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Kurobe H, Hori T, Fujita H, Higaki T, Fukunishi T, Sogabe H, Izutani H. Clinical efficacy of TEVAR utilizing fenestrated stent-grafts for zone 0 in an elderly frail patient with giant aortic arch aneurysm. Ann Med Surg (Lond) 2024; 86:4854-4860. [PMID: 39118757 PMCID: PMC11305792 DOI: 10.1097/ms9.0000000000002268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 06/02/2024] [Indexed: 08/10/2024] Open
Abstract
Introduction and importance Elderly and frail patients with thoracic aortic aneurysms (TAAs) near to origins of cervical arteries present facing challenges with aortic arch replacement with cardiopulmonary bypass, and traditional tube-type stent-grafts are also inadequate for transcatheter endovascular aortic repair (TEVAR). Thus, necessitating precise treatment with fenestrated stent-grafts from zone 0. This approach is crucial for achieving favorable postoperative outcomes without compromising activities of daily living (ADL). Case presentations An 85-year-old-man admitted to the hospital for treatment of a large TAA. While arch replacement is a definitive procedure, it is highly invasive, and the postoperative ADL are expected to be significantly lower than preoperative levels. Therefore, we performed a debranching TEVAR from Zone 0 with fenestrated stent-graft. The patient was discharged from the hospital on the 11th postoperative day. Clinical discussion In frail and elderly patients for whom conventional surgery may not be viable, TEVAR emerges as a preferred alternative. However, TEVAR of TAA proximal to the aortic arch continues to pose challenges, necessitating meticulous attention to the cervical branches in the intervention strategy. While surgical intervention in these patients necessitates careful consideration of its suitability, including the potential for postoperative enhancement in ADL, the use of fenestrated stent-grafts from Zone 0 emerges as one of the treatment modalities. Conclusion The authors present a very elderly case in which fenestrated stent-grafts were used to avoid aortic arch replacement for a large aortic arch aneurysm, resulting in a good postoperative course with no decline in ADL.
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Affiliation(s)
- Hirotsugu Kurobe
- Department of Cardiovascular & Thoracic Surgery, Graduate School of Medicine, EHIME University, Toon
- Division of Cardiovascular Surgery, Shinsenkai Imabari Daiichi Hospital, Imabari
| | - Takaki Hori
- Division of Cardiovascular Surgery, Kamagaya General Hospital, Kamagaya, Japan
| | - Hiroshi Fujita
- Division of Cardiovascular Surgery, Shinsenkai Imabari Daiichi Hospital, Imabari
| | - Tomohide Higaki
- Department of Cardiovascular & Thoracic Surgery, Graduate School of Medicine, EHIME University, Toon
| | - Takuma Fukunishi
- Department of Cardiovascular & Thoracic Surgery, Graduate School of Medicine, EHIME University, Toon
| | - Hitoshi Sogabe
- Division of Cardiovascular Surgery, Shinsenkai Imabari Daiichi Hospital, Imabari
| | - Hironori Izutani
- Department of Cardiovascular & Thoracic Surgery, Graduate School of Medicine, EHIME University, Toon
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Okamoto T, Yokoi Y, Sato N, Suzuki S, Enomoto T, Onishi R, Nakamura N, Okubo Y, Nagasawa A, Mishima T, Shiraishi S, Tsuchida M. Outcomes of thoracic endovascular aortic repair using fenestrated stent grafts in patients with thoracic aortic distal arch aneurysms. Eur J Cardiothorac Surg 2024; 65:ezae062. [PMID: 38439540 DOI: 10.1093/ejcts/ezae062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/28/2023] [Accepted: 02/06/2024] [Indexed: 03/06/2024] Open
Abstract
OBJECTIVES Thoracic endovascular aortic repair (TEVAR) for aortic arch aneurysms is challenging because of anatomical restrictions and the presence of cervical branches. Revascularization of the cervical branch is required when conventional commercial stent grafts are used. TEVAR using fenestrated stent grafts (FSG) often does not require additional procedures to revascularize cervical branches. This study aimed to evaluate the features and initial and midterm outcomes of TEVAR using fenestrated stent grafts. METHODS From April 2007 to December 2016, 101 consecutive patients underwent TEVAR using fenestrated stent grafts for distal aortic arch aneurysms at a single centre. Technical success, complications, freedom from aneurysm-related death, secondary intervention and aneurysm progression were retrospectively investigated. RESULTS All the patients underwent TEVAR using fenestrated stent grafts. The 30-day mortality rate was zero. Cerebral infarction, access route problems and spinal cord injury occurred in 4, 3 and 2 patients, respectively. Each type of endoleak was observed in 38 of the 101 patients during the course of the study; 20/38 patients had minor type 1 endoleaks at the time of discharge. The endoleak disappeared in 2 patients and showed no significant change in 8 patients; however, the aneurysm expanded over time in 10 patients. Additional treatment was performed in 8 of the 10 patients with type 1 endoleaks and dilatation of the aneurysm. The rate of freedom from aneurysm-related death during the observation period was 98%. CONCLUSIONS TEVAR with FSG is a simple procedure, with few complications. Additional treatment has been observed to reduce aneurysm-related deaths, even in patients with endoleaks and enlarged aneurysms. Based on this study, the outcomes of endovascular repair of aortic arch aneurysms using a fenestrated stent graft seem acceptable.
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Affiliation(s)
- Takeshi Okamoto
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yoshihiko Yokoi
- Division of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Noriaki Sato
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Shuhei Suzuki
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takashi Enomoto
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Ryo Onishi
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Norihito Nakamura
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yuka Okubo
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Ayako Nagasawa
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takehito Mishima
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Shuichi Shiraishi
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masanori Tsuchida
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Fujioka S, Kitamura T, Mishima T, Mori H, Fukuzumi M, Shikata F, Miyaji K. Coil-in-Plug Method for Left Subclavian Artery Embolization in Thoracic Endovascular Aortic Repair with Arch Vessel Debranching. Ann Vasc Dis 2023; 16:189-194. [PMID: 37779651 PMCID: PMC10539117 DOI: 10.3400/avd.oa.23-00012] [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: 02/10/2023] [Accepted: 06/04/2023] [Indexed: 10/03/2023] Open
Abstract
Objectives: Since 2018, we have routinely placed an Amplatzer vascular plug (AVP) in the proximal left subclavian artery (LSCA) to prevent embolic events during thoracic endovascular aortic repair with arch vessel debranching (d-TEVAR). Type II endoleaks of LSCA origin were observed in two patients (20%), and the coil-in-plug (CIP) method, i.e., microcatheter insertion through the plug and addition of coil embolization, which has been used since August 2019, was performed. This study aims to evaluate the effectiveness of the CIP method for LSCA embolization. Methods: A total of 26 patients who underwent d-TEVAR for an aortic arch aneurysm between 2018 and 2022 were retrospectively reviewed. Ten patients who underwent d-TEVAR with a simple AVP placement (the control group) and 16 patients who underwent d-TEVAR with the CIP method (the CIP group) were compared. Results: Two patients had type II endoleaks in the control group, whereas none had them in the CIP group. LSCA length was significantly shorter in patients with endoleaks than in those without endoleaks (24.5 vs. 50.3 mm; p<0.01). No perioperative deaths or cerebral infarctions occurred in either group. Conclusions: AVP placement in the LSCA during d-TEVAR effectively prevented perioperative cerebral infarction. d-TEVAR with CIP was especially useful in patients with a short LSCA.
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Affiliation(s)
- Shunichiro Fujioka
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Tadashi Kitamura
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Toshiaki Mishima
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Hisaya Mori
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Masaomi Fukuzumi
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Fumiaki Shikata
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Kagami Miyaji
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
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4
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Iida Y, Hachiya T, Oka H, Inaba Y, Miki T, Shimizu H. Clinical outcomes of Najuta thoracic stent graft system for arch aneurysms. Front Surg 2023; 10:1167714. [PMID: 37260597 PMCID: PMC10228724 DOI: 10.3389/fsurg.2023.1167714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/02/2023] [Indexed: 06/02/2023] Open
Abstract
Objectives We aimed to elucidate the perioperative and short-term clinical outcomes of the Najuta thoracic stent graft system with fenestrations for supra-aortic vessels. Methods We retrospectively investigated the perioperative and short-term clinical outcomes of 20 patients treated for arch or distal arch aneurysms using the Najuta thoracic stent graft system during the period from May 2019 to February 2023. Results The technical success rate of the Najuta thoracic stent graft system was 95%. Of the 20 patients, 17 patients (85.0%) underwent concomitant extra-anatomical supra-aortic bypass. Postoperative CT revealed type Ia (n = 2) and type II (n = 3) endoleaks which disappeared on follow-up. The postoperative complications were stroke (n = 2, 10.0%), paraplegia (n = 1, 5.0%), and paraparesis (n = 1, 5.0%). In a very old patient, a blood transfusion was performed from the common iliac artery using the retroperitoneal approach. There were no aorta-related complications such as retrograde type A dissection or distal stent graft-induced new entry. Conclusions We treated arch or distal arch thoracic aneurysms by inserting a tube-type stent graft as a scaffold on the peripheral site and placing the Najuta thoracic stent graft on the proximal site. By extending the landing zone to Zone 0 and using a low radial force, which is a feature of the Najuta thoracic stent graft system, postoperative bird-beak and aorta-related complications were avoided. The treatment of arch and distal arch aortic aneurysms using the Najuta thoracic stent graft system showed acceptable perioperative and short-term clinical outcomes. Thoracic endovascular aortic repair using the Najuta thoracic stent graft system may be a potential treatment option for arch and distal arch aortic aneurysms, warranting further studies.
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Affiliation(s)
- Yasunori Iida
- Department of Cardiovascular Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
- Department of Cardiovascular Surgery, Keio University, Tokyo, Japan
| | - Takashi Hachiya
- Department of Cardiovascular Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Hidetoshi Oka
- Department of Cardiovascular Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Yu Inaba
- Department of Cardiovascular Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Takahisa Miki
- Department of Cardiovascular Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Hideyuki Shimizu
- Department of Cardiovascular Surgery, Keio University, Tokyo, Japan
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5
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Tian Y, Wang C, Xie P. Mid-term outcomes of left subclavian artery revascularization with Castor stent graft in treatment of type B aortic dissection in left subclavian artery. J Interv Med 2023; 6:74-80. [PMID: 37409064 PMCID: PMC10318335 DOI: 10.1016/j.jimed.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/07/2023] [Accepted: 04/09/2023] [Indexed: 07/07/2023] Open
Abstract
Background Here we analyzed mid-term data of thoracic endovascular aneurysm repair (TEVAR) surgery with Castor single-branched stent graft placement for the management of Stanford type B aortic dissection (STBAD) involving the left subclavian artery (LSA). Methods Between April 2014 and February 2019, 32 patients with STBAD involving a Castor single-branched stent graft were included. We analyzed their outcomes, including technical success rate (TSR), surgical duration (SD), presence of ischemia, perioperative complications, LSA patency, and survival rate (SR), using computed tomography angiography and clinical evaluation during mid-term follow-up. Results The mean patient age was 54.63 ± 12.37 years (range, 36-83 years). The TSR was 96.88% (n = 31/32). The mean SD was 87.44 ± 10.89 with a mean contrast volume of 125.31 ± 19.30 mL. No neurological complications or deaths occurred during the study period. The patients had a mean hospital stay of 7.84 ± 3.20 days. At a mean follow-up of 68.78 ± 11.26 months, four non-aortic deaths (12.5%) were observed. The LSA patency rate was 100% (n = 28/28). There was only one case of type I endoleak immediately after surgery (3.12%) (type I from LSA). However, none of the patients experienced type II endoleaks, and there were no cases of retrograde type A aortic dissection or stent graft-driven new distal entry. Finally, all patients exhibited good LSA patency. Conclusion TEVAR using a Castor single-branched stent graft may be a highly feasible and efficient procedure for the management of STBAD involving the LSA.
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Affiliation(s)
- Yu Tian
- Department of Interventional Therapy, Cancer Hospital Chinese Academy of Medical Science, ShenZhen Center, Guangdong Province, China
| | - Chengjie Wang
- Department of Vascular Surgery, Yuhuangding Hospital, Yantai, Shandong Province, China
| | - Peng Xie
- Department of Orthopedics, The 3rd Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong Province, China
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6
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Shukuzawa K, Baba T, Nishie R, Ozawa H, Omori M, Hara M, Tachihara H, Ohki T. An autopsy case of retrograde in situ branched stent grafting for a complex aortic arch aneurysm. J Vasc Surg Cases Innov Tech 2022; 8:313-318. [PMID: 35812121 PMCID: PMC9260453 DOI: 10.1016/j.jvscit.2022.04.007] [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: 01/20/2022] [Accepted: 04/04/2022] [Indexed: 11/30/2022] Open
Abstract
Although retrograde in situ branched stent grafting (RIBS) is one possible treatment option for thoracic aortic aneurysms, concerns exist regarding the durability of the stent graft (SG) at the junction between the main SG and the branched SG. We report on the autopsy results of a patient treated with RIBS for a complex aortic arch aneurysm. The patient had died of a nonaortic cause 14 months after the RIBS procedure. On computed tomography analysis and a leak test, the harvested SG was intact without any stent fracture, stenosis, or junctional leak at 1 atm water pressure (760 mm Hg).
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Affiliation(s)
| | | | | | | | | | | | | | - Takao Ohki
- Correspondence: Takao Ohki, MD, PhD, Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo 105-8461, Japan
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7
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Cao SH, Canonge J, Gaudric J, Dion D, Kuntz S, Jayet J, Koskas F, Heim F, Lejay A, Chakfé N. Degradation Phenomena on "Homemade" Explanted Aortic Textile Endografts. EJVES Vasc Forum 2021; 53:2-8. [PMID: 34604828 PMCID: PMC8463824 DOI: 10.1016/j.ejvsvf.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/21/2021] [Accepted: 07/19/2021] [Indexed: 11/25/2022] Open
Abstract
Objective In the 1990s, the concept of “homemade” endografts (EGs) using commercially available materials was proposed in clinical practice for endovascular abdominal aortic repair (EVAR). The aim of this study was to analyse the ageing phenomena of these EGs in light of explant analyses. Methods The study focused on five explanted homemade EGs collected from 2012 to 2014. The explants were assessed in accordance with the ISO 9001/13485 certified standard protocol, which included naked eye evaluation, organic remnant cleaning, and microscopic and endoscopic examinations and analysis (magnification range from 20% to 200%). The observations report followed a classification based on 12 features assessing the fabric cover, the stitch filament, and the stents. Results The reasons for explantation were type 1 endoleak in three cases and aneurysm sac growth in two. The implantation duration ranged from 56 to 202 months. Sixty three per cent of the fabric surface lesions (holes and tears) were related to abrasion between the fabric and the stents. Up to 33% of the knots used to connect adjacent stents were broken on one EG. Other defects including running suture rupture and stent corrosion were also observed. The overall hole cumulated surface ranged from 0.377 mm2 (56 month of implantation) up to 3.21 mm2 (78 month of implantation). Conclusion In this study, various ageing phenomena on homemade textile EGs were identified and classified. The main damaging mechanisms were related to abrasion stress leading to tears and holes in the fabric, stitch ruptures, and detachment of stent segments responsible for serious EG deformations and further degradation. Main homemade endografts damaging mechanisms are related to abrasion stress (friction wear). Abrasion stent–metal, knot ruptures, and kinking phenomena were associated. Some damaging mechanisms were related to the creation technique (one piece stent skeleton).
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Affiliation(s)
- Sheng-Heng Cao
- Groupe Européen de Recherche sur les Prothèses Appliquées à la Chirurgie Vasculaire, Strasbourg, France
| | - Jennifer Canonge
- Groupe Européen de Recherche sur les Prothèses Appliquées à la Chirurgie Vasculaire, Strasbourg, France
| | - Julien Gaudric
- Groupe Européen de Recherche sur les Prothèses Appliquées à la Chirurgie Vasculaire, Strasbourg, France.,Department of Vascular Surgery La Pitié Salpétrière, Sorbonne Université, Paris, France
| | - Delphine Dion
- Groupe Européen de Recherche sur les Prothèses Appliquées à la Chirurgie Vasculaire, Strasbourg, France
| | - Salomé Kuntz
- Groupe Européen de Recherche sur les Prothèses Appliquées à la Chirurgie Vasculaire, Strasbourg, France.,Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Jérémie Jayet
- Groupe Européen de Recherche sur les Prothèses Appliquées à la Chirurgie Vasculaire, Strasbourg, France.,Department of Vascular Surgery La Pitié Salpétrière, Sorbonne Université, Paris, France
| | - Fabien Koskas
- Department of Vascular Surgery La Pitié Salpétrière, Sorbonne Université, Paris, France
| | - Frédéric Heim
- Groupe Européen de Recherche sur les Prothèses Appliquées à la Chirurgie Vasculaire, Strasbourg, France.,Laboratoire de Physique et Mécanique Textile, Université de Haute-Alsace, Mulhouse, France
| | - Anne Lejay
- Groupe Européen de Recherche sur les Prothèses Appliquées à la Chirurgie Vasculaire, Strasbourg, France.,Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Nabil Chakfé
- Groupe Européen de Recherche sur les Prothèses Appliquées à la Chirurgie Vasculaire, Strasbourg, France.,Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
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Hybrid Surgery to Manage Aortic Arch Pathology. ACTA ACUST UNITED AC 2021; 57:medicina57090909. [PMID: 34577832 PMCID: PMC8471267 DOI: 10.3390/medicina57090909] [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: 07/21/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 11/29/2022]
Abstract
Background and Objectives: Aortic arch disease is still a high-risk surgical challenge despite major advances both in surgical and anesthesiological management. A combined surgical and endovascular approach has been proposed for aortic arch disease treatment to avoid hypothermia and circulatory arrest in high-risk patients. Materials and Methods: Between June 2004 and June 2021, 112 patients were referred to our department for aortic arch surgery; 38 (33.9%) patients underwent supra-aortic debranching and endovascular treatment. Of these, 21 (55%) patients underwent type I aortic arch hybrid debranching procedure and in 17 (45%) patients a type II aortic arch hybrid debranching procedure was performed. None of the patients were emergent. Results: No intra-operative deaths were recorded. In the type I aortic arch hybrid debranching patients’ group, one patient died at home waiting the endovascular step, one developed ascending aortic dissection and another one developed a pseudoaneurysm at the site of the debranching at follow-up. In the type II aortic arch hybrid debranching patients’ group, left carotid artery branch closure was detected at follow-up in one patient. Thirty day/in-hospital rates of adverse neurological events for both the surgical and endovascular procedures were 3% for minor stroke, with no permanent neurological deficit and 0% for permanent paraplegia/paraparesis. In 100% of the cases, the endovascular step succeeded and the type Ia endoleak rate was 0%. Conclusions: Hybrid arch surgery is a valuable option for aortic arch aneurysm treatment in patients with high surgical risk. The choice of aortic arch debranching between type I or type II is crucial and depends on anatomic and clinical patient characteristics. Further larger scale studies are needed to better define the advantages of these techniques.
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9
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Queiroz AB, Lopes JB, Marcos VC, Santos HM, Fidelis RJR, de Araújo Filho JS, Passos LCS. Physician-modified Stent Graft for Total Endovascular Aortic Arch Repair. Ann Vasc Surg 2021; 72:667.e17-667.e20. [PMID: 33333191 DOI: 10.1016/j.avsg.2020.10.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/19/2020] [Accepted: 10/25/2020] [Indexed: 11/16/2022]
Abstract
Endovascular techniques have proven useful in aortic arch management because they allow less invasive treatment and potentially faster recovery. We present the case of a 66-year-old woman with a 2-month history of precordial pain. Imaging studies revealed a saccular aortic arch aneurysm in the anterior portion of the arch. A Valiant Navion CoveredSeal (Medtronic, Santa Rosa, CA) device was modified with a double fenestration and used to treat it. The symptoms resolved and follow-up imaging showed aneurysm exclusion and patency of the supra-aortic branches. To our knowledge, this the first total endovascular arch repair to have been performed with this device.
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Affiliation(s)
- Andre Brito Queiroz
- Hospital Ana Nery, Aortic Team, Division of Vascular and Endovascular Surgery, Cardiac Surgery, Cardiology and Anesthesia, Universidade Federal da Bahia, Salvador, Brazil; Hospital Ana Nery, Division of Vascular Surgery, Universidade Federal da Bahia, Salvador, Brazil.
| | - Jackson Brandão Lopes
- Hospital Ana Nery, Aortic Team, Division of Vascular and Endovascular Surgery, Cardiac Surgery, Cardiology and Anesthesia, Universidade Federal da Bahia, Salvador, Brazil
| | - Vitória Castro Marcos
- Hospital Ana Nery, Division of Vascular Surgery, Universidade Federal da Bahia, Salvador, Brazil
| | - Herlon Moura Santos
- Hospital Ana Nery, Division of Vascular Surgery, Universidade Federal da Bahia, Salvador, Brazil
| | - Ronald José Ribeiro Fidelis
- Hospital Ana Nery, Aortic Team, Division of Vascular and Endovascular Surgery, Cardiac Surgery, Cardiology and Anesthesia, Universidade Federal da Bahia, Salvador, Brazil; Hospital Ana Nery, Division of Vascular Surgery, Universidade Federal da Bahia, Salvador, Brazil
| | | | - Luiz Carlos Santana Passos
- Hospital Ana Nery, Aortic Team, Division of Vascular and Endovascular Surgery, Cardiac Surgery, Cardiology and Anesthesia, Universidade Federal da Bahia, Salvador, Brazil
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10
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Sato H, Fukada J, Tamiya Y, Mikami T, Sibata T, Harada R, Naraoka S, Kamada T, Kawaharada N, Kurimoto Y. Long-Term Clinical Outcomes of Thoracic Endovascular Aortic Repair for Arch Aneurysms with the Najuta Thoracic Stent-Graft System. Ann Vasc Dis 2020; 13:384-389. [PMID: 33391555 PMCID: PMC7758573 DOI: 10.3400/avd.oa.20-00102] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: The treatment for arch aneurysms by endovascular repair is often difficult. This study evaluated the long-term outcomes of thoracic endovascular aortic repair for aortic arch aneurysms treated with the Najuta stent-graft system. Materials and Methods: From January 2009 to December 2019, 37 patients underwent treatment for aortic aneurysms with the Najuta stent graft system at two institutes, including our hospital. We retrospectively analyzed the short- and long-term clinical outcomes. Results: Of all 37 cases, the technical success rate was 97.3% (36 of 37). The mean proximal neck length was 20.1±5.3 mm. The postoperative results revealed 10 patients with type Ia endoleaks (27.8%), 6 with stroke (16.7%), and one with paraplegia (2.8%). In the chronic phase, the overall survival rates and the rates of freedom from aorta-related events at 7 years were 71.3% and 50.7%, respectively. Between two groups divided based on the proximal neck diameter of 20 mm, the <20-mm group had significantly higher rates of aorta-related events in terms of freedom from aortic events (P=0.046). Conclusion: The fenestrated stent graft can be a less invasive option for the treatment of high-risk patients with aortic aneurysms.
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Affiliation(s)
- Hiroshi Sato
- Department of Cardiovascular Surgery, Otaru General Hospital, Otaru, Hokkaido, Japan
| | - Joji Fukada
- Department of Cardiovascular Surgery, Otaru General Hospital, Otaru, Hokkaido, Japan
| | - Yukihiko Tamiya
- Department of Cardiovascular Surgery, Otaru General Hospital, Otaru, Hokkaido, Japan
| | - Takuma Mikami
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Tsuyoshi Sibata
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Ryo Harada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Syuichi Naraoka
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Takeshi Kamada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Yoshihiko Kurimoto
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
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Jing Z, Lu Q, Feng J, Zhou J, Feng R, Zhao Z, Bao J, Jiang W, Zhang X, Shu C, Fu W, Liu C, Guo W, Zhang X, Chen Z, Liu C, Han X. Endovascular Repair of Aortic Dissection Involving the Left Subclavian Artery by Castor Stent Graft: A Multicentre Prospective Trial. Eur J Vasc Endovasc Surg 2020; 60:854-861. [PMID: 33183920 DOI: 10.1016/j.ejvs.2020.08.022] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 07/20/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The left subclavian artery (LSA) origin can be intentionally covered by stent grafts, to provide adequate proximal landing zones during thoracic endovascular repair for Stanford type B aortic dissections (TBADs). To preserve the LSA, a novel single branched stent graft, named "Castor" was designed and a clinical trial conducted to investigate its suitability. METHODS From April 2013 to March 2015, 73 patients with TBAD were treated by Castor stent grafts at 11 Chinese tertiary hospitals as part of a single arm prospective clinical trial. There were 50 acute (<2 weeks [68.5%]) and 23 chronic aortic dissections (>2 weeks [31.5%]). RESULTS The technical success rate was 97% (n = 71/73). The two failures were caused by occlusion of the branch section of the stent graft. There were four intra-operative endoleaks (two type Ia, two type B from the LSA). The endoleak rate was 5% (n = 4/73). There was one in hospital death and no major complications. The median follow up time was 61 months (range 48-72 months). The mortality was 5% (n = 4/73) within one year and 7% within six years (n = 5/73). Two deaths were of unknown cause and three were not related to the aorta. Two new entry tears were found on the proximal or distal edge of the stent graft and were retreated endovascularly. Six occlusions of the branch section of the Castor stent graft were found, and the follow up patency rate of the branch section was 93% (n = 63/68). Two intra-operative endoleaks were left during follow up and eventually disappeared according to the latest computed tomography angiograms. CONCLUSION For patients with TBADs needing anchoring proximal to the origin of LSA, the Castor single branched stent graft may provide an easily manipulated, safe, and effective endovascular treatment.
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Affiliation(s)
- Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
| | - Qingsheng Lu
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
| | - Jiaxuan Feng
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Jian Zhou
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Rui Feng
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zhiqing Zhao
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Junmin Bao
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Weiliang Jiang
- Department of Vascular Surgery, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiwei Zhang
- Department of Vascular Surgery, People's Hospital of Jiangsu Province, Jiangsu, China
| | - Chang Shu
- Department of Vascular Surgery, Second Xiangya Hospital of Central South University, Hunan, China
| | - Weiguo Fu
- Department of Vascular Surgery, Zhongshan Affiliated Hospital of Fudan University, Shanghai, China
| | - Changjian Liu
- Department of Vascular Surgery, Gulou Affiliated Hospital of Nanjing University, Jiangsu, China
| | - Wei Guo
- Department of Vascular Surgery, General Hospital of the People's Liberation Army, Beijing, China
| | - Xiaoming Zhang
- Department of Vascular Surgery, People's Affiliated Hospital of Peking University, Beijing, China
| | - Zhong Chen
- Department of Vascular Surgery, Anzhen Affiliated Hospital of Capital Medical University, Beijing, China
| | - Changwei Liu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Xinwei Han
- Department of Vascular Surgery, First Affiliated Hospital of Zhengzhou University, Henan, China
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Furuta A, Azuma T, Yokoi Y, Domoto S, Niinami H. The midterm results of thoracic endovascular aortic repair with a precurved fenestrated endograft in zone 0-1. Eur J Cardiothorac Surg 2020; 58:722-729. [PMID: 32623460 DOI: 10.1093/ejcts/ezaa165] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/18/2020] [Accepted: 03/20/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Thoracic endovascular aortic repair (TEVAR) for the treatment of aortic arch disease remains challenging due to certain anatomical and haemodynamic features. The purpose of this study was to evaluate the midterm results of TEVAR with a second-generation fenestrated endograft for aortic arch disease. METHODS This non-randomized, interventional study was part of a multicentre clinical trial conducted between 2010 and 2011 and was designed to assess the effectiveness of a second-generation precurved fenestrated endograft for aortic arch disease. Midterm data collected during the fifth postoperative year from 205 patients treated with this endograft with the proximal landing of zone 0 or 1 were assessed regarding survival, reoperation and complications. RESULTS The initial and technical success rates were 94% and 91%, respectively. Ninety-seven percent of patients were treated using zone 0. The rate of in-hospital deaths was 3%. Overall survival was 71% at 5 years; thoracic aorta-related death-free survival rates at 1 and 5 years after surgery were 99.5% and 97.8%, respectively. Aneurysm-related event-free survival rates at 1 and 5 years after surgery were 86.8% and 77.1%, respectively. Reoperation-free survival rates at 5 years were 86.6%. The most frequent reason for reoperation was type Ia endoleak (5%), followed by type II endoleak (2%). Incidences of cerebral infarction, device migration, spinal cord ischaemia and supra-aortic branch stenosis were 6%, 1%, 1% and 1%, respectively. CONCLUSIONS The precurved fenestrated endograft provided appropriate conformability to the aortic arch and made zone 0 landing possible with simplified, less-invasive manipulations. The midterm results of TEVAR with this endograft suggest this method is a valuable endovascular treatment option for aortic arch disease. CLINICAL TRIAL REGISTRATION NUMBER UMIN000007213.
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Affiliation(s)
- Akihisa Furuta
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, The Heart Institute of Japan, Shinjukuku, Tokyo, Japan
| | - Takashi Azuma
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, The Heart Institute of Japan, Shinjukuku, Tokyo, Japan
| | - Yoshihiko Yokoi
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, The Heart Institute of Japan, Shinjukuku, Tokyo, Japan
| | - Satoru Domoto
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, The Heart Institute of Japan, Shinjukuku, Tokyo, Japan
| | - Hiroshi Niinami
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, The Heart Institute of Japan, Shinjukuku, Tokyo, Japan
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13
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Kudo T, Kuratani T, Shimamura K, Sawa Y. Early and midterm results of thoracic endovascular aortic repair using a branched endograft for aortic arch pathologies: A retrospective single-center study. JTCVS Tech 2020; 4:17-25. [PMID: 34317956 PMCID: PMC8307048 DOI: 10.1016/j.xjtc.2020.09.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 11/26/2022] Open
Abstract
Background Zone 0 landing hybrid thoracic endovascular aortic repair (TEVAR) includes a few moderately invasive surgical procedures. To reduce invasiveness, TEVAR with a branched aortic arch stent-graft can be considered. This study aimed to elucidate the effectiveness of performing TEVAR using a Bolton (Bolton Medical, Inc, Sunrise, Fla) branched endograft by analyzing early and midterm results. Methods We enrolled 28 patients (mean age, 78.4 years) who underwent TEVAR with the Bolton branched endograft in Osaka University Hospital between October 2012 and June 2018 with a mean follow-up period of 4.0 years. Double-side and single-side branched devices were used in 24 (85.7%) and 4 (14.3%) patients, respectively. Results All procedures were successful; no cases of endoleak or conversion to open repair were noted during the 30-day postoperative period. The perioperative stroke rate was 14.3% (4 out of 28); midterm stroke was not detected. All patients with perioperative stroke had atheroma grade ≥2 in the brachiocephalic artery. No type 1a endoleak was reported during the early or midterm results. The cumulative survival rate, aorta-related death-free rate, and aortic event-free survival rate at 5 years were 80.8%, 95.8%, and 81.6%, respectively. Conclusions We achieved satisfactory early and midterm results by using a Bolton branched endograft for high-risk patients with arch pathologies except for high postoperative stroke. Although this treatment method is associated with postoperative stroke, performing strict evaluation of atheroma may prevent such complication. By preventing intraoperative stroke, TEVAR with this custom-made Bolton branched endograft may be considered a less-invasive treatment.
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Affiliation(s)
- Tomoaki Kudo
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Toru Kuratani
- Department of Minimally Invasive Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Kazuo Shimamura
- Department of Minimally Invasive Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Short-term efficacy of unibody single-branched stent in the treatment of lesions involving the left subclavian artery: two-year follow-up outcomes. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2020; 17:120-123. [PMID: 32165886 PMCID: PMC7051869 DOI: 10.11909/j.issn.1671-5411.2020.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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15
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XiaoHui M, Li W, Wei G, XiaoPing L, Xin J, Hongpeng Z, Lijun W. Comparison of supra-arch in situ fenestration and chimney techniques for aortic dissection involving the left subclavian artery. Vascular 2018; 27:153-160. [PMID: 30319067 DOI: 10.1177/1708538118807013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Introduction Endovascular intervention involving the aortic arch, particularly in thoracic aortic dissection, remains challenging and controversial at current time when there is no commercially suitable grafts on most of the international markets. This study compared two endovascular treatments that maintain left subclavian artery perfusion using two modified techniques for type-B aortic dissection patients. Methods Consecutive cases utilizing chimney or in situ fenestration techniques to preserve left subclavian artery in type B AD from 2006 to 2015 in our single institution were retrospectively reviewed. Statistical analyses were performed with Student t-test, Wilcoxon rank sum, and Fisher exact tests when appropriate. Significant statistical differences were determined with p < 0.05. Results A total of 85 cases, including 67 (79.8%) with chimney and 18 (21.2%) with in situ fenestration techniques were identified in this retrospective study. In chimney group, there were 18 (26.9%) acute, 29 (43.3%) sub-acute, and 20 (29.9%) chronic aortic dissections. We implanted 24 Zenith and 43 Talent aortic endografts along with 55 balloon-expandable bare stents and 12 self-expanding covered stents in chimney group. Whereas in in situ fenestration group, there were four (22.2%) acute, six (33.3%) subacute, and eight (44.5%) chronic aortic dissections, all of which received Zenith endografts with 11 balloon-expandable covered and seven self-expanding covered stents, respectively. Demographic variables were similarly distributed with 100% intraoperative technical overall success in both groups. Comparing to in situ fenestration group, chimney group has shorter procedural and fluoroscopy time, less blood loss, and contrast volume used. All patients were followed-up to 52 months (median 38, range 24–52). Overall group mortality is 3.6% (3/84). All deaths were from chimney group. There was no procedure-related stroke observed within the study series. Primary patency was maintained while aortic remodeling with complete false lumen was achieved in all patients except that there were three (4.55%) Type-I endoleak cases in early post-operative period and one (1.5%) stent compression at 3-months follow-up in chimney group. There were no stent-related complications observed in in situ fenestration group. Conclusion Although there were previous studies describing the similar techniques, this study appears to be the first study to compare in situ fenestration and chimney techniques for aortic dissection involving the left subclavian artery according to the MEDLINE search. Although we are unable to establish the superiority between two approaches due to small sample size and relative short period of follow-up, in situ fenestration may represent a more favorable option, especially among aortic dissections with short proximal landing zones in the study.
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Affiliation(s)
- Ma XiaoHui
- Department of Vascular Surgery, General Hospital of People's Liberation Amy, Beijing, China
| | - Wei Li
- Division of Vascular and Endovascular Surgery, Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, NY, USA
| | - Guo Wei
- Department of Vascular Surgery, General Hospital of People's Liberation Amy, Beijing, China
| | - Liu XiaoPing
- Department of Vascular Surgery, General Hospital of People's Liberation Amy, Beijing, China
| | - Jia Xin
- Department of Vascular Surgery, General Hospital of People's Liberation Amy, Beijing, China
| | - Zhang Hongpeng
- Department of Vascular Surgery, General Hospital of People's Liberation Amy, Beijing, China
| | - Wang Lijun
- Department of Vascular Surgery, General Hospital of People's Liberation Amy, Beijing, China
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Case Series of Aortic Arch Aneurysm in Patients with Bovine Arch Treated with Proximal Scalloped and Fenestrated Stent Graft. Cardiovasc Intervent Radiol 2018; 41:1648-1653. [PMID: 30120530 DOI: 10.1007/s00270-018-2058-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 08/09/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The bovine arch is the most common variant of the aortic arch and occurs when the innominate artery shares a common origin with the left common carotid artery. We report an endovascular repair of aortic arch aneurysm in patients with a bovine arch using the Najuta proximal scalloped and fenestrated stent graft. MATERIALS AND METHODS Thoracic endovascular aneurysm repairs using the Najuta stent graft were performed at our facility. It was inserted and deployed at a zone 0 with precise positional adjustment of the scallop of the stent graft to the brachiocephalic trunk. RESULTS Overall, eight patients with bovine aortic arch were treated with fenestrated endovascular aneurysm repair. Technical success was 100% with no 30-day death. The follow-up period ranged from 7 to 29 (median 12) months. None of the patients had a stroke or paraplegia, and no endoleak was observed. All brachiocephalic trunks scalloped, and the left subclavian artery fenestrated vessels remained patent during the follow-up period. CONCLUSION The Najuta stent graft repair of aortic arch aneurysms in patients with a bovine arch is a safe and effective treatment option, with good immediate and short-term results.
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Toya N, Ohki T, Fukushima S, Shukuzawa K, Ito E, Akiba T. Fenestrated endovascular repair of aortic arch aneurysm in patients with bovine arch using the Najuta stent graft. J Vasc Surg Cases Innov Tech 2018; 4:148-151. [PMID: 29942907 PMCID: PMC6012989 DOI: 10.1016/j.jvscit.2018.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 01/24/2018] [Indexed: 11/05/2022] Open
Abstract
We describe the case of a 74-year-old man with a thoracic aortic aneurysm with a bovine arch who underwent fenestrated endovascular repair of aortic arch aneurysm using the Najuta stent graft (Kawasumi Laboratories, Inc, Tokyo, Japan). He has had a previous endovascular aneurysm repair and femoropopliteal bypass for abdominal aortic aneurysm combined with peripheral arterial disease. The Najuta stent graft was inserted and deployed at zone 0 with delicate positional adjustment of the fenestration of the stent graft to the brachiocephalic trunk. There was no endoleak or complication. His postoperative course was uneventful. At 7-month follow-up, complete exclusion of the aneurysm was noted. The Najuta stent graft repair of aortic arch aneurysms is a safe and effective treatment option for patients with a bovine arch.
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Affiliation(s)
- Naoki Toya
- Division of Vascular Surgery, Department of Surgery, The Jikei University Kashiwa Hospital, Kashiwa, Japan
| | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Soichiro Fukushima
- Division of Vascular Surgery, Department of Surgery, The Jikei University Kashiwa Hospital, Kashiwa, Japan
| | - Kota Shukuzawa
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Eisaku Ito
- Division of Vascular Surgery, Department of Surgery, The Jikei University Kashiwa Hospital, Kashiwa, Japan
| | - Tadashi Akiba
- Department of Surgery, The Jikei University Kashiwa Hospital, Kashiwa, Japan
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18
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Rudarakanchana N, Jenkins MP. Hybrid and total endovascular repair of the aortic arch. Br J Surg 2018; 105:315-327. [DOI: 10.1002/bjs.10713] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 09/04/2017] [Indexed: 01/12/2023]
Abstract
Abstract
Background
Recent advances in endovascular technology have enabled minimally invasive repair of the aortic arch, with specifically designed stent-grafts. This article reviews hybrid and total endovascular repair in the management of aortic arch pathology.
Methods
Studies relating to aortic arch management were identified using MEDLINE and Embase, focusing on endovascular repair.
Results
Hybrid arch repair is associated with an early mortality rate of some 12 per cent, and carries significant risk of stroke (up to 15 per cent), paraplegia (up to 6 per cent), retrograde dissection (up to 6·5 per cent) and proximal endoleak (6 per cent). Despite patients being of overall higher perioperative risk, hybrid repair has morbidity and early mortality rates comparable to those of open arch replacement. However, rates of freedom from aortic rupture or reintervention are significantly lower in the longer term, owing to the incidence of endoleak. Total endovascular arch repair may be achieved by the use of parallel stents or in situ fenestration in the emergency setting, or use of custom-made devices (scalloped, fenestrated or branched stent-grafts) in the elective setting. Reports of these relatively novel technologies suggest acceptable short-term outcomes, but long-term data are still awaited.
Conclusion
Repair of aortic arch pathology presents a formidable challenge for endovascular technology. Open aortic arch repair remains the standard in younger, fitter patients, but endovascular technology and experience continue to evolve with encouraging early outcomes and expanding indications.
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Affiliation(s)
- N. Rudarakanchana
- Department of Vascular Surgery, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - M. P. Jenkins
- Department of Vascular Surgery, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
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Lin J, Udgiri N, Guidoin R, Panneton J, Guan X, Guillemette M, Wang L, Du J, Zhu D, Nutley M, Zhang Z. In Vitro Laser Fenestration of Aortic Stent-Grafts: A Qualitative Analysis Under Scanning Electron Microscope. Artif Organs 2016; 40:E241-E252. [DOI: 10.1111/aor.12777] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 04/08/2016] [Accepted: 05/09/2016] [Indexed: 12/22/2022]
Affiliation(s)
- Jing Lin
- Key Laboratory of Textile Science & Technology of Ministry of Education and College of Textiles; Donghua University; Shanghai China
| | - Naval Udgiri
- Division of Vascular Surgery; Eastern Virginia Medical School, Sentara Heart Hospital; Norfolk VA USA
| | - Robert Guidoin
- Department of Surgery, Faculty of Medicine; Laval University and Axe Médecine Régénératrice, Centre de Recherche CHU; Québec QC
| | - Jean Panneton
- Division of Vascular Surgery; Eastern Virginia Medical School, Sentara Heart Hospital; Norfolk VA USA
| | - Xiaoning Guan
- Key Laboratory of Textile Science & Technology of Ministry of Education and College of Textiles; Donghua University; Shanghai China
| | - Maxime Guillemette
- Department of Surgery, Faculty of Medicine; Laval University and Axe Médecine Régénératrice, Centre de Recherche CHU; Québec QC
| | - Lu Wang
- Key Laboratory of Textile Science & Technology of Ministry of Education and College of Textiles; Donghua University; Shanghai China
| | - Jia Du
- Key Laboratory of Textile Science & Technology of Ministry of Education and College of Textiles; Donghua University; Shanghai China
| | - Dajie Zhu
- Key Laboratory of Textile Science & Technology of Ministry of Education and College of Textiles; Donghua University; Shanghai China
| | - Mark Nutley
- Division of Vascular Surgery and Department of Diagnostic Imaging; University of Calgary, Peter Lougheed Center; Calgary AB Canada
| | - Ze Zhang
- Department of Surgery, Faculty of Medicine; Laval University and Axe Médecine Régénératrice, Centre de Recherche CHU; Québec QC
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Early- and Mid-term Results of the Chimney Technique in the Repair of Aortic Arch Pathologies. Cardiovasc Intervent Radiol 2016; 39:1550-1556. [DOI: 10.1007/s00270-016-1439-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 07/02/2016] [Indexed: 11/25/2022]
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Van Der Weijde E, Bakker OJ, Heijmen RH. A custom-made scalloped stentgraft to preserve left subclavian artery flow in descending thoracic aortic disease with a short neck. Expert Rev Med Devices 2016; 13:487-96. [PMID: 27018248 DOI: 10.1586/17434440.2016.1171710] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
In thoracic stentgrafting, a short proximal landing zone may necessitate intentional occlusion of the left subclavian artery, which may lead to brain, spinal cord, and left arm malperfusion. A scalloped stentgraft is designed for adequate proximal sealing and preserving the left subclavian artery flow. We performed a systematic review, describe the required pre-operative planning and details of the perioperative technique used and report our own experience. In literature, only 29 patients were reported so far using a proximal scalloped stentgraft. Results show a high technical success rate and low complication rate. These results are comparable to the results from our own institution. From these first small series the scalloped thoracic endovascular aortic repair appears to be a safe and relatively simple solution for thoracic aortic disease involving the left subclavian artery.
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Affiliation(s)
- Emma Van Der Weijde
- a Department of Cardiothoracic Surgery , St. Antonius Hospital , Nieuwegein , The Netherlands
| | - Olaf J Bakker
- a Department of Cardiothoracic Surgery , St. Antonius Hospital , Nieuwegein , The Netherlands.,b Department of Vascular & Endovascular Surgery , University Medical Center Utrecht , Utrecht , The Netherlands
| | - Robin H Heijmen
- a Department of Cardiothoracic Surgery , St. Antonius Hospital , Nieuwegein , The Netherlands
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Toya N, Shukuzawa K, Fukushima S, Momose M, Akiba T, Ohki T. Aortic arch aneurysm repair using the Najuta stent graft in a challenging compromised seal zone. J Vasc Surg Cases 2016; 2:21-24. [PMID: 31724606 PMCID: PMC6849988 DOI: 10.1016/j.jvsc.2016.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 02/02/2016] [Indexed: 11/25/2022] Open
Abstract
We report the case of a 67-year-old patient with an anatomically complex aneurysm of the aortic arch treated by fenestrated thoracic endovascular aortic repair with subclavian-carotid extrathoracic bypass. We used the Najuta thoracic stent graft, which was approved for use in January 2013 in Japan and successfully excluded the aneurysm. Our case shows that the Najuta stent graft procedure is a feasible treatment if open repair is unsuitable for cases of aortic arch aneurysm with a challenging compromised seal zone.
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Affiliation(s)
- Naoki Toya
- Division of Vascular Surgery, Department of Surgery, The Jikei University Kashiwa Hospital, Chiba, Japan
| | - Kota Shukuzawa
- Division of Vascular Surgery, Department of Surgery, The Jikei University Kashiwa Hospital, Chiba, Japan
| | - Soichiro Fukushima
- Division of Vascular Surgery, Department of Surgery, The Jikei University Kashiwa Hospital, Chiba, Japan
| | - Masamichi Momose
- Division of Vascular Surgery, Department of Surgery, The Jikei University Kashiwa Hospital, Chiba, Japan
| | - Tadashi Akiba
- Department of Surgery, The Jikei University Kashiwa Hospital, Chiba, Japan
| | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
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Katada Y, Kondo S, Tsuboi E, Rokkaku K, Irie Y, Yokoyama H. Endovascular Total Arch Repair Using In Situ Fenestration for Arch Aneurysm and Chronic Type A Dissection. Ann Thorac Surg 2016; 101:625-30. [DOI: 10.1016/j.athoracsur.2015.07.032] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 06/24/2015] [Accepted: 07/09/2015] [Indexed: 11/15/2022]
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24
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Lu Q, Feng J, Zhou J, Zhao Z, Li H, Teng Z, Jing Z. Endovascular repair by customized branched stent-graft: A promising treatment for chronic aortic dissection involving the arch branches. J Thorac Cardiovasc Surg 2015; 150:1631-8.e5. [DOI: 10.1016/j.jtcvs.2015.08.032] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 07/30/2015] [Accepted: 08/11/2015] [Indexed: 10/23/2022]
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Joseph G, Premkumar P, Thomson V, Varghese M, Selvaraj D, Sahajanandan R. Externalized Guidewires to Facilitate Fenestrated Endograft Deployment in the Aortic Arch. J Endovasc Ther 2015; 23:160-71. [PMID: 26511895 PMCID: PMC4712411 DOI: 10.1177/1526602815614557] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To describe a precannulated fenestrated endograft system utilizing externalized guidewires to facilitate aortic arch endovascular repair and to report its use in 2 patients with challenging anatomy. Technique: For distal arch repair, a fenestration for the left subclavian artery (LSA) is made onsite in a standard thoracic endograft tailored to the patient anatomy; it is precannulated with a nitinol guidewire (NGw), which is passed from the femoral artery and externalized from the left brachial artery prior to endograft delivery system introduction over a parallel stiff guidewire. Steps are then taken to remove guidewire intertwining, prevent NGw wrapping around the delivery system, and orient the LSA fenestration superiorly when the delivery system moves into the arch. Gentle traction on the ends of the NGw during endograft deployment facilitates proper fenestration alignment. A covered stent is deployed in the LSA fenestration. The technique is illustrated in a patient with congenital coarctation of the aorta and descending aortic aneurysm. For total arch repair, endograft fenestrations are made for all 3 arch branches; the left common carotid artery (LCCA) and LSA fenestrations are each cannulated with NGws, which travel together from the femoral artery, pass through a LSA snare loop, and are exteriorized from the LCCA. After endograft deployment, the innominate artery fenestration is separately cannulated using right brachial access. Placement of a parallel externalized hydrophilic guidewire passing through the LCCA fenestration (but not the LSA snare loop) and removal of the LCCA fenestration NGw allows exteriorization of the LSA fenestration NGw from the left brachial artery by pulling the LSA snare. Covered stents are deployed in all 3 fenestrations. The technique is presented in a patient with type B aortic dissection. Conclusion: Use of the precannulated fenestrated endograft system described is feasible and has the potential to make aortic arch endovascular repair simpler, more reliable, and safer.
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Affiliation(s)
- George Joseph
- Department of Cardiology, Christian Medical College, Vellore, India
| | - Prabhu Premkumar
- Department of Vascular Surgery, Christian Medical College, Vellore, India
| | - Viji Thomson
- Department of Cardiology, Christian Medical College, Vellore, India
| | - Mithun Varghese
- Department of Cardiology, Christian Medical College, Vellore, India
| | - Dheepak Selvaraj
- Department of Vascular Surgery, Christian Medical College, Vellore, India
| | - Raj Sahajanandan
- Department of Anesthesiology, Christian Medical College, Vellore, India
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Kurimoto Y, Maruyama R, Ujihira K, Nishioka N, Hasegawa K, Iba Y, Hatta E, Yamada A, Nakanishi K. Thoracic Endovascular Aortic Repair for Challenging Aortic Arch Diseases Using Fenestrated Stent Grafts From Zone 0. Ann Thorac Surg 2015; 100:24-32; discussion 32-3. [DOI: 10.1016/j.athoracsur.2015.01.071] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 01/06/2015] [Accepted: 01/16/2015] [Indexed: 11/30/2022]
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Matsuyama M, Nakamura K, Nagahama H, Nina K, Endou J, Kojima K, Nishimura M, Ishii H, Yokota A. Long-term results of endovascular repair for distal arch and descending thoracic aortic aneurysms treated by custom-made endografts: usefulness of fenestrated endografts. Ann Vasc Dis 2015; 7:383-92. [PMID: 25593623 DOI: 10.3400/avd.oa.14-00057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 08/14/2014] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE We evaluated early and long-term results of atherosclerotic aneurysm repair with custom-made endografts. MATERIALS AND METHODS Eighty-one consecutive patients underwent thoracic endovascular aortic repair with custom-made endografts. Fenestrated grafts were used in 37 patients (45.7%) to maintain blood flow of the neck and a landing zone for as long as possible for distal arch or proximal descending aneurysms. The rates of perioperative mortality, stroke, paraplegia, and primary endoleaks were assessed to evaluate in-hospital safety. The rates of endoleak development, survival, and freedom from aortic-related death were assessed to evaluate long-term efficiency. RESULTS Twenty-four patients (29.6%) underwent urgent operations, and 38 (46.9%) underwent distal arch or proximal descending aortic aneurysm repair. There was one case (1.2%) of in-hospital mortality and no cases of stroke. Permanent spinal injury occurred in one patient (1.2%). Early and late endoleaks occurred in one and 16 patients, respectively. The actuarial survival rates were 88.9%, 64.9%, and 51.7% at 1, 5, and 10 years, respectively. The actuarial rates of freedom from endoleaks were 90.1%, 81.3%, and 68.6% at 1, 5, and 10 years, respectively. CONCLUSION Early results of custom-made endografts were excellent, and fenestrated endografts were safe for distal arch and proximal descending aortic aneurysms.
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Affiliation(s)
- Masakazu Matsuyama
- Department of Cardiovascular, Thoracic and General Surgery, University of Miyazaki, Miyazaki, Miyazaki, Japan
| | - Kunihide Nakamura
- Department of Cardiovascular, Thoracic and General Surgery, University of Miyazaki, Miyazaki, Miyazaki, Japan
| | - Hiroyuki Nagahama
- Department of Cardiovascular, Thoracic and General Surgery, University of Miyazaki, Miyazaki, Miyazaki, Japan
| | - Katsuhiko Nina
- Department of Cardiovascular Surgery, Miyazaki Prefectural Nobeoka Hospital, Nobeoka, Miyazaki, Japan
| | - Jouji Endou
- Department of Cardiovascular, Thoracic and General Surgery, University of Miyazaki, Miyazaki, Miyazaki, Japan
| | - Kazushi Kojima
- Department of Cardiovascular Surgery, Miyazaki Prefectural Nobeoka Hospital, Nobeoka, Miyazaki, Japan
| | - Masanori Nishimura
- Department of Cardiovascular, Thoracic and General Surgery, University of Miyazaki, Miyazaki, Miyazaki, Japan
| | - Hirohito Ishii
- Department of Cardiovascular, Thoracic and General Surgery, University of Miyazaki, Miyazaki, Miyazaki, Japan
| | - Atsuko Yokota
- Department of Cardiovascular Surgery, Miyazaki Prefectural Nobeoka Hospital, Nobeoka, Miyazaki, Japan
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Tan TW, Coulter AH, Zhang WW. Percutaneous In situ Left Subclavian Artery Fenestration Using Reentry Catheter during Endovascular Thoracic Aortic Aneurysm Repair. Int J Angiol 2015; 25:e77-e80. [PMID: 28031661 DOI: 10.1055/s-0034-1395978] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Left subclavian artery (LSA) revascularization is recommended during elective thoracic endovascular aortic aneurysm repair (TEVAR) when coverage is required for adequate proximal seal. Reported method for LSA revascularization includes open bypass, covered stent placement using chimney technique, and in situ laser fenestration. We reported a novel technique using percutaneous Outback reentry device for LSA revascularization in a 68-year-old male patient who underwent TEVAR for a 9-cm thoracic aortic aneurysm. This technique can be used as an alternative method for LSA in situ fenestration, and laser equipment is not required.
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Affiliation(s)
- Tze-Woei Tan
- Division of Vascular and Endovascular Surgery, Louisiana State University Health Shreveport, Shreveport, Louisiana
| | - Amy H Coulter
- Division of Vascular and Endovascular Surgery, Louisiana State University Health Shreveport, Shreveport, Louisiana
| | - Wayne W Zhang
- Division of Vascular and Endovascular Surgery, Louisiana State University Health Shreveport, Shreveport, Louisiana
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Early outcomes of extra-thoracic debranching thoracic endovascular aortic repair for distal aortic arch disease. J Artif Organs 2014; 17:236-42. [DOI: 10.1007/s10047-014-0774-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 05/19/2014] [Indexed: 10/25/2022]
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30
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Nagata T, Nakamura Y, Yamamoto H, Sato M. A fenestrated stent graft for surgical resection of lung cancer invading the aortic arch. J Thorac Cardiovasc Surg 2013; 146:238-9. [DOI: 10.1016/j.jtcvs.2013.02.070] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 02/14/2013] [Accepted: 02/28/2013] [Indexed: 11/28/2022]
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31
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Yasuda S, Imoto K, Uchida K, Kawaguchi S, Yokoi Y, Shigematsu H, Masuda M. Stent-graft implantation for clinically diagnosed syphilitic aortic aneurysm in an HIV-infected patient. Ann Thorac Cardiovasc Surg 2013; 20 Suppl:862-6. [PMID: 23774613 DOI: 10.5761/atcs.cr.12.02211] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We describe our experience with stent-graft placement in a patient with a clinically diagnosed syphilitic aortic aneurysm.The patient was a 43-year-old man with syphilitic and human immunodeficiency virus (HIV) co-infection. Computed tomography (CT) revealed an aortic aneurysm with 89 mm in maximum size which was located at distal aortic arch and was considered syphilis derived saccular aneurysm. The aneurysm was judged at high risk of rupture from its shape. We decided to perform stent-graft implantation. Before surgery, the patient was given antibacterial and anti-HIV agents. Hand-made fenestrated stent graft by Tokyo Medical University was implanted. The graft was placed from the ascending aorta to Th 9 level in the descending aorta. The aneurysm completely disappeared during follow-up, with no flare-up of syphilitic infection up to 2 years after surgery.The number of patients with syphilis and human immunodeficiency virus co-infection is now increasing. Stent-graft implantation may be an effective treatment in such immunocompromised patients.
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Affiliation(s)
- Shota Yasuda
- Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
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32
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Zhu Y, Guo W, Liu X, Jia X, Xiong J, Wang L. The Single-centre Experience of the Supra-arch Chimney Technique in Endovascular Repair of Type B Aortic Dissections. Eur J Vasc Endovasc Surg 2013; 45:633-8. [DOI: 10.1016/j.ejvs.2013.02.016] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2012] [Accepted: 02/18/2013] [Indexed: 11/29/2022]
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33
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Azuma T, Yokoi Y, Yamazaki K. The next generation of fenestrated endografts: results of a clinical trial to support an expanded indication for aortic arch aneurysm treatment. Eur J Cardiothorac Surg 2013; 44:e156-63; discussion e163. [DOI: 10.1093/ejcts/ezt241] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Kawaguchi S, Shimizu H, Yoshitake A, Shimazaki T, Iwahashi T, Ogino H, Ishimaru S, Shigematsu H, Yozu R. Endovascular stent graft repair for thoracic aortic aneurysms: the history and the present in Japan. Ann Vasc Dis 2013; 6:129-36. [PMID: 23825491 DOI: 10.3400/avd.ra.12.00018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 02/28/2013] [Indexed: 11/13/2022] Open
Abstract
Stent-grafts for endovascular repair of thoracic aortic aneurysms have been commercially available for more than ten years in the West, whereas, in Japan, a manufactured stent-graft was not approved for the use until March 2008. Nevertheless, endovascular thoracic intervention began to be performed in Japan in the early 1990s, with homemade devices used in most cases. Many researchers have continued to develop their homemade devices. We have participated in joint design and assessment efforts with a stent-graft manufacturer, focusing primarily on fenestrated stent-grafts used in repairs at the distal arch, a site especially prone to aneurysm. In March 2008, TAG (W.L. Gore & Associates, Inc., Flagstaff, Arizona, USA) was approved as a stent graft for the thoracic area first in Japan, which was major turning point in treatment for thoracic aortic aneurysms. Subsequently, TALENT (Medtronic, Inc., Minneapolis, Minnesota, USA) was approved in May 2009, and TX2 (COOK MEDICAL Inc., Bloomington, Indiana, USA) in March 2011. Valiant as an improved version of TALENT was approved in November 2011, and TX2 Proform as an improved version of TX2 began to be supplied in October 2012. These stent grafts are excellent devices that showed good results in Western countries, and marked effectiveness can be expected by making the most of the characteristics of each device. A clinical trial in Japan on Najuta (tentative name) (Kawasumi Labo., Inc., Tokyo, Japan) as a line-up of fenestrated stent grafts that can be applied to distal arch aneurysms showing a high incidence, and allow maintenance of blood flow to the arch vessel was initiated. This trial was completed, and Najuta has just been approved in January of 2013 in Japan, and further development is expected. In the U.S., great efforts have recently been made to develop and manufacture excellent stent grafts for thoracic aneurysms, and rapid progress has been achieved. In particular, in the area of the aortic arch, in which we often experience aneurysmal change, but there are no commercially available devices which are urgently needed. Companies are competing keenly to develop devices. To our knowledge, more than 4 manufacturers are involved in the development of functionally new stent grafts in this area. The introduction of branched stent grafts may not be faraway.
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Affiliation(s)
- Satoshi Kawaguchi
- Division of Cardiovascular Surgery, Department of Surgery, Keio University School of Medicine, Tokyo, Japan
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35
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Yuri K, Yokoi Y, Yamaguchi A, Hori D, Adachi K, Adachi H. Usefulness of fenestrated stent grafts for thoracic aortic aneurysms. Eur J Cardiothorac Surg 2013; 44:760-7. [DOI: 10.1093/ejcts/ezt127] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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36
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Total arch replacement via antero-lateral thoracotomy with partial sternotomy in patients with a tracheostoma: report of two cases. Surg Today 2013; 44:972-5. [PMID: 23467979 DOI: 10.1007/s00595-013-0537-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 10/26/2012] [Indexed: 10/27/2022]
Abstract
Midsternotomy in patients with a coexisting tracheostomy is associated with a risk of deep sternal wound infection (DSWI) or mediastinitis. We herein present two cases of total arch replacement using a surgical technique designed to avoid the danger of DSWI. Total arch replacement via an antero-lateral thoracotomy with partial sternotomy can be one of the options for patients with a tracheostoma or after laryngectomy, and can both protect organs and avoid DSWI.
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Abraham CZ, Lioupis C. RETRACTED: Treatment of aortic arch aneurysms with a modular transfemoral multibranched stent-graft: Initial experience. J Thorac Cardiovasc Surg 2013; 145:S110-7. [DOI: 10.1016/j.jtcvs.2012.11.064] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Accepted: 11/28/2012] [Indexed: 10/27/2022]
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38
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Yokoi Y, Azuma T, Yamazaki K. Advantage of a precurved fenestrated endograft for aortic arch disease: Simplified arch aneurysm treatment in Japan 2010 and 2011. J Thorac Cardiovasc Surg 2013; 145:S103-9. [DOI: 10.1016/j.jtcvs.2012.11.058] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 09/13/2012] [Accepted: 11/28/2012] [Indexed: 11/29/2022]
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39
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Fukuda I, Daitoku K, Minakawa M, Fukuda W. Shaggy and calcified aorta: surgical implications. Gen Thorac Cardiovasc Surg 2013; 61:301-13. [DOI: 10.1007/s11748-013-0203-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Indexed: 12/01/2022]
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40
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Oláh Z, Szabolcs Z, Hüttl K, Pólos M, Rényi-Vámos F, Széphelyi K, Sótonyi P, Acsády G. [Hybrid repair for a ruptured aortic arch and descending aortic aneurysm in a kidney-transplanted patient]. Magy Seb 2012; 65:230-3. [PMID: 22940393 DOI: 10.1556/maseb.65.2012.4.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CASE REPORT We present a case of a 53 year old male renal transplanted patient, who presented with severe dyspnea. Chest X-ray and CT angiography showed a left sided haemothorax caused by an aortic arch aneurysm rupture. Acute operation was carried out, an ascendo-anonymo-carotid "Y" bypass was performed from sternotomy and a stent graft implantation through femoral artery. As a second step, the blood clot mass, which caused compression atelectasis of the left lung, was removed by a thoracic surgeon. At follow-up the patient was in good condition, the bypass graft functioned well, the stent graft stayed in good position, the aneurysm sack was reduced and the left lung expanded well. DISCUSSION Traditional operation of aortic arch aneurysm carries high mortality and morbidity rate, because of use of extracorporeal perfusion and deep hypothermic circulatory arrest. Hybrid operation became an alternative treatment. After circulation of supra-aortic arteries secured by "debranching procedure", a stent graft implantation is done. Such interventions means less strain for patients, but strict follow up is required, because lack of long-term data. Hybrid reconstruction of the aortic arch aneurysm is rarely performed in acute cases, but means an alternative treatment for high risk patients with acceptable results.
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Affiliation(s)
- Zoltán Oláh
- Semmelweis Egyetem Érsebészeti Klinika 1122 Budapest Városmajor u. 68.
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41
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Lioupis C, Corriveau MM, MacKenzie K, Obrand D, Steinmetz O, Abraham C. Treatment of Aortic Arch Aneurysms with a Modular Transfemoral Multibranched Stent Graft: Initial Experience. Eur J Vasc Endovasc Surg 2012; 43:525-32. [DOI: 10.1016/j.ejvs.2012.01.031] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Accepted: 01/29/2012] [Indexed: 10/28/2022]
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42
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Ferrero E, Ferri M, Viazzo A, Robaldo A, Zingarelli E, Sansone F, Casabona R, Nessi F. Is total debranching a safe procedure for extensive aortic-arch disease? A single experience of 27 cases. Eur J Cardiothorac Surg 2012; 41:177-82. [PMID: 21820909 DOI: 10.1016/j.ejcts.2011.05.058] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Thoracic, arch, and proximal descending thoracic aorta diseases are still considered an enormous challenge. The hybrid approach developed in recent years (supra-aortic trunks debranching and thoracic endovascular repair aortic repair; TEVAR) may improve the morbidity and mortality of the population at risk. The aim of this study was to analyze retrospectively our experience in the hybrid treatment of aortic-arch aneurysms and dissections. METHOD We carried out a retrospective review of 27 patients who required a surgical debranching of the supra-aortic trunks and a TEVAR in the management of the aortic arch and proximal descending thoracic aortic disease. The aortic lesions included 18 degenerative arch-aortic aneurysms, four complicated aortic dissections, two subclavian artery aneurysms, and three penetrating atherosclerotic ulcers. Technical success was achieved in all patients. RESULTS The 30-day mortality rate was 11.1% (3/27). Mean follow-up was 16.7 months (range, 1-56), and the survival rate was 77.8%. The endoleaks' rate was 3.7% (1/27), due to a stent-graft migration. CONCLUSION Hybrid approaches may represent an alternative option in the treatment of complex aortic lesions involving the arch and the proximal descending thoracic aorta in high-risk patients and emergency cases. However, the promising early results need to be confirmed by longer follow-up and larger comparative series.
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Affiliation(s)
- Emanuele Ferrero
- Vascular and Endovascular Surgery Unit, Mauriziano Umberto I Hospital, Largo Turati 62, 10128 Turin, Italy.
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43
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Hybrid treatment of a ruptured aneurysm in the distal aortic arch: report of a case. Surg Today 2012; 42:1019-21. [PMID: 22527178 DOI: 10.1007/s00595-012-0181-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Accepted: 08/15/2011] [Indexed: 10/28/2022]
Abstract
An 80-year-old man was transferred to our hospital for surgical treatment of a ruptured aortic arch aneurysm. Based on a history of severe heart failure and coronary artery bypass, we considered him unsuitable for conventional open repair. He underwent a hybrid repair, in the form of supra-aortic vessel debranching followed by endoluminal aortic repair. Although the ostia of the left carotid and left subclavian arteries were occluded by the stent-graft, the left supra-aortic vessels and the left internal thoracic artery attached to the coronary artery were perfused through an extra-anatomic bypass from the right axillary artery to the left carotid artery and the left axillary artery. After additional endovascular repair for recurrent hemosputum, the patient recovered without complications. Although continued follow-up is necessary, acute hybrid arch repair seems feasible for treating ruptured aortic arch aneurysms, even in the setting of severe heart failure and a previous coronary artery bypass.
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Yuri K, Yamaguchi A, Hori D, Shiraishi M, Nagano H, Tamura A, Noguchi K, Naito K, Nemoto K, Adachi H. Surgical treatment for thoracic aneurysms: comparison of stent grafting and open surgery. Ann Vasc Dis 2012; 5:15-20. [PMID: 23555481 DOI: 10.3400/avd.oa.11.00920] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Accepted: 12/06/2011] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Early and mid-term results of stent graft (SG) treatment for thoracic aortic aneurysms (thoracic endovascular aneurysm repair: TEVAR) were retrospectively compared with open surgical treatment. METHODS The records of 213 patients in whom single thoracic aortic aneurysm repairs had been performed in our department from January 2006 through August 31, 2009 were reviewed. Acute aortic dissection was excluded. Each case was reviewed for indications for TEVAR from an anatomical standpoint. Among 62 cases in which TEVAR was indicated, 30 (SG group) were treated by TEVAR and 32, by open surgery (OP group). Early and mid-term results were analyzed retrospectively in both groups. RESULTS There were no operative deaths in either group. The SG group demonstrated significantly less operative bleeding, a shorter operative time, and shorter postoperative hospital stay compared with the OP group. There were 3 deaths in the SG group and 4 in the OP group, which occurred within an average of 656.4 days during the follow up period. The 3 year actuarial survival rate was 88.7% in the SG group and 87.1% in the OP group, and there were no significant differences between the groups. CONCLUSION Although early and mid-term results of TEVAR and open surgery were similar, TEVAR is generally less invasive and may be preferable for high-risk patients, compared with open surgical repair. (English Translation of Jpn J Vasc Surg 2010; 19: 51-56.).
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Affiliation(s)
- Koichi Yuri
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Saitama, Japan
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Zastrow C, Motaganahalli RL, Matsumura JS. Femoral-femoral stabilizing buddy wire for embolization of the internal iliac artery. J Vasc Surg 2012; 55:1526-8. [PMID: 22209616 DOI: 10.1016/j.jvs.2011.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2011] [Revised: 10/03/2011] [Accepted: 11/01/2011] [Indexed: 10/14/2022]
Abstract
Internal iliac artery (IIA) embolization is performed in a variety of clinical scenarios, most commonly in patients undergoing endovascular aneurysm repair (EVAR) with an iliac artery aneurysm or inadequate distal landing zone. In these patients, IIA embolization with iliac limb extension is often performed. While IIA embolization can be routinely performed with either ipsilateral or contralateral femoral arterial access, it can be challenging in some patients with an acutely angulated aortic or iliac bifurcation and in patients with short or ectatic common iliac arteries. In this select group of patients with difficult anatomy, IIA embolization can be challenging and may lead to increased radiation exposure and contrast administration. Having a sheath precisely positioned and stabilized at the internal iliac artery origin will facilitate embolization of the IIA. This report describes a novel technique in which crossover femoral-femoral artery buddy wire placement achieves stable positioning of large sheaths for concurrent IIA embolization at the time of EVAR.
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46
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Hongo N, Miyamoto S, Shuto R, Wada T, Matsumoto S, Kiyosue H, Mori H. Endovascular Aortic Arch Reconstruction Using In Situ Stent-Graft Fenestration in the Brachiocephalic Artery. J Vasc Interv Radiol 2011; 22:1144-8. [DOI: 10.1016/j.jvir.2011.04.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Revised: 03/31/2011] [Accepted: 04/07/2011] [Indexed: 11/26/2022] Open
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47
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Thoracic Endovascular Aortic Repair With Aortic Arch Vessel Revascularization. Ann Vasc Surg 2011; 25:748-51. [DOI: 10.1016/j.avsg.2010.12.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2010] [Revised: 12/20/2010] [Accepted: 12/24/2010] [Indexed: 11/22/2022]
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48
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Thoracic endovascular aortic repair with homemade stent grafts: early and mid-term outcomes. Surg Today 2011; 41:1054-61. [PMID: 21773893 DOI: 10.1007/s00595-010-4489-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Accepted: 05/25/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE We reviewed our experience with homemade stent grafts in the repair of a variety of thoracic aortic lesions. The objective of this study was to assess the early and mid-term outcomes of this therapy. METHODS From 1999 to 2007, homemade stent grafts were inserted in 88 patients with an atherosclerotic aneurysm, dissection, pseudoaneurysm, trauma, or rupture in the thoracic aorta. The endoprostheses were stainless steel Z-stents covered by a polyester graft, and were custom-designed for each patient. RESULTS Placement of stent grafts was technically successful in 81 of the 88 patients (92%). Within 30 days after treatment, 3 patients died, 3 had a cerebral infarction, and 3 had onset of paraplegia or paraparesis. Primary endoleaks were observed in 8 patients (9%). During the mean follow-up period of 32 ± 26 months, 7 patients had persistent endoleaks and 7 had stent-graft migration. The aneurysm-related mortality rate was 7%. The rate of freedom from open-surgery conversion at 32 months was 89.0%. CONCLUSIONS Our early experience with elective and emergency thoracic endovascular aortic repair using homemade stent grafts provided therapeutic benefits to high-risk patients. Endoleaks and stent-graft migrations were the factors most commonly responsible for secondary intervention in the mid-term period. Careful follow-up of patients treated with this approach is needed to avoid major complications in the long term.
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Obitsu Y, Koizumi N, Takahashi S, Iida Y, Saiki N, Watanabe Y, Kawaguchi S, Shigematsu H. Hybrid procedures combining conventional and thoracic endovascular aortic repair for thoracic aortic aneurysms. Surg Today 2011; 41:922-7. [PMID: 21748607 DOI: 10.1007/s00595-010-4377-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Accepted: 02/08/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE To minimize surgical invasiveness for extensive aortic aneurysms and expand the indications for thoracic endovascular aortic repair (TEVAR), we evaluated outcomes of hybrid procedures combining conventional surgical aortic repair and TEVAR for thoracic aortic aneurysms. METHODS The following hybrid procedures were performed: second-stage TEVAR after total aortic arch replacement using the elephant trunk as the landing zone in 17 patients; and for multiple aortic aneurysms, vascular graft replacement and TEVAR in 13 patients, vascular graft replacement and TEVAR with bypass in 2 patients, and TEVAR with bypass in 23 patients. RESULTS There were three (5.3%) hospital deaths, from serious complications including stroke, paraplegia, paraparesis, and aspiration pneumonia; and eight late deaths. There was only one aneurysm-related death, of a patient who underwent emergency surgery for an esophageal fistula resulting from enlargement of a residual false lumen of a thoracoabdominal aorta after second-stage TEVAR. CONCLUSION Hybrid procedures minimize surgical invasiveness in thoracic aortic aneurysm repair, but further evaluation of a larger number of patients is necessary.
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Affiliation(s)
- Yukio Obitsu
- Department of Vascular Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
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Double-chimney technology for treating secondary type I endoleak after endovascular repair for complicated thoracic aortic dissection. J Vasc Surg 2011; 54:212-5. [DOI: 10.1016/j.jvs.2010.11.120] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Revised: 11/17/2010] [Accepted: 11/27/2010] [Indexed: 11/19/2022]
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