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Huo W, He M, Bao X, Lu Y, Tian W, Feng J, Zeng Z, Feng R. Minimally Invasive Endovascular Repair for Nondissected Ascending Aortic Disease: A Systematic Review. Emerg Med Int 2023; 2023:5592622. [PMID: 37767197 PMCID: PMC10522436 DOI: 10.1155/2023/5592622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/03/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
Objective The aim of this study is to evaluate the efficacy of endovascular treatment for nondissected diseases of the ascending aorta. Data Sources. PubMed, Embase, and SciELO. Review Methods. In this study, we conducted a search on the PubMed, Embase, and SciELO databases for all cases of ascending aortic endovascular repair included in the literature published between January 2007 and July 2023, excluding type A aortic dissection. We reviewed 56 case reports and 7 observational studies included in this study, assessing the techniques, equipment, procedural steps, and results. We summarized the age, complications, follow-up time, and access route. Results This study includes 63 articles reporting 105 patients (mean age: 64.96 ± 17.08 years) who received endovascular repair for nondissected ascending aortic disease. The types of disease include aneurysm (N = 16), pseudoaneurysm (N = 71), penetrating aortic ulcer (N = 10), intramural hematoma (N = 2), thrombosis (N = 2), iatrogenic coarctation (N = 1), and rupture of the aorta (N = 3). The success rate of surgery is 99.05% (104/105). Complications include endoleak (10.48%, 11/105), stroke (5.71%, 6/105), postoperative infection (1.91%, 2/105), acute renal failure (0.95%, 1/105), aortic rupture (0.95%, 1/105), thrombosis (0.95%, 1/105), and splenic infarction (0.95%, 1/105). Five patients required conversion to open surgery, two patients underwent endovascular reintervention, and four of these five patients underwent surgery due to endoleak. Early mortality was 2.86% (3/105). Conclusion While the viability and results of endovascular repair for the treatment of ascending aortic disease are acknowledged in some circumstances, further research is needed to determine the safety and effectiveness of endovascular treatment for ascending aortic disease.
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Affiliation(s)
- Weixue Huo
- Department of Vascular Surgery, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Mengwei He
- Department of Vascular Surgery, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Xianhao Bao
- Department of Vascular Surgery, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Ye Lu
- Department of Vascular Surgery, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Wen Tian
- Department of Vascular Surgery, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Jiaxuan Feng
- Department of Vascular Surgery, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Zhaoxiang Zeng
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Rui Feng
- Department of Vascular Surgery, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
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2
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Sheng CC, Santini A, Annie FH, Rawala M, Bhatt DL, Nanjundappa A. Successful Endovascular Treatment of an Anastomotic Pseudoaneurysm in the Ascending Aorta. Am J Cardiol 2023; 203:157-160. [PMID: 37494865 DOI: 10.1016/j.amjcard.2023.05.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 05/14/2023] [Accepted: 05/31/2023] [Indexed: 07/28/2023]
Abstract
We present a case of a 72-year-old-male with an ascending aortic anastomotic pseudoaneurysm following Dacron graft repair of an iatrogenic ascending aortic dissection that occurred during an open mitral valve repair, which was successfully treated with endovascular graft placement. In conclusion, this uncommon finding demonstrates a complex pathology and additional clinical examples of the versatility of endovascular stent grafts within the ascending aorta.
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Affiliation(s)
- Calvin Chen Sheng
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Adrian Santini
- Charleston Area Medical Center Vascular Center of Excellence, Charleston Area Medical Center, Charleston, West Virginia
| | - Frank H Annie
- Charleston Area Medical Center Vascular Center of Excellence, Charleston Area Medical Center, Charleston, West Virginia
| | - Muhammad Rawala
- Charleston Area Medical Center Vascular Center of Excellence, Charleston Area Medical Center, Charleston, West Virginia
| | - Deepak L Bhatt
- Director of Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System, New York, New York 10029
| | - Aravinda Nanjundappa
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
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3
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Uchino M, Fumoto H, Yunoki J, Nakayama Y. Thoracic endovascular aortic repair of an ascending aortic pseudoaneurysm. Asian Cardiovasc Thorac Ann 2023:2184923231176144. [PMID: 37186691 DOI: 10.1177/02184923231176144] [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: 05/17/2023]
Abstract
A 74-year-old man with a history of two thoracic aortic repairs, including a modified Bentall procedure using a mechanical valve and total arch replacement, was referred to our hospital with the development of hoarseness. Computed tomography revealed an anastomotic pseudoaneurysm between the prosthetic grafts in the ascending aorta. Two aortic cuffs for abdominal aorta were deployed through the left axillary artery using a transcatheter aortic valve replacement guidewire placed at the supra-aortic mechanical valve during ventricular rapid pacing and were successfully covered with an inlet to the pseudoaneurysm on postoperative computed tomography. The postoperative course was favorable.
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Affiliation(s)
- Motonori Uchino
- Department of Cardiovascular Surgery, Oosumikanoya Hospital, Kanoya, Japan
| | - Hideyuki Fumoto
- Department of Cardiovascular Surgery, Oosumikanoya Hospital, Kanoya, Japan
| | - Junji Yunoki
- Department of Thoracic and Cardiovascular Surgery, Saga University Faculty of Medicine, Saga, Japan
| | - Yoshihiro Nakayama
- Department of Cardiovascular Surgery, Oosumikanoya Hospital, Kanoya, Japan
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4
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Ascending aorta thoracic endovascular aortic repair for infected pseudoaneurysm. J Vasc Surg Cases Innov Tech 2022; 8:244-247. [PMID: 35510219 PMCID: PMC9058959 DOI: 10.1016/j.jvscit.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 02/12/2022] [Indexed: 12/02/2022] Open
Abstract
A 70-year-old woman with a bioprosthetic aortic valve replacement for aortic valve endocarditis complicated by recurrent endocarditis and requiring homograft aortic root replacement 10 years earlier had presented at 1 month after her admission for pseudomonal bacteremia with right-sided chest pain. An aortic pseudoaneurysm, identified on computed tomography, was treated with an ascending aorta thoracic endovascular aortic repair using two overlapping abdominal aortic stent grafts in the ascending aorta. Postoperative and follow-up imaging demonstrated exclusion of the pseudoaneurysm with stable positioning of the stent grafts. Ascending aorta thoracic endovascular aortic repair can be performed safely with good short-term results in patients presenting with infected pseudoaneurysms of the ascending aorta.
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5
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Nomura Y, Koide Y, Kawasaki R, Murakami H. Endovascular Repair for Ascending Aortic Graft Side Branch Pseudoaneurysm: A Report of Two Cases. EJVES Vasc Forum 2022; 55:48-51. [PMID: 35515008 PMCID: PMC9062449 DOI: 10.1016/j.ejvsvf.2022.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 03/13/2022] [Accepted: 03/28/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction A pseudoaneurysm arising from the side branch of the prosthesis, following ascending aortic replacement, is extremely rare. Re-intervention usually involves open surgery, replacement of the ascending aorta, or ligation of the side branch. Redo surgery with an additional sternotomy carries the risk of cardiac and vascular injuries, and endovascular treatment can reduce such adverse events. Report This study describes the successful thoracic endovascular aortic repair (TEVAR) of two cases of pseudoaneurysms arising from the side branch after ascending aortic replacement. Case 1 involved a 79 year old man who underwent ascending aortic replacement and omentopexy for a ruptured tuberculous aortic aneurysm 13 years ago. The pseudoaneurysm was mushroom shaped with a 30 mm protrusion. Case 2 involved an 83 year old man who underwent ascending aortic replacement for Stanford type A acute aortic dissection 11 years ago. The pseudoaneurysm was rod shaped with a 27 mm protrusion. In both cases, the pseudoaneurysm arising from the side branch was not noted on computed tomography (CT) until one year earlier and was first identified at a routine follow up examination. The pseudoaneurysms required surgical repair because of the risk of rupture; however, TEVAR was selected considering the risks of redo surgery and the patients' ages. It was performed via a femoral artery approach without adverse events using a commercially available thoracic aortic device. Post-operative CT scan showed complete exclusion of the pseudoaneurysm. Discussion Although TEVAR is usually not indicated for ascending aortic pathologies, if there is an anatomical indication and a compatible stent graft, TEVAR for the ascending aorta should be the first choice in patients who are inoperable, at high risk and undergoing redo surgery.
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Affiliation(s)
- Yoshikatsu Nomura
- Department of Cardiovascular Surgery, Hyogo Brain and Heart Centre at Himeji, Hyogo, Japan
| | - Yutaka Koide
- Department of Radiology, Hyogo Brain and Heart Centre at Himeji, Hyogo, Japan
| | - Ryota Kawasaki
- Department of Radiology, Hyogo Brain and Heart Centre at Himeji, Hyogo, Japan
| | - Hirohisa Murakami
- Department of Cardiovascular Surgery, Hyogo Brain and Heart Centre at Himeji, Hyogo, Japan
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6
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Piffaretti G, Czerny M, Riambau V, Gottardi R, Wolfgruber T, Probst C, Matt P, Antonello M, Gerosa G, Hamady M, Fontana F, Ferrarese S, Lomazzi C, Grassi V, Fernandez-Alonso S, Trimarchi S. Endovascular repair of ascending aortic diseases with custom-made endografts. Eur J Cardiothorac Surg 2021; 59:741-749. [PMID: 33394032 DOI: 10.1093/ejcts/ezaa383] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 08/28/2020] [Accepted: 09/15/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES The aim of this article is to report the mid-term results of ascending thoracic endovascular aortic repair using a custom-made device (CMD). METHODS This was a retrospective study performed at tertiary centres. Nine patients considered unfit for open surgery received elective total endovascular repair of the ascending aorta with a Relay® (Terumo Aortic, Sunrise; FL, USA) CMD: pseudoaneurysn (n = 5), localized dissection (n =3) and contained rupture (n = 1). RESULTS Primary clinical success was achieved in all patients with no major complications and no early conversion to open surgery. All patients were discharged home and independent: median length of stay was 7 days (interquartile range, 6-18). No patient was lost to follow-up at a median 26 months (interquartile range, 12-36). Three patients died 2, 6 and 24 months after intervention; 1 was aorta related (late aorto-atrial fistula due to infection that required open surgery). At the last follow-up available, no endoleaks, migrations, fractures or ruptures were observed in the remaining 6 patients. CONCLUSIONS Ascending thoracic endovascular aortic repair with Terumo Aortic CMDs was technically feasible, effective and safe in very selected lesions. CMDs showed good ascending aorta conformability with different configurations and diameters, and satisfactory mid-term durability as shown by both structural integrity and aortic lesion exclusion.
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Affiliation(s)
- Gabriele Piffaretti
- Vascular Surgery-Department of Medicine and Surgery, ASST Settelaghi University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy
| | - Martin Czerny
- Department of Cardiovascular Surgery, Faculty of Medicine, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany
| | - Vicente Riambau
- Vascular Surgery Division, Cardiovascular Institute, Hospital Clinic University of Barcelona, Barcelona, Spain
| | - Roman Gottardi
- Department of Cardiac Surgery, Paracelsus Medical University, Salzburg, Austria
| | - Thomas Wolfgruber
- Department of Cardiac Surgery, Paracelsus Medical University, Salzburg, Austria.,Department of Radiology, Paracelsus Medical University, Salzburg, Austria
| | - Chris Probst
- Department of Cardiac Surgery, University of Bonn, Bonn, Germany
| | - Peter Matt
- Department of Cardiac Surgery, Herzzentrum Luzern, Luzern, Switzerland
| | - Michele Antonello
- Vascular and Cardiac Surgery-Department of Cardiac, Thoracic and Vascular Sciences, University of Padua School of Medicine, Padua, Italy
| | - Gino Gerosa
- Vascular and Cardiac Surgery-Department of Cardiac, Thoracic and Vascular Sciences, University of Padua School of Medicine, Padua, Italy
| | - Mohamad Hamady
- Interventional Radiology-Department of Surgery and Cancer, St Mary's Hospital Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Federico Fontana
- Interventional Radiology-Department of Medicine and Surgery, ASST Settelaghi University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy
| | - Sandro Ferrarese
- Vascular Surgery-Department of Medicine and Surgery, ASST Settelaghi University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy.,Cardiac Surgery-Department of Medicine and Surgery, ASST Settelaghi University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy
| | - Chiara Lomazzi
- Vascular Surgery, Fondazione IRCCS Cà Granda, Milan, Italy
| | - Viviana Grassi
- Vascular Surgery, Fondazione IRCCS Cà Granda, Milan, Italy
| | | | - Santi Trimarchi
- Vascular Surgery, Fondazione IRCCS Cà Granda, Milan, Italy.,Department of Clinical and Community Sciences, Ospedale Maggiore Policlinico, Milan, Italy
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7
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Shi J, Liu L, Wei X, Ma M. Back-Table Modified Stent-Graft for Endovascular Repair of Ascending Aorta. J Endovasc Ther 2021; 28:888-896. [PMID: 34190632 DOI: 10.1177/15266028211028201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To investigate the effectiveness of modified stent-grafts (SGs) for the management of ascending aortic pathologies. MATERIALS AND METHODS From January 2015 to December 2019, 31 individuals were treated by ascending aortic endovascular repair with a back-table modified SG for acute (n=4) or chronic (n=1) type A aortic dissections, penetrating aortic ulcers (n=18), pseudoaneurysms (n=2), anastomotic fistula (n=1), and endoleaks after thoracic endovascular aortic repair (TEVAR) (n=5). The commercially available thoracic aortic SGs were modified with a fenestration or truncation technique on the back-table according to aortography during the operation. RESULTS The 30-day mortality and aorta-related mortality rates were 12.9% and 6.5%, respectively. There were 2 strokes, 3 respiratory insufficiencies, and 6 endoleaks during hospitalization. During a mean follow-up of 28.8±16.6 months, the overall survival rates at 1 year and 3 years were both 80.6%. Free from adverse event rates at 1 year and 3 years were 88.9% and 84.7%, respectively. There were 2 deaths during follow-up: One patient died of cachexia 1 month after discharge, and the other patient died of acute myocardial infarction 3 months after discharge. One patient with a pseudoaneurysm underwent open ascending aorta replacement 3 months after discharge for a type Ia endoleak. Another patient suffered from cerebellar infarction 17 months after discharge. CONCLUSION The modified SG for endovascular repair of the ascending aorta is a practicable alternative and presents acceptable outcomes in high-risk patients.
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Affiliation(s)
- Juan Shi
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ligang Liu
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiang Wei
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Mingjia Ma
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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8
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Hauck SR, Kupferthaler A, Stelzmüller M, Eilenberg W, Ehrlich M, Neumayer C, Wolf F, Loewe C, Funovics MA. Endovascular Stent-Graft Repair of the Ascending Aorta: Assessment of a Specific Novel Stent-Graft Design in Phantom, Cadaveric, and Clinical Application. Cardiovasc Intervent Radiol 2021; 44:1448-1455. [PMID: 34180002 PMCID: PMC8382630 DOI: 10.1007/s00270-021-02859-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/24/2021] [Indexed: 11/24/2022]
Abstract
Purpose To test a stent-graft specifically designed for the ascending aorta in phantom, cadaver, and clinical application, and to measure deployment accuracy to overcome limitations of existing devices. Methods A stent-graft has been designed with support wires to fixate the apices toward the inner curvature, thereby eliminating the forward movement of the proximal end which can happen with circumferential tip capture systems. The device was deployed in three aortic phantoms, and in four cadavers, deployment precision was measured. Subsequently, the device was implanted in a patient to exclude a pseudoaneurysm originating from the distal anastomosis after ascending aortic replacement. Results The stent-grafts were successfully deployed in all phantoms and cadavers. Deployment accuracy of the proximal end of the stent-graft was within 1 mm proximally and 14 mm distally to the intended landing zone on the inner curvature, and 2–8 mm distal to the intended landing zone on the outer curvature. In clinical application, the pseudoaneurysm could be successfully excluded without complications. Conclusion The novel stent-graft design promises accurate placement in the ascending aorta. The differential deployment of the apices at the inner and outer curvatures allows deployment perpendicular to the aortic axis. Level of Evidence No level of evidence.
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Affiliation(s)
- Sven R Hauck
- Cardiovascular and Interventional Radiology, Department of Bioimaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Alexander Kupferthaler
- Cardiovascular and Interventional Radiology, Department of Bioimaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.,Department of Diagnostic and Interventional Radiology, Ordensklinikum Linz, Linz, Austria
| | - Marlies Stelzmüller
- Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Wolf Eilenberg
- Department of Vascular Surgery, Medical University of Vienna, Vienna, Austria
| | - Marek Ehrlich
- Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Christoph Neumayer
- Department of Vascular Surgery, Medical University of Vienna, Vienna, Austria
| | - Florian Wolf
- Cardiovascular and Interventional Radiology, Department of Bioimaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Christian Loewe
- Cardiovascular and Interventional Radiology, Department of Bioimaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Martin A Funovics
- Cardiovascular and Interventional Radiology, Department of Bioimaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.
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9
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Gottardi R, Buchholz S, Hegazy Y, Sodian R. Treatment of a massive pseudoaneurysm originating from the ascending aorta with an off-the-shelf stent graft. Eur J Cardiothorac Surg 2021; 60:1234-1236. [PMID: 34113958 DOI: 10.1093/ejcts/ezab276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/16/2021] [Accepted: 05/02/2021] [Indexed: 11/14/2022] Open
Abstract
A 73-year-old patient who underwent an emergency coronary bypass surgery in our institution and who required postoperative extracorporeal membrane oxygenation support in December 2019 presented in August 2020 with a rapidly growing subxiphoidal, pulsating swelling. A computed tomography scan revealed a massive mediastinal pseudoaneurysm originating from an 8-mm Dacron graft that was sutured to the ascending aorta during the index surgery for arterial extracorporeal membrane oxygenation cannulation. Due to the location and extent of the pseudoaneurysm, an open surgical revision was deemed high risk. Because no bypass conduit originated from the ascending aorta, we decided to occlude the entry of the pseudoaneurysm with a stent graft. Also, urgency did not allow for the manufacturing of a custom-made device, so an off-the-shelf stent graft had to be implanted. Currently, the only off-the-shelf thoracic stent graft with a length suitable for the ascending aorta (<7 cm) is the Medtronic Valiant Navion prosthesis, of which 2 prostheses (37 mm × 52 mm; covered seal) were successfully implanted to exclude the pseudoaneurysm. A follow-up computed tomography scan performed 4 months postoperatively showed no perfusion and regression of the pseudoaneurysm. With the growing number of reports describing stent graft placement in the ascending aorta, more off-the-shelf stent grafts suitable for the ascending aorta are desirable.
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Affiliation(s)
- Roman Gottardi
- Department of Cardiovascular and Thoracic Surgery, MediClin Heart Institute Lahr/Baden, Lahr, Germany.,Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Stefan Buchholz
- Department of Cardiovascular and Thoracic Surgery, MediClin Heart Institute Lahr/Baden, Lahr, Germany
| | - Yasser Hegazy
- Department of Cardiovascular and Thoracic Surgery, MediClin Heart Institute Lahr/Baden, Lahr, Germany
| | - Ralf Sodian
- Department of Cardiovascular and Thoracic Surgery, MediClin Heart Institute Lahr/Baden, Lahr, Germany
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10
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Post-operative Recurrent Ascending Aortic Pseudoaneurysm with Aorto-cutaneous Fistula- Endovascular management with an In-situ Stent-Graft Fenestration for the Innominate Artery. Ann Vasc Surg 2021; 75:534.e5-534.e9. [PMID: 33951525 DOI: 10.1016/j.avsg.2021.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 02/22/2021] [Accepted: 04/04/2021] [Indexed: 11/21/2022]
Abstract
Ascending aortic pseudoaneurysm is a known complication of previous cardiac surgery that needs surgical or endovascular intervention. The presence of arch branches complicates the later approach necessitating additional procedures, either hybrid surgical or endovascular modification of the grafts. We describe a patient who developed an ascending aortic pseudoaneurysm after mitral valve replacement, which recurred after surgical patch closure with the formation of a cutaneous fistula. This high-risk patient was managed by an endovascular approach with in-situ fenestration for the innominate artery by a simple technique.
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11
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Grewal A, Odonkor P, Ghoreishi M, Deshpande SP. Anesthetic Considerations in Endovascular Repair of the Ascending Aorta. J Cardiothorac Vasc Anesth 2021; 35:3085-3097. [PMID: 34059437 DOI: 10.1053/j.jvca.2021.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 04/10/2021] [Accepted: 04/14/2021] [Indexed: 11/11/2022]
Abstract
Since the first endovascular aortic repair in 1990, endovascular devices and the indications for their use have significantly grown. Considerable progress has been made in endovascular devices and techniques, such that endovascular repair is now considered first-line treatment for patients with descending aortic disease. However, for patients with ascending aortic disease, open surgical repair with cardiopulmonary bypass and hypothermic cardiac arrest was the only option until recently. Although the outcomes for open surgical repair of the ascending aorta have improved over the years, approximately 30% of patients with an emergent surgical indication, such as type A aortic dissection, are considered to be too high risk for open repair. For these patients, endovascular repair of the ascending aorta offers a life-saving procedure. The ascending aorta is regarded as the final frontier for endovascular therapy. Endovascular repair of it has posed a formidable challenge thus far, due to its unique anatomy, hemodynamic forces, and lack of an appropriate stent-graft designed specifically for the ascending aorta. Although currently there are no comprehensive data from randomized clinical trials, there are several case series and case reports that have shown favorable outcomes. Improvements in available devices soon will drive an exponential increase in the number of patients undergoing endovascular ascending aortic repair. In this review, the authors discuss multiple aspects of endovascular ascending aortic repair including the unique surgical and anesthetic considerations, the devices used, and the available outcomes data, and future directions are also explored.
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Affiliation(s)
- Ashanpreet Grewal
- Department of Anesthesiology, Division of Cardiothoracic Anesthesiology, University of Maryland School of Medicine, Baltimore, MD.
| | - Patrick Odonkor
- Department of Anesthesiology, Division of Cardiothoracic Anesthesiology, University of Maryland School of Medicine, Baltimore, MD
| | - Mehrdad Ghoreishi
- Department of Surgery, Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Seema P Deshpande
- Department of Anesthesiology, Division of Cardiothoracic Anesthesiology, University of Maryland School of Medicine, Baltimore, MD
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12
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Eid-Lidt G, Vega Servín S, Farjat Pasos JI, Ramírez Marroquín S, Criales Vera SA, Gaspar Hernández J. Acute Aortic Syndrome of Ascending Thoracic Aorta: Transcarotid Percutaneous Exclusion of a Ruptured Pseudoaneurysm. JACC Case Rep 2020; 2:2414-2418. [PMID: 34317184 PMCID: PMC8305088 DOI: 10.1016/j.jaccas.2020.09.059] [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: 06/18/2020] [Revised: 08/09/2020] [Accepted: 09/04/2020] [Indexed: 11/16/2022]
Abstract
Treatment of ascending aorta disease is surgical; however, some series have evaluated the effectiveness of endovascular treatment. We report the case of a patient with a ruptured pseudoaneurysm who underwent endovascular repair via the left common carotid artery. The clinical and neurological evolution was satisfactory during the in-hospital follow-up. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Guering Eid-Lidt
- Department of Interventional Cardiology, Ignacio Chavez National Institute of Cardiology, Mexico City, Mexico
| | - Said Vega Servín
- Department of Interventional Cardiology, Ignacio Chavez National Institute of Cardiology, Mexico City, Mexico
| | - Julio Iván Farjat Pasos
- Department of Interventional Cardiology, Ignacio Chavez National Institute of Cardiology, Mexico City, Mexico
| | - Samuel Ramírez Marroquín
- Department of Cardiovascular Surgery, Ignacio Chavez National Institute of Cardiology, Mexico City, Mexico
| | | | - Jorge Gaspar Hernández
- Department of Interventional Cardiology, Ignacio Chavez National Institute of Cardiology, Mexico City, Mexico
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13
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Fatal hemoptysis from coil migration after endovascular coil embolization of a pseudoaneurysm years after anterior thoracolumbar scoliosis correction despite the acceptable original position of the screw: An autopsy case report. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2020.100775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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14
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Trimarchi S, Grassi V, Lomazzi C, Domanin M, Bissacco D, Bellosta R, Piffaretti G. Endovascular type A aortic repair-When? J Card Surg 2020; 36:1742-1744. [PMID: 33029800 DOI: 10.1111/jocs.15103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/10/2020] [Accepted: 09/24/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Santi Trimarchi
- Department of Surgery, Vascular Surgery, Ospedale Maggiore Policlinico, Fondazione IRCCS Cà Granda, Milan, Italy.,Department of Clinical and Community Sciences, University of Milan School of Medicine, Milan, Italy
| | - Viviana Grassi
- Department of Surgery, Vascular Surgery, Ospedale Maggiore Policlinico, Fondazione IRCCS Cà Granda, Milan, Italy
| | - Chiara Lomazzi
- Department of Surgery, Vascular Surgery, Ospedale Maggiore Policlinico, Fondazione IRCCS Cà Granda, Milan, Italy
| | - Maurizio Domanin
- Department of Surgery, Vascular Surgery, Ospedale Maggiore Policlinico, Fondazione IRCCS Cà Granda, Milan, Italy.,Department of Clinical and Community Sciences, University of Milan School of Medicine, Milan, Italy
| | - Daniele Bissacco
- Department of Surgery, Vascular Surgery, Ospedale Maggiore Policlinico, Fondazione IRCCS Cà Granda, Milan, Italy
| | - Raffaello Bellosta
- Vascular Surgery, Cardiovascular Department, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Gabriele Piffaretti
- Vascular Surgery, Department of Medicine and Surgery, ASST Settelaghi University Teaching Hospital, University of Insubria School of Medicine, Varese, Italy
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15
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Wang C, Regar E, Lachat M, von Segesser LK, Maisano F, Ferrari E. Endovascular treatment of non-dissected ascending aorta disease: a systematic review. Eur J Cardiothorac Surg 2019; 53:317-324. [PMID: 28958041 DOI: 10.1093/ejcts/ezx308] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 07/19/2017] [Accepted: 07/30/2017] [Indexed: 12/20/2022] Open
Abstract
Severe ascending aorta disease includes aneurysms, pseudoaneurysms (ascending aorta pseudoaneurysms), penetrating aortic ulcers and Type A aortic dissections. Surgical replacement of the aortic root, ascending aorta or aortic arch is the common treatment for severe ascending aortic disease involving the root, the ascending aorta and/or the arch. Despite good surgical results, there is still a risk for morbidity and mortality following surgery for ascending aorta replacement when elderly patients or patients at high risk for surgery are concerned. Less invasive endovascular treatments for ascending aorta repair are under evaluation, and some reports appeared in the available literature in the last decade. However, clinical series or randomized studies are not yet available, and the use of these techniques is still questionable. In this study, we analysed the outcomes of reported cases of endovascular treatment for ascending aorta disease, excluding Type A aortic dissection. We reviewed reports published until February 2017, and we evaluated the employed technology, the devices, the procedural steps and the outcomes. A total of 26 articles reported 67 patients (mean age 65 ± 17 years) who received endovascular treatment for ascending aorta disease: aneurysms, ascending aorta pseudoaneurysms, penetrating aortic ulcers, intramural haematoma, thrombosis, iatrogenic coarctation and aortic rupture. Complications included endoleak (9 cases), stroke (3 cases), non-ST-elevation myocardial infarction (1 case) and splenic infarction (1 case). Three patients required conversion to open surgery, and 1 patient underwent endovascular reintervention. Early mortality was 2.9%. As an alternative treatment for ascending aorta disease in selected high-risk patients, the endovascular repair will gain popularity, but further analysis is required.
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Affiliation(s)
- Changtian Wang
- Department of Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland.,Department of Cardiovascular Surgery, Nanjing Jinling Hospital, Nanjing, China
| | - Evelyn Regar
- Department of Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - Mario Lachat
- Department of Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - Ludwig K von Segesser
- Department of Surgery and Anesthesiology, Cardiovascular Research Unit, University Hospital of Lausanne, Lausanne, Switzerland
| | - Francesco Maisano
- Department of Cardiovascular Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - Enrico Ferrari
- Department of Cardiovascular Surgery, Cardiocentro Ticino Foundation, Lugano, Switzerland
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16
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Skripochnik E, Ford B, Bilfinger TV, Weinstein JB, Tassiopoulos AK, Loh SA. Endovascular Repair of the Ascending Aorta for an Anastomotic Saphenous Vein Graft Aneurysm. Ann Vasc Surg 2019; 64:412.e1-412.e5. [PMID: 31669481 DOI: 10.1016/j.avsg.2019.10.058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/26/2019] [Accepted: 10/09/2019] [Indexed: 11/29/2022]
Abstract
The ascending aorta is the final segment of the aorta to be explored with endovascular stent grafts. With a patient population of increasingly advanced age and disease, there are situations where traditional open repair for ascending aneurysms or dissections may be prohibitive. However, the ascending aorta has multiple hostile characteristics that make endovascular treatment challenging. There is also a lack of approved specialized devices in the United States for this aortic territory. We demonstrate the feasibility of adapting an abdominal aortic graft to the ascending aorta for the treatment of a saphenous vein graft aneurysm with a discussion of the technical considerations for the operation.
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Affiliation(s)
- Edvard Skripochnik
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stony Brook Medicine, Stony Brook, NY; Division of Cardiothoracic Surgery, Department of Surgery, Stony Brook Medicine, Stony Brook, NY; Division of Cardiology, Department of Medicine, Stony Brook Medicine, Stony Brook, NY.
| | - Benjamin Ford
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stony Brook Medicine, Stony Brook, NY; Division of Cardiothoracic Surgery, Department of Surgery, Stony Brook Medicine, Stony Brook, NY; Division of Cardiology, Department of Medicine, Stony Brook Medicine, Stony Brook, NY
| | - Thomas V Bilfinger
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stony Brook Medicine, Stony Brook, NY; Division of Cardiothoracic Surgery, Department of Surgery, Stony Brook Medicine, Stony Brook, NY; Division of Cardiology, Department of Medicine, Stony Brook Medicine, Stony Brook, NY
| | - Jonathan B Weinstein
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stony Brook Medicine, Stony Brook, NY; Division of Cardiothoracic Surgery, Department of Surgery, Stony Brook Medicine, Stony Brook, NY; Division of Cardiology, Department of Medicine, Stony Brook Medicine, Stony Brook, NY
| | - Apostolos K Tassiopoulos
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stony Brook Medicine, Stony Brook, NY; Division of Cardiothoracic Surgery, Department of Surgery, Stony Brook Medicine, Stony Brook, NY; Division of Cardiology, Department of Medicine, Stony Brook Medicine, Stony Brook, NY
| | - Shang A Loh
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stony Brook Medicine, Stony Brook, NY; Division of Cardiothoracic Surgery, Department of Surgery, Stony Brook Medicine, Stony Brook, NY; Division of Cardiology, Department of Medicine, Stony Brook Medicine, Stony Brook, NY
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17
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Piffaretti G, Grassi V, Lomazzi C, Brinkman WT, Navarro TP, Jenkins MP, Trimarchi S, Bernardes RC, Procopio RJ, Schneider JE, AbuRahma AF, Kaufman JA, Pearce BJ. Thoracic endovascular stent graft repair for ascending aortic diseases. J Vasc Surg 2019; 70:1384-1389.e1. [DOI: 10.1016/j.jvs.2019.01.075] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 01/11/2019] [Indexed: 12/29/2022]
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18
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Primary Endovascular Repair of the Ascending Aorta. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018; 13:448-450. [PMID: 30540589 DOI: 10.1097/imi.0000000000000561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Different case series have been published demonstrating the feasibility of endovascular repair of the ascending aorta in selected patients deemed unfit for open surgery. However, the use of commercially available stent graft in the ascending aorta remains off-label, and their excessive length often prevents their deployment in the ascending aorta. Here we report a case of successful primary endovascular repair of the ascending aorta using a physician modified off-the-shelf device.
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19
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Burdess A, Mani K, Tegler G, Wanhainen A. Stent-graft induced new entry tears after type B aortic dissection: how to treat and how to prevent? THE JOURNAL OF CARDIOVASCULAR SURGERY 2018; 59:789-796. [DOI: 10.23736/s0021-9509.18.10570-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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20
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Khoynezhad A, White RA. Regarding "A systematic review of primary endovascular repair of the ascending aorta". J Vasc Surg 2018; 68:658. [PMID: 30037684 DOI: 10.1016/j.jvs.2018.01.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 01/18/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Ali Khoynezhad
- Department of Cardiovascular Surgery, MemorialCare Heart and Vascular Institute, Los Angeles, Calif
| | - Rod A White
- Department of Cardiovascular Surgery, MemorialCare Heart and Vascular Institute, Los Angeles, Calif
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21
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Plichta RP, Hughes GC. Thoracic endovascular aortic repair for the ascending aorta: experience and pitfalls. J Vis Surg 2018; 4:92. [PMID: 29963381 DOI: 10.21037/jovs.2018.03.01] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 02/09/2018] [Indexed: 11/06/2022]
Abstract
Thoracic endovascular aortic repair (TEVAR) of the ascending aorta is a developing alternative treatment strategy, which currently is specifically aimed at patients who are too high risk for open surgery. TEVAR has been applied to patients with a variety of pathologies of the ascending aorta including type A dissection, intramural hematoma (IMH), penetrating ulcers, aneurysm and pseudoaneurysm. Here we discuss the current evidence regarding the use of TEVAR for the ascending aorta as well as the latest techniques and pitfalls of the procedure. The challenges of this modality are considerable, and the techniques that have been applied draw from the many facets of endovascular experience. There is limited literature regarding the use of stent grafts in the ascending aorta, and the pool of patients currently considered appropriate candidates for the procedure is small. This is an evolving intervention that warrants further study and the development of devices specifically engineered to meet the anatomical and physiologic challenges of the ascending aorta.
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Affiliation(s)
- Ryan P Plichta
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - G Chad Hughes
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
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22
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Kreibich M, Rylski B, Kondov S, Morlock J, Scheumann J, Kari FA, Schröfel H, Siepe M, Beyersdorf F, Czerny M. Endovascular treatment of acute Type A aortic dissection-the Endo Bentall approach. J Vis Surg 2018; 4:69. [PMID: 29780715 DOI: 10.21037/jovs.2018.03.14] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 03/12/2018] [Indexed: 01/04/2023]
Abstract
Outcome after classical surgical repair of acute Type A aortic dissection has steadily improved over the years and several modifications in cannulation and perfusion added to this achievement. However, subgroups remain where results of classical surgical repair still have room for improvement, particularly patients with severe preoperative malperfusion as well as elderly patients with a limited physiological reserve. So far, only small case series or case reports have been published on the endovascular treatment of dissected ascending aortas. However, a tube alone is not sufficient to fix the entire complex underlying problem in the vast majority of patients with acute Type A aortic dissection. In addition, these published reports are either due to a favorable anatomy or due to very localized disease processes, which are the exception and not the rule. The concept of an endovascular valve-carrying conduit may significantly increase the number of patients suitable for endovascular therapy and it may soon be common practice.
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Affiliation(s)
- Maximilian Kreibich
- Department of Cardiovascular Surgery, Heart Center University Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bartosz Rylski
- Department of Cardiovascular Surgery, Heart Center University Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Stoyan Kondov
- Department of Cardiovascular Surgery, Heart Center University Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Julia Morlock
- Department of Cardiovascular Surgery, Heart Center University Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Johannes Scheumann
- Department of Cardiovascular Surgery, Heart Center University Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Fabian A Kari
- Department of Cardiovascular Surgery, Heart Center University Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Holger Schröfel
- Department of Cardiovascular Surgery, Heart Center University Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthias Siepe
- Department of Cardiovascular Surgery, Heart Center University Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, Heart Center University Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Martin Czerny
- Department of Cardiovascular Surgery, Heart Center University Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
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23
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Lader JM, Smith DE, Staniloae C, Fallahi A, Iqbal SN, Galloway AC, Williams MR. Ascending Aortic Stenting for Acute Supraaortic Stenosis From Graft Collapse. Ann Thorac Surg 2018; 105:e243-e245. [PMID: 29428837 DOI: 10.1016/j.athoracsur.2018.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 01/06/2018] [Indexed: 11/16/2022]
Abstract
A 78-year-old man with remote type-A dissection presented with acute-onset dyspnea. Twenty-two years prior, treatment for his aortic disease required replacement of ascending and arch aneurysms with a polyester graft (Dacron) using the graft inclusion technique. He presented currently in cardiogenic shock. Echocardiography demonstrated new severe hypokinesis of all apical segments. Left-heart catheterization revealed a 120 mm Hg intragraft gradient. Computed tomography arteriography was unrevealing, but intraaortic ultrasound demonstrated critical intragraft stenosis. A balloon expandable stent (Palmaz stent, Cordis, Milpitas, CA) was deployed in the stenotic region with gradient resolution. The patient later underwent aortic root replacement and ascending aneurysm repair (Bio-Bentall technique) and is doing well at 24 months.
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Affiliation(s)
- Joshua M Lader
- Department of Medicine, New York University School of Medicine, New York, New York.
| | - Deane E Smith
- Department of Medicine, New York University School of Medicine, New York, New York
| | - Cezar Staniloae
- Department of Medicine, New York University School of Medicine, New York, New York
| | - Arzhang Fallahi
- Department of Medicine, New York University School of Medicine, New York, New York
| | - Sohah N Iqbal
- Department of Medicine, New York University School of Medicine, New York, New York
| | - Aubrey C Galloway
- Department of Cardiothoracic Surgery, New York University School of Medicine, New York, New York
| | - Mathew R Williams
- Department of Cardiothoracic Surgery, New York University School of Medicine, New York, New York
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24
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Henley MD, Farber MA, Ikonomidis JS, Kolarczyk LM, Teeter EG, Barrick BP, Caranasos TG, Martinelli SM. A Tale of Three Surgeries: Management of a Massive Recurrent Mycotic Aortic Pseudoaneurysm. J Cardiothorac Vasc Anesth 2017; 32:550-557. [PMID: 29126684 DOI: 10.1053/j.jvca.2017.08.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Megan D Henley
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Mark A Farber
- Department of Surgery, Division of Vascular Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - John S Ikonomidis
- Department of Surgery, Division of Cardiothoracic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Lavinia M Kolarczyk
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Emily G Teeter
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Brian P Barrick
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Thomas G Caranasos
- Department of Surgery, Division of Cardiothoracic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Susan M Martinelli
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
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25
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Baikoussis NG, Antonopoulos CN, Papakonstantinou NA, Argiriou M, Geroulakos G. Endovascular stent grafting for ascending aorta diseases. J Vasc Surg 2017; 66:1587-1601. [DOI: 10.1016/j.jvs.2017.07.064] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 07/11/2017] [Indexed: 01/03/2023]
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26
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Nauta FJH, de Beaufort HWL, Conti M, Marconi S, Kamman AV, Ferrara A, van Herwaarden JA, Moll FL, Auricchio F, Trimarchi S. Impact of thoracic endovascular aortic repair on radial strain in an ex vivo porcine model. Eur J Cardiothorac Surg 2017; 51:783-789. [PMID: 28043989 DOI: 10.1093/ejcts/ezw393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 11/01/2016] [Indexed: 11/14/2022] Open
Abstract
Objectives To quantify the impact of thoracic endovascular aortic repair (TEVAR) on radial aortic strain with the aim of elucidating stent-graft-induced stiffening and complications. Methods Twenty fresh thoracic porcine aortas were connected to a mock circulatory loop driven by a centrifugal flow pump. A high-definition camera captured diameters at five different pressure levels (100, 120, 140, 160, and 180 mmHg), before and after TEVAR. Three oversizing groups were created: 0-9% ( n = 7), 10-19% ( n = 6), and 20-29% ( n = 6). Radial strain (or deformation) derived from diameter amplitude divided by baseline diameter at 100 mmHg. Uniaxial tensile testing evaluated Young's moduli of the specimens. Results Radial strain was reduced after TEVAR within the stented segment by 49.4 ± 24.0% ( P < 0.001). As result, a strain mismatch was observed between the stented segment and the proximal non-stented segment (7.0 ± 2.5% vs 11.8 ± 3.9%, P < 0.001), whereas the distal non-stented segment was unaffected ( P = 0.99). Stent-graft oversizing did not significantly affect the amount of strain reduction ( P = 0.30). Tensile testing showed that the thoracic aortas tended to be more elastic proximally than distally ( P = 0.11). Conclusions TEVAR stiffened the thoracic aorta by 2-fold. Such segmental stiffening may diminish the Windkessel function considerably and might be associated with TEVAR-related complications, including stent-graft-induced dissection and aneurysmal dilatation. These data may have implications for future stent-graft design, in particular for TEVAR of the highly compliant proximal thoracic aorta.
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Affiliation(s)
- Foeke J H Nauta
- Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Italy.,Department of Vascular Surgery, University Medical Center Utrecht, The Netherlands
| | - Hector W L de Beaufort
- Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Italy.,Department of Vascular Surgery, University Medical Center Utrecht, The Netherlands
| | - Michele Conti
- Department of Civil Engineering and Architecture, Beta-lab, University of Pavia, Italy
| | - Stefania Marconi
- Department of Civil Engineering and Architecture, Beta-lab, University of Pavia, Italy
| | - Arnoud V Kamman
- Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Italy.,Department of Vascular Surgery, University Medical Center Utrecht, The Netherlands
| | - Anna Ferrara
- Department of Civil Engineering and Architecture, Beta-lab, University of Pavia, Italy
| | | | - Frans L Moll
- Department of Vascular Surgery, University Medical Center Utrecht, The Netherlands
| | - Ferdinando Auricchio
- Department of Civil Engineering and Architecture, Beta-lab, University of Pavia, Italy
| | - Santi Trimarchi
- Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Italy
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27
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de Beaufort H, Nauta F, Conti M, Cellitti E, Trentin C, Faggiano E, van Bogerijen G, Figueroa C, Moll F, van Herwaarden J, Auricchio F, Trimarchi S. Extensibility and Distensibility of the Thoracic Aorta in Patients with Aneurysm. Eur J Vasc Endovasc Surg 2017; 53:199-205. [DOI: 10.1016/j.ejvs.2016.11.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 11/15/2016] [Indexed: 12/31/2022]
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28
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Arnaoutakis GJ, Szeto WY. The future is now: An endovascular option for type A aortic dissection. J Thorac Cardiovasc Surg 2017; 153:S12-S13. [DOI: 10.1016/j.jtcvs.2016.08.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 08/15/2016] [Indexed: 10/21/2022]
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29
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Nauta FJH, Lau KD, Arthurs CJ, Eagle KA, Williams DM, Trimarchi S, Patel HJ, Figueroa CA. Computational Fluid Dynamics and Aortic Thrombus Formation Following Thoracic Endovascular Aortic Repair. Ann Thorac Surg 2017; 103:1914-1921. [PMID: 28063468 DOI: 10.1016/j.athoracsur.2016.09.067] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 08/28/2016] [Accepted: 09/19/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND We present the possible utility of computational fluid dynamics in the assessment of thrombus formation and virtual surgical planning illustrated in a patient with aortic thrombus in a kinked ascending aortic graft following thoracic endovascular aortic repair. METHODS A patient-specific three-dimensional model was built from computed tomography. Additionally, we modeled 3 virtual aortic interventions to assess their effect on thrombosis potential: (1) open surgical repair, (2) conformable endografting, and (3) single-branched endografting. Flow waveforms were extracted from echocardiography and used for the simulations. We used the computational index termed platelet activation potential (PLAP) representing accumulated shear rates of fluid particles within a fluid domain to assess thrombosis potential. RESULTS The baseline model revealed high PLAP in the entire arch (119.8 ± 42.5), with significantly larger PLAP at the thrombus location (125.4 ± 41.2, p < 0.001). Surgical repair showed a 37% PLAP reduction at the thrombus location (78.6 ± 25.3, p < 0.001) and a 24% reduction in the arch (91.6 ± 28.9, p < 0.001). Single-branched endografting reduced PLAP in the thrombus region by 20% (99.7 ± 24.6, p < 0.001) and by 14% in the arch (103.8 ± 26.1, p < 0.001), whereas a more conformable endograft did not have a profound effect, resulting in a modest 4% PLAP increase (130.6 ± 43.7, p < 0.001) in the thrombus region relative to the baseline case. CONCLUSIONS Regions of high PLAP were associated with aortic thrombus. Aortic repair resolved pathologic flow patterns, reducing PLAP. Branched endografting also relieved complex flow patterns reducing PLAP. Computational fluid dynamics may assist in the prediction of aortic thrombus formation in hemodynamically complex cases and help guide repair strategies.
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Affiliation(s)
- Foeke J H Nauta
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA; Thoracic Aortic Research Center, Vascular Surgery, Policlinico San Donato IRCCS, University of Milan, Italy
| | - Kevin D Lau
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Christopher J Arthurs
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom
| | - Kim A Eagle
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - David M Williams
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Santi Trimarchi
- Thoracic Aortic Research Center, Vascular Surgery, Policlinico San Donato IRCCS, University of Milan, Italy
| | - Himanshu J Patel
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Carlos A Figueroa
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA; Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA.
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30
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Dake MD. On the Endovascular Climb to the Type A Dissection Summit, Reaching a New Base Camp ∗. J Am Coll Cardiol 2016; 68:1955-1957. [DOI: 10.1016/j.jacc.2016.07.772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 07/20/2016] [Indexed: 10/20/2022]
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31
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Kubota H. Endovascular stent graft repair of the ascending aorta-final frontier in the endovascular treatment of the aorta. J Thorac Dis 2016; 8:E1358-E1360. [PMID: 27867627 PMCID: PMC5107519 DOI: 10.21037/jtd.2016.10.04] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 08/15/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Hiroshi Kubota
- Department of Cardiovascular Surgery, Kyorin University, Tokyo, Japan
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32
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Klonaris C, Georgopoulos S, Katsargyris A. Endovascular treatment of the ascending aorta: new frontiers for thoracic endovascular aneurysm repair? J Thorac Dis 2016; 8:1901-3. [PMID: 27618954 DOI: 10.21037/jtd.2016.07.35] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Chris Klonaris
- 1st Department of Surgery, Vascular Division, LAIKO Hospital, Athens University Medical School, Athens, Greece
| | - Sotirios Georgopoulos
- 1st Department of Surgery, Vascular Division, LAIKO Hospital, Athens University Medical School, Athens, Greece
| | - Athanasios Katsargyris
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University, Nuremberg, Germany
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33
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Kotelis D, Kalder J, Jacobs MJ. Endovascular repair of the ascending aorta: the last frontier? J Thorac Dis 2016; 8:E825-6. [PMID: 27618839 DOI: 10.21037/jtd.2016.07.49] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Drosos Kotelis
- European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Johannes Kalder
- European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Michael J Jacobs
- European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, University Hospital RWTH Aachen, Aachen, Germany;; European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
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Arnaoutakis GJ, Szeto WY. Endovascular approaches to the ascending aorta are right around the corner. J Thorac Cardiovasc Surg 2016; 152:285-6. [DOI: 10.1016/j.jtcvs.2016.03.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 03/08/2016] [Indexed: 11/28/2022]
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Howell E, Sweet MP, Pal JD. Transapical Endovascular Repair of an Ascending Aortic Pseudoaneurysm. J Card Surg 2016; 31:456-60. [DOI: 10.1111/jocs.12766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Eric Howell
- Division of Cardiothoracic SurgeryDepartment of SurgeryUniversity of WashingtonSeattleWashington
| | - Matthew P. Sweet
- Division of Vascular SurgeryDepartment of SurgeryUniversity of WashingtonSeattleWashington
| | - Jay D. Pal
- Division of Cardiothoracic SurgeryDepartment of SurgeryUniversity of WashingtonSeattleWashington
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Andersen ND. Isolated ascending aorta endografting: Another brush for the aortic reconstruction artist. J Thorac Cardiovasc Surg 2016; 151:1615-6. [PMID: 27021158 DOI: 10.1016/j.jtcvs.2016.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 03/04/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Nicholas D Andersen
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.
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