1
|
Norman AV, Smolkin ME, Farivar BS, Tracci MC, Weaver ML, Kern JA, Ratcliffe SJ, Clouse WD. Current Transthoracic Supra-Aortic Trunk Surgical Reconstruction Has Similar 30-Day Cardiovascular Outcomes Compared to Extra-Anatomic Revascularization but With Higher Morbidity Burden. Ann Vasc Surg 2024; 100:155-164. [PMID: 37852366 DOI: 10.1016/j.avsg.2023.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Operative risk for supra-aortic trunk (SAT) surgical revascularization for occlusive disease, particularly transthoracic reconstruction (TR), remains ill-defined. This study sought to describe and compare 30-day outcomes of TR and extra-anatomic (ER) SAT surgical reconstruction for an occlusive indication across the United States over a contemporary 15-year period. METHODS Using the National Surgical Quality Improvement Program, TR and ER performed during 2005-2019 were identified. Procedures performed for nonocclusive indications and those concomitant with coronary or valve operations were excluded. Rates of stroke, death, myocardial infarction (MI) and these as composite outcome (S/D/M) were compared. Logistic regression with stabilized inverse probability weighting (IPW) was used to compare groups via average treatment effect (ATE) while adjusting for covariate imbalances. RESULTS Over the 15-year period, 166 TR and 1,900 ER patients were identified. The majority of ERs were carotid-subclavian bypass (n = 1,344; 70.7%) followed by carotid-carotid bypass (n = 261; 13.7%) and subclavian/carotid transpositions (n = 123; 6.5%). TR consisted of aorto-SAT bypass (n = 120; 72.3%) and endarterectomy (n = 46; 27.7%). The median age was 64 years for TR and 65 years in ER (P = 0.039). Those undergoing TR were more often women (69.0% vs. 56.9%; P = 0.001) and less likely to have undergone previous cardiac surgery (9.2% vs. 20.8%; P = 0.006). TR were also less frequently hypertensive (68.1% vs. 75.4%; P = 0.038) and had statistically lower preoperative creatinine levels (0.86 vs 0.91; P = 0.002). Unadjusted rates of MI (0.6% vs. 1.3%; P = 0.72) and stroke (3.6% vs. 1.9%; P = 0.15) were similar between groups with mortality (3.6% vs. 1.5%; P = 0.05) and S/D/M (6.6% vs. 3.9%; P = 0.10) trending higher with TR. IPWs could be calculated for 1,754 patients (148 TR; 1,606 ER). The estimated probability of S/D/M was 3.8% in the ER group and 6.2% in TR; no difference was seen in ATE (2.4%; 95% confidence interval [CI]: -1.5 to 6.2; P = 0.23). No differences were seen in individual component ATEs (stroke: 3.0% vs. 1.7%; ATE = 1.3%; 95% CI: -3.9 to 1.3; P = 0.32; mortality: 3.8% vs. 1.4%; ATE = 2.4%; 95% CI: -5.6 to 0.7; P = 0.13). Secondary outcomes showed TR patients were more likely to have non-home discharge (18.7% vs. 6.6%; ATE = 12.1%; 95% CI: 5.0-19.2; P < 0.001) and longer lengths of stay (6.1 vs. 4.0; ATE = 2.2 days; 95% CI: 0.9-3.4; P < 0.001). Moreover, TR patients were more likely to require transfusion (22.7% vs. 5.0%; ATE = 17.7%; 95% CI: 10.2-25.2; P < 0.001) and develop sepsis (2.7% vs. 0.2%; ATE = 2.5%; 95% CI: 0.1-5.0; P = 0.04). CONCLUSIONS Transthoracic and extra-anatomic surgical reconstruction of the SATs for occlusive disease have similar operative cardiovascular risk. However, morbidity tends to be higher with TR due to higher transfusion requirements, sepsis risk, and need for facility stay. These results suggest ER as a first-line approach in those with proper disease anatomy is reasonable with lower morbidity, while TR remains justified in appropriate patients.
Collapse
Affiliation(s)
- Anthony V Norman
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, VA
| | - Mark E Smolkin
- Division of Biostatistics, Department of Public Health Sciences, Old Med School, University of Virginia, Charlottesville, VA
| | - Behzad S Farivar
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, VA
| | - Margaret C Tracci
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, VA
| | - M Libby Weaver
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, VA
| | - John A Kern
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, VA
| | - Sarah J Ratcliffe
- Division of Biostatistics, Department of Public Health Sciences, Old Med School, University of Virginia, Charlottesville, VA
| | - W Darrin Clouse
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, VA.
| |
Collapse
|
2
|
Wang LJ, Nixon TP, Crofts SC, Latz CA, Goudreau BJ, Conrad MF, Eagleton MJ, Clouse WD. Comparison of 30 Day Stroke and Death in Hybrid Intervention and Open Surgical Reconstruction for the Treatment of Tandem Carotid Bifurcation and Supra-aortic Trunk Disease. Eur J Vasc Endovasc Surg 2021; 61:83-88. [DOI: 10.1016/j.ejvs.2020.08.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 08/18/2020] [Accepted: 08/27/2020] [Indexed: 11/29/2022]
|
3
|
Chong JH, Harky A, Badran A, Panagiotopoulos N, Odurny A, Philips M, Livesey S, Pousios D. Aorto-innominate artery bypass for migrated stent. J Card Surg 2020; 36:312-314. [PMID: 33032362 DOI: 10.1111/jocs.15092] [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: 06/20/2020] [Revised: 08/05/2020] [Accepted: 09/22/2020] [Indexed: 11/28/2022]
Abstract
We report a case of a 64-year-old female who first presented with a transient ischemic attack in 2007 due to an innominate artery stenosis, which indicated an endovascular stent placement. In 2008, she presented with recurrence of symptoms and was diagnosed with in-stent restenosis alongside an unusual occurrence of retrograde migration into the ascending aortic arch. We performed an aorto-innominate bypass through a median sternotomy. The patient was discharged without any complications thereafter, and the graft has shown excellent patency. As of 2019, the patient remains well.
Collapse
Affiliation(s)
- Jun Heng Chong
- GKT School of Medical Education, King's College London, London, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.,Liverpool Center for Cardiovascular Science, Liverpool Heart and Chest Hospital, University of Liverpool, Liverpool, UK
| | - Abdul Badran
- Department Cardiothoracic Surgery, Southampton General Hospital, Southampton, UK
| | | | - Allan Odurny
- Department of Interventional Radiology, Southampton General Hospital, Southampton, UK
| | - Michael Philips
- Department of Vascular Surgery, Southampton General Hospital, Southampton, UK
| | - Steven Livesey
- Department Cardiothoracic Surgery, Southampton General Hospital, Southampton, UK
| | - Dimitrios Pousios
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.,Department Cardiothoracic Surgery, Southampton General Hospital, Southampton, UK
| |
Collapse
|
4
|
Vértes M, Nguyen DT, Székely G, Bérczi Á, Dósa E. Middle and Distal Common Carotid Artery Stenting: Long-Term Patency Rates and Risk Factors for In-Stent Restenosis. Cardiovasc Intervent Radiol 2020; 43:1134-1142. [PMID: 32440962 PMCID: PMC7369259 DOI: 10.1007/s00270-020-02522-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 05/09/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE In the absence of literature data, we aimed to determine the long-term patency rates of middle/distal common carotid artery (CCA) stenting and to investigate predisposing factors in the development of in-stent restenosis (ISR). MATERIALS AND METHODS Fifty-one patients (30 males, median age 63.5 years), who underwent stenting with 51 self-expandable stents for significant (≥ 60%) stenosis of the middle/distal CCA, were analyzed retrospectively. Patient (atherosclerotic risk factors, comorbidities, medications), vessel (elongation), lesion (stenosis grade, length, calcification, location), and stent characteristics (material, diameter, length, fracture) were examined. Duplex ultrasonography was used to monitor stent patency. The Mann-Whitney U and Fisher's exact tests, Kaplan-Meier analyses, and a log-rank test were used statistically. RESULTS The median follow-up time was 35 months (interquartile range, 20-102 months). Significant (≥ 70%) ISR developed in 14 patients (27.5%; stenosis, N = 10; entire CCA occlusion, N = 4). Primary patency rates were 98%, 92%, 83%, 73%, and 61% at 6, 12, 24, 60, and 96 months, respectively. Reintervention was performed in six patients (11.8%) with nonocclusive ISR. Secondary patency rates were 100% at 6 and 12 months and 96% at 24, 60, and 96 months. In-stent restenosis developed more frequently (P < .001) in patients with hyperlipidemia; primary patency rates were also significantly worse (Chi-square, 11.08; degrees of freedom, 1; P < .001) in patients with hyperlipidemia compared to those without. CONCLUSION Stenting of the middle/distal CCA can be performed with acceptable patency rates. If intervention is unequivocally needed, patients with hyperlipidemia will require closer follow-up care. LEVEL OF EVIDENCE Level 3, Local non-random sample.
Collapse
Affiliation(s)
- Miklós Vértes
- Heart and Vascular Center, Semmelweis University, Városmajor Street 68, Budapest, 1122, Hungary
| | - Dat T Nguyen
- Heart and Vascular Center, Semmelweis University, Városmajor Street 68, Budapest, 1122, Hungary
| | - György Székely
- Heart and Vascular Center, Semmelweis University, Városmajor Street 68, Budapest, 1122, Hungary
| | - Ákos Bérczi
- Heart and Vascular Center, Semmelweis University, Városmajor Street 68, Budapest, 1122, Hungary
| | - Edit Dósa
- Heart and Vascular Center, Semmelweis University, Városmajor Street 68, Budapest, 1122, Hungary.
| |
Collapse
|
5
|
Zacharias N, Goodney PP, DeSimone JP, Stone DH, Wanken ZJ, Suckow BD, Columbo JA, Powell RJ. Outcomes of Innominate Artery Revascularization Through Endovascular, Hybrid, or Open Approach. Ann Vasc Surg 2020; 69:190-196. [PMID: 32554196 DOI: 10.1016/j.avsg.2020.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/06/2020] [Accepted: 06/09/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Atherosclerotic disease of the innominate artery (IA) is rare and can lead to cerebral, upper extremity, and vertebral steal symptoms. Nonocclusive lesions can be treated with endovascular interventions, often with a hybrid approach while performing a right carotid endarterectomy (RCEA). Calcified IA lesions have a high risk of embolization to bilateral cerebral hemispheres. Occlusive lesions may require treatment through a median sternotomy and bypass. The purpose of our study is to review our short-term and long-term outcomes of IA revascularization. METHODS Our operative database was used to identify patients who underwent IA revascularization between January 1998 and December 2018. Patients who underwent innominate artery stenting (IAS), combined with RCEA and IAS as well as aortoinnominate bypass (AIB), were identified. Our primary end points were freedom from neurologic event, all-cause mortality, and need for reintervention. RESULTS Thirty-three patients (18 females [55%]) who underwent IA revascularization were identified. Average age was 67 ± 8 years, and mean clinical follow-up was 51 ± 21 months. Most patients (30 [91%]) were on a statin and antiplatelet therapy. Twenty-one patients (64%) were symptomatic. Twelve patients (36%) were asymptomatic and underwent combined RCEA with retrograde IAS for critical right carotid stenosis and IA stenosis. Preoperative imaging included a carotid duplex and computed tomography angiography. Eighteen patients (55%) underwent RCEA + IAS, 11 patients (33%) underwent isolated IAS, and 4 patients (12%) underwent AIB. In our attempt to protect bilateral hemispheres during IAS for heavily calcified lesions, we used right common carotid artery (CCA) clamping although open exposure and left CCA embolic protection filter was placed through transfemoral approach. Patients who underwent AIB had chronic heavily calcified IA occlusions or occluded IA stents with failed endovascular interventions. Perioperative stroke rate was 3%, involving 1 patient who developed reperfusion syndrome after RCEA + IAS. Perioperative mortality was 0%. Long-term stroke rate was 0%, and long-term mortality was 15% (5 of 33) because of cardiac disease. Overall restenosis rate was 9%, involving 3 patients who required secondary interventions for IA in-stent restenosis. CONCLUSIONS IA interventions through a hybrid approach or an open approach are safe, with acceptable perioperative stroke and mortality rates. Long-term patency of these interventions is acceptable. Bilateral cerebral embolic protection can be accomplished by clamping the right CCA through an open exposure and placing a filter in the left CCA through a transfemoral approach. Patients undergoing IAS appear to have a higher rate of restenosis compared with AIB, and therefore, close follow-up with noninvasive imaging is recommended.
Collapse
Affiliation(s)
- Nikolaos Zacharias
- Department of Surgery, Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
| | - Philip P Goodney
- Department of Surgery, Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Joseph P DeSimone
- Department of Surgery, Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - David H Stone
- Department of Surgery, Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Zachary J Wanken
- Department of Surgery, Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Bjoern D Suckow
- Department of Surgery, Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Jesse A Columbo
- Department of Surgery, Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Richard J Powell
- Department of Surgery, Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| |
Collapse
|
6
|
Clouse WD, Ergul EA, Wanken ZJ, Kleene J, Stone DH, Darling RC, Cambria RP, Conrad MF. Risk and outcome profile of carotid endarterectomy with proximal intervention is concerning in multi-institutional assessment. J Vasc Surg 2018; 68:760-769. [DOI: 10.1016/j.jvs.2017.12.069] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 12/20/2017] [Indexed: 11/17/2022]
|
7
|
Nakanishi S, Ise H, Ishikawa N, Takeyoshi D, Kobayashi D, Kimura F, Harada H, Kamiya H. Total arch replacement as treatment for repeated cerebral infarctions due to unstable plaque simultaneously in the innominate artery and left subclavian artery: a case report. J Surg Case Rep 2018; 2018:rjy172. [PMID: 30057743 PMCID: PMC6055639 DOI: 10.1093/jscr/rjy172] [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: 04/23/2018] [Accepted: 06/29/2018] [Indexed: 11/12/2022] Open
Abstract
We report a case of total arch replacement in a patient who suffered repeated cerebral infarctions due to unstable plaque simultaneously in the innominate and left subclavian arteries.
Collapse
Affiliation(s)
- Sentaro Nakanishi
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa, Hokkaido, Japan
| | - Hayato Ise
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa, Hokkaido, Japan
| | - Natsuya Ishikawa
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa, Hokkaido, Japan
| | - Daisuke Takeyoshi
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa, Hokkaido, Japan
| | - Daita Kobayashi
- Department of Cardiovascular Surgery, Kojinkai Memorial Hospital, Aikoku 191-212, Kushiro, Hokkaido, Japan
| | - Fumiaki Kimura
- Department of Cardiovascular Surgery, Kojinkai Memorial Hospital, Aikoku 191-212, Kushiro, Hokkaido, Japan
| | - Hideyuki Harada
- Department of Cardiovascular Surgery, Kojinkai Memorial Hospital, Aikoku 191-212, Kushiro, Hokkaido, Japan
| | - Hiroyuki Kamiya
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa, Hokkaido, Japan
| |
Collapse
|
8
|
Results of subclavian to carotid artery bypass for occlusive disease of the common carotid artery: A retrospective cohort study. Int J Surg 2018; 53:111-116. [PMID: 29581047 DOI: 10.1016/j.ijsu.2018.03.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 03/19/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Optimal treatment of significant atherosclerosis of the common carotid artery (CCA) is not well-defined. The purpose of this study was to evaluate the long-term results of prosthetic subclavian to carotid bypass for occlusive disease of the CCA. MATERIAL AND METHODS From January 1994 to December 2015, 45 patients, mean age 67 years, underwent an ipsilateral subclavian to carotid bypass for occlusive disease of the CCA. Thirty-eight patients (84%) presented with neurologic symptoms, including transitory ischemic attacks in 29 cases and minor strokes in 9 cases. The graft material consisted of a 7 mm polytetrafluoroethylene conduit, and the distal anastomosis was done on the carotid bulb in 21 patients, on the internal carotid artery in 19 cases, and on the distal CCA in 5 cases. Median length of follow-up was 58 months. Study endpoints were the combined postoperative stroke/mortality rate, graft infection, overall late survival, freedom from ipsilateral stroke, and graft patency. RESULTS Postoperative stroke/mortality rate was 2%. No graft infection was observed throughout follow-up. At 60 months, overall survival, freedom from stroke, and graft patency were 71% (standard error [SE] = 0.07), 98% (SE = 0.02), and 95.5% (SE = 0.06), respectively. CONCLUSIONS Subclavian to carotid bypass allows very good patency rates and excellent protection from postoperative and late stroke, remaining a benchmark for any other treatment method.
Collapse
|
9
|
Transradial retrograde percutaneous transluminal angioplasty with stenting of long segment occlusion of subclavian artery. J Cardiol Cases 2017; 15:119-121. [DOI: 10.1016/j.jccase.2016.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 11/03/2016] [Accepted: 12/04/2016] [Indexed: 11/22/2022] Open
|
10
|
Lai CH, Tsai CL, Chang WC, Su CS, Lee WL. Iatrogenic Subclavian Artery Perforation Rescued by Operator-Modified Graft Stent. Yonsei Med J 2017; 58:462-466. [PMID: 28120581 PMCID: PMC5290030 DOI: 10.3349/ymj.2017.58.2.462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 12/08/2015] [Accepted: 12/17/2015] [Indexed: 11/27/2022] Open
Abstract
Subclavian artery (SCA) perforation is a rare complication while performing SCA intervention. In our present report, a 73-year-old female, with stenosis of the left SCA and situs inversus, presented with exercise-induced left arm weakness. The SCA stenosis was treated with direct stenting with a balloon-expansible Express LD 10×25 mm stent. However, it caused iatrogenic SCA perforation and hemothorax. The perforation was sealed by endovascular repair with operator-modified Endurant II graft stent, which complicated with occlusion of left common carotid artery. And, the carotid artery was rescued by another stent. The graft stent, which was originally designed for abdominal aortic aneurysm, can be modified to suitable length and take as a rescue stent of large vessel with iatrogenic perforation. Due to strong radial force of graft stent, preservation of large side branches should been watched out.
Collapse
Affiliation(s)
- Chih Hung Lai
- Divisions of Interventional Cardiology and Adult Cardiac Surgery, Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Chung Lin Tsai
- Divisions of Interventional Cardiology and Adult Cardiac Surgery, Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Wei Chun Chang
- Divisions of Interventional Cardiology and Adult Cardiac Surgery, Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Chieh Shou Su
- Divisions of Interventional Cardiology and Adult Cardiac Surgery, Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C
| | - Wen Lieng Lee
- Divisions of Interventional Cardiology and Adult Cardiac Surgery, Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.
| |
Collapse
|
11
|
Retrograde stenting of proximal lesions with carotid endarterectomy increases risk. J Vasc Surg 2016; 63:1517-23. [DOI: 10.1016/j.jvs.2016.01.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 01/13/2016] [Indexed: 11/23/2022]
|
12
|
Ben Ahmed S, Benezit M, Hazart J, Brouat A, Daniel G, Rosset E. Outcomes of the Endovascular Treatment for the Supra-Aortic Trunks Occlusive Disease: A 14-Year Monocentric Experience. Ann Vasc Surg 2016; 33:55-66. [DOI: 10.1016/j.avsg.2016.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 02/14/2016] [Accepted: 02/27/2016] [Indexed: 11/15/2022]
|
13
|
Open Reconstructions for Symptomatic Atherosclerotic Lesions of the Supra-aortic Vessels: Thirty Years Results from Two University Hospitals. Ann Vasc Surg 2015; 29:404-10. [DOI: 10.1016/j.avsg.2014.09.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 09/01/2014] [Accepted: 09/12/2014] [Indexed: 11/22/2022]
|
14
|
Management of atherosclerotic supraaortic lesions. Eur Surg 2014. [DOI: 10.1007/s10353-014-0268-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
15
|
Contemporary comparison of supra-aortic trunk surgical reconstructions for occlusive disease. J Vasc Surg 2014; 59:1577-82, 1582.e1-2. [DOI: 10.1016/j.jvs.2013.12.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 12/06/2013] [Accepted: 12/07/2013] [Indexed: 11/15/2022]
|
16
|
Dayama A, Riesenman PJ, Cheek RA, Kasirajan K. Endovascular Management of Aortic Arch Vessel Occlusion. Vasc Endovascular Surg 2012; 46:273-6. [DOI: 10.1177/1538574411436330] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A 56-year-old female presented with pain in her bilateral upper extremities. Angiogram demonstrated occlusion of her left subclavian and innominate arteries (IAs). The patient’s left subclavian occlusion was successfully treated with percutaneous mechanical thrombectomy, angioplasty, and stenting. One month later, endovascular revascularization of the IA was performed. Initially the lesion could not be directly transversed from neither an antegrade nor a retrograde approach. Wires were passed from the brachial and femoral arteries into the right common carotid artery where the femoral wire was snared and brought out through the right brachial access. Over this through-and-through wire access, angioplasty and stenting of the IA was performed with an excellent angiographic result. In follow-up, the patient remained free of upper extremity symptoms. Occlusive lesions of the aortic arch vessels can be successfully managed with antegrade and retrograde endovascular techniques.
Collapse
Affiliation(s)
- Anand Dayama
- Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, Emory University, Atlanta, GA, USA
| | - Paul J. Riesenman
- Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, Emory University, Atlanta, GA, USA
| | - Rick A. Cheek
- Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, Emory University, Atlanta, GA, USA
| | - Karthikeshwar Kasirajan
- Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, Emory University, Atlanta, GA, USA
| |
Collapse
|
17
|
Takach TJ, Duncan JM, Livesay JJ, Ott DA, Cervera RD, Cooley DA. Contemporary Relevancy of Carotid–Subclavian Bypass Defined by an Experience Spanning Five Decades. Ann Vasc Surg 2011; 25:895-901. [DOI: 10.1016/j.avsg.2011.06.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2011] [Revised: 06/10/2011] [Accepted: 06/14/2011] [Indexed: 10/17/2022]
|
18
|
Proximal Common Carotid Artery Lesions: Endovascular and Open Repair. Eur J Vasc Endovasc Surg 2011; 41:728-34. [DOI: 10.1016/j.ejvs.2011.02.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2010] [Accepted: 02/21/2011] [Indexed: 11/23/2022]
|
19
|
Ochoa VM, Yeghiazarians Y. Subclavian artery stenosis: a review for the vascular medicine practitioner. Vasc Med 2010; 16:29-34. [PMID: 21078767 DOI: 10.1177/1358863x10384174] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Peripheral artery disease assessment typically focuses on the evaluation of lower extremity symptoms and physical findings. Few practitioners consider the importance of upper extremity arterial disease; which, besides causing hand and arm symptoms, can be associated with significant neurologic and cardiac sequelae. A review of the existing literature through PubMed using the search term 'subclavian stenosis' was performed. The latest original articles, including clinical studies, case reports and limited reviews of this topic were adapted. A comprehensive article review focusing on the diagnostic and treatment approach for subclavian stenosis was prepared. In conclusion, vascular medicine practitioners including cardiologists and vascular surgeons caring for patients with arterial disease should routinely assess for subclavian stenosis. There are excellent screening tools and effective medical therapies which can be instituted if diagnosed early. When the need for revascularization arises, percutaneous modalities are favored given their proven long-term efficacy, decreased morbidity and mortality, and cost-effectiveness.
Collapse
Affiliation(s)
- Victor M Ochoa
- Division of Cardiology, University of California San Francisco, San Francisco, CA 94143-0103, USA
| | | |
Collapse
|
20
|
Ryer EJ, Oderich GS. Two-Wire (0.014 & 0.018-Inch) Technique to Facilitate Innominate Artery Stenting Under Embolic Protection. J Endovasc Ther 2010; 17:652-6. [DOI: 10.1583/10-3156.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
21
|
Late Stent Fractures after Endoluminal Treatment of Ostial Supraaortic Trunk Arterial Occlusive Lesions. J Vasc Interv Radiol 2010; 21:1364-9. [DOI: 10.1016/j.jvir.2010.04.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 03/30/2010] [Accepted: 04/29/2010] [Indexed: 11/23/2022] Open
|
22
|
|
23
|
Shah QA, Memon MZ, Tummala RP, Qureshi AI. Combined surgical and endovascular approach to treat symptomatic in-stent occlusion of the left common carotid artery origin. J Neurosurg 2008; 110:935-8. [PMID: 19072307 DOI: 10.3171/2008.9.jns08774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Symptomatic occlusive lesions at the origins of the supra-aortic vessels pose challenges for treatment. Endovascular angioplasty and stent placement via the transfemoral approach is possible, but obtaining a stable position for the guide catheter via this approach is technically difficult. The authors describe the case of a 56-year-old man presenting with symptomatic occlusion of a previously placed stent at the origin of the left common carotid artery (CCA). An endovascular revascularization of the left CCA was planned. However, the absence of a lumen proximal to the stent prevented stable placement of a guide catheter via the transfemoral route. Consequently, the authors used a combined surgical and endovascular approach to gain access to the lesion. The left CCA was exposed surgically distal to the occlusion and clamped just proximal to its bifurcation to preserve flow from the external to the internal carotid artery (ICA) and to prevent embolism into the ICA. A wire was passed retrograde through the occlusive lesion and then was subsequently advanced proximally into the femoral sheath. This allowed transfemoral advancement of the appropriate endovascular devices to perform an angioplasty and placement of a stent. The patient remained neurologically stable, and postoperative studies showed improvement in cerebral perfusion. This case demonstrates the feasibility of distal-to-proximal stent delivery with a combined endovascular and surgical approach.
Collapse
Affiliation(s)
- Qaisar A Shah
- Zeenat Qureshi Stroke Research Center, Minnesota Stroke Initiative, University of Minnesota, Minneapolis, Minnesota, USA.
| | | | | | | |
Collapse
|
24
|
Bakken AM, Palchik E, Saad WE, Hart JP, Singh MJ, Rhodes JM, Waldman DL, Davies MG. Outcomes of Endoluminal Therapy for Ostial Disease of the Major Branches of the Aortic Arch. Ann Vasc Surg 2008; 22:388-94. [DOI: 10.1016/j.avsg.2007.07.040] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2007] [Revised: 07/08/2007] [Accepted: 07/18/2007] [Indexed: 11/30/2022]
|
25
|
Namdari S, Park MJ, Weiss APC, Carney WI. Chronic hand ischemia treated with radial artery balloon angioplasty: case report. J Hand Surg Am 2008; 33:551-4. [PMID: 18406959 DOI: 10.1016/j.jhsa.2007.12.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Revised: 12/27/2007] [Accepted: 12/31/2007] [Indexed: 02/02/2023]
Abstract
Although balloon angioplasty in heart and lower extremity vessels has been extensively studied and reported, little information exists regarding its use for digital ischemia in the hand. We report a case of successful balloon angioplasty of the distal radial artery to reverse present and prevent further digital tip cyanosis and necrosis.
Collapse
Affiliation(s)
- Surena Namdari
- Division of Vascular Surgery and the Department of Orthopaedics, Brown Medical School, Rhode Island Hospital, Providence, RI, USA
| | | | | | | |
Collapse
|
26
|
Byrne J, Darling RC, Roddy SP, Mehta M, Paty PSK, Kreienberg PB, Chang BB, Ozsvath KJ, Sternbach Y, Shah DM. Long term outcome for extra-anatomic arch reconstruction. An analysis of 143 procedures. Eur J Vasc Endovasc Surg 2007; 34:444-50. [PMID: 17689113 DOI: 10.1016/j.ejvs.2007.05.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2006] [Accepted: 05/14/2007] [Indexed: 11/24/2022]
Abstract
PURPOSE With the FDA approval of thoracic endografts, extra-anatomic reconstruction of the aortic arch has allowed for more suitable proximal landing zones and increased applicability of thoracic endovascular procedures. We evaluated our short term and long term results of extra-anatomic reconstruction of the carotid and subclavian vessels. METHODS One hundred and forty three (143) procedures were performed for extra-anatomic carotid and subclavian reconstruction. Of these 143 operations: 85 were carotid subclavian reconstructions, 22 were carotid crossover bypasses, 30 were subclavian carotid reconstructions and 6 were carotid subclavian transpositions. Sixty (42%) were male, 20 (14%) were diabetic, and 63 (44%) were current smokers. Mean age was 63 (SD +/- 12.3). Indication for surgery was primarily for occlusive or embolic disease (97%). In those patients undergoing bypass graft, prosthetic (ePTFE) was used in 93%. Follow-up was performed at 3 and 6 month intervals by ultrasound and pulse volume recordings where indicated. Life table analyses were used to analyze patency. RESULTS Of the 143 reconstructions operative mortality was 1 (0.7%). Non-fatal complications included 3 (2.1%) for bleeding, 1 (0.7%) wound infection, 2 (1.4%) TIA, 1 (0.7%) suffered a non-fatal stroke, 2 (1.4%) had postoperative myocardial infarctions, and 6 (4.3%) late (>30-day) occlusions. Follow-up was 1 to 124 months (mean: 39 months). Primary patency at 1 year was 98%, 3 years 96%, and 5 years was 92%. CONCLUSION Extra-anatomic arch reconstruction can be performed safely and appears to be durable over long term follow-up. Its use with endovascular grafting should provide a durable reconstruction for patients who require aortic "debranching" prior endovascular thoracic aortic aneurysm repair.
Collapse
Affiliation(s)
- J Byrne
- The Institute for Vascular Health and Disease, Albany Medical College/Albany Medical Center Hospital, Albany, NY, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Takach TJ, Reul GJ, Cooley DA, Duncan JM, Livesay JJ, Ott DA, Gregoric ID. Myocardial thievery: the coronary-subclavian steal syndrome. Ann Thorac Surg 2006; 81:386-92. [PMID: 16368420 DOI: 10.1016/j.athoracsur.2005.05.071] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2005] [Revised: 05/18/2005] [Accepted: 05/19/2005] [Indexed: 10/25/2022]
Abstract
Coronary-subclavian steal syndrome entails the reversal of blood flow in a previously constructed internal mammary artery coronary conduit, which produces myocardial ischemia. The most frequent cause of the syndrome is atherosclerotic disease in the ipsilateral, proximal subclavian artery. Although coronary-subclavian steal was initially reported to be rare, the increasing documentation of this phenomenon and its potentially catastrophic consequences in recent series suggests that the incidence of the problem has been underreported and that its clinical impact has been underestimated. We review the causes and background of coronary-subclavian steal; methods of preventing, diagnosing, and treating it; and the potential influence of various treatment regimens on long-term survival and the likelihood of late adverse events in patients with coronary-subclavian steal syndrome.
Collapse
Affiliation(s)
- Thomas J Takach
- Department of Cardiovascular Surgery, The Texas Heart Institute, St. Luke's Episcopal Hospital, Houston, Texas, USA
| | | | | | | | | | | | | |
Collapse
|
28
|
Guerra-Requena M, Galindo-García A, García-Fresnillo B, Blanco-Cañibano E. Pseudoaneurisma de carótida común tras la canalización de la vena yugular interna. ANGIOLOGIA 2006. [DOI: 10.1016/s0003-3170(06)75002-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
29
|
Aerts NR, Erling Jr. N, Lichtenfels E. Derivação carótido-carotídea por via retrofaríngea: seguimento tardio. J Vasc Bras 2005. [DOI: 10.1590/s1677-54492005000400015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Existem diversas opções para o tratamento da doença oclusiva dos troncos supra-aórticos, de acordo com a apresentação clínica e a localização das lesões arteriais. As abordagens cervicais são aceitas como alternativas de baixa morbimortalidade, com elevada perviedade em longo prazo. Os autores relatam um caso tratado com sucesso através de derivação carótido-carotídea cruzada por via retrofaríngea associada à endarterectomia da bifurcação carotídea. São discutidos também os aspectos clínicos e as opções cirúrgicas ou endovasculares para o melhor tratamento desses pacientes.
Collapse
Affiliation(s)
| | - Nilon Erling Jr.
- Complexo Hospitalar Santa Casa de Porto Alegre; Hospital de Pronto-Socorro de Porto Alegre
| | | |
Collapse
|