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Pecoraro F, Volpe P, Boccalon L, Migliara B, Rivolta N, Silvestro A, Trabattoni PLM, Massara M, Diaco DA, Dinoto E, Urso F, Alberti A, Feriani G, Franchin M, Ravini ML, Saccu C. Outcome Analysis From a Multicenter Registry on Unibody Stent-Graft System for the Treatment of Spontaneous Infrarenal Acute Aortic Syndrome (MURUSSIAS Registry). J Endovasc Ther 2024; 31:232-240. [PMID: 36000341 DOI: 10.1177/15266028221118507] [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
PURPOSE This study reports the outcomes from a Multicenter Registry on unibody stent-graft system for the treatment of spontaneous infrarenal acute aortic syndrome (MURUSSIAS registry). MATERIALS AND METHODS The retrospective MURUSSIAS registry included spontaneous infrarenal acute aortic dissection (IAAS) managed with the unibody stent-graft system (AFX endovascular AAA system; Endologix Inc., Irvine, California) outside the current instruction for use. IAAS considered aortic dissection (AD), intramural hematoma (IMH), and penetrating aortic ulcer (PAU). Indications to IAAS treatment were symptoms, associated dilated abdominal aorta (>3 cm), rapidly-growing (>0.5 cm/6 months) aorta, IAAS disease progression. Measured results were technical success, early (within 30 days) and midterm outcomes (after 30 days), including mortality, complications, symptoms recurrence, type I/III endoleak occurrence, stent-graft patency, survival, and freedom from reintervention. The mean follow-up was 22.12 ± 17 months. RESULTS The MURUSSIAS registry included 83 patients from 7 participating centers. IAAS indication to treatment were symptoms in 42 (51%). In 14 (17%) patients, the infrarenal aortic length was <80 mm, and in 28 (34%), the aortic bifurcation diameter was <16 mm. Technical success was 100%. Mortality occurred early in 1 (1%) and at the midterm in 3 (4%) patients. Complications occurred early in 10 (12%) patients (1 severe, 3 moderates, and 6 mild) and at midterm in 2 (2%) (2 moderate). No symptoms' recurrence or type I/III endoleaks were registered. The 36-month estimated survival and freedom from reinterventions were 89% and 92%, respectively. CONCLUSIONS The MURUSSIAS registry is the largest collection of spontaneous IAAS managed endovascularly using the AFX endovascular AAA system. The IAAS peculiar anatomic features were fitted with the used technique with excellent results. This treatment strategy might be considered in IAAS unless specifically-designed endovascular solutions will be available also in the emergent setting. Further studies are required to assess the longer-term performances and the stability of the reported technique. CLINICAL IMPACT The lack of specifically designed devices for infrarenal acute aortic syndrome (IAAS) disease remains an issue principally for its specific anatomic features. The MURUSSIAS registry retrospectively examined the outcomes of spontaneous IAAS treated using the unibody stent-graft system in a spontaneous national study; and reports the largest available data on this topic. The use of the unibody stent-graft system showed to fit the anatomic peculiarities of IAAS with excellent outcomes. This IAAS treatment strategy should be considered unless specifically designed endovascular solutions will be available.
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Affiliation(s)
- Felice Pecoraro
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Palermo, Italy
- Vascular Surgery Unit, AOU Policlinico "P. Giaccone," Palermo, Italy
| | - Pietro Volpe
- Vascular and Endovascular Surgery Unit, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli," Reggio Calabria, Italy
| | - Luca Boccalon
- Vascular Surgery Unit, ASST Ospedale Maggiore Crema, Crema, Italy
| | - Bruno Migliara
- Vascular and Endovascular Surgery Unit, Pederzoli Hospital, Peschiera del Garda, VR, Italy
| | - Nicola Rivolta
- Vascular Surgery Unit, ASST-Settelaghi, Università degli studi dell'Insubria, Varese, Italy
| | - Antonino Silvestro
- Chirurgia Vascolare ed Endovascolare, ASST Rhodense, Garbagnate Milanese, Italy
| | - Piero L M Trabattoni
- Vascular and Endovascular Surgery Unit, Monzino Cardiology Centre, Milano, Italy
| | - Mafalda Massara
- Vascular and Endovascular Surgery Unit, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli," Reggio Calabria, Italy
| | - Domenico A Diaco
- Vascular Surgery Unit, ASST Ospedale Maggiore Crema, Crema, Italy
| | - Ettore Dinoto
- Vascular Surgery Unit, AOU Policlinico "P. Giaccone," Palermo, Italy
| | - Francesca Urso
- Vascular Surgery Unit, AOU Policlinico "P. Giaccone," Palermo, Italy
| | - Antonino Alberti
- Vascular and Endovascular Surgery Unit, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli," Reggio Calabria, Italy
| | - Giovanni Feriani
- Vascular and Endovascular Surgery Unit, Pederzoli Hospital, Peschiera del Garda, VR, Italy
| | - Marco Franchin
- Vascular Surgery Unit, ASST-Settelaghi, Università degli studi dell'Insubria, Varese, Italy
| | - Matteo L Ravini
- Chirurgia Vascolare ed Endovascolare, ASST Rhodense, Garbagnate Milanese, Italy
| | - Claudio Saccu
- Vascular and Endovascular Surgery Unit, Monzino Cardiology Centre, Milano, Italy
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Czerny M, Pacini D, Aboyans V, Al-Attar N, Eggebrecht H, Evangelista A, Grabenwöger M, Stabile E, Kolowca M, Lescan M, Micari A, Muneretto C, Nienaber C, de Paulis R, Tsagakis K, Rylski B, Braverman AC, Di Marco L, Eagle K, Falk V, Gottardi R. Current options and recommendations for the use of thoracic endovascular aortic repair in acute and chronic thoracic aortic disease: an expert consensus document of the European Society for Cardiology (ESC) Working Group of Cardiovascular Surgery, the ESC Working Group on Aorta and Peripheral Vascular Diseases, the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC and the European Association for Cardio-Thoracic Surgery (EACTS). Eur J Cardiothorac Surg 2020; 59:65-73. [DOI: 10.1093/ejcts/ezaa268] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 06/04/2020] [Indexed: 12/14/2022] Open
Abstract
Abstract
Since its clinical implementation in the late nineties, thoracic endovascular aortic repair (TEVAR) has become the standard treatment of several acute and chronic diseases of the thoracic aorta. While TEVAR has been embraced by many, this disruptive technology has also stimulated the continuing evolution of open surgery, which became even more important as late TEVAR failures do need open surgical correction justifying the need to unite both treatment options under one umbrella. This fact shows the importance of—in analogy to the heart team—aortic centre formation and centralization of care, which stimulates continuing development and improves outcome . The next frontier to be explored is the most proximal component of the aorta—the aortic root, in particular in acute type A aortic dissection—which remains the main challenge for the years to come. The aim of this document is to provide the reader with a synopsis of current evidence regarding the use or non-use of TEVAR in acute and chronic thoracic aortic disease, to share latest recommendations for a modified terminology and for reporting standards and finally to provide a glimpse into future developments.
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Affiliation(s)
- Martin Czerny
- University Heart Center Freiburg—Bad Krozingen, Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | | | | | - Nawwar Al-Attar
- Golden Jubilee National Hospital, University of Glasgow, Glasgow, UK
| | | | | | | | - Eugenio Stabile
- Department of Advanced Biomedical Sciences, University of Napoli “Federico II”, Naples, Italy
| | | | - Mario Lescan
- Department of Cardiac, Thoracic and Vascular Surgery, University of Tübingen, Tübingen, Germany
| | - Antonio Micari
- Department of Cardiology, Humanitas Gavazzeni, Bergamo, Italy
| | | | | | | | | | - Bartosz Rylski
- University Heart Center Freiburg—Bad Krozingen, Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
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Kudo T, Kuratani T, Shimamura K, Sawa Y. Early and midterm results of thoracic endovascular aortic repair using a branched endograft for aortic arch pathologies: A retrospective single-center study. JTCVS Tech 2020; 4:17-25. [PMID: 34317956 PMCID: PMC8307048 DOI: 10.1016/j.xjtc.2020.09.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 11/26/2022] Open
Abstract
Background Zone 0 landing hybrid thoracic endovascular aortic repair (TEVAR) includes a few moderately invasive surgical procedures. To reduce invasiveness, TEVAR with a branched aortic arch stent-graft can be considered. This study aimed to elucidate the effectiveness of performing TEVAR using a Bolton (Bolton Medical, Inc, Sunrise, Fla) branched endograft by analyzing early and midterm results. Methods We enrolled 28 patients (mean age, 78.4 years) who underwent TEVAR with the Bolton branched endograft in Osaka University Hospital between October 2012 and June 2018 with a mean follow-up period of 4.0 years. Double-side and single-side branched devices were used in 24 (85.7%) and 4 (14.3%) patients, respectively. Results All procedures were successful; no cases of endoleak or conversion to open repair were noted during the 30-day postoperative period. The perioperative stroke rate was 14.3% (4 out of 28); midterm stroke was not detected. All patients with perioperative stroke had atheroma grade ≥2 in the brachiocephalic artery. No type 1a endoleak was reported during the early or midterm results. The cumulative survival rate, aorta-related death-free rate, and aortic event-free survival rate at 5 years were 80.8%, 95.8%, and 81.6%, respectively. Conclusions We achieved satisfactory early and midterm results by using a Bolton branched endograft for high-risk patients with arch pathologies except for high postoperative stroke. Although this treatment method is associated with postoperative stroke, performing strict evaluation of atheroma may prevent such complication. By preventing intraoperative stroke, TEVAR with this custom-made Bolton branched endograft may be considered a less-invasive treatment.
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Affiliation(s)
- Tomoaki Kudo
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Toru Kuratani
- Department of Minimally Invasive Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Kazuo Shimamura
- Department of Minimally Invasive Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Pakeliani D, Lachat M, Blohmé L, Kobayashi M, Chaykovska L, Pfammatter T, Puippe G, Veith FJ, Pecoraro F. Improved technique for sheath supported contralateral limb gate cannulation in endovascular abdominal aortic aneurysm repair. VASA 2019; 49:39-42. [PMID: 31549917 DOI: 10.1024/0301-1526/a000820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: To present a technique of sheath supported contralateral limb gate (CLG) cannulation of modular bifurcated stent-graft in endovascular abdominal aortic repair. Materials and methods: After totally percutaneous bilateral femoral access, the 9F introducer sheath is exchanged to a 30 cm 12 fr introducer sheath over a stiff wire contralateral to the intended main stent-graft insertion side and advanced into the aorta below the lowest renal artery. Parallel to the stiff wire within the sheath an additional standard J-tip guidewire with a 5 fr Pigtail angiographic catheter is advanced to the level of the renal arteries. After main body deployment, the 12 fr introducer sheath and J-tip wire with pigtail catheter are retracted until the CLG opening level, maintaining the stiff "buddy" wire in position to support the 12 fr sheath, maintaining its distal opening close to the contralateral gate opening to achieve easy cannulation. Results: Retrospective analysis of video archive from July 2016 to February 2018 evidenced 55 recorded EVAR cases. All CLG cannulations were obtained with Standard J-tip or Terumo Glidewire wires and with Pig-Tail or Berenstein catheters. Technical success was 100 %. Mean fluoroscopy time to accomplish CLG cannulation was 37.6 33 (range 1-105) seconds. The aortic carrefour angulation on coronal axis strongly correlates with cannulation time p = <.001, with longer cannulation time for higher carrefour angulations on coronal axis (Pearson correlation coefficient 0.47). Conclusions: The use of 12 fr sheath with parallel wire introduction technique, appears to be a safe and reliable tool to facilitate CLG cannulation during EVAR procedures.
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Affiliation(s)
- David Pakeliani
- Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland.,Vascular Surgery Unit, Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | | | - Linus Blohmé
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | | | - Lyubov Chaykovska
- Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland.,Aortic Center Hirslanden, Zurich, Switzerland
| | - Thomas Pfammatter
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Gilbert Puippe
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Frank J Veith
- Division of Vascular Surgery, New York University Langone Medical Center, New York, NY, USA.,Division of Vascular Surgery, The Cleveland Clinic, Cleveland, OH, USA
| | - Felice Pecoraro
- University of Palermo, Department of Surgical, Oncological and Oral Sciences, Vascular Surgery Unit, Palermo, Italy
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