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Hori D, Kusadokoro S, Shimizu T, Kimura N, Yamaguchi A. Prosthetic Graft Dilation at the Aortic Arch in the Era of Hybrid Aortic Surgery. Ann Vasc Dis 2020; 13:163-169. [PMID: 32595793 PMCID: PMC7315240 DOI: 10.3400/avd.oa.20-00005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: This study aims to evaluate the chronological size changes of the prosthetic graft in the aortic arch, which is used as a landing zone for a subsequent stent grafting in hybrid aortic surgery. Materials and Methods: Eighty-five patients who underwent total aortic arch replacement followed by computed tomography follow-up for at least 30 months after the surgery were included in the study. Results: Prosthetic grafts used were Hemashield (Maquet, Rastatt, Germany), J-Graft (Japan Lifeline Inc., Tokyo, Japan) and Triplex (Terumo, Tokyo, Japan). There was an initial increase in diameter compared to package size after implantation (Hemashield, 1.04±0.035 vs. J-Graft, 1.06±0.027 vs. Triplex, 1.04±0.023, p=0.13). Significant difference in graft dilation ratio was observed in Triplex (1.18±0.062) at long-term compared to Hemashield (1.07±0.052, p<0.001) and J-Graft (1.10±0.071, p<0.001). Multivariate analysis showed that age (r=0.002; 95% confidence interval [CI], 0.0001–0.0037; p=0.035), knitted-type prosthesis (r=0.089; 95% CI, 0.0610–0.1163; p<0.0001), and prevalence of cerebral vascular disease (r=0.038; 95% CI, 0.0030–0.0732; p=0.034) were independently associated with graft dilation after surgery. Conclusion: Prosthetic graft selection and appropriate sizing of the stent graft should be considered for each individual undergoing hybrid aortic surgery to maintain sufficient oversizing of the stent graft.
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Affiliation(s)
- Daijiro Hori
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Saitama, Japan
| | - Sho Kusadokoro
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Saitama, Japan
| | - Toshikazu Shimizu
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Saitama, Japan
| | - Naoyuki Kimura
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Saitama, Japan
| | - Atsushi Yamaguchi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Saitama, Japan
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Ullery BW, Suh GY, Hirotsu K, Zhu D, Lee JT, Dake MD, Fleischmann D, Cheng CP. Geometric Deformations of the Thoracic Aorta and Supra-Aortic Arch Branch Vessels Following Thoracic Endovascular Aortic Repair. Vasc Endovascular Surg 2018; 52:173-180. [DOI: 10.1177/1538574417753452] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To utilize 3-D modeling techniques to better characterize geometric deformations of the supra-aortic arch branch vessels and descending thoracic aorta after thoracic endovascular aortic repair. Methods: Eighteen patients underwent endovascular repair of either type B aortic dissection (n = 10) or thoracic aortic aneurysm (n = 8). Computed tomography angiography was obtained pre- and postprocedure, and 3-D geometric models of the aorta and supra-aortic branch vessels were constructed. Branch angle of the supra-aortic branch vessels and curvature metrics of the ascending aorta, aortic arch, and stented thoracic aortic lumen were calculated both at pre- and postintervention. Results: The left common carotid artery branch angle was lower than the left subclavian artery angles preintervention ( P < .005) and lower than both the left subclavian and brachiocephalic branch angles postintervention ( P < .05). From pre- to postoperative, no significant change in branch angle was found in any of the great vessels. Maximum curvature change of the stented lumen from pre- to postprocedure was greater than those of the ascending aorta and aortic arch ( P < .05). Conclusion: Thoracic endovascular aortic repair results in relative straightening of the stented aortic region and also accentuates the native curvature of the ascending aorta when the endograft has a more proximal landing zone. Supra-aortic branch vessel angulation remains relatively static when proximal landing zones are distal to the left common carotid artery.
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Affiliation(s)
- Brant W. Ullery
- Providence Heart and Vascular Institute, Portland, OR, USA
- Both authors contributed equally to this work
| | - Ga-Young Suh
- Division of Vascular Surgery, Stanford University, Stanford, CA, USA
- Both authors contributed equally to this work
| | - Kelsey Hirotsu
- Stanford School of Medicine, Stanford University, Stanford, CA, USA
| | - David Zhu
- Division of Vascular Surgery, Stanford University, Stanford, CA, USA
| | - Jason T. Lee
- Division of Vascular Surgery, Stanford University, Stanford, CA, USA
| | - Michael D. Dake
- Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
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Ardellier FD, D'Ostrevy N, Cassagnes L, Ouchchane L, Dubots E, Chabrot P, Boyer L, Camilleri L. CT patterns of acute type A aortic arch dissection: longer, higher, more anterior. Br J Radiol 2017; 90:20170417. [PMID: 28830228 DOI: 10.1259/bjr.20170417] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES This study analysed CT patterns of the acute dissected aortic arch using original biometric features along with comparison with normal aortas. METHODS The diagnostic CT scans of 57 patients (42 males, age (mean ± SD: 64.5 ± 13.8 years) admitted with acute Stanford type A dissection involving the aortic arch were analysed by semi-automatic detection protocol of the true lumen of the dissection. We measured the distances from the apex to the ascending and descending aorta, the curvilinear length of the entire arch and of its segments (especially between the brachiocephalic artery trunk and the left subclavian artery), as well as the surface area, angle, height and shift of the arch. These measurements were compared with results previously obtained in a healthy cohort in an analysis adjusted for age, sex and weight. The surface area and rotation of the false lumen were also analysed. RESULTS Compared to normal aortic arches (N), dissected aortic arches (D) were longer (D: 155 ± 26 mm, N: 135 ± 25 mm, p = 0.002), higher (D: 51 ± 10 mm, N: 45 ± 9 mm, p = 0.04), and with a more anterior apex (shift: D: 1.19 ± 0.56, N: 1.40 ± 0.62, p = 0.007). False lumen occupied between 47-65% of the aorta, turned preferentially clockwise and its rotation decreased progressively along the arch. CONCLUSIONS The morphology of the dissected aortic arch differs from that of the normal arch. Thus, our compilation of aortic arch measurements may help improve existing endovascular devices and/or design of new endoprostheses. Advances in knowledge: In this article, we provide a comprehensive set of measurements of the dissected aortic arch, and show that dissected aortic arches are longer, higher, and with a more anterior apex than normal arches.
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Affiliation(s)
| | - Nicolas D'Ostrevy
- 2 Service de Chirurgie cardio-vasculaire, Hôpital Gabriel Montpied, CHU Clermont-Ferrand, Clermont-Ferrand, France.,3 IGT, UMR CNRS 6602, Institut Pascal, Université d'Auvergne, Clermont-Ferrand, France
| | - Lucie Cassagnes
- 1 Service de Radiologie, Hôpital Gabriel Montpied, CHU Clermont-Ferrand, Clermont-Ferrand, France.,3 IGT, UMR CNRS 6602, Institut Pascal, Université d'Auvergne, Clermont-Ferrand, France
| | - Lemlih Ouchchane
- 3 IGT, UMR CNRS 6602, Institut Pascal, Université d'Auvergne, Clermont-Ferrand, France.,4 Service de Biostatistiques, Hôpital Gabriel Montpied, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Emilie Dubots
- 4 Service de Biostatistiques, Hôpital Gabriel Montpied, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Pascal Chabrot
- 1 Service de Radiologie, Hôpital Gabriel Montpied, CHU Clermont-Ferrand, Clermont-Ferrand, France.,3 IGT, UMR CNRS 6602, Institut Pascal, Université d'Auvergne, Clermont-Ferrand, France
| | - Louis Boyer
- 1 Service de Radiologie, Hôpital Gabriel Montpied, CHU Clermont-Ferrand, Clermont-Ferrand, France.,3 IGT, UMR CNRS 6602, Institut Pascal, Université d'Auvergne, Clermont-Ferrand, France
| | - Lionel Camilleri
- 2 Service de Chirurgie cardio-vasculaire, Hôpital Gabriel Montpied, CHU Clermont-Ferrand, Clermont-Ferrand, France.,3 IGT, UMR CNRS 6602, Institut Pascal, Université d'Auvergne, Clermont-Ferrand, France
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d'ostrevy N, Ardellier FD, Cassagnes L, Ouchchane L, Azarnoush K, Camilleri L, Sakka L. The apex of the aortic arch backshifts with aging. Surg Radiol Anat 2016; 39:703-710. [PMID: 27921138 DOI: 10.1007/s00276-016-1792-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 11/27/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Only a few studies, involving small numbers of patients, have globally assessed the curvature of the thoracic aorta but without any details concerning the location of the supra-aortic trunks. OBJECTIVES Using CT to describe normal aortic-arch morphology and its changes with age and sex. METHODS 344 CT scans were studied. We measured the distances from the apex to the ascending and descending aorta, the curvilinear length of the entire arch, that of the segment, including bifurcations of supra-aortic vessels, and the angle, height, and shift of the arch. RESULTS In men, the arch was significantly longer (146.2 vs 122.8 mm; p < 0.001), higher (49.3 vs 40.1 mm, p < 0.001), and wider transversely (83.6 vs 73.3 mm; p < 0.001) than in women. The average men's arch also had a more acute angle at the apex (79.7° vs 83.7° p < 0.001). Neither morphology nor age influenced the winding angle around the mediastinum. Aging was accompanied by deflection and extension of the aortic arch, which grew more anteroposteriorly (6.1 mm/10 years in men) than vertically (2.5 mm/10 years in men), while the apex moved towards the rear of the arch. The ascending aorta was the only curvilinear length unaffected by age, whereas the supra-aortic trunks parted from each other. CONCLUSION We believe that all these original observations could lead to a better assessment of normal aging of the aorta and guide technical choices during surgical or hybrid procedures.
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Affiliation(s)
- N d'ostrevy
- Heart Surgery Department, Clermont-Ferrand University Hospital, Place H. Dunant, 63000, Clermont-Ferrand, France. .,ISIT-UMR 6284 UdA-CNRS, Institut des Sciences de l'Image pour les Techniques interventionnelles, Clermont Université, Université d'Auvergne, BP 10448, 63000, Clermont-Ferrand, France.
| | - F D Ardellier
- Radiology Department, Clermont-Ferrand University Hospital, 63000, Clermont-Ferrand, France
| | - L Cassagnes
- Radiology Department, Clermont-Ferrand University Hospital, 63000, Clermont-Ferrand, France.,ISIT-UMR 6284 UdA-CNRS, Institut des Sciences de l'Image pour les Techniques interventionnelles, Clermont Université, Université d'Auvergne, BP 10448, 63000, Clermont-Ferrand, France
| | - L Ouchchane
- ISIT-UMR 6284 UdA-CNRS, Institut des Sciences de l'Image pour les Techniques interventionnelles, Clermont Université, Université d'Auvergne, BP 10448, 63000, Clermont-Ferrand, France.,Laboratoire de Biostatistique Informatique Médicale et Technologies de Communication, University Clermont1, 63000, Clermont-Ferrand, France
| | - K Azarnoush
- Heart Surgery Department, Clermont-Ferrand University Hospital, Place H. Dunant, 63000, Clermont-Ferrand, France.,INRA, UMR 1019 Nutrition Humaine, 63122, Saint Genès Champanelle, France
| | - L Camilleri
- Heart Surgery Department, Clermont-Ferrand University Hospital, Place H. Dunant, 63000, Clermont-Ferrand, France.,ISIT-UMR 6284 UdA-CNRS, Institut des Sciences de l'Image pour les Techniques interventionnelles, Clermont Université, Université d'Auvergne, BP 10448, 63000, Clermont-Ferrand, France
| | - L Sakka
- Laboratoire d'anatomie, University Clermont1, 63000, Clermont-Ferrand, France
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256 Slice Multi-detector Computed Tomography Thoracic Aorta Computed Tomography Angiography: Improved Luminal Opacification Using a Patient-Specific Contrast Protocol and Caudocranial Scan Acquisition. J Comput Assist Tomogr 2016; 40:964-970. [PMID: 27755255 DOI: 10.1097/rct.0000000000000456] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CLINICAL RELEVANCE STATEMENT Caudocranial scan direction and contrast injection timing based on measured patient vessel dynamics can significantly improve arterial and aneurysmal opacification and reduce both contrast and radiation dose in the assessment of thoracic aortic aneurysms (TAA) using helical thoracic computed tomography angiography (CTA). OBJECTIVES To investigate opacification of the thoracic aorta and TAA using a caudocranial scan direction and a patient-specific contrast protocol. MATERIALS AND METHODS Thoracic aortic CTA was performed in 160 consecutive patients with suspected TAA using a 256-slice computed tomography scanner and a dual barrel contrast injector. Patients were subjected in equal numbers to one of two contrast protocols. Patient age and sex were equally distributed across both groups. Protocol A, the department's standard protocol, consisted of a craniocaudal scan direction with 100 mL of contrast, intravenously injected at a flow rate of 4.5 mL/s. Protocol B involved a caudocranial scan direction and a novel contrast formula based on patient cardiovascular dynamics, followed by 100 mL of saline at 4.5 mL/s. Each scan acquisition comprised of 120 kVp, 200 mA with modulation, temporal resolution 0.27 seconds, and pitch 0.889:1. The dose length product was measured between each protocol and data generated were compared using Mann-Whitney U nonparametric statistics. Receiver operating characteristic analysis, visual grading characteristic (VGC), and κ analyses were performed. RESULTS Mean opacification in the thoracic aorta and aneurysm measured was 24 % and 55%, respectively. The mean contrast volume was significantly lower in protocol B (73 ± 10 mL) compared with A (100 ± 1 mL) (P<0.001). The contrast-to-noise ratio demonstrated significant differences between the protocols (protocol A, 18.2 ± 12.9; protocol B, 29.7 ± 0.61; P < 0.003). Mean effective dose in protocol B (2.6 ± 0.4 mSv) was reduced by 19% compared with A (3.2 ± 0.8 mSv) (P < 0.004). Aneurysmal detectability demonstrated significant increases by receiver operating characteristic and visual grading characteristic analysis for protocol B compared with A (P < 0.02), and reader agreement increased from poor to excellent. CONCLUSIONS Significant increase in the visualization of TAAs following a caudocranial scan direction during helical thoracic CTA can be achieved using low-contrast volume based on patient-specific contrast formula.
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Böckler D, Brunkwall J, Taylor P, Mangialardi N, Hüsing J, Larzon T, Hyhlik-Dürr A, Gawenda M, Clough R, Ronchey S, Örman L. Thoracic Endovascular Aortic Repair of Aortic Arch Pathologies with the Conformable Thoracic Aortic Graft: Early and 2 year Results from a European Multicentre Registry. Eur J Vasc Endovasc Surg 2016; 51:791-800. [DOI: 10.1016/j.ejvs.2016.02.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 02/05/2016] [Indexed: 10/21/2022]
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Kanaoka Y, Ohki T, Maeda K, Baba T, Fujita T. Multivariate Analysis of Risk Factors of Cerebral Infarction in 439 Patients Undergoing Thoracic Endovascular Aneurysm Repair. Medicine (Baltimore) 2016; 95:e3335. [PMID: 27082585 PMCID: PMC4839829 DOI: 10.1097/md.0000000000003335] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The aim of the study is to identify the potential risk factors of cerebral infarction associated with thoracic endovascular aneurysm repair (TEVAR). TEVAR was developed as a less invasive surgical alternative to conventional open repair for thoracic aortic aneurysm treatment. However, outcomes following TEVAR of aortic and distal arch aneurysms remain suboptimal. Cerebral infarction is a major concern during the perioperative period. We included 439 patients who underwent TEVAR of aortic aneurysms at a high-volume teaching hospital between July 2006 and June 2013. Univariate and multivariate logistic regression analyses were performed to identify perioperative cerebral infarction risk factors. Four patients (0.9%) died within 30 days of TEVAR; 17 (3.9%) developed cerebral infarction. In univariate analysis, history of ischemic heart disease and cerebral infarction and concomitant cerebrovascular disease were significantly associated with cerebral infarction. "Shaggy aorta" presence, left subclavian artery coverage, carotid artery debranching, and pull-through wire use were identified as independent risk factors of cerebral infarction. In multivariate analysis, history of ischemic heart disease (odds ratio [OR] 6.49, P = 0.046) and cerebral infarction (OR 43.74, P = 0.031), "shaggy aorta" (OR 30.32, P < 0.001), pull-through wire use during surgery (OR 7.196, P = 0.014), and intraoperative blood loss ≥800 mL (OR 24.31, P = 0.017) were found to be independent risk factors of cerebral infarction. This study identified patient- and procedure-related risk factors of cerebral infarction following TEVAR. These results indicate that patient outcomes could be improved through the identification and management of procedure-related risk factors.
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Affiliation(s)
- Yuji Kanaoka
- From the Division of Vascular Surgery, Department of Surgery, Jikei University school of Medicine, Tokyo, Japan
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Melissano G, Tshomba Y, Rinaldi E, Chiesa R. Initial clinical experience with a new low-profile thoracic endograft. J Vasc Surg 2015; 62:336-42. [DOI: 10.1016/j.jvs.2015.02.049] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 02/24/2015] [Indexed: 11/16/2022]
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Moulakakis KG, Mylonas SN, Dalainas I, Sfyroeras GS, Markatis F, Kotsis T, Kakisis J, Liapis CD. The chimney-graft technique for preserving supra-aortic branches: a review. Ann Cardiothorac Surg 2013; 2:339-46. [PMID: 23977603 DOI: 10.3978/j.issn.2225-319x.2013.05.14] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 05/24/2013] [Indexed: 11/14/2022]
Abstract
Evolution in the endovascular era has influenced the management of aortic arch pathologies. "Chimney" or "snorkel" graft technique has been used as an alternative in high risk patients unfit for open repair. We reviewed the published literature on the chimney graft technique for preservation of the supra-aortic branches in order to provide an extensive insight of its feasibility and efficacy and investigate its outcomes. 18 reports were identified, with a total of 124 patients and 136 chimney. Primary technical success was achieved in 123/124 patients (99.2%). The perioperative mortality rate was 4.8% and the stroke rate was 4%, while events of spinal cord ischemia were rare. The overall endoleak rate was 18.5%; 13 patients (10.5%) developed a type I endoleak and 10 (8%) patients a type II endoleak. During a median follow-up period of 11.4 months (range, 0.87-20.1 months) all implanted chimney grafts remained patent. From this, we conclude that endovascular aortic arch repair with chimney grafts is associated with a lower mortality rate compared to totally open or hybrid reconstruction. However, the stroke rate remains noteworthy, and requires longterm data to elucidate.
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Affiliation(s)
- Konstantinos G Moulakakis
- Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece; ; The Systematic Review Unit, The Collaborative Research (CORE) Group, Sydney, Australia
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Affiliation(s)
- Marzia Leacche
- From the Vanderbilt Heart & Vascular Institute, Nashville, Tenn
| | | | - David X. Zhao
- From the Vanderbilt Heart & Vascular Institute, Nashville, Tenn
| | - John G. Byrne
- From the Vanderbilt Heart & Vascular Institute, Nashville, Tenn
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Koullias GJ, Wheatley GH. State-of-the-Art of Hybrid Procedures for the Aortic Arch: A Meta-Analysis. Ann Thorac Surg 2010; 90:689-97. [DOI: 10.1016/j.athoracsur.2009.12.016] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2009] [Revised: 12/06/2009] [Accepted: 12/09/2009] [Indexed: 10/19/2022]
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Sun L, Zhao X, Chang Q, Zhu J, Liu Y, Yu C, Lv B, Zheng J, Qi R. Repair of Chronic Type B Dissection With Aortic Arch Involvement Using a Stented Elephant Trunk Procedure. Ann Thorac Surg 2010; 90:95-100. [DOI: 10.1016/j.athoracsur.2010.03.048] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Revised: 03/06/2010] [Accepted: 03/11/2010] [Indexed: 11/28/2022]
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Predictive Factors for Cerebrovascular Accidents After Thoracic Endovascular Aortic Repair. Ann Thorac Surg 2009; 88:1877-81. [DOI: 10.1016/j.athoracsur.2009.08.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Revised: 08/10/2009] [Accepted: 08/11/2009] [Indexed: 11/20/2022]
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Desai ND, Szeto WY. Complex aortic arch aneurysm and dissections: hybrid techniques for surgical and endovascular therapy. Curr Opin Cardiol 2009; 24:521-7. [DOI: 10.1097/hco.0b013e3283317c91] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hybrid Cardiovascular Procedures. JACC Cardiovasc Interv 2008; 1:459-68. [PMID: 19463346 DOI: 10.1016/j.jcin.2008.07.002] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Revised: 07/08/2008] [Accepted: 07/12/2008] [Indexed: 11/22/2022]
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