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Derycke L, Tomasi J, Desgranges P, Pesteil F, Plissonier D, Pernot M, Millon A, Martinez R, Chakfe N, Alsac JM. Assessment of Thoracic Endovascular Aortic Repair Using Relay Proximal Scallop: Results of a French Prospective Multicentre Study. Eur J Vasc Endovasc Surg 2023; 66:821-829. [PMID: 37567339 DOI: 10.1016/j.ejvs.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 06/01/2023] [Accepted: 08/02/2023] [Indexed: 08/13/2023]
Abstract
OBJECTIVE A proximal scallop design allows aortic arch repair without complex endovascular manipulation in the aortic arch. The aim was to assess the safety and efficacy at one year of the Relay proximal scallop stent graft. METHODS A prospective multicentre study evaluated consecutive patients treated with the Relay proximal scallop stent graft in 10 French aortic centres. All consecutive patients eligible for elective thoracic endovascular repair with proximal scallop in the 10 participating centres between January 2015 and July 2018 were included. Primary endpoints were 30 day mortality, stroke, and spinal cord ischaemia (SCI) rates. Outcomes including safety and efficacy, technical and clinical success, all cause death, neurological events, vessel patency, and device specific complications were analysed. Survival and survival without severe complications were estimated using Kaplan-Meier estimates. RESULTS Ten aortic centres treated 40 patients for thoracic aortic aneurysm (45%), penetrating atherosclerotic aneurysm (30%), and dissection (25%). Half of the procedures (50%) targeted zone 0 of the aortic arch (zone 0 in 17.5% and zones 0/1 in 32.5%), 37.5% targeted zone 2 (35% zone 2 alone; 2.5% zones 1/2), and 15% targeted zone 1 (12.5% zone 1 alone). Median follow up was one year. Thirty day mortality, stroke, and SCI rates were 10%, 5%, and 0% respectively. Primary technical success was 95%. Type Ia, Ib, and III endoleaks rates were 5.4%, 0%, and 0% respectively at one month. The overall mortality rate at one year was 17.5%. Aneurysm expansion was > 5 mm in one case at one year associated with type Ia endoleak (3%). There was no supra-aortic trunk thrombosis, one (2%) graft kink, and no migration. CONCLUSION One year outcomes showed that the Relay proximal scallop stent graft is an acceptable answer to thoracic aortic disease to deal with short proximal landing zones.
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Affiliation(s)
- Lucie Derycke
- Department of Cardio-Vascular and Vascular Surgery, Hôpital Européen Georges Pompidou, Paris, France.
| | - Jacques Tomasi
- Department of Thoracic and Cardiovascular Surgery, University Hospital Centre-INSERM LTSI 1099, Rennes, France
| | - Pascal Desgranges
- Department of Vascular Surgery, Centre Hospitalier Universitaire Henri Mondor, Créteil, France
| | - Francis Pesteil
- Department of Vascular Medicine and Surgery, Dupuytren University Hospital, Limoges, France
| | - Didier Plissonier
- Department of Vascular Surgery, Rouen University Hospital, Rouen, France
| | - Mathieu Pernot
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Pessac, France
| | - Antoine Millon
- Department of Vascular and Endovascular Surgery, Hospices Civils de Lyon, Louis Pradel University Hospital, Bron, France
| | - Robert Martinez
- Department of Cardiovascular Surgery, University Hospital of Tours, Tours, France
| | - Nabil Chakfe
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Jean-Marc Alsac
- Department of Cardio-Vascular and Vascular Surgery, Hôpital Européen Georges Pompidou, Paris, France
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Sousa J, Vilares AT, Teixeira J. Use of custom-made scalloped thoracic stent grafts in different hostile aortic anatomies. Chirurgia (Bucur) 2021. [DOI: 10.23736/s0394-9508.20.05102-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Costache VS, Meekel JP, Costache A, Melnic T, Bucurenciu C, Chitic A, Candea G, Solomon C, Yeung KK. One-Year Single-Center Results of the Multilayer Flow Modulator Stents for the Treatment of Type B Aortic Dissection. J Endovasc Ther 2020; 28:20-31. [PMID: 32873130 PMCID: PMC7816551 DOI: 10.1177/1526602820950720] [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: 12/21/2022]
Abstract
Purpose To report a single-center series of patients with type B aortic dissection treated with the Multilayer Flow Modulator (MFM). Materials and Methods Over a 36-month period, 23 patients (median age 53 years; 20 men) with complicated type B aortic dissections (2 acute, 5 subacute, and 16 chronic) were treated with the MFM. Primary endpoints of rupture or dissection-related death, overall mortality, and reintervention were evaluated using the Kaplan-Meier method; estimates for freedom from the endpoints are reported with the 95% confidence interval (CI). Secondary outcomes included technical success, adverse events, and aortic remodeling. Clinical and imaging data were collected preoperatively, directly postoperatively, and annually to 36 months for analysis using computational fluid dynamics (CFD). Results Initial technical success was 91.3%. The estimates of the endpoints at 12 months were 100% for freedom from rupture or aortic-related death, 95.7% for freedom from overall mortality, and 91.3% for freedom from reintervention. No device-related neurological or systemic complications occurred, and no additional reinterventions were needed during follow-up. A total of 144 branches overstented by the MFM remained patent. Morphologic analysis of the aortic dissection showed progressive true lumen volume increase (75.9%, p<0.001) with concomitant false lumen volume decrease (42.8%, p<0.001); the CFD analyses showed increased laminar flow. Conclusion In the current series, the MFM provided a safe and feasible treatment option for complicated acute, subacute, and chronic type B aortic dissections, with high technical success, low mortality, and active aortic remodeling. Further studies should elucidate the long-term safety of the MFM and its effectiveness in a larger patient cohort.
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Affiliation(s)
- Victor S Costache
- NEXTcardio Project, Lucian Blaga University, Sibiu, Romania.,Cardiovascular Department, Polisano European Hospital, Sibiu, Romania
| | - Jorn P Meekel
- NEXTcardio Project, Lucian Blaga University, Sibiu, Romania.,Department of Vascular Surgery, Amsterdam University Medical Centers, Amsterdam, the Netherlands.,Department of Surgery, Zaans Medisch Centrum, Zaandam, the Netherlands.,Amsterdam Cardiovascular Sciences, VU University Medical Center Amsterdam, the Netherlands
| | - Andreea Costache
- NEXTcardio Project, Lucian Blaga University, Sibiu, Romania.,Cardiovascular Department, Polisano European Hospital, Sibiu, Romania
| | - Tatiana Melnic
- NEXTcardio Project, Lucian Blaga University, Sibiu, Romania.,Cardiovascular Department, Polisano European Hospital, Sibiu, Romania
| | | | - Anca Chitic
- NEXTcardio Project, Lucian Blaga University, Sibiu, Romania.,Cardiovascular Department, Polisano European Hospital, Sibiu, Romania
| | | | - Crina Solomon
- NEXTcardio Project, Lucian Blaga University, Sibiu, Romania
| | - Kak K Yeung
- NEXTcardio Project, Lucian Blaga University, Sibiu, Romania.,Department of Vascular Surgery, Amsterdam University Medical Centers, Amsterdam, the Netherlands.,Amsterdam Cardiovascular Sciences, VU University Medical Center Amsterdam, the Netherlands
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Fernández-Alonso L, Fernández Alonso S, Martínez Aguilar E, Santamarta Fariña E, Alegret Solé J, Atienza Pascual M, López San Martín M, Sánchez Rodríguez JM, Alvarez A, Centeno Vallepuga R. Fenestrated and Scalloped Endovascular Grafts in Zone 0 and Zone 1 for Aortic Arch Disease. Ann Vasc Surg 2020; 69:360-365. [PMID: 32554200 DOI: 10.1016/j.avsg.2020.06.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/02/2020] [Accepted: 06/03/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The aim of this study is to present midterm results of thoracic endovascular aortic repair (TEVAR) using scalloped or fenestrated custom-made endovascular grafts (CMEGs) in aortic arch Zones 0 and 1. METHODS A retrospective review of prospectively collected data involving consecutive patients with aortic arch disease treated by scalloped or fenestrated Relay Plus stent grafts (Terumo Aortic, Sunrise, FL) landed in Zones 0 and 1. Patient demographics, operative details, clinical outcomes, and complications were analyzed. RESULTS Between February 2014 and February 2020, 14 patients (9 male and 5 female) with a median age of 66 years (range 48-84) underwent scalloped or fenestrated TEVAR to preserve flow to the supra-aortic trunks (SATs). In 6 cases the landing zone was Zone 0 and in 8, Zone 1. Target vessels for the scallops were left common carotid artery in 8 cases (Zone 1) and innominate artery (IA) in 1 (Zone 0). All 5 fenestrations were designed to preserve the IA (Zone 0). Technical success was 100% with no endoleaks on completion angiography. One fatal perioperative stroke (7%) occurred in a patient with a fenestration for the IA and atherosclerotic plaques in the arch. During median follow-up of 37.5 (3-72) months, no other patient died, and all the target vessels and cervical revascularizations remained patent. There was no paraplegia, no retrograde dissection, and no other complication. Two patients (14%) with scallops in Zone 1 developed late endoleak: 1 type Ib at 6 months and 1 type Ia endoleak at 12 months. There were no endoleaks at all in the group of fenestrated endografts (Zone 0). CONCLUSIONS When anatomy allows, endovascular treatment using scalloped or fenestrated CMEGs in Zones 0 and 1 is a feasible technique to treat patients with aortic arch disease involving the SATs.
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Affiliation(s)
| | | | | | | | - Jordi Alegret Solé
- Division of Vascular Surgery, Complejo Hospitalario of Navarra, Pamplona, Spain
| | | | | | | | - Andrés Alvarez
- Division of Vascular Surgery, Hospital Universitario de Cabueñes, Gijon, Spain
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Saremi F, Hassani C, Lin LM, Lee C, Wilcox AG, Fleischman F, Cunningham MJ. Image Predictors of Treatment Outcome after Thoracic Aortic Dissection Repair. Radiographics 2018; 38:1949-1972. [DOI: 10.1148/rg.2018180025] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Farhood Saremi
- From the Departments of Radiology (F.S., C.H., L.M.L., C.L., A.G.W.) and Cardiovascular Surgery (C.H., F.F., M.J.C.), University of Southern California, USC University Hospital, 1500 San Pablo St, Los Angeles, CA 90033
| | - Cameron Hassani
- From the Departments of Radiology (F.S., C.H., L.M.L., C.L., A.G.W.) and Cardiovascular Surgery (C.H., F.F., M.J.C.), University of Southern California, USC University Hospital, 1500 San Pablo St, Los Angeles, CA 90033
| | - Leah M. Lin
- From the Departments of Radiology (F.S., C.H., L.M.L., C.L., A.G.W.) and Cardiovascular Surgery (C.H., F.F., M.J.C.), University of Southern California, USC University Hospital, 1500 San Pablo St, Los Angeles, CA 90033
| | - Christopher Lee
- From the Departments of Radiology (F.S., C.H., L.M.L., C.L., A.G.W.) and Cardiovascular Surgery (C.H., F.F., M.J.C.), University of Southern California, USC University Hospital, 1500 San Pablo St, Los Angeles, CA 90033
| | - Alison G. Wilcox
- From the Departments of Radiology (F.S., C.H., L.M.L., C.L., A.G.W.) and Cardiovascular Surgery (C.H., F.F., M.J.C.), University of Southern California, USC University Hospital, 1500 San Pablo St, Los Angeles, CA 90033
| | - Fernando Fleischman
- From the Departments of Radiology (F.S., C.H., L.M.L., C.L., A.G.W.) and Cardiovascular Surgery (C.H., F.F., M.J.C.), University of Southern California, USC University Hospital, 1500 San Pablo St, Los Angeles, CA 90033
| | - Mark J. Cunningham
- From the Departments of Radiology (F.S., C.H., L.M.L., C.L., A.G.W.) and Cardiovascular Surgery (C.H., F.F., M.J.C.), University of Southern California, USC University Hospital, 1500 San Pablo St, Los Angeles, CA 90033
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