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Ohira S, Gregory V, Goldberg JB, Malekan R, Laskowski I, De La Pena C, Lansman SL, Spielvogel D, Kai M. Zone 2 arch repair for acute type A dissection: Evolution from arch-first to proximal-first repair. JTCVS Tech 2023; 21:7-17. [PMID: 37854804 PMCID: PMC10580043 DOI: 10.1016/j.xjtc.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/05/2023] [Accepted: 06/13/2023] [Indexed: 10/20/2023] Open
Abstract
Objective With growing experience of acute type A aortic dissection repair, Zone 2 arch repair has been advocated. The aim of this study is to compare the outcome between "proximal-first" and "arch-first" Zone 2 repair. Methods From January 2015 to March 2023, 45 patients underwent Zone 2 arch repair out of 208 acute type A aortic dissection repairs: arch-first, N = 19, and proximal-first technique, N = 26, since January 2021. Indications were aortic arch or descending tear, complex dissection in neck vessels, cerebral malperfusion, or aneurysm of the aortic arch. Results The lowest bladder temperature was higher in the proximal-first technique (24.9 °C vs 19.7 °C, P < .001). Cardiopulmonary bypass (230 vs 177.5 minutes, P < .001), myocardial ischemic (124 vs 91 minutes, P < .001), and lower-body circulatory arrest (87 vs 28 minutes, P < .001) times were shorter in the proximal-first technique. The arch-first group required more packed red blood cells (arch-first, 2 units vs proximal-first, 0 units, P = .048), platelets (arch-first, 4 units vs proximal-first, 2 units, P = .003), and cryoprecipitates (arch-first, 2 units vs proximal-first, 1 unit, P = .024). Operative mortality and major morbidities were higher in the arch-first group (57.9% vs 11.5%, P = .001). One-year survival was comparable (arch-first, 89.5% ± 7.0% vs proximal-first, 92.0% ± 5.5%, P = .739). Distal intervention was successfully performed in 5 patients (endovascular, N = 3, and open repair, N = 2). Conclusions Zone 2 arch repair using the proximal-first technique for acute type A aortic dissection repair yields shorter lower-body ischemic time with a warmer core temperature, resulting in shorter cardiopulmonary bypass time, less blood product use, and fewer morbidities when compared with the arch-first technique.
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Affiliation(s)
- Suguru Ohira
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, NY
- New York Medical College, Valhalla, NY
| | | | - Joshua B. Goldberg
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, NY
- New York Medical College, Valhalla, NY
| | - Ramin Malekan
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, NY
- New York Medical College, Valhalla, NY
| | - Igor Laskowski
- New York Medical College, Valhalla, NY
- Division of Vascular Surgery, Department of Surgery, Westchester Medical Center, Valhalla, NY
| | - Corazon De La Pena
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, NY
- New York Medical College, Valhalla, NY
| | - Steven L. Lansman
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, NY
- New York Medical College, Valhalla, NY
| | - David Spielvogel
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, NY
- New York Medical College, Valhalla, NY
| | - Masashi Kai
- Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, NY
- New York Medical College, Valhalla, NY
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Żołnierczuk M, Miśkiewicz M, Paduch J, Rybicka A, Rynio P, Jędrzejczak T, Pacholewicz J, Gutowski P, Krajewska A, Kazimierczak A. Questionable Long-Term Results of the Extended Provisional Extension to Induce Complete Attachment (E-PETTICOAT) Technique in the Management of Chronic Type B Aortic Dissection. Ann Vasc Surg 2023; 89:210-215. [PMID: 36064129 DOI: 10.1016/j.avsg.2022.08.012] [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: 05/30/2022] [Revised: 08/04/2022] [Accepted: 08/25/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Published interim results of the extended provisional extension to induce complete attachment (e-PETTICOAT) technique suggested favorable remodeling in chronic type B Aortic Dissection (cTBAD). This report presents long-term results of the e-PETTICOAT technique for the management of cTBAD (without aneurysmal dilatation). METHODS Patients with cTBAD below the 55 mm aortic size were eligible for the management using the e-PETTICOAT technique. Follow-up was conducted at 1, 2 and 5 years based on the computed tomography angiogram. All the presurgery risk factors (entry >1 cm, inner curve entry, fusiform index >0.65, false lumen > 22 mm, aortic size >40 mm, recurrent pain or hypertension, and Stanford Dissection Risk Calculation) and postsurgery complications were examined in the study. RESULTS A total of 20 patients underwent the e-PETTICOAT surgery. The survival rate at 1, 2, and 5 years was 75%, 70%, and 64%, respectively, and the percentage of patients without any reinterventions was 100%, 93%, and 18%. Aortic degeneration was recognized in 30%, 55%, and 85% of the patients. Only 3 of the 20 patients were alive and without any reintervention after 5 years. The receiver operating curve analysis does not indicate any factor that would predict the remodeling result in the long-term follow-up. CONCLUSIONS The use of e-PETTICOAT technique in cTBAD might not have a beneficial influence on the long-term results.
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Affiliation(s)
- Michał Żołnierczuk
- Department of Vascular Surgery, Pomeranian Medical University, Szczecin, Poland.
| | - Marek Miśkiewicz
- Department of Vascular Surgery, Pomeranian Medical University, Szczecin, Poland
| | - Jarosław Paduch
- Department of Vascular Surgery, Pomeranian Medical University, Szczecin, Poland
| | - Anita Rybicka
- Department of Nursing, Pomeranian Medical University, Szczecin, Poland
| | - Paweł Rynio
- Department of Vascular Surgery, Pomeranian Medical University, Szczecin, Poland
| | - Tomasz Jędrzejczak
- Department of Cardiac Surgery, Pomeranian Medical University, Szczecin, Poland
| | - Jerzy Pacholewicz
- Department of Cardiac Surgery, Pomeranian Medical University, Szczecin, Poland
| | - Piotr Gutowski
- Department of Vascular Surgery, Pomeranian Medical University, Szczecin, Poland
| | - Agata Krajewska
- Department of Neurology, Pomeranian Medical University, Szczecin, Poland
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Rajani RR. The optimal length of aortic coverage during index thoracic endovascular aortic repair for dissection remains unclear. J Vasc Surg 2023; 77:46. [PMID: 36549798 DOI: 10.1016/j.jvs.2022.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 09/26/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Ravi R Rajani
- Department of Surgery, Division of Vascular and Endovascular Surgery, Emory University School of Medicine, Atlanta, GA.
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4
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Eidt JF, Vasquez J. Changing Management of Type B Aortic Dissections. Methodist Debakey Cardiovasc J 2023; 19:59-69. [PMID: 36910545 PMCID: PMC10000326 DOI: 10.14797/mdcvj.1171] [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: 10/14/2022] [Accepted: 01/12/2023] [Indexed: 03/09/2023] Open
Abstract
The purpose of this manuscript is to review recent trends in the management of acute type B aortic dissection. Due to its efficacy and low morbidity, thoracic endografting has rapidly been adopted as the treatment of choice for most patients with malperfusion or rupture as a consequence of acute aortic dissection. This technology is increasingly applied to patients without rupture or malperfusion, so-called "uncomplicated" dissections, to reduce the incidence of late aneurysmal degeneration in the ungrafted segments of the thoracoabdominal aorta. A variety of techniques have been proposed, including intentional rupture of the dissection membrane to obliterate the false lumen as well as the candy-plug technique to eliminate retrograde flow in the false lumen.
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Affiliation(s)
- John F Eidt
- Texas A&M College of Medicine, Bryan, Texas, US.,Baylor Scott and White Heart and Vascular Hospital, Dallas, Texas, US
| | - Javier Vasquez
- Baylor Scott and White Heart and Vascular Hospital, Dallas, Texas, US
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5
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Chronic Thoracic Aortic Dissection: How to Treat, When to Intervene. Life (Basel) 2022; 12:life12101511. [DOI: 10.3390/life12101511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/23/2022] [Accepted: 09/23/2022] [Indexed: 11/17/2022] Open
Abstract
Thoracic aortic dissection (AD) is associated with increased morbidity and mortality. Acute aortic syndrome is the first presentation of the disease in most cases. While acute AD management follows concrete guidelines because of its urgent and life-threatening nature, chronic AD is usually overlooked, although it concerns a wide spectrum of patients surviving an acute event. Acute AD survivors ultimately enter a chronic aortic disease course. Patients with chronic thoracic AD (CTAD) require lifelong surveillance and a proportion of them may present with symptoms and late complications demanding further surgical or endovascular treatment. However, the available data concerning the management of CTAD is sparse in the literature. The management of patients with CTAD is challenging as far as determining the best medical therapy and deciding on intervention are concerned. Until recently, there were no guidelines or recommendations for imaging surveillance in patients with chronic AD. The diagnostic methods for imaging aortic diseases have been improved, while the data on new endovascular and surgical approaches has increased significantly. In this review, we summarize the current evidence in the diagnosis and management of CTAD and the latest recommendations for the surgical/endovascular aortic repair of CTAD.
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6
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Aoki A, Maruta K, Masuda T, Omoto T. Procedure and Aortic Remodeling Effects of Entry Closure with Stentgraft for Type B Aortic Dissection: Comparison between the Patients with Narrow True Lumen and Those with Aneurysmal Dilated False Lumen. Ann Vasc Dis 2022; 15:175-185. [PMID: 36310734 PMCID: PMC9558141 DOI: 10.3400/avd.oa.22-00089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 08/13/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives: Appropriateness of device selection, procedure protocol and aortic remodeling effects of entry closure (TEVAR) with stent-graft (SG) for patent false lumen type B aortic dissection (TBAD) were compared between the patients with narrow true lumen (narrow group) and those with aneurysmal dilated false lumen (aneurysmal group). Methods: Twenty-six patients with narrow true lumen (narrow group) and 20 patients with aneurysmal false lumen (aneurysmal group) were included in this study. In narrow group, straight SG was implanted from Zone 3 regardless the distance between the left subclavian artery and entry. In aneurysmal group, straight or taped SG was implanted with proximal landing zone length 20 mm or more. Thoracic aortic anatomy was evaluated by CT and aortic remodeling was defined as true lumen diameter ≥50% of the aortic diameter and occlusion of false lumen. Aorta related death, retrograde type A aortic dissection (RTAD), stentgraft induced new entry (SINE) and aortic maximum diameter enlargement 5 mm or more (aortic expansion) were included in the aortic event. Results: There was no procedure related complication in narrow group and 1 patient died due to aortic rupture in aneurysmal group, Type Ia endoleak by enhanced CT 7 days after TEVAR was detected in one patient in each group. Achievement of aortic remodeling was significantly better in narrow group. Aortic event occurred in only one patient in narrow group, in whom aortic expansion was observed. In aneurysmal group, aortic event occurred 12 patients (60%) and 2 RTAD, 5 SINE, and 8 aorta expansion were observed. Aortic event free rate was significantly better in narrow group. Conclusion: TEVAR procedure for the TBAD patients with narrow true lumen seemed to be appropriate, however, different TEVAR procedure or additional procedures would be required for those with aneurysmal dilated false lumen to obtain favorable outcomes. (This is secondary publication from Jpn J Vasc Surg 2021; 30: 347–357.)
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Affiliation(s)
- Atsushi Aoki
- Division of Cardiovascular Surgery, Department of Surgery, Showa University
| | - Kazuto Maruta
- Division of Cardiovascular Surgery, Department of Surgery, Showa University
| | - Tomoaki Masuda
- Division of Cardiovascular Surgery, Department of Surgery, Showa University
| | - Tadashi Omoto
- Division of Cardiovascular Surgery, Department of Surgery, Showa University
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7
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Burbelko M, Wagner HJ, Mahnken AH. [Chronic type B aortic dissection-what to do?]. RADIOLOGIE (HEIDELBERG, GERMANY) 2022; 62:556-562. [PMID: 35737001 DOI: 10.1007/s00117-022-01022-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/24/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Chronic type B aortic dissection requires optimal medical therapy. However, secondary complications like organ or extremity malperfusion or development of aneurysmal dilatation require interventional therapy. OBJECTIVES Presentation of different endovascular treatment options for complications of chronic type B aortic dissection. MATERIALS AND METHODS Analysis of current literature with regard to indications, techniques, results, and differential indications of interventional techniques for the treatment of chronic type B aortic dissection complications. RESULTS Endovascular implantation of an aortic stent graft is interventional standard therapy for treatment of aneurysmal dilatation of the aorta following type B dissection. Technical problems are the proximal and distal landing zones and the treatment of persistent flow in the false lumen. CONCLUSION Endovascular treatment of chronic complicated type B aortic dissection is increasingly used compared to open surgical treatment because not only are more complex stent grafts (fenestrated and branched devices) available but also because of newly developed techniques for effective occlusion of flow in the false lumen (e.g., candy plug).
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Affiliation(s)
- Michael Burbelko
- Institut für Radiologie und Interventionelle Therapie, Vivantes Klinikum im Friedrichshain, Landsberger Allee 49, 10249, Berlin, Deutschland
| | - Hans-Joachim Wagner
- Institut für Radiologie und Interventionelle Therapie, Vivantes Klinikum im Friedrichshain, Landsberger Allee 49, 10249, Berlin, Deutschland.
| | - Andreas H Mahnken
- Klinik für Diagnostische und Interventionelle Radiologie, UKGM Marburg, Philipps-Universität Marburg, Marburg, Deutschland
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9
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Endovascular Management of Chronic Type B Aortic Dissection. Tech Vasc Interv Radiol 2021; 24:100752. [PMID: 34602265 DOI: 10.1016/j.tvir.2021.100752] [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: 11/22/2022]
Abstract
Acute uncomplicated type B aortic dissection (aTBAD) is often treated non operatively, with medical management primarily focused on blood pressure and heart rate control. After a 3 month period following the initial diagnosis, the dissection is considered chronic. Frequent clinical and imaging follow-up is performed to evaluate for dissection stability, aneurysmal degeneration, and visceral malperfusion, which would represent indication for surgical or endovascular repair. In this article we discuss four cases of chronic type B aortic dissection (cTBAD) managed with thoracic endovascular aortic repair (TEVAR) and varying techniques.
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10
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Makhija RR, Mukherjee D. Endovascular therapies for Type B Aortic Dissection. Cardiovasc Hematol Disord Drug Targets 2021; 21:167-178. [PMID: 34565325 DOI: 10.2174/1871529x21666210924141446] [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: 02/26/2021] [Revised: 07/30/2021] [Accepted: 08/20/2021] [Indexed: 11/22/2022]
Abstract
Aortic dissection is a life-threatening condition resulting from a tear in the intimal layer of the aorta, requiring emergent diagnosis and prompt multi-disciplinary management strategy for best patient outcomes. While type A dissection involving ascending aorta is best managed surgically due to high early mortality, type B aortic dissection (TBAD) involving descending aorta generally has better outcomes with conservative management and medical therapy as primary strategy is favored. However, there has been a recent paradigm shift in management of TBAD due to late aneurysmal degeneration of TBAD increasing morbidity and mortality at longer-term. Late surgical intervention can be prevented by early endovascular intervention when combined with optimal medical therapy. In this narrative review, we explore available literature on different endovascular therapies for TBAD in different populations of patients.
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Affiliation(s)
- Rakhee R Makhija
- Division of Cardiovascular Medicine, Texas Tech University, El Paso. United States
| | - Debabrata Mukherjee
- Department of Internal Medicine, Division of Cardiovascular Medicine, Texas Tech University, El Paso, United States. United States
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11
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Modern Management of Type B Aortic Dissections. CURRENT SURGERY REPORTS 2021. [DOI: 10.1007/s40137-021-00299-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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12
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Li D, Zheng T, Liu Z, Li Y, Yuan D, Fan Y. Influence of Distal Re-entry Tears on False Lumen Thrombosis After Thoracic Endovascular Aortic Repair in Type B Aortic Dissection Patients: A Computational Fluid Dynamics Simulation. Cardiovasc Eng Technol 2021; 12:426-437. [PMID: 33768445 DOI: 10.1007/s13239-021-00532-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 03/05/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE Distal re-entry tears play a significant role in false lumen (FL) thrombosis, which will strongly affect the postoperative long-term survival of patients with type B aortic dissection (TBAD) after thoracic endovascular aortic repair (TEVAR). This study aimed to investigate the influence of a peculiar morphological parameter of the residual re-entry tears in TBAD patients after TEVAR on long-term FL thrombosis using the computational fluid dynamics. METHODS Ideal population-based three-dimensional models of post-operative TBAD were established. Numerical simulation was performed to investigate the hemodynamic differences caused by different tear features, including the tear count, the maximum distance between tears, and the tear area. RESULTS Although the low relative residence time (RRT) area did not change significantly when the tear distance was fixed, the area of oscillatory shear index (OSI) > 0.45 and endothelial cell activation potential (ECAP) > 1.5 decreased significantly with the tear count and area increased and a dramatic increase in blood flow into the FL was also observed. When tear count and total area were fixed, for each 10-mm increase in the maximum distance between tears, the area of low RRT in the FL increased significantly, while the average pressure difference increased by 10.85%. CONCLUSION The different morphology of the re-entry tears had different effects on the thrombosis-related hemodynamic parameters in FL following TEVAR. and the number of re-entry tears was most crucial to the potential thrombosis in the post-TEVAR FL of TBAD patients.
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Affiliation(s)
- Da Li
- Department of Applied Mechanics, Sichuan University, Chengdu, 610065, China
| | - Tinghui Zheng
- Department of Applied Mechanics, Sichuan University, Chengdu, 610065, China
| | - Zhan Liu
- Department of Applied Mechanics, Sichuan University, Chengdu, 610065, China
| | - Yan Li
- Department of Applied Mechanics, Sichuan University, Chengdu, 610065, China
| | - Ding Yuan
- Department Vascular Surgery of West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China.
| | - Yubo Fan
- Beijing Advanced Innovation Center of Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, China.
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13
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Grimm JC, Szeto WY. Commentary: Managing the septum in chronic type B aortic dissections-power up the laser. J Thorac Cardiovasc Surg 2020; 164:460-461. [PMID: 33010882 DOI: 10.1016/j.jtcvs.2020.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 09/04/2020] [Accepted: 09/04/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Joshua C Grimm
- Division of Cardiovascular Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pa
| | - Wilson Y Szeto
- Division of Cardiovascular Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pa.
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14
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Spanos K, Kölbel T. Role of Endoluminal Techniques in the Management of Chronic Type B Aortic Dissection. Cardiovasc Intervent Radiol 2020; 43:1808-1820. [PMID: 32601718 PMCID: PMC8490267 DOI: 10.1007/s00270-020-02566-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 06/20/2020] [Indexed: 12/22/2022]
Abstract
In recent guidelines of international societies, the most frequent indication for treatment after chronic type B aortic dissection (cTBAD) is aneurysmal dilatation. Endovascular repair is recommended in patients with moderate to high surgical risk or with contraindications to open repair. During the last decade, many advances have been made in the field of endovascular techniques and devices. The aim of this article is to address the current status of endoluminal techniques for the management of cTBAD including standard thoracic endovascular repair, new devices, fenestrated and branched abdominal aortic devices and false lumen occlusion techniques.
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Affiliation(s)
- Konstantinos Spanos
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center, University Hospital Hamburg Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Tilo Kölbel
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center, University Hospital Hamburg Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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15
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He Y, Jia S, Sun G, Cao L, Wang X, Zhang H, Jia X, Ma X, Xiong J, Liu X, Guo W. Fenestrated/Branched Endovascular Repair for Postdissection Thoracoabdominal Aneurysms: A Systematic Review with Pooled Data Analysis. Vasc Endovascular Surg 2020; 54:510-518. [PMID: 32436464 DOI: 10.1177/1538574420927131] [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] [Indexed: 11/16/2022]
Abstract
PURPOSE Patients who have survived an acute aortic dissection remain at risk for postdissection thoracoabdominal aortic aneurysms (PD-TAAAs). Fenestrated/branched endovascular repair for PD-TAAA is increasingly used in some high-volume centers, but outcomes are still limited because of the additional challenges compared to atherosclerotic thoracoabdominal aneurysms. This study was performed to evaluate the literature on fenestrated/branched endovascular repair for PD-TAAAs. METHODS PubMed, Embase, and the Cochrane Database were searched for relevant studies published until September 2019. Outcome data were extracted to evaluate the technical success, 30-day mortality, later survival, major complications, endoleaks, target vessel patency, and reintervention. Studies were analyzed in a pooled proportion meta-analysis. RESULTS In total, 143 patients from 4 studies were identified for the pooled data analysis. The pooled technical success rate was 98% (95% CI: 86%-100%). After the treatment, the overall estimated 30-day mortality rate was 3% (95% CI: 1%-8%), early spinal cord ischemia rate was 10% (95% CI: 4%-21%), early renal injury rate was 5% (95% CI: 1%-19%), endoleak rate was 33% (95% CI: 22%-47%), reintervention rate at a median follow-up of 22.5 months was 34% (95% CI: 27%-42%), and all-cause mortality rate was 12% (95% CI: 6%-24%). CONCLUSIONS The use of fenestrated/branched stent grafts for the treatment of PD-TAAA appears generally feasible based on the limited literature, but endoleaks and reinterventions are frequent.
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Affiliation(s)
- Yuan He
- Department of Vascular Surgery, Chinese PLA General Hospital, Haidian District, Beijing, People's Republic of China
| | - Senhao Jia
- Department of Vascular Surgery, Chinese PLA General Hospital, Haidian District, Beijing, People's Republic of China
| | - Guoyi Sun
- Department of Vascular Surgery, Chinese PLA General Hospital, Haidian District, Beijing, People's Republic of China
| | - Long Cao
- Department of Vascular Surgery, Chinese PLA General Hospital, Haidian District, Beijing, People's Republic of China.,Department of General Surgery, Chinese PLA No. 983 Hospital, Hebei District, Tianjin, People's Republic of China
| | - Xinhao Wang
- Department of Vascular Surgery, Chinese PLA General Hospital, Haidian District, Beijing, People's Republic of China
| | - Hongpeng Zhang
- Department of Vascular Surgery, Chinese PLA General Hospital, Haidian District, Beijing, People's Republic of China
| | - Xin Jia
- Department of Vascular Surgery, Chinese PLA General Hospital, Haidian District, Beijing, People's Republic of China
| | - Xiaohui Ma
- Department of Vascular Surgery, Chinese PLA General Hospital, Haidian District, Beijing, People's Republic of China
| | - Jiang Xiong
- Department of Vascular Surgery, Chinese PLA General Hospital, Haidian District, Beijing, People's Republic of China
| | - Xiaoping Liu
- Department of Vascular Surgery, Chinese PLA General Hospital, Haidian District, Beijing, People's Republic of China
| | - Wei Guo
- Department of Vascular Surgery, Chinese PLA General Hospital, Haidian District, Beijing, People's Republic of China
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16
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He Y, Zhang H, Sun G, Cao L, Wang X, Ge Y, Liu X, Jia X, Ma X, Xiong J, Wu Y, Wei R, Jia S, Guo W. Application of a Reversed Off-the-Shelf Iliac Branched Device Stent in Revascularization of the Renal Artery Originating from the False Lumen. Ann Vasc Surg 2020; 67:569.e1-569.e7. [PMID: 32234399 DOI: 10.1016/j.avsg.2020.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 03/12/2020] [Accepted: 03/14/2020] [Indexed: 10/24/2022]
Abstract
Fenestrated/branched endovascular aneurysm repair is a feasible and effective treatment option for patients with postdissection thoracoabdominal/abdominal aneurysm. However, this technique is cumbersome when the target vessel originates from the false lumen. We herein report our primary experiences in utilizing a reversed off-the-shelf iliac branched device (IBD) stent to reconstruct the renal artery originating from the false lumen. This technique was performed in 3 patients (all men; 49, 46, and 45 years old) in our center. After deployment of the main aortic endograft, the distal re-entry in the common iliac artery was dilated by a balloon. The off-the-shelf IBD was then reversely deployed to allow for deployment of the bridging stent graft. Finally, the IBD and the bridging stents were assembled and the IBD was connected to the main graft. No migration of the IBDs occurred, and all target vessels remained patent during follow-up. Utilization of a reversed off-the-shelf IBD for the renal artery originating from the false lumen is a feasible option, especially for patients with specific anatomical characteristics of postdissection aortic aneurysms.
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Affiliation(s)
- Yuan He
- Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Hongpeng Zhang
- Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Guoyi Sun
- Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Long Cao
- Department of General Surgery, Chinese PLA No. 983 Hospital, Tianjin, People's Republic of China
| | - Xinhao Wang
- Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Yangyang Ge
- Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Xiaoping Liu
- Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Xin Jia
- Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Xiaohui Ma
- Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Jiang Xiong
- Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Ye Wu
- Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Ren Wei
- Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Senhao Jia
- Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Wei Guo
- Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China.
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