1
|
Kanamori LR, Tenorio ER, Babocs D, Savadi S, Baghbani-Oskouei A, Huang Y, Figueroa A, Tanenbaum M, Costa Filho JE, Baig M, Macedo TA, Timaran CH, Oderich GS. Indications, Safety and Effectiveness of Transcatheter Electrosurgical Septotomy During Endovascular Repair of Aortic Dissections. J Vasc Surg 2024:S0741-5214(24)01660-4. [PMID: 39074740 DOI: 10.1016/j.jvs.2024.07.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 07/05/2024] [Accepted: 07/10/2024] [Indexed: 07/31/2024]
Abstract
OBJECTIVE Endovascular repair of aortic dissections may be complicated by inadequate sealing zones, persistent false lumen (FL) perfusion, and limited space for catheter manipulation and target artery incorporation. The aim of this study was to describe the indications, technical success, and early outcomes of transcatheter electrosurgical septotomy (TES) during endovascular repair of aortic dissections. METHODS We reviewed the clinical data of consecutive patients treated by endovascular repair of aortic dissections with adjunctive TES in two centers between 2021-2023. Endpoints were technical success, defined by successful septotomy without dislodgment of the lamella or target artery occlusion, and 30-day rates of major adverse events (MAEs). RESULTS Among 197 patients treated by endovascular repair for aortic dissections, 36 (18%) patients (median age, 61.5 years (IQR 55-72.5); 83% males) underwent adjunctive TES for acute (n = 3, 8%), subacute (n = 1, 3%), or chronic post-dissection aneurysms (n = 32, 89%). Indications for TES were severe true lumen (TL) compression (≤ 16mm) in 28 patients (78%), target vessel origin from FL in 19 (53%), creation of suitable landing zone in 12 (33%), and organ/limb malperfusion in four (11%). Endovascular repair included fenestrated-branched endovascular aortic repair (FB-EVAR) in 18 patients (50%), thoracic EVAR (TEVAR)/ EVAR/PETTICOAT in 11 (31%), and arch branch repair in 7 (19%). All patients had dissections extending through Zones 5 to 7, and 28 patients (78%) underwent TES across the renal-mesenteric segment. Technical success of TES was 92% (33/36) for all patients and 97% (32/33) among those with subacute or chronic post-dissection aneurysms. There were three technical failures, including two patients with acute dissections with inadvertent SMA dissection in one patient and distal dislodgement of the dissection lamella in two patients. There were no arterial disruptions. Mean post-septotomy aortic lumen increased from 13.2±4.8mm to 28.4±6.8mm (P<.001). All 18 patients treated by FB-EVAR had successful incorporation of 78 target arteries. There was one (3%) early death from stroke, and three (8%) patients had MAEs. After a median follow-up of 8 months (IQR, 4.5-13.5 months), 13 (36%) patients had secondary interventions, and two (6%) died from non-aortic-related events. There were no other complications associated with TES. CONCLUSION TES is an adjunctive technique that may optimize sealing zones and luminal aortic diameter during endovascular repair of subacute and chronic post-dissection. Although no arterial disruptions or target vessel loss occurred, but patients with acute dissections are prone to technical failures related to dislodgement of the lamella.
Collapse
Affiliation(s)
- Lucas Ruiter Kanamori
- Advanced Aortic Research Program, Department of Cardiothoracic and Vascular Surgery, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Emanuel R Tenorio
- Advanced Aortic Research Program, Department of Cardiothoracic and Vascular Surgery, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Dora Babocs
- Advanced Aortic Research Program, Department of Cardiothoracic and Vascular Surgery, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Safa Savadi
- Advanced Aortic Research Program, Department of Cardiothoracic and Vascular Surgery, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Aidin Baghbani-Oskouei
- Advanced Aortic Research Program, Department of Cardiothoracic and Vascular Surgery, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Ying Huang
- Advanced Aortic Research Program, Department of Cardiothoracic and Vascular Surgery, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Andres Figueroa
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Mira Tanenbaum
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jose Eduardo Costa Filho
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Mirza Baig
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Thanila A Macedo
- Department of Diagnostic Radiology, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Carlos H Timaran
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Gustavo S Oderich
- Advanced Aortic Research Program, Department of Cardiothoracic and Vascular Surgery, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX.
| |
Collapse
|
2
|
Eleshra A, Kölbel T, Haulon S, Bertoglio L, Rohlffs F, Dias N, Panuccio G, Tsilimparis N. Urgent Candy-Plug Technique for Distal False Lumen Occlusion in Chronic Aortic Dissection. J Vasc Surg 2024:S0741-5214(24)01527-1. [PMID: 39029810 DOI: 10.1016/j.jvs.2024.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 07/08/2024] [Accepted: 07/11/2024] [Indexed: 07/21/2024]
Abstract
INTRODUCTION This study aimed to assess the impact of urgency on early and midterm outcomes of the Candy-Plug (CP) technique for distal false lumen (FL) occlusion in thoracic endovascular aortic repair (TEVAR) for aortic dissection (AD). METHODS The CP registry was reviewed, and patients were categorized into elective and urgent/emergent groups for analysis. Endpoints included technical success, clinical success, early (30-day) computed tomography angiography (CTA) findings, early (30-day) mortality, adverse events, aortic remodeling in patients with available CTA follow-up and re-intervention. RESULTS A total of 155 patients received a custom-made Candy-Plug with 32 patients (44% males, mean age 61±9 years) were treated urgently vs. 123 patients (63% males, mean age 62±11 years) electively. The primary CP rate was higher in the urgent group; (28/32, (88%) in the urgent group vs. 96/123 (78%) in the elective group, p=051). The mean contrast volume was higher in the urgent group; (157±56ml in the urgent group vs. 130±71ml in the elective group, p=.017). Technical success was achieved in all patients in both groups. Clinical success was achieved in 25/32 (78%) patients in the urgent group vs. 113/123 (92%) in the elective group, p=.159. The early mortality rate was 4/32, (13%) patients in the urgent group vs. 1/123 (1%) in the elective group, p=.120). There was no statistically significant difference regarding the early adverse events between the urgent and elective CP groups. Early aortic-related re-interventions were required in 6/32 (19%) patients in the urgent group vs. 6/123 (5%) in the elective group, p=.094. Thoracic aortic aneurysm sac regression was lower in the urgent group (5/28, (18%) in the urgent group vs. 63/114 (55%) in the elective group, p=001). Stable thoracic aortic aneurysm sac was higher in the urgent group (22/28, (79%) in the urgent group vs. 47/114 (41%) in the elective group, p=000). An increase in thoracic aortic aneurysm sac occurred in 1/28 (4%) patient in the urgent group vs. 4/114 (4%) patients in the elective group, p=.096. CONCLUSION The urgent use of the CP technique for distal FL occlusion in AD was feasible and effective. The decrease in aortic FL sac diameter may be affected by the urgent use of CP due to limited sizing availability. However, it achieved high rate of aortic remodeling.
Collapse
Affiliation(s)
- Ahmed Eleshra
- German Aortic Center, University Heart & Vascular Center, University Medical Center Eppendorf, Hamburg, Germany; Department of Vascular Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
| | - Tilo Kölbel
- German Aortic Center, University Heart & Vascular Center, University Medical Center Eppendorf, Hamburg, Germany
| | | | - Luca Bertoglio
- Division of Vascular Surgery, Department of Sperimental and Clinical Sciences (DSCS), University and ASST Spedali Civili Hospital of Brescia, Brescia, Italy
| | - Fiona Rohlffs
- German Aortic Center, University Heart & Vascular Center, University Medical Center Eppendorf, Hamburg, Germany
| | - Nuno Dias
- Skåne University Hospital, Malmö, Sweden
| | - Giuseppe Panuccio
- German Aortic Center, University Heart & Vascular Center, University Medical Center Eppendorf, Hamburg, Germany
| | - Nikolaos Tsilimparis
- German Aortic Center, University Heart & Vascular Center, University Medical Center Eppendorf, Hamburg, Germany; University Hospital, LMU, Munich, Germany
| |
Collapse
|
3
|
Grandi A, D'Oria M, Panuccio G, Rohlffs F, Eleshra A, Torrealba J, Nana P, Lepidi S, Melloni A, Bertoglio L, Kölbel T. Design, evolution, and experience with the candy plug device for endovascular false lumen occlusion of chronic aortic dissections. Expert Rev Med Devices 2024:1-4. [PMID: 38803133 DOI: 10.1080/17434440.2024.2360987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 05/17/2024] [Indexed: 05/29/2024]
Abstract
INTRODUCTION The management of the false lumen (FL) when dealing with aortic dissection is a crucial aspect since inducing its thrombosis is necessary in order to achieve aortic remodeling. One of the pitfalls of endovascular treatment of aortic dissection (AD) is retrograde distal FL perfusion and pressurization, which prevents FL thrombosis and thus aortic remodeling, while being associated with aneurysmal degeneration of the FL and poor long-term outcomes. AREAS COVERED Currently, there is no CE/FDA approved device for FL closure, however different techniques and devices have been proposed to overcome this challenge, the most known of which is the Candy Plug (CP). This review aims to describe the CP device, its implantation technique, and the available data in the literature (PubMed, Cochrane, and EMBASE databases; last queried, December 31, 2023). EXPERT OPINIONS While the treatment of AD remains technically challenging, the use of the CP technique to close any distal FL reperfusion proved to be feasible and safe with excellent rates of both technical and clinical success. Furthermore, recent studies have shown a quick learning curve with this technique.
Collapse
Affiliation(s)
- Alessandro Grandi
- German Aortic Center Hamburg, Department of Vascular Medicine, University Medical Center Eppendorf, Hamburg, Germany
- Division of Vascular Surgery, Department of Experimental and Clinical Sciences, University of Brescia, Brescia, Italy
| | - Mario D'Oria
- Division of Vascular and Endovascular Surgery, Department of Clinical Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Giuseppe Panuccio
- German Aortic Center Hamburg, Department of Vascular Medicine, University Medical Center Eppendorf, Hamburg, Germany
| | - Fiona Rohlffs
- German Aortic Center Hamburg, Department of Vascular Medicine, University Medical Center Eppendorf, Hamburg, Germany
| | - Ahmed Eleshra
- German Aortic Center Hamburg, Department of Vascular Medicine, University Medical Center Eppendorf, Hamburg, Germany
| | - Jose Torrealba
- German Aortic Center Hamburg, Department of Vascular Medicine, University Medical Center Eppendorf, Hamburg, Germany
| | - Petroula Nana
- German Aortic Center Hamburg, Department of Vascular Medicine, University Medical Center Eppendorf, Hamburg, Germany
| | - Sandro Lepidi
- Division of Vascular and Endovascular Surgery, Department of Clinical Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Andrea Melloni
- Division of Vascular Surgery, Department of Experimental and Clinical Sciences, University of Brescia, Brescia, Italy
| | - Luca Bertoglio
- Division of Vascular Surgery, Department of Experimental and Clinical Sciences, University of Brescia, Brescia, Italy
| | - Tilo Kölbel
- German Aortic Center Hamburg, Department of Vascular Medicine, University Medical Center Eppendorf, Hamburg, Germany
| |
Collapse
|
4
|
Gorgatti F, Nana P, Panuccio G, Rohlffs F, Torrealba JI, Kölbel T. Post-dissection Thoraco-abdominal Aortic Aneurysm Managed by Fenestrated or Branched Endovascular Aortic Repair. Eur J Vasc Endovasc Surg 2024:S1078-5884(24)00377-0. [PMID: 38697255 DOI: 10.1016/j.ejvs.2024.04.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 03/27/2024] [Accepted: 04/28/2024] [Indexed: 05/04/2024]
Abstract
OBJECTIVE Fenestrated or branched endovascular aortic repair (F/B-EVAR) is a valuable treatment in patients with chronic post-dissection thoraco-abdominal aneurysm (PD-TAAA). This study aimed to analyse early and follow up outcomes of F/B-EVAR in these patients. METHODS Thirty day and follow up outcomes of consecutive patients with PD-TAAA treated with F/B-EVAR in a tertiary centre over eight years were analysed retrospectively. All patients presenting with PD-TAAA and managed with F/B-EVAR were eligible. A modified Crawford's classification system was used. Thirty day mortality and major adverse event (MAE) rates were analysed. Time to event data were estimated with Kaplan-Meier survival analysis. RESULTS Fifty five patients (80% men, mean age 63.7 ± 7.7 years) were included: 12 (22%) were managed urgently; 25 (46%) for chronic type B aortic dissection; and the remainder for residual type A aortic dissection. Of these patients, 88% had undergone previous thoracic endovascular aortic repair. Prophylactic cerebrospinal fluid drainage (CSFD) was used in 91%. Fifteen (27%) patients were treated with F-EVAR, nine (16%) with fenestrations and branches, and 31 (56%) with B-EVAR. False lumen adjunctive procedures were used in 56%. Technical success was achieved in 96% of patients. The thirty day mortality rate was 7% and MAE rate was 20%. Spinal cord injury (SCI) grades 1 - 3 and grade 3 rates were 13% and 2%, respectively. Mean follow up was 33.0 ± 18.4 months. Survival and freedom from unscheduled re-intervention were 86% (standard error [SE] 5%) and 55% (SE 8%) at 24 months, respectively. Freedom from target vessel stenosis and occlusion was higher in F-EVAR at the 12 month follow up (p = .006) compared with B-EVAR. CONCLUSION Fenestrated or branched endovascular repairs in patients with PD-TAAA showed high technical success, with acceptable early mortality and MAE rates. The SCI rate was > 10%, despite CSFD use and staged procedures. Almost a half of patients needed an unscheduled re-intervention within 24 months after F/B-EVAR.
Collapse
Affiliation(s)
- Filippo Gorgatti
- German Aortic Centre, Department of Vascular Medicine, University Heart and Vascular Centre UKE Hamburg, Hamburg, Germany
| | - Petroula Nana
- German Aortic Centre, Department of Vascular Medicine, University Heart and Vascular Centre UKE Hamburg, Hamburg, Germany.
| | - Giuseppe Panuccio
- German Aortic Centre, Department of Vascular Medicine, University Heart and Vascular Centre UKE Hamburg, Hamburg, Germany
| | - Fiona Rohlffs
- German Aortic Centre, Department of Vascular Medicine, University Heart and Vascular Centre UKE Hamburg, Hamburg, Germany
| | - José I Torrealba
- German Aortic Centre, Department of Vascular Medicine, University Heart and Vascular Centre UKE Hamburg, Hamburg, Germany
| | - Tilo Kölbel
- German Aortic Centre, Department of Vascular Medicine, University Heart and Vascular Centre UKE Hamburg, Hamburg, Germany
| |
Collapse
|
5
|
Loschi D, Santoro A, Rinaldi E, Anselmi C, Grignani C, Chiesa R, Melissano G. Open and endovascular reinterventions after Candy Plug false lumen embolization of type B aortic dissection. J Vasc Surg 2023; 78:1409-1417. [PMID: 37572890 DOI: 10.1016/j.jvs.2023.07.063] [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: 05/27/2023] [Revised: 07/24/2023] [Accepted: 07/28/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVE In the majority of patients with chronic type B aortic dissection, there is persistent retrograde flow in the false lumen (FL) through distal re-entry tears. Among several endovascular techniques proposed for FL management, the "Candy Plug" (CP) technique has gained acceptance with good early results. The aim of this study is to report the types and outcomes of open and endovascular reinterventions and identify mechanisms of procedure failure as well as other causes for reinterventions. METHODS All patients with type B aortic dissection submitted to thoracic endovascular aneurysm repair and CP implantation for FL embolization from January 2016 to December 2022 at our institution were included in this study. The preoperative, intraoperative, and postoperative data of the primary intervention and secondary reinterventions, when performed, were prospectively collected and retrospectively analyzed. Preoperative and postoperative computed tomography angiography were also analyzed. RESULTS During the study period, 33 patients were submitted to thoracic endovascular aneurysm repair and CP implantation. Twenty-three patients (69.7%) showed thoracic FL complete thrombosis with aortic stability or positive remodeling at a mean follow-up of 45 ± 23.1 months. Ten patients (30.3%) underwent aortic reinterventions (male, n = 9; mean age, 60.5 ± 7.6 years). Of these 10 patients, in four patients, complete thrombosis of the FL was never achieved, leading to ongoing perfusion of the FL, defined as "primary failure." The other six patients underwent reinterventions for different causes: two patients, after initial sealing, showed a progressive enlargement of the abdominal FL leading to distal degeneration. One patient showed proximal degeneration, two patients showed a type II thoracoabdominal aortic aneurysm and CP implantation was used as a planned procedure to reduce the extent of the surgical procedure, and one patient had recurrent, intractable back pain despite complete thrombosis of the FL. Reinterventions were open in five cases and endovascular in five. One in-hospital death (postoperative day 27) after a type II thoracoabdominal aortic aneurysm open repair was recorded. In addition, two cases of delayed spinal cord ischemia after open reintervention were recorded: one resulting in permanent paraplegia and one transitory with complete recovery. CONCLUSIONS The CP technique was safe and effective; however, a significant rate of aortic-related reintervention was observed. Several mechanisms led to reinterventions either in terms of "primary failure" of the CP or subsequent aneurysmal degeneration. Complex reinterventions were often necessary, with a high rate of major complications in case of open repair. Life-long and closer surveillance might be required in these patients.
Collapse
Affiliation(s)
- Diletta Loschi
- "Vita-Salute" University, Scientific Institute H. San Raffaele, Milan, Italy.
| | - Annarita Santoro
- "Vita-Salute" University, Scientific Institute H. San Raffaele, Milan, Italy
| | - Enrico Rinaldi
- "Vita-Salute" University, Scientific Institute H. San Raffaele, Milan, Italy
| | - Claudia Anselmi
- "Vita-Salute" University, Scientific Institute H. San Raffaele, Milan, Italy
| | - Camilla Grignani
- "Vita-Salute" University, Scientific Institute H. San Raffaele, Milan, Italy
| | - Roberto Chiesa
- "Vita-Salute" University, Scientific Institute H. San Raffaele, Milan, Italy
| | - Germano Melissano
- "Vita-Salute" University, Scientific Institute H. San Raffaele, Milan, Italy
| |
Collapse
|
6
|
Bertoglio L, Bilman V, Rohlffs F, Panuccio G, Chiesa R, Kölbel T. Self-occluding Candy-Plug: Implantation Technique to Obtain False Lumen Thrombosis in Chronic Aortic Dissections. J Endovasc Ther 2023; 30:811-816. [PMID: 35707893 DOI: 10.1177/15266028221102661] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To describe the implantation steps of the latest generation of candy-plug device (third CP generation [CP III]) and to illustrate its possible pitfalls by discussing a case in whom this device was employed to occlude the false lumen (FL) of a chronic type B aortic dissection. TECHNIQUE A 69 year-old male patient who underwent a frozen elephant trunk arch repair due to residual type A aortic dissection developed a FL aneurysmal degeneration limited to the descending thoracic aorta. Two thoracic stent-grafts were deployed into the true lumen up to the celiac trunk origin. Then, the FL was occluded with a self-occluding CP III device (Cook Medical, Bloomington, Indiana), placed at the same level as the distal thoracic stent-graft. The distal un-stented sleeve was pushed upward to allow immediate occlusion of its central lumen, avoiding interference with reno-visceral arteries arising from the FL. Both intraoperative transesophageal echocardiography and follow-up computed tomographic angiography scan demonstrated complete FL thrombosis. CONCLUSION The introduction of CP III with its self-occluding mechanism helped to shorten and standardize the procedure. However, adjunctive steps may be needed to immediately obtain FL occlusion and avoid hampering the perfusion of vessels arising from the FL.
Collapse
Affiliation(s)
- Luca Bertoglio
- Division of Vascular Surgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, IRCCS Hospital San Raffaele, Milan, Italy
| | - Victor Bilman
- Division of Vascular Surgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, IRCCS Hospital San Raffaele, Milan, Italy
| | - Fiona Rohlffs
- German Aortic Centre, Department of Vascular Medicine, University Hospital Eppendorf, Hamburg, Germany
| | - Giuseppe Panuccio
- German Aortic Centre, Department of Vascular Medicine, University Hospital Eppendorf, Hamburg, Germany
| | - Roberto Chiesa
- Division of Vascular Surgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, IRCCS Hospital San Raffaele, Milan, Italy
| | - Tilo Kölbel
- German Aortic Centre, Department of Vascular Medicine, University Hospital Eppendorf, Hamburg, Germany
| |
Collapse
|
7
|
Eleshra A, Haulon S, Bertoglio L, Lindsay T, Rohlffs F, Dias N, Tsilimparis N, Panuccio G, Kölbel T. Custom Made Candy Plug for Distal False Lumen Occlusion in Aortic Dissection: International Experience. Eur J Vasc Endovasc Surg 2023; 66:50-56. [PMID: 36958480 DOI: 10.1016/j.ejvs.2023.03.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 02/26/2023] [Accepted: 03/13/2023] [Indexed: 03/25/2023]
Abstract
OBJECTIVE To evaluate early and midterm outcomes of the Candy Plug (CP) technique for distal false lumen (FL) occlusion in thoracic endovascular aortic repair for aortic dissection (AD) in a more real world cohort of patients from an international multicentre registry. METHODS A multicentre retrospective study was conducted of all consecutive patients from the contributing centres with subacute and chronic AD treated with the CP technique from October 2013 to April 2020 at 18 centres. RESULTS A custom made CP was used in 155 patients (92 males, mean age 62 ± 11 years). Fourteen (9%) presented with ruptured false lumen aneurysms. Technical success was achieved in all patients (100%). Clinical success was achieved in 138 patients (89%). The median hospital stay was 7 days (1 - 77). The 30 day mortality rate was 3% (n = 5). Stroke occurred in four patients (3%). Spinal cord ischaemia occurred in three patients (2%). The 30 day computed tomography angiogram (CTA) confirmed successful CP placement at the intended level in all patients. Early complete FL occlusion was achieved in 120 patients (77%). Early (30 day) CP related re-intervention was required in four patients (3%). The early (30 day) stent graft related re-intervention rate was 8% (n = 12). Follow up CTA was available in 142 patients (92%), with a median follow up of 23 months (6 - 87). Aneurysmal regression was achieved in 68 of 142 patients (47%); the aneurysm diameter remained stable in 69 of 142 patients (49%) and increased in five of 142 patients (4%). A higher rate of early FL occlusion was detected in the largest volume centre patients (50 [88%] vs. 70 [71%] from other centres; p = .019). No other differences in outcome were identified regarding volume of cases or learning curve. CONCLUSION This international CP technique experience confirmed its feasibility and low mortality and morbidity rates. Aortic remodelling and false lumen thrombosis rates were high and support the concept of distal FL occlusion in AD using the CP technique.
Collapse
Affiliation(s)
- Ahmed Eleshra
- German Aortic Centre, University Heart & Vascular Centre, University Medical Centre Eppendorf, Hamburg, Germany; Department of Vascular Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
| | | | - Luca Bertoglio
- San Raffaele Hospital, Milan, Italy; Division of Vascular Surgery, Department of Sperimental and Clinical Sciences (DSCS), University and ASST Spedali Civili Hospital of Brescia, Brescia, Italy
| | | | - Fiona Rohlffs
- German Aortic Centre, University Heart & Vascular Centre, University Medical Centre Eppendorf, Hamburg, Germany
| | - Nuno Dias
- Skåne University Hospital, Malmö, Sweden
| | - Nikolaos Tsilimparis
- German Aortic Centre, University Heart & Vascular Centre, University Medical Centre Eppendorf, Hamburg, Germany; University Hospital, LMU, Munich, Germany
| | - Giuseppe Panuccio
- German Aortic Centre, University Heart & Vascular Centre, University Medical Centre Eppendorf, Hamburg, Germany
| | - Tilo Kölbel
- German Aortic Centre, University Heart & Vascular Centre, University Medical Centre Eppendorf, Hamburg, Germany
| |
Collapse
|
8
|
Spanos K, Kodolitsch Y, Detter NC, Panuccio G, Rohlffs F, Eleshra A, Kölbel T. Endovascular treatment of aortic aneurysms and dissections in patients with genetically triggered aortic diseases. Semin Vasc Surg 2022; 35:320-333. [DOI: 10.1053/j.semvascsurg.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/20/2022] [Accepted: 06/27/2022] [Indexed: 11/11/2022]
|
9
|
Rohlffs F, Tsilimparis N, Panuccio G, Heidemann F, Behrendt CA, Kölbel T. The Knickerbocker Technique: Technical Aspects and Single-Center Results of a New Endovascular Method for False Lumen Occlusion in Chronic Aortic Dissection. J Endovasc Ther 2022:15266028221090439. [PMID: 35502737 DOI: 10.1177/15266028221090439] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To describe the technical aspects and early results of a new endovascular fenestration method for false lumen occlusion in chronic aortic dissection: the Knickerbocker Technique. METHODS A retrospective observational study including all consecutively treated patients between November 1, 2012, through May 31, 2016, who underwent thoracic endovascular aortic repair with false lumen occlusion using the Knickerbocker Technique for thoracic false lumen aneurysm in chronic aortic dissection in a tertiary care center. Primary endpoints consisted of technical (correct deployment of the stent-graft) and clinical (false lumen occlusion) success. Secondary endpoints included overall survival and morbidity after 30 days. In 12 patients, follow-up computed tomography angiogram (CTA) was available and aortic remodeling was evaluated. RESULTS We identified 16 eligible patients (75% men, mean age: 69 years, range: 52-80 years). Technical success was 94%. Overall survival after 30 days was 100%; there was 1 aortic reintervention (additional false lumen embolization due to endoleak type 1a in 1 patient). Median total follow-up was 31.5 months (range: 3-66 months). Four (25%) of 16 patients died during follow-up, in 3 of those patients the cause of death is unknown, and 1 patient developed cardiac tamponade after being treated by fenestrated thoracic endovascular aortic repair. Imaging follow-up with CTA was available in 12 patients (median imaging follow-up: 27.5 months, range: 1-57 months). Nine (75%) of 12 patients showed thoracic aortic remodeling, and in 3 patients aneurysm size was stable. No patient showed aneurysm growth. CONCLUSION The Knickerbocker Technique is a feasible endovascular fenestration method to achieve false lumen occlusion and aortic remodeling in chronic aortic dissection with low invasiveness.
Collapse
Affiliation(s)
- Fiona Rohlffs
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Nikolaos Tsilimparis
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Giuseppe Panuccio
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Franziska Heidemann
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Christian-Alexander Behrendt
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Tilo Kölbel
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|