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Yammine H, Frederick JR, Alegria J, Madjarov JM, Clemons GA, Arko SJ, Thorne TD, Arko FR. Thoracic Stent Grafts Induce Persistent Aortic Remodeling in Aortic Coarctation. Ann Vasc Surg 2024; 108:1-9. [PMID: 38838987 DOI: 10.1016/j.avsg.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND This study's objective is to describe outcomes of adult patients who underwent thoracic stent graft placement treatment for primary or recurrent aortic coarctation. METHODS This is a retrospective study of 30 adult patients who underwent thoracic stent graft placement for aortic coarctation at our institution. Average age was 46.5 years, with 53.3% of patients presented with no prior treatment or repair for coarctation. Indications for repair included gradient ≥20 mm Hg with anatomic evidence of coarctation on imaging with left ventricular hypertrophy, pseudoaneurysm, aneurysm, refractory hypertension, or claudication. Stent grafts used for repair included MDT (Medtronic, Santa Rosa, CA) and GORE TAG (W. L. Gore & Associates, Flagstaff, AZ). RESULTS Patients were observed for a median of 979 days, with one death during the study. All patients had complete resolution of symptoms with no recurrences. Thoracic endovascular aortic repair significantly reduced the gradient across the coarctation (P < 0.0001). Aortic coarctation diameter significantly increased at 30 days postoperatively and continued to increase up to 5 years posttreatment. At 3+ years, aortic remodeling was observed at the coarctation site and surrounding regions. At 30 days, systolic, diastolic, and mean arterial pressure were all reduced. Systolic and diastolic blood pressure and mean arterial pressure continued to significantly improve 1-year posttreatment. CONCLUSIONS Stent grafts are a safe and effective treatment for aortic coarctation. We observed a clinically significant improvement in blood pressure and longitudinal aortic remodeling of the coarctation segment and the entire aorta that persisted more than more than 3 years.
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Affiliation(s)
- Halim Yammine
- Atrium Health, Sanger Heart and Vascular Institute, Charlotte, NC.
| | - John R Frederick
- Atrium Health, Sanger Heart and Vascular Institute, Charlotte, NC
| | - Jorge Alegria
- Atrium Health, Sanger Heart and Vascular Institute, Charlotte, NC
| | - Jeko M Madjarov
- Atrium Health, Sanger Heart and Vascular Institute, Charlotte, NC
| | | | - Stephen J Arko
- Atrium Health, Sanger Heart and Vascular Institute, Charlotte, NC
| | - Tre D Thorne
- Atrium Health, Sanger Heart and Vascular Institute, Charlotte, NC
| | - Frank R Arko
- Atrium Health, Sanger Heart and Vascular Institute, Charlotte, NC
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Clark AJ, Drullinsky D, Pradella M, Mehta CK. Aortic arch and frozen elephant trunk repair of a right-sided aortic arch with pseudoaneurysm rupture. J Vasc Surg Cases Innov Tech 2023; 9:101258. [PMID: 37520168 PMCID: PMC10382922 DOI: 10.1016/j.jvscit.2023.101258] [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: 03/04/2023] [Accepted: 06/05/2023] [Indexed: 08/01/2023] Open
Abstract
A 53-year-old man with a history of vascular ring repair secondary to a right-sided aortic arch with a retroesophageal subclavian artery and ligamentum arteriosum to the descending thoracic aorta presented to our institution with a large aortic pseudoaneurysm of the distal aortic arch. Computed tomography demonstrated a right-sided aortic arch with a 5.8-cm pseudoaneurysm arising from the distal arch with concern for rupture. The patient underwent successful two-stage repair, including a left carotid artery to subclavian artery bypass, followed by total arch replacement with the frozen elephant trunk technique. He recovered well postoperatively, and computed tomography showed complete, successful repair of the pseudoaneurysm.
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Affiliation(s)
- Aaron J. Clark
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - David Drullinsky
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Maurice Pradella
- Department of Radiology, Northwestern Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Christopher K. Mehta
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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Di Domenico R, Fargion AT, Speziali S, Petroni R, Villani F, Esposito D, Pratesi C. Hybrid Surgical Approach to a Giant Post-Coarctation Aortic Aneurysm. J Endovasc Ther 2021; 28:961-964. [PMID: 34392728 DOI: 10.1177/15266028211032954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To report a rare case of giant aortic coarctation (CoA)-related descending thoracic aneurysmal degeneration, complicated by an acute aortic dissection. CASE REPORT A 57-year-old man referred with acute chest pain to the emergency department. A computed tomography angiography (CTA) revealed a CoA with a giant post-stenotic descending thoracic aneurysm (14 cm) and a concomitant left subclavian artery (LSA) aneurysm, complicated by an acute type B aortic dissection. A single-stage hybrid procedure was planned in an urgent setting. Initially, a left common carotid-to-left subclavian artery (LCCA-LSA) bypass was performed to gain a suitable proximal landing zone, the procedure was then completed with 3 thoracic endografts and 1 aortic dissection stent through a percutaneous femoral approach. The patient was discharged in postoperative day 8th without complications; the CTA performed at 1 month demonstrated patency of supra-aortic and visceral vessels, dilation of CoA site and exclusion of the false lumen. CONCLUSIONS CoA is a congenital malformation rarely found in adults that may represent a challenge for the surgeon, especially when combined with a complication like an acute aortic dissection. This case shows that a hybrid approach is a safe and feasible treatment option even in such complex anatomies.
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Affiliation(s)
| | | | - Sara Speziali
- Department of Vascular Surgery, University of Florence, Florence, Italy
| | - Rachele Petroni
- Department of Vascular Surgery, University of Florence, Florence, Italy
| | - Flavio Villani
- Department of Vascular Surgery, University of Florence, Florence, Italy
| | - Davide Esposito
- Department of Vascular Surgery, University of Florence, Florence, Italy
| | - Carlo Pratesi
- Department of Vascular Surgery, University of Florence, Florence, Italy
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Goto T, Nishi H, Kitahara M, Sakakibara S, Kakizawa Y. Successful hybrid TEVAR for distal anastomotic pseudoaneurysm and coarctation following previous palliative left subclavian artery to descending aorta bypass: A case report. Int J Surg Case Rep 2020; 74:124-127. [PMID: 32836206 PMCID: PMC7452679 DOI: 10.1016/j.ijscr.2020.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/24/2020] [Accepted: 08/03/2020] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Anastomotic pseudoaneurysm is one of the most common but catastrophic complications in coarctation of the aorta (CoA); this is equally true even if the initial surgery is not directly related to the coarctation. Redo open heart surgery is usually required for the pseudoaneurysm; however, redo surgery remains challenging with high morbidity and mortality rates. PRESENTATION OF CASE A 38-year-old woman with CoA, who had undergone left subclavian artery (LSCA) to descending aorta bypass 21 years prior, was referred to us for the treatment of distal anastomotic pseudoaneurysm. Zone 2 thoracic endovascular aortic repair (TEVAR) with LSCA debranching was performed to exclude the distal anastomotic pseudoaneurysm and expand the CoA using a stent graft. The patient completely recovered and resumed work without delay. DISCUSSION In patients who require surgical treatment for both pseudoaneurysm and CoA, hybrid TEVAR can be an alternative surgical option instead of conventional open repair. CONCLUSION TEVAR for concomitant pseudoaneurysm and native CoA is feasible and less invasive, especially for young patients who have to resume work early after surgery.
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Affiliation(s)
- Takasumi Goto
- Department of Cardiovascular Surgery, Osaka General Medical Center, Osaka, Japan
| | - Hiroyuki Nishi
- Department of Cardiovascular Surgery, Osaka General Medical Center, Osaka, Japan.
| | - Mutsunori Kitahara
- Department of Cardiovascular Surgery, Osaka General Medical Center, Osaka, Japan
| | - Satoshi Sakakibara
- Department of Cardiovascular Surgery, Osaka General Medical Center, Osaka, Japan
| | - Yumi Kakizawa
- Department of Cardiovascular Surgery, Osaka General Medical Center, Osaka, Japan
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Kim HM, Cho YK, Kim JH, Seo TS, Song MG, Jeon YS, Cho SB, Im NY. Clinical Outcomes of the Seal® Thoracic Stent Graft for Traumatic Aortic Injury in a Korean Multicenter Retrospective Study. Ann Vasc Surg 2019; 61:400-409. [PMID: 31394246 DOI: 10.1016/j.avsg.2019.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 05/24/2019] [Accepted: 06/03/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Thoracic endovascular aneurysm repair (TEVAR) has been used as a primary treatment for blunt traumatic aortic injury (TAI). However, the outcomes of midterm surveillance of Seal® stent-graft durability for TAI have not been extensively studied. Thus, we aimed to report the midterm outcomes of TEVAR using the Seal® stent graft for blunt TAI. METHODS Patients with blunt TAI treated with TEVAR using the Seal® thoracic stent graft between 2007 and 2013 in Korea were included. Midterm outcomes included technical/clinical success, in-hospital death, aorta/procedure/device-related adverse events, secondary procedures, and 30-day and all-cause mortality. RESULTS A total of 99 patients (54% men; mean age, 48 years) were included. Grade III or higher injuries were present in 95% of patients, including 15 free ruptures of the thoracic aorta, and 64% of injuries were located in zone III. The median procedure and hospitalization duration were 90 min and 11 days, respectively. The technical success rate was 98%. The number of in-hospital mortalities (n = 8) and stroke (n = 2) were observed at 30 days. Late stroke and paraplegia (>30 days) were not observed during the mean 49 ± 26 months of follow-up (median, 48 months; range, 0-117 months). There were no aorta-related mortalities or conversions to open repair. Secondary procedures were performed in 8 patients, all of which were carotid-subclavian bypasses for delayed left subclavian occlusion. The all-cause mortality rate was 5% at 30 days and 8% at 1 year. The survival rate was 95% at 30 days, 92% at 1 year, 92% at 3 years, and 89% at 5 years. One type Ia endoleak occurred at 18 months after the procedure. CONCLUSIONS TEVAR with the Seal® stent graft for TAI showed favorable midterm outcomes. The incidence of major adverse events after the procedure was low.
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Affiliation(s)
- Han Myun Kim
- Department of Radiology, Kangnam Seong-Sim Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Young Kwon Cho
- Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, Seoul, Korea.
| | - Jeong Ho Kim
- Department of Radiology, Gachon University Gil Hospital, Gachon University College of Medicine, Incheon, Korea
| | - Tae-Seok Seo
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Myung Gyu Song
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Yong Sun Jeon
- Department of Radiology, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| | - Sung Bum Cho
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Nam Yeul Im
- Department of Radiology, Chonnam National University Hospital, Chonnam National University College of Medicine, Gwangju-si, Korea
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Beckmann E, Jassar AS. Coarctation repair-redo challenges in the adults: what to do? J Vis Surg 2018; 4:76. [PMID: 29780722 DOI: 10.21037/jovs.2018.04.07] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 04/02/2018] [Indexed: 01/06/2023]
Abstract
Aortic coarctation is one of the most common congenital cardiac pathologies. Repair of native aortic coarctation is nowadays a common and safe procedure. However, late complications, including re-coarctation and aneurysm formation, are not uncommon. The incidence of these complications is dependent on the type of the initial operation. Both endovascular and conventional open repair play important roles in the treatment of late complications after previous coarctation repair. This article will review the incidence of late complications after coarctation repair and will discuss the treatment options for redo coarctation repair in adult patients.
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Affiliation(s)
- Erik Beckmann
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Arminder S Jassar
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Noly PE, Legris-Falardeau V, Ibrahim R, El-Hamamsy I, Cartier R, Lamarche Y, Bouchard D, Dorval JF, Poirier N, Demers P. Results of a multimodal approach for the management of aortic coarctation and its complications in adults. Interact Cardiovasc Thorac Surg 2017; 25:335-342. [DOI: 10.1093/icvts/ivx039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 01/23/2017] [Indexed: 01/23/2023] Open
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Nauta FJH, van Bogerijen GHW, Trentin C, Conti M, Auricchio F, Moll FL, van Herwaarden JA, Trimarchi S. Impact of Thoracic Endovascular Aortic Repair on Pulsatile Circumferential and Longitudinal Strain in Patients With Aneurysm. J Endovasc Ther 2017; 24:281-289. [DOI: 10.1177/1526602816687086] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To quantify both pulsatile longitudinal and circumferential aortic strains before and after thoracic endovascular aortic repair (TEVAR), potentially clarifying TEVAR-related complications. Methods: This retrospective study assessed the impact of TEVAR on pulsatile aortic strains through custom developed software and cardiac-gated computed tomography imaging of 8 thoracic aneurysm patients (mean age 71.0±8.2 years; 6 men) performed before TEVAR and during follow-up (median 0.1 months, interquartile range 0.1–5.8). Lengths of the ascending aorta, the aortic arch, and the descending aorta were measured. Diameters and areas were computed at the sinotubular junction, brachiocephalic trunk, left subclavian artery, and the celiac trunk. Pulsatile longitudinal and circumferential strains were quantified as systolic increments of length and circumference divided by the corresponding diastolic values. Results: Average pulsatile longitudinal strain ranged from 1.4% to 7.1%, was highest in the arch (p<0.001), and increased after TEVAR by 77% in the arch (7.1%±2.5% vs 12.5%±5.1%, p=0.04) and by 69% in the ascending aorta (5.6±2.3% vs 9.4±4.4%, p=0.06). Average pulsatile circumferential strain ranged from 3.6% to 5.0% before TEVAR and did not differ significantly throughout the thoracic aorta; there was a nonsignificant increase after TEVAR at the unstented sinotubular junction (5.0%±1.4% vs 6.3%±1.0%, p=0.18), with a significant increase at the celiac trunk (3.6%±1.8% vs 6.2%±1.8%, p=0.02). Pulsatile circumferential strains within stented segments were deemed unreliable due to image artifacts. Conclusion: TEVAR was associated with an increase of pulsatile longitudinal strains (in the arch) and circumferential strains (at the celiac trunk) in unstented aortic segments. These observations suggest increased pulsatile wall stress after TEVAR in segments adjacent to the device, which may contribute to the understanding of stent-graft–related complications such as retrograde dissection, aneurysm formation, and rupture.
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Affiliation(s)
- Foeke J. H. Nauta
- Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Italy
- Department of Vascular Surgery, University Medical Center Utrecht, the Netherlands
| | - Guido H. W. van Bogerijen
- Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Italy
- Department of Vascular Surgery, University Medical Center Utrecht, the Netherlands
| | - Chiara Trentin
- Istituto Universitario di Studi Superiori di Pavia (IUSS), Pavia, Italy
| | - Michele Conti
- Department of Civil Engineering and Architecture, Structural Mechanics Division, University of Pavia, Italy
| | - Ferdinando Auricchio
- Istituto Universitario di Studi Superiori di Pavia (IUSS), Pavia, Italy
- Department of Civil Engineering and Architecture, Structural Mechanics Division, University of Pavia, Italy
| | - Frans L. Moll
- Department of Vascular Surgery, University Medical Center Utrecht, the Netherlands
| | | | - Santi Trimarchi
- Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Italy
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Nauta FJH, Kamman AV, Ibrahim ESH, Agarwal PP, Yang B, Kim K, Williams DM, van Herwaarden JA, Moll FL, Eagle KA, Trimarchi S, Patel HJ, Figueroa CA. Assessment of CardiOvascular Remodelling following Endovascular aortic repair through imaging and computation: the CORE prospective observational cohort study protocol. BMJ Open 2016; 6:e012270. [PMID: 27856475 PMCID: PMC5128949 DOI: 10.1136/bmjopen-2016-012270] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Thoracic aortic stent grafts are orders of magnitude stiffer than the native aorta. These devices have been associated with acute hypertension, elevated pulse pressure, cardiac remodelling and reduced coronary perfusion. However, a systematic assessment of such cardiovascular effects of thoracic endovascular aortic repair (TEVAR) is missing. The CardiOvascular Remodelling following Endovascular aortic repair (CORE) study aims to (1) quantify cardiovascular remodelling following TEVAR and compare echocardiography against MRI, the reference method; (2) validate computational modelling of cardiovascular haemodynamics following TEVAR using clinical measurements, and virtually assess the impact of more compliant stent grafts on cardiovascular haemodynamics; and (3) investigate diagnostic accuracy of ECG and serum biomarkers for cardiac remodelling compared to MRI. METHODS AND ANALYSIS This is a prospective, nonrandomised, observational cohort study. We will use MRI, CT, echocardiography, intraluminal pressures, ECG, computational modelling and serum biomarkers to assess cardiovascular remodelling in two groups of patients with degenerative thoracic aneurysms or penetrating aortic ulcers: (1) patients managed with TEVAR and (2) control patients managed with medical therapy alone. Power analysis revealed a minimum total sample size of 20 patients (α=0.05, power=0.97) to observe significant left ventricular mass increase following TEVAR after 1 year. Consequently, we will include 12 patients in both groups. Advanced MRI sequences will be used to assess myocardial and aortic strain and distensibility, myocardial perfusion and aortic flow. ECG, echocardiography and serum biomarkers will be collected and compared against the imaging data. Computational models will be constructed from each patient imaging data, analysed and validated. All measurements will be collected at baseline (prior to TEVAR) and 1-year follow-up. The expected study period is 3 years. ETHICS AND DISSEMINATION This study has been approved by the University of Michigan IRB. The results will be disseminated through scientific journals and conference presentations. TRIAL REGISTRATION NUMBER NCT02735720.
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Affiliation(s)
- Foeke J H Nauta
- Cardiovascular Center, University of Michigan Health System, Ann Arbor, Michigan, USA
- Department of Vascular Surgery, Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Milan, Italy
| | - Arnoud V Kamman
- Cardiovascular Center, University of Michigan Health System, Ann Arbor, Michigan, USA
- Department of Vascular Surgery, Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Milan, Italy
| | - El-Sayed H Ibrahim
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Prachi P Agarwal
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Bo Yang
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Karen Kim
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - David M Williams
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Joost A van Herwaarden
- Department of Vascular Surgery, University of Utrecht, Utrecht, Midden-Nederland, The Netherlands
| | - Frans L Moll
- Department of Vascular Surgery, University of Utrecht, Utrecht, Midden-Nederland, The Netherlands
| | - Kim A Eagle
- Cardiovascular Center, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Santi Trimarchi
- Department of Vascular Surgery, Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Milan, Italy
| | - Himanshu J Patel
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - C Alberto Figueroa
- Departments of Biomedical Engineering and Surgery, University of Michigan, Ann Arbor, Michigan, USA
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Galiñanes EL, Krajcer Z. Most Coarctations, Recoarctations, and Coarctation-Related Aneurysms Should Be Treated Endovascularly. AORTA (STAMFORD, CONN.) 2016. [PMID: 27069944 DOI: 10.12945/j.aorta.2015.14-049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
For patients with coarctation of the aorta (CoA), surgical intervention results in an overall survival rate nearly twice that of medical management. Therefore, surgical correction of CoA has traditionally been warranted in the majority of patients, even though open repair entails its own complications. With the advent of endovascular technology, many interventionalists hoped that this approach would decrease the complications associated with open surgical repair of CoA. Nevertheless, there is still an ongoing debate about the merits of traditional open surgery versus endovascular therapy. In this review, we discuss the role of these two approaches for the management of CoA, recoarctation, and coarctation-related aneurysms.
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Affiliation(s)
- Edgar Luis Galiñanes
- Department of Cardiovascular Surgery, Texas Heart Institute, Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Houston, Texas, USA
| | - Zvonimir Krajcer
- Department of Cardiology, Texas Heart Institute, Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
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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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Brunkwall S, Ahmad W, Mylonas S, Sharkawy M, Wippermann J, Brunkwall J. The Ascending Aorta as an Exit Site for a Through-and-Through Wire in TEVAR. J Endovasc Ther 2015; 22:934-7. [PMID: 26394811 DOI: 10.1177/1526602815607441] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To describe a technique for trans-ascending aorta through-and-through guidewire placement for thoracic endograft advancement and deployment. CASE REPORT A 55-year-old man presented with a symptomatic pseudoaneurysm of the distal aortic arch after aortic coarctation open repair. He had also undergone mechanical aortic valve replacement. Planned were a left-sided carotid-subclavian bypass and a thoracic endovascular aortic repair with a chimney graft to the left common carotid artery. After carotid-subclavian bypass, efforts to retrograde cannulate the aortic arch and advance the thoracic endograft were unsuccessful. Because of the mechanical heart valve, no transapical approach could be used. Access to the ascending aorta was gained through a midline sternotomy. A through-and-through wire was positioned from the ascending aorta to femoral artery, which provided the required stability for advancement of the thoracic endograft. Six-month computed tomography documented patent endografts and carotid-subclavian bypass and no evidence of endoleak. CONCLUSION A trans-ascending aorta through-and-through guidewire is a feasible adjunct that can be added to the endovascular armamentarium when transcardiac or transbrachial approaches are impossible or ineffective.
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Affiliation(s)
- Silke Brunkwall
- Department of Vascular and Endovascular Surgery, University of Cologne, Germany
| | - Wael Ahmad
- Department of Vascular and Endovascular Surgery, University of Cologne, Germany
| | - Spyridon Mylonas
- Department of Vascular and Endovascular Surgery, University of Cologne, Germany
| | - Mohamed Sharkawy
- Department of Surgery, Kasr El Aini Hospital, Faculty of Medicine, Cairo, Egypt
| | - Jens Wippermann
- Department of Cardiovascular Surgery, University of Cologne, Germany
| | - Jan Brunkwall
- Department of Vascular and Endovascular Surgery, University of Cologne, Germany
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Galiñanes EL, Krajcer Z. Most Coarctations, Recoarctations, and Coarctation-Related Aneurysms Should Be Treated Endovascularly. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2015; 3:136-9. [PMID: 27069944 DOI: 10.12945/j.aorta.2015.14.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 07/24/2015] [Indexed: 11/18/2022]
Abstract
For patients with coarctation of the aorta (CoA), surgical intervention results in an overall survival rate nearly twice that of medical management. Therefore, surgical correction of CoA has traditionally been warranted in the majority of patients, even though open repair entails its own complications. With the advent of endovascular technology, many interventionalists hoped that this approach would decrease the complications associated with open surgical repair of CoA. Nevertheless, there is still an ongoing debate about the merits of traditional open surgery versus endovascular therapy. In this review, we discuss the role of these two approaches for the management of CoA, recoarctation, and coarctation-related aneurysms.
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Affiliation(s)
- Edgar Luis Galiñanes
- Department of Cardiovascular Surgery, Texas Heart Institute, Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Houston, Texas, USA
| | - Zvonimir Krajcer
- Department of Cardiology, Texas Heart Institute, Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
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Bosanquet DC, Twine CP, Tang TY, Boyle JR, Bell RE, Bicknell CD, Jenkins MP, Loftus IM, Modarai B, Vallabhaneni SR. Pragmatic Minimum Reporting Standards for Thoracic Endovascular Aortic Repair. J Endovasc Ther 2015; 22:356-67. [DOI: 10.1177/1526602815584925] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- David C. Bosanquet
- South East Wales Regional Vascular Network, Royal Gwent Hospital, Newport, Wales, UK
| | - Christopher P. Twine
- South East Wales Regional Vascular Network, Royal Gwent Hospital, Newport, Wales, UK
| | - Tjun Y. Tang
- Department of General Surgery, Changi General Hospital, Singapore
| | - Jonathan R. Boyle
- Regional Vascular Unit, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
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