardiovascular Surgery, Hitachi General Hospital, Ibaraki, Japan
| |
Collapse
|
3
|
Wu M, Zeng Z, Bao X, Ren L, Feng J, Feng R, Xiong J. Long-term Outcomes of Endovascular Repair for Blunt Thoracic Aortic Injury: A 10 Year Multi-center Experience. J Endovasc Ther 2024:15266028241245326. [PMID: 38605568 DOI: 10.1177/15266028241245326] [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: 04/13/2024]
Abstract
OBJECTIVE This study aimed to assess the long-term outcomes in patients treated by thoracic endovascular aortic repair (TEVAR) for blunt thoracic aortic injuries (BTAI). MATERIALS AND METHODS From January 2010 to December 2019, this retrospective observational study was conducted at 3 centers, involving 62 consecutive BTAI patients who underwent TEVAR. Computed tomography angiography scans were planned to be conducted at 6 months post-procedure, and annually thereafter. RESULTS Technical success was achieved in all 62 procedures (100%), which included cases of dissection (n=35, 56.45%), pseudoaneurysm (n=20, 32.26%), and rupture (n=7, 11.29%). Mean injury severity score was 31.66±8.30. A total of 21 supra-arch branches were revascularized by chimney technique, with 12 cases involving the left subclavian artery (LSA) and 9 cases involving the left common carotid artery. In addition, 11 LSAs were covered during the procedure. The in-hospital mortality rate was 1.61% (n=1). The mean follow-up time was 86.82±30.58 months. The all-cause follow-up mortality rate was 3.28% (n=2). Stenosis or occlusion of 3 supra-arch branches (4.92%) was identified at follow-up, with 2 cases (3.28%) requiring re-intervention. No spinal cord ischemia, endoleak, or migration was observed. CONCLUSIONS Despite only including patients with long-term follow-up, this study confirms the long-term safety and effectiveness of TEVAR for BTAI. For young BTAI patients, as the thoracic aorta increases with age, longer follow-up is needed to observe the potential mismatch between the endograft and the aorta. CLINICAL IMPACT This study confirms the long-term safety and effectiveness of endovascular treatment for blunt thoracic aortic injury (BTAI). For young BTAI patients, as the thoracic aorta increases with age, longer follow-up is needed to observe the potential mismatch between the endograft and the aorta. Through a remarkably extended follow-up period (86.82±30.58 months) conducted at multiple centers in China, this study confirms the long-term safety and effectiveness of endovascular treatment for BTAI.
Collapse
Affiliation(s)
- Mingwei Wu
- Department of Vascular and Endovascular Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Zhaoxiang Zeng
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Xianhao Bao
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Luxia Ren
- Department of Vascular and Endovascular Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Jiaxuan Feng
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Rui Feng
- Department of Vascular Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiang Xiong
- Department of Vascular and Endovascular Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| |
Collapse
|
4
|
Nakase A, Inoue Y. A rare case of lethal Najuta endograft collapse. J Cardiothorac Surg 2023; 18:306. [PMID: 37941002 PMCID: PMC10634010 DOI: 10.1186/s13019-023-02436-6] [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: 02/28/2023] [Accepted: 11/04/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND The development of fenestrated endograft, Najuta endograft Kawasumi Laboratories, Inc, Tokyo, Japan) in thoracic endovascular aortic repair (TEVAR) has enabled the treatment of aortic arch aneurysms approaching zone 0 without the need of supra-aortic vessel branch reconstruction. However, the indications of Najuta remain controversial due to complications such as endograft collapse, which is rare and lethal. CASE PRESENTATION We here report a 75-year-old male patient with arch saccular aneurysm. Because of his liver cirrhosis, 2 debranching TEVAR has chosen as a treatment using Najuta. After extrathoracic bypass was performed, a CTAG stent graft was implanted distal to the LSCA in order to deliver Najuta stent graft steadily. Najuta stent graft was successfully positioned in zone 0. However, he was suffered from stent-graft collapse. After additional TEVAR to salvage stent-graft collapse to zone 0, he complicated type A dissection, which was treated by ascending aorta replacement. After salvage operation complicated multiorgan failure and he died.
Collapse
Affiliation(s)
- Akihiro Nakase
- Department of Cardiovascular Surgery, Tokyo Dental College Ichikawa General Hospital, Sugano 5-11-13, Ichikawa, Chiba, 272-8513, Japan
| | - Yoshito Inoue
- Department of Cardiovascular Surgery, Tokyo Dental College Ichikawa General Hospital, Sugano 5-11-13, Ichikawa, Chiba, 272-8513, Japan.
| |
Collapse
|
5
|
Arima D, Suzuki K, Kando Y, Ishigami N. Stent Graft Collapse after Zone 0 Landing Thoracic Endovascular Aortic Repair. Ann Vasc Dis 2023; 16:234-237. [PMID: 37779658 PMCID: PMC10539125 DOI: 10.3400/avd.cr.23-00030] [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: 04/11/2023] [Accepted: 06/30/2023] [Indexed: 10/03/2023] Open
Abstract
A zone 0 landing thoracic endovascular aortic repair was performed on a 69-year-old man with a saccular aortic arch aneurysm. Seven days after the surgery, the patient experienced diminished consciousness and lower limb paralysis. Stent graft collapse was seen on a computed tomography scan. Thereafter, the patient underwent total arch replacement and emergency stent graft removal.
Collapse
Affiliation(s)
- Daisuke Arima
- Department of Cardiovascular Surgery, Fujieda Municipal General Hospital, Fujieda, Shizuoka, Japan
| | - Kazuchika Suzuki
- Department of Cardiovascular Surgery, Fujieda Municipal General Hospital, Fujieda, Shizuoka, Japan
| | - Yumi Kando
- Department of Cardiovascular Surgery, Fujieda Municipal General Hospital, Fujieda, Shizuoka, Japan
| | - Naoyuki Ishigami
- Department of Cardiovascular Surgery, Fujieda Municipal General Hospital, Fujieda, Shizuoka, Japan
| |
Collapse
|
6
|
Prendes CF, Grab M, Stana J, Gouveia E Melo R, Mehmedovic A, Grefen L, Tsilimparis N. In vitro evaluation of the optimal degree of oversizing of thoracic endografts in prosthetic landing areas: a pilot study. J Vasc Surg Cases Innov Tech 2023; 9:101195. [PMID: 37496652 PMCID: PMC10366543 DOI: 10.1016/j.jvscit.2023.101195] [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: 11/30/2022] [Accepted: 02/28/2023] [Indexed: 07/28/2023] Open
Abstract
Objective The optimal degree of proximal thoracic endograft oversizing when aiming for durable sealing in prosthetic grafts is unknown. The aim of the present study was to create an in vitro model for testing different oversized thoracic endografts in a reproducible and standardized manner and, subsequently, determine the optimal oversizing range when planning procedures with a proximal landing in prosthetic zones in the descending thoracic aorta or aortic arch. Methods An in vitro model consisting of a fixed 24-mm polyethylene terephthalate (Dacron; DuPont) graft sutured proximally and distally to two specifically designed 40-mm rings, with four force sensing resistors attached at four equally distant positions and a USB camera attached proximally for photographic and video documentation was used for deployment of Zenith TX2 (Cook Medical Inc) dissection platform endografts with diameters between 24 and 36 mm. After deployment, ballooning with a 32-mm compliant balloon was performed to simulate real-life conditions. The assessment of oversizing included visual inspection, calculation of the valley areas created between the prosthetic wall and the stent graft fabric, distance between the stent graft peaks, the radial force exerted by the proximal sealing stent, and the pull-out force necessary for endograft extraction. Results A total of 70 endografts were deployed with the oversizing ranging from 0% to 50%: 10 × 24 mm, 10 × 26 mm, 10 × 28 mm, 10 × 30 mm, 10 × 32 mm, 10 × 34 mm, and 10 × 36 mm. Two cases of infolding occurred with 50% oversizing. The valley areas increased from 8.79 ± 0.23 mm2 with 16.7% oversizing to 14.26 ± 0.45 mm2 with 50% oversizing (P < .001). A significant difference was found in the pull-out force required for endografts with <10% oversizing vs ≥10% oversizing (P < .001). The difference reached a plateau at ∼4 N with oversizing of >15%. The mean radial force of the proximal sealing stent was greater after remodeling with a compliant balloon (0.55 ± 0.02 N vs 0.60 ± 0.02 N after ballooning; P < .001). However, greater oversizing did not lead to an increase in the radial force exerted by the proximal sealing stent. Conclusions The findings from the present study offer additional insight into the mechanics of oversized stent grafts in surgical grafts. In endografts with the Zenith stent design (TX2), oversizing of <16.7% resulted in reduced resistance to displacement forces, and oversizing of >50% was associated with major infolding in 20% of cases. Long-term in vitro and in vivo testing is required to understand how these mechanical properties affect the clinical outcomes of oversizing.
Collapse
Affiliation(s)
- Carlota F. Prendes
- Department of Vascular Surgery, University Hospital of Munich, Munich, Germany
| | - Maximilian Grab
- Department of Cardiac Surgery, University Hospital of Munich, Munich, Germany
- Department of Medical Materials and Implants, Technical University of Munich, Munich, Germany
| | - Jan Stana
- Department of Vascular Surgery, University Hospital of Munich, Munich, Germany
| | - Ryan Gouveia E Melo
- Vascular Surgery Department, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Aldin Mehmedovic
- Department of Vascular Surgery, University Hospital of Munich, Munich, Germany
| | - Linda Grefen
- Department of Cardiac Surgery, University Hospital of Munich, Munich, Germany
| | | |
Collapse
|
7
|
Gennai S, Leone N, Mezzetto L, Veraldi GF, Santi D, Spaggiari G, Resch T, Silingardi R. Systematic review and meta-analysis of long-term reintervention following thoracic endovascular repair for blunt traumatic aortic injury. J Vasc Surg 2023:S0741-5214(23)00280-X. [PMID: 36754248 DOI: 10.1016/j.jvs.2023.01.196] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/13/2023] [Accepted: 01/30/2023] [Indexed: 02/09/2023]
Abstract
OBJECTIVE To investigate the long-term reinterventions of thoracic endovascular repair (TEVAR) after blunt traumatic aortic injury. METHODS MEDLINE, EMBASE, and Cochrane databases were interrogated until June 2021. Inclusion criteria were blunt traumatic aortic injury treated with TEVAR and mean follow-up of more than 60 months. A systematic review was conducted and data were pooled using a random effects model of proportions applying the Freeman-Tukey transformation. Late reintervention was the primary outcome. Secondary outcomes were procedure-related complications (endoleak, in-stent thrombosis, occlusion, infolding/collapse, bird-beak, migration, and left arm claudication), overall and aortic-related mortality, and aortic diameter changes. RESULTS Eleven studies with a low quality assessment were included. Four hundred eight patients were collected and the 389 surviving more than 30 days were included. The mean follow-up was 8.2 years (95% confidence interval [CI], 5.7-10.8; I2 = 40.2%). Late reintervention was 2.1% (95% CI, 0.6-3.9; I2 = 0.0%; 11/389 cases) with 0.1% (95% CI, 0.0-1.2; I2 = 0.0%; 3/389) occurring after 5 years. Bird-beak was identified in 38.7% (95% CI, 16.4-63.6; I2 = 86.6%). Left arm claudication occurring after 30 days was 3.1% (95% CI, 0.1-8.6; I2 = 26.9%; 11/140 cases). In-stent thrombosis was 1.9% (95% CI, 0.1-5.2; I2 = 51.8%; 11/389 cases). Endoleak was 0.5% (95% CI, 0.0-1.9; I2 = 0.0%; 5/389 cases). Infolding, occlusion, and migration were reported in 2 of 389, 1 of 389, and 0 of 389 patients, respectively. Overall late survival was 95.6% (95% CI, 88.1-99.8; I2 = 84.7%; 358/389 patients) and only one patient accounted for aortic related mortality. The increase in proximal and distal aortic diameters was estimated at 2.7 mm (95% CI, 1.2-4.3; I2 = 0.0%) and 2.5 mm (95% CI, 1.1-3.9; I2 = 0.0%), respectively. CONCLUSIONS TEVAR demonstrates remarkably good long-term results and reinterventions are rarely required. Aortic reinterventions tend to occur within the first and after the fifth year.
Collapse
Affiliation(s)
- Stefano Gennai
- Department of Vascular Surgery, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Nicola Leone
- Department of Vascular Surgery, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, Modena, Italy.
| | - Luca Mezzetto
- Vascular Surgery, University Hospital of Verona, Verona, Italy
| | | | - Daniele Santi
- Unit of Endocrinology, Department of Medical Specialties, Ospedale Civile of Baggiovara, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy; Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Giorgia Spaggiari
- Unit of Endocrinology, Department of Medical Specialties, Ospedale Civile of Baggiovara, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - Timothy Resch
- Department of Vascular Surgery, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Roberto Silingardi
- Department of Vascular Surgery, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, Modena, Italy
| |
Collapse
|
8
|
Hayashi J, Nakajima H, Asakura T, Sho R, Tokunaga C, Takazawa A, Yoshitake A. Safety and arch complications after hemiarch versus total arch replacement with stented elephant trunk in acute type 1 dissection: Is a stent graft always beneficial? JTCVS OPEN 2022; 11:14-22. [PMID: 36172444 PMCID: PMC9510885 DOI: 10.1016/j.xjon.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 05/26/2022] [Accepted: 06/17/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE We aimed to determine the efficacy of total arch replacement with stented elephant trunk by comparing it with hemiarch replacement with and without open stent graft for acute aortic dissection type 1. METHODS We reviewed records of 177 patients who underwent hemiarch replacement (HAR group) (concomitant open stent, 125) and 98 patients who underwent total arch replacement (TAR group) (concomitant stented elephant trunk, 91) for acute type 1 dissection. Compared with the TAR group, the HAR group was older (68.1 vs 60.9 years; P < .01) and had more thrombosed false lumen (28.8% vs 4.1%, P < .01). RESULTS In-hospital death occurred for 7 patients in the HAR group and 1 patient in the TAR group (P = .17). More patients in the TAR group had a postoperative thrombosed false lumen, compared with the HAR group (68% vs 54%, P = .03). In patients with preoperative nonthrombosed false lumen in the HAR group, the rate of postoperative thrombosis was significantly lower than with versus without an open stent (31% vs 65%, P = .01). The rate of freedom from an aortic arch event in the TAR group at 5 years was significantly greater than that in the HAR group (100% vs 83.7%, P = .01). CONCLUSIONS Stented elephant trunk with TAR provided a high rate of false lumen thrombosis and a low incidence of arch events, whereas an open stent during HAR was not beneficial in terms of false lumen thrombosis and arch event prevention.
Collapse
Affiliation(s)
- Jun Hayashi
- Department of Cardiovascular Surgery, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Hiroyuki Nakajima
- Department of Cardiovascular Surgery, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Toshihisa Asakura
- Department of Cardiovascular Surgery, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Ri Sho
- Department of Public Health & Hygiene, Yamagata University Graduate School of Medical Science, Yamagata, Japan
| | - Chiho Tokunaga
- Department of Cardiovascular Surgery, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Akitoshi Takazawa
- Department of Cardiovascular Surgery, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Akihiro Yoshitake
- Department of Cardiovascular Surgery, International Medical Center, Saitama Medical University, Saitama, Japan
| |
Collapse
|
9
|
Nakayama T, Nakamura Y, Yasumoto Y, Yoshiyama D, Kuroda M, Nishijima S, Tsuruta R, Narita T, Ito Y. Collapse of Najuta endograft (aortic arch graft) in patient with intermittent paraparesis. Indian J Thorac Cardiovasc Surg 2022; 38:521-524. [PMID: 36050969 PMCID: PMC9424382 DOI: 10.1007/s12055-022-01363-w] [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: 01/27/2022] [Revised: 03/23/2022] [Accepted: 04/18/2022] [Indexed: 10/18/2022] Open
Abstract
A 50-year-old male underwent thoracic endovascular aortic repair (TEVAR) for distal arch traumatic aortic dissection. Following placement of a Najuta endograft (Kawasumi Laboratories, Inc., Tokyo, Japan) from zone 0 to zone 4, patency of the three vessels was confirmed. Later, the patient suddenly experienced complete intermittent loss of motor and sensory functions in the bilateral lower extremities. Contrast computed tomography (CT) findings indicated endograft stenosis. Following an additional TEVAR procedure, the paraparesis state was temporarily improved. Thereafter, he was readmitted due to congestive heart failure with intermittent paraparesis and contrast CT findings indicated endograft collapse. An emergency procedure for re-expansion of the collapsed endograft and urgent surgery for replacement of the aortic arch was successful. In cases with intermittent paraparesis, endograft collapse should be considered.
Collapse
Affiliation(s)
- Taisuke Nakayama
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, 107-1 Kanegasaku Matsudo-shi, Chiba-ken, 270-2251 Japan
| | - Yoshitsugu Nakamura
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, 107-1 Kanegasaku Matsudo-shi, Chiba-ken, 270-2251 Japan
| | - Yuto Yasumoto
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, 107-1 Kanegasaku Matsudo-shi, Chiba-ken, 270-2251 Japan
| | - Daiki Yoshiyama
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, 107-1 Kanegasaku Matsudo-shi, Chiba-ken, 270-2251 Japan
| | - Miho Kuroda
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, 107-1 Kanegasaku Matsudo-shi, Chiba-ken, 270-2251 Japan
| | - Shuhei Nishijima
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, 107-1 Kanegasaku Matsudo-shi, Chiba-ken, 270-2251 Japan
| | - Ryo Tsuruta
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, 107-1 Kanegasaku Matsudo-shi, Chiba-ken, 270-2251 Japan
| | - Takuya Narita
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, 107-1 Kanegasaku Matsudo-shi, Chiba-ken, 270-2251 Japan
| | - Yujiro Ito
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, 107-1 Kanegasaku Matsudo-shi, Chiba-ken, 270-2251 Japan
| |
Collapse
|
10
|
Torsello GF. [Update on thoracic endovascular aneurysm repair : New stent graft designs]. RADIOLOGIE (HEIDELBERG, GERMANY) 2022; 62:551-555. [PMID: 35759018 DOI: 10.1007/s00117-022-01032-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/31/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND In the last decade, new stent graft designs have evolved to tackle challenges in thoracic endovascular aortic repair. A specific focus on access vessel issues has led to the introduction of new low-profile endograft designs for most of the major products. OBJECTIVE The main objective of this article is to provide an overview of the available publications on new stent graft designs. MATERIALS AND METHODS Assessing recent publications on the major reiterations of thoracic endografts, benefits and drawbacks are discussed. RESULTS Recent reiterations of major endografts for thoracic aortic endovascular repair have focused mainly on the development of low-profile devices. Through alterations on graft fabric as well as stent material and design, delivery systems were reduced in profile, thus, reducing access vessel complications or enabling an endovascular procedure altogether. Long-term data are already available for one endoprosthesis. Other refinements include in situ adaptation of the stent graft to the aortic arch curvature as well as the option of staged deployment to allow more precision and reduce manipulation close to supra-aortic branches. CONCLUSIONS Especially in the case of low-profile endografts, preliminary and long-term results of access vessel complications are promising. In order to draw final conclusions as to how durable the results of aneurysm exclusion are, more long-term studies are warranted.
Collapse
Affiliation(s)
- Giovanni Federico Torsello
- Ärztliche Leitung Angiographie/Interventionsradiologie CCM, Klinik für Radiologie - Arbeitsbereich Interventionelle Radiologie, Campus Charité Mitte, Campus Virchow-Klinikum, CC 06 Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland.
| |
Collapse
|
11
|
Singla A, Cook V, Kotecha K, Mohabbat W. A wolf in wolf's clothing? The complexities of decision involved with acute thoracic endovascular aortic intervention for penetrating aortic ulcer and intramural hematoma. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2022. [DOI: 10.4103/ijves.ijves_8_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|
12
|
Open repair versus thoracic endovascular aortic repair for treating traumatic aortic injury. Asian J Surg 2021; 45:2224-2230. [PMID: 34836763 DOI: 10.1016/j.asjsur.2021.11.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/20/2021] [Accepted: 11/19/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND/OBJECTIVE Blunt traumatic aortic injury (BTAI) is rare and fatal. Treatment has evolved with advances in imaging and the emergence of thoracic endovascular aortic repair (TEVAR). This study reports a single-center, 5-year experience of TEVAR and open repair for BTAI. METHODS Patients with BTAI treated at a level I trauma center from 2014 to 2019 were retrospectively reviewed with patient charts and successive computed tomography angiography images. Patients were grouped according to treatment modality: open repair, TEVAR, or medical management, chosen based on patients' characteristics and injury severity. Groups were compared in terms of preoperative demographics, injury characteristics, operative variables, short-term, and long-term outcomes. RESULTS Forty-two patients were included in the study: 16 (38%) underwent open repair, 17 (40.4%) underwent TEVAR, seven (16.6%) were managed medically, and two (4.7%) died during triage. The median age was 49 years (interquartile range [IQR], 38-57.5 years), and 92.5% were male; the median Injury Severity Score was 33 (IQR, 29-41). Overall mortality was 7.5%. The median hospital stay was 33 days (IQR, 19.5-58.5). Patients undergoing open repair were significantly younger (43 vs. 55 years; p = 0.002) and had a smaller aortic diameter (22.3 vs. 24.0 mm; p=<0.001) than those undergoing TEVAR. No BTAI-related late mortality or reintervention was observed during follow-ups. CONCLUSION This study demonstrated excellent outcomes with multidisciplinary team efforts and appropriate application of treatment modality. TEVAR is ideal for older or severely injured patients; open repair is an important alternative for young patients or patients with unsuitable aortic anatomy.
Collapse
|
13
|
Ashraf F, Ambreen T, Park CW, Kim DI. Comparative evaluation of ballet-type and conventional stent graft configurations for endovascular aneurysm repair: A CFD analysis. Clin Hemorheol Microcirc 2021; 78:1-27. [PMID: 33459700 PMCID: PMC8293652 DOI: 10.3233/ch-200996] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE: Cross limb stent graft (SG) configuration technique for endovascular aneurysm repair (EVAR) is employed for splayed aortic bifurcations to avoid device kinking and smoothen cannulation. The present study investigates three types of stent graft (SG) configurations for endovascular aneurysm repair (EVAR) in abdominal aortic aneurysm. A computational fluid dynamic analysis was performed on the pulsatile non-Newtonian flow characteristics in three ideally modeled geometries of abdominal aortic (AA) SG configurations. METHODS: The three planar and crosslimb SG configurations were ideally modeled, namely, top-down nonballet-type, top-down ballet-type, and bottom-up nonballet-type configurations. In top-down SG configuration, most of the device is deployed in the main body in the vicinity of renal artery and the limbs are extended to the iliac artery. While in the bottom-up configuration, some of the SG device is deployed in the main body, the limbs are deployed in aortic bifurcation, and the extra stent graft of the main body is extended to the proximal aorta until the below of the renal artery. The effects of non-Newtonian pulsatile flow on the wall stresses and flow patterns of the three models were investigated and compared. Moreover, the average wall shear stress (AWSS), oscillatory shear stress index (OSI), absolute helicity, pressure distribution, graft displacement and flow visualization plots were analyzed. RESULTS: The top-down ballet-type showed less branch blockage effect than the top-down nonballet-type models. Furthermore, the top-down ballet-type configuration showed an increased tendency to sustain high WSS and higher helicity characteristics than that of the bottom-up and top-down non-ballet type configurations. However, displacement forces of the top-down ballet-type configuration were 40% and 9.6% higher than those of the bottom-up and top-down nonballet-type configurations, respectively. CONCLUSIONS: Some complications such as graft tearing, thrombus formation, limb disconnection during long term follow up periods might be relevant to hemodynamic characteristics according to the configurations of EVAR. Hence, the reported data required to be validated with the clinical results.
Collapse
Affiliation(s)
- Fahmida Ashraf
- School of Mechanical Engineering, Kyungpook National University, Daegu, South Korea
| | - Tehmina Ambreen
- School of Mechanical Engineering, Kyungpook National University, Daegu, South Korea
| | - Cheol Woo Park
- School of Mechanical Engineering, Kyungpook National University, Daegu, South Korea
| | - Dong-Ik Kim
- Division of Vascular Surgery, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea
| |
Collapse
|
14
|
Lounes Y, Chassin-Trubert L, Gandet T, Ozdemir BA, Peyron A, Akodad M, Alric P, Canaud L. Endovascular aortic arch repair with a pre-cannulated double-fenestrated physician-modified stent graft: a benchtop experiment. Interact Cardiovasc Thorac Surg 2021; 32:942-949. [PMID: 34047348 DOI: 10.1093/icvts/ivab023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/06/2020] [Accepted: 01/01/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The critical step in total endovascular aortic arch repair is to ensure alignment of fenestrations with, and thus maintenance of flow to, supra-aortic trunks. This experimental study evaluates the feasibility and accuracy of a double-fenestrated physician-modified endovascular graft [single common large fenestration for the brachiocephalic trunk and left common carotid artery and a distal small fenestration for left subclavian artery (LSA) with a preloaded guidewire for the LSA] for total endovascular aortic arch repair. METHODS Eight fresh human cadaveric thoracic aortas were harvested. Thoracic endografts with a physician-modified double fenestration were deployed for total endovascular aortic arch repair in a bench test model. A guidewire was preloaded through the distal fenestration for the LSA. All experiments were undertaken in a hybrid room under fluoroscopic guidance with subsequent angioscopy and open evaluation for assessment. RESULTS Mean aortic diameter in zone 0 was 31.3 ± 3.33 mm. Mean duration for stent graft modification was 20.1 ± 5.8 min. Mean duration of the procedure was 24 ± 8.6 min. The Medtronic Valiant Captivia stent graft was used in 6 and the Cook Alpha Zenith thoracic stent graft in 2 cases. LSA catheterization was technically successful with supra-aortic trunk patency in 100% of cases. CONCLUSIONS The use of a double-fenestrated stent graft with a preloaded guidewire appears to be a useful technical addition to facilitate easy and correct alignment of stent graft fenestrations with supra-aortic trunk origins.
Collapse
Affiliation(s)
- Youcef Lounes
- Department of Vascular and Thoracic Surgery, Arnaud de Villeneuve Hospital, Montpellier, France.,Arnaud de Villeneuve Hospital, INSERM U1046, UM1, CHRU of Montpellier, Montpellier, France
| | - Lucien Chassin-Trubert
- Department of Vascular and Thoracic Surgery, Arnaud de Villeneuve Hospital, Montpellier, France.,Arnaud de Villeneuve Hospital, INSERM U1046, UM1, CHRU of Montpellier, Montpellier, France
| | - Thomas Gandet
- Department of Cardio-Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France
| | - Baris Ata Ozdemir
- Department of Vascular and Thoracic Surgery, Arnaud de Villeneuve Hospital, Montpellier, France.,Arnaud de Villeneuve Hospital, INSERM U1046, UM1, CHRU of Montpellier, Montpellier, France.,Arnaud de Villeneuve Hospital, University of Bristol, Bristol, UK
| | - Antoine Peyron
- Legal Department, Lapeyronie Hospital, Montpellier, France
| | - Mariama Akodad
- Cardiology Department, Montpellier University Hospital, Montpellier, France
| | - Pierre Alric
- Department of Vascular and Thoracic Surgery, Arnaud de Villeneuve Hospital, Montpellier, France.,Arnaud de Villeneuve Hospital, INSERM U1046, UM1, CHRU of Montpellier, Montpellier, France
| | - Ludovic Canaud
- Department of Vascular and Thoracic Surgery, Arnaud de Villeneuve Hospital, Montpellier, France.,Arnaud de Villeneuve Hospital, INSERM U1046, UM1, CHRU of Montpellier, Montpellier, France
| |
Collapse
|
15
|
Jordan WD, Desai N, Letter AJ, Matsumura JS. Long-term outcomes of the conformable TAG thoracic endoprosthesis in a prospective multicenter trial. J Vasc Surg 2021; 74:1491-1498. [PMID: 34022380 DOI: 10.1016/j.jvs.2021.04.063] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 04/22/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Gore conformable TAG thoracic endoprosthesis (CTAG) was engineered to enhance conformability in the thoracic aorta and has demonstrated greater deployment accuracy and wall apposition than the original TAG device. The Food and Drug Administration approved the CTAG in 2011 based on the 1-year results of the pivotal trial for the CTAG device. In the present report, we have documented the outcomes for those patients through 5 years. METHODS The CTAG aneurysm study was a prospective, multicenter trial that assessed the safety and effectiveness of the CTAG device as treatment of descending thoracic aortic aneurysms. Follow-up imaging assessments consisted of radiographs and computed tomography at annual intervals through 5 years. A core imaging laboratory was used to assess the aneurysm size, device integrity, and endoleaks. RESULTS A total of 66 patients were enrolled (51 pivotal arm patients and 15 continued access patients) from October 2009 through September 2011. The baseline characteristics, procedural characteristics, and outcomes through 2 years were reported previously. Through 5 years, five patients (7.6%) had required device-related reintervention (one type Ia endoleak or contained rupture of the descending thoracic aorta, one type Ib endoleak, two indeterminate endoleaks, and one thoracic aortic pseudoaneurysm). Four patients (6.1%) had died of aneurysm-related causes, with one death occurring within 30 days of the index procedure. A total of 24 patients (36.3%) had died during the 5-year study period. Seven patients (10.6%) had experienced stroke or transient ischemic attack through 5 years, with one early stroke (postoperative day 28). Prosthesis or intercomponent migration was observed in six patients (9.1%) through 5 years; however, no patient had developed a type III junctional endoleak. No stent-graft fracture or compression was observed through 5 years. At 5 years, 14 patients (50.0%) showed sac regression, 5 (17.9%) showed sac expansion, and 9 (32.1%) showed sac stability using on a 5-mm threshold for change. CONCLUSIONS Thoracic endovascular aortic repair with the CTAG device was associated with low rates of aneurysm-related mortality and reintervention through 5 years. Proximal endoleak was rare, and most patients showed sac regression or stability at 5 years after the initial thoracic endovascular aortic repair.
Collapse
Affiliation(s)
- William D Jordan
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Emory University School of Medicine, Atlanta, Ga.
| | - Nimesh Desai
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa
| | | | - Jon S Matsumura
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| |
Collapse
|
16
|
Teraa M, Hazenberg CE, Houben IB, Trimarchi S, van Herwaarden JA. Important issues regarding planning and sizing for emergent TEVAR. THE JOURNAL OF CARDIOVASCULAR SURGERY 2020; 61:708-712. [PMID: 32964898 DOI: 10.23736/s0021-9509.20.11571-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In the past decades, treatment of acute thoracic aortic syndrome underwent drastic changes with a central role for thoracic endovascular aortic repair (TEVAR). One of the essential factors in the success of TEVAR is accurate sizing of the endograft, as both under- and oversizing can lead to suboptimal results and disastrous complications. The aim of this review was to give an overview of issues regarding endograft sizing in emergent TEVAR. Sizing of the endograft can be complicated by specific factors related to the underlying disease. For instance, different types of the acute thoracic aortic syndrome, i.e. blunt thoracic injury, thoracic aortic aneurysm or dissection with concomitant rupture are associated with hemorrhagic shock and the need for resuscitation, which leads to profound changes in diameter of the thoracic aorta. These diameter changes should be taken into account during endograft sizing. Measuring the thoracic aorta based on the admission CTA can lead to inaccurate sizing, even if proper centerline-based measurements are performed. The use of real-time imaging, in particular intravascular ultrasound (IVUS), has been shown to provide more accurate endograft sizing in acute thoracic aortic syndromes, especially if associated with hypovolemia. Future research should provide additional data on the exact role of different intra-operative imaging modalities (e.g. IVUS, transesophageal echocardiography [TEE], three dimensional CTA) on endograft sizing and long-term outcomes to ultimately improve patient outcome.
Collapse
Affiliation(s)
- Martin Teraa
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands -
| | | | - Ignas B Houben
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Santi Trimarchi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Joost A van Herwaarden
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| |
Collapse
|
17
|
Martinelli O, Malaj A, Faccenna F, Ruberto F, Alunno A, Totaro M, Irace L. Open Conversion for Recurrent Endograft Occlusion after Endovascular Treatment of Blunt Traumatic Aortic Injury: A Peculiar Case Report. Ann Vasc Surg 2020; 67:568.e1-568.e8. [PMID: 32234576 DOI: 10.1016/j.avsg.2020.03.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 03/14/2020] [Accepted: 03/15/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND We report a rare case of delayed, symptomatic thoracic endograft thrombosis after the initial thoracic endovascular aortic repair (TEVAR) for blunt thoracic aortic injury which was successfully retreated with a redo TEVAR, followed by open conversion due to recurrent partial occlusion of the distal edge of the endografts. METHODS Two years ago, a 22-year-old man had undergone an emergency TEVAR for blunt thoracic aortic injury. A Zenith Cook 22 × 100 mm (Cook Incorporated, Bloomington, IN) endograft was used. Six months later, he underwent an emergency endovascular relining of the endograft using the same type of device. The multiorgan perfusion was completely restored except for the spinal cord injury. After 8 months, a recurrent partial occlusion of the distal edge of the second graft was documented. The thoracic aorta was replaced with a 22-mm silver-coated graft (Maquet Spain, SLU). RESULTS Histology examination showed a neointimal formation and thickening and fibrosis of the inner 1/3 of the media with loss of smooth muscle cells and increase of the elastic fibers. CONCLUSIONS The need for secondary interventions or open conversion because of potential complications after TEVAR for traumatic aortic injury is an additional consideration when weighing the risks and benefits of endovascular repair and subsequent surveillance strategies.
Collapse
Affiliation(s)
| | - Alban Malaj
- American Hospital, Laprake, Tirana, Albania.
| | - Federico Faccenna
- Department of Vascular Surgery, "Sapienza" University of Rome, Rome, Italy
| | - Franco Ruberto
- Department of Anaesthesiology, Critical Care Medicine and Pain Therapy, "Sapienza" University of Rome, Rome, Italy
| | - Alessia Alunno
- Department of Vascular Surgery, "Sapienza" University of Rome, Rome, Italy
| | - Marco Totaro
- Department of the Heart and Great Vessels, "Sapienza" University of Rome, Rome, Italy
| | - Luigi Irace
- Department of Vascular Surgery, "Sapienza" University of Rome, Rome, Italy
| |
Collapse
|
18
|
Torsello GF, Argyriou A, Stavroulakis K, Bosiers MJ, Austermann M, Torsello GB. One-Year Results From the SURPASS Observational Registry of the CTAG Stent-Graft With the Active Control System. J Endovasc Ther 2020; 27:421-427. [PMID: 32193990 PMCID: PMC7288855 DOI: 10.1177/1526602820913007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Purpose: To report the outcomes from the observational SURPASS
registry, which was created to assess the performance of the Conformable TAG
(CTAG) stent-graft with the Active Control System (ACS) in patients undergoing
thoracic endovascular aortic repair (TEVAR) in a real-world setting.
Materials and Methods: The SURPASS registry
(ClinicalTrials.gov; identifier NCT03286400) was an
observational, prospective, single-arm, post-market, international study that
enrolled patients undergoing TEVAR using the CTAG with ACS for both acute and
chronic thoracic aortic disease between October 2017 and July 2018. The CTAG
with ACS features 2-stage deployment of the stent-graft and an optional
angulation mechanism that modifies only the proximal end of the stent-graft.
During the observation period, 127 patients (mean age 67.1±12.1 years, range
27–86; 92 men) were enrolled and treated for an array of aortic pathologies,
including chronic and acute lesions and 4 ruptured descending thoracic
aneurysms. The primary outcome of this study was technical success; secondary
outcomes were clinical success and major adverse events at 30 days and 12
months. The numbers of 2-stage device deployments and applications of the
angulation mechanism were recorded, along with the reasons for use.
Results: Technical success of the TEVAR was 97.6% owing to
unintentional partial coverage of supra-aortic branches in 3 cases (the vessels
were patent on imaging). The stent-graft was repositioned at its intermediate
diameter in 79 patients (62.2%), and the angulation feature was applied in 64
cases (50.4%), mainly to improve proximal wall apposition and orthogonality in
the aorta. The desired effect was achieved in 60 cases (93.8%). There was no
device compression, bird-beak configuration, fracture, or graft occlusion. The
30-day and 12-month clinical success rates were 97.6% and 92.9%, respectively.
There were 3 aorta-related deaths at 30 days and a further 3 at 12 months.
Fatalities were due to a retrograde type A dissection (0.8%), paraplegia, bowel
ischemia, sepsis in the setting of a mycotic aneurysm, aneurysm rupture post
aortoesophageal fistula, and multiorgan dysfunction syndrome. Three endoleaks (2
type Ia and 1 type III) required reintervention. Conclusion: In the
SURPASS registry, the use of the CTAG device with ACS showed promising outcomes
despite the challenging pathologies. The new delivery system enables a
controlled staged delivery with in situ adjustments during positioning,
facilitating the treatment of complex aortic disease.
Collapse
Affiliation(s)
- Giovanni Federico Torsello
- Department of Vascular Surgery, St Franziskus Hospital Münster, University of Münster, Germany.,Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Charité Campus Virchow-Klinikum, Charité University Medicine Berlin, Germany
| | - Angeliki Argyriou
- Department of Vascular Surgery, St Franziskus Hospital Münster, University of Münster, Germany
| | | | - Michel J Bosiers
- Department of Vascular Surgery, St Franziskus Hospital Münster, University of Münster, Germany
| | - Martin Austermann
- Department of Vascular Surgery, St Franziskus Hospital Münster, University of Münster, Germany
| | - Giovanni B Torsello
- Department of Vascular Surgery, St Franziskus Hospital Münster, University of Münster, Germany
| | | |
Collapse
|
19
|
Alhaizaey A, Aljabri B, Alghamdi M, AlAhmari A, Abulyazied A, Asiry M, Al-Omran M. Delayed Aortic Stent Collapse in Blunt Traumatic Aortic Injury Repair. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2020; 7:129-136. [PMID: 32018308 PMCID: PMC7000265 DOI: 10.1055/s-0039-3401022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background
Endovascular stent grafting has emerged as an option to treat traumatic aorta injuries with reported significantly low mortality and morbidity. Stent collapse is one of the complications that can occur in this type of treatment. The aim of this article is to analyze the expected cause of stent collapse and to draw attention to the importance of the surveillance follow-up, as this phenomenon may occur late postdeployment.
Methods
A retrospectively collected dataset from the two highest volume trauma centers in Saudi Arabia was analyzed between April 2007 and October 2012. A total of 66 patients received stent grafts for traumatic aortic injury and were included in the study. We apply Ishimaru's anatomical aortic arch zones and Benjamin's aortic injury grading systems. There were 35 patients with aortic injury at zone 2, 26 patients in zone 3, and 5 patients in zone 4. About 96% (63) of the injuries were grades 2 and 3, including large intimal flap or aortic wall pseudoaneurysm with change in wall contour. The technical success rate, as defined by complete exclusion of lesions without leaks, stroke, arm ischemia or stent-related complications, was 90%.
Results
Proximal stent collapse occurred in 4.5% of patients (3 of 66 inserted stents) during follow-up of 4 to 8 years (mean, 6 years). Patients with stent collapse tended to have an acute aortic arch angle with long-intraluminal stent lip, when compared with patients with noncollapsed stents. Intraluminal lip protrusion more than 10-mm increased collapse (
p
< 0.001). Stent-grafts sizes larger than 28 mm also demonstrated a higher collapse rate (
p
< 0.001).
Conclusions
The risk of stent collapse appears related to poor apposition of the stent due to severe aortic arch angulation in young patients and to large stent sizes (>28 mm). Such age groups may have more anatomical and aortic size changes during the growth. Clinical and radiological surveillance is essential in follow-up after stent-graft treatment for traumatic aortic injury.
Collapse
Affiliation(s)
- Abdullah Alhaizaey
- Division of Vascular Surgery, King Khalid University, Aseer Central Hospital, Abha, Saudi Arabia
| | - Badr Aljabri
- Division of Vascular Surgery, King Khalid University, Aseer Central Hospital, Abha, Saudi Arabia
| | - Musaad Alghamdi
- Division of Vascular Surgery, King Khalid University, Aseer Central Hospital, Abha, Saudi Arabia
| | - Ali AlAhmari
- Division of Vascular Surgery, King Khalid University, Aseer Central Hospital, Abha, Saudi Arabia
| | - Ahmed Abulyazied
- Division of Vascular Surgery, King Khalid University, Aseer Central Hospital, Abha, Saudi Arabia
| | - Mohammed Asiry
- Division of Vascular Surgery, King Khalid University, Aseer Central Hospital, Abha, Saudi Arabia
| | - Mohammed Al-Omran
- Division of Vascular Surgery, King Khalid University, Aseer Central Hospital, Abha, Saudi Arabia
| |
Collapse
|
20
|
Affiliation(s)
- Mourad Boufi
- Department of Vascular Surgery, APHM, University Hospital Nord, Marseille, France.,Aix-Marseille Université, IFSTTAR, Marseille, France
| | - Giorgiana Alexandru
- Department of Vascular Surgery, APHM, University Hospital Nord, Marseille, France
| |
Collapse
|
21
|
Gaudric J, Politi MT, Fernández JM, Carre E, Capurro C, Fullana JM. Calculation of the aortic arch angles from three-dimensional reconstructions of computed tomography scans: Comparison between an automated program and visual assessment. Comput Biol Med 2019; 114:103440. [DOI: 10.1016/j.compbiomed.2019.103440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 09/06/2019] [Accepted: 09/07/2019] [Indexed: 10/26/2022]
|
22
|
Shen Y, Zhang S, Zhu G, Chen Y, Chen Z, Jing Z, Lu Q. Risk factors of distal segment aortic enlargement after complicated type B aortic dissection. J Interv Med 2019; 2:154-159. [PMID: 34805893 PMCID: PMC8562164 DOI: 10.1016/j.jimed.2019.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objectives Distal segment aortic enlargement (DSAE) is a common complication that influences the long-term prognosis of type B aortic dissection (TBAD) after thoracic endovascular aortic repair (TEVAR). In this study, a multivariate analysis was performed to find potential factors predictive of DSAE. Methods A single-center retrospective study was performed from 1999 to 2016. Included in the study were complicated TBAD patients who underwent TEVAR with uncovered residual tears. Based on the diameter of the distal segment of the uncovered aorta, we assigned patients to an enlargement group and a non-enlargement group. Data extracted from the medical records included demographic and clinical characteristics and follow-up computed tomography angiography data. The primary endpoints were the all-cause mortality and the presumably aortic-related events that required reintervention during the follow-up period. Results For the 333 patients, all-cause mortality was 38 (11.41%), and 76 (22.82%) patients underwent reintervention. A total of 70 (21.02%) patients experienced DSAE, among them were 2 patients who died of aortic rupture and 58 patients who accepted reintervention. Multivariate analysis reviewed independent risk factors of postoperative DSAE, including current smoking, the residual length of the patent false lumen, the postoperative number of dissection tears in the thoracic aorta and type III aortic arch; as well as protective factors, including the application of a restrictive bare stent (RBS), the length of covered stent in the descending thoracic aorta, and the distance from the residual first tear to the left subclavian artery (LSA). Conclusion DSAE after TEVAR for patients with a complicated TBAD can be influenced by their current smoking habit, the residual length of patent false lumen, the postoperative number of dissection tears in the thoracic aorta and the aortic arch type. Meanwhile, RBS usage, the length of the covered stent in the descending thoracic aorta and the distance from the residual first tear to the LSA could have positive effect on the prognosis.
Collapse
Affiliation(s)
- Yu Shen
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, 17 Building, 168 Changhai Road, Shanghai, China
| | - Simeng Zhang
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, 17 Building, 168 Changhai Road, Shanghai, China.,Department of Congenital Heart Disease, Fuwai Hospital, National Center of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guanglang Zhu
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, 17 Building, 168 Changhai Road, Shanghai, China
| | - Yanqing Chen
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, 17 Building, 168 Changhai Road, Shanghai, China
| | - Zheng Chen
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, 17 Building, 168 Changhai Road, Shanghai, China
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, 17 Building, 168 Changhai Road, Shanghai, China
| | - Qingsheng Lu
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, 17 Building, 168 Changhai Road, Shanghai, China
| |
Collapse
|
23
|
Marrocco-Trischitta MM, Spampinato B, Mazzeo G, Mazzaccaro D, Milani V, Alaidroos M, Ambrogi F, Nano G. Impact of the Bird-Beak Configuration on Postoperative Outcome After Thoracic Endovascular Aortic Repair: A Meta-analysis. J Endovasc Ther 2019; 26:771-778. [DOI: 10.1177/1526602819865906] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose: To investigate the association between the bird-beak configuration (BBC), a wedge-shaped gap between the undersurface of a thoracic endograft and the lesser curvature of the arch after thoracic endovascular aortic repair (TEVAR), and postoperative outcome after TEVAR. Methods: The study was performed according to the PRISMA guidelines. The PubMed, EMBASE, and Cochrane databases were searched to identify all case series reporting BBC after TEVAR between 2006 and April 2018. Data analysis was performed considering the difference in the risk of complications for presence vs absence of BBC. After screening 1633 articles, 21 studies were identified that matched the selection criteria; 12 of these reported detailed information to investigate the postoperative outcome using proportion meta-analysis with a random effects model. The pooled risk difference is reported with the 95% confidence interval (CI). Heterogeneity of the included studies was assessed with the I2 statistic (low 25%, medium 50%, high 75%). Results: Complications occurred within a range of 0 to 72 months in 14.7% (95% CI 7.4% to 27.3%) of patients with BBC and in 6.3% (95% CI 2.5% to 15.4%) of patients without BBC. A cumulative incidence could not be assessed. The summary risk difference was 11.1% (95% CI −0.1% to 22.3%, p=0.052). There was significant heterogeneity ( I2=85.6%). The Egger test did not show evidence of publication bias (p=0.975). When specifically considering type Ia endoleak and endograft migration, the risk difference between BBC and non-BBC patients was 8.2% (95% CI 0.3% to 16.1%, p=0.042; I2=69.0%). The specific risk difference for endograft collapse/infolding and thrombosis was 3.7% (95% CI −3.5% to 11.1%, p=0.308; I2=10.2%). Conclusion: At present the literature does not provide statistical evidence to establish an overall prognostic value of the BBC. Nevertheless, the BBC appears to be associated with a high risk of type Ia endoleak and endograft migration, which warrants specific and long-term surveillance. Clinically relevant values for BBC grading should be established to perhaps define indications for preemptive treatment based on the presence of BBC only.
Collapse
Affiliation(s)
- Massimiliano M. Marrocco-Trischitta
- Clinical Research Unit, Cardiovascular Department, IRCCS Policlinico San Donato, Milan, Italy
- Vascular Surgery Unit, Cardiovascular Department, IRCCS Policlinico San Donato, Milan, Italy
| | - Benedetta Spampinato
- Vascular Surgery Unit, Cardiovascular Department, IRCCS Policlinico San Donato, Milan, Italy
- Residency Program in Vascular Surgery, University of Milan, Italy
| | - Girolomina Mazzeo
- Vascular Surgery Unit, Cardiovascular Department, IRCCS Policlinico San Donato, Milan, Italy
- Residency Program in Vascular Surgery, University of Milan, Italy
| | - Daniela Mazzaccaro
- Vascular Surgery Unit, Cardiovascular Department, IRCCS Policlinico San Donato, Milan, Italy
| | - Valentina Milani
- Biostatistics Service, IRCCS Policlinico San Donato, Milan Italy
| | - Moad Alaidroos
- Vascular Surgery Unit, Policlinico San Marco, Zingonia, Italy
| | - Federico Ambrogi
- Biostatistics Service, IRCCS Policlinico San Donato, Milan Italy
- Laboratory of Medical Statistics, University of Milan, Italy
| | - Giovanni Nano
- Vascular Surgery Unit, Cardiovascular Department, IRCCS Policlinico San Donato, Milan, Italy
- Department of “Scienze Biomediche per la Salute,” University of Milan, Italy
| |
Collapse
|
24
|
Agostinelli A, Carino D, Borrello B, Marcato C, Volpi A, Gherli T, Nicolini F. Blunt traumatic injury to the thoracic aorta treated with thoracic endovascular aortic repair: a single-centre 20-year experience. Interact Cardiovasc Thorac Surg 2019; 28:17-22. [PMID: 30007311 DOI: 10.1093/icvts/ivy211] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 06/03/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Blunt thoracic aortic injury can be treated with thoracic endovascular aortic repair (TEVAR) with excellent short and mid-term outcomes. However, few data are available about the long-term results. Our goal was to report our single-centre, 20-year experience using TEVAR to treat blunt thoracic aortic injury. METHODS We retrospectively reviewed our institutional database to identify all patients treated with TEVAR for traumatic lesions of the aortic isthmus. We identified 35 patients since 1998. Patients' charts were analysed for preoperative characteristics, intraoperative variables and short-term outcomes. Information about the long-term follow-up was collected by analysing cross-sectional images and via phone calls. Follow-up was 100% complete. Rates of survival and of freedom from aortic redo were estimated using Kaplan-Meier methods. RESULTS Twenty-nine patients were men (82%). The median age was 42 years (range 22-79 years) and the mean injury severity score was 38 (±13). The endovascular procedure was successfully carried out in all patients. The left subclavian artery was intentionally overstented in 11 patients (31%). Two patients died perioperatively (5.7%). The estimated survival was 92% and 87% at 5 and 10 years, respectively, with no aorta-related deaths. The estimated freedom from aortic redo was 96% and 91% at 5 and 10 years, respectively. CONCLUSIONS Our data corroborate the excellent results of the endovascular treatment of blunt thoracic aortic injury when follow-up is extended to 20 years. New-generation devices, which are more comfortable and have smaller diameters, may further improve the results of TEVAR in treating traumatic aortic injury. Surveillance with cross-sectional imaging remains mandatory.
Collapse
Affiliation(s)
| | - Davide Carino
- Department of Cardiac Surgery, Parma University Hospital, Parma, Italy.,Aortic Institute at Yale-New Haven, Yale University School of Medicine, New Haven, CT, USA
| | - Bruno Borrello
- Department of Cardiac Surgery, Parma University Hospital, Parma, Italy
| | - Carla Marcato
- Department of Radiology, Parma University Hospital, Parma, Italy
| | - Annalisa Volpi
- 1st Anesthesia and Intensive Care Department, Parma University Hospital, Parma, Italy
| | - Tiziano Gherli
- Department of Cardiac Surgery, Parma University Hospital, Parma, Italy
| | | |
Collapse
|
25
|
Etheridge JC, Ahanchi SS, Dexter DJ, Cain BC, Collins JN, Panneton JM. The impact of intravascular ultrasound on outcomes of endovascular repair of blunt traumatic aortic injury. TRAUMA-ENGLAND 2019. [DOI: 10.1177/1460408618776333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- James C Etheridge
- Division of Vascular Surgery, Eastern Virginia Medical School, Norfolk, USA
| | - S Sadie Ahanchi
- Division of Vascular Surgery, Eastern Virginia Medical School, Norfolk, USA
| | - David J Dexter
- Division of Vascular Surgery, Eastern Virginia Medical School, Norfolk, USA
| | - Brandon C Cain
- Division of Vascular Surgery, Eastern Virginia Medical School, Norfolk, USA
| | - Jay N Collins
- Division of Trauma and Critical Care, Eastern Virginia Medical School, Norfolk, USA
| | - Jean M Panneton
- Division of Vascular Surgery, Eastern Virginia Medical School, Norfolk, USA
| |
Collapse
|
26
|
Buczkowski P, Puślecki M, Majewska N, Urbanowicz T, Misterski M, Juszkat R, Kulesza J, Żabicki B, Stefaniak S, Ligowski M, Szarpak L, Jemielity M, Rivas E, Ruetzler K, Perek B. Endovascular treatment of complex diseases of the thoracic aorta-10 years single centre experience. J Thorac Dis 2019; 11:2240-2250. [PMID: 31372261 PMCID: PMC6626816 DOI: 10.21037/jtd.2019.06.26] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 05/13/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND Introduction of invasive endovascular techniques constituted a real a breakthrough in the treatment of aortic aneurysm dissection and rupture. We assessed the effectiveness and safety of thoracic endovascular aortic repair (TEVAR) in patients with thoracic aortic pathologies. METHODS Between 2007 and 2017, 118 patients with thoracic aortic pathology underwent TEVAR. Among them, 20 (16.9%) patients required hybrid procedures. Stent grafts indication were thoracic aortic aneurysm in 46 (39.0%) patients, type B dissection in 68 (57.6%) patients and other indications in 4 (3.3%). Procedural success rate, in-hospital and late mortality and morbidity were evaluated. RESULTS The patients were followed-up for a mean of 55 months (range, 6-118 months). The technical success rate was 96%. Five patients died during the first 30 days after procedure (mortality 4.2%), four due to ischemic stroke followed by multi-organ failure and another one hemodynamically significant type I endoleak. Most of them were noted in the first years of our study. Five others died during post-discharged period. Four patients developed neurological complications, including stroke (n=2; 1.7%) and paraparesis (n=2; 1.7%). There were 6 (5.1%) primary (5 type I and 1 type II) and 3 (2.5%) secondary endoleaks (1 type I and 2 type III). Secondary interventions were required in 8 subjects. There was one case of stent collapse and two retrograde aortic dissection. CONCLUSIONS Treatment of descending aortic diseases by using stent graft implantation has become the method of choice, decreasing the risk of open surgery, especially in patients with severe clinical state and comorbidities. However, effectiveness and safety may be achieved by experience team.
Collapse
Affiliation(s)
- Piotr Buczkowski
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - Mateusz Puślecki
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
- Department of Medical Rescue, Poznan University of Medical Sciences, Poznan, Poland
| | - Natalia Majewska
- Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Tomasz Urbanowicz
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - Marcin Misterski
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - Robert Juszkat
- Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Jerzy Kulesza
- Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Bartosz Żabicki
- Department of Radiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Sebastian Stefaniak
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - Marcin Ligowski
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Marek Jemielity
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - Eva Rivas
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Kurt Ruetzler
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Bartłomiej Perek
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| |
Collapse
|
27
|
Riambau V, Blanco Amil C, Capoccia L, Mestres G, Yugueros X. The most relevant unmet needs in endovascular management of descending thoracic aorta. THE JOURNAL OF CARDIOVASCULAR SURGERY 2019; 60:275-280. [PMID: 30827086 DOI: 10.23736/s0021-9509.19.10911-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Endovascular repair of descending thoracic aorta (DTA) is considered as first interventional option for most part of the aortic disorders. However, many unmet needs and issues are still limiting its applicability. One of the major limitations is related to the existing gaps in evidence. Clear and robust evidence is still needed in many aspects of the management of DTA pathologies. In numerous clinical scenarios, adequate trials are lacking. Besides those gaps in evidence, it is well recognized that thoracic endografting (TEVAR) is technically evolving in order to overcome technical and device-related complications and limitations. We can deploy endografts in any aortic segment: in the descending, in the ascending, in the arch, even preserving aortic branches. Nevertheless, from the pure technical point of view, current generations of endografts still need more development and improvement. Durability remains the major concern for any endovascular treatment, and thoracic endografting is not an exception. As Galenus said, the physician is only nature's assistant, thoracic endograft should also follow the natural anatomy instead of fighting against it. We will focus the following pages on the graft conformability and compliance, both related to durability and safety of thoracic endografting. We will review the current knowledge and concerns associated with the anatomical and hemodynamic modifications induced by the thoracic endograft strength, stiffness and straightness and their implications for the future thoracic endograft designs.
Collapse
Affiliation(s)
- Vincent Riambau
- Division of Vascular Surgery, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Carla Blanco Amil
- Division of Vascular Surgery, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain -
| | - Laura Capoccia
- Division of Vascular and Endovascular Surgery, Department of Surgery, Umberto I Polyclinic, Sapienza University, Rome, Italy
| | - Gaspar Mestres
- Division of Vascular Surgery, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Xavier Yugueros
- Division of Vascular Surgery, Cardiovascular Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain
| |
Collapse
|
28
|
Han J, Xiang H, Ridley WE, Ridley LJ. Bird's beak configuration: Thoracic aortic graft. J Med Imaging Radiat Oncol 2018; 62 Suppl 1:19. [PMID: 30309082 DOI: 10.1111/1754-9485.07_12785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Jason Han
- Department of Radiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Hao Xiang
- Department of Radiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | | | - Lloyd J Ridley
- Department of Radiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia.,Medical Imaging, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
29
|
García Reyes ME, Gonçalves Martins G, Fernández Valenzuela V, Domínguez González JM, Maeso Lebrun J, Bellmunt Montoya S. Long-Term Outcomes of Thoracic Endovascular Aortic Repair Focused on Bird Beak and Oversizing in Blunt Traumatic Thoracic Aortic Injury. Ann Vasc Surg 2018; 50:140-147. [DOI: 10.1016/j.avsg.2018.02.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 10/22/2017] [Accepted: 02/08/2018] [Indexed: 10/18/2022]
|
30
|
Sattah AP, Secrist MH, Sarin S. Complications and Perioperative Management of Patients Undergoing Thoracic Endovascular Aortic Repair. J Intensive Care Med 2017; 33:394-406. [PMID: 28946776 DOI: 10.1177/0885066617730571] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Endovascular treatments have become increasingly common for patients with a variety of thoracic aortic pathologies. Although considered less invasive than traditional open surgical approaches, they are nonetheless complex procedures. Patients undergo manipulation of an often calcified aorta near the origin of the carotid and subclavian vessels and have stents placed in a curved vessel adjacent to a perpetually beating heart. These stents can obstruct blood flow to the spinal cord, induce an inflammatory response, and in rare cases erode into the adjacent trachea or esophagus. Renal complications range from contrast-induced nephropathy to hypotension and ischemia to dissection. Emboli can lead to strokes and mesenteric ischemia. These patients have complex medical histories, and skilled perioperative management is critical to achieving the best clinical outcomes. Here, we review the medical management of the most common complications in these patients including stroke, spinal cord ischemia, renal injury, retrograde dissections, aortoesophageal and aortobronchial fistulas, postimplantation syndrome, mesenteric ischemia, and endograft failure.
Collapse
Affiliation(s)
- Anna P Sattah
- 1 School of Arts and Sciences, Duke University, Durham, NC, USA.,2 School of Medicine and Department of Surgery, University of Virginia, Charlottesville, VA, USA.,3 Department of Anesthesia and Critical Care, George Washington University Medical Center, Washington, DC, USA.,4 Holy Cross Hospital, Silver Spring, MD, USA
| | - Michael H Secrist
- 5 College of Humanities, Brigham Young University, Provo, UT, USA.,6 Doctor of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.,7 Department of Interventional Radiology, University of California, Irvine, CA, USA.,8 Department of Radiology, George Washington University Medical Center, Washington, DC, USA
| | - Shawn Sarin
- 2 School of Medicine and Department of Surgery, University of Virginia, Charlottesville, VA, USA.,9 Kasturba Medical College, Karnataka, India.,10 Northeast Ohio Medical Universities, Rootstown, OH, USA.,11 Department of Interventional Radiology, National Institutes of Health, Stapleton, New York City, NY, USA.,12 Department of Interventional Radiology, George Washington University Medical Center, Washington, DC, USA
| |
Collapse
|
31
|
Ardellier FD, D'Ostrevy N, Cassagnes L, Ouchchane L, Dubots E, Chabrot P, Boyer L, Camilleri L. CT patterns of acute type A aortic arch dissection: longer, higher, more anterior. Br J Radiol 2017; 90:20170417. [PMID: 28830228 DOI: 10.1259/bjr.20170417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES This study analysed CT patterns of the acute dissected aortic arch using original biometric features along with comparison with normal aortas. METHODS The diagnostic CT scans of 57 patients (42 males, age (mean ± SD: 64.5 ± 13.8 years) admitted with acute Stanford type A dissection involving the aortic arch were analysed by semi-automatic detection protocol of the true lumen of the dissection. We measured the distances from the apex to the ascending and descending aorta, the curvilinear length of the entire arch and of its segments (especially between the brachiocephalic artery trunk and the left subclavian artery), as well as the surface area, angle, height and shift of the arch. These measurements were compared with results previously obtained in a healthy cohort in an analysis adjusted for age, sex and weight. The surface area and rotation of the false lumen were also analysed. RESULTS Compared to normal aortic arches (N), dissected aortic arches (D) were longer (D: 155 ± 26 mm, N: 135 ± 25 mm, p = 0.002), higher (D: 51 ± 10 mm, N: 45 ± 9 mm, p = 0.04), and with a more anterior apex (shift: D: 1.19 ± 0.56, N: 1.40 ± 0.62, p = 0.007). False lumen occupied between 47-65% of the aorta, turned preferentially clockwise and its rotation decreased progressively along the arch. CONCLUSIONS The morphology of the dissected aortic arch differs from that of the normal arch. Thus, our compilation of aortic arch measurements may help improve existing endovascular devices and/or design of new endoprostheses. Advances in knowledge: In this article, we provide a comprehensive set of measurements of the dissected aortic arch, and show that dissected aortic arches are longer, higher, and with a more anterior apex than normal arches.
Collapse
Affiliation(s)
| | - Nicolas D'Ostrevy
- 2 Service de Chirurgie cardio-vasculaire, Hôpital Gabriel Montpied, CHU Clermont-Ferrand, Clermont-Ferrand, France.,3 IGT, UMR CNRS 6602, Institut Pascal, Université d'Auvergne, Clermont-Ferrand, France
| | - Lucie Cassagnes
- 1 Service de Radiologie, Hôpital Gabriel Montpied, CHU Clermont-Ferrand, Clermont-Ferrand, France.,3 IGT, UMR CNRS 6602, Institut Pascal, Université d'Auvergne, Clermont-Ferrand, France
| | - Lemlih Ouchchane
- 3 IGT, UMR CNRS 6602, Institut Pascal, Université d'Auvergne, Clermont-Ferrand, France.,4 Service de Biostatistiques, Hôpital Gabriel Montpied, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Emilie Dubots
- 4 Service de Biostatistiques, Hôpital Gabriel Montpied, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Pascal Chabrot
- 1 Service de Radiologie, Hôpital Gabriel Montpied, CHU Clermont-Ferrand, Clermont-Ferrand, France.,3 IGT, UMR CNRS 6602, Institut Pascal, Université d'Auvergne, Clermont-Ferrand, France
| | - Louis Boyer
- 1 Service de Radiologie, Hôpital Gabriel Montpied, CHU Clermont-Ferrand, Clermont-Ferrand, France.,3 IGT, UMR CNRS 6602, Institut Pascal, Université d'Auvergne, Clermont-Ferrand, France
| | - Lionel Camilleri
- 2 Service de Chirurgie cardio-vasculaire, Hôpital Gabriel Montpied, CHU Clermont-Ferrand, Clermont-Ferrand, France.,3 IGT, UMR CNRS 6602, Institut Pascal, Université d'Auvergne, Clermont-Ferrand, France
| |
Collapse
|
32
|
Girsowicz E, Georg Y, Lefebvre F, Lejay A, Thaveau F, Roy C, Ohana M, Chakfe N. Anatomical Study of Healthy Aortic Arches. Ann Vasc Surg 2017; 44:179-189. [PMID: 28479453 DOI: 10.1016/j.avsg.2017.03.196] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 03/16/2017] [Accepted: 03/28/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND With the steady increase of endovascular procedures involving the aortic arch (AA), an actual depiction of its anatomy has become mandatory. It has also become necessary to evaluate the natural evolution of the AA morphology as part of the evaluation of endovascular devices durability. The objective of this study was to perform a morphological and anatomical study of the AA and of the supra aortic trunks (SAT) in healthy patients, with an evaluation of their evolution with time, with a specific orientation applied to endovascular therapies of the AA. METHODS Sixty-one patients (31 men, mean age 50.8 [18-82]) with a normal anatomy were included in the study. Measurements included the diameters of the AA and SAT in 17 locations, their distance and angulation based on computed tomography angiography data. Statistical analysis focused on descriptive statistics, differences between genders, as well as correlations with age. RESULTS Aortic diameters (mean ± SD) were 29.5 ± 3.9 mm at the ascending aorta, 28.6 ± 3.9 mm at the innominate artery (IA), 27.1 ± 3.2 mm at the left common carotid artery (LCCA), 25.3 ± 3.0 mm at the left subclavian artery (LSCA), 23.9 ± 3.3 mm at the descending aorta. Mean angulation of the AA was 82° (95% confidence interval [CI]: 78.95-85.19°), mean angulation between LSCA/LCCA was -5.7° (95% CI: -0.9 to 18.7°) and -1.8° (95% CI: 5.4-26.4°) between LCCA/IA. Mean distance between the LSCA and the LCCA was 14.3 mm (95% CI: 13-15.6 mm) and 21.8 mm (95% CI: 20.3-23.4 mm) between LCCA and IA. All diameters of the AA increased with age (P < 0.05). Men had diameters statistically (P < 0.05) greater than women except at the LCCA ostium level. A statistically significant increase of the distances between the LSCA and the LCCA, between the LSCA and the IA and between the IA and the LCCA was found with age, P = 0.027, <0.01 and 0.012 respectively. CONCLUSIONS This study allows obtaining accurate information of the AA and the SAT anatomy. It enabled to obtain a better understanding of the three-dimensional aspects of the AA, confirmed the variability and heterogeneity of the SAT disposition, and discussed the principles of vascular aging.
Collapse
Affiliation(s)
- Elie Girsowicz
- Department of Vascular Surgery and Kidney Transplantation, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France.
| | - Yannick Georg
- Department of Vascular Surgery and Kidney Transplantation, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - François Lefebvre
- Department of Methodology and Biostatistics, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Anne Lejay
- Department of Vascular Surgery and Kidney Transplantation, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Fabien Thaveau
- Department of Vascular Surgery and Kidney Transplantation, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Catherine Roy
- Department of Radiology, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Mickael Ohana
- Department of Radiology, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Nabil Chakfe
- Department of Vascular Surgery and Kidney Transplantation, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| |
Collapse
|
33
|
Reutersberg B, Haller B, Mariss J, Eckstein HH, Ockert S. Measurements After Image Post-processing Are More Precise in the Morphometric Assessment of Thoracic Aortic Aneurysms: An Intermodal and Intra-observer Evaluation. Eur J Vasc Endovasc Surg 2016; 52:509-517. [PMID: 27545857 DOI: 10.1016/j.ejvs.2016.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 07/13/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Precise pre-procedural anatomical analysis of aneurysmal anatomy is essential for successful thoracic endovascular aortic repair (TEVAR). Since surgeons and radiologists have to perform multiple measurements in the same patient, high intra-observer reliability of any imaging method is mandatory. Commercially available three dimensional (3D) post-processing techniques are expected to be superior to conventional two dimensional multiplanar reconstructions (MPRs) derived from computed tomography angiograms (CTAs). However, few data exist to support this view. This study aims to evaluate the intermodal and intra-observer differences using 3D software (3surgery) in descending thoracic aortic aneurysms (dTAAs). METHODS Pre-operative CTAs (performed between 2004 and 2010) of 30 dTAAs (mean maximum diameter 61.4 ± 13 mm) were assessed by three independent investigators with different experience in the measurement of aortic pathologies. Intra-observer reliability and intermodal differences (3D vs. 2D) were investigated using pre-specified measurement points (distances of total length, maximum diameter, proximal and distal landing zones). Statistical analyses were performed using the Bland-Altman method and a mixed regression model. RESULTS Intermodal comparison showed that 2D measurements significantly underestimate the measured distances (maximum diameter 3.7 mm [95% CI -5.3 to -2.1] and landing zone maximum 1.4 mm [95% CI -2.0 to -0.2] shorter with 2D, p < .05). In almost all 3D measurements, all investigators showed lower variability comparing the intra-observer differences, most notably in the measuring point total length (reduction of the SD up to 7.9 mm). CONCLUSIONS These data show that both techniques led to significant measurement disparity. This occurs especially at the point of indication (maximum diameter) and the total length of the aneurysm (important for correct stent graft selection). But overall the variability is reduced with the 3D technique, which also tends to measure greater distances. The use of post-processing software therefore leads to more precise device selection for TEVAR in TAA.
Collapse
Affiliation(s)
- B Reutersberg
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - B Haller
- Institute for Statistics and Epidemiology, Technische Universität München, Munich, Germany
| | - J Mariss
- Radiologie Nordhessen, Fritzlar, Germany; Department for Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - H-H Eckstein
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
| | - S Ockert
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Department for Heart-, Thoracic- and Vascular-Surgery, Cantonal Hospital, Lucerne, Switzerland
| |
Collapse
|
34
|
Ziza V, Canaud L, Molinari N, Branchereau P, Marty-Ané C, Alric P. Thoracic endovascular aortic repair: A single center's 15-year experience. J Thorac Cardiovasc Surg 2016; 151:1595-1603.e7. [DOI: 10.1016/j.jtcvs.2015.12.030] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 11/22/2015] [Accepted: 12/12/2015] [Indexed: 11/26/2022]
|
35
|
Böckler D, Brunkwall J, Taylor P, Mangialardi N, Hüsing J, Larzon T, Hyhlik-Dürr A, Gawenda M, Clough R, Ronchey S, Örman L. Thoracic Endovascular Aortic Repair of Aortic Arch Pathologies with the Conformable Thoracic Aortic Graft: Early and 2 year Results from a European Multicentre Registry. Eur J Vasc Endovasc Surg 2016; 51:791-800. [DOI: 10.1016/j.ejvs.2016.02.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 02/05/2016] [Indexed: 10/21/2022]
|
36
|
Abstract
UNLABELLED Introduction Thoracic endovascular aneurysm repair has been employed to treat late complications after aortic coarctation correction. However, its use in children has seldomly been reported. Case report We present the case of a 15-year-old child who presented with a ruptured aneurysm of the descending aorta complicated later by an aortic-oesophageal fistula following aortic coarctation stenting that was managed with multiple bridging endovascular interventions until a definitive repair was performed. CONCLUSION Thoracic endovascular aneurysm repair may be used successfully as a bridging intervention to a definitive repair in children with life-threatening aortic complications following aortic coarctation repair.
Collapse
|
37
|
Cole D, Seller A, Peng YG. Descending Aortic Stent Graft Collapse During Frozen Elephant Trunk Repair: Detection Using Invasive Blood Pressure Monitoring and Intraoperative Transesophageal Echocardiography. J Cardiothorac Vasc Anesth 2016; 30:1344-9. [PMID: 27021175 DOI: 10.1053/j.jvca.2015.12.016] [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: 09/04/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Devon Cole
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL
| | - Aaron Seller
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL
| | - Yong G Peng
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL.
| |
Collapse
|
38
|
Khashram M, He Q, Oh TH, Khanafer A, Wright IA, Vasudevan TM, Lo ASN, Roake JA, Civil I. Late Radiological and Clinical Outcomes of Traumatic Thoracic Aortic Injury Managed with Thoracic Endovascular Aortic Repair. World J Surg 2016; 40:1763-70. [DOI: 10.1007/s00268-016-3457-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|
39
|
Chiang CH, Yeh ML, Chen WL, Kan CD. Apparatus for Comparison of Pullout Forces for Various Thoracic Stent Grafts at Varying Neck Angulations and Oversizes. Ann Vasc Surg 2015; 31:196-204. [PMID: 26597245 DOI: 10.1016/j.avsg.2015.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 10/07/2015] [Accepted: 10/11/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND The purpose of this study is to provide an apparatus for comparison of pullout forces for various thoracic stent grafts at varying neck angulations and oversizes. METHODS An in vitro platform capable of performing pullout tests was used on stent grafts in angulated silicone tubes designed for this study (0°, 45°, 90°, and 135° with a 32-mm inner diameter) in a temperature-controlled chamber (37 ± 2°C). Three commercial stent grafts with sizes commonly used in Taiwan (Valiant: 34, 36, 38, and 40 mm; Zenith TX2: 34, 36, 38, and 40 mm; and TAG: 34, 37, and 40 mm) were used, and each size was tested 8 times for each angulation condition. RESULTS The mean dislodgement forces (DFs) at 0° angulation within 10-20% oversize were approximately 22.7, 9.6, and 9.0 N for the Valiant, Zenith TX2, and TAG devices, respectively, whereas the mean DFs decreased by 46%, 38%, and 50% to 12.3, 5.9, and 4.5 N when the angulation reached 135°. Regression analysis shows that neck angulation was a significant factor for the Valiant and Zenith TX2 devices (P < 0.0001 and P < 0.0001, respectively) but not for the TAG device (P = 0.483). In addition, oversize and interactions between variables (angulation × oversize) exhibited significant effects on the DFs for all devices (P < 0.0001). CONCLUSIONS We successfully built up an apparatus for comparison of pullout forces for various thoracic stent grafts at varying neck angulations and oversizes. With the empirical comparative data of different brand stent grafts under various conditions shown and compared, our findings suggest that aortic neck angulation has a negative correlation with stent-graft fixation. To have better stent-graft fixation and seal in the aortic arch for thoracic endovascular aortic repair, a longer landing zone with cautiously selected oversize is a more suitable selection.
Collapse
Affiliation(s)
- Cheng-Hsien Chiang
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Ming-Long Yeh
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Ling Chen
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Chung-Dann Kan
- Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| |
Collapse
|
40
|
Biomechanical implications of excessive endograft protrusion into the aortic arch after thoracic endovascular repair. Comput Biol Med 2015; 66:235-41. [DOI: 10.1016/j.compbiomed.2015.09.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 09/01/2015] [Accepted: 09/14/2015] [Indexed: 12/12/2022]
|
41
|
Pasta S, Scardulla F, Rinaudo A, Raffa GM, D’Ancona G, Pilato M, Scardulla C. An In Vitro Phantom Study on the Role of the Bird-Beak Configuration in Endograft Infolding in the Aortic Arch. J Endovasc Ther 2015; 23:172-81. [DOI: 10.1177/1526602815611888] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose: To assess endograft infolding for excessive bird-beak configurations in the aortic arch in relation to hemodynamic variables by quantifying device displacement and rotation of oversized stent-grafts deployed in a phantom model. Methods: A patient-specific, compliant, phantom pulsatile flow model was reconstructed from a patient who presented with collapse of a Gore TAG thoracic endoprosthesis. Device infolding was measured under different flow and pressure conditions for 3 protrusion extensions (13, 19, and 24 mm) of the bird-beak configuration resulting from 2 TAG endografts with oversizing of 11% and 45%, respectively. Results: The bird-beak configuration with the greatest protrusion extension exhibited the maximum TAG device displacement (1.66 mm), while the lowest protrusion extension configuration led to the minimum amount of both displacement and rotation parameters (0.25 mm and 0.6°, respectively). A positive relationship was found between the infolding parameters and the flow circulating in the aorta and left subclavian artery. Similarly, TAG device displacement was positively and significantly (p<0.05) correlated with the pulse pressure for all bird-beak configurations and device sizes. However, no collapse was observed under chronic perfusion testing maintained for 30 days and pulse pressure of 100 mm Hg. Conclusion: These findings suggest that endograft infolding depends primarily on the amount of aortic pulsatility and flow rate and that physiological flows do not necessarily engender hemodynamic loads on the proximal bird-beak segment sufficient to cause TAG collapse. Hemodynamic variables may allow for identification of patients at high risk of endograft infolding and help guide preventive intervention to avert its occurrence.
Collapse
Affiliation(s)
- Salvatore Pasta
- Fondazione Ri.MED, Palermo, Italy
- Cardiac Surgery and Heart Transplantation Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
| | | | | | - Giuseppe Maria Raffa
- Cardiac Surgery and Heart Transplantation Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
| | - Giuseppe D’Ancona
- Cardiovascular Medicine Clinical and Research Unit, Vivantes Klinikum im Friedrichschein und Am Urban, Berlin, Germany
| | - Michele Pilato
- Cardiac Surgery and Heart Transplantation Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
| | - Cesare Scardulla
- Cardiac Surgery and Heart Transplantation Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
| |
Collapse
|
42
|
Huang C, Liu Z, Huang D, Qiao T, Zhou M, Liu C. Application of Unibody Single-Branch Endografts in Stanford Type B Dissections with Primary Entry Tear Adjacent to the Left Subclavian Artery: A Computed Tomography–Based Planning Study. Ann Vasc Surg 2015; 29:1174-80. [DOI: 10.1016/j.avsg.2015.02.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Revised: 02/16/2015] [Accepted: 02/20/2015] [Indexed: 11/30/2022]
|
43
|
Faure EM, Canaud L, Marty-Ané C, Becquemin JP, Alric P. Endovascular management of rupture in acute type B aortic dissections. Eur J Vasc Endovasc Surg 2015; 49:655-660. [PMID: 25805327 DOI: 10.1016/j.ejvs.2015.01.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 01/27/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Reports of thoracic endovascular aortic repair (TEVAR) for complicated acute type B aortic dissection (ABAD) bring together a large range of clinical presentations. With a 30 day mortality of 50% when managed with open surgery, rupture is the most devastating complication of ABAD. This study investigated the outcome of TEVAR for ABAD complicated by rupture (r-ABAD) to assess the results of this particularly critical subgroup. METHODS A review of consecutive TEVAR for r-ABAD in two tertiary referral centers was performed using a prospectively maintained database. RESULTS Between 2000 and 2013, 24 patients (mean age 71 years; 14 males) underwent TEVAR for r-ABAD. Sixteen (67%) were in shock (Systolic blood pressure <80 mmHg) before surgery. Seven patients had coverage of the left subclavian artery, of whom four had partial arch debranching procedures via cervical access concomitant with TEVAR. Median length of aortic coverage was 150 mm, median proximal oversizing was 13.3% (range 6.2-33.3%). Technical success was achieved in 100%. There were four in hospital deaths (16%). Two patients (8%) had paraplegia, but neither stroke nor renal insufficiency requiring dialysis occurred. During a mean follow up of 28 months, there was one aortic dissection related death and eight patients (40% of the surviving patients) required re-intervention. All re-interventions were managed endovascularly. At last follow up CT scan, eight patients (40%) had complete remodeling of the aortic wall. CONCLUSION With 16% in hospital mortality and 8% early major complications, this study confirms the feasibility of TEVAR for r-ABAD with a lower peri-operative morbidity and mortality rate compared with open surgery. Given the high rate of re-intervention, close follow up is required in surviving patients.
Collapse
Affiliation(s)
- E M Faure
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve University Hospital, Montpellier, France; Department of Vascular Surgery, Henri Mondor University Hospital, Créteil, France.
| | - L Canaud
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve University Hospital, Montpellier, France
| | - C Marty-Ané
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve University Hospital, Montpellier, France
| | - J-P Becquemin
- Department of Vascular Surgery, Henri Mondor University Hospital, Créteil, France
| | - P Alric
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve University Hospital, Montpellier, France
| |
Collapse
|
44
|
Kische S, D'Ancona G, Ortak J, Bermaoui B, Stoeckicht Y, Ince H. Complicated type B aortic dissection should not be treated with uncovered stents: a lesson not yet learned. Ann Vasc Surg 2015; 29:841.e13-7. [PMID: 25733217 DOI: 10.1016/j.avsg.2014.12.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 11/03/2014] [Accepted: 12/07/2014] [Indexed: 10/23/2022]
Abstract
Whenever some basic rules for endovascular aortic repair of type B aortic dissection are not followed, iatrogenic complications may develop. A 64-year-old gentleman was referred to our institution for revision of previous treatment of complex type B aortic dissection with 2 bare stents. At 3 months, the most proximal aortic bare stent had entered, via the proximal tear, the false lumen. Aortic expansion and dynamic obstruction at the level of the renal arteries had also developed. In a first step, we removed the proximal aortic bare stent surgically. Few days later, 2 covered endografts were implanted into the true lumen of the thoracic aorta with clinical success. The rationale for using endovascular treatment in patients with complicated type B aortic dissection is coverage of the entry tear with covered nonoversized endografts. Negative results are achieved whenever these very simple rules are not strictly followed.
Collapse
Affiliation(s)
- Stephan Kische
- Department of Cardiology, Vivantes Klinikum im Friedrichshain and Am Urban, Berlin, Germany; Rostock University Medical Center, Rostock, Germany
| | - Giuseppe D'Ancona
- Department of Cardiology, Vivantes Klinikum im Friedrichshain and Am Urban, Berlin, Germany; Rostock University Medical Center, Rostock, Germany.
| | - Jasmin Ortak
- Department of Cardiology, Vivantes Klinikum im Friedrichshain and Am Urban, Berlin, Germany; Rostock University Medical Center, Rostock, Germany
| | | | - Yannik Stoeckicht
- Department of Cardiology, Vivantes Klinikum im Friedrichshain and Am Urban, Berlin, Germany; Rostock University Medical Center, Rostock, Germany
| | - Hüseyin Ince
- Department of Cardiology, Vivantes Klinikum im Friedrichshain and Am Urban, Berlin, Germany; Rostock University Medical Center, Rostock, Germany
| |
Collapse
|
45
|
Canaud L, Marty-Ané C, Ziza V, Branchereau P, Alric P. Minimum 10-year follow-up of endovascular repair for acute traumatic transection of the thoracic aorta. J Thorac Cardiovasc Surg 2015; 149:825-9. [DOI: 10.1016/j.jtcvs.2014.10.113] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 10/19/2014] [Accepted: 10/26/2014] [Indexed: 10/24/2022]
|
46
|
Pasta S, Raffa GM, D'Ancona G, Pilato M. Commentary: The bird-beak stent-graft configuration: the end of aortic arch endograft collapse? J Endovasc Ther 2014; 21:803-4. [PMID: 25453881 DOI: 10.1583/14-4778c.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
47
|
van Bogerijen GHW, Auricchio F, Conti M, Lefieux A, Reali A, Veneziani A, Tolenaar JL, Moll FL, Rampoldi V, Trimarchi S. Aortic Hemodynamics After Thoracic Endovascular Aortic Repair, With Particular Attention to the Bird-Beak Configuration. J Endovasc Ther 2014; 21:791-802. [DOI: 10.1583/14-4778mr.1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
48
|
Multidetector CT findings of complications of surgical and endovascular treatment of aortic aneurysms. Radiol Clin North Am 2014; 52:961-89. [PMID: 25173654 DOI: 10.1016/j.rcl.2014.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aortic aneurysms remain a significant problem in the population, and there is a concerted effort to identify, define, image, and treat these conditions to ultimately improve outcomes. The rapid development of diagnostic modalities, operative strategies, and endovascular techniques within the realm of this aortic disease has transformed the field and broadened the spectrum of patients that can be treated with minimally invasive techniques. This investigation has a broad spectrum of normal expected findings that must be differentiated from early or late complications in which intervention is required. In this article, normal and abnormal postoperative and post-TEVAR/EVAR MDCT findings are described.
Collapse
|
49
|
Orr N, Minion D, Bobadilla JL. Thoracoabdominal aortic aneurysm repair: current endovascular perspectives. Vasc Health Risk Manag 2014; 10:493-505. [PMID: 25170271 PMCID: PMC4145733 DOI: 10.2147/vhrm.s46452] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Thoracoabdominal aneurysms account for roughly 3% of identified aneurysms annually in the United States. Advancements in endovascular techniques and devices have broadened their application to these complex surgical problems. This paper will focus on the current state of endovascular thoracoabdominal aneurysm repair, including specific considerations in patient selection, operative planning, and perioperative complications. Both total endovascular and hybrid options will be considered.
Collapse
Affiliation(s)
- Nathan Orr
- Vascular and Endovascular Surgery, Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - David Minion
- Vascular and Endovascular Surgery, Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - Joseph L Bobadilla
- Vascular and Endovascular Surgery, Department of Surgery, University of Kentucky, Lexington, KY, USA
| |
Collapse
|
50
|
Mosquera VX, Marini M, Velasco C, Estévez-Cid F, Herrera-Noreña JM, Cao I, Gulías D, Cuenca JJ. Análisis morfológico del arco aórtico en pacientes sometidos a cirugía híbrida y correlación con resultados a medio plazo. CIRUGIA CARDIOVASCULAR 2014. [DOI: 10.1016/j.circv.2013.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|