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Chuter TAM, Buck DG, Schneider DB, Reilly LM, Messina LM. Development of a Branched Stent-Graft for Endovascular Repair of Aortic Arch Aneurysms. J Endovasc Ther 2016; 10:940-5. [PMID: 14656176 DOI: 10.1177/152660280301000517] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To develop a branched stent-graft for endovascular repair of aortic arch aneurysm. Methods: Four different prototypes of a branched aortic stent-graft were inserted into a rubber model of the human aortic arch under fluoroscopic guidance. Each prototype was tested, modified, and tested again through a series of 4 iterations. The first 3 prototypes had multiple short side branches, as docking sites for extensions into the branches of the aortic arch. The last iteration had only 1 short branch for an extension into the distal aorta and 1 long branch for direct perfusion of the innominate artery. Results: With every re-design, the prototype aortic stent-graft became shorter, and its insertion site moved to a more proximally located arch artery. Stent-graft insertion, orientation, and extension also became quicker and easier with each change in device design. However, the only system to perform reliably was the last, which was subsequently used to treat a large, symptomatic pseudoaneurysm of the aortic arch in a high-risk patient. Conclusions: None of our multibranched systems was simple, safe, or durable enough for insertion into the aortic arch; only an iteration that had a short branch for an extension into the distal aorta and a long branch for direct perfusion of the innominate artery could be deployed without difficulty or delay.
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Affiliation(s)
- Timothy A M Chuter
- Division of Vascular Surgery, University of California, San Francisco, California 94143, USA.
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2
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Tielliu IFJ, Verhoeven ELG, Zeebregts CJ, Prins TR, van den Dungen JJAM. Thoracic Stent Grafts with a Distal Fenestration for the Celiac Axis. Vascular 2016; 13:236-40. [PMID: 16229797 DOI: 10.1258/rsmvasc.13.4.236] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Descending thoracic aneurysms can be treated with a stent graft provided that there is sufficient proximal and distal aortic neck length above the celiac axis. One of the options for the treatment of thoracic aneurysms with a too short distal neck is described in this report. For this purpose, a stent graft was constructed with a scallop for the celiac axis. Three cases are presented, and the technical details are described.
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Affiliation(s)
- Ignace F J Tielliu
- Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands.
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3
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Scali ST, Feezor RJ, Chang CK, Stone DH, Goodney PP, Nelson PR, Huber TS, Beck AW. Safety of elective management of synchronous aortic disease with simultaneous thoracic and aortic stent graft placement. J Vasc Surg 2012; 56:957-64.e1. [PMID: 22743020 DOI: 10.1016/j.jvs.2012.03.272] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2012] [Revised: 03/30/2012] [Accepted: 03/31/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND Simultaneous treatment of multilevel aortic disease is controversial due to the theoretic increase in morbidity. This study was conducted to define the outcomes in patients treated electively with simultaneous thoracic endovascular aortic aneurysm repair (TEVAR) and abdominal aortic endovascular endografting for synchronous aortic pathology. METHODS Patients treated with simultaneous TEVAR and endovascular aneurysm repair (T&E) at the University of Florida were identified from a prospectively maintained endovascular aortic registry and compared with those treated with TEVAR alone (TA). The study excluded patients with urgent or emergency indications, thoracoabdominal or mycotic aneurysm, and those requiring chimney stents, fenestrations, or visceral debranching procedures. Demographics, anatomic characteristics, operative details, and periprocedural morbidity were recorded. Mortality and reintervention were estimated using life-table analysis. RESULTS From 2001 to 2011, 595 patients underwent TEVAR, of whom 457 had elective repair. Twenty-two (18 men, 82%) were identified who were treated electively with simultaneous T&E. Mean ± standard deviation age was 66 ± 9 years, and median follow-up was 8.8 months (range, 1-34 months). Operative indications for the procedure included dissection-related pathology in 10 (45%) and various combinations of degenerative etiologies in 12 (55%). Compared with TA, T&E patients had significantly higher blood loss (P < .0001), contrast exposure (P < .0001), fluoroscopy time (P < .0001), and operative time (P < .0001). The temporary spinal cord ischemia rate was 13.6% (n = 3) for the T&E group and 6.0% for TA (P = .15); however, the permanent spinal cord ischemia rate was 4% for both groups (P = .96). The 30-day mortality for T&E was 4.5% (n = 1) compared with 2.1% (n = 10) for TA. Temporary renal injury (defined by a 25% increase over baseline creatinine) occurred in two T&E patients (9.1%), with none requiring permanent hemodialysis; no significant difference was noted between the two groups (P = .14). One-year mortality and freedom from reintervention in the T&E patients were 81% and 91%, respectively. CONCLUSIONS Acceptable short-term morbidity and mortality can be achieved with T&E compared with TA, despite longer operative times, greater blood loss, and higher contrast exposure. There was a trend toward higher rates of renal and spinal cord injury, so implementation of strategies to reduce the potential of these complications or consideration of staged repair is recommended. Short-term reintervention rates are low, but longer follow-up and greater patient numbers are needed to determine procedural durability and applicability.
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Affiliation(s)
- Salvatore T Scali
- Division of Vascular Surgery & Endovascular Therapy, University of Florida, Gainesville, FL 32610-0128, USA.
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Rodd C, Desigan S, Cheshire N, Jenkins M, Hamady M. The Suitability of Thoraco-abdominal Aortic Aneurysms for Branched or Fenestrated Stent Grafts – And the Development of a New Scoring Method to Aid Case Assessment. Eur J Vasc Endovasc Surg 2011; 41:175-85. [DOI: 10.1016/j.ejvs.2010.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Accepted: 10/02/2010] [Indexed: 10/18/2022]
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Bakoyiannis CN, Economopoulos KP, Kafeza M, Papalambros E. Commentary: Higher paraplegia/paraparesis and technical success rates of concurrent hybrid procedures in the treatment of thoracoabdominal aortic aneurysms. J Endovasc Ther 2010; 17:609-11. [PMID: 20939717 DOI: 10.1583/10-3051c.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Chris N Bakoyiannis
- First Department of Surgery, University of Athens, School of Medicine, Laiko General Hospital, Athens, Greece
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6
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Choong AMTL, Clough RE, Bicknell C, Warren O, Hamady M, Jenkins MP, Cheshire NJW. Recent advances in thoraco-abdominal aortic aneurysm repair. Surgeon 2010; 8:28-38. [PMID: 20222400 DOI: 10.1016/j.surge.2009.10.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Thoraco-abdominal aortic aneurysm repair remains a formidable challenge to vascular surgeons. The traditional repair of thoraco-laparotomy with aortic cross-clamping is associated with a high morbidity and mortality despite significant advances in perioperative critical care, anaesthetic and surgical techniques. The advent of the endovascular revolution has shown a marked paradigm in the approach to all aneurysm repairs. As a logical progression from the open repair, the St Mary's visceral hybrid repair combines traditional open techniques (retrograde visceral and renal revascularisation via mid-line laparotomy) with endovascular stent grafting, thereby avoiding the need for thoracotomy and aortic cross-clamping. In specialist centres, the results have been encouraging and easily comparable to the open repair. The technique has been used in several centres around the world and represents a robust, transferrable method of repairing thoraco-abdominal aortic aneurysms. Stent-grafting technologies have reached a point of sophistication that wholly endovascular methods of repairing thoraco-abdominal aortic aneurysms are being performed in several centres around the world. Although these stent grafts have to be customised to the individual patient and are only suitable for certain types of aneurysmal anatomies, they represent the future of thoraco-abdominal aortic aneurysm repair. We review the history of thoraco-abdominal aortic aneurysm repair, the exciting advances in their treatment and discuss our approach to the management of thoraco-abdominal aortic aneurysms in the 21st century.
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Affiliation(s)
- A M T L Choong
- Department of Biosurgery and Surgical Technology, Division of Surgery, Oncology, Reproductive Biology and Anaesthetics, Imperial College London, UK.
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8
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Bakoyiannis C, Kalles V, Economopoulos K, Georgopoulos S, Tsigris C, Papalambros E. Hybrid Procedures in the Treatment of Thoracoabdominal Aortic Aneurysms:. J Endovasc Ther 2009; 16:443-50. [DOI: 10.1583/1545-1550-16.4.443] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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9
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von Meyenfeldt E, Schnater J, Reekers J, Balm R. An Emergency Visceral Hybrid Procedure for Ruptured Thoraco-Abdominal Aortic Aneurysms. Eur J Vasc Endovasc Surg 2009; 38:162-8. [DOI: 10.1016/j.ejvs.2009.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Accepted: 03/07/2009] [Indexed: 11/25/2022]
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10
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Barnett BP, Qazi U, Perler BA, Malas MB. Novel approach to a type I endoleak following a hybrid repair of an arch aortic aneurysm. Vasc Endovascular Surg 2009; 43:389-92. [PMID: 19628521 DOI: 10.1177/1538574409338329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Hybrid surgical and endovascular approaches such as open visceral vessel debranching and subsequent endovascular exclusion of thoracic abdominal aortic aneurysms (TAAA) represents a significant development in treatment of TAAAs. As compared to traditional endovascular aneurysm repair, hybrid repairs commonly have a higher rate of endoleak and other endograft-related complications. In this report, we present a 71 year-old man with significant comorbidities including chronic obstructive pulmonary disease, hypertension and prostate cancer. The patient after undergoing debranching of the thoracic arch followed by endograft repair of an arch aneurysm developed a proximal type I and type II endoleak fed by the previously ligated left subclavian artery. Despite coiling of the left subclavian artery and proximal extension of the endograft, a type I endoleak persisted. Several months after the left subclavian artery was coiled, a catheter was advanced through the coils and beyond the site of ligation directly into the aneurysmal sac. Once in the aneurysmal sac, multiple coils were deployed resulting in successful treatment of the type I endoleak. This report highlights the unique challenges in treating proximal descending thoracic aneurysms and represents the first report of the treatment of a type I endoleak with reaccess through a previously coiled vessel for deployment of embolics directly into the aneurysmal sac.
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Affiliation(s)
- Brad P Barnett
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland 21224, USA
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11
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Wei G, Xin J, Yang D, Liu X, Tai Y, Zhang H, Liang F, Zhang G. A New Modular Stent Graft to Reconstruct Aortic Arch. Eur J Vasc Endovasc Surg 2009; 37:560-5. [DOI: 10.1016/j.ejvs.2009.01.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2008] [Accepted: 01/24/2009] [Indexed: 10/21/2022]
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12
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Mastracci TM, Greenberg RK. Complex aortic disease: Changes in perception, evaluation and management. J Vasc Surg 2008; 48:17S-23S; discussion 23S. [DOI: 10.1016/j.jvs.2008.09.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Revised: 08/26/2008] [Accepted: 09/04/2008] [Indexed: 11/28/2022]
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13
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Dzsinich C, Hüttl K, Cavarra G, Dzsinich M. [Thoracoabdominal aortic aneurysm hybrid repair]. Magy Seb 2008; 61:71-5. [PMID: 18426710 DOI: 10.1556/maseb.61.2008.2.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Introduction of endografting has significantly changed the treatment options of aortic aneurysms; they can be successfully applied for aortic arch or thoracoabdominal aorta aneurysm repairs, as well. In order to create safe landing zones for the endografts on these segments, a modification of the original anatomy is needed using transpositions and/or bypasses, which is called "debranching". These hybrid procedures that combine traditional and endovascular techniques may reduce surgical trauma and offer solution for patients being unfit for major surgery. We carried out a hybrid intervention in a lady who had a 60 mm Crawford Type IV aortic aneurysm including the orifice of the celiac trunk. First, an aorto-splenic artery PTFE bypass was performed and the celiac trunk was oversewn proximally to its trifurcation. The spleen remained viable through the gastroepiploic artery. Four days thereafter we covered the aneurysm using a 34 mm Thoracic Excluder. The patient tolerated both procedures well, and was discharged in stable condition. One year after this intervention, a follow-up CT scan confirmed the good position of the endograft, no endoleak and involution of the aneurysm was detected. Good patency of the aorto-splenic artery bypass was seen. This was the first thoracoabdominal hybrid surgery case performed in Hungary.
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Affiliation(s)
- Csaba Dzsinich
- Allami Egészségügyi Központ Szív-, Er- és Mellkassebészeti Osztály, Budapest, Hungary.
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Donas KP, Czerny M, Guber I, Teufelsbauer H, Nanobachvili J. Hybrid Open-endovascular Repair for Thoracoabdominal Aortic Aneurysms: Current Status and Level of Evidence. Eur J Vasc Endovasc Surg 2007; 34:528-33. [PMID: 17683957 DOI: 10.1016/j.ejvs.2007.05.023] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2007] [Accepted: 05/27/2007] [Indexed: 10/23/2022]
Abstract
PURPOSE To report the results of a systematic review of the literature and to provide evidence for the hybrid open-endovascular repair (HOER) in patients with thoracoabdominal aortic aneurysms (TAAAs). METHODS A comprehensive literature review was performed and all studies identified that reported the results of HOER in patients with TAAA and information about primary technical and clinical success in evaluating the immediate and long-term complications such as neurological, renal and respiratory morbidity. All studies were reviewed by two independent observers for the above mentioned parameters. RESULTS After careful selection according to the given criteria, 13 studies were included in our statistical analysis. The number of reported patients totalled 58. Of those, 37 were men (64.4%) and the mean age of the patients was 68.1 years (range 35-80, 95%CI [72.8, 64.9]). All patients were unfit for open repair with severe comorbidities. The mean follow-up period was 14.5+/-8.7 months (range 4-36, 95%CI [18.7, 9.9]) and the mean aneurysm diameter was 7.15cm (range 5 to 12, 95%CI [7.87, 6.69]). 229 (97.8%) of the 234 visceral vessel grafts remained patent during the follow-up period. Reintervention was necessary in one (1.6%) of the five patients with an occluded graft. The overall long-term endoleak rate was 20.6% (12/58 patients) and the reintervention rate was 13.7% (8/58 patients). No patients developed procedure-related neurological deficits. The overall early and long-term mortality rate for completed procedures was 15.5% (9/58). CONCLUSIONS HOER shows promising mid-term results for high-risk patients who have TAAA, however, present evidence does not allow robust conclusions.
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Affiliation(s)
- K P Donas
- Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna, Austria
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Lawlor DK, Faizer R, Forbes TL. The Hybrid Aneurysm Repair: Extending the Landing Zone in the Thoracoabdominal Aorta. Ann Vasc Surg 2007; 21:211-5. [PMID: 17349365 DOI: 10.1016/j.avsg.2006.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2005] [Revised: 04/27/2006] [Accepted: 05/22/2006] [Indexed: 11/18/2022]
Abstract
We present two cases of concomitant management of a type I thoracoabdominal aneurysm and an infrarenal aneurysm via laparotomy, open infrarenal aortic replacement, visceral bypasses from the infrarenal graft, and finally endovascular exclusion of the thoracoabdominal aneurysm. While there are other reports of hybrid procedures for patients with preexisting aortic grafts in place or with retrograde visceral perfusion from a native iliac artery for type II thoracoabdominal aneurysm, these are the first reported cases of concurrent management of a type I thoracoabdominal aneurysm and an infrarenal aneurysm using the infrarenal graft as a distal landing zone for the thoracoabdominal endograft.
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Affiliation(s)
- D K Lawlor
- Division of Vascular Surgery, Department of Surgery, University of Western Ontario, London Health Sciences Center, London, Ontario, Canada, N6A 4G5.
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Zoffoli G, Saccani S, Larini P, Colli A, Gherli T. Endovascular Treatment of Traumatic Aortic Dissection and Innominate Artery Pseudoaneurysm. ACTA ACUST UNITED AC 2006; 61:447-50. [PMID: 16917465 DOI: 10.1097/01.ta.0000229991.73863.3d] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hiramoto JS, Schneider DB, Reilly LM, Chuter TAM. A Double-Barrel Stent-Graft for Endovascular Repair of the Aortic Arch. J Endovasc Ther 2006; 13:72-6. [PMID: 16445326 DOI: 10.1583/04-1711r.1] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To extend the role of endovascular aneurysm repair in the presence of angulation and dilatation of the distal arch that compromise the proximal implantation site. CASE REPORT A 70-year-old man with an asymptomatic 7-cm thoracic aortic aneurysm was treated with a TAG stent-graft. However, attempts to gain secure hemostatic implantation of the endograft resulted in inadvertent coverage of the subclavian and left carotid arteries. Flow to the left carotid artery was re-established by transcarotid insertion of a self-expanding covered stent alongside the primary stent-graft. CONCLUSION This technique may have a role as an intended part of endovascular repair when there is no suitable implantation site in the descending thoracic aorta.
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Affiliation(s)
- Jade S Hiramoto
- Division of Vascular Surgery, University of California San Francisco, California 94143-0222, USA.
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Anderson JL, Adam DJ, Berce M, Hartley DE. Repair of thoracoabdominal aortic aneurysms with fenestrated and branched endovascular stent grafts. J Vasc Surg 2005; 42:600-7. [PMID: 16242539 DOI: 10.1016/j.jvs.2005.05.063] [Citation(s) in RCA: 133] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2005] [Accepted: 05/31/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To report the repair of thoracoabdominal aortic aneurysms (TAAAs) with fenestrated and branched endovascular stent grafts (EVSGs). METHODS Four patients with asymptomatic TAAAs were treated with custom-designed Zenith fenestrated and branched EVSGs. Three patients had undergone previous open aortic aneurysm repair. Thirteen visceral vessels in four patients were targeted for incorporation by graft fenestrations and branches. RESULTS The fenestration/orifice interface was secured with balloon-expandable Genesis stents or Jostent stent grafts in 9 of 13 target vessels. Completion angiography demonstrated antegrade perfusion in 12 of 13 target vessels. One renal artery occluded because of graft rotation during deployment. There were no endoleaks. Three patients required additional surgical procedures related to access vessels. One patient required reoperation for bleeding from an extra-anatomic bypass graft and subsequently died from multisystem organ failure. Three patients made an uncomplicated recovery. No patient developed spinal cord ischemia. Computed tomography at 12 months in the 3 survivors demonstrated complete aneurysm exclusion with antegrade perfusion in all 10 target vessels. CONCLUSIONS TAAA repair with fenestrated and branched EVSGs is feasible and provides an acceptable and promising alternative to conventional surgical repair in selected patients.
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Murray D, Ghosh J, Khwaja N, Murphy M, Baguneid M, Walker MG. Staged Open and Endovascular Repair of Thoracoabdominal Aneurysms Using the Common Carotid Artery. Ann Vasc Surg 2005; 19:103-7. [PMID: 15714377 DOI: 10.1007/s10016-004-0049-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The purpose of this study was to demonstrate the feasibility of staged open and endoluminal repair of complex thoracoabdominal aneurysms. We report the management of two patients with a staged, open abdominal and endoluminal thoracic repair of Crawford extent II aneurysms, where iliofemoral access was impossible and thoracic repair effected by endograft deployment via a common carotid artery. From this experience we conclude that staged open and endovascular repair for both ruptured and elective Crawford extent II thoracoabdominal aneurysms can be performed using the common carotid artery, when anatomy is favorable.
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Affiliation(s)
- David Murray
- Department of Vascular Surgery, Manchester Royal Infirmary, Manchester, UK
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Saito N, Kimura T, Toma M, Teragaki M, Minaminimura H, Kita T, Inoue K. Successful endovascular repair of an aneurysm of the ductus diverticulum with a branched stent graft: Case report and review of literature. J Vasc Surg 2004; 40:1228-33. [PMID: 15622379 DOI: 10.1016/j.jvs.2004.08.045] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aneurysm of the ductus diverticulum rarely has been reported in adults, and the reported aneurysms were treated with conventional open surgery or were diagnosed at autopsy. We report a successful endovascular repair of an aneurysm of the ductus diverticulum with the Inoue branched stent graft. In a 78-year-old woman, an abnormal shadow was noted at the aortopulmonary window on a chest x-ray film. A computed tomography scan demonstrated a 3.8-cm saccular aneurysm, which protruded inferiorly from the distal end of the aortic arch. The aneurysm was considered an aneurysm of the ductus diverticulum, and surgery was required. However, the patient was considered at high risk for respiratory dysfunction with conventional open surgery. Endovascular repair with an Inoue single-branched stent graft was performed with the patient under local anesthesia, successfully and without complication or endoleak. To our knowledge, this is the first report of endovascular treatment of an aneurysm of the ductus diverticulum.
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Affiliation(s)
- Naritatsu Saito
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Japan.
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Szmidt J, Rowiński O, Gałazka Z, Jakimowicz T, Nazarewski S, Grochowiecki T, Pacho R. Simultaneous Endovascular Exclusion of Thoracic Aortic Aneurysm with Open Abdominal Aortic Aneurysm Repair. Eur J Vasc Endovasc Surg 2004; 28:442-8. [PMID: 15350571 DOI: 10.1016/j.ejvs.2004.06.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2004] [Indexed: 11/28/2022]
Abstract
BACKGROUND The treatment of aneurysms at multiple sites within the aorta is problematic. METHODS Between March 2002 and June 2003 in the Department of General, Vascular and Transplant Surgery, Medical University of Warsaw six patients with coexisting abdominal and descending thoracic aortic aneurysms underwent simultaneous open abdominal aortic aneurysm (AAA) repair and endoluminal thoracic aortic aneurysm (TAA) repair. The indication for a combined procedure was a diagnosed descending TAA and AAA with no significant risk factors for open aortic surgery or technical contraindications for endovascular treatment of TAA. RESULTS One patient died in the peri-operative period while the other five patients all recovered well after surgery and were discharged with both aneurysms excluded. CONCLUSION Endovascular treatment of TAA combined with a simultaneous open AAA repair is an efficient and relatively safe treatment modality in patients with TAA and AAA disqualified from endovascular repair. The fact that thoracotomy is not a necessity significantly lowers the complication rate in these patients.
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Affiliation(s)
- J Szmidt
- Department of General, Vascular and Transplant Surgery, Medical University of Warsaw, Warszawa, Poland
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Affiliation(s)
- John J Ricotta
- Department of Surgery, State University of New York at Stony Brook, Room 020, University Hospital, Stony Brook, NY 11794, USA
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Rimmer J, Wolfe JHN. Type III thoracoabdominal aortic aneurysm repair: a combined surgical and endovascular approach. Eur J Vasc Endovasc Surg 2004; 26:677-9. [PMID: 14603431 DOI: 10.1016/s1078-5884(03)00299-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- J Rimmer
- Regional Vascular Unit, St Mary's Hospital, London, UK
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Chuter TAM, Schneider DB, Reilly LM, Lobo EP, Messina LM. Modular branched stent graft for endovascular repair of aortic arch aneurysm and dissection. J Vasc Surg 2003; 38:859-63. [PMID: 14560246 DOI: 10.1016/s0741-5214(03)01023-1] [Citation(s) in RCA: 160] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE We describe a modular stent graft for use in endovascular repair of aneurysms of the aortic arch. METHOD Carotid-carotid and left carotid-subclavian bypass grafts are created surgically. Two large, fully stented grafts are inserted endoluminally. The proximal component is bifurcated, with a wide proximal trunk and two distal limbs, one long and narrow, the other short and wide. This component is inserted through the carotid artery and deployed with the trunk and short wide limb in the ascending thoracic aorta; the long narrow limb opens into the innominate artery. After delivery system removal and carotid artery repair, a distal component is inserted through a femoral approach to bridge the gap between the short, wide distal limb of the proximal component and the nondilated descending thoracic aorta. The result is a branched stent graft, implanted proximally into the ascending aorta and distally into the innominate artery and descending thoracic aorta. CONCLUSION The system has been used successfully to treat a large wide-necked pseudoaneurysm of the aortic arch.
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Affiliation(s)
- Timothy A M Chuter
- Division of Vascular Surgery, University of California-San Francisco, 505 Parnassus Avenue, M-488, San Francisco, CA 94143, USA.
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Chuter TAM, Buck DG, Schneider DB, Reilly LM, Messina LM. Development of a Branched Stent-Graft for Endovascular Repair of Aortic Arch Aneurysms. J Endovasc Ther 2003. [DOI: 10.1583/1545-1550(2003)010<0940:doabsf>2.0.co;2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lamme B, de Jonge ICDYM, Reekers JA, de Mol BAJM, Balm R. Endovascular treatment of thoracic aortic pathology: feasibility and mid-term results. Eur J Vasc Endovasc Surg 2003; 25:532-9. [PMID: 12787695 DOI: 10.1053/ejvs.2002.1852] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE to report our experience with 21 consecutive patients treated with a thoracic stent-graft. DESIGN retrospective analysis. MATERIALS AND METHODS Between October 1998 and February 2002, 21 patients (12 male), mean age 55.6 years (range 19-86 years), were treated for aorticortic pathology localized to the descending aorta (18 patients), the aortic arch (2 patients) and the ascending aorta (1 patient) and comprising true aneurysms (8 patients), false aneurysms (6 patients), traumatic rupture (4 patients), mycotic aneurysms (2 patients), and ruptured aneurysm (1 patient). Plain chest X-rays and computed tomography was performed at 3, 6 and 12 months postoperatively and then annually. RESULTS the median (range) operation time was 85min (50-305min), hospital stay 6 days (3-63 days) and follow-up 24 months (5-44 months). Complications occurred in 5 patients and comprised intraoperative migration (1), type I endoleak (1), type II endoleak (1), ischemic myelopathy (1), pneumonia (2), suture granuloma (1) and common femoral artery dissection (1). CONCLUSIONS stent-grafting can be successfully employed to treat a wide range of thoracic aortic pathologies with a mortality, morbidity and resource utilization that is considerably less than that associated with conventional surgery. However, long term follow-up on safety and efficacy is needed.
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Affiliation(s)
- B Lamme
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
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