1
|
Xiang D, Chai B, Huang J, Liang H, Liang B, Zhao H, Zheng C. The Impact of Oversizing in Thoracic Endovascular Aortic Repair on Long-Term Outcomes in Uncomplicated Type B Aortic Dissection: A Single-Center Retrospective Study. J Endovasc Ther 2024; 31:862-872. [PMID: 37078474 DOI: 10.1177/15266028231166282] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
PURPOSE The purpose of this study was to assess the impact of oversizing in thoracic endovascular aortic repair (TEVAR) on early and long-term survival and major adverse events in patients with uncomplicated type B aortic dissection (TBAD). METHODS Between January 2010 and December 2018, 226 patients who were diagnosed with uncomplicated TBAD and received TEVAR were analyzed retrospectively. The patients were divided into ≤5% oversizing (n=153) and >5% oversizing (n=73) groups. Primary end points were all-cause and aortic-related mortalities. Secondary end points were procedure-related complications, including retrograde type A aortic dissection (RTAD), endoleak, distal stent-induced new entry (SINE), and late reintervention. All-cause and aortic-related mortalities were assessed using the Kaplan-Meier survival method, while procedure-related complications were evaluated using a competing risk model with all-cause death as a competing risk. RESULTS Mean oversizing was 2.1%±1.5% in the ≤5% oversizing group and 9.6%±4.1% in the >5% oversizing group. Differences in the 30-day mortality and adverse events between the 2 groups were statistically insignificant. The freedom from all-cause mortality was comparable between the ≤5% oversizing group and the >5% oversizing group (≤5%: 93.3% at 5 years, >5%: 92.3% at 5 years, p=0.957). No significant difference was observed between both groups in the freedom from aortic-related mortality (≤5%: 95.0% at 5 years, >5%: 96.7% at 5 years, p=0.928). However, the competing risk analyses revealed that the cumulative incidence of RTAD was statistically significantly greater in the >5% oversizing group than in the ≤5% oversizing group (≤5%: 1(0.7%) at 5 years, >5%: 6(6.9%) at 5 years, p=0.007). All RTADs occurred within a year of TEVAR. The differences in the cumulative incidences of type I endoleak, distal SINE, and late reintervention were not significant between the 2 groups. CONCLUSION The differences in the 5-year all-cause mortality and aortic-related mortality between patients with uncomplicated TBAD who received TEVAR with ≤5% oversizing and those who got TEVAR with >5% oversizing were insignificant. However, oversizing >5% was considerably associated with an increased risk of RTAD within a year of TEVAR, suggesting that oversizing ≤5% may be the appropriate size for TEVAR in patients with uncomplicated TBAD. CLINICAL IMPACT For patients with uncomplicated TBAD, choosing oversizing ≤5% in endovascular treatment is beneficial to reduce the risk of postoperative retrograde type A aortic dissection. This finding provides a basis for stent size selection in endovascular repair. In addition, one year after TEVAR is the main time period for postoperative retrograde type A aortic dissection, and attention should be paid to the management and follow-up of this period.
Collapse
Affiliation(s)
- Dongqiao Xiang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Bin Chai
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Jia Huang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Huimin Liang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Bin Liang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Huangxuan Zhao
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Chuansheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| |
Collapse
|
2
|
Hari Y, Takagi H. Urgent Thoracic Endovascular Aortic Repair for Type-B 0,D Acute Aortic Dissection. Ann Vasc Surg 2024; 109:1-8. [PMID: 39025222 DOI: 10.1016/j.avsg.2024.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/27/2024] [Accepted: 05/31/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND The objective of the present study is to clarify safety and efficacy of thoracic endovascular aortic repair (TEVAR), excluding the primary entry in the descending aorta, for type-B0,D acute aortic dissection (TB0,DAAD) (so-called retrograde type-A acute aortic dissection). METHODS Forty-six patients with hyperacute-phase (within 2 days after the onset) type-A acute aortic dissection (TAAAD) and TB0,DAAD underwent urgent (on the admission or next day) intervention (TEVAR or conventional surgical aortic repair [CSAR]) for 2 years. Results of TEVAR for TB0,DAAD were compared with those of CSAR for TAAAD. Outcomes included 30-day mortality, aortic reintervention, and major complications (stroke and paraplegia/paraparesis). Details of TEVAR were also analyzed. RESULTS Seven patients with TB0,DAAD and 39 patients with TAAAD underwent respectively urgent TEVAR and CSAR. Aortic reintervention was significantly more frequent in the TEVAR than CSAR group (28.6% vs. 0%, P < 0.01). There was no difference in incidence of death and stroke between the TEVAR and CSAR group. All the 7 patients survived and 5 of the 7 (71.4%) patients were relieved of aortic reintervention for 30 days following TEVAR. One patient, however, underwent aortic arch replacement on postoperative day (POD) 1 owing to the patent and nonshrinking ascending false lumen (FL). The entry existed in the aortic arch. Another patient underwent ascending and transverse aortic replacement with frozen elephant trunk on POD13 due to proximal stent graft-induced new entry irrespective of the thrombosed and shrinking ascending FL. Because of the patent and nonshrinking ascending FL, 1 patient underwent additional TEVAR for the residual entry in the distal descending thoracic aorta on POD33 and subsequently ascending aortic replacement 4 months later. No entry was detected in the ascending or transverse aorta. The ascending FL in the other 4 patients was thrombosed early, shrinking gradually, and disappeared at last following TEVAR. CONCLUSIONS Urgent TEVAR for TB0,DAAD may be alternative to CSAR in selected cases. Accurate diagnosis of the primary entry location on preinterventional computed tomography scans for exclusion of the entry and cautious selection and delivery of a stent graft to prevent stent graft-induced new entry or endoleak are requisite for success of the procedure, remodeling of the FL, and satisfactory prognosis.
Collapse
Affiliation(s)
- Yosuke Hari
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan; Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan; Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan.
| |
Collapse
|
3
|
Wang J, Bai Z, Chen B. A Systematic Review and Meta-Analysis of Current Evidence Related to the Impact of Endovascular Repair Timing on Prognosis of Acute Stanford Type B Aortic Dissection. Ann Vasc Surg 2024; 108:47-56. [PMID: 38960090 DOI: 10.1016/j.avsg.2024.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 04/10/2024] [Accepted: 04/22/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND The objective of this study was to determine whether thoracic endovascular aortic repair (TEVAR) timing is more beneficial in the acute phase (first 14 days) than in the subacute phase (14-90 days) for the administration of acute Stanford type B aortic dissection (TBAD). METHODS A comprehensive literature search was conducted in databases (EMBASE, PubMed and Cochrane Library) until December 2023 to identify studies reporting the results of TEVAR used for patients with acute TBAD. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated utilizing either the random-effects model or the fixed-effects model. RESULTS A total of 25 studies involving 4,827 individuals with TBAD (including 1,609 with subacute TBAD) met our selection criteria. Early results revealed a lower incidence of Ia endoleaks (OR, 1.55; 95% CI, 1.03-2.33; P = 0.04) and aortic ruptures (OR, 2.89; 95% CI, 0.98-8.50; P = 0.05) in subacute TBAD. Apart from these findings, there was little difference in other incidents between the 2 groups. Regarding late outcomes, we observed significantly higher rates of retrograde dissection (OR, 2.12; 95% CI, 1.04-4.34; P = 0.04), distal stent-induced new entry (OR, 2.39; 95% CI, 1.24-4.61; P = 0.009), and reintervention (OR, 1.45; 95% CI, 0.05-1.99; P = 0.02) in acute TBAD than in subacute TBAD, whereas no significant differences were found for other outcomes between the 2 groups. Also, TEVAR appeared to yield comparable results for false lumen thrombosis and true lumen regression in both groups. CONCLUSIONS Subacute TBAD repair with TEVAR demonstrates a more effective reduction in adverse event rates compared to immediate treatment in the acute phase.
Collapse
Affiliation(s)
- Jian Wang
- Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang University's Medical School, Hangzhou, Zhejiang, China.
| | - Zhixuan Bai
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Zhejiang University's Medical School, Hangzhou, Zhejiang, China
| | - Bing Chen
- Department of Vascular Surgery, The Second Affiliated Hospital of Zhejiang University's Medical School, Hangzhou, Zhejiang, China.
| |
Collapse
|
4
|
Li M, Ma T, Cai Y, Li J, Meng Z, Dong Z, Wang S. Numerical simulation of the distal stent graft-induced new entry after TEVAR. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2024; 40:e3819. [PMID: 38551141 DOI: 10.1002/cnm.3819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 02/16/2024] [Accepted: 03/19/2024] [Indexed: 05/15/2024]
Abstract
The study aimed to investigate the mechanical factors for distal stent graft-induced new entry (dSINE) in aortic dissection patients and discussed these factors in conjunction with aortic morphology. Two patients (one dSINE and one non-dSINE), with the same age, gender, and type of implanted stent, were selected, then aortic morphological parameters were calculated. In addition, the stent material parameters used by the patients were also fitted. Simulations were performed based on the patient's aortic model and the stent graft used. The true lumen segment at the distal stent graft was designated as the "dSINE risk zone," and mechanical parameters (maximum principal strain, maximum principal stress) were computed. When approaching the area with higher mechanical parameters in the dSINE risk zone, dSINE patient exhibited higher values and growth rates in mechanical parameters compared to non-dSINE patient. Furthermore, dSINE patient also presented larger aortic taper ratio, stent oversizing ratio, and expansion mismatch ratio of the distal true lumen (EMRDTR). The larger mechanical parameters and growth rates in dSINE patient corresponded to a greater aortic taper ratio, stent oversizing ratio, and EMRDTR. The failure of dSINE prediction by the stent tortuosity index indicated that mechanical parameters were the fundamental reasons for dSINE development.
Collapse
Affiliation(s)
- Meixuan Li
- Department of Aeronautics and Astronautics, Institute of Biomechanics, Fudan University, Shanghai, China
| | - Tao Ma
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, and National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Yunhan Cai
- Department of Aeronautics and Astronautics, Institute of Biomechanics, Fudan University, Shanghai, China
| | - Jianming Li
- Department of Aeronautics and Astronautics, Institute of Biomechanics, Fudan University, Shanghai, China
| | - Zhuangyuan Meng
- Department of Aeronautics and Astronautics, Institute of Biomechanics, Fudan University, Shanghai, China
| | - Zhihui Dong
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, and National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Shengzhang Wang
- Department of Aeronautics and Astronautics, Institute of Biomechanics, Fudan University, Shanghai, China
- Institute of Biomedical Engineering Technology, Academy of Engineering and Technology, Fudan University, Shanghai, China
| |
Collapse
|
5
|
Shimamoto T, Komiya T, Matsuo T. Diameter changes of the thoracic aorta caused by acute type B aortic dissection. Asian Cardiovasc Thorac Ann 2024; 32:91-96. [PMID: 38115679 DOI: 10.1177/02184923231221893] [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: 12/21/2023]
Abstract
BACKGROUND The impact of type B acute aortic dissection (TBAAD) on historical pre-TBAAD diameters of the thoracic aorta is rarely reported. The aim of this study was to assess the extent of changes in aortic diameters induced by dissection, measured with a computed tomography (CT) scan obtained before and after TBAAD. METHODS Between January 2004 and December 2014, CT angiography of 50 non-Marfan patients with nonbicuspid aortic valves diagnosed with TBAAD were compared to historical CTs on file. RESULTS The ascending aorta and proximal arch showed negligible change. The proximal, mid, and distal aorta diameters changed compared with predissected values (107.7 ± 4.8%, 109.3 ± 4.9%, and 105.7 ± 5.8%, respectively). Neither sex, false lumen status, or mural calcification, nor prior thoracoabdominal aortic ectasia, correlated with the diameter change. Age ≥80 years in the proximal descending aorta did correlate with the diameter change (110.7 ± 4.0% vs 106.1 ± 4.6% p = 0.01). CONCLUSIONS Although identifying predicting factors for an aortic diameter increase all along with the thoracic aorta was still challenging, the degree of diameter change by aortic dissection was 105.7% to 109.3% in descending thoracic aorta, most prominent in middle descending aorta.
Collapse
Affiliation(s)
- Takeshi Shimamoto
- Department of Cardiovascular Surgery, Hamamatsu Rosai Hospital, Shizuoka, Japan
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Okayama, Japan
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Okayama, Japan
| | - Takeshiko Matsuo
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Okayama, Japan
| |
Collapse
|
6
|
Nomura Y, Kawasaki R, Koide Y, Okada T, Yasumori K, Sakamoto T, Tanaka H, Murakami H. Aortic Remodeling After Thoracic Endovascular Aortic Repair for Nonacute Uncomplicated Type B Aortic Dissection. Ann Vasc Surg 2024; 99:209-216. [PMID: 37805171 DOI: 10.1016/j.avsg.2023.07.111] [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: 06/06/2023] [Revised: 07/19/2023] [Accepted: 07/30/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND Entry closure with thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection (TBAD) results in aortic remodeling recently. This study aimed to evaluate the relationship between aortic diameter or timing of surgical intervention from onset and remodeling after TEVAR for uncomplicated nonacute TBAD. METHODS Between April 2014 and December 2021, 83 consecutive patients underwent TEVAR for TBAD at our center. Forty patients with subacute and chronic uncomplicated TBADs with a patent false lumen, who could be followed up for at least 6 months, were included in this study. Indications for TEVAR included aortic diameter enlargement and preemptive treatment to prevent future aneurysmal changes in patients at risk of aortic diameter enlargement. Aortic remodeling was accessed, and data between the remodeling and nonremodeling groups were compared. RESULTS The technical success rate was 97.5%, with a type Ia endoleak remaining in 1 patient. No operative or in-hospital mortality occurred. Paraparesis occurred in only 1 patient (2.5%). Follow-up was completed at a median of 53.5 months. Late death occurred in 3 cases, but there were no aortic-related deaths. Late aortic remodeling was achieved in 22 patients (55%). The preoperative maximum aortic diameter (PMAD) in the thoracic aortic region was 51.5 mm in the nonremodeling group, significantly larger than 42.5 mm in the remodeling group (P < 0.0001). The cutoff value of the PMAD for predicting aortic remodeling was 45 mm (area under the curve, 0.917; P = 0.028). The remodeling group had an earlier time from onset to intervention than the nonremodeling group, with a cutoff value of 6.3 months (area under the curve, 0.743; P = 0.021). CONCLUSIONS TEVAR for nonacute uncomplicated TBAD resulted in a late aortic remodeling rate of 55%. This study suggested that a PMAD of >45 mm or a period >6.3 months between dissection onset and surgery hinders aortic remodeling after TEVAR.
Collapse
Affiliation(s)
- Yoshikatsu Nomura
- Department of Cardiovascular Surgery, Hyogo Prefectural Harima-Himeji General Medical Center, Himeji, Hyogo, Japan.
| | - Ryota Kawasaki
- Department of Radiology, Hyogo Prefectural Harima-Himeji General Medical Center, Himeji, Hyogo, Japan
| | - Yutaka Koide
- Department of Radiology, Hyogo Prefectural Harima-Himeji General Medical Center, Himeji, Hyogo, Japan
| | - Tasuku Okada
- Department of Cardiovascular Surgery, Hyogo Prefectural Harima-Himeji General Medical Center, Himeji, Hyogo, Japan
| | - Ken Yasumori
- Department of Cardiovascular Surgery, Hyogo Prefectural Harima-Himeji General Medical Center, Himeji, Hyogo, Japan
| | - Toshihito Sakamoto
- Department of Cardiovascular Surgery, Hyogo Prefectural Harima-Himeji General Medical Center, Himeji, Hyogo, Japan
| | - Hiroshi Tanaka
- Department of Cardiovascular Surgery, Hyogo Prefectural Harima-Himeji General Medical Center, Himeji, Hyogo, Japan
| | - Hirohisa Murakami
- Department of Cardiovascular Surgery, Hyogo Prefectural Harima-Himeji General Medical Center, Himeji, Hyogo, Japan
| |
Collapse
|
7
|
Li X, Zhang Y, Sun Z, Wang H, Zhang C, Cui Y, Jiang W. Prevention of distal stent graft-induced new entry after endovascular repair for type B aortic dissection: A retrospective cohort study. J Thorac Cardiovasc Surg 2024; 167:28-38.e8. [PMID: 35249759 DOI: 10.1016/j.jtcvs.2022.01.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 01/06/2022] [Accepted: 01/28/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Distal stent graft-induced new entry (dSINE) can occur after thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD). In this study we aimed to compare the effectiveness of restrictive bare stent (RBS), tapered stent graft (TSG), and non-TSG in TEVAR in preventing dSINE after a midterm follow-up. METHODS This retrospective cohort study included patients with TBAD who underwent TEVAR (June 2010 to December 2018). The occurrence of dSINE during follow-up was examined. Predictors of dSINE were determined using Fine-Gray regression with death as the competing event. Survival was evaluated using Cox proportional hazards regression. RESULTS Finally, 364 patients were included: 111 with non-TSG TEVAR, 125 with TSG TEVAR, and 128 with TEVAR with RBS. After 54.5 months, incidences of dSINE in the 3 groups were 12.61%, 4.80%, and 1.56%, respectively (P = .002). On Fine-Gray regression adjusted for clinically relevant covariates, the expansion mismatch ratio (subdistribution hazard ratio, 1.09; 95% CI, 1.07-1.12; P < .001) and complete false lumen thrombosis (subdistribution hazard ratio, 0.35; 95% CI, 0.13-0.94; P = .037) were identified as predictors of dSINE. The Cox proportional hazards regression analysis revealed that dSINE was not only a risk factor for aortic-related mortality (hazard ratio, 17.90; 95% CI, 3.27-98.12; P = .001), but also a predominant risk factor for all-cause mortality (hazard ratio, 4.91; 95% CI, 1.66-14.52; P = .004). CONCLUSIONS dSINE can happen in TBAD patients who undergo TEVAR. Thus, long-term surveillance is crucial. TSG and RBS had lower expansion mismatch ratios, which might help prevent dSINE.
Collapse
Affiliation(s)
- Xianwei Li
- Department of Vascular Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, People's Republic of China
| | - Yingnan Zhang
- Department of Vascular Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, People's Republic of China
| | - Zhanfeng Sun
- Department of Vascular Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, People's Republic of China
| | - Haitao Wang
- Department of Vascular Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, People's Republic of China
| | - Chuanqi Zhang
- Department of Vascular Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, People's Republic of China
| | - Yunfu Cui
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, People's Republic of China.
| | - Weiliang Jiang
- Department of Vascular Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, People's Republic of China.
| |
Collapse
|
8
|
Zhang X, Wang D, Zhang X, Liang S, Wu Z, Wen Z, Ventikos Y, Xiong J, Chen D. A CT-based predictive model for stent-induced vessel damage: application to type B aortic dissection. Eur Radiol 2023; 33:8682-8692. [PMID: 37368110 DOI: 10.1007/s00330-023-09773-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 03/14/2023] [Accepted: 03/26/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVES The distal stent-induced new entry (distal SINE) is a life-threatening device-related complication after thoracic endovascular aortic repair (TEVAR). However, risk factors for distal SINE are not fully determined, and prediction models are lacking. This study aimed to establish a predictive model for distal SINE based on the preoperative dataset. METHODS Two hundred and six patients with Stanford type B aortic dissection (TBAD) that experienced TEVAR were involved in this study. Among them, thirty patients developed distal SINE. Pre-TEVAR morphological parameters were measured based on the CT-reconstructed configurations. Virtual post-TEVAR morphological and mechanical parameters were computed via the virtual stenting algorithm (VSA). Two predictive models (PM-1 and PM-2) were developed and presented as nomograms to help risk evaluation of distal SINE. The performance of the proposed predictive models was evaluated and internal validation was conducted. RESULTS Machine-selected variables for PM-1 included key pre-TEVAR parameters, and those for PM-2 included key virtual post-TEVAR parameters. Both models showed good calibration in both development and validation subsamples, while PM-2 outperformed PM-1. The discrimination of PM-2 was better than PM-1 in the development subsample, with an optimism-corrected area under the curve (AUC) of 0.95 and 0.77, respectively. Application of PM-2 in the validation subsample presented good discrimination with an AUC of 0.9727. The decision curve demonstrated that PM-2 was clinically useful. CONCLUSION This study proposed a predictive model for distal SINE incorporating the CT-based VSA. This predictive model could efficiently predict the risk of distal SINE and thus might contribute to personalized intervention planning. CLINICAL RELEVANCE STATEMENT This study established a predictive model to evaluate the risk of distal SINE based on the pre-stenting CT dataset and planned device information. With an accurate VSA tool, the predictive model could help to improve the safety of the endovascular repair procedure. KEY POINTS • Clinically useful prediction models for distal stent-induced new entry are still lacking, and the safety of the stent implantation is hard to guarantee. • Our proposed predictive tool based on a virtual stenting algorithm supports different stenting planning rehearsals and real-time risk evaluation, guiding clinicians to optimize the presurgical plan when necessary. • The established prediction model provides accurate risk evaluation for vessel damage, improving the safety of the intervention procedure.
Collapse
Affiliation(s)
- Xuehuan Zhang
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Dianpeng Wang
- School of Mathematics, Beijing Institute of Technology, Beijing, China
| | - Xuyang Zhang
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Shichao Liang
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Ziheng Wu
- Department of Vascular Surgery, First Affiliated Hospital of Medical College, Zhejiang University, Zhejiang, China
| | - Zipeng Wen
- The High School Affiliated to Renmin University of China, Beijing, China
| | - Yiannis Ventikos
- School of Life Science, Beijing Institute of Technology, Beijing, China
- Department of Mechanical Engineering, University College London, London, UK
| | - Jiang Xiong
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China.
| | - Duanduan Chen
- School of Medical Technology, Beijing Institute of Technology, Beijing, China.
- Department of Thoracic and Cardiovascular Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing, China.
| |
Collapse
|
9
|
Hiraoka T, Furukawa T, Imai K, Takahashi S. Distal Stent Graft-Induced New Entry After Frozen Elephant Trunk Procedure for Aortic Dissection. Ann Vasc Surg 2023; 97:340-350. [PMID: 37244478 DOI: 10.1016/j.avsg.2023.05.015] [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: 01/18/2023] [Revised: 04/25/2023] [Accepted: 05/09/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the risk factors of distal stent graft-induced new entry (dSINE) after frozen elephant trunk (FET) procedure for aortic dissection (AD) and to consider strategies to prevent this complication. METHODS This retrospective review included 52 patients who had undergone aortic arch repair for AD with the FET procedure using J Graft FROZENIX from 2014 to 2020 at a single center. Baseline characteristics, aortic characteristics and mid-term outcomes were compared between patients with and without dSINE. The extent of unfolding of the device and movement of the distal edge of the device were analyzed by multidetector computed tomography. The primary endpoints were survival and freedom from reintervention. RESULTS dSINE was the most prevalent complication after FET procedure, with an incidence of 23%. Eleven of 12 patients with dSINE underwent secondary interventions. dSINE was common in chronic aortic dissection (P = 0.001) and was associated with the residual false lumen area (P < 0.001) and movement distance of the distal edge of the device in the cranial direction (P < 0.001). CONCLUSIONS The distal edge of the FET is more likely to move in the cranial direction, and this movement may cause dSINE.
Collapse
Affiliation(s)
- Toshifumi Hiraoka
- Department of Cardiovascular Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure City, Hiroshima, Japan.
| | - Tomokuni Furukawa
- Department of Cardiovascular Surgery, Akane-Foundation Tsuchiya General Hospital, Naka-ku, Hiroshima, Japan
| | - Katsuhiko Imai
- Department of Cardiovascular Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure City, Hiroshima, Japan
| | - Shinya Takahashi
- Department of Cardiovascular Surgery, Hiroshima University Hospital, Minami-ku, Hiroshima, Japan
| |
Collapse
|
10
|
Luan J, Qiao Y, Mao L, Fan J, Zhu T, Luo K. The role of aorta distal to stent in the occurrence of distal stent graft-induced new entry tear: A computational fluid dynamics and morphological study. Comput Biol Med 2023; 166:107554. [PMID: 37839217 DOI: 10.1016/j.compbiomed.2023.107554] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 09/04/2023] [Accepted: 09/28/2023] [Indexed: 10/17/2023]
Abstract
Distal stent graft-induced new entry tear (dSINE) is an important complication of thoracic endovascular aortic repair (TEVAR) for the treatment of type B aortic dissection (TBAD). This study aims to explore whether the aorta distal to the stent plays an important role in the occurrence of dSINE. Sixty-nine patient-specific geometrical models of twenty-three enrolled patients were reconstructed from preoperative, postoperative, and predSINE computed tomography scans. Computational fluid dynamics (CFD) simulations were performed to calculate the von Mises stress in the CFD group. Meanwhile, morphological measurements were performed in all patients, including measurements of the inverted pyramid index at different follow-up time points and the postoperative true lumen volume change rate. In the CFD study, the time-averaged von Mises stress of the true lumen distal to the stent in dSINE patients was significantly higher than that in the CFD controls (20.42 kPa vs. 15.47 kPa). In the morphological study, a special aortic plane (plane A) with an extremely small area distal to the stent was observed in dSINE patients, which resulted in an inverted pyramid structure in the true lumen distal to the stent. This structure in dSINE patients became increasingly obvious during the follow-up period and finally reached the maximum value before dSINE occurred (mean, 3.91 vs. 1.23). At the same time, enlargement of the true lumen distal to the stent occurs before dSINE, manifesting as a continuous increase in the true lumen volume (mean, 0.70 vs. 013). A new theory of what causes dSINE to occur has been proposed: the inverted pyramid structure of the true lumen distal to the stent caused an increase in the von Mises stress in this region and aortic enlargement, which ultimately led to the occurrence of dSINE.
Collapse
Affiliation(s)
- Jingyang Luan
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yonghui Qiao
- State Key Laboratory of Clean Energy Utilization, Zhejiang University, Hangzhou, China
| | - Le Mao
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jianren Fan
- State Key Laboratory of Clean Energy Utilization, Zhejiang University, Hangzhou, China; Shanghai Institute for Advanced Study of Zhejiang University, Shanghai, China
| | - Ting Zhu
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Kun Luo
- State Key Laboratory of Clean Energy Utilization, Zhejiang University, Hangzhou, China; Shanghai Institute for Advanced Study of Zhejiang University, Shanghai, China.
| |
Collapse
|
11
|
Nakajima T, Iba Y, Ogura K, Kawaharada N. Partial arch replacement of type A aortic dissection after thoracic endovascular aortic repair for type B dissection. Egypt Heart J 2023; 75:81. [PMID: 37801163 PMCID: PMC10558405 DOI: 10.1186/s43044-023-00412-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/30/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Stent graft-induced new entry (SINE), defined as the stent graft-induced formation of a new entry point for blood to enter an area, is increasingly being observed after thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection worldwide. We herein describe a case of Stanford type A aortic dissection due to proximal SINE after TEVAR for Stanford type B dissection. CASE PRESENTATION This case involved a 58-year-old man with type A aortic dissection due to SINE. Six years previously, he had developed severe back pain and was diagnosed with type B aortic dissection after computed tomography examination. Because the primary entry was positioned at the descending aorta, we conducted TEVAR for exclusion of the entry with a GORE TAG conformable thoracic aortic graft. He was thereafter followed by our hospital. Six years later, he developed jaw pain and was examined at another hospital. He was transferred to our hospital because of the possibility of type A dissection. Computed tomography revealed type A aortic dissection with proximal site SINE. Emergency partial arch replacement was conducted, and he was discharged on postoperative day 27. Because the entry was at the lesser curve of the arch, we excluded the entry and conducted partial arch replacement. CONCLUSIONS In this case, proximal SINE occurred 6 years after TEVAR. Because SINE may occur even in the long term after TEVAR, careful follow-up is necessary.
Collapse
Affiliation(s)
- Tomohiro Nakajima
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan.
| | - Yutaka Iba
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Keishi Ogura
- Division of Radiology and Nuclear Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| |
Collapse
|
12
|
Ogino H, Iida O, Akutsu K, Chiba Y, Hayashi H, Ishibashi-Ueda H, Kaji S, Kato M, Komori K, Matsuda H, Minatoya K, Morisaki H, Ohki T, Saiki Y, Shigematsu K, Shiiya N, Shimizu H, Azuma N, Higami H, Ichihashi S, Iwahashi T, Kamiya K, Katsumata T, Kawaharada N, Kinoshita Y, Matsumoto T, Miyamoto S, Morisaki T, Morota T, Nanto K, Nishibe T, Okada K, Orihashi K, Tazaki J, Toma M, Tsukube T, Uchida K, Ueda T, Usui A, Yamanaka K, Yamauchi H, Yoshioka K, Kimura T, Miyata T, Okita Y, Ono M, Ueda Y. JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection. Circ J 2023; 87:1410-1621. [PMID: 37661428 DOI: 10.1253/circj.cj-22-0794] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | - Koichi Akutsu
- Cardiovascular Medicine, Nippon Medical School Hospital
| | - Yoshiro Chiba
- Department of Cardiology, Mito Saiseikai General Hospital
| | | | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University
| | | | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | - Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine
| | | | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
| | - Hirooki Higami
- Department of Cardiology, Japanese Red Cross Otsu Hospital
| | | | - Toru Iwahashi
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kentaro Kamiya
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine
| | | | - Takuya Matsumoto
- Department of Vascular Surgery, International University of Health and Welfare
| | | | - Takayuki Morisaki
- Department of General Medicine, IMSUT Hospital, the Institute of Medical Science, the University of Tokyo
| | - Tetsuro Morota
- Department of Cardiovascular Surgery, Nippon Medical School Hospital
| | | | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kenji Okada
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | | | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Masanao Toma
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Takuro Tsukube
- Department of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center
| | - Tatsuo Ueda
- Department of Radiology, Nippon Medical School
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kazuo Yamanaka
- Cardiovascular Center, Nara Prefecture General Medical Center
| | - Haruo Yamauchi
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Yutaka Okita
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
| | | |
Collapse
|
13
|
Wang K, Armour CH, Ma T, Dong Z, Xu XY. Hemodynamic parameters impact the stability of distal stent graft-induced new entry. Sci Rep 2023; 13:12123. [PMID: 37495611 PMCID: PMC10372056 DOI: 10.1038/s41598-023-39130-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/19/2023] [Indexed: 07/28/2023] Open
Abstract
Stent graft-induced new entry tear (SINE) is a serious complication in aortic dissection patients caused by the stent-graft itself after thoracic endovascular aortic repair (TEVAR). The stability of SINE is a key indicator for the need and timing of reinterventions. This study aimed to understand the role of hemodynamics in SINE stability by means of computational fluid dynamics (CFD) analysis based on patient-specific anatomical information. Four patients treated with TEVAR who developed a distal SINE (dSINE) were included; two patients had a stable dSINE and two patients experienced expansion of the dSINE upon follow-up examinations. CFD simulations were performed on geometries reconstructed from computed tomography scans acquired upon early detection of dSINE in these patients. Computational results showed that stable dSINEs presented larger regions with low time-averaged wall shear stress (TAWSS) and high relative residence time (RRT), and partial thrombosis was observed at subsequent follow-ups. Furthermore, significant systolic antegrade flow was observed in the unstable dSINE which also had a larger retrograde flow fraction (RFF) on the SINE plane. In conclusion, this pilot study suggested that high RRT and low TAWSS may indicate stable dSINE by promoting thrombosis, whereas larger RFF and antegrade flows inside dSINE might be associated with its expansion.
Collapse
Affiliation(s)
- Kaihong Wang
- Department of Chemical Engineering, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
| | - Chlӧe H Armour
- Department of Chemical Engineering, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
| | - Tao Ma
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhihui Dong
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Xiao Yun Xu
- Department of Chemical Engineering, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK.
| |
Collapse
|
14
|
Bondesson J, Suh GY, Dake MD, Lee JT, Cheng CP. Cardiac Pulsatile Helical Deformation of the Thoracic Aorta Before and After Thoracic Endovascular Aortic Repair of Type B Dissections. J Endovasc Ther 2023:15266028231179592. [PMID: 37300396 DOI: 10.1177/15266028231179592] [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: 06/12/2023]
Abstract
PURPOSE Type B aortic dissections propagate with either achiral (nonspiraling) or right-handed chiral (spiraling) morphology, have mobile dissection flaps, and are often treated with thoracic endovascular aortic repair (TEVAR). We aim to quantify cardiac-induced helical deformation of the true lumen of type B aortic dissections before and after TEVAR. MATERIAL AND METHODS Retrospective cardiac-gated computed tomography (CT) images before and after TEVAR of type B aortic dissections were used to construct systolic and diastolic 3-dimensional (3D) surface models, including true lumen, whole lumen (true+false lumens), and branch vessels. This was followed by extraction of true lumen helicity (helical angle, twist, and radius) and cross-sectional (area, circumference, and minor/major diameter ratio) metrics. Deformations between systole and diastole were quantified, and deformations between pre- and post-TEVAR were compared. RESULTS Eleven TEVAR patients (59.9±4.6 years) were included in this study. Pre-TEVAR, there were no significant cardiac-induced deformations of helical metrics; however, post-TEVAR, significant deformation was observed for the true lumen proximal angular position. Pre-TEVAR, cardiac-induced deformations of all cross-sectional metrics were significant; however, only area and circumference deformations remained significant post-TEVAR. There were no significant differences of pulsatile deformation from pre- to post-TEVAR. Variance of proximal angular position and cross-sectional circumference deformation decreased after TEVAR. CONCLUSION Pre-TEVAR, type B aortic dissections did not exhibit significant helical cardiac-induced deformation, indicating that the true and false lumens move in unison (do not move with respect to each other). Post-TEVAR, true lumens exhibited significant cardiac-induced deformation of proximal angular position, suggesting that exclusion of the false lumen leads to greater rotational deformations of the true lumen and lack of true lumen major/minor deformation post-TEVAR means that the endograft promotes static circularity. Population variance of deformations is muted after TEVAR, and dissection acuity influences pulsatile deformation while pre-TEVAR chirality does not. CLINICAL IMPACT Description of thoracic aortic dissection helical morphology and dynamics, and understanding the impact of thoracic endovascular aortic repair (TEVAR) on dissection helicity, are important for improving endovascular treatment. These findings provide nuance to the complex shape and motion of the true and false lumens, enabling clinicians to better stratify dissection disease. The impact of TEVAR on dissection helicity provides a description of how treatment alters morphology and motion, and may provide clues for treatment durability. Finally, the helical component to endograft deformation is important to form comprehensive boundary conditions for testing and developing new endovascular devices.
Collapse
Affiliation(s)
- Johan Bondesson
- Division of Vascular Surgery, Stanford University, Stanford, CA, USA
- Division of Dynamics, Chalmers University of Technology, Gothenburg, Sweden
| | - Ga-Young Suh
- Division of Vascular Surgery, Stanford University, Stanford, CA, USA
- Department of Biomedical Engineering, California State University, Long Beach, CA, USA
| | - Michael D Dake
- Department of Surgery, The University of Arizona, Tucson, AZ, USA
| | - Jason T Lee
- Division of Vascular Surgery, Stanford University, Stanford, CA, USA
| | | |
Collapse
|
15
|
Cheng L, Xiang D, Zhang S, Zheng C, Wu X. Reintervention after Thoracic Endovascular Aortic Repair of Uncomplicated Type B Aortic Dissection. J Clin Med 2023; 12:jcm12041418. [PMID: 36835969 PMCID: PMC9964661 DOI: 10.3390/jcm12041418] [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: 01/13/2023] [Revised: 02/02/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Data are scarce regarding the incidence, reasons, potential risk factors, and long-term outcomes of reintervention after thoracic endovascular aortic repair (TEVAR) in patients with uncomplicated type B aortic dissection (TBAD). METHODS Between January 2010 and December 2020, 238 patients with uncomplicated TBAD who received TEVAR were analyzed retrospectively. The clinical baseline data, aorta anatomy, dissection characteristics, and details of the TEVAR procedure were evaluated and compared. A competing-risk regression model was used to estimate the cumulative incidences of reintervention. The multivariate Cox model was used to identify the independent risk factors. RESULTS The mean follow-up time was 68.6 months. A total of 27 (11.3%) cases of reintervention were observed. The competing-risk analyses showed that the 1-, 3-, and 5-year cumulative incidences of reintervention were 5.07%, 7.08%, and 14.0%, respectively. Reasons for reintervention included endoleak (25.9%), aneurysmal dilation (22.2%), retrograde type A aortic dissection (18.5%), distal stent-graft-induced new entry and false lumen expansion (18.5%), and dissection progression and/or malperfusion (14.8%). Multivariable Cox analysis demonstrated that a larger initial maximal aortic diameter (Hazard ratio [HR], 1.75; 95% Confidence interval [CI], 1.13-2.69, p = 0.011) and increased proximal landing zone oversizing (HR, 1.07; 95% CI, 1.01-1.47, p = 0.033) were the significant risk factors for reintervention. Long-term survival rates were comparable between patients with or without reintervention (p = 0.915). CONCLUSIONS Reintervention after TEVAR in patients with uncomplicated TBAD is not uncommon. A larger initial maximal aortic diameter and excessive proximal landing zone oversizing are associated with the second intervention. Reintervention does not significantly affect long-term survival.
Collapse
Affiliation(s)
- Li Cheng
- Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Dongqiao Xiang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Shan Zhang
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Chuansheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
- Correspondence: (C.Z.); (X.W.)
| | - Xiaoyan Wu
- Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
- Correspondence: (C.Z.); (X.W.)
| |
Collapse
|
16
|
Morokuma H, Hamada K, Shimauchi K, Osaki J, Takahashi B, Yamamoto H, Hayashi N, Jinnouchi K, Itoh M, Yunoki J, Kamohara K. How to select the optimal size of frozen elephant trunk in total arch replacement for type A acute aortic dissection. Asian Cardiovasc Thorac Ann 2023; 31:75-80. [PMID: 36330614 DOI: 10.1177/02184923221133934] [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: 11/06/2022]
Abstract
BACKGROUND Total arch replacement (TAR) with a frozen elephant trunk (FET) is a common technique for acute aortic dissection, but there is no consensus on the optimal size of the FET. METHODS Forty-four patients who underwent TAR with FET for acute aortic dissection at our hospital since 2014 were included. The aortic diameter obtained from FET was measured on postoperative computed tomography (CT) and the estimated oversizing ratio was calculated. We investigated the relationship between the estimated oversizing ratio and postoperative outcomes. We also measured the maximum true lumen diameter, circumference of the true lumen, and total aortic diameter at the same level as the FET end on preoperative CT and examined the correlation with the aortic diameter obtained from FET. RESULTS The average estimated oversizing ratio was 109%. Early postoperative CT showed complete thrombosis of the false lumen in 41 (93.2%) patients. No distal stent graft-induced new entry occurred during follow-up. The correlation coefficients between the three measurements and aortic diameter obtained from FET were 0.64 (maximum true lumen diameter), 0.76 (true lumen diameter calculated from circumference), and 0.72 (total aortic diameter), respectively. CONCLUSIONS The aortic diameter obtained from FET on postoperative CT was strongly correlated with the true lumen diameter calculated from the circumference and total aortic diameter on preoperative CT. It is reasonable to select a size of approximately 130% of the true lumen diameter calculated from the circumference or 80% to 85% of the total aortic diameter.
Collapse
Affiliation(s)
- Hiroyuki Morokuma
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, 13030Saga University, Saga, Japan
| | - Kouhei Hamada
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, 13030Saga University, Saga, Japan
| | - Kouta Shimauchi
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, 13030Saga University, Saga, Japan
| | - Jun Osaki
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, 13030Saga University, Saga, Japan
| | - Baku Takahashi
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, 13030Saga University, Saga, Japan
| | - Hiroaki Yamamoto
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, 13030Saga University, Saga, Japan
| | - Nagi Hayashi
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, 13030Saga University, Saga, Japan
| | - Kouki Jinnouchi
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, 13030Saga University, Saga, Japan
| | - Manabu Itoh
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, 13030Saga University, Saga, Japan
| | - Junji Yunoki
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, 13030Saga University, Saga, Japan
| | - Keiji Kamohara
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, 13030Saga University, Saga, Japan
| |
Collapse
|
17
|
Xiang D, Chai B, Gui Y, Huang J, Liang H, Liang B, Zhao H, Yang F, Zheng C. Risk factors for distal stent graft-induced new entry after endovascular repair in uncomplicated type B aortic dissection. J Vasc Surg 2023; 77:37-45.e1. [PMID: 36058432 DOI: 10.1016/j.jvs.2022.08.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/17/2022] [Accepted: 08/23/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We investigated the risk factors for distal stent graft-induced new entry (dSINE) after thoracic endovascular aortic repair for patients with uncomplicated type B aortic dissection (TBAD) and reported the outcomes of using a tapered stent graft and dSINE reintervention. METHODS A total of 226 patients with uncomplicated TBAD who had undergone thoracic endovascular aortic repair between January 2010 and December 2018 were analyzed retrospectively. The global features of the thoracic aorta and the local features of the proximal and distal landing zones were evaluated and compared between the dSINE and non-dSINE groups. A multivariate Cox model was used to identify the independent risk factors for dSINE. The cumulative incidence of reintervention was estimated using competing risk models. RESULTS After a median follow-up of 4.6 years, 16 patients (7.1%) had developed dSINE. Multivariable Cox regression analysis demonstrated that a type III aortic arch, decreased angle, increased distal oversizing, and increased distal mismatch ratio were significant risk factors for dSINE. Of the patients with tapered stent grafts, five with a ≤4-mm taper had developed dSINE. However, no dSINE was seen in the >4-mm taper group (P = .024). Reintervention was performed for 7 of the 16 patients with dSINE (43.8%). The mean time from the initial detection of dSINE to reintervention was 6.43 ± 4.62 months. The competing risk analyses showed that the cumulative incidence of reintervention in the dSINE group at 1, 3, and 5 years was 25.0%, 37.5%, and 43.5%, respectively. CONCLUSIONS A type III aortic arch, excessive distal oversizing and mismatch ratio, and severe angulation were associated with dSINE in patients with uncomplicated TBAD. The use of a tapered stent graft with a >4-mm taper could help prevent dSINE in patients with a high taper ratio. Aggressive reintervention was associated with favorable long-term outcomes for patients with progressive dSINE.
Collapse
Affiliation(s)
- Dongqiao Xiang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Bin Chai
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yuxi Gui
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Jia Huang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Huimin Liang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Bin Liang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Huangxuan Zhao
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China.
| | - Fan Yang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China.
| | - Chuansheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China.
| |
Collapse
|
18
|
Wada T, Yamamoto H, Takagi D, Kadohama T, Yamaura G, Kiryu K, Igarashi I. Aortic remodeling, reintervention, and survival after zone 0 arch repair with frozen elephant trunks for acute type A aortic dissection: Midterm results. JTCVS Tech 2022; 14:29-38. [PMID: 35967231 PMCID: PMC9366877 DOI: 10.1016/j.xjtc.2022.05.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 05/24/2022] [Indexed: 12/13/2022] Open
Abstract
Objectives To investigate the midterm results after zone 0 arch repair with frozen elephant trunks for acute type A aortic dissection. Methods Between October 2014 and April 2021, 196 patients underwent zone 0 arch repair with frozen elephant trunks for acute type A aortic dissection. The true lumen area, aortic lumen area, and false lumen status were assessed at four aortic levels, the proximal and distal descending thoracic aorta (level A and level B, respectively), celiac artery branching (level C), and terminal aorta (level D). Aortic remodeling (postoperative area as a percentage of the preoperative area) was classified into 3 groups, positive (true lumen area ≥120% with aortic lumen <120% or true lumen area ≥80% with aortic lumen <80%), minimal (80% ≤ true lumen area and aortic lumen area <120%), and negative remodeling (all other changes). Results In-hospital mortality was 13 (6.6%) patients. The overall survival rate was 85.1% at 5 years. The freedom from distal aortic reintervention was 89.9% at 5 years. The prevalence of completely thrombosed or obliterated false lumen at 2 years was 96.8% at level A, 88.4% at level B, 47.2% at level C, and 27.6% at level D. The prevalence of positive aortic remodeling at 2 years was 84.7% at level A, 75.0% at level B, 29.2% at level C, and 16.7% at level D. Conclusions Zone 0 arch repair with frozen elephant trunks for acute type A aortic dissection can avoid invasive aortic arch resection and facilitate aortic remodeling of the descending thoracic aorta. The FET effect on aortic remodeling is limited at the aortic level below the FET stent end.
Collapse
Key Words
- AL, aortic lumen
- ATAAD, acute type A aortic dissection
- CPB, cardiopulmonary bypass
- CT, computed tomography
- FET, frozen elephant trunk
- FL, false lumen
- TAR, total arch replacement
- TEVAR, thoracic endovascular aortic repair
- TL, true lumen
- Z-0-FET, zone 0 arch repair with frozen elephant trunk
- acute type A aortic dissection
- aortic remodeling
- dSINE, distal stent graft-induced new entry
- distal stent-induced new entry
- frozen elephant trunk
- zone 0 arch repair
Collapse
Affiliation(s)
- Takuya Wada
- Department of Cardiovascular Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Hiroshi Yamamoto
- Department of Cardiovascular Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Daichi Takagi
- Department of Cardiovascular Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Takayuki Kadohama
- Department of Cardiovascular Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Gembu Yamaura
- Department of Cardiovascular Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Kentaro Kiryu
- Department of Cardiovascular Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Itaru Igarashi
- Department of Cardiovascular Surgery, Akita University Graduate School of Medicine, Akita, Japan
| |
Collapse
|
19
|
Geragotellis A, Surkhi AO, Jubouri M, Alsmadi AS, El-Dayeh Y, Kayali F, Mohammed I, Bashir M. Endovascular reintervention after frozen elephant trunk: where is the evidence? THE JOURNAL OF CARDIOVASCULAR SURGERY 2022; 63:425-433. [PMID: 35621064 DOI: 10.23736/s0021-9509.22.12393-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The introduction of the single-step hybrid frozen elephant trunk (FET) procedure for total arch replacement has revolutionized the field of aortovascular surgery. FET has proven to achieve excellent results in the repair of complex thoracic aorta pathologies. However, there remains a risk of reintervention post-FET for a variety of causes. This secondary intervention can either be performed endovascular, with thoracic endovascular aortic repair (TEVAR), or via open surgery. Multiple FET hybrid prosthesis are commercially available, each requiring different rates of endovascular reintervention. The current review will focus on providing an overview of the reintervention rates for main causes in relation to the FET grafts on the market. In addition, strategies to prevent reintervention will be highlighted. A comprehensive literature search was conducted on multiple electronic databases including PubMed, Ovid, Scopus and Embase to highlight the evidence in the literature on endovascular reintervention after FET. The main causes for secondary intervention are distal stent graft-induced new entry (dSINE), endoleak and negative aortic remodeling, and to a much lesser extent, graft kinking and aorto-esophageal fistulae. In addition, it is clear that the Thoraflex Hybrid (Terumo Aortic, Inchinnan, UK) is the superior FET device, showing excellent reintervention rates for all the above causes. Interestingly, the choice of FET device as well as its size and length can help prevent the need for reintervention. The FET procedure is indeed associated with excellent clinical outcomes, however, the need for reintervention may still arise. Importantly, the Thoraflex Hybrid prosthesis has shown excellent results when it comes to endovascular reintervention. Finally, several strategies exist that can prevent reintervention.
Collapse
Affiliation(s)
| | | | - Matti Jubouri
- Hull York Medical School, University of York, York, UK
| | - Ayah S Alsmadi
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Yazan El-Dayeh
- Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Fatima Kayali
- School of Medicine, University of Central Lancashire, Preston, UK
| | - Idhrees Mohammed
- Institute of Cardiac and Aortic Disorders (ICAD), SRM Institutes for Medical Science (SIMS Hospital), Chennai, Tamil Nadu, India
| | - Mohamad Bashir
- Department of Vascular and Endovascular Surgery, Velindre University NHS Trust, Health Education and Improvement Wales (HEIW), Cardiff, UK -
| |
Collapse
|
20
|
Hiraoka A, Iida Y, Furukawa T, Ueki C, Miyake K, Mieno M, Okamura H. Predictive factors of distal stent graft-induced new entry after frozen elephant trunk procedure for aortic dissection. Eur J Cardiothorac Surg 2022; 62:6604743. [PMID: 35678563 DOI: 10.1093/ejcts/ezac325] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 05/12/2022] [Accepted: 06/03/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The incidence rate of distal stent graft-induced new entry after frozen elephant trunk technique for aortic dissection remains controversial. The aim of this study was to investigate the incidence and seek the clinical and anatomical predictive factors. METHODS This study is a retrospective multicenter evaluation of complications including distal stent graft-induced new entry, aortic events, and re-intervention after the frozen elephant trunk procedure for aortic dissection. RESULTS Our cohort included total 177 consecutive patients who underwent the frozen elephant trunk procedure for acute and chronic aortic dissection at five centers in Japan from May 2014 to March 2021. The incidence rate of distal stent graft-induced new entry was 14.1% (25/177 patients). The cumulative incidence of d-SINE was 7.1%, 12.4%, 21.4% after 12, 36, and 60 months, respectively. Distal stent graft-induced new entry was not associated with mid-term survival rate. After competing risk regression analysis, onset time > 48 hours (subdistribution hazard ratio, 3.80; 95% confidence interval, 1.13-12.79; P=0.031) was detected as an independent predictor. CONCLUSIONS Awareness that there is a relatively higher incidence of distal stent graft-induced new entry after frozen elephant trunk procedures is important. Non-hyperacute phase was detected as an independent risk factor. Preemptive endovascular repair may be appropriate to protect new entry in high-risk patients.
Collapse
Affiliation(s)
- Arudo Hiraoka
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Yasunori Iida
- Department of Cardiovascular Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Tomokuni Furukawa
- Department of Cardiovascular Surgery, Akane-Foundation Tsuchiya General Hospital, Hiroshima, Japan
| | - Chikara Ueki
- Department of Cardiovascular Surgery, Shizuoka Graduate University of Public Health, Shizuoka, Japan
| | - Koichi Miyake
- Department of Radiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Makiko Mieno
- Department of Medical Informatics, Center for Information, Jichi Medical University, Tochigi, Japan
| | - Homare Okamura
- Department of Cardiovascular Surgery, Nerima Hikarigaoka Hospital, Tokyo, Japan
| |
Collapse
|
21
|
Geragotellis A, Al-Tawil M, Jubouri M, Tan SZCP, Williams I, Bashir M. Risk profile analysis of uncomplicated type B aortic dissection patients undergoing thoracic endovascular aortic repair: Laboratory and radiographic predictors. J Card Surg 2022; 37:2811-2820. [PMID: 35652486 DOI: 10.1111/jocs.16655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 04/22/2022] [Indexed: 01/16/2023]
Abstract
BACKGROUND There is emerging evidence to support pre-emptive thoracic endovascular aortic repair (TEVAR) intervention for uncomplicated type B aortic dissection (unTBAD). Pre-emptive intervention would be particularly beneficial in patients that have a higher baseline risk of progressing to complicated TBAD (coTBAD). There remain debate on the optimal clinical, laboratory, morphological, and radiological parameters, which would identify the highest-risk patients that would benefit most from pre-emptive TEVAR. AIM This review summarizes evidence on the clinical, laboratory, and morphological parameters that increase the risk profiles of unTBAD patients. METHODS A comprehensive literature search was carried out on multiple electronic databases including PubMed, EMBASE, Ovid, and Scopus to collate all research evidence on the clinical, laboratory, and morphological parameters that increase the risk profiles of unTBAD patients RESULTS: At present, there are no clear clinical guidelines using risk-stratification to inform the selection of unTBAD patients for TEVAR. However, there are noticeable literature trends that can assist with the identification of the most at-risk unTBAD patients. Patients are at particular risk when they have refractory pain and/or hypertension, elevated C-reactive protein (CRP), larger aortic diameter, and larger entry tears. These risks should be considered alongside factors that increase the procedural risk of TEVAR to create a well-balanced approach. Advances in biomarkers and imaging are likely to identify more pertinent parameters in the future to optimize the development of balanced, risk-stratified treatment protocols. CONCLUSION There are a variety of risk profiling parameters that can be used to identify the high-risk unTBAD patient, with novel biomarkers and imaging parameters emerging. Longer-term evidence verifying these parameters would be ideal. Further randomized controlled trials and multicentre registry analyses are also warranted to guide risk-stratified selection protocols.
Collapse
Affiliation(s)
| | | | - Matti Jubouri
- Hull York Medical School, University of York, York, UK
| | - Sven Z C P Tan
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Ian Williams
- Department of Vascular Surgery, Heath Park, University Hospital of Wales, Cardiff, UK
| | - Mohamad Bashir
- Vascular & Endovascular Surgery, Health Education & Improvement Wales (HEIW), Velindre University NHS Trust, Cardiff, UK
| |
Collapse
|
22
|
Niu L, Bao X, Yu W, Li C, Wu J, Yan J, Xin H, Wang H, Wang Y. Thoracic endovascular aortic repair of highly tapered type B aortic dissection with proximal tapered stent grafts and distal restrictive stent grafts. Ann Vasc Surg 2022; 86:380-388. [PMID: 35595209 DOI: 10.1016/j.avsg.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 04/28/2022] [Accepted: 05/02/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study evaluated aortic remodeling in highly tapered type B aortic dissection (TBAD) patients who underwent thoracic endovascular aortic repair (TEVAR) with a proximal tapered stent graft plus a distal restrictive stent graft to maximize thoracic coverage while avoiding distal excessive oversizing. METHODS Thirty-four patients presenting with highly tapered TABD were randomized to restricted TEVAR (r-TEVAR) and standard TEVAR groups. Highly tapered TBAD was defined as the maximal diameter of the true lumen at proximal and distal thoracic aorta landing zone tapers greater than 8 mm or taper ratio greater than 20%. Patients in the r-TEVAR group underwent proximal tapered stent grafts plus distal restrictive stent grafts to match the taper ratio of the descending thoracic aorta (DTA) and extend the length of stent coverage. Patients in the standard TEVAR group underwent proximal tapered stent grafts implantation without distal restrictive stent grafts. Aortic remodeling was estimated by computed tomography angiography (CTA) during the follow-up. RESULTS In total, 16 patients underwent r-TEVAR, and 18 patients underwent standard TEVAR. The taper ratio of the stent graft matched the DTA in the r-TEVAR group (24.7±3.4% vs. 27.3±4.2%, P=0.068) but did not match that in the standard TEVAR group (13.5±3.3% vs. 30.5±9.6%, P<0.001). The length of stent graft coverage in the r-TEVAR group was longer than that in the standard TEVAR group (220.4±21.1 mm vs. 175.3±17.8 mm, P<0.001). Compared with the standard TEVAR group, the r-TEVAR group had better complete remodeling of the DTA at 6 months (40% vs. 5.6%, P=0.03), 12 months (60% vs. 16.7%, P=0.027) and 24 months (78.6% vs. 41.2%, P=0.036) after the operation. There was no difference in the cumulative survival rate between the r-TEVAR and standard TEVAR groups (P=0.166). CONCLUSIONS r-TEVAR with overlapping proximal tapered stent grafts and distal restrictive stent grafts can match the taper of highly tapered TABD, extend the length of stent graft coverage, and lead to better remodeling of the DTA than standard TEVAR.
Collapse
Affiliation(s)
- Liyuan Niu
- Department of Vascular Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xia Bao
- Department of Vascular Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wenjuan Yu
- Department of Pathology, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Changfeng Li
- Department of Vascular Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jiang Wu
- Department of Vascular Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Junwei Yan
- Department of Vascular Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Hai Xin
- Department of Vascular Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Haofu Wang
- Department of Vascular Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yuewei Wang
- Department of Vascular Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China.
| |
Collapse
|
23
|
Yang G, Ge H, Wu G, Zhang Y, Zhang L, Zhang M, Li X, Zhou M. Five-Year Results of Aortic Remodeling for Acute, Subacute, and Chronic Type B Aortic Dissection Following Endovascular Repair. Front Cardiovasc Med 2022; 9:847368. [PMID: 35656393 PMCID: PMC9152007 DOI: 10.3389/fcvm.2022.847368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 04/28/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThis study was performed to compare aortic remodeling and clinical outcomes in patients with acute, subacute, and chronic type B aortic dissection (TBAD) after thoracic endovascular aortic repair (TEVAR).MethodsWe retrospectively examined 323 consecutive patients with acute (n = 129), subacute (n = 161), and chronic (n = 33) TBAD who underwent TEVAR from June 2013 to December 2016 in in multicenter institution. Patient demographics, clinical data, and imaging characteristics were recorded and compared among the three groups.ResultsThe three groups had comparable baseline characteristics. Perioperative mortality rates were similar among the acute (2.3%), subacute (0.0%), and chronic (0.0%) groups (P = 0.34). Perioperative morbidity rates, including the rates of visceral and lower limb malperfusion and cerebral infraction, were also similar. The rate of perioperative endoleak was significantly higher in the chronic group (18.1%) than in the acute (3.9%) and subacute (3.7%) groups (P = 0.02). The mean follow-up duration was 78 ± 22 months (range, 36–101 months). The mortality rates were comparable among the three groups. The rates of reintervention and lower limb malperfusion were higher in the chronic group than in the acute and subacute groups. FL diameter reduction were more robust in the acute and subacute groups than in the chronic group.ConclusionPatients with acute, subacute, and chronic TBAD had different outcomes in this study. Patients with acute and subacute TBAD had fewer complications than those with chronic TBAD. Aortic remodeling after TEVAR was more favorable in patients with acute and subacute TBAD than in patients with chronic TBAD. TEVAR promotes more positive remodeling at the stent graft level than at the distal level of the aorta.
Collapse
Affiliation(s)
- Guangmin Yang
- Department of Vascular Surgery, Drum Tower Hospital, Affiliated to School of Medicine, Nanjing University, Nanjing, China
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Hongwei Ge
- Department of Vascular Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Guangyan Wu
- Department of Vascular Surgery, Drum Tower Hospital, Affiliated to School of Medicine, Nanjing University, Nanjing, China
| | - Yepeng Zhang
- Department of Vascular Surgery, Drum Tower Hospital, Affiliated to School of Medicine, Nanjing University, Nanjing, China
| | - Leiyang Zhang
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Ming Zhang
- Department of Vascular Surgery, Drum Tower Hospital, Affiliated to School of Medicine, Nanjing University, Nanjing, China
- Ming Zhang,
| | - Xiaoqiang Li
- Department of Vascular Surgery, Drum Tower Hospital, Affiliated to School of Medicine, Nanjing University, Nanjing, China
| | - Min Zhou
- Department of Vascular Surgery, Drum Tower Hospital, Affiliated to School of Medicine, Nanjing University, Nanjing, China
- *Correspondence: Min Zhou,
| |
Collapse
|
24
|
Jubouri M, Kayali F, Saha P, Ansari DM, Rezaei Y, Tan SZCP, Mousavizadeh M, Hosseini S, Mohammed I, Bashir M. Incidence of Distal Stent Graft Induced New Entry vs. Aortic Remodeling Associated With Frozen Elephant Trunk. Front Cardiovasc Med 2022; 9:875078. [PMID: 35360036 PMCID: PMC8960270 DOI: 10.3389/fcvm.2022.875078] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 02/21/2022] [Indexed: 01/05/2023] Open
Abstract
BackgroundThe introduction of the frozen elephant trunk (FET) technique for total arch replacement (TAR) has revolutionized the field of aortivascular surgery by allowing hybrid repair of complex aortic pathologies in a single step through combining an open surgical approach with an endovascular one. FET has been associated with favorable aortic remodeling, however, its is also associated with development of distal stent graft induced new entry (dSINE) tears postoperatively. The rate of aortic remodeling and the incidence of dSINE have been linked together, in addition, there seems to be a relationship between these two variables and FET insetion length as well as graft size.AimsThe scope of this review is to highlight the rate of aortic remodeling as well the incidence of dSINE associated with different FET devices available commercially. This review also aimed to investigate the relationship between aortic remodeling, dSINE, FET insertion length and FET graft size.MethodsWe conducted a comprehensive literature search using multiple electronic databases including PubMed, Ovid, Scopus and Embase in order to collate all research evidence on the above mentioned variables.ResultsThoraflex™ Hybrid Plexus seems to yield optimum aortic remodeling by promoting maximum false thrombosis as well true lumen expansion. Thoraflex Hybrid™ is also associated with the lowest incidence of dSINE post-FET relative to the other FET devices on the market. Aortic remodeling and dSINE do influence each other and are both linked with FET graft length and size.ConclusionThe FET technique for TAR shows excellent aortic remodeling but is associated with a considerable risk of dSINE development. However, Thoraflex™ Hybrid has demonstrated itself to be the superior FET device on the aortic arch prostheses market. Since aortic remodeling, dSINE, FET insertion length and stent graft size are all interconnect, the choice of FET device length and size must be made with great care for optimum results.
Collapse
Affiliation(s)
- Matti Jubouri
- Hull York Medical School, University of York, York, United Kingdom
| | - Fatima Kayali
- School of Medicine, University of Central Lancashire, Preston, United Kingdom
| | - Priyanshu Saha
- School of Medicine, St George's University of London, London, United Kingdom
| | - Daniyal M. Ansari
- School of Medicine, St George's University of London, London, United Kingdom
| | - Yousef Rezaei
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sven Z. C. P. Tan
- Barts and The London School of Medicine and Dentistry, Queen Mary University, London, United Kingdom
| | - Mostafa Mousavizadeh
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Saeid Hosseini
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Idhrees Mohammed
- Institute of Cardiac and Aortic Disorders (ICAD), SRM Institutes for Medical Science (SIMS Hospital), Chennai, India
| | - Mohamad Bashir
- Vascular and Endovascular Surgery, Velindre University NHS Trust, Health Education and Improvement Wales (HEIW), Cardiff, United Kingdom
- *Correspondence: Mohamad Bashir
| |
Collapse
|
25
|
Zhang B, Sun X, Liu Y, Dun Y, Liang S, Yu C, Qian X, Gao H, Ren J, Wang L, Zhou S. Hybrid Technique on the Total Arch Replacement for Type A Aortic Dissection: 12-year Clinical and Radiographical Outcomes From a Single Center. Front Cardiovasc Med 2022; 9:820653. [PMID: 35295249 PMCID: PMC8918914 DOI: 10.3389/fcvm.2022.820653] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/06/2022] [Indexed: 11/26/2022] Open
Abstract
Objective Hybrid total arch replacement (HTAR) was an alternative for type A aortic dissection (TAAD). This study aimed to evaluate the clinical and radiographical outcomes of HTAR for TAAD and to evaluate the clinical outcomes of performing this procedure under mild hypothermia. Methods A total of 209 patients who underwent HTAR for TAAD were retrospectively analyzed and stratified into mild (n = 48) and moderate (n = 161) hypothermia groups to evaluate the effects of mild hypothermia on the clinical outcomes. Long-term clinical outcomes were evaluated by the overall survival and adverse aortic events (AAEs). A total of 176 patients with preoperative and at least one-time postoperative aortic computed tomography angiography in our institute were included for evaluating the late aortic remodeling (aortic diameter and false lumen thrombosis). Results The median follow-up period was 48.3 (interquartile range [IQR] = 28.4–73.7) months. The overall survival rate was 88.0, 83.2, and 77.1% at the 1, 5, and 10 years, respectively, and in the presence of death as a competing risk, the cumulative incidence of AAEs was 4.8, 9.9, and 12.1% at the 1, 5, and 10 years. The aortic diameters were stable in the descending thoracic and abdominal aorta (P > 0.05 in all the measured aortic segments). A total of 100% complete false lumen thrombosis rate in the stent covered and distal thoracic aorta were achieved at 1 year (64/64) and 4 years (18/18), respectively after HTAR. The overall composite adverse events morbidity and mortality were 18.7 and 10.0%. Mild hypothermia (31.2, IQR = 30.2–32.0) achieved similar composite adverse events morbidity (mild: 14.6 vs. moderate: 19.9%, P = 0.41) and early mortality (mild: 10.4 vs. moderate: 9.9%, P = 1.00) compared with moderate hypothermia (median 27.7, IQR = 27–28.1) group, but mild hypothermia group needed shorter cardiopulmonary bypass (mild: 111, IQR = 93–145 min vs. moderate: 136, IQR = 114–173 min, P < 0.001) and aortic cross-clamping (mild: 45, IQR = 37–56 min vs. moderate: 78, IQR = 54–107 min, P < 0.001) time. Conclusion Hybrid total arch replacement achieved desirable early and long-term clinical outcomes for TAAD. Performing HTAR under mild hypothermia was as safe as under moderate hypothermia. After HTAR for TAAD, dissected aorta achieved desirable aortic remodeling, presenting as stable aortic diameters and false lumen complete thrombosis. In all, HTAR is a practical treatment for TAAD.
Collapse
|
26
|
Jubouri M, Al-Tawil M, Yip HCA, Bashir A, Tan SZCP, Bashir M, Anderson R, Bailey D, Nienaber CA, Coselli JS, Williams I. Mid- and long-term outcomes of thoracic endovascular aortic repair in acute and subacute uncomplicated type B aortic dissection. J Card Surg 2022; 37:1328-1339. [PMID: 35191082 DOI: 10.1111/jocs.16349] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 01/28/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Uncomplicated type B aortic dissection (un-TBAD) has been managed conservatively with medical therapy to control the heart rate and blood pressure to limit disease progression, in addition to radiological follow-up. However, several trials and observational studies have investigated the use of thoracic endovascular aortic repair (TEVAR) in un-TBAD and suggested that TEVAR provides a survival benefit over medical therapy. Outcomes of TEVAR have also been linked with the timing of intervention. AIMS The scope of this review is to collate and summarize all the evidence in the literature on the mid- and long-term outcomes of TEVAR in un-TBAD, confirming its superiority. We also aimed to investigate the relationship between the timing of TEVAR intervention and results. METHODS We carried out a comprehensive literature search on multiple electronic databases including PubMed, Scopus, and EMBASE to collate and summarize all research evidence on the mid- and long-term outcomes of TEVAR in un-TBAD, as well as its relationship with intervention timing. RESULTS TEVAR has proven to be a safe and effective tool in un-TBAD, offering superior mid- and long-term outcomes including all-cause and aorta-related mortality, aortic-specific adverse events, aortic remodeling, and need for reintervention. Additionally, performing TEVAR during the subacute phase of dissection seems to yield optimal results. CONCLUSION The evidence demonstrating a survival advantage in favor TEVAR over medical therapy in un-TBAD means that with further research, particular trials and observational studies, TEVAR could become the gold-standard treatment option for un-TBAD patients.
Collapse
Affiliation(s)
- Matti Jubouri
- Hull York Medical School, University of York, York, UK
| | | | | | - Ali Bashir
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Sven Z C P Tan
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Mohamad Bashir
- Vascular and Endovascular Surgery, Velindre University NHS Trust, Health Education & Improvement Wales (HEIW), Cardiff, Wales, UK
| | - Richard Anderson
- Department of Cardiology, University Hospital of Wales, Cardiff, Wales, UK
| | - Damian Bailey
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, Wales, UK
| | - Christoph A Nienaber
- Cardiology and Aortic Centre, Royal Brompton and Harefield Hospital NHS Foundation Trust, London, UK
| | - Joseph S Coselli
- Michael E. DeBakey Department of Surgery, Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Texas, USA.,Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas, USA.,Department of Cardiovascular Surgery, CHI St Luke's-Baylor St. Luke's Medical Center, Houston, Texas, USA
| | - Ian Williams
- Department of Vascular Surgery, University Hospital of Wales, Cardiff, Wales, UK
| |
Collapse
|
27
|
Wang R, Kan Y, Yang M, Zhang H, Zhang X, Dai X, Zhai S, Hu H, Zhang X, Chen B, Huang J, Qin X, Xiao Z, Lu X, Guo W, Si Y, Fu W. Clinical Results and Aortic Remodeling After Endovascular Treatment for Complicated Type B Aortic Dissection With the “Fabulous” Stent System. Front Cardiovasc Med 2022; 9:817675. [PMID: 35237674 PMCID: PMC8882966 DOI: 10.3389/fcvm.2022.817675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 01/14/2022] [Indexed: 12/03/2022] Open
Abstract
Objective To report the clinical outcomes and aortic remodeling after the implantation of a self-developed, biomechanically optimized, two-stage thoracic stent system named Fabulous. Background Given the efficacy of the PETTICOAT concept, the benefits of Fabulous and the behavior of remodeling in different segments need further investigation. Methods This is a prospective and multicenter study. From 2017 to 2019, 145 patients (mean age, 56.6 years; 88.3% male) from 14 centers were included in this cohort. The clinical results and core laboratory results were from a central electronic data capture system. Computed tomographic angiography was performed preoperatively, 1 month, 6 months and yearly thereafter and was used for volumetric analysis by 3mensio (Bilthoven, The Netherlands). After the 1-year follow-up, 97.2 and 87.6% of the clinical and imaging results of the eligible patients were available. Results Both stent grafts and bare stents were successfully delivered in place in 100% of the patients. The 30-day mortality and 1-year freedom from all-cause mortality were 2.1 and 96.6%, respectively. The incidence of entry flow was 11.7% at 30 days and 6.2% at 365 days. No cases of stent-induced new entry (SINE) or reintervention were observed. After the 1-year follow-up, the true lumen/overall volume ratio reached 88%. The following subdivided segment volume changes were recorded: stent graft segment TL +56%; FL −92%, bare stent segment TL +32%; FL −75%, and there were no significant changes in the visceral segment. Conclusions These outcomes indicated that there were favorable clinical benefits of Fabulous stent system. This device achieved a low short-term mortality and a low incidence of reintervention. In addition, patients undergoing Fabulous stent system implantation showed remodeling both on descending aorta and on the distal aorta. The volume changes in the TL and FL varied in the different segments. The long-term follow-up is still ongoing.
Collapse
Affiliation(s)
- Ruihan Wang
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuanqing Kan
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Mou Yang
- Vascular Surgery, Yantai Yuhuangding Hospital Affiliated With Qingdao University, Yantai, China
| | - Hongkun Zhang
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaoming Zhang
- Department of Vascular Surgery, Peking University People's Hospital, Beijing, China
| | - Xiangchen Dai
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Shuiting Zhai
- Department of Vascular and Endovascular Surgery, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, China
| | - Hejie Hu
- Department of Vascular Surgery, The First Affiliated Hospital of USTC, Hefei, China
| | - Xiwei Zhang
- Department of Vascular Surgery, Jiangsu Province Hospital, Nanjing, China
| | - Bing Chen
- Department of Vascular Surgery, School of Medicine, Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Jianhua Huang
- Department of General and Vascular Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Xiao Qin
- Department of Vascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Zhanxiang Xiao
- Department of General Surgery, Hainan Province People's Hospital, Haikou, China
| | - Xinwu Lu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai, China
| | - Wei Guo
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Yi Si
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- *Correspondence: Yi Si
| | - Weiguo Fu
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Weiguo Fu
| |
Collapse
|
28
|
Doberne JW, Sabe AA, Vekstein AM, Wojnarski CM, Anand J, Voight S, Raman V, Halpern S, Armstrong JL, Zhu A, Weissler EH, Jawitz OK, Williams AR, Hughes GC. Stent Graft-Induced Aortic Wall Injury (SAWI) - Incidence, Risk Factors, and Outcomes. Ann Thorac Surg 2022; 114:684-692. [PMID: 35150615 DOI: 10.1016/j.athoracsur.2022.01.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 01/02/2022] [Accepted: 01/04/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Stent graft-induced new entry (SINE) has been described in thoracic endovascular aortic repair (TEVAR) for aortic dissection. The incidence of stent graft-induced aortic wall injury (SAWI) related to iatrogenic injury in non-dissections is incompletely described. We describe incidence, risk factors, and outcomes of SAWI. METHODS All post-TEVAR CT angiograms (1/2005-12/2018) were reviewed for radiographic evidence of SAWI. Endograft-induced aortic dissections were likewise considered SAWI. Patient characteristics, time to SAWI, and need for re-intervention were noted. Cox proportional hazards modeling was used to identify risk factors for SAWI. RESULTS Within the study cohort (n=430), 38 (9%) patients developed SAWI during a median follow-up of 2.3 years (IQR 4.8 years). 42% (n=16) of SAWI were proximal, 53% (n=20) distal and 5% (n=2) both proximal and distal. Nine (23%) were distal intimal flap injuries in dissection cases, thus sub-classifying them as SINE. 29% (n=11) of SAWI required re-intervention. Of these, 45% (n=5) were open and 55% (n=6) endovascular. TEVAR for acute dissection had a higher incidence of SAWI development (HR 4.6, 95% CI: [2.4, 9.0]; p<0.001) as compared to other indications. Use of devices with proximal bare springs or barbs was also associated with increased SAWI incidence (HR 5.3, 95% CI: [2.6, 11.0]; p<0.001). CONCLUSIONS The rate of SAWI following TEVAR is low (9%), but nearly one-third will require re-intervention. TEVAR in the setting of acute dissection and use of devices with proximal bare springs or barbs were associated with an increased incidence of SAWI.
Collapse
Affiliation(s)
- Julie W Doberne
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Ashraf A Sabe
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Andrew M Vekstein
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Charles M Wojnarski
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Jatin Anand
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Soraya Voight
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Vignesh Raman
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Samantha Halpern
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Jenna L Armstrong
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Alexander Zhu
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - E Hope Weissler
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Oliver K Jawitz
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Adam R Williams
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - G Chad Hughes
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.
| |
Collapse
|
29
|
Orimoto Y, Ishibashi H, Maruyama Y, Imaeda Y, Mitsuoka H, Arima T, Suzuki K. The PETTICOAT-snowshoe technique prevents distal stent graft-induced new entry in patients with aortic dissection. Ann Vasc Surg 2022; 84:201-210. [PMID: 35108556 DOI: 10.1016/j.avsg.2022.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/27/2021] [Accepted: 01/10/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE Distal stent graft-induced new entry (SINE) is a serious complication of thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection (TBAD). The PETTICOAT-snowshoe technique was developed to prevent distal SINE for double-barrel TBAD. Initially, a proximal stent-graft (SG) is deployed, followed by the extension of a bare stent above the celiac artery and deployment of a second SG within the bare stent. This study examined whether the PETTICOAT-snowshoe technique prevents distal SINE. MATERIALS AND METHODS This was a single-center, retrospective study comparing two groups that underwent conventional standard TEVAR between January 2013 and September 2018 and TEVAR using the PETTICOAT-snowshoe technique after October 2018 for double-barrel TBAD. RESULTS Twenty-seven patients (74% male) underwent standard TEVAR (group A), while another 27 (78% male) underwent the PETTICOAT-snowshoe technique (group B). TEVAR was performed in the chronic phase on 15 patients (55.6%) in group A and on 16 (59.2%) in group B. Aorta-related mortality occurred in one patient in group A (3.7%). Oversizing ratios at the distal edge of the SG diameter to the major axis of the true lumen were 25% ± 26% and 25% ± 21% in groups A and B, respectively. During the follow-up period, five patients (18.5%) in group A and none in group B (p = 0.02) developed distal SINE. Three out of the five patients with distal SINE in group A were treated with additional TEVAR, one with thoracoabdominal aortic replacement, and one with conservative observation. The freedom from distal SINE rate was significantly higher in group B than in group A (p = 0.04). CONCLUSIONS The PETTICOAT-snowshoe technique significantly prevented distal SINE during the mid-term period even with the same distal SG oversizing as conventional standard TEVAR.
Collapse
Affiliation(s)
- Yuki Orimoto
- Department of Vascular Surgery, Aichi Medical University, Nagakute, Aichi, Japan.
| | - Hiroyuki Ishibashi
- Department of Vascular Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Yuki Maruyama
- Department of Vascular Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Yusuke Imaeda
- Department of Vascular Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Hiroki Mitsuoka
- Department of Vascular Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Takahiro Arima
- Department of Vascular Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Kojiro Suzuki
- Department of Radiology, Aichi Medical University, Nagakute, Aichi, Japan
| |
Collapse
|
30
|
Burdess A, D'Oria M, Mani K, Tegler G, Lindström D, Mogensen J, Kölbel T, Wanhainen A. Early experience with a novel dissection-specific stent-graft to prevent distal stent-graft-induced new entry tears after thoracic endovascular repair of chronic type B aortic dissections. Ann Vasc Surg 2021; 81:36-47. [PMID: 34785340 DOI: 10.1016/j.avsg.2021.10.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/10/2021] [Accepted: 10/14/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE The aim was to report short and mid-term outcomes of a novel, investigational, dissection-specific stent-graft (DSSG), specifically designed to address the features of chronic type B aortic dissection (CTBAD) and reduce the risk of distal stent-graft-induced new entry tears (dSINE). MATERIALS AND METHODS A retrospective single center cohort study of all patients undergoing TEVAR with the DSSG for CTBAD from January 1, 2017 to January 31, 2020. The DSSG, which is a modified stent-graft based on the Cook Zenith Alpha Thoracic platform, has no proximal barbs and a customized longer body length with substantial taper. The second and third distal Z-stents are sited internally to avoid any contact of the metal skeleton with the dissection membrane and have reduced radial force, while the most distal stent was removed creating a distal 30 mm unsupported Dacron graft. RESULTS Sixteen patients (13 males, 3 females) with a median age of 66 years (range 31-79 years) underwent elective TEVAR of CTBAD using the DSSG. Six patients (38%) had an underlying connective tissue disorder. The median tapering was 10mm (range 4mm-21mm) and median length 270mm (range 210-380 mm). Technical success was achieved in all but one case (96%). One patient died within 30 days, due to retrograde type A dissection with cardiac tamponade. The 30-day rate of stroke, spinal cord ischemia and re-interventions was 0%. After median imaging follow-up time of 17 months (range 1 - 31 months), one patient developed a dSINE four months after the index procedure. After median survival follow-up of 23 months (range 2 - 35 months), one late death occurred due to traumatic brain injury, while no aortic-related death occurred during follow-up. Complete false lumen (FL) thrombosis was achieved in nine patients while the remaining six showed partial FL thrombosis. No instances of diameter increase at the level of treated aortic segment were noted with serial measurements showing either stable (n=7) or decreased (n=8) maximal transverse diameter. CONCLUSIONS Use of a novel DSSG with low radial force for TEVAR in the setting of CTBAD is safe and feasible. This early real-world experience shows promising mid-term effectiveness with low rates of dSINE or unplanned re-interventions and satisfactory aortic remodelling during follow-up. Longer follow-up is needed, however, before any firm conclusions can be drawn.
Collapse
Affiliation(s)
- Anne Burdess
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden; The Northern Vascular Unit, Freeman Hospital, Newcastle, United Kingdom
| | - Mario D'Oria
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden; Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Cattinara ASUIGI, Trieste, Italy
| | - Kevin Mani
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - Gustaf Tegler
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - David Lindström
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden
| | | | - Tilo Kölbel
- German Aortic Center, Department of Vascular Medicine, University Heart and Vascular Center, Hamburg, Germany
| | - Anders Wanhainen
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden; Department of perioperative Sciences, Surgery, Umeå University, Umeå, Sweden.
| |
Collapse
|
31
|
Charchyan E, Breshenkov D, Belov Y. A new dissection-specific hybrid stent graft for patients with DeBakey type I aortic dissection. Eur J Cardiothorac Surg 2021; 61:596-604. [PMID: 34734250 DOI: 10.1093/ejcts/ezab441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 08/25/2021] [Accepted: 08/28/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES We present our first experience of using a new dissection-specific hybrid stent graft (SG) (the 'Soft Elephant Trunk') in the frozen elephant trunk technique, in patients with non-acute DeBakey type I aortic dissection. METHODS Between September 2016 and February 2021, patients with non-acute DeBakey type I aortic dissection underwent the frozen elephant trunk procedure at our centre using 3 SG types: group Z used stiff, distal Z-shaped nitinol SGs (E-Vita, Medtronic); group R used a stiff, ring-shaped nitinol SG (Thoraflex); and group S used a soft, distal dissection-specific SG. Predictors of distal SG-induced new entry were analysed. End points were hospital- and midterm-follow-up results. RESULTS The study comprised 109 patients with 46 (42.2%), 22 (20.2%) and 41 (37.6%) patients in groups Z, R and S, respectively. No significant differences were found in early outcomes. Freedom from distal SG-induced new entry was comparable in groups Z, R and S (68.9% vs 92.9% vs 100%, log-rank = 0.14). There was no significant difference in follow-up between the groups. Four-year survival rates were 80.44%, 71.59% and 95.06% in groups Z, R and S, respectively. On multivariable analysis, the presence of connective tissue disorders [hazard ratio (HR) = 5.62, P = 0.11] and SG diameter (HR = 1.37, P = 0.034) were strong predictors of distal SG-induced new entry. CONCLUSIONS Dissection-specific hybrid SG with a soft distal end is effective in patients with non-acute DeBakey type I aortic dissection. Compared to non-soft distal SGs, this can reduce the incidence of distal complications. Long-term outcomes are necessary to determine the potential advantages and disadvantages of the new prosthesis.
Collapse
Affiliation(s)
- Eduard Charchyan
- Department of Aortic Surgery, Petrovsky National Research Centre of Surgery, Moscow, Russia
| | - Denis Breshenkov
- Department of Aortic Surgery, Petrovsky National Research Centre of Surgery, Moscow, Russia
| | - Yuriy Belov
- Department of Aortic Surgery, Petrovsky National Research Centre of Surgery, Moscow, Russia
| |
Collapse
|
32
|
Abstract
For decades, the mainstay of management for acute, uncomplicated type B aortic dissection (TBAD) has been anti-impulse medical therapy, focusing on close control of blood pressure, and heart rate. However, the natural history of this entity has remained one of aortic degeneration over time and significant morbidity and mortality. More recently, the advent of endovascular therapy has driven a revolution in the management of TBAD. While thoracic endovascular aortic repair (TEVAR) was rapidly adopted for the treatment of complicated type B aortic dissection due to significantly improved morbidity and mortality when compared with tradition open surgical techniques, its role in the management of uncomplicated dissection remained controversial. However, the accumulation of favorable data on aortic remodeling and survival following early TEVAR for uncomplicated dissection is driving a shift in paradigm and practice. This is particularly true of patients exhibiting certain features at the time of presentation that are associated with increased risk of failure of optimal medical therapy. This article reviews the current evidence in the literature addressing TEVAR for acute, uncomplicated TBAD. In addition, it presents the state of the art in FDA-approved thoracic endograft platforms, guidance regarding case planning, and step-by-step procedural description, including the management of common challenges, and complications.
Collapse
Affiliation(s)
- Margaret C Tracci
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA.
| | - W Darrin Clouse
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA
| |
Collapse
|
33
|
Clark MR, Taylor AC, Farivar BS, Williams CA, Khaja MS, Angle JF. Secondary Interventions After TEVAR for Aortic Dissection. Tech Vasc Interv Radiol 2021; 24:100753. [PMID: 34602270 DOI: 10.1016/j.tvir.2021.100753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The goal of thoracic endograft placement in type B aortic dissection is to prevent aneurysmal degeneration and other complications. Although TEVAR is a highly effective tool for managing type B aortic dissection, many patients will require additional interventions. In this article, we present a case-based review of techniques for the management of persistent false lumen perfusion and stent-graft induced new entry tears after TEVAR for aortic dissection.
Collapse
Affiliation(s)
- Meghan R Clark
- Division of Vascular and Interventional Radiology, Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA
| | - Amy C Taylor
- Division of Vascular and Interventional Radiology, Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA
| | - Behzad S Farivar
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA
| | - Carlin A Williams
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, VA
| | - Minhaj S Khaja
- Division of Vascular and Interventional Radiology, Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA
| | - John F Angle
- Division of Vascular and Interventional Radiology, Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA.
| |
Collapse
|
34
|
Zhuravleva IY, Timchenko TP, Vladimirov SV, Lyashenko MM, Kuznetsova EV, Chernyavskiy AM. Ab ovo: Factors Affecting the Radial Stiffness of Thoracic Aorta Stent-Grafts. Sovrem Tekhnologii Med 2021; 13:17-25. [PMID: 34513062 PMCID: PMC8353689 DOI: 10.17691/stm2021.13.1.02] [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: 08/10/2020] [Indexed: 11/14/2022] Open
Abstract
The aim of the investigation was to study the factors influencing the radial stiffness of the thoracic aorta stent-grafts with the stent elements made of nitinol tubes by laser cutting and thermal shape setting.
Collapse
Affiliation(s)
- I Yu Zhuravleva
- Professor, Head of the Laboratory of Bioprostheses; Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation, 15 Rechkunovskaya St., Novosibirsk, 630055, Russia
| | - T P Timchenko
- Junior Researcher, Laboratory of Bioprostheses; Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation, 15 Rechkunovskaya St., Novosibirsk, 630055, Russia
| | - S V Vladimirov
- Engineer, Laboratory of Bioprostheses; Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation, 15 Rechkunovskaya St., Novosibirsk, 630055, Russia
| | - M M Lyashenko
- Acting Head, Department of the Aorta and Coronary Arteries; Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation, 15 Rechkunovskaya St., Novosibirsk, 630055, Russia
| | - E V Kuznetsova
- Research Assistant, Laboratory of Bioprostheses; Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation, 15 Rechkunovskaya St., Novosibirsk, 630055, Russia
| | - A M Chernyavskiy
- Professor, Director, Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation, 15 Rechkunovskaya St., Novosibirsk, 630055, Russia
| |
Collapse
|
35
|
Tan WT, Liew YM, Mohamed Mokhtarudin MJ, Pirola S, Wan Ab Naim WN, Amry Hashim S, Xu XY, Lim E. Effect of Vessel Tortuosity on Stress Concentration at the Distal Stent-Vessel Interface: Possible Link With New Entry Formation Through Biomechanical Simulation. J Biomech Eng 2021; 143:081005. [PMID: 33764388 DOI: 10.1115/1.4050642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Indexed: 12/16/2022]
Abstract
A computational approach is used to investigate potential risk factors for distal stent graft-induced new entry (dSINE) in aortic dissection (AD) patients. Patient-specific simulations were performed based on computed tomography images acquired from six AD patients (three dSINE and three non-dSINE) to analyze the correlation between anatomical characteristics and stress/strain distributions. Sensitivity analysis was carried out using idealized models to independently assess the effect of stent graft length, stent tortuosity and wedge apposition angle at the landing zone on key biomechanical variables. Mismatch of biomechanical properties between the stented and nonstented regions led to high stress at the distal stent graft-vessel interface in all patients, as well as shear strain in the neighboring region, which coincides with the location of tear formation. Stress was observed to increase with the increase of stent tortuosity (from 263 kPa at a tortuosity angle of 50 deg to 313 kPa at 30 deg). It was further amplified by stent graft landing at the inflection point of a curve. Malapposition of the stent graft led to an asymmetrical segment within the aorta, therefore changing the location and magnitude of the maximum von Mises stress substantially (up to +25.9% with a +25 deg change in the distal wedge apposition angle). In conclusion, stent tortuosity and wedge apposition angle serve as important risk predictors for dSINE formation in AD patients.
Collapse
Affiliation(s)
- Wei Ting Tan
- Department of Biomedical Engineering, Faculty of Engineering, University Malaya, Kuala Lumpur 50603, Malaysia
| | - Yih Miin Liew
- Department of Biomedical Engineering, Faculty of Engineering, University Malaya, Kuala Lumpur 50603, Malaysia
| | - Mohd Jamil Mohamed Mokhtarudin
- Department of Mechanical Engineering, College of Engineering, Universiti Malaysia Pahang, Gambang, Pahang 26300, Malaysia
| | - Selene Pirola
- Department of Chemical Engineering, Imperial College London, Imperial College Rd, Kensington, London SW7 2AZ, UK
| | - Wan Naimah Wan Ab Naim
- Faculty of Mechanical and Automotive Engineering Technology, Universiti Malaysia Pahang, Pekan, Pahang 26600, Malaysia
| | - Shahrul Amry Hashim
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Xiao Yun Xu
- Department of Chemical Engineering, Imperial College London, Imperial College Rd, Kensington, London SW7 2AZ, UK
| | - Einly Lim
- Department of Biomedical Engineering, Faculty of Engineering, University Malaya, Kuala Lumpur 50603, Malaysia
| |
Collapse
|
36
|
Osswald A, Schucht R, Schlosser T, Jánosi RA, Thielmann M, Weymann A, Ruhparwar A, Tsagakis K. Changes of stent-graft orientation after frozen elephant trunk treatment in aortic dissection. Eur J Cardiothorac Surg 2021; 61:142-149. [PMID: 34329387 DOI: 10.1093/ejcts/ezab297] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 04/29/2021] [Accepted: 05/13/2021] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Our goal was to evaluate the extent of stent-graft (SG) elastic recoil in the descending aorta after the frozen elephant trunk procedure in acute (AAD) and chronic (CAD) aortic dissection as well as the impact of SG movement on distal stent graft-induced new entry (d-SINE). METHODS We retrospectively analysed 149 (105 AAD, 44 CAD) of 259 aortic dissection patients after the frozen elephant trunk procedure between January 2005 and April 2019. Inclusion criteria were at least 1-year computed tomography angiography (CTA) aortic examinations during a follow-up time of 3.8 ± 2.7 years and absence of open or endovascular reintervention. Multiplanar reconstruction of CTA scans was used to define the SG vector position and movement in a virtual Cartesian coordinate system. The angle φ of vector movement and changes of aortic areas at the distal landing zone were analysed. RESULTS The distal SG position changed over time in the cranial (10.06 ± 11.12 mm), dorsal (8.45 ± 11.12 mm) and lateral (4.96 ± 9.89 mm) directions (P < 0.001). The total change of φ (4.08 ± 7.03°) was greater in AAD than in CAD (P = 0.026). d-SINE was more common in CAD (P < 0.001) and was associated with the size of the aortic area, aortic area enlargement and continuous SG unfolding (P < 0.001). CONCLUSIONS With the frozen elephant trunk technique, movement and change of SG orientation in the descending aorta were observed over time. Elastic recoil was greater in AAD than in CAD. The incidence of d-SINE was particularly dependent on the size of the aortic lumen and SG radial expansion and less on elastic recoil.
Collapse
Affiliation(s)
- Anja Osswald
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, Essen, Germany
| | - Robert Schucht
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, Essen, Germany
| | - Thomas Schlosser
- Department of Radiology, West-German Heart and Vascular Center Essen, Essen, Germany
| | - Rolf Alexander Jánosi
- Department of Cardiology, West-German Heart and Vascular Center Essen, Essen, Germany
| | - Matthias Thielmann
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, Essen, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, Essen, Germany
| | - Konstantinos Tsagakis
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, Essen, Germany
| |
Collapse
|
37
|
Liu F, Ge Y, Rong D, Xue Y, Fan W, Miao J, Ge X, Zhao Z, Guo W. A S-Shaped Association of Distal Oversizing Ratio with Distal Stent-Graft-Induced New Entry Following Thoracic Endovascular Aortic Repair for Stanford B Aortic Dissection. Ann Vasc Surg 2021; 77:54-62. [PMID: 34175415 DOI: 10.1016/j.avsg.2021.04.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 03/20/2021] [Accepted: 04/19/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND This study was performed to evaluate the nonlinear association of the distal oversizing ratio with distal stent-graft-induced new entry (dSINE) following thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD) and to find the optimal value of the distal oversizing ratio for prevention strategy of dSINE. METHODS Total of 177 patients who underwent TEVAR for TBAD from the Registry Of type B aortic dissection with the Utility of STent graft were retrospectively investigated. Patients were stratified into two groups on the median distal oversizing ratio: lower group (≤16%, n = 88) and higher group (>16%, n = 89). The Kaplan-Meier method was used to estimate the cumulative incidence of dSINE. The multivariate Cox proportional hazards model was used to identify the association of the distal oversizing ratio with dSINE. Restricted cubic smoothing spline plots and two-piecewise regression were used to analyze the possible nonlinear association. RESULTS Eleven patients developed dSINE (6.21%) during the median follow-up time of 12.37 months (interquartile range, 8.07-18.17 months). An S-shaped association of the distal oversizing ratio with dSINE was identified. When the distal oversizing ratio was ≤40%, the risk of dSINE increased with distal oversizing ratio, and the risk of dSINE was highest when the distal oversizing ratio reached 40% (adjusted HR, 1.09; 95% CI, 1.02-1.17; P = 0.011). A larger distal oversizing ratio over 40% did not generate a greater risk of dSINE (adjusted HR, 0.95; 95% CI, 0.87-1.05; P = 0.455). CONCLUSIONS This study substantiated previous findings that the dSINE was associated with the increasing distal oversizing ratio. We also found an S-shaped association between the distal oversizing ratio and dSINE after TEVAR for TBAD. The distal oversizing ratio of 40% can be used for stratified management of patients who underwent TEVAR for TBAD.
Collapse
Affiliation(s)
- Feng Liu
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital; Department of Vascular and Endovascular Surgery, the First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yangyang Ge
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital
| | - Dan Rong
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital
| | - Yan Xue
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital
| | - Weidong Fan
- Department of Cardiology, Henan Provincial Chest Hospital, Zhengzhou, China
| | - Jianhang Miao
- Department of General Surgery, Zhongshan People's Hospital, Zhongshan, China
| | - Xiaohu Ge
- Department of Vascular Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Urumchi, China
| | - Zengren Zhao
- Department of General Surgery, the First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wei Guo
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital.
| |
Collapse
|
38
|
Wada T, Yamamoto H, Kadohama T, Takagi D. Aortic remodeling mismatch: A potential risk factor of late distal stent graft-induced new entry after frozen elephant trunk deployment. JTCVS Tech 2021; 8:46-48. [PMID: 34401808 PMCID: PMC8350949 DOI: 10.1016/j.xjtc.2021.04.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/12/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Takuya Wada
- Department of Cardiovascular Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Hiroshi Yamamoto
- Department of Cardiovascular Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Takayuki Kadohama
- Department of Cardiovascular Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Daichi Takagi
- Department of Cardiovascular Surgery, Akita University Graduate School of Medicine, Akita, Japan
| |
Collapse
|
39
|
Bi J, Niu F, Li P, Dai X, Zhu J, Liu Z. Midterm outcomes of fenestrated TEVAR using physician-modified endovascular grafts for zone 2. Vascular 2021; 30:432-440. [PMID: 34098809 DOI: 10.1177/17085381211019611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To summarize the experience and midterm outcomes of physician-modified endovascular grafts for zone 2 thoracic endovascular aortic repair. METHODS A retrospective analysis was conducted of 51 consecutive patients (mean age 57.6 ± 12.5 years, 39 males) treated with thoracic endovascular aortic repair using physician-modified endovascular grafts for reconstructing the left subclavian artery from November 2015 to December 2019. The primary endpoints during follow-up were the overall mortality, aorta-related mortality, and major complications. The secondary endpoints were reintervention and the patency of the target branches, the demographics and technical details were also described and analyzed. RESULTS Sixty-three thoracic stent-grafts were deployed in 51 patients and emergency surgery was performed in 10 patients (19.6%). Technical success was 94.1% (48/51). The incidence of perioperative complications was 15.7%, and the 30-day mortality was 0%. At a mean follow-up of 42.0 ± 14.4 months (range, 14-63 months), all the left subclavian arteries remained patent. All-cause mortality was 3.9% (2/51) and not aorta-related deaths. Estimated survival at one and three years was 98.0 ± 1.9% and 96.0 ± 2.8%, respectively. CONCLUSIONS The physician-modified endovascular grafts is feasible and effective to preserve left subclavian artery in thoracic endovascular aortic repair for aortic arch pathologies with unhealthy proximal landing zone.
Collapse
Affiliation(s)
- Jiaxue Bi
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Fang Niu
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Peng Li
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiangchen Dai
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Jiechang Zhu
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Zongwei Liu
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| |
Collapse
|
40
|
Bondesson J, Suh GY, Marks N, Dake MD, Lee JT, Cheng CP. Influence of thoracic endovascular aortic repair on true lumen helical morphology for Stanford type B dissections. J Vasc Surg 2021; 74:1499-1507.e1. [PMID: 33940073 DOI: 10.1016/j.jvs.2021.04.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Thoracic endovascular aortic repair (TEVAR) can change the morphology of the flow lumen in aortic dissections, which may affect aortic hemodynamics and function. This study characterizes how the helical morphology of the true lumen in type B aortic dissections is altered by TEVAR. METHODS Patients with type B aortic dissection who underwent computed tomography angiography before and after TEVAR were retrospectively reviewed. Images were used to construct three-dimensional stereolithographic surface models of the true lumen and whole aorta using custom software. Stereolithographic models were segmented and co-registered to determine helical morphology of the true lumen with respect to the whole aorta. The true lumen region covered by the endograft was defined based on fiducial markers before and after TEVAR. The helical angle, average helical twist, peak helical twist, and cross-sectional eccentricity, area, and circumference were quantified in this region for pre- and post-TEVAR geometries. RESULTS Sixteen patients (61.3 ± 8.0 years; 12.5% female) were treated successfully for type B dissection (5 acute and 11 chronic) with TEVAR and scans before and after TEVAR were retrospectively obtained (follow-up interval 52 ± 91 days). From before to after TEVAR, the true lumen helical angle (-70.0 ± 71.1 to -64.9 ± 75.4°; P = .782), average helical twist (-4.1 ± 4.0 to -3.7 ± 3.8°/cm; P = .674), and peak helical twist (-13.2 ± 15.2 to -15.4 ± 14.2°/cm; P = .629) did not change. However, the true lumen helical radius (1.4 ± 0.5 to 1.0 ± 0.6 cm; P < .05) and eccentricity (0.9 ± 0.1 to 0.7 ± 0.1; P < .05) decreased, and the cross-sectional area (3.0 ± 1.1 to 5.0 ± 2.0 cm2; P < .05) and circumference (7.1 ± 1.0 to 8.0 ± 1.4 cm; P < .05) increased significantly from before to after TEVAR. The distinct bimodal distribution of chiral and achiral native dissections disappeared after TEVAR, and subgroup analyses showed that the true lumen circumference of acute dissections increased with TEVAR, although it did not for chronic dissections. CONCLUSIONS The unchanged helical angle and average and peak helical twists as a result of TEVAR suggest that the angular positions of the true lumen are constrained and that the endografts were helically conformable in the angular direction. The decrease of helical radius indicated a straightening of the corkscrew shape of the true lumen, and in combination with more circular and expanded lumen cross-sections, TEVAR produced luminal morphology that theoretically allows for lower flow resistance through the endografted portion. The impact of TEVAR on dissection flow lumen morphology and the interaction between endografts and aortic tissue can provide insight for improving device design, implantation technique, and long-term clinical outcomes.
Collapse
Affiliation(s)
- Johan Bondesson
- Division of Dynamics, Chalmers University of Technology, Gothenburg, Sweden.
| | - Ga-Young Suh
- Department of Biomedical Engineering, California State University, Long Beach, Calif; Division of Vascular Surgery, Stanford University, Stanford, Calif
| | - Neil Marks
- Division of Vascular Surgery, Stanford University, Stanford, Calif
| | - Michael D Dake
- Department of Surgery, University of Arizona, Tucson, Ariz
| | - Jason T Lee
- Division of Vascular Surgery, Stanford University, Stanford, Calif
| | | |
Collapse
|
41
|
Jung JC, Sohn B, Chang HW, Lee JH, Kim DJ, Kim JS, Lim C, Park KH. Diameter change in completely remodelled proximal descending aorta after acute type I dissection repair: implications for estimating the pre-dissection size. Eur J Cardiothorac Surg 2021; 60:614-621. [PMID: 33667303 DOI: 10.1093/ejcts/ezab096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 01/17/2020] [Accepted: 01/26/2021] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES Pre-dissection diameter of the proximal descending thoracic aorta (p-DTA), if available, would be the reference for determining the size of the stent graft or elephant trunk. Acute type B dissection is known to increase p-DTA diameter by 23% (Rylski factor). This study aimed to investigate the accuracy of estimating post-remodelling diameter of the p-DTA based on the Rylski factor and other post-dissection morphological parameters in acute type I dissection, based on the assumption that the post-remodelling diameter is similar to the pre-dissection diameter. METHODS In 60 patients with acute type I dissection showing complete remodelling of the p-DTA false lumen after surgical repair, preoperative and post-remodelling computed tomography scans were reviewed. Parameters, including maximal true lumen diameter (TLDmax) and aortic area-derived diameter divided by the Rylski factor (AoDRylski), were measured at the p-DTA. RESULTS After complete remodelling, p-DTA diameter decreased by 4.1 mm (P < 0.001). The equivalent to the Rylski factor was 15%. Both TLDmax and AoDRylski frequently showed ≥2 mm discrepancy from post-remodelling aortic diameter (36.7% and 48.3%, respectively, P = 0.30). When 2 parameters coincided within 2 mm, two-third of their estimations were accurate. AoDRylski was more accurate than TLDmax in patients with a large extent of circumferential dissection, and vice versa with less circumferential dissection (P = 0.027). CONCLUSIONS Prediction of post-remodelling aortic diameter relying on a single morphologic parameter carries a substantial risk of overestimation and underestimation. Evaluation based on the extent of circumferential dissection together with the 2 parameters may provide a more reliable estimation.
Collapse
Affiliation(s)
- Joon Chul Jung
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Bongyeon Sohn
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Hyoung Woo Chang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Jae Hang Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Dong Jung Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Jun Sung Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Cheong Lim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Kay-Hyun Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| |
Collapse
|
42
|
Zhuravleva II, Liashenko MM, Shadanov AA, Sirota DA, Cherniavskiĭ AM. [Quo vadimus? Fundamental problems of developing hybrid prostheses of thoracic aorta]. ANGIOLOGIIA I SOSUDISTAIA KHIRURGIIA = ANGIOLOGY AND VASCULAR SURGERY 2021; 27:103-112. [PMID: 35050254 DOI: 10.33529/angio2021412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This article is a review briefly characterizing the state of the art of hybrid surgery of the thoracic aorta using the frozen elephant trunk technique worldwide and in Russia, also discussing unsolved problems of fundamental science, being key issues in creation of new models of hybrid prostheses of the thoracic aorta. The main attention is paid to the problem of radial stiffness of the stent-graft portion of the prosthesis. Performed is a detailed analysis of the factors influencing this characteristic of the sent graft: shape, size and number of cells of the stent element, thickness of the nitinol wire it is made of, method of edge connection, nitinol properties depending on the alloy grade and methods of thermoforming. It is shown that excessive stiffness leads to the development of d-SINE syndrome. This is followed by discussing the problem of optimal stiffness of stent grafts, based on the design of stent graft elements and elastic properties of the wall of the true channel of a dissecting aortic aneurysm. Also proposed is an approach to solving the problem of d-SINE, consisting in creation of conical stent grafts and/or a gradual decrease of radial stiffness of stent elements in the direction of the distal portion. Comprehensively addressed are disadvantages of the graft portion of the prosthesis, in 95% of items made of polyethylene terephthalate fiber: susceptibility to degradation associated with manufacturing defects and intraoperative microdamages, abrasive effect in the zone of contact with stent elements, partial postoperative hydrolysis and an inflammatory reaction to a foreign body, often being clinically pronounced. Also touched upon are certain aspects of creating hermetic coatings of the graft portion, with the use of vancomycin possessing low cytotoxicity as part of an antibacterial component being promising. As a whole, it is demonstrated that advances in creating a novel generation of hybrid prostheses should be associated with new approaches and materials, to be obtained at the junction of medicine and fundamental sciences.
Collapse
Affiliation(s)
- I Iu Zhuravleva
- Department of Aorta and Coronary Arteries Surgery, Laboratory of Bioprosthetics, National Medical Research Centre named after Academician E.N. Meshalkin, RF Ministry of Public Health, Novosibirsk, Russia
| | - M M Liashenko
- Department of Aorta and Coronary Arteries Surgery, Laboratory of Bioprosthetics, National Medical Research Centre named after Academician E.N. Meshalkin, RF Ministry of Public Health, Novosibirsk, Russia
| | - A A Shadanov
- Department of Aorta and Coronary Arteries Surgery, Laboratory of Bioprosthetics, National Medical Research Centre named after Academician E.N. Meshalkin, RF Ministry of Public Health, Novosibirsk, Russia
| | - D A Sirota
- Department of Aorta and Coronary Arteries Surgery, Laboratory of Bioprosthetics, National Medical Research Centre named after Academician E.N. Meshalkin, RF Ministry of Public Health, Novosibirsk, Russia
| | - A M Cherniavskiĭ
- Department of Aorta and Coronary Arteries Surgery, Laboratory of Bioprosthetics, National Medical Research Centre named after Academician E.N. Meshalkin, RF Ministry of Public Health, Novosibirsk, Russia
| |
Collapse
|
43
|
Ouchi T, Kato N, Kato H, Higashigawa T, Ito H, Nakajima K, Chino S, Tokui T, Mizumoto T, Sakuma H. Relevance of Aortic Dissection Chronicity to the Development of Stent Graft-induced New Entry. Ann Thorac Surg 2020; 110:1983-1989. [PMID: 32479754 DOI: 10.1016/j.athoracsur.2020.04.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/24/2020] [Accepted: 04/03/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The relevance of aortic dissection chronicity to the development of stent graft-induced new entry (SINE) is unknown. METHODS This study enrolled 69 patients who underwent thoracic endovascular aortic repair (TEVAR) for chronic aortic dissection from January 2006 to December 2017 and were followed up for ≥6 months. Their medical records were reviewed retrospectively. Patients were stratified according to TEVAR timing into an early group (≤6 months from the onset of aortic dissection) and a late group (>6 months after the onset). The incidence of SINE as well as the interval between TEVAR and the development of SINE was compared between these groups. RESULTS During the follow-up period, SINE occurred in 12% (3/26) and 35% (15/43) of patients in the early and late groups, respectively (P = .029). The interval between TEVAR and SINE development was significantly longer in the late group than the early group (median, 92 days vs 1144 days, respectively; P = .002). According to the multivariate analysis results, the late group (hazard ratio, 3.667; 95% confidence interval, 1.037-12.968; P = .044) and the distal oversizing ratio (hazard ratio, 1.492; 95% confidence interval, 1.071-2.080; P = .018) were the independent predictors for SINE development. CONCLUSIONS TEVAR should be performed in the early period of the chronic phase to prevent SINE. Close and lifelong follow-up is mandatory for patients who undergo TEVAR >6 months after onset because SINE can develop several years after TEVAR in those patients.
Collapse
Affiliation(s)
- Takafumi Ouchi
- Department of Radiology, Mie University Hospital, Tsu, Japan
| | - Noriyuki Kato
- Department of Radiology, Mie University Hospital, Tsu, Japan.
| | - Hiroaki Kato
- Department of Radiology, Mie University Hospital, Tsu, Japan
| | | | - Hisato Ito
- Department of Thoracic and Cardiovascular Surgery, Mie University Hospital, Tsu, Japan
| | - Ken Nakajima
- Department of Radiology, Ise Red Cross Hospital, Ise, Japan
| | - Shuji Chino
- Department of Radiology, Ise Red Cross Hospital, Ise, Japan
| | - Toshiya Tokui
- Department of Thoracic Surgery, Ise Red Cross Hospital, Ise, Japan
| | - Toru Mizumoto
- Department of Cardiovascular Surgery, Anjo Kosei Hospital, Aichi, Japan
| | - Hajime Sakuma
- Department of Radiology, Mie University Hospital, Tsu, Japan
| |
Collapse
|
44
|
Usai MV, Nugroho NT, Oberhuber A, Asciutto G. Influence of TEVAR on blood pressure in subacute type B aortic dissection (TBAD) patients with refractory and non-refractory arterial hypertension. INT ANGIOL 2020; 40:60-66. [PMID: 32959641 DOI: 10.23736/s0392-9590.20.04433-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Aim of this study was to compare the modifications of systemic blood pressure in patients with subacute type b aortic dissection (TBAD) and refractory (rHTN) and non-refractory arterial hypertension (N-rHTN) treated by thoracic endovascular aortic repair (TEVAR). METHODS Patients were divided into two groups, rHTN defined as blood pressure >140/90 mmHg with ≥5 antihypertensive drugs and patients with N-rHTN. Primary endpoint was the variation of mean systolic, diastolic and overall pressure (MSP, MDP and MAP) before and after antihypertensive treatment or TEVAR. Secondary endpoints were the 30-days mortality. Fifty-seven patients were included in this study. RESULTS Of the 44 Patients of the TEVAR group 21 were included in the N-rHTN group. The MSP before and after surgery for the N-rHTN group was 130 (±10 SD) and 111 (±22 SD) mmHg, P=0.01. In the rHTN group 164 (±17 SD) and 118 (±17 SD) mmHg (P=0.01). The reduction of MSP was greater in the rHTN group (P=0.01). The MAP before and after the TEVAR for the N-rHTN group was 90 (±10 SD) and 74 (±12 SD) mmHg (P=0.01), in the rHTN group 111 (±14 SD) and 70 (±9 SD) mmHg (P=0.01). The overall mortality rate group was 2.2% (1/44). CONCLUSIONS TEVAR for TBAD appears to positively affect blood pressure in patients with rHTN and N-rHTN.
Collapse
Affiliation(s)
- Marco V Usai
- Department of Vascular and Endovascular Surgery, University Hospital of Münster, Münster, Germany -
| | - Nyityasmono T Nugroho
- Department of Vascular and Endovascular Surgery, University Hospital of Münster, Münster, Germany
| | - Alexander Oberhuber
- Department of Vascular and Endovascular Surgery, University Hospital of Münster, Münster, Germany
| | - Giuseppe Asciutto
- Department of Vascular and Endovascular Surgery, University Hospital of Münster, Münster, Germany
| |
Collapse
|
45
|
An Innovative Customized Stent Graft Manufacture System Assisted by Three-Dimensional Printing Technology. Ann Thorac Surg 2020; 112:308-314. [PMID: 32950488 DOI: 10.1016/j.athoracsur.2020.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/06/2020] [Accepted: 07/06/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Commercially available thoracic aortic stent grafts rarely match the geometric characteristics of the aorta perfectly, which can lead to complications. Customization maybe a solution for this problem, but the delay inherent in the current manufacturing process makes it unable to meet the urgent requirement of acute aortic events. We established and optimized a rapid design and manufacture system for a customized aortic stent graft assisted by 3-dimensional (3D) printing technology. We also evaluated the preliminary feasibility and capability of this customized stent graft. METHODS Seven essential production steps comprised the rapid design and manufacture process for the customized stent graft system assisted by 3D printing technology. Optimization of the manufacture process was refined over time in 3 stages. Bench test and in vivo experiments were used to verify the feasibility of this system and evaluate the preliminary usability of the customized stent graft. RESULTS After optimization, the theoretical production time of the customized stent graft was reduced to approximately 12 hours. Bench test showed radial forces against the aorta wall were better distributed in the customized stent graft than in the control stent graft. In vivo experimental results showed that the customized stent graft system worked effectively. CONCLUSIONS It was feasible to rapidly design and manufacture a customized aortic stent graft assisted by 3D printing technology, which demonstrated better geometric compliance and physical characters in the bench test and in in vivo experimentation. The manufacturing process could be accelerated to approximately 12 hours, which might be optimized further to meet urgent clinic requirements.
Collapse
|
46
|
Meng Z, Ma T, Cai Y, Liu X, Wang S, Dong Z, Fu W. Numerical modeling and simulations of type B aortic dissection treated by stent-grafts with different oversizing ratios. Artif Organs 2020; 44:1202-1210. [PMID: 32530055 DOI: 10.1111/aor.13750] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 05/13/2020] [Accepted: 06/05/2020] [Indexed: 11/28/2022]
Abstract
Retrograde type A dissection after thoracic endovascular aortic repair has been a major drawback of endovascular treatment. This study investigated the biomechanical mechanism of stent-graft-induced new lesions after implantation and analyzed the relationship between radial force and spring-back force of the stent-graft when it was implanted virtually under different oversizing ratios. Based on the computed tomography angiography images, a three-dimensional geometric model of a patient-specific aortic dissection was established. The stent was designed in CAD software and the stent-graft implantation procedure under different oversizing ratios was simulated in the finite element analysis software. Implantation simulations were performed six times for each stent-graft model under 0%, 3%, 6%, 9%, 12%, and 15% oversizing ratios and the peak stress of the aorta was compared among groups. It was observed that the peak stress of the aorta was located where the proximal bare stent interacted with aortic wall and its value was increased by 62.2% from 0% to 15% oversizing ratio. The conclusions are reached that the long-term higher stress in the aortic wall may lead to the emergence of new lesions in these areas, and the radial force plays a key role in the formation of a new entry in the real aorta model.
Collapse
Affiliation(s)
- Zhuangyuan Meng
- Department of Aeronautics and Astronautics, Fudan University, Shanghai, China
| | - Tao Ma
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yunhan Cai
- Department of Aeronautics and Astronautics, Fudan University, Shanghai, China
| | - Xudong Liu
- Department of Aeronautics and Astronautics, Fudan University, Shanghai, China
| | - Shengzhang Wang
- Department of Aeronautics and Astronautics, Fudan University, Shanghai, China
| | - Zhihui Dong
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Weiguo Fu
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
47
|
Yamane Y, Katayama K, Furukawa T, Shimizu H, Okazaki T, Takasaki T, Kurosaki T, Takahashi S. Mid-Term Results of Frozen Elephant Trunk Technique for Chronic Aortic Dissection. Ann Vasc Dis 2020; 13:137-143. [PMID: 32595789 PMCID: PMC7315230 DOI: 10.3400/avd.oa.19-00131] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 02/03/2020] [Indexed: 12/19/2022] Open
Abstract
Objective: In this study, we report our experience using the frozen elephant trunk (FET) technique for chronic aortic dissection. Methods: Between January 2011 and December 2017, 15 patients underwent total arch replacement (TAR) with the FET technique for chronic aortic dissection (CAD). Results: Hospital mortality was 6.7% (n=1). No patients experienced spinal cord injury. Distal stent-induced new entry (dSINE) occurred in the early postoperative period in one patient. There were four unplanned additional operations to manage dSINE. Five patients suffered from dSINE, and aortoesophageal fistula developed in three of them. Short insertion length of the FET and large angle between the distal edge of the FET and the descending aorta were significantly more common in the dSINE group than in the non-dSINE group. The cumulative survival rates at 1, 3, and 5 years were 93.3%, 93.3%, and 66.4%, respectively. The cumulative aortic event-free rates at 1, 2, and 3 years were 85.7%, 77.1%, and 52.9%, respectively. Conclusion: The FET technique for CAD provided good early results. Short insertion length of the FET, however, can induce dSINE, which requires an additional operation at mid-term. Thus, surgical indication of the FET technique for CAD must be discussed.
Collapse
Affiliation(s)
- Yoshitaka Yamane
- Department of Cardiovascular Surgery, Hiroshima University Hospital, Hiroshima, Hiroshima, Japan
| | - Keijiro Katayama
- Department of Cardiovascular Surgery, Hiroshima University Hospital, Hiroshima, Hiroshima, Japan
| | - Tomokuni Furukawa
- Cardiovascular Center, Department of Cardiovascular Surgery, Akane-Foundation Tsuchiya General Hospital, Hiroshima, Hiroshima, Japan
| | - Haruna Shimizu
- Department of Cardiovascular Surgery, Hiroshima University Hospital, Hiroshima, Hiroshima, Japan
| | - Takanobu Okazaki
- Department of Cardiovascular Surgery, Hiroshima University Hospital, Hiroshima, Hiroshima, Japan
| | - Taiichi Takasaki
- Department of Cardiovascular Surgery, Hiroshima University Hospital, Hiroshima, Hiroshima, Japan
| | - Tatsuya Kurosaki
- Department of Cardiovascular Surgery, Hiroshima University Hospital, Hiroshima, Hiroshima, Japan
| | - Shinya Takahashi
- Department of Cardiovascular Surgery, Hiroshima University Hospital, Hiroshima, Hiroshima, Japan
| |
Collapse
|
48
|
Dun Y, Shi Y, Guo H, Liu Y, Zhang B, Sun X, Qian X, Yu C. The surgical management of retrograde type A aortic dissection after thoracic endovascular aortic repair. Interact Cardiovasc Thorac Surg 2020; 30:732-738. [PMID: 32016403 DOI: 10.1093/icvts/ivz326] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 11/26/2019] [Accepted: 12/12/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Our goal was to review the surgical treatment of retrograde type A aortic dissection (RTAD) after thoracic endovascular aortic repair (TEVAR) in our centre. METHODS From January 2014 to April 2018, 22 patients with RTAD after TEVAR were operated on in our centre. The mean age at operation was 52.0 ± 8.0 years old. The median interval between the primary TEVAR procedure and RTAD was 4.6 months (range 0-120 months). The postoperative mortality and morbidity rates were calculated to evaluate the early and long-term results. RESULTS Twenty patients received total arch replacement with the frozen elephant trunk technique and 2 patients received total arch replacement alone. The mean cardiopulmonary bypass time, aortic cross-clamp time and selective cerebral perfusion time were 172.4 ± 39.3, 100.1 ± 30.3 and 19.7 ± 10.5 min, respectively. The incidence of major adverse events was 18.6% (4/22), including stroke in 1 patient, myocardial dysfunction in 1 patient and renal failure necessitating dialysis in 3 patients. Death within 30 days was 13.6% (3/22 patients). The follow-up data were available for all 19 survivors. The mean follow-up period was 32.2 ± 16.2 months (range 10-62 months). No deaths or aortic-related events occurred during the follow-up period. CONCLUSIONS Total arch replacement with or without the frozen elephant trunk technique was suitable for the management of RTAD after TEVAR, with acceptable early and long-term results.
Collapse
Affiliation(s)
- Yaojun Dun
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi Shi
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongwei Guo
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yanxiang Liu
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bowen Zhang
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaogang Sun
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiangyang Qian
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Cuntao Yu
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
49
|
Society for Vascular Surgery (SVS) and Society of Thoracic Surgeons (STS) reporting standards for type B aortic dissections. J Vasc Surg 2020; 71:723-747. [DOI: 10.1016/j.jvs.2019.11.013] [Citation(s) in RCA: 172] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 11/03/2019] [Indexed: 12/11/2022]
|
50
|
Association Between Targeted Aortic Segment Tortuosity and Stent-Graft–Induced New Entry After Thoracic Endovascular Aortic Repair for Aortic Dissection or Intramural Hematoma. AJR Am J Roentgenol 2020; 214:679-686. [DOI: 10.2214/ajr.19.21398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|