|
1
|
Olson KA, Chung CY, Aksamit NO, Hill CE, Brown CVR, Teixeira PG. Rule of four: an anatomic and value-based approach to stent-graft inventory for blunt thoracic aortic injury. Eur J Trauma Emerg Surg 2023; 49:2173-2176. [PMID: 37029792 DOI: 10.1007/s00068-023-02267-z] [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: 01/05/2023] [Accepted: 03/26/2023] [Indexed: 04/09/2023]
Abstract
PURPOSE As blunt thoracic aortic injury (BTAI) treatment has shifted from open to thoracic endovascular aortic repair (TEVAR), logistical challenges exist in creating and maintaining inventories of appropriately sized stent-grafts, including storage demands, shelf-life management and cost. We hypothesized that most injured aortas can be successfully repaired with a narrow range of stent-graft sizes and present a value-based anatomic approach to optimizing inventory. METHODS CT-scans of all patients with BTAI admitted to our Level I trauma center from Apr 2010-Dec 2018 were reviewed. Patients with anatomy incompatible with TEVAR were excluded. For each patient, after aortic sizing a set of two stent-grafts most likely to be utilized was selected from a list of twenty commercially available GORE conformable TAG endografts based on manufacturer instructions. Stent-graft sizes were then ranked based on the number of cases they would be suitable for. MATLAB was utilized to determine the combinations of stent-grafts which would cover the most patients. RESULTS Twenty-eight patients with BTAI were identified and three were excluded based on iliac diameter. Most patients were male (68%), mean age 42.3 ± 20.2 years, mean ISS 37.0 ± 9.8. Overall mortality was 25%. Of the 20 available stent-graft options, a combination of four stent-grafts would successfully treat 100% of the patients in this series. CONCLUSIONS Based on actual CT-scan aortic measurements, we demonstrated that an inventory of four sent-graft sizes was sufficient to treat 100% of patients with BTAI. These data can be utilized as a value-based anatomic approach to aortic stent-graft institutional inventory creation and maintenance.
Collapse
Affiliation(s)
- Kristofor A Olson
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, 1500 Red River Street, Annex, Austin, TX, 78701, USA.
| | - C Yvonne Chung
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, 1500 Red River Street, Annex, Austin, TX, 78701, USA
- R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD, USA
| | - Nikolas O Aksamit
- Department of Mathematics and Statistics, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Charles E Hill
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, 1500 Red River Street, Annex, Austin, TX, 78701, USA
| | - Carlos V R Brown
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, 1500 Red River Street, Annex, Austin, TX, 78701, USA
| | - Pedro G Teixeira
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, 1500 Red River Street, Annex, Austin, TX, 78701, USA.
| |
Collapse
|
|
2
|
Reyes Valdivia A, Milner R, Heijmen R, Riambau V, Rousseau H, Tinelli G, Kotelis D, Zanabili Al-Sibbai AA, Pitoulias G, Zúñiga CG, de Beaufort HWL, Panagiotis D, Chaudhuri A. Mid-term outcomes of the use of endoanchors during thoracic endovascular aortic repair in multicentre analysis. Vascular 2022; 31:455-462. [DOI: 10.1177/17085381221076320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To describe mid-term outcomes of the use of EndoAnchors as an adjunct for arch and thoracic endovascular aortic repair (TEVAR). Methods A retrospective multicentre series from nine centres using the Heli-FX EndoAnchor System (Medtronic Inc, Minneapolis, USA) at TEVAR over May 2014–May 2019 is presented. The study is registered at ClinicalTrials.gov with number NCT04100499. The primary outcome was freedom from Type I endoleak at EndoAnchors deployments; secondary outcomes included evaluation of aortic wall penetration (AWP) at first computed tomography scan, EndoAnchor-related issues and mortality. Results 54 high-risk patients (35 males/19 females, age 73 ± 11 years) with arch, thoracic and thoracoabdominal aneurysmal disease (3 chronic post-dissection and one patch pseudoaneurysm), with a mean neck length 19.7 ± 6.6 mm that were treated with multiple hybrid and endovascular techniques were included. A total of 329 EndoAnchors were used with a mean of 6.1 ± 2.5 per patient. Overall adequate AWP was 86%, whereas arch (Ishimaru’s zones 0–2) deployments achieved 80.6% when compared to 87.3% in descending thoracic aorta (dTA); although there was no statistical significance. Freedom from type I endoleaks was 88% at 2 year follow-up, due to 4 type IA endoleaks, two of them successfully treated, one with conservative treatment due to complexity of repair and remaining patient died 1 year later due to endograft infection. There were reported five EndoAnchor-related issues; four losses and one renal stent-graft was crushed due to catheter deflection solved with balloon reinflation. None of the losses had clinical significance. Overall mortality is described for 7 (9.5%) patients, one of them aneurysm-related. Conclusions The adjunctive use of EndoAnchors in TEVAR and complex TEVAR procedures achieved acceptable outcomes at midterm in a high-risk series with hostile seal zones. Still, they should be still judiciously used as there is lack of data to suggest a more liberal use; therefore, the landing zone should not be compromised in favour of their use.
Collapse
Affiliation(s)
- Andrés Reyes Valdivia
- Department of Vascular and Endovascular Surgery, Ramón y Cajal´s University Hospital, Madrid, Spain
| | - Ross Milner
- Section of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Chicago Medicine, Chicago, Ill
| | - Robin Heijmen
- Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Vicente Riambau
- Vascular Surgery Division, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Spain
| | - Hervé Rousseau
- Department of Radiology, Rangueil Hospital, CHU de Toulouse, Toulouse Cedex, France
| | - Giovanni Tinelli
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Drosos Kotelis
- Department of Vascular Surgery, University Hospital RWTH Aachen, European Vascular Center Aachen-Maastricht, Aachen, Germany
| | | | - Georgios Pitoulias
- Aristotle University of Thessaloniki - Faculty of Medicine, Second Department of Surgery Division of Vascular Surgery. G. Gennimatas” Thessaloniki General Hospital
| | - Claudio Gandarias Zúñiga
- Department of Vascular and Endovascular Surgery, Ramón y Cajal´s University Hospital, Madrid, Spain
| | | | - Doukas Panagiotis
- Department of Vascular Surgery, University Hospital RWTH Aachen, European Vascular Center Aachen-Maastricht, Aachen, Germany
| | | |
Collapse
|