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Kuntz S, Thaveau F, Ohana M, Pasquinelli G, Chakfé N, Lejay A. Calcium in the (Big) Pipes: Intra-TEVAR Calcifications! EJVES Vasc Forum 2023; 60:64-67. [PMID: 37876922 PMCID: PMC10590760 DOI: 10.1016/j.ejvsvf.2023.09.006] [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: 05/17/2023] [Revised: 08/30/2023] [Accepted: 09/15/2023] [Indexed: 10/26/2023] Open
Abstract
Introduction Calcification of a vascular endograft and adjacent tissues (adventitia, media, and neointima) can result in graft failure. This report shows a rare case of intraluminal calcifications in the distal end of a thoracic endovascular aortic repair (TEVAR) endograft implanted 11 years previously for grade IV blunt traumatic aortic injury (BTAI) in a young patient. Report A 24 year old man required TEVAR for a BTAI caused by a motorcycle accident. The procedure consisted of TEVAR and an emergency left carotid subclavian venous bypass. Eleven years after the procedure, he had severe hypertension. Intra-TEVAR calcifications appeared, gradually increasing on computed tomography angiography (CTA). Calcifications in the distal luminal end of the TEVAR were responsible for a 60% stenosis on CTA. An open approach was indicated after multidisciplinary discussion, based on the gradient value. The patient underwent explantation, with total replacement of the aortic arch and descending thoracic aorta with re-implantation of the supra-aortic vessels, under extracorporeal circulation. Macroscopic analysis showed no device degeneration but revealed a solid mass at the distal end of the TEVAR. Both microcomputed tomography and histopathology confirmed the calcific nature of the lesions. Conclusion This case highlights a rare long term graft failure due to calcified neo-atherosclerosis in a TEVAR.
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Affiliation(s)
- Salomé Kuntz
- Department of Vascular Surgery and Kidney Transplantation, University of Strasbourg, Strasbourg, France
- GEPROMED, Strasbourg, France
| | - Fabien Thaveau
- Department of Vascular Surgery and Kidney Transplantation, University of Strasbourg, Strasbourg, France
- GEPROMED, Strasbourg, France
| | - Michaël Ohana
- Department of Radiology, University of Strasbourg, Strasbourg, France
| | - Gianandrea Pasquinelli
- Department of Medical and Surgical Sciences - DIMEC, University of Bologna, Bologna, Italy
- Pathology Unit, IRCCS AOUBO, Bologna, Italy
| | - Nabil Chakfé
- Department of Vascular Surgery and Kidney Transplantation, University of Strasbourg, Strasbourg, France
- GEPROMED, Strasbourg, France
| | - Anne Lejay
- Department of Vascular Surgery and Kidney Transplantation, University of Strasbourg, Strasbourg, France
- GEPROMED, Strasbourg, France
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Bhamidipati CM, Tohill BC, Robe C, Reid KJ, Eglitis NC, Farber MA, Jordan WD. Physiologic risk stratification is important to long-term mortality, complications, and readmission in thoracic endovascular aortic repair. J Vasc Surg Cases Innov Tech 2023; 9:101174. [PMID: 37334158 PMCID: PMC10275962 DOI: 10.1016/j.jvscit.2023.101174] [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: 02/14/2023] [Accepted: 03/15/2023] [Indexed: 06/20/2023] Open
Abstract
Use of the American Society of Anesthesiologists (ASA) physical status classification is important for periprocedural risk stratification. However, the collective effect after adjustment for the Society for Vascular Surgery (SVS) medical comorbidity grading system on long-term all-cause mortality, complications, and discharge disposition is unknown. We examined these associations in patients after thoracic endograft placement. Data from three thoracic endovascular aortic repair (TEVAR) trials through 5 years of follow-up were included. Patients with acute complicated type B dissection (n = 50), traumatic transection (n = 101), or descending thoracic aneurysm (n = 66) were analyzed. The patients were stratified into three groups according to the ASA class: I-II, III, and IV. Multivariable proportional hazards regression models were used to examine the effect of ASA class on 5-year mortality, complications, and rehospitalizations after adjustment for SVS risk score and potential confounders. The largest proportion of patients treated by TEVAR across the ASA groups (n = 217) was ASA IV (n = 97; 44.7%; P < .001), followed by ASA III (n = 83; 38.2%) and ASA I-II (n = 37; 17.1%). Among the ASA groups, the ASA I-II patients were, on average, 6 years younger than those with ASA III and 3 years older than those with ASA IV (ASA I-II: age, 54.3 ± 22.0 years; ASA III: age, 60.0 ± 19.7 years; ASA IV: age, 51.0 ± 18.4 years; P = .009). Multivariable adjusted 5-year outcome models showed that ASA class IV, independent of the SVS score, conferred an increased risk of mortality (hazard ratio [HR], 3.83; 95% confidence interval [CI], 1.19-12.25; P = .0239) and complications (HR, 4.53; 95% CI, 1.69-12.13; P = .0027) but not rehospitalization (HR, 1.84; 95% CI, 0.93-3.68; P = .0817) compared with ASA class I-II. Procedural ASA class is associated with long-term outcomes among post-TEVAR patients, independent of the SVS score. The ASA class and SVS score remain important to patient counseling and postoperative outcomes beyond the index operation.
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Affiliation(s)
- Castigliano M. Bhamidipati
- Division of Cardiothoracic Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR
| | | | | | | | - Nicholas C. Eglitis
- Division of Cardiac Anesthesia and Critical Care, Oregon Health & Science University, Portland, OR
| | - Mark A. Farber
- Division of Vascular Surgery, University of North Carolina, Chapel Hill, NC
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Dake MD, Brinkman WT, Han SM, Matsumura JS, Sweet MP, Patel HJ, Taylor BS, Oderich GS. Outcomes of Endovascular Repair of Aortic Aneurysms with the GORE® Thoracic Branch Endoprosthesis for Left Subclavian Artery Preservation. J Vasc Surg 2022; 76:1141-1149.e3. [PMID: 35709864 DOI: 10.1016/j.jvs.2022.05.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/10/2022] [Accepted: 05/23/2022] [Indexed: 01/16/2023]
Abstract
OBJECTIVE OR BACKGROUND Thoracic endovascular aortic repair has emerged as the dominant paradigm for treatment of patients with descending thoracic aortic aneurysms. For aneurysms involving the aortic arch in the region of the left subclavian artery (LSA), branch vessel preservation to maintain blood flow to the LSA is recommended. Branched aortic endografts are an alternative to surgical revascularization of the LSA. METHODS Across 34 investigative sites, 84 patients with Zone 2 aneurysm were enrolled in a nonrandomized, prospective study of a single branched aortic endograft. The thoracic branch endoprosthesis device allows for graft placement proximal to the LSA and incorporates a single side branch for left subclavian perfusion. RESULTS Over half of the patients were male (63%). Their average age was 70 (±11) years. The aneurysm morphology was fusiform in 43 and saccular in 41 patients. The mean aneurysm diameter at screening was 56.2 mm. The mean follow up was 30 months (range 2.6 to 50.7 months). Reported here are the patient outcomes at 1 and 12 months. Pre-defined technical success with implantation of the device in landing Zone 2 was achieved in 92% (n=77) of patients. There were no cases of aortic rupture, lesion-related mortality, or new onset renal failure. There was no peri-operative (30-day) mortality. A single case each of permanent paraplegia and paraparesis occurred. Three patients experienced a procedure-related stroke. Through 12 months, four patients died; none of the deaths were adjudicated as related to the device or procedure. One aortic reintervention was required. A single case of aortic enlargement (core laboratory) was reported at 6 months. Type 1 (n=3) and III (n=5) endoleaks occurred in 9.8% of patients of which one (Type III) required reintervention. CONCLUSIONS Results from this device study in patients with Zone 2 aneurysm demonstrate that early safety and efficacy outcomes are maintained up to 12 months after the endovascular procedure with low mortality and reintervention rates and an acceptable frequency of procedural complications, including neurologic complications.
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Affiliation(s)
- Michael D Dake
- Department of Medical Imaging, University of Arizona Health System, Tucson, AZ.
| | | | - Sukgu M Han
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Jon S Matsumura
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Matthew P Sweet
- Department of Surgery, University of Washington, Seattle, WA
| | - Himanshu J Patel
- Joe D. Morris Collegiate Professor in Cardiac Surgery, University of Michigan, Ann Arbor, MI
| | - Bradley S Taylor
- Department of Surgery, University of Maryland Medical Center, Baltimore, MD
| | - Gustavo S Oderich
- Cardiothoracic & Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX
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Panesar H, Simonian G, O'Connor D. GORE ® TAG ® conformable thoracic stent graft for the treatment of descending aortic pathologies. Future Cardiol 2022; 18:431-441. [PMID: 35040336 DOI: 10.2217/fca-2021-0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Endovascular repair of the descending thoracic aorta has gained widespread acceptance as a primary treatment modality for thoracic aortic disease due to its minimally invasive approach and improved survival rates. GORE® TAG® Conformable Thoracic Stent Graft was designed for descending thoracic aortic aneurysms, penetrating ulcers, aortic transections and type B aortic dissections, which are accepted indications for endovascular therapy. The aim of this review is to summarize the clinical literature, focusing mainly on the publications that came from manufacturer's pre-market and post-market studies. Including the Global Registry for Endovascular Aortic Treatment (GREAT), sponsored by WL Gore & Associates (Flagstaff, AZ, USA), which is a large database of endovascular repair of various thoracic, abdominal and thoraco-abdominal aortic pathologies to identify and evaluate only those with isolated thoracic aortic pathology (arch and descending thoracic).
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Affiliation(s)
| | - Gregory Simonian
- Division of Vascular Surgery, Heart and Vascular Hospital, Hackensack University Medical Center, Hackensack, NJ 07601, USA
| | - David O'Connor
- Division of Vascular Surgery, Heart and Vascular Hospital, Hackensack University Medical Center, Hackensack, NJ 07601, USA
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Skrypnik D, Bischoff MS, Meisenbacher K, Kronsteiner DB, Böckler D. A 10-Year Single-Center Experience With the GORE TAG Conformable Thoracic Stent Graft in the Treatment of Thoracic Aortic Disease. J Endovasc Ther 2021; 29:370-380. [PMID: 34632839 PMCID: PMC9096584 DOI: 10.1177/15266028211049340] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: The aim of this study was to report 10-year real-world single-center experience with the GORE TAG conformable thoracic aortic graft (CTAG), focusing on rupture-free survival, aortic-related reintervention, and device-related complications during midterm and long-term follow-up (FU). Methods: This retrospective study analyzes results of thoracic endovascular aortic repair (TEVAR) performed between January 2009 and December 2018. Out of 419 TEVAR procedures within this period, 194 patients (male 57.2%, 111/194), with a mean age of 65 ± 13 years, were treated with the CTAG device. Indication for TEVAR was a thoracic aortic aneurysm in 24.7% (48/194), type B aortic dissection in 32.5% (63/194), penetrating aortic ulcer 15.5% (30/194), and miscellaneous 27.3% (53/194). Emergently were operated 43.8% (85/194) patients. Median follow-up (FU) including computed tomography imaging was 43.5 months (Q1-Q3: 8.6–67.0) and was completed in 91.2% (177/194) of patients. Results: Overall survival rates were 75.8% (95% confidence interval [CI] = [0.76–0.70]) and 56.6% (95% CI = [0.57–0.50]) at 12 and 60 months, respectively. Cumulative incidence for aortic rupture was 11.9% (95% CI = [0.07–0.17]) at 60 and 90 months, respectively. Cumulative incidence for aortic-related reintervention was 27.5% (95% CI = [0.21–0.34]) at 60 and 90 months. Cumulative incidence for migration was 2.8% (95% CI = [0.004–0.05]) and 3.9% (95% CI = [0.007–0.07]) at 60 and 90 months, respectively. New endograft infections or material fatigue were not observed. Conclusions: The herein reported 10-year real-world single-center experience with the CTAG observed favorable long-term outcome. Thus, the device demonstrates appropriate persistent safety, efficacy, and clinical durability up to long-term FU in the treatment of diverse thoracic aortic pathologies.
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Affiliation(s)
- Denis Skrypnik
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Moritz S Bischoff
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Katrin Meisenbacher
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Dorothea B Kronsteiner
- Institute of Medical Biometry and Informatics, Heidelberg University, Heidelberg, Germany
| | - Dittmar Böckler
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
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Five-Year Outcomes with Conformable GORE® TAG® endoprosthesis used in traumatic aortic transections. Ann Thorac Surg 2021; 113:1536-1542. [PMID: 34126073 DOI: 10.1016/j.athoracsur.2021.05.054] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/21/2021] [Accepted: 05/17/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND The Conformable GORE® TAG® thoracic endoprosthesis (CTAG) device (W.L. Gore and Associates, Flagstaff, AZ) seeks to optimize thoracic endovascular repair (TEVAR) of blunt aortic injuries (BAI) by better apposing to the aortic arch. The TAG 08-02 study evaluated safety and effectiveness of the CTAG device in the 5-years following treatment. METHODS This prospective, single-arm study was conducted at 30 U.S. sites with follow-up through 5 years. Patients were evaluated for all-cause mortality and device events through follow-up. An independent core lab reviewed pre- and post-treatment images. RESULTS Fifty-one initial cohort patients and 50 continued access patients were enrolled and received a total of 111 CTAG devices (mean, 1.1/subject; range 1.0 - 3.0) during initial treatment. On average patients were 42.7 ± 19.5 years old with a mean Injury Severity Score of 31.5 ± 14.5 and most presented with polytraumatic injuries. The median time between injury and treatment was 21.0 hours (range, 3.2 - 334.4 hours). Sixty patients had partial or complete left subclavian artery coverage, but only one patient developed a stroke that was unable to be attributed to the device or procedure. The freedom of all-cause mortality was 95% and 89% at 1-month and 5-years post-procedure, respectively. There were 2 minor endoleaks. There were no aortic ruptures, wire frame fractures, erosions, lumen obstructions, device compressions, or thrombus related events reported. CONCLUSIONS Five-year outcomes verify the CTAG device is a safe, effective, and durable option for BAI patients undergoing TEVAR.
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Walsh K, O'Connor DJ, Weaver F, Trimarchi S, Cao L, Wilderman M, Ratnathicam A, Cook K, Napolitano M, Simonian G. Survival after endovascular therapy in patients with ruptured thoracic aortic diseases: Results from the Global Registry for Endovascular Aortic Treatment Registry. J Vasc Surg 2020; 72:1544-1551. [DOI: 10.1016/j.jvs.2020.02.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 02/09/2020] [Indexed: 12/01/2022]
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D'Alessio I, Domanin M, Bissacco D, Rimoldi P, Palmieri B, Piffaretti G, Trimarchi S. Thoracic endovascular aortic repair for traumatic aortic injuries: insight from literature and practical recommendations. THE JOURNAL OF CARDIOVASCULAR SURGERY 2020; 61:681-696. [PMID: 32964899 DOI: 10.23736/s0021-9509.20.11580-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Thoracic endovascular aortic repair (TEVAR) for treatment of blunt traumatic aortic injuries (BTAIs) is nowadays the gold standard technique in adult patients, replacing gradually the use of open repair (OR). Although randomized controlled trials will never be performed comparing TEVAR to OR for BTAIs management, trauma and vascular societies guidelines today primarily recommend the former for BTAI patients with a suitable anatomy. The aim of this review was to describe past and recent data published in literature regarding pros and cons of TEVAR treatment in BTAI, and to analyze some debated issues and future perspectives. EVIDENCE ACQUISITION Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and Scale for the Assessment of Narrative Review Articles (SANRA) were used to obtain and describe selected articles on TEVAR in BTAI. EVIDENCE SYNTHESIS Young (<50 years) men were the most operated population. The use of TEVAR increased over the years, with a progressive reduction in mortality and overall postoperative complication rates when compared with OR. Lack of information remains about the percentage of urgent cases. CONCLUSIONS TEVAR is considered nowadays the treatment of choice in BTAI patients. In case of aortic rupture (grade IV) the treatment is mandatory, while intimal tear (grade I) and intramural hematoma (grade II) can be safely managed with no operative management (NOM). Debate is still ongoing on grade III (pseudoaneurysms). Unfortunately, several aspects remain not yet clarified, including disease classification, type and grade to treat, timing (urgent versus elective), priority of vascular injuries in polytrauma patients, and TEVAR use in pediatrics and young patients.
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Affiliation(s)
- Ilenia D'Alessio
- Unit of Vascular Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maurizio Domanin
- Unit of Vascular Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy - .,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Daniele Bissacco
- Unit of Vascular Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Pierantonio Rimoldi
- Department of Cardio-Thoraco-Vascular Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Bruno Palmieri
- Department of Cardio-Thoraco-Vascular Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Gabriele Piffaretti
- Unit of Vascular Surgery, Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
| | - Santi Trimarchi
- Unit of Vascular Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Watkins AC, Dalal A, Lee JT, Dake MD. Current Status of Endoluminal Treatment of Descending Thoracic Aortic Aneurysms. Cardiovasc Intervent Radiol 2020; 43:1770-1778. [PMID: 32449019 DOI: 10.1007/s00270-020-02526-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 05/09/2020] [Indexed: 11/27/2022]
Abstract
Thoracic endovascular aortic repair (TEVAR) was proved to be effective in thoracic descending aortic aneurysm (TDAA) repair in 1994 and approved by the FDA in 2005. Since then, TEVAR has become the first-line, recommended treatment for intact or ruptured DTAA or as a bridge to definitive open surgical repair in connective tissue disease. TEVAR has decreased perioperative morbidity and mortality compared to open surgery due to the lack of thoracotomy, aortic cross-clamping and left heart bypass. Improvement in materials, manufacturing and device delivery systems have allowed for the expansion of indications. Thoughtful and accurate pre-procedure planning is the hallmark of successful TEVAR. Familiarization and adherence to the instructions for use for an aortic device will give the best possible chance of success.
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Affiliation(s)
- A Claire Watkins
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Alex Dalal
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
| | - Jason T Lee
- Division of Vascular Surgery, Stanford University, Stanford, CA, USA
| | - Michael D Dake
- University for Health Sciences, University of Arizona, Health Sciences Innovation Building, 9th Floor SVP Suite, 1670 E. Drachman Street, PO Box 210216, Tucson, AZ, 85721-0216, USA.
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Invited commentary. J Vasc Surg 2018; 68:990. [DOI: 10.1016/j.jvs.2018.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 02/07/2018] [Indexed: 11/15/2022]
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Chou EL, Twerdahl EH, Eagleton MJ. Endovascular management of penetrating and non-penetrating aortic injury. VASA 2018; 48:23-33. [PMID: 30227809 DOI: 10.1024/0301-1526/a000740] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Aortic trauma is a devastating injury often associated with significant polytrauma. Penetrating injury of the aorta is highly lethal and therefore rarely encountered in the hospital setting. The management of blunt trauma of the aorta has changed significantly over the past decade, principally due to improved imaging technology and the development of endovascular therapy. The most common site of injury is the proximal descending thoracic aorta. The degree of aortic wall injury guides the indication for therapy, while a combination of the degree of injury and the extent of co-morbid injuries drives the timing of repair. Lower grade injuries frequently do not require any surgical intervention. Thoracic aortic endograft repair can be performed in a safe, expeditious fashion. Short-term and mid-term outcomes appear excellent, with patient survival based mainly on concomitant traumatic injuries. Long-term outcomes are less well known. Future endeavors will be guided toward gaining a better understanding of the indications for repair and the long-term outcomes for endograft devices designed for this purpose.
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Affiliation(s)
- Elizabeth L Chou
- 1 Massachusetts General Hospital, Division of Vascular and Endovascular Surgery, Boston, USA
| | - Eric H Twerdahl
- 1 Massachusetts General Hospital, Division of Vascular and Endovascular Surgery, Boston, USA
| | - Matthew J Eagleton
- 1 Massachusetts General Hospital, Division of Vascular and Endovascular Surgery, Boston, USA
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Bodell BD, Taylor AC, Patel PJ. Thoracic Endovascular Aortic Repair: Review of Current Devices and Treatments Options. Tech Vasc Interv Radiol 2018; 21:137-145. [DOI: 10.1053/j.tvir.2018.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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13
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Wang GJ, Goodney PP, Sedrakyan A. Conceptualizing treatment of uncomplicated type B dissection using the IDEAL framework. J Vasc Surg 2018; 67:662-668. [PMID: 29389429 DOI: 10.1016/j.jvs.2017.10.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 10/10/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The objective of this study was to introduce a new framework, called IDEAL (idea, development, exploration, assessment, and long-term study), to guide physicians, investigators, and regulatory agencies through the life cycle of device development and procedural refinement. METHODS This review describes the IDEAL framework and illustrates its application for treatment of uncomplicated type B dissection (uTBD) as an example of this process. RESULTS Components of IDEAL are summarized and applied to devices used to treat uTBD. Treatment of uTBD is currently in the exploration phase, with concurrent assessment and long-term study being facilitated by detailed registries. CONCLUSIONS The application of IDEAL to the development and monitoring of technologies standardizes the nomenclature, facilitates evidence-based practice, and enhances the innovation process.
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Affiliation(s)
- Grace J Wang
- Division of Vascular Surgery and Endovascular Therapy, Hospital of the University of Pennsylvania, Philadelphia, Pa.
| | - Philip P Goodney
- Division of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
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14
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Partial distal deployment for precise placement of the GORE Thoracic Endoprosthesis. J Vasc Surg 2017; 66:661-665. [DOI: 10.1016/j.jvs.2017.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 05/01/2017] [Indexed: 11/22/2022]
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Hu FY, Fang ZB, Leshnower BG, Duwayri Y, Jordan WD, Gillespie TW, Veeraswamy RK. Contemporary evaluation of mortality and stroke risk after thoracic endovascular aortic repair. J Vasc Surg 2017; 66:718-727.e5. [PMID: 28502542 DOI: 10.1016/j.jvs.2017.01.069] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 01/29/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE During the past decade, thoracic endovascular aortic repair (TEVAR) has increased as a treatment option for a variety of aortic pathologic processes. Despite this rise in the use of thoracic stent grafts, real-world outcomes from a robust, adjudicated, contemporary data set have yet to be reported. Previous studies have shown periprocedural mortality rates between 1.5% and 9.5% and procedure-related stroke rates of 2.3% to 8.2%. With advances in device engineering and increased experience of physicians, we hypothesized that the rates of these complications would be reduced in a more recent sample set. The purpose of this study was to determine current rates of mortality and stroke after TEVAR, to identify risk factors that contribute to 30-day mortality, and to develop a simple scoring system that allows risk stratification of patients undergoing TEVAR. METHODS We examined the 30-day mortality rate after TEVAR using the 2013 to 2014 American College of Surgeons National Surgical Quality Improvement Program database. Patients undergoing TEVAR for all aortic disease were identified using procedure codes. Bivariate analyses were performed to evaluate the association of preoperative, intraoperative, and postoperative variables with 30-day mortality, followed by multivariable logistic analysis using preoperative variables only, with P < .10 as the criterion for model entry. The predictive logistic model was internally validated by cross-validation. Variables included in the multivariable model were used to develop a risk score. RESULTS There were 826 patients included. The 30-day mortality and stroke rates were 7.63% (n = 63) and 4.5% (n = 37), respectively. In regression analysis, mortality was independently associated with age ≥80 years (odds ratio [OR], 2.32; 95% confidence interval [CI], 1.25-4.31), emergency case (OR, 2.61; 95% CI, 1.39-4.90), American Society of Anesthesiologists classification >3 (OR, 2.89; 95% CI, 1.34-6.24), transfusion >4 units in the 72 hours before surgery (OR, 2.86; 95% CI, 1.30-6.28), preoperative creatinine concentration ≥1.8 mg/dL (OR, 2.07; 95% CI, 1.05-4.08), and preoperative white blood cell count ≥12 × 109/L (OR, 2.65; 95% CI, 1.41-4.96). Incorporating these factors, a 6-point risk score was generated and demonstrated high predictability for overall 30-day mortality. CONCLUSIONS Recent data from a national, retrospective data set demonstrate that high perioperative mortality and stroke rates have persisted during the last decade. The risk score derived from this data set is simple and convenient and serves as a prognostic tool in the preoperative risk stratification of patients being evaluated for TEVAR.
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Affiliation(s)
- Frances Y Hu
- Division of Vascular and Endovascular Therapy, Department of Surgery, Emory University, Atlanta, Ga
| | - Zachary B Fang
- Division of Vascular and Endovascular Therapy, Department of Surgery, Emory University, Atlanta, Ga
| | - Bradley G Leshnower
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University, Atlanta, Ga
| | - Yazan Duwayri
- Division of Vascular and Endovascular Therapy, Department of Surgery, Emory University, Atlanta, Ga
| | - William D Jordan
- Division of Vascular and Endovascular Therapy, Department of Surgery, Emory University, Atlanta, Ga
| | - Theresa W Gillespie
- Department of Surgery and Department of Hematology & Medical Oncology, Emory University, Atlanta, Ga
| | - Ravi K Veeraswamy
- Division of Vascular Surgery, Department of Surgery, the Medical University of South Carolina, Charleston, SC.
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van der Zee CP, Vainas T, van Brussel FA, Tielliu IF, Zeebregts CJ, van der Laan MJ. Endovascular treatment of traumatic thoracic aortic lesions: a systematic review and meta-analysis. THE JOURNAL OF CARDIOVASCULAR SURGERY 2017; 60:100-110. [PMID: 28471152 DOI: 10.23736/s0021-9509.17.09942-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION To provide an overview of the experience of endovascular treatment for traumatic thoracic aortic lesions (TTAL). Thoracic aortic injury secondary to high-energy chest trauma constitutes an emergency situation with potentially devastating outcome. In the present time, the majority of patients are treated with thoracic endovascular aortic repair. The aim of this study was to provide a systematic overview of endovascular aortic repair in patients with TTAL with special attention to perioperative mortality, paraplegia, stroke, influence of left subclavian artery (LSA) coverage herein, and long-term stent-related complications. EVIDENCE ACQUISITION PubMed and Embase were searched for studies describing endovascular treatment of TTAL in the period between January 1st, 2000 and January 30th, 2016. The methodological quality of articles was assessed using the MINORS score and PRISMA guidelines. Data on early mortality, perioperative complications, and long-term stent-related complications were extracted. EVIDENCE SYNTHESIS A total of 2005 reports were screened, and 74 publications were finally included in the analysis describing treatment of 1882 patients. Early mortality rate, paraplegia rate, and stroke rate were 7.5%, 0.4%, and 1.5%, respectively. LSA coverage did not increase the risk of stroke. The severity of injuries had a positive association on early mortality. Late stent related mortality and morbidity were uncommon. CONCLUSIONS TTAL can be treated endovascularly with low mortality and (neurological) morbidity. LSA coverage does not increase the risk of neurological complications but is associated with a moderate risk of left arm ischemia. Long-term stent-related complications are rare, but the available data is limited.
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Affiliation(s)
- Cornelis P van der Zee
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands -
| | - Tryfon Vainas
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Ignace F Tielliu
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Clark J Zeebregts
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Maarten J van der Laan
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Der Aortenbogen – was ist bei der endovaskulären Versorgung zu beachten? GEFASSCHIRURGIE 2016. [DOI: 10.1007/s00772-016-0164-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bischoff MS, Müller-Eschner M, Meisenbacher K, Peters AS, Böckler D. Device Conformability and Morphological Assessment After TEVAR for Aortic Type B Dissection: A Single-Centre Experience with a Conformable Thoracic Stent-Graft Design. Med Sci Monit Basic Res 2015; 21:262-70. [PMID: 26718893 PMCID: PMC4725445 DOI: 10.12659/msmbr.897010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background The aim of this study was to analyze device conformability in TEVAR of acute and chronic (a/c) type B aortic dissections (TBAD) using the Gore Conformable Thoracic Aortic Stent-graft (CTAG). Material/Methods From January 1997 to February 2014, a total of 90 out of 405 patients in our center received TEVAR for TBAD. Since November 2009, 23 patients (16 men; median age: 62 years) were treated with the CTAG. Indications were complicated aTBAD in 15 (65%) and expanding cTBAD in 8 (35%) patients. Primary endpoints were the assessment of device conformability by measuring the distance (D) from the radiopaque gold band marker (GM) at the proximal CTAG end to the inner curvature (IC) of the arch on parasagittal multiplanar reformations of CT angiography, as well as the evaluation of aortic diameter changes following TEVAR. Median follow-up was 13.3 months (range: 2 days to 35 months). Results Primary and secondary success rates were 91.3% (21/23) and 95.6% (22/23), respectively. There was 1 type Ia endoleak, retrograde dissection or primary conversion was not observed. Median GM-IC-D was 0 mm (range: 0 mm to 10 mm). GM-IC-D was associated with zone 2 placement compared to zone 3 (P=0.036). There was no association between GM-IC-D formation and arch type. In aTBAD cases the true lumen significantly increased after TEVAR (P=0.017) and the false lumen underwent shrinkage (P=0.025). In cTBAD patients the false lumen decreased after TEVAR (P=0.036). Conclusions The CTAG shows favorable conformability and wall apposition in challenging arch pathologies such as TBAD.
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Affiliation(s)
- Moritz S Bischoff
- Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Matthias Müller-Eschner
- Department of Radiodiagnostics and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Katrin Meisenbacher
- Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas S Peters
- Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Dittmar Böckler
- Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Heidelberg, Germany
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Biomechanical implications of excessive endograft protrusion into the aortic arch after thoracic endovascular repair. Comput Biol Med 2015; 66:235-41. [DOI: 10.1016/j.compbiomed.2015.09.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 09/01/2015] [Accepted: 09/14/2015] [Indexed: 12/12/2022]
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20
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Pasta S, Scardulla F, Rinaudo A, Raffa GM, D’Ancona G, Pilato M, Scardulla C. An In Vitro Phantom Study on the Role of the Bird-Beak Configuration in Endograft Infolding in the Aortic Arch. J Endovasc Ther 2015; 23:172-81. [DOI: 10.1177/1526602815611888] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose: To assess endograft infolding for excessive bird-beak configurations in the aortic arch in relation to hemodynamic variables by quantifying device displacement and rotation of oversized stent-grafts deployed in a phantom model. Methods: A patient-specific, compliant, phantom pulsatile flow model was reconstructed from a patient who presented with collapse of a Gore TAG thoracic endoprosthesis. Device infolding was measured under different flow and pressure conditions for 3 protrusion extensions (13, 19, and 24 mm) of the bird-beak configuration resulting from 2 TAG endografts with oversizing of 11% and 45%, respectively. Results: The bird-beak configuration with the greatest protrusion extension exhibited the maximum TAG device displacement (1.66 mm), while the lowest protrusion extension configuration led to the minimum amount of both displacement and rotation parameters (0.25 mm and 0.6°, respectively). A positive relationship was found between the infolding parameters and the flow circulating in the aorta and left subclavian artery. Similarly, TAG device displacement was positively and significantly (p<0.05) correlated with the pulse pressure for all bird-beak configurations and device sizes. However, no collapse was observed under chronic perfusion testing maintained for 30 days and pulse pressure of 100 mm Hg. Conclusion: These findings suggest that endograft infolding depends primarily on the amount of aortic pulsatility and flow rate and that physiological flows do not necessarily engender hemodynamic loads on the proximal bird-beak segment sufficient to cause TAG collapse. Hemodynamic variables may allow for identification of patients at high risk of endograft infolding and help guide preventive intervention to avert its occurrence.
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Affiliation(s)
- Salvatore Pasta
- Fondazione Ri.MED, Palermo, Italy
- Cardiac Surgery and Heart Transplantation Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
| | | | | | - Giuseppe Maria Raffa
- Cardiac Surgery and Heart Transplantation Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
| | - Giuseppe D’Ancona
- Cardiovascular Medicine Clinical and Research Unit, Vivantes Klinikum im Friedrichschein und Am Urban, Berlin, Germany
| | - Michele Pilato
- Cardiac Surgery and Heart Transplantation Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
| | - Cesare Scardulla
- Cardiac Surgery and Heart Transplantation Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
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22
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Endovascular repair for blunt thoracic aortic injury using the Zenith Alpha low-profile device. J Vasc Surg 2015; 62:1495-503.e1. [PMID: 26391458 DOI: 10.1016/j.jvs.2015.07.098] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 07/29/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The objective of this study was to report 30-day results from a prospective, nonrandomized, multicenter trial that evaluated the safety and effectiveness of the Zenith Alpha thoracic endovascular graft (Cook Medical, Bloomington, Ind) for treatment of blunt thoracic aortic injuries (BTAIs). METHODS Eligible patients with BTAIs (grade II to grade IV) in the descending thoracic aorta were treated with the Zenith Alpha device, which is available in smaller graft diameters (starting at 18 mm) and lower profile delivery systems (starting at 16F) than currently available thoracic endografts. The device (nitinol stents and polyester graft material) accommodates a tighter aortic curvature (radius of 20 mm) than the predicate Zenith TX2 Pro-Form. Follow-up clinical and imaging evaluations were performed at 30 days, at 6 and 12 months, and annually thereafter through 5 years. The primary end point was 30-day mortality. RESULTS Between January 2013 and May 2014, 50 patients (44 men; mean age, 43 ± 19 years; range, 18-89 years) were treated with the Zenith Alpha device at 17 U.S. sites. The mean Injury Severity Score was 31 ± 14 (range, 3-66). Technical success was achieved in 100% of patients, with 0% intraoperative mortality. Device access was entirely percutaneous in 22 patients (44%). Smaller size grafts (18-24 mm) were used in 15 patients (30%). The mean procedure time was 85 ± 44 minutes (range, 34-278 minutes), and mean blood loss was 103 ± 145 mL (range, 0-1000 mL). The 30-day mortality rate was 2%; one patient died 24 days after the procedure of respiratory failure related to associated injuries and not to the device or procedure as adjudicated by an independent Clinical Events Committee (CEC). One patient experienced a stroke 7 days after the procedure (cause undetermined by the CEC), and one patient underwent reintervention for a site-reported proximal type I endoleak (core laboratory reported unknown endoleak type) at 30 days after the procedure. There have been no conversions to open surgical repair, paraplegia, or aortic rupture within 30 days. CONCLUSIONS Short-term results indicate that the Zenith Alpha thoracic endovascular graft appears safe and effective for the treatment of BTAIs. This low-profile device enables complete percutaneous repair in a large percentage of patients and can achieve high rates of technical success and very low rates of aortic injury-related mortality within 30 days.
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Li Y, Zhang T, Guo W, Duan C, Wei R, Ge Y, Jia X, Liu X. Endovascular chimney technique for juxtarenal abdominal aortic aneurysm: a systematic review using pooled analysis and meta-analysis. Ann Vasc Surg 2015; 29:1141-50. [PMID: 26004962 DOI: 10.1016/j.avsg.2015.02.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 02/09/2015] [Accepted: 02/13/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND To evaluate the safety and efficacy of chimney endovascular abdominal aortic repair (Ch-EVAR) for juxtarenal abdominal aortic aneurysm. METHODS Electronic literature published between 2003 and 2014 were searched from MEDLINE and EMBASE online databases. Inclusion criteria for articles included that more than 3 patients were enrolled, chimney graft techniques were used, and the basic outcomes, such as indications, mortality within 30-day or during follow-up, complications, endoleaks, and branch vessel patency were collected. The data were pooled for analysis. Meta-analysis was performed using Stata version 11 and heterogeneity was estimated using Cochrane Q statistic and I(2) statistic. RESULTS In total, 12 electronic literature met the inclusion criteria and 236 patients (mean age, 73.9 years) undergone Ch-EVAR were collected. A total of 335 chimney grafts were implanted, including 288 to the renal arteries and 47 to superior mesenteric arteries. Mortality (<30 days) and mortality (during follow-up; a mean of 12 months) were 3.8% (9/236) and 10.6% (25/236), respectively. The rate of type I, II and III endoleaks during follow-up was 11.8% (28/236), 8.1% (19/236), and 0.4% (1/236), respectively. The chimney graft patency at 6 month was 96.6%. Meta-analysis showed that the rates of endoleaks (during follow-up), mortality (<30 days) and mortality (during follow-up) were 18%, 7% and 13%, respectively. CONCLUSIONS Chimney graft is an efficient therapy with high initial technical success rate and favorable rates for perioperative outcomes.
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Affiliation(s)
- Yue Li
- Clinical Division of Surgery, Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Tao Zhang
- Department of Vascular Surgery, Peking University People's Hospital, Beijing, People's Republic of China
| | - Wei Guo
- Clinical Division of Surgery, Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China.
| | - Chen Duan
- Clinical Division of Surgery, Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Ren Wei
- Clinical Division of Surgery, Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Yangyang Ge
- Clinical Division of Surgery, Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Xin Jia
- Clinical Division of Surgery, Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Xiaoping Liu
- Clinical Division of Surgery, Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China
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Kotelis D, Brenke C, Wörz S, Rengier F, Rohr K, Kauczor HU, Böckler D, von Tengg-Kobligk H. Aortic morphometry at endograft position as assessed by 3D image analysis affects risk of type I endoleak formation after TEVAR. Langenbecks Arch Surg 2015; 400:523-9. [PMID: 25702140 DOI: 10.1007/s00423-015-1291-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 02/12/2015] [Indexed: 10/24/2022]
Abstract
PURPOSE The purpose of this study was to identify morphologic factors affecting type I endoleak formation and bird-beak configuration after thoracic endovascular aortic repair (TEVAR). METHODS Computed tomography (CT) data of 57 patients (40 males; median age, 66 years) undergoing TEVAR for thoracic aortic aneurysm (34 TAA, 19 TAAA) or penetrating aortic ulcer (n = 4) between 2001 and 2010 were retrospectively reviewed. In 28 patients, the Gore TAG® stent-graft was used, followed by the Medtronic Valiant® in 16 cases, the Medtronic Talent® in 8, and the Cook Zenith® in 5 cases. Proximal landing zone (PLZ) was in zone 1 in 13, zone 2 in 13, zone 3 in 23, and zone 4 in 8 patients. In 14 patients (25%), the procedure was urgent or emergent. In each case, pre- and postoperative CT angiography was analyzed using a dedicated image processing workstation and complimentary in-house developed software based on a 3D cylindrical intensity model to calculate aortic arch angulation and conicity of the landing zones (LZ). RESULTS Primary type Ia endoleak rate was 12% (7/57) and subsequent re-intervention rate was 86% (6/7). Left subclavian artery (LSA) coverage (p = 0.036) and conicity of the PLZ (5.9 vs. 2.6 mm; p = 0.016) were significantly associated with an increased type Ia endoleak rate. Bird-beak configuration was observed in 16 patients (28%) and was associated with a smaller radius of the aortic arch curvature (42 vs. 65 mm; p = 0.049). Type Ia endoleak was not associated with a bird-beak configuration (p = 0.388). Primary type Ib endoleak rate was 7% (4/57) and subsequent re-intervention rate was 100%. Conicity of the distal LZ was associated with an increased type Ib endoleak rate (8.3 vs. 2.6 mm; p = 0.038). CONCLUSIONS CT-based 3D aortic morphometry helps to identify risk factors of type I endoleak formation and bird-beak configuration during TEVAR. These factors were LSA coverage and conicity within the landing zones for type I endoleak formation and steep aortic angulation for bird-beak configuration.
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Affiliation(s)
- Drosos Kotelis
- Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany,
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Pasta S, Raffa GM, D'Ancona G, Pilato M. Commentary: The bird-beak stent-graft configuration: the end of aortic arch endograft collapse? J Endovasc Ther 2014; 21:803-4. [PMID: 25453881 DOI: 10.1583/14-4778c.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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van Bogerijen GHW, Auricchio F, Conti M, Lefieux A, Reali A, Veneziani A, Tolenaar JL, Moll FL, Rampoldi V, Trimarchi S. Aortic Hemodynamics After Thoracic Endovascular Aortic Repair, With Particular Attention to the Bird-Beak Configuration. J Endovasc Ther 2014; 21:791-802. [DOI: 10.1583/14-4778mr.1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Malgor RD, Bilfinger TV, McCormack J, Tassiopoulos AK. Outcomes of blunt thoracic aortic injury in adolescents. Ann Vasc Surg 2014; 29:502-10. [PMID: 25463340 DOI: 10.1016/j.avsg.2014.10.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 10/04/2014] [Accepted: 10/09/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Blunt traumatic aortic injury (BTAI) is of very rare occurrence in adolescents. The purpose of our study was to assess the clinical presentation and treatment outcomes of BTAI in this subset of patients. METHODS We reviewed prospective data of 18 patients who were 20 years or younger with BTAI among 28,000 trauma patients from January 1993 to December 2011. Outcomes of interest were the trends on the type of repair (nonoperative [NOP], open repair [OR], or endovascular treatment [ET]) and the impact of concomitant injuries using the Injury Severity Score (ISS) on early morbidity and mortality. RESULTS Thirteen (72%) patients with BTAI were male with a cohort median age of 16 ± 3 years. The mechanism of trauma was car accident in 12 patients, pedestrian struck by car in 5, and motorcycle crash in 1. The total ISS was 46.2 ± 15.3 being the highest score of the thoracic component (4.6 ± 0.6) followed by the head score (4 ± 1.2). Two (11%) patients were pronounced dead in the emergency department and other 2 succumbed within 24 hr from admission. Of those 14 (78%) patients who survived longer than 24 hr, the ISS was significantly lower compared with those pronounced dead earlier (37.8 ± 10.7 vs. 59.6 ± 11.6; P = 0.0009). Ten patients (71%) underwent OR, 3 (17%) ET, and other 2 (28%) patients were treated nonoperatively. The ISS was similar among all 3 treatment groups (OR: 33 ± 8 vs. ET: 53 ± 9 vs. NOP: 51 ± 6; P = nonsignificant). No paraplegia or renal failure was noted in either ET or OR group. In-hospital and overall mortality were 21% and 39%. Of those who survived hospitalization, 8 (73%) patients were discharged home and 3 (27%) to a rehabilitation center. CONCLUSIONS The incidence of BTAI is very low in adolescents. Mortality rate is considerable even in young patients and it is associated with high ISS and degree of aortic wall disruption. Young patients with BTAI who survive hospitalization have a lower ISS and are often discharged home rather than to a rehabilitation facility.
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Affiliation(s)
- Rafael D Malgor
- Division of Vascular Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY.
| | - Thomas V Bilfinger
- Division of Cardiothoracic Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY
| | - Jane McCormack
- Division of Trauma/Surgical Critical Care, Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY
| | - Apostolos K Tassiopoulos
- Division of Vascular Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY
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Malgor RD, Bilfinger TV. Left Subclavian Artery Occlusion During Blunt Thoracic Aortic Injury Endovascular Repair. Ann Thorac Surg 2014; 98:386. [DOI: 10.1016/j.athoracsur.2014.01.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Revised: 12/14/2013] [Accepted: 01/10/2014] [Indexed: 10/25/2022]
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Abstract
US FDA approval of the conformable Gore TAG thoracic endoprosthesis for multiple indications including aneurysm, traumatic transection and Type B dissection marks significant progress in minimally invasive therapies for the treatment of complex, life-threatening thoracic aortic pathology. This second generation device, with its enhanced flexibility and conformability, is providing improvements in both short- and long-term outcomes for many patients who may otherwise be denied life-saving treatment for thoracic aortic pathology.
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Affiliation(s)
- Mark D Morasch
- St. Vincent Heart and Vascular center, Northwestern University, 2900 12th Avenue N, Suite 400E, Billings, MT 59101, USA
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Alberta HB, Secor JL, Smits TC, Farber MA, Jordan WD, Azizzadeh A, Rovin JD, Matsumura JS. Comparison of thoracic aortic diameter changes after endograft placement in patients with traumatic and aneurysmal disease. J Vasc Surg 2014; 59:1241-6. [DOI: 10.1016/j.jvs.2013.11.075] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 11/08/2013] [Accepted: 11/16/2013] [Indexed: 11/28/2022]
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