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Ferraresi M, Katsarou M, Luigi Molinari AC, Segreti S, Rossi G. Endovascular repair of ascending aortic pathologies in patients unfit for open surgery: case series and literature review. J Vasc Surg Cases Innov Tech 2024; 10:101455. [PMID: 38510094 PMCID: PMC10951535 DOI: 10.1016/j.jvscit.2024.101455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/26/2024] [Indexed: 03/22/2024] Open
Abstract
The number of vascular centers performing endovascular repair of ascending aortic disease is constantly increasing. Accordingly to the guidelines, open surgical repair remains the gold standard for these pathologies. However, approximately one quarter of patients are deemed unfit for open surgery. In this study, we describe three cases of ascending thoracic endovascular aortic repair (TEVAR) performed at our center. All the patients were deemed unfit for open surgery by the aortic team. Two patients had an ascending aortic pseudoaneurysm, and the third had a focal type A aortic dissection. In two cases, we used two abdominal aortic cuffs deployed from zone 0B to zone 0C, with no need for supra-aortic trunk debranching. In one case, we performed a "reverse" extrathoracic debranching, and we deployed a thoracic endograft from zone 0B to zone 2. Complications included one minor stroke and one inguinal hematoma. In one patient with an infected pseudoaneurysm, we performed ascending TEVAR as a bridge strategy for open repair. This patient developed a type Ia endoleak; however, clinical stabilization and infection control were obtained, and he was able to undergo heart surgery successfully. He underwent a second reintervention to treat superior mesenteric embolic occlusion. At 2 years of follow-up, all three patients were alive. Our preliminary experience demonstrates the technical feasibility and clinical appropriateness of ascending TEVAR using standard, commercially available endografts. However, no consensus has been reached regarding some critical aspects, such as the development of a standardized technique or the efficacy of the currently available devices. The improvements in graft design and the adoption of the "aortic team" approach could help in the near future to standardize the procedure, establish appropriate indications, and ensure good clinical outcomes.
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Affiliation(s)
- Marco Ferraresi
- Division of Vascular Surgery, Cardio-Thoracic-Vascular Department, Alessandro Manzoni Hospital, Lecco, Italy
| | - Maria Katsarou
- Division of Vascular Surgery, Cardio-Thoracic-Vascular Department, Alessandro Manzoni Hospital, Lecco, Italy
| | | | - Sara Segreti
- Division of Vascular Surgery, Cardio-Thoracic-Vascular Department, Alessandro Manzoni Hospital, Lecco, Italy
| | - Giovanni Rossi
- Division of Vascular Surgery, Cardio-Thoracic-Vascular Department, Alessandro Manzoni Hospital, Lecco, Italy
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Lima GB, Breite M, Pochettino A, Bonnichsen C, DeMartino RR, Mendes BC. Endovascular repair of an ascending aortic pseudoaneurysm. J Vasc Surg Cases Innov Tech 2023; 9:101279. [PMID: 37767350 PMCID: PMC10520440 DOI: 10.1016/j.jvscit.2023.101279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 07/10/2023] [Indexed: 09/29/2023] Open
Affiliation(s)
- Guilherme B. Lima
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Matthew Breite
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Alberto Pochettino
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Crystal Bonnichsen
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | | | - Bernardo C. Mendes
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
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Huo W, He M, Bao X, Lu Y, Tian W, Feng J, Zeng Z, Feng R. Minimally Invasive Endovascular Repair for Nondissected Ascending Aortic Disease: A Systematic Review. Emerg Med Int 2023; 2023:5592622. [PMID: 37767197 PMCID: PMC10522436 DOI: 10.1155/2023/5592622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/03/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
Objective The aim of this study is to evaluate the efficacy of endovascular treatment for nondissected diseases of the ascending aorta. Data Sources. PubMed, Embase, and SciELO. Review Methods. In this study, we conducted a search on the PubMed, Embase, and SciELO databases for all cases of ascending aortic endovascular repair included in the literature published between January 2007 and July 2023, excluding type A aortic dissection. We reviewed 56 case reports and 7 observational studies included in this study, assessing the techniques, equipment, procedural steps, and results. We summarized the age, complications, follow-up time, and access route. Results This study includes 63 articles reporting 105 patients (mean age: 64.96 ± 17.08 years) who received endovascular repair for nondissected ascending aortic disease. The types of disease include aneurysm (N = 16), pseudoaneurysm (N = 71), penetrating aortic ulcer (N = 10), intramural hematoma (N = 2), thrombosis (N = 2), iatrogenic coarctation (N = 1), and rupture of the aorta (N = 3). The success rate of surgery is 99.05% (104/105). Complications include endoleak (10.48%, 11/105), stroke (5.71%, 6/105), postoperative infection (1.91%, 2/105), acute renal failure (0.95%, 1/105), aortic rupture (0.95%, 1/105), thrombosis (0.95%, 1/105), and splenic infarction (0.95%, 1/105). Five patients required conversion to open surgery, two patients underwent endovascular reintervention, and four of these five patients underwent surgery due to endoleak. Early mortality was 2.86% (3/105). Conclusion While the viability and results of endovascular repair for the treatment of ascending aortic disease are acknowledged in some circumstances, further research is needed to determine the safety and effectiveness of endovascular treatment for ascending aortic disease.
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Affiliation(s)
- Weixue Huo
- Department of Vascular Surgery, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Mengwei He
- Department of Vascular Surgery, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Xianhao Bao
- Department of Vascular Surgery, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Ye Lu
- Department of Vascular Surgery, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Wen Tian
- Department of Vascular Surgery, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Jiaxuan Feng
- Department of Vascular Surgery, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Zhaoxiang Zeng
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Rui Feng
- Department of Vascular Surgery, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
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Skripochnik E, Ford B, Bilfinger TV, Weinstein JB, Tassiopoulos AK, Loh SA. Endovascular Repair of the Ascending Aorta for an Anastomotic Saphenous Vein Graft Aneurysm. Ann Vasc Surg 2019; 64:412.e1-412.e5. [PMID: 31669481 DOI: 10.1016/j.avsg.2019.10.058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/26/2019] [Accepted: 10/09/2019] [Indexed: 11/29/2022]
Abstract
The ascending aorta is the final segment of the aorta to be explored with endovascular stent grafts. With a patient population of increasingly advanced age and disease, there are situations where traditional open repair for ascending aneurysms or dissections may be prohibitive. However, the ascending aorta has multiple hostile characteristics that make endovascular treatment challenging. There is also a lack of approved specialized devices in the United States for this aortic territory. We demonstrate the feasibility of adapting an abdominal aortic graft to the ascending aorta for the treatment of a saphenous vein graft aneurysm with a discussion of the technical considerations for the operation.
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Affiliation(s)
- Edvard Skripochnik
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stony Brook Medicine, Stony Brook, NY; Division of Cardiothoracic Surgery, Department of Surgery, Stony Brook Medicine, Stony Brook, NY; Division of Cardiology, Department of Medicine, Stony Brook Medicine, Stony Brook, NY.
| | - Benjamin Ford
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stony Brook Medicine, Stony Brook, NY; Division of Cardiothoracic Surgery, Department of Surgery, Stony Brook Medicine, Stony Brook, NY; Division of Cardiology, Department of Medicine, Stony Brook Medicine, Stony Brook, NY
| | - Thomas V Bilfinger
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stony Brook Medicine, Stony Brook, NY; Division of Cardiothoracic Surgery, Department of Surgery, Stony Brook Medicine, Stony Brook, NY; Division of Cardiology, Department of Medicine, Stony Brook Medicine, Stony Brook, NY
| | - Jonathan B Weinstein
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stony Brook Medicine, Stony Brook, NY; Division of Cardiothoracic Surgery, Department of Surgery, Stony Brook Medicine, Stony Brook, NY; Division of Cardiology, Department of Medicine, Stony Brook Medicine, Stony Brook, NY
| | - Apostolos K Tassiopoulos
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stony Brook Medicine, Stony Brook, NY; Division of Cardiothoracic Surgery, Department of Surgery, Stony Brook Medicine, Stony Brook, NY; Division of Cardiology, Department of Medicine, Stony Brook Medicine, Stony Brook, NY
| | - Shang A Loh
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stony Brook Medicine, Stony Brook, NY; Division of Cardiothoracic Surgery, Department of Surgery, Stony Brook Medicine, Stony Brook, NY; Division of Cardiology, Department of Medicine, Stony Brook Medicine, Stony Brook, NY
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Almanfi A, Krajcer Z. Minimally Invasive Endovascular Repair of Ascending Thoracic Aortic Aneurysm with Use of Local Anesthesia and Conscious Sedation. Tex Heart Inst J 2019; 46:120-123. [PMID: 31236076 DOI: 10.14503/thij-17-6558] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Ascending thoracic aortic aneurysm (ATAA) is typically treated surgically. No commercially available device has been specifically designed for endovascular ATAA repair, and currently, multiple anatomic and technical challenges affect its feasibility. Previously, such repairs have been performed with the patients under general anesthesia. We describe a novel, minimally invasive approach to endovascular repair of ATAA, involving local anesthesia, conscious sedation, and 24-hour hospitalization. Two consecutive male patients (ages, 79 and 54 yr) who had comorbidities underwent percutaneous transfemoral endovascular ATAA repair with use of commercially available endografts. Patient 1 had a saccular aneurysm, and Patient 2 had a pseudoaneurysm consequent to recent surgical ATAA repair. The patients were discharged from the hospital 24 hours after technically successful, uncomplicated procedures. At 2 months, computed tomograms showed no endoleak or stent-graft migration. Our experience shows that minimally invasive endovascular ATAA repair is feasible for selected high-risk patients. We describe the procedure, access and closure devices, and challenges associated with this approach.
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A systematic review of primary endovascular repair of the ascending aorta. J Vasc Surg 2018; 67:332-342. [DOI: 10.1016/j.jvs.2017.06.099] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 06/19/2017] [Indexed: 11/21/2022]
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Baikoussis NG, Antonopoulos CN, Papakonstantinou NA, Argiriou M, Geroulakos G. Endovascular stent grafting for ascending aorta diseases. J Vasc Surg 2017; 66:1587-1601. [DOI: 10.1016/j.jvs.2017.07.064] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 07/11/2017] [Indexed: 01/03/2023]
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Leung Wai Sang S, Bavaria JE, Giri JS, Wickramasinghe R, Desai N. Transfemoral Valve-in-Valve Sapien 3 in a Patient with an Ascending Aortic Aneurysm. J Card Surg 2016; 31:318-20. [DOI: 10.1111/jocs.12724] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Jay S. Giri
- Medicine; University of Pennsylvania; Philadelphia Pennsylvania
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Ahmad K, Terp K, Andersen G, Hjortdal V. Aortic aneurysms and trans-apical endovascular repair in high risk heart transplant recipient, one year follow up. J Thorac Dis 2015; 7:E555-9. [PMID: 26716055 DOI: 10.3978/j.issn.2072-1439.2015.11.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Aortic aneurysms cause major morbidities and mortalities. Operative intervention in ascending aneurysms and dissections is the treatment of choice although there is the risk of major complications because of technical difficulties, late diagnoses, affected hemodynamic and organ mal perfusion. Improved survival of heart transplant (HTx) recipients, acceptance of older donors with co morbidities and advances in HTx give rise to new pathological challenges in the cardiovascular field. Only a few articles have been reported about cardiac and aorta surgery in HTx recipients. Endovascular treatment for aortic pathology in zone 0 is an emerging treatment option. We report the first trans-apical endovascular ascending aorta repair (EVAR) in a 26-year-old HTx recipient, with the history of mediastinitis and lack of femoral access. She had an uneventful operative and post-operative EVAR course.
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Affiliation(s)
- Khalil Ahmad
- 1 Department of Cardiothoracic and Vascular Surgery, Institute of Clinical Medicine, 2 Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Kim Terp
- 1 Department of Cardiothoracic and Vascular Surgery, Institute of Clinical Medicine, 2 Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Gratien Andersen
- 1 Department of Cardiothoracic and Vascular Surgery, Institute of Clinical Medicine, 2 Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Vibeke Hjortdal
- 1 Department of Cardiothoracic and Vascular Surgery, Institute of Clinical Medicine, 2 Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
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