1
|
Wang GQ, Qin YF, Shi ST, Zhang KW, Zhai ST, Li TX. Retrograde type A aortic dissection during or after thoracic endovascular aortic repair: a single center 16-year experience. Front Cardiovasc Med 2023; 10:1160142. [PMID: 37547252 PMCID: PMC10401432 DOI: 10.3389/fcvm.2023.1160142] [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: 02/06/2023] [Accepted: 07/10/2023] [Indexed: 08/08/2023] Open
Abstract
Objective This article aims to investigate the incidence rate of retrograde type A aortic dissection (RTAD) and the risk factors of RTAD in relation to thoracic endovascular aortic repair (TEVAR). Methods Patients with thoracic aortic disease who underwent TEVAR at Henan Provincial People's Hospital from January 2004 to December 2019 were enrolled in the present research. The risk factors associated with RTAD following TEVAR using univariate and multiple logistic regression analyses. Results During the study period, A total of 1,688 TEVAR patients were included in this study, and of these, 1,592 cases were included in the type B aortic dissection (TBAD) group, and 96 cases were included in the non-TBAD group. There were 1,230 cases of aortic dissection and 362 cases of aortic intramural hematoma and/or penetrating ulcer in the TBAD group. The non-TBAD group included 68 cases of thoracic aortic aneurysm, 21 cases of thoracic aortic pseudoaneurysm, and seven cases of congenital aortic coarctation. The overall incidence rate of RTAD was 1.1% (18/1,688) in patients, all of which occurred in the TBAD group. The cohort comprised 18 RTAD patients with an average age of 56.78, consisting of 13 males and 5 females. Among them, 13 individuals exhibited hypertension. Ten instances happened within the TEVAR perioperative period, including two cases during the surgery, six cases occurred within three months, two cases occurred after one year, and the longest interval was 72 months following TEVAR. TEVAR was successfully implemented in 17 patients, while the operation technique was temporarily altered in one case. The new entry position for RTAD was identified as the proximal region of the stent graft (SG) in 13 patients, while in five cases, the entry site was more than 2 cm away from the proximal region of the SG. 17 cases were at the greater curvature of the aorta, and one case was at the lesser curvature. Multivariate logistic regression analysis revealed that the SG oversizing ratio is a relevant risk factor for RTAD. However, ascending aortic diameter, aortic arch type, SG type, and anchored region were not directly related to the occurrence of RTAD. Conclusion RTAD is a rare yet catastrophic complication. It could occur both during the procedure, early and late postoperative periods. Maintaining an appropriate SG oversizing ratio is crucial to minimize the risk of RTAD.
Collapse
Affiliation(s)
- Guo-quan Wang
- Department of Vascular Surgery, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, China
- Henan Provincial Neurointerventional Engineering Research Center, Henan International Joint Laboratory of Cerebrovascular Disease, and Henan Engineering Research Center of Cerebrovascular Intervention Innovation, Zhengzhou, China
| | - Ya-fei Qin
- Department of Vascular Surgery, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, China
- Henan Provincial Neurointerventional Engineering Research Center, Henan International Joint Laboratory of Cerebrovascular Disease, and Henan Engineering Research Center of Cerebrovascular Intervention Innovation, Zhengzhou, China
| | - Shuai-tao Shi
- Department of Vascular Surgery, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, China
- Henan Provincial Neurointerventional Engineering Research Center, Henan International Joint Laboratory of Cerebrovascular Disease, and Henan Engineering Research Center of Cerebrovascular Intervention Innovation, Zhengzhou, China
| | - Ke-wei Zhang
- Department of Vascular Surgery, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, China
- Henan Provincial Neurointerventional Engineering Research Center, Henan International Joint Laboratory of Cerebrovascular Disease, and Henan Engineering Research Center of Cerebrovascular Intervention Innovation, Zhengzhou, China
| | - Shui-ting Zhai
- Department of Vascular Surgery, Zhengzhou University People’s Hospital, Henan Provincial People’s Hospital, Zhengzhou, China
- Henan Provincial Neurointerventional Engineering Research Center, Henan International Joint Laboratory of Cerebrovascular Disease, and Henan Engineering Research Center of Cerebrovascular Intervention Innovation, Zhengzhou, China
| | - Tian-xiao Li
- Henan Provincial Neurointerventional Engineering Research Center, Henan International Joint Laboratory of Cerebrovascular Disease, and Henan Engineering Research Center of Cerebrovascular Intervention Innovation, Zhengzhou, China
- Department of Cerebrovascular Disease and Neurosurgery, Zhengzhou University People's Hospital, Henan Provincial People’s Hospital, Zhengzhou, China
| |
Collapse
|
2
|
Molano F, Rey Chaves CE, Conde D, Girón F, Núñez-Rocha RE, Ayala D, González J, Cortés F, Cortés D, Fajardo E, Barón V. The Clinical Impact of Thoracic Endovascular Aortic Repair in the Management of Thoracic Aortic Diseases. J Endovasc Ther 2023:15266028221148381. [PMID: 36609171 DOI: 10.1177/15266028221148381] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE Thoracic endovascular aortic repair (TEVAR) has been described to be superior to an open surgical approach, and previous studies have found superiority in TEVAR by reducing overall morbidity and mortality rates. This study aimed to describe the outcomes of TEVAR for patients with thoracic aortic disease at a high complexity. MATERIALS AND METHODS Descriptive study, developed by a retrospective review of a prospectively collected database. Patients aged above 18 years who underwent TEVAR between 2012 and 2022 were included. Patient demographics, perioperative data, surgical outcomes, morbidity, and mortality were described. Statistical and multivariate analyses were made. Statistical significance was reached when p values were <0.05. RESULTS A total of 66 patients were included. Male patients were 60.61% and the mean age was 69.24 years. Associated aortic diseases were aneurysms (68.18%), ulcer-related (4.55%), intramural-related hematoma (7.58%), trauma-related pathology (1.52%), and aortic dissection (30.30%). The mean hospital stay was 18.10 days, and intensive care unit was required for 98.48%. At 30 days, the mortality rate was 10.61% and the reintervention rate was 21.21%. Increased intraoperative blood loss (p=0.001) and male sex (p=0.04) showed statistical relationship with mortality. Underweight patients have 6.7 and 11.4 times more risk of complications and endoleak compared with higher body mass index values (p=0.04, 95% confidence interval [CI]=0.82-7.21) and (p=0.02, 95% CI=1.31-12.57), respectively. CONCLUSION Thoracic endovascular aortic repair seems to be a feasible option for patients with thoracic aortic pathologies, with adequate rates of mortality and morbidity. Underweight patients seem to have an increased risk of overall morbidity and increased risk for endoleak. Further prospective studies are needed to prove our results. CLINICAL IMPACT Obesity and BMI are widely studied in the surgical literature. According to our study, there is a paradox regarding the outcomes of patients treated with TEVAR in terms of postoperative complications and mortality related to the body mass index. And shouldn't be considered as a high-risk feature in terms of postoperative morbidity and mortality in this procedure.
Collapse
Affiliation(s)
- Fernando Molano
- Hospital Militar Central, Bogotá, D.C., Colombia
- Department of Surgery, Hospital Universitario Mayor-Méderi, Bogotá. D.C., Colombia
| | | | - Danny Conde
- Department of Surgery, Hospital Universitario Mayor-Méderi, Bogotá. D.C., Colombia
- School of Medicine, Universidad del Rosario, Bogotá, D.C., Colombia
| | - Felipe Girón
- School of Medicine, Universidad del Rosario, Bogotá, D.C., Colombia
| | | | - Daniela Ayala
- School of Medicine, Universidad del Rosario, Bogotá, D.C., Colombia
| | - Juliana González
- School of Medicine, Universidad del Rosario, Bogotá, D.C., Colombia
| | - Felipe Cortés
- Department of Surgery, Hospital Universitario Mayor-Méderi, Bogotá. D.C., Colombia
| | - Diana Cortés
- School of Medicine, Universidad del Rosario, Bogotá, D.C., Colombia
| | - Ernesto Fajardo
- Department of Surgery, Hospital Universitario Mayor-Méderi, Bogotá. D.C., Colombia
- School of Medicine, Universidad del Rosario, Bogotá, D.C., Colombia
| | - Vladimir Barón
- Department of Surgery, Hospital Universitario Mayor-Méderi, Bogotá. D.C., Colombia
- School of Medicine, Universidad del Rosario, Bogotá, D.C., Colombia
| |
Collapse
|
3
|
Impact of Female Sex on Outcomes of Patients Undergoing Thoracic Endovascular Aortic Aneurysm Repair: A Ten-Year Retrospective Nationwide Study in France. J Clin Med 2022; 11:jcm11082253. [PMID: 35456346 PMCID: PMC9029404 DOI: 10.3390/jcm11082253] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/06/2022] [Accepted: 04/12/2022] [Indexed: 12/04/2022] Open
Abstract
The impact of sex on the outcomes of patients with cardiovascular disease is still incompletely understood. The aim of this nationwide multicenter observational study was to investigate the impact of sex on post-operative outcomes in patients undergoing thoracic endovascular aortic repair (TEVAR) for intact thoracic aortic aneurysm (iTAA). The French National Health Insurance Information System was searched to identify these patients over a ten-year retrospective period. Post-operative outcomes, 30-day and overall mortality were recorded. Among the 7383 patients included (5521 men and 1862 women), females were significantly older than males (66.8 vs. 64.8 years, p < 0.001). They were less frequently diagnosed with cardiovascular comorbidities. Post-operatively, women had less frequently respiratory (10.9 vs. 13.7%, p = 0.002) as well as cardiac complications (34.3 vs. 37.3%, p = 0.023), but they had more frequently arterial complications (52.8 vs. 49.8%, p = 0.024). There was no significant difference on overall mortality for a mean follow-up of 2.2 years (26.9 vs. 27.6%, p = 0.58). In the multivariable regression model, female sex was not associated with 30-day or overall mortality. Although women had a favorable comorbidity profile, the short-term and long-term survival was similar. The significantly higher rate of arterial complications suggests that women may be at higher risk of access-vessel-related complications.
Collapse
|
4
|
Gennai S, Leone N, Maria Bartolotti LA, Covic T, Lauricella A, Andreoli F, Saitta G, Silingardi R. Endoleak outcomes with different stent-graft generations in a 25-years thoracic endovascular aortic repair experience. Vascular 2021; 30:1069-1079. [PMID: 34971330 DOI: 10.1177/17085381211051486] [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] [Indexed: 11/16/2022]
Abstract
INTRODUCTION To compare endoleak outcomes after thoracic endovascular aneurysm repair (TEVAR) with different stent-graft generations into long-term follow-up. DESIGN retrospective, observational, and single-center cohort study. METHODS TEVAR procedures performed between November 1995 and December 2020 were analyzed. The primary endpoint of this study was the freedom from endoleak (type I/III) in four stent-graft generations during the follow-up period. The first generation (GEN1) included: Vanguard; AneuRx and Talent; Stentor; Excluder; Endologix; EndoFit. The second generation (GEN2) included: TAG and TX. The third (GEN3) included: Relay Plus; Valiant Captivia; Zenith Alpha and custom-made. The fourth (GEN4) included: Relay Pro; Conformable C-TAG; Navion; E-Vita; Najuta; Nexus; standard and custom-made thoraco-abdominal devices. Nonaortic and aorta-related survival was considered as secondary outcome. RESULTS A total of 509 TEVAR were included with a 44.3 ± 42.5 months mean follow-up. Freedom from endoleak at 5 years was 65.6%, 61.4%, 76.2%, and 69.1% for GEN1, GEN2, GEN3, and GEN4, respectively (p = 0.368). The first two generations demonstrated a higher endoleak rate when compared with the two most recent ones (27.2 vs 18.2%, respectively; p = 0.043). GEN1 was an independent risk factor (p = 0.014) and GEN4 was an independent protective factor (p = 0.001) for endoleak. GEN1 was found to be a risk factor for type-Ia endoleak (p = 0.059). GEN4 demonstrated a protective association regarding type-Ib endoleak (p = 0.012). Overall survival was 75.3%, 44.4%, 27.2%, and 17.6% at 1, 5, 10, and 15 years, respectively. Survival distinguished as non-related versus aortic-related was 86.7% vs 23.5%, 52.7% vs 9.8%, 32.9% vs 2.0%, 21.2% vs 0% at 1, 5, 10, and 15 years, respectively (p< 0.000). CONCLUSION Endoleak occurred in a non-negligible percentage of TEVAR patients. A significant reduction of endoleak incidence over evolving stent-grafts generations was registered. Newer stent-graft generations demonstrated better long-term endoleak. Data about long-term outcomes require ongoing updates to prove both the reliability and the durability of newer stent-graft generations.
Collapse
Affiliation(s)
- Stefano Gennai
- Department of Vascular Surgery, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, 220340University of Modena and Reggio Emilia, Modena, Italy
| | - Nicola Leone
- Department of Vascular Surgery, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, 220340University of Modena and Reggio Emilia, Modena, Italy
| | - Luigi A Maria Bartolotti
- Department of Vascular Surgery, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, 220340University of Modena and Reggio Emilia, Modena, Italy
| | - Tea Covic
- Department of Vascular Surgery, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, 220340University of Modena and Reggio Emilia, Modena, Italy
| | - Antonio Lauricella
- Department of Vascular Surgery, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, 220340University of Modena and Reggio Emilia, Modena, Italy
| | - Francesco Andreoli
- Department of Vascular Surgery, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, 220340University of Modena and Reggio Emilia, Modena, Italy
| | - Giuseppe Saitta
- Department of Vascular Surgery, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, 220340University of Modena and Reggio Emilia, Modena, Italy
| | - Roberto Silingardi
- Department of Vascular Surgery, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, 220340University of Modena and Reggio Emilia, Modena, Italy
| |
Collapse
|
5
|
Alnahhal KI, Narayanan MK, Lingutla R, Parikh S, Iafrati M, Kumar S, Zhan Y, Salehi P. Outcomes of Thoracic Endovascular Aortic Repair in Octogenarians. Vasc Endovascular Surg 2021; 56:158-165. [PMID: 34689667 DOI: 10.1177/15385744211051502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this study is to compare outcomes between octogenarians and non-octogenarians undergoing thoracic endovascular aortic repair (TEVAR). METHODS Using the National Inpatient Sample database, we identified octogenarians (≥80 years) and non-octogenarians (<80 years) who had undergone thoracic endovascular aortic repair between 2012 and 2017. We compared patients' demographic, socioeconomic, comorbidity data between the two groups as well as the procedure indications and perioperative outcomes. A multivariable logistic regression analysis was conducted to evaluate the impact of advanced age (≥80 years) on the in-hospital mortality rates in patients who underwent TEVAR. This analysis was also performed for a separate cohort which included only patients who underwent TEVAR for ruptured thoracic aortic aneurysm. RESULTS A total of 4108 patients were included in our study; 3432 (83.5%) patients were <80 years (37.9% female; median age, 64 years; 34.3% non-white) and 676 (16.5%) patients were ≥80 years (50.7% female; median age, 83 years; 20.4% non-white). Non-ruptured thoracic aortic aneurysm was the most common indication for TEVAR in older patients (61.4%), whereas type B aortic dissection was the most common indication in younger patients (36.4%). In-hospital complications were comparable between the two groups except for respiratory complications that were higher in the younger patients (21.2% vs. 15.2%; P <.001). The multivariable analysis demonstrated that advanced age had no association with increased in-hospital mortality rates (adjusted odds ratio [aOR], 1.41; 95% confidence interval [CI], .97-2.05), However, in ruptured thoracic aortic aneurysm cohort, octogenarians had higher in-hospital mortality rates (aOR, 1.86; 95% CI, 1.04-3.32). CONCLUSIONS Octogenarians have acceptable rates of perioperative morbidity and mortality compared to the younger group and should be considered for TEVAR. Octogenarians are at higher risk for in-hospital mortality in the setting of ruptured thoracic aortic aneurysm, supporting the appropriateness of elective TEVAR in selected Octogenarians.
Collapse
Affiliation(s)
- Khaled I Alnahhal
- Division of Vascular Surgery, Cardiovascular Center, 1867Tufts Medical Center, Boston, MA, USA
| | - Meyyammai K Narayanan
- Division of Vascular Surgery, Cardiovascular Center, 1867Tufts Medical Center, Boston, MA, USA
| | | | - Shailraj Parikh
- Division of Vascular Surgery, Cardiovascular Center, 1867Tufts Medical Center, Boston, MA, USA
| | - Mark Iafrati
- Division of Vascular Surgery, Cardiovascular Center, 1867Tufts Medical Center, Boston, MA, USA
| | - Shivani Kumar
- Division of Vascular Surgery, Cardiovascular Center, 1867Tufts Medical Center, Boston, MA, USA
| | - Yong Zhan
- Division of Cardiac Surgery, Cardiovascular Center, 1867Tufts Medical Center, Boston, MA, USA
| | - Payam Salehi
- Division of Vascular Surgery, Cardiovascular Center, 1867Tufts Medical Center, Boston, MA, USA
| |
Collapse
|
6
|
Bai J, Wang C, Liu Y, Jin J, Wu J, Ji X, Qu L. A Novel Fenestrating Device, "Quick Fenestrater," for Reconstructing Supra-aortic Arteries In Situ during Thoracic Endovascular Aortic Repair. Can J Cardiol 2021; 37:1539-1546. [PMID: 33989709 DOI: 10.1016/j.cjca.2021.04.024] [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] [Received: 08/10/2020] [Revised: 04/07/2021] [Accepted: 04/18/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND In situ fenestration (ISF) is an effective approach for reconstructing supra-aortic branches during thoracic endovascular aortic repair (TEVAR). A dedicated device is needed for ISF. METHODS The "Quick Fenestrater" (QF) underwent in vitro, animal-based, and initial clinical testing. In vitro, the polytetrafluoroethylene and Dacron aortic endografts were fenestrated using the QF, and the structure of the graft, fenestration hole, and shed particulate material were evaluated. Eight white swine had QF-aided ISF combined with TEVAR and bridge stent implantation. The outcomes were assessed using intraoperative angiography and biopsy. Finally, 13 patients were treated with QF-assisted ISF, combined with TEVAR, and the success rate, technical details, and intra- and post-operative complications were recorded. RESULTS The endograft structure was not damaged during in vitro testing. The fenestration hole was clean, and no particulate material was detected. In animal studies, all animals survived, the supra-aortic arteries were patent, and the endografts and bridge stents had normal morphology. In clinical studies, the technical success rate was 100%, and no fenestration-related neurological complications or death occurred. One patient had a local access-related hematoma perioperatively and recovered after conservative treatment. Three patients had type III endoleaks, which resolved with no additional treatment. During a mean follow-up of 22.1±6 months, no thoracic complications were identified, and the bridge stents were patent with no endoleaks. No adverse cerebrovascular events, cardiovascular events, or death occurred. CONCLUSIONS QF-assisted ISF is a safe and effective method for the reconstruction of supra-aortic branches during TEVAR. Intermediate-term follow-up results validate the application of the novel fenestration device.
Collapse
Affiliation(s)
- Jun Bai
- Department of Vascular and Endovascular Surgery, Changzheng Hospital, Naval Medical University, Shanghai, 200001, China
| | - Chao Wang
- Department of Vascular and Endovascular Surgery, Changzheng Hospital, Naval Medical University, Shanghai, 200001, China
| | - Yandong Liu
- Department of Vascular and Endovascular Surgery, Changzheng Hospital, Naval Medical University, Shanghai, 200001, China
| | - Jie Jin
- Department of Vascular and Endovascular Surgery, Changzheng Hospital, Naval Medical University, Shanghai, 200001, China
| | - Jianjin Wu
- Department of Vascular and Endovascular Surgery, Changzheng Hospital, Naval Medical University, Shanghai, 200001, China
| | - Xiangguo Ji
- Department of Vascular and Endovascular Surgery, Changzheng Hospital, Naval Medical University, Shanghai, 200001, China
| | - Lefeng Qu
- Department of Vascular and Endovascular Surgery, Changzheng Hospital, Naval Medical University, Shanghai, 200001, China.
| |
Collapse
|
7
|
Sun X, Kan Y, Huang L, Dong Z, Guo D, Si Y, Fu W. Evaluation for the safety and effectiveness of the in situ fenestration system in TEVAR for aortic arch pathologies: protocol for a prospective, multicentre and single-arm study. BMJ Open 2021; 11:e043599. [PMID: 33619193 PMCID: PMC7903081 DOI: 10.1136/bmjopen-2020-043599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Thoracic endovascular aortic repair (TEVAR) has gradually become the mainstream therapy for aortic arch pathologies (AAP). Our centre developed the in situ fenestration (ISF) system according to years of clinical experience and technological innovation. This study aims to evaluate the safety and effectiveness of the innovative, self-developed ISF system in TEVAR for AAP. METHODS AND ANALYSIS The study is a prospective, multicentre and single-arm study. Patients diagnosed with AAPs in five centres on 1 January 2021 will be recruited and general TEVAR with ISF system will be performed. Clinical information and CT angiography images will be collected and recorded. Patients will be followed up for 5 years. Safety and efficacy endpoints are planned to be reported to evaluate this self-developed ISF system. ETHICS AND DISSEMINATION The study is a registry. We have registered the study on the Chinese Clinical Trial Registry website (http://www.chictr.org.cn/). This study has been approved by the Ethics Committee of Zhongshan Hospital Fudan University (B2020-371) and individual consents will be signed at the time of enrolment. We anticipate that this self-developed ISF system will result in favourable social and economic benefits. Findings will be disseminated in peer-reviewed journals to provide reference for future clinical practice. TRIAL REGISTRATION NUMBER ChiCTR1900026696.
Collapse
Affiliation(s)
- Xiaofan Sun
- Department of Vascular Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Yuanqing Kan
- Department of Vascular Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Lihong Huang
- Department of Vascular Surgery, Zhongshan Hospital Fudan University, Shanghai, China
- Department of Biostatistics, Zhongshan Hospital Fudan University, Shanghai, China
| | - Zhihui Dong
- Department of Vascular Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Daqiao Guo
- Department of Vascular Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Yi Si
- Department of Vascular Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Weiguo Fu
- Department of Vascular Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| |
Collapse
|
8
|
Qin J, Wu X, Li W, Ye K, Yin M, Liu G, Cui C, Zhao Z, Liu X, Lu X. Laser fenestration of aortic arch stent grafts for endovascular treatment of retrograde type A dissection. Int J Cardiol 2020; 328:69-74. [PMID: 33340586 DOI: 10.1016/j.ijcard.2020.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 11/07/2020] [Accepted: 12/02/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Retrograde type A dissection (RTAD) is a rare but life-threatening event following thoracic endovascular aortic repair (TEVAR), and its total endovascular treatment is a huge challenge. This research aimed to evaluate the safety, effectiveness, technical success, and medical outcomes of in situ laser fenestration of aortic arch stent grafts during TEVAR of RTAD. METHODS We retrospectively reviewed the clinical data of 15 patients with RTAD who received in situ laser fenestration of aortic arch stent grafts during TEVAR between Mar 2016 and Dec 2019. All patients were subjected to intraoperative extracorporeal brain perfusion. The preoperative, intraoperative and postoperative medical data were collected and analyzed. RESULTS The mean age of the 15 patients was 64 ± 8 years, 8 of whom were male. The immediate overall technical success rates, including aortic stent deployment were 100% and primary fenestration success was achieved in 13 (86.7%) patients. The mean postoperative length of stay was 10 ± 4 days. Stroke occurred in 1 case. No in-hospital/30-day death nor permanent paraplegia/paresis was observed. The mean follow-up time was 13 ± 5 months. Two type Ia endoleaks were found, but no late occlusion and migration of the supra-aortic branch arteries stents during the follow-up were observed. CONCLUSIONS The in situ laser fenestration of aortic arch stent grafts during TEVAR of RTAD is a potential total endovascular therapy of RTAD for patients unsuitable for direct surgical repair.
Collapse
Affiliation(s)
- Jinbao Qin
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai 200011, PR China
| | - Xiaoyu Wu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai 200011, PR China
| | - Weimin Li
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai 200011, PR China
| | - Kaichuang Ye
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai 200011, PR China
| | - Minyi Yin
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai 200011, PR China
| | - Guang Liu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai 200011, PR China
| | - Chaoyi Cui
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai 200011, PR China
| | - Zhen Zhao
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai 200011, PR China; Vascular Center of Shanghai JiaoTong University, Shanghai, 200011, PR China.
| | - Xiaobing Liu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai 200011, PR China; Vascular Center of Shanghai JiaoTong University, Shanghai, 200011, PR China.
| | - Xinwu Lu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai 200011, PR China; Vascular Center of Shanghai JiaoTong University, Shanghai, 200011, PR China.
| |
Collapse
|
9
|
Debranching thoracic endovascular aortic repair for distal aortic arch aneurysm in elderly patients aged over 75 years old. J Cardiothorac Surg 2020; 15:13. [PMID: 31924243 PMCID: PMC6954511 DOI: 10.1186/s13019-020-1047-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 01/02/2020] [Indexed: 11/26/2022] Open
Abstract
Background We examined the outcome of debranching thoracic endovascular aortic repair (d-TEVAR) without sternotomy for distal aortic arch aneurysm in patients aged ≥75 years. Methods Patients who underwent d-TEVAR or TAR for aortic arch aneurysm between 2008 and 2015 at our hospital and aged ≥75 years were included. Age, sex, left ventricular ejection fraction, preoperative creatinine level, diabetes, cerebrovascular disease, and chronic obstructive pulmonary disease were matched using PS. Results Among 74 patients (d-TEVAR: 51, TAR: 23), 17 patients in each group were matched. No difference in surgical outcome was detected between the d-TEVAR and TAR groups, including 30-day death (0% vs. 0%), hospital death (5.8% vs. 0%: p = 0.31) and incidence of cerebral infarction (5.8% vs. 7.6%: p = 0.27) as well as the long-term outcomes of 5-year survival (92.8% vs. 74.8%: p = 0.30) and 5-year aorta-related event-free rate (88.2% vs. 100%: p = 0.15). Average duration of ICU stay (1.3 ± 1.1 days vs. 5.6 ± 1.3 days: p = 0.025) and hospital stay (16.5 ± 5.2 days vs. 37.7 ± 19.6 days: p = 0.017) were significantly shorter in the d-TEVAR group. Conclusion Our results indicated that d-TEVAR is less invasive without affecting long-term outcome up to 5 years. Although the number of the patients included in the study was small, debranching TEVAR could be one of the treatments of the choice in the elderly, especially with comorbidities.
Collapse
|
10
|
Qiao Y, Mao L, Ding Y, Fan J, Zhu T, Luo K. Hemodynamic consequences of TEVAR with in situ double fenestrations of left carotid artery and left subclavian artery. Med Eng Phys 2019; 76:32-39. [PMID: 31882394 DOI: 10.1016/j.medengphy.2019.10.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 10/02/2019] [Accepted: 10/20/2019] [Indexed: 11/25/2022]
Abstract
The aortic major branches after thoracic endovascular aortic repair (TEVAR) could be preserved by in situ fenestration (ISF). This study aims to explore the hemodynamic consequences of ISF-TEVAR with double fenestrations. Two patients with aortic dissection and aneurysm, respectively, were treated by ISF-TEVAR and both the left carotid artery (LCA) and left subclavian artery (LSA) were reconstructed by fenestration technique. The blood was considered a non-Newtonian fluid and the Windkessel model was adopted at the aortic outlets. Simulations were performed in two postoperative models to analyze the effects of the double fenestration stents on the hemodynamics. The postoperative wall pressure of the LCA and LSA is relatively low and the pressure difference between the inner and outer walls of the protruding segment of the LSA stent is found. Acceleration occurs when blood flows around the fenestration stents and the shear-thinning rheological behavior is observed at the aortic arch. Moreover, regions susceptible to thrombosis are identified and the surface exposed to high relative residence time is located at the aortic arch after the LSA stent. The presence of the double fenestration stents has a profound impact on the postoperative hemodynamics, and the aortic arch and rebuilt branches should be closely watched during follow-up.
Collapse
Affiliation(s)
- 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
| | - Ying Ding
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jianren Fan
- State Key Laboratory of Clean Energy Utilization, Zhejiang University, Hangzhou, 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.
| |
Collapse
|
11
|
An Z, Tan MW, Song ZG, Tang H, Lu FL, Xu ZY. Retrograde Type A Dissection after Ascending Aorta Involved Endovascular Repair and Its Surgical Repair with Stented Elephant Trunk. Ann Vasc Surg 2019; 58:198-204.e1. [DOI: 10.1016/j.avsg.2018.11.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 10/21/2018] [Accepted: 11/11/2018] [Indexed: 12/19/2022]
|
12
|
Rylski B, Muñoz C, Beyersdorf F, Siepe M, Reser D, Carrel T, Schoenhoff F, Schlensak C, Lescan M, Eckstein HH, Reutersberg B, Erbel R, Janosi RA, Czerny M. How does descending aorta geometry change when it dissects? Eur J Cardiothorac Surg 2019; 53:815-821. [PMID: 28958027 DOI: 10.1093/ejcts/ezx292] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 07/15/2017] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES Thoracic endovascular aortic repair is the treatment of choice in complicated acute type B aortic dissection. How to infer predissection aortic diameter is not well understood. Our aim was to delineate changes in descending aortic geometry due to dissection. METHODS Five tertiary centres reviewed their acute aortic dissection type B databases containing 802 patients. All patients who had undergone computed tomography angiography less than 2 years before and immediately after aortic dissection onset were included. We compared the aortic geometry before and after the dissection onset. RESULTS Altogether 25 patients were included [median age 60 (first quartile 52, third quartile 72) years; 60% men]. In all except 1 patient, the maximum descending aortic diameter was less than 45 mm before aortic dissection onset. The largest increase in diameter induced by the dissection was observed in the proximal descending aorta 28.2 (25.1, 32.1) vs 34.6 (31.3, 39.1) mm (+6.4 mm; +23%; P < 0.001). The thoracic descending aortic length increased after the dissection onset [253.3 (229.3, 271.9) vs 261.3 (247.9, 285.4) mm; P = 0.003]. The predissection aortic diameter of the proximal thoracic descending aorta was 7.9 (5.2, 10.7) mm larger (P < 0.001) than the post-dissection area-derived true-lumen diameter and 2.5 (1.3, 6.1) mm larger than the maximum true-lumen diameter (P < 0.001). CONCLUSIONS Type B aortic dissection increases the diameter, length and volume of the descending thoracic aorta. The predissection aortic diameter most closely resembles the post-dissection maximum diameter of the true lumen.
Collapse
Affiliation(s)
- Bartosz Rylski
- Department of Cardiovascular Surgery, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Camila Muñoz
- Department of Cardiovascular Surgery, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthias Siepe
- Department of Cardiovascular Surgery, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Diana Reser
- Division of Cardiovascular Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Thierry Carrel
- Department of Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland
| | - Florian Schoenhoff
- Department of Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland
| | - Christian Schlensak
- Department of Thoracic, Cardiac and Vascular Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Mario Lescan
- Department of Thoracic, Cardiac and Vascular Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Benedikt Reutersberg
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Raimund Erbel
- Institute of Medical Informatics, Biometry and Epidemiology, University Clinic Essen, University Duisburg-Essen, Essen, Germany
| | - Rolf Alexander Janosi
- Department of Cardiology, West-German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Martin Czerny
- Department of Cardiovascular Surgery, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| |
Collapse
|
13
|
Wang L, Zhou X, Guo D, Hou K, Shi Z, Tang X, Fu W. A New Adjustable Puncture Device for In Situ Fenestration During Thoracic Endovascular Aortic Repair. J Endovasc Ther 2018; 25:474-479. [PMID: 29865946 DOI: 10.1177/1526602818776623] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To describe a new adjustable puncture system for in situ fenestration in thoracic endovascular aortic repair (TEVAR). Technique: An adjustable puncture needle for use in conjunction with a steerable 8-F, 55-cm Fustar sheath is demonstrated in a 65-year-old man with acute complicated type B dissection involving the left subclavian artery (LSA). The puncture device features an inflatable balloon at the tip, a central lumen for 0.018-inch guidewires, and a 3-level puncture depth. After thoracic stent-graft deployment at zone 2, the needle/sheath combination was delivered from a left brachial artery access. The needle was adjusted perpendicular to the fabric of the stent-graft with the assistance of the steerable sheath. The balloon at the tip was inflated to center the needle, and the puncture depth was selected on the puncture needle system. Holding the sheath and puncture needle together, a hole was created in the graft fabric. The aperture was sequentially dilated to accommodate the mating stent selected to maintain perfusion to the LSA. This new device has been successfully applied in 6 patients treated with TEVAR for different arch pathologies. Conclusion: This new puncture device could assist in situ fenestration and improve the technical success rate.
Collapse
Affiliation(s)
- Lixin Wang
- Vascular Surgery Department, Zhongshan Hospital, Fudan University, Shanghai, China
- Vascular Surgery Institute, Fudan University, Shanghai, China
- Vascular Surgery Department, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China
| | - Xiushi Zhou
- Vascular Surgery Department, Zhongshan Hospital, Fudan University, Shanghai, China
- Vascular Surgery Institute, Fudan University, Shanghai, China
| | - Daqiao Guo
- Vascular Surgery Department, Zhongshan Hospital, Fudan University, Shanghai, China
- Vascular Surgery Institute, Fudan University, Shanghai, China
| | - Kai Hou
- Radiology Department, Zhongshan Hospital, Fudan University, Shanghai, China
- Radiology Institute of Shanghai Municipal, Shanghai, China
| | - Zhenyu Shi
- Vascular Surgery Department, Zhongshan Hospital, Fudan University, Shanghai, China
- Vascular Surgery Institute, Fudan University, Shanghai, China
| | - Xiao Tang
- Vascular Surgery Department, Zhongshan Hospital, Fudan University, Shanghai, China
- Vascular Surgery Institute, Fudan University, Shanghai, China
| | - Weiguo Fu
- Vascular Surgery Department, Zhongshan Hospital, Fudan University, Shanghai, China
- Vascular Surgery Institute, Fudan University, Shanghai, China
- Vascular Surgery Department, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China
| |
Collapse
|
14
|
An Z, Song Z, Tang H, Han L, Xu Z. Retrograde Type A Dissection after Thoracic Endovascular Aortic Repair: Surgical Strategy and Literature Review. Heart Lung Circ 2018; 27:629-634. [DOI: 10.1016/j.hlc.2017.03.168] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 01/19/2017] [Accepted: 03/17/2017] [Indexed: 11/27/2022]
|
15
|
Bokoch MP, Hiramoto JS, Lobo EP, Shalabi A. Rapid Ventricular Pacing for Landing Zone Precision During Thoracic Endovascular Aortic Arch Repair: A Case Series. J Cardiothorac Vasc Anesth 2017; 31:2141-2146. [DOI: 10.1053/j.jvca.2017.03.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Indexed: 11/11/2022]
|
16
|
Lu N, He Z, Xu T, Chen X, Chen X, Ma X, Tan X. Association of Thyroid Function with Early/Mid-term Aorta-Related Adverse Events and Readmissions after Thoracic Endovascular Aortic Repair. Sci Rep 2017; 7:14730. [PMID: 29116203 PMCID: PMC5676739 DOI: 10.1038/s41598-017-15370-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 10/26/2017] [Indexed: 02/05/2023] Open
Abstract
The prognosis of patients after thoracic endovascular aortic repair (TEVAR) is affected by several clinical characteristics. This study aimed to evaluate whether thyroid hormones predicts early (30 days) and mid-term (12 months) aorta-related adverse events (ARAE) and readmissions (ARAR) in patients after TEVAR. A total of 338 continuous patients who underwent TEVAR were included and stratified based on quartile of free thyroxine (FT4) levels examined before surgery. The relationship of FT4 levels with early or mid-term ARAE and ARAR were assessed using univariate and multiple logistic regression analysis. The incidence of ARAE and ARAR were 2.7% and 4.1% within 30 days, and 8.9% and 13.5% within 12 months, respectively. After adjusting for confounders, the lowest FT4 quartile group were noted to be at significantly greater risk than the highest FT4 quartile group in early (OR 10.105, 95% CI 1.103 to 92.615, P = 0.041) and mid-term (OR 5.687, 95% CI 1.708 to 18.935, P = 0.005) ARAR, but not significantly different in early (OR 2.097, 95% CI 0.228 to 19.307, P = 0.513) and mid-term (OR 0.695, 95% CI 0.207 to 2.332, P = 0.556) ARAE. Thus, patients with low-normal FT4 levels after TEVAR are at greater risk of ARAR, but not ARAE, in both the early and the mid-term follow-up periods.
Collapse
Affiliation(s)
- Nan Lu
- Department of Cardiology, the First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, 515041, China
- Image Center, Wuhan Asia Heart Hospital, Wuhan, Hubei, 430000, China
| | - Zhuoqiao He
- Department of Cardiology, the First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, 515041, China
| | - Tan Xu
- Department of Cardiology, the First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, 515041, China
| | - Xin Chen
- Image Center, Wuhan Asia Heart Hospital, Wuhan, Hubei, 430000, China
| | - Xianfeng Chen
- Image Center, Wuhan Asia Heart Hospital, Wuhan, Hubei, 430000, China
| | - Xiaojing Ma
- Image Center, Wuhan Asia Heart Hospital, Wuhan, Hubei, 430000, China
| | - Xuerui Tan
- Department of Cardiology, the First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, 515041, China.
| |
Collapse
|
17
|
Awad H, Ramadan ME, El Sayed HF, Tolpin DA, Tili E, Collard CD. Spinal cord injury after thoracic endovascular aortic aneurysm repair. Can J Anaesth 2017; 64:1218-1235. [PMID: 29019146 DOI: 10.1007/s12630-017-0974-1] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 08/04/2017] [Accepted: 09/13/2017] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Thoracic endovascular aortic aneurysm repair (TEVAR) has become a mainstay of therapy for aneurysms and other disorders of the thoracic aorta. The purpose of this narrative review article is to summarize the current literature on the risk factors for and pathophysiology of spinal cord injury (SCI) following TEVAR, and to discuss various intraoperative monitoring and treatment strategies. SOURCE The articles considered in this review were identified through PubMed using the following search terms: thoracic aortic aneurysm, TEVAR, paralysis+TEVAR, risk factors+TEVAR, spinal cord ischemia+TEVAR, neuromonitoring+thoracic aortic aneurysm, spinal drain, cerebrospinal fluid drainage, treatment of spinal cord ischemia. PRINCIPAL FINDINGS Spinal cord injury continues to be a challenging complication after TEVAR. Its incidence after TEVAR is not significantly reduced when compared with open thoracoabdominal aortic aneurysm repair. Nevertheless, compared with open procedures, delayed paralysis/paresis is the predominant presentation of SCI after TEVAR. The pathophysiology of SCI is complex and not fully understood, though the evolving concept of the importance of the spinal cord's collateral blood supply network and its imbalance after TEVAR is emerging as a leading factor in the development of SCI. Cerebrospinal fluid drainage, optimal blood pressure management, and newer surgical techniques are important components of the most up-to-date strategies for spinal cord protection. CONCLUSION Further experimental and clinical research is needed to aid in the discovery of novel neuroprotective strategies for the protection and treatment of SCI following TEVAR.
Collapse
Affiliation(s)
- Hamdy Awad
- Department of Anesthesiology, Wexner Medical Center, The Ohio State University, Doan Hall 534, 410 West 10th Avenue, Columbus, OH, 43210, USA.
| | - Mohamed Ehab Ramadan
- Department of Anesthesiology, Wexner Medical Center, The Ohio State University, Doan Hall 534, 410 West 10th Avenue, Columbus, OH, 43210, USA.,Department of Anesthesiology, Theodor Bilharz Research Institute, Giza, Egypt
| | - Hosam F El Sayed
- Division of Vascular Diseases & Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Daniel A Tolpin
- Division of Cardiovascular Anesthesiology, The Texas Heart Institute, Baylor St. Luke's Medical Center, Houston, TX, USA
| | - Esmerina Tili
- Department of Anesthesiology, Wexner Medical Center, The Ohio State University, Doan Hall 534, 410 West 10th Avenue, Columbus, OH, 43210, USA
| | - Charles D Collard
- Division of Cardiovascular Anesthesiology, The Texas Heart Institute, Baylor St. Luke's Medical Center, Houston, TX, USA
| |
Collapse
|
18
|
Cole SP. Intensive Care Management of Thoracic Aortic Surgical Patients, Including Thoracic and Infradiaphragmatic Endovascular Repair (EVAR/TEVAR). Semin Cardiothorac Vasc Anesth 2016; 19:331-41. [PMID: 26660057 DOI: 10.1177/1089253215613791] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The patient with thoracic aortic disease can present for open or endovascular repair. Thoracic endovascular aortic repair (TEVAR) has emerged as a minimally invasive option for a multitude of aortic pathology, including dissections, aneurysms, traumatic injuries, and ulcers. Postoperative management of these patients depends on the extent of procedure, whether it was open or endovascular, and, finally, on the preoperative comorbidities present. While procedural success has catapulted TEVAR to popularity, midterm results have been mixed. Additionally, periprocedural complications such as paraplegia and renal failure remain a significant morbidity in these patients.
Collapse
|
19
|
Abstract
Thoracic aortic aneurysms are typically asymptomatic and discovered incidentally on an imaging study ordered for other indications. Small aneurysms are managed with antihypertensive therapy and surveillance imaging, using either echocardiography, computed tomographic angiography (CTA), or magnetic resonance angiography (MRA). Aneurysms are repaired when the risk of rupture or dissection exceeds the risk of repair; size thresholds for repair are determined by the underlying etiology of the aneurysm, with lower thresholds for those with genetic aortopathies. In contrast to the silent and asymptomatic nature of aneurysms, acute aortic syndromes-which include aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcer-are usually associated with recognizable symptoms and signs. Acute aortic syndromes involving the ascending aorta are treated with emergent surgery, whereas those involving the descending aorta are now often treated with endovascular stent-grafting techniques. After acute aortic syndromes have been successfully treated, prognosis is favorable with close follow-up that includes optimal medical management and regular surveillance imaging.
Collapse
Affiliation(s)
- David M Dudzinski
- Thoracic Aortic Center, Massachusetts General Hospital, Yawkey 5, Boston, MA, 02114, USA.
| | - Eric M Isselbacher
- Thoracic Aortic Center, Massachusetts General Hospital, Yawkey 5, Boston, MA, 02114, USA.
| |
Collapse
|
20
|
Bischoff MS, Ante M, Meisenbacher K, Böckler D. Outcome of thoracic endovascular aortic repair in patients with thoracic and thoracoabdominal aortic aneurysms. J Vasc Surg 2016; 63:1170-1181.e1. [DOI: 10.1016/j.jvs.2015.11.045] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 11/12/2015] [Indexed: 01/16/2023]
|
21
|
Mazzaccaro D, Occhiuto MT, Stegher S, Righini P, Malacrida G, Nano G. New technologies in vascular surgery: San Donato's experience in the last decades. Eur Heart J Suppl 2016; 18:E37-E41. [PMID: 28533715 DOI: 10.1093/eurheartj/suw021] [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: 11/15/2022]
Abstract
The Department of Vascular Surgery I at IRCCS Policlinico San Donato has been part of the Cardiovascular Center "Edmondo Malan" since the end of the 1980s. Surgical activity of the Department has always been designed to prevent and treat vascular diseases such as aneurysms of the thoracic and abdominal aorta and peripheral vessels, carotid artery stenosis, peripheral arterial disease, and chronic venous insufficiency. Excellent results have been achieved with the endovascular treatment of both symptomatic and asymptomatic carotid artery stenosis also by using innovative devices. Another point of interest regards the endovascular treatment of more complex thoraco-abdominal aortic aneurysms. We report our experience in the last decades.
Collapse
Affiliation(s)
- Daniela Mazzaccaro
- Operative Unit of Vascular Surgery I, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Maria Teresa Occhiuto
- Operative Unit of Vascular Surgery I, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Silvia Stegher
- Operative Unit of Vascular Surgery I, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Paolo Righini
- Operative Unit of Vascular Surgery I, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Giovanni Malacrida
- Operative Unit of Vascular Surgery I, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Giovanni Nano
- Operative Unit of Vascular Surgery I, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| |
Collapse
|
22
|
Makino T, Kawada K, Masuhara H, Hata Y, Otsuka H, Koezuka S, Tochigi N, Shibuya K, Watanabe Y, Iyoda A. One-stage operation for thoracic aortic arch aneurysm and left lung carcinoma: a case report. J Cardiothorac Surg 2016; 11:51. [PMID: 27067151 PMCID: PMC4827179 DOI: 10.1186/s13019-016-0440-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 04/03/2016] [Indexed: 11/26/2022] Open
Abstract
Background The simultaneous surgical treatment of thoracic aortic arch aneurysm (TAA) and lung carcinoma is extremely rare. Case presentation We report the simultaneous surgical treatment of TAA and squamous cell carcinoma of the lung in a 72-year-old Japanese man. We performed a one-stage operation that consisted of aortic arch replacement for aortic arch aneurysm with a 3-branched artificial vessel under separate cerebral and systemic extracorporeal circulation, and left upper lobectomy for lung cancer via a left lateral thoracotomy. Conclusions Although patients should be carefully selected for this procedure, the simultaneous surgical treatment of TAA and lung carcinoma can be performed safely.
Collapse
Affiliation(s)
- Takashi Makino
- Division of Chest Surgery, Toho University School of Medicine, Tokyo, Japan
| | - Kota Kawada
- Division of Chest Surgery, Toho University School of Medicine, Tokyo, Japan
| | - Hiroshi Masuhara
- Division of Cardiovascular Surgery, Toho University School of Medicine, Tokyo, Japan
| | - Yoshinobu Hata
- Division of Chest Surgery, Toho University School of Medicine, Tokyo, Japan
| | - Hajime Otsuka
- Division of Chest Surgery, Toho University School of Medicine, Tokyo, Japan
| | - Satoshi Koezuka
- Division of Chest Surgery, Toho University School of Medicine, Tokyo, Japan
| | - Naobumi Tochigi
- Department of Surgical Pathology, Toho University School of Medicine, Tokyo, Japan
| | - Kazutoshi Shibuya
- Department of Surgical Pathology, Toho University School of Medicine, Tokyo, Japan
| | - Yoshinori Watanabe
- Division of Cardiovascular Surgery, Toho University School of Medicine, Tokyo, Japan
| | - Akira Iyoda
- Division of Chest Surgery, Toho University School of Medicine, Tokyo, Japan.
| |
Collapse
|
23
|
Van Der Weijde E, Bakker OJ, Heijmen RH. A custom-made scalloped stentgraft to preserve left subclavian artery flow in descending thoracic aortic disease with a short neck. Expert Rev Med Devices 2016; 13:487-96. [PMID: 27018248 DOI: 10.1586/17434440.2016.1171710] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
In thoracic stentgrafting, a short proximal landing zone may necessitate intentional occlusion of the left subclavian artery, which may lead to brain, spinal cord, and left arm malperfusion. A scalloped stentgraft is designed for adequate proximal sealing and preserving the left subclavian artery flow. We performed a systematic review, describe the required pre-operative planning and details of the perioperative technique used and report our own experience. In literature, only 29 patients were reported so far using a proximal scalloped stentgraft. Results show a high technical success rate and low complication rate. These results are comparable to the results from our own institution. From these first small series the scalloped thoracic endovascular aortic repair appears to be a safe and relatively simple solution for thoracic aortic disease involving the left subclavian artery.
Collapse
Affiliation(s)
- Emma Van Der Weijde
- a Department of Cardiothoracic Surgery , St. Antonius Hospital , Nieuwegein , The Netherlands
| | - Olaf J Bakker
- a Department of Cardiothoracic Surgery , St. Antonius Hospital , Nieuwegein , The Netherlands.,b Department of Vascular & Endovascular Surgery , University Medical Center Utrecht , Utrecht , The Netherlands
| | - Robin H Heijmen
- a Department of Cardiothoracic Surgery , St. Antonius Hospital , Nieuwegein , The Netherlands
| |
Collapse
|
24
|
Terzi F, Rocchi G, Fattori R. Current challenges in endovascular therapy for thoracic aneurysms. Expert Rev Cardiovasc Ther 2016; 14:599-607. [DOI: 10.1586/14779072.2016.1141677] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|
25
|
Rylski B, Czerny M, Südkamp M, Siepe M, Beyersdorf F. The TEVAR App: a contemporary guide to thoracic endovascular aortic repair. Interact Cardiovasc Thorac Surg 2015; 22:228-30. [DOI: 10.1093/icvts/ivv310] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 09/30/2015] [Indexed: 11/14/2022] Open
|