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Baldaia L, Duque M, Silva M, Silva E, Nunes C, Constâncio V, Orelhas L, Fonseca M, Antunes LF. Thoracic aortic aneurysms, a single center's 10-years experience and analysis of outcomes. Vascular 2024:17085381241236575. [PMID: 38391289 DOI: 10.1177/17085381241236575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
INTRODUCTION Thoracic aortic aneurysms (TAAs) are an increasingly prevalent pathology with significant associated morbidity and mortality. Thoracic endovascular aortic repair (TEVAR) is the primary line of treatment. The purpose of this study was to analyse a single center's experience in the treatment of TAAs and identify possible risk factors for worse outcomes. METHODS A retrospective review of our institutional database was done to identify all patients treated for TAAs in a 10-year period, from 1 January 2012 to 31 December 2022. Data were extracted from patients' medical records. Primary outcome was all-cause mortality and secondary outcomes were procedure related morbidity (vascular access complications, medullary ischaemia, stroke, endoleaks, migration, aneurysm sac enlargement >5 mm) and need for reintervention at 1-, 6- and 12-month follow-up. A descriptive and inferential analysis of the data was performed. Statistical analyses were conducted using the IBM Statistical Package for Social Sciences (SPSS) software. RESULTS We identified 34 patients treated for TAAs in this period. Mean age was 68 years [47-87] and 79.4% of patients were male. Mean aneurysm diameter was 63 mm [35-100], 55.9% fusiform and 44.1% saccular. The majority (91.2%) were located at the descending thoracic aorta and 3 (8.8%) of them extended to the aortic arch. The most common aetiology was degenerative in 22 patients (64.7%), followed by aortic dissection in 8 patients (23.5%). Elective surgery was performed in 19 (61.3%) patients and 12 (38.7%) had urgent repair. TEVAR was the treatment of choice in 24 (77.4%) patients, and the remaining 7 (22.6%) were treated with hybrid surgery. Mean length of hospital stay was 10 days [2-80] (6 days for elective repair versus 16 days for urgent repair, p = .016). Follow-up period ranged from 1 month to 10 years. At 1 year follow-up, all-cause mortality was 15%, morbidity was 30% (with 6 (22%) patients having a type Ia endoleak) and need for reintervention was 22%. Aneurysm diameter was a significant risk factor for procedure related morbidity (median diameter of 73.5 mm versus 56.0 mm in patients with no morbidity; p = .027). The presence of type Ia endoleak was significantly associated with higher reintervention rates (p = .001), but not with higher mortality rates (p = .515). Age, female sex, aetiology and urgent repair weren't associated with any significant differences in the outcomes. CONCLUSIONS TEVAR proved to be effective in the treatment of TAAs, with good outcomes at short and mid-term follow-up. TAAs should be diagnosed earlier and be promptly treated when meeting criteria to prevent worse outcomes.
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Affiliation(s)
- Leonor Baldaia
- Department of Angiology and Vascular Surgery, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Mariana Duque
- Department of General Surgery, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Miguel Silva
- Department of Angiology and Vascular Surgery, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Eduardo Silva
- Department of Angiology and Vascular Surgery, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Celso Nunes
- Department of Angiology and Vascular Surgery, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Vânia Constâncio
- Department of Angiology and Vascular Surgery, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Luís Orelhas
- Department of Angiology and Vascular Surgery, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Manuel Fonseca
- Department of Angiology and Vascular Surgery, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Luís F Antunes
- Department of Angiology and Vascular Surgery, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Weissler EH, Hammill BG, Armstrong JL, Vekstein AM, Chodavadia P, Long CA, Roe M, Hughes GC. Association Between Device Type and Type IIIb Endoleaks Following Thoracic Endovascular Aortic Repair. Eur J Vasc Endovasc Surg 2023; 65:112-119. [PMID: 36209962 DOI: 10.1016/j.ejvs.2022.10.005] [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] [Received: 03/17/2022] [Revised: 08/24/2022] [Accepted: 10/02/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Endoleaks following thoracic endovascular aortic repair (TEVAR) can lead to the need for re-intervention and aortic rupture. Given the recent recall of a specific thoracic stent graft type due to concerns about type IIIb endoleak (T3bE), in which blood leaks through the stent graft fabric, the aim was to characterise patterns of T3bEs among available TEVAR devices. METHODS Reports related to thoracic stent grafts in the Food and Drug Administration's (FDA) Manufacturer and User Facility Device Experience (MAUDE) database between 2010 and 2020 were reviewed. Proportional reporting ratios (PRRs) and chi squared tests were used to assess for the presence of a signal of association between device type and T3bE. A PRR > 2 and chi squared value > 4 with three or more reports overall constituted a signal of association. The institutional database of patients undergoing TEVAR for thoracic aneurysms since 2002 was also queried for T3bE. RESULTS There were 7 328 MAUDE reports available for analysis. When analysing T3bEs in the MAUDE database, the lowest PRR was 0.36 (95% confidence interval [CI] 0 - 1.03 in Gore CTAG, nine T3bE among 1 328 reports) and the highest was 2.07 (95% CI 1.72 - 2.42 in Medtronic Valiant, 64 T3bE among 2 520 reports). The T3bE chi squared value for Medtronic Valiant was 17.3. The relationship between Medtronic Valiant and T3bE was ascertainable by MAUDE data as early as 2013. Among 542 TEVARs for an aneurysm indication at Duke University Hospital since 2002, there were eight T3bEs - all in devices with sutured on graft material. CONCLUSION The Medtronic Valiant device met criteria for association with type IIIb endoleaks in the FDA's MAUDE database and met those criteria as early as 2013. A possible relationship between woven graft fabric and T3bEs is supported by the observation that all types of T3bE that occurred among a large number of TEVARs at the institution followed placement of grafts with sutured on woven fabric.
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Affiliation(s)
- E Hope Weissler
- Division of Vascular and Endovascular Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Bradley G Hammill
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Jenna L Armstrong
- Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Andrew M Vekstein
- Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Parth Chodavadia
- Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Chandler A Long
- Division of Vascular and Endovascular Surgery, Duke University School of Medicine, Durham, NC, USA
| | | | - G Chad Hughes
- Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, NC, USA.
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Mezzetto L, Mastrorilli D, Bravo G, Scorsone L, Gennai S, Leone N, D'Oria M, Veraldi E, Veraldi GF. Celiac Artery Coverage After Thoracic Endovascular Aortic Procedure: A Meta-Analysis of Early and Late Results. J Endovasc Ther 2022:15266028221090443. [PMID: 35466769 DOI: 10.1177/15266028221090443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND/AIM Clinical outcomes of celiac artery (CA) coverage during aortic procedures are often contradicting and the fate of this additional maneuver is still unclear. This study summarizes the results of available literature and aims to clarify the impact of CA coverage during thoracic endovascular aneurysm repair (TEVAR) in patients with inadequate distal sealing zone. METHODS Prospective and retrospective, observational original articles focused on CA coverage during elective/urgent TEVAR for descending thoracic aortic pathology (DTAP) were included. PubMed/MEDLINE, Embase, and Cochrane Central Register of Controlled Trials database were examined to identify articles published from January 2007 to December 2020, according to PRISMA guidelines. Early and late visceral (any sign or symptom reported) and neurological (both transient and permanent) complications were considered as primary outcomes. Onset of any endoleak, type IB endoleak, need of reintervention, and TEVAR-related mortality were considered as secondary outcomes. RESULTS A total of 5618 articles were extracted for analysis and 13 studies were finally included in the synthesis. A total of 178 CAs were covered during 2653 TEVAR (7%). Spinal cord ischemia was 8% (95% CI, 5-14%, I2 0%) Any endoleak and type IB endoleak was observed in 12% (95% CI, 6-21%, I2 17%) and 5% (95% CI, 2-11%, I2 0%), respectively. Thoracic endovascular aneurysm repair-related reoperation was necessary in 8% (95% CI, 4-14%, I2 0%), the majority of which (14/18, 78%) performed for distal sealing failure; mortality rate was 9% (95% CI, 5-14%, I2 0%). Out of 178 patients, 168 (94%) were available for follow-up, ranged 12 to 42 months. Visceral complications, any endoleak, and type IB endoleak were identified in 15% (95% CI, 10-23%, I2 45%), 20% (95% CI, 13-29%, I2 8%), and 8% (95% CI, 4-15%, I2 0%), respectively. Thoracic endovascular aneurysm repair-related reintervention was required in 8% (95% CI, 4-14%, I2 0%). Mortality rate was 17% (95% CI, 12-25%, I2 4%). CONCLUSIONS Celiac artery coverage in DTAP should be regarded as a "bailout" procedure especially in urgent/emergent settings but requires caution in elective cases. Even if transient visceral ischemia is frequent, life-threatening complications are rare. Early and late mortality rates are similar to standard TEVAR although the risk of type IB endoleak and reintervention may be an issue.
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Affiliation(s)
- Luca Mezzetto
- Vascular Surgery, Integrated University Hospital of Verona, Verona, Italy
| | - Davide Mastrorilli
- Vascular Surgery, Integrated University Hospital of Verona, Verona, Italy
| | - Giulia Bravo
- Department of Medicine, University of Udine, Udine, Italy
| | - Lorenzo Scorsone
- Vascular Surgery, Integrated University Hospital of Verona, Verona, Italy
| | - Stefano Gennai
- Vascular Surgery, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Nicola Leone
- Vascular Surgery, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Mario D'Oria
- Vascular and Endovascular Surgery, Trieste University Hospital, Trieste, Italy
| | - Edoardo Veraldi
- Vascular Surgery, Integrated University Hospital of Verona, Verona, Italy
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Liisberg M, Baudier F, Akgül C, Lindholt JS. Long-term Thoracic Endovascular Repair follow-up from 1999-2019 - a Single-Center Experience. Ann Vasc Surg 2022; 86:399-407. [PMID: 35460855 DOI: 10.1016/j.avsg.2022.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 02/22/2022] [Accepted: 04/06/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Thoracic endovascular aortic repair (TEVAR) was introduced in the early 1990's, and long-term follow-up studies are warranted in current guidelines. METHODS Patients undergoing TEVAR were consecutively included from 1999-2019. Thoracic aortic disease includes thoracic aortic aneurysms, aortic dissection, traumatic rupture, penetrating aortic ulcer (PAU) and intramural hematoma (IMH). Our prospective database recorded baseline characteristics, endoleak or aneurysm growth and death. Patients were included at time of treatment and censored at death, or first reintervention depending on the analysis. Primary endpoint was all-cause death, secondary endpoint was reintervention. Survival and failure analysis were done using StataIC 16.0® and truncated at 15 years of follow-up. RESULTS 256 patients were included - 63% were men. Their mean age at intervention was 66.2 ± 14.5 years and they were followed for a mean of 5.2 ± 4.5 years. Indications for TEVAR were acute aortic syndrome 40.6%, chronic aortic disease 44.5%, and traumatic rupture in 14.8 %. Technical success was seen in 94.1 % of the operations, and the left subclavian artery was covered in 27.7%. 30-day mortality rate was 21.2% (22/104) and 1.75% (2/114) (p<0.001) for urgent and elective patients, respectively. Twelve patients (4.7%) died within 24 hours of treatment. Overall, long-term mortality recorded112 (43,8%) deaths, 29 patients had reinterventions (11.3 % (95% confidence interval: 7.7-15.9)), aneurysms accounted for 62.1% of all reinterventions. 24 (82.8%) reinterventions occurred within the first 5 years. CONCLUSION This long-term follow-up study shows excess mortality in patients treated for acute aortic syndrome compared to chronic aortic disease, within the first 30 days, this difference diminishes at the end of follow-up. Most endoleak occur within the first five years, though new endoleak continue to develop decades after in previous endoleak-free patients calling for lifelong surveillance.
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Affiliation(s)
- Mads Liisberg
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Denmark; Elite Research Centre of Individualised Treatment of Arterial Diseases (CIMA), Odense University Hospital, Denmark; Clinical Institute, University of Southern Denmark, Denmark.
| | - Francois Baudier
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Denmark; Elite Research Centre of Individualised Treatment of Arterial Diseases (CIMA), Odense University Hospital, Denmark
| | - Cengiz Akgül
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Denmark; Elite Research Centre of Individualised Treatment of Arterial Diseases (CIMA), Odense University Hospital, Denmark
| | - Jes S Lindholt
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Denmark; Elite Research Centre of Individualised Treatment of Arterial Diseases (CIMA), Odense University Hospital, Denmark; Clinical Institute, University of Southern Denmark, Denmark
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Shu C, He H, Fu W, Guo W, Li M, Xi E, Guo S, Chen X, Xiao Z, Yu S, Huang J, Dai X, Wang Z, Li W, Zheng Q, Li Q, Wang L, Li X, Wang J, Gu F. 1-Year Outcomes of a Multicenter Randomized Controlled Trial of the Ankura II Thoracic Endoprosthesis for the Endovascular Treatment of Stanford Type B Aortic Dissections. Front Cardiovasc Med 2022; 9:805585. [PMID: 35369315 PMCID: PMC8964940 DOI: 10.3389/fcvm.2022.805585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 02/16/2022] [Indexed: 11/13/2022] Open
Abstract
Background The Ankura II Thoracic Stent Graft System (Lifetech, Shenzhen, China) is an evolution of the Ankura stent graft. This study reports one-year outcomes of the Ankura II Thoracic Stent Graft System for endovascular treatment of Stanford type B aortic dissections. Methods The Ankura II Thoracic Aortic Endovascular Trial was a randomized, single-blinded, clinical trial conducted at 12 Chinese institutes. The enrolled patients diagnosed with Stanford type B aortic dissections (TBADs) were randomly assigned to the Ankura group or Ankura II group. Standard follow-up examinations were performed at 1, 6, and 12 months. Safety and efficacy data were analyzed. Results 132 patients with TBADs were enrolled. The outcomes for the primary safety end points revealed that the Ankura II stent graft was statistically non-inferior compared to the Ankura stent graft. The 1-month device-related major adverse events (1.6 vs. 0%; p = 0.48), 1-month all-cause mortality (1.7 vs. 4.5%; p = 0.621), 12-month survival rate (95.2 ± 2.7% vs. 94.1 ± 2.9%; p = 0.769), and major adverse event (MAE) rate (5.1 vs. 4.7% at 1 month; p = 0.73 and 5.8 vs. 8.9% at 12 months; p = 0.718) of Ankura II group are all comparable to Ankura group. The two groups showed similar primary effectiveness and true lumen expansion effect, and false lumen remodeling was improved in Ankura II group (−100.0 vs. −48.5%; p = 0.08). Conclusions The one-year outcomes from this prospective, randomized, multicenter study demonstrate that Ankura II stent graft shows comparable results to Ankura for treating TBADs, resulting in low mortality rates, MAEs and reintervention rates. Clinical Trial Registration ChiCTR-TRC-12002844.
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Affiliation(s)
- Chang Shu
- Department of Vascular Surgery, Second Xiangya Hospital, Central South University, Changsha, China
- Department of Vascular Surgery, Fuwai Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
- *Correspondence: Chang Shu
| | - Hao He
- Department of Vascular Surgery, Second Xiangya Hospital, Central South University, Changsha, China
| | - Weiguo Fu
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei Guo
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Ming Li
- Department of Vascular Surgery, Second Xiangya Hospital, Central South University, Changsha, China
- Department of Vascular Surgery, The First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, China
| | - Erping Xi
- Department of Vascular Surgery, Wuhan General Hospital of Guangzhou Military Region, Wuhan, China
| | - Shuguang Guo
- Department of Vascular Surgery, Kunming General Hospital of Chengdu Military Region, Kunming, China
| | - Xueming Chen
- Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhanxiang Xiao
- Department of Vascular Surgery, Hainan Provincial People's Hospital, Haikou, China
| | - Shiqiang Yu
- Department of Vascular Surgery, The First Affiliated Hospital of the Fourth Military Medical University, Xi'an, China
| | - Jianhua Huang
- Department of Vascular Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Xiangchen Dai
- Department of Vascular Surgery, General Hospital of Tianjin Medical University, Tianjin, China
| | - Zhiwei Wang
- Department of Vascular Surgery, Wuhan University People's Hospital, Wuhan, China
| | - Wei Li
- Medical Research and Statistics Center, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Qingshan Zheng
- Drug Clinical Research Center, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Quanming Li
- Department of Vascular Surgery, Second Xiangya Hospital, Central South University, Changsha, China
| | - Lunchang Wang
- Department of Vascular Surgery, Second Xiangya Hospital, Central South University, Changsha, China
| | - Xin Li
- Department of Vascular Surgery, Second Xiangya Hospital, Central South University, Changsha, China
| | - Junwei Wang
- Department of Vascular Surgery, Second Xiangya Hospital, Central South University, Changsha, China
| | - Feng Gu
- Department of Vascular Surgery, Second Xiangya Hospital, Central South University, Changsha, China
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Chow SCY, Ho JYK, Fujikawa T, Lim K, Chu CM, Yu SCH, Bashir M, Wong RHL. Valiant NAVION stent graft system application: First Asian case-series analysis. J Card Surg 2021; 36:841-847. [PMID: 33522638 DOI: 10.1111/jocs.15306] [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: 12/02/2020] [Revised: 12/22/2020] [Accepted: 12/24/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIM The Valiant NavionTM stent graft system is a third-generation low profile thoracic endograft designed for thoracic endovascular aortic repair. In this population analysis, we report on the first Asian all-comers experience and outcomes who underwent thoracic endovascular aortic repair with the use of this new stent graft system. METHODS Between May 2019 and October 2020, 21 patients with different aortic pathologies were prospectively recruited and retrospectively analyzed. Important clinical and device-related outcomes were evaluated. The endpoints included short-term survival, technical success, access failures, major vascular and clinical complications, endoleaks, and hospital stay. RESULTS The commonest indication of stenting was penetrating aortic ulcers (28.6%) and six (28.6%) patients had emergency stenting performed for aortic transection or rupture. 30 days of survival postprocedure was recorded and complete. There were no major vascular complications. Deployment accuracy was 100%, and the technical success rate was 94.7% (18/19) with one patient having a Type 2 endoleak on follow-up imaging. No neurological complications were noted. The mean operative time was 95 ± 73.6 min and the mean fluoroscopy time was 16.2 ± 10.8 min. Mean hospital stay for elective zone 2, 3, and 4 stenting was 5.3 ± 3.8 days, and only one patient postzone 1 thoracic endovascular aortic repair required a brief (0.5 days) ICU stay. All procedures were performed via the percutaneous transfemoral route with 100% success in percutaneous closure. CONCLUSION This first reported Asian case series demonstrated versatility, safety, and efficacy of the Valiant NavionTM stent in Asian patients with different aortic pathologies.
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Affiliation(s)
- Simon C Y Chow
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
| | - Jacky Y K Ho
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
| | - Takuya Fujikawa
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
| | - Kevin Lim
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
| | - Cheuk Man Chu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
| | - Simon C H Yu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
| | - Mohamad Bashir
- Department of Cardiovascular and Endovascular Surgery, Blackburn Teaching Hospital, Blackburn, UK
| | - Randolph H L Wong
- Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
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Reyes-Valdivia A, Kratimenos T, Ferraresi M, Sica S, Lovato L, Accarino G, Pagliaricco G, Tshomba Y, Tinelli G. A multicenter "real-world" study of the valiant NAVION stent graft. Int J Cardiol 2020; 331:63-68. [PMID: 33164839 DOI: 10.1016/j.ijcard.2020.10.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 09/23/2020] [Accepted: 10/20/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The aim of the present study was to evaluate early results of thoracic endovascular aortic repair (TEVAR) using the Valiant Navion™ stent graft in a "real-world" scenario. METHODS All patients who underwent TEVAR with the Valiant Navion™ endograft between November 2018 and November 2019 were included in this retrospective multicenter study (six European centers). The primary endpoints were technical success, incidence of major adverse events (MAEs), access failure, deployment failure, deployment accuracy, and rate of intraoperative endoleaks (ELs). RESULTS One hundred-sixteen patients with varying thoracic aortic diseases were included. Eighteen patients (15.5%) were treated for an off-label condition. The technical success rate was 100%, without any access or deployment failures. The proximal and distal deployment accuracy rates were 99.1% and 97.4%, respectively. There were no intraoperative MAEs, including death. Two (1.7%) type Ib ELs were detected at the first postoperative CTA, all of which were in off-label procedures and related to the short length of the sealing neck. No type III ELs were detected. The median hospitalization time was 8 days (IQR 4-12), including a median intensive care unit stay of 1 day (IQR 1-2). The in-hospital mortality rate was 4.3%. At a median follow-up time of 98 days (IQR 39-187), there were no aortic-related mortalities or new onset of endoleaks. CONCLUSION Our initial experience with the Valiant Navion™ endograft in a wide variety of aortic diseases showed safe early outcomes, especially for on-label procedures.
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Affiliation(s)
- Andrés Reyes-Valdivia
- Department of Vascular and Endovascular Surgery, Ramón y Cajal's University Hospital, 28034 Madrid, Spain
| | - Theodoros Kratimenos
- Interventional Radiology Department, Evangelismos Hospital, 10676 Athens, Greece
| | - Marco Ferraresi
- School of Vascular Surgery, University of Milan, 20122 Milan, Italy
| | - Simona Sica
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Gemelli IRCCS - Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Luigi Lovato
- Cardiovascular Radiology Unit, Cardiovascular and Thoracic Department S. Orsola, Malpighi Hospital, 40138 Bologna, Italy
| | - Giancarlo Accarino
- U.O.C. di Chirurgia Vascolare ed Endovascolare, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d'Aragona, 84131 Salerno, Italy
| | - Gabriele Pagliaricco
- Azienda Ospedaliera Universitaria Ospedali Riuniti di Ancona, 60020 Ancona, Italy
| | - Yamume Tshomba
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Gemelli IRCCS - Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
| | - Giovanni Tinelli
- Unit of Vascular Surgery, Fondazione Policlinico Universitario Gemelli IRCCS - Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
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Vento V, Lejay A, Kuntz S, Ancetti S, Heim F, Chakfé N, Gargiulo M. Current status on aortic endografts. THE JOURNAL OF CARDIOVASCULAR SURGERY 2020; 61:544-554. [PMID: 32964901 DOI: 10.23736/s0021-9509.20.11614-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Endovascular treatment has become widespread to treat aneurysmal disease, especially located in the aorta. The modern era of abdominal aortic aneurysm repair started between 1986 and 1991, and in the last 30 years, Endovascular Treatment for abdominal aortic aneurysms evolved both due to the development of new materials and devices and the increasing appeal and effectiveness of the endovascular therapy itself. Vascular surgeons are using nowadays different solutions of Endovascular Treatment to treat all the expressions of aortic pathology (aneurysms, dissections and trauma) both in the acute and elective setting. Despite its use in every location of the aorta (the ascending aorta, the aortic arch, the thoracic aorta, thoraco-abdominal aorta, pararenal, iuxtarenal and infrarenal aortic aneurysms and iliac aneurysms), its safety and efficiency, endovascular treatment for aortic aneurysms presents some drawbacks: despite a lower short-term morbi-mortality, reinterventions and long-term patency are higher compared to open repair. In this review, we detail the most used types of endografts according to location, their performances and durability for each device. We conclude by discussing options to overcome ET limitations. Therefore, an obvious question arises: what we need in the future? What can the technological progress gives to physicians to further improve this new way of treating aorta?
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Affiliation(s)
- Vincenzo Vento
- Unit of Vascular Surgery, Department of Experimental Diagnostic and Specialty Medicine (DIMES), S. Orsola-Malpighi Polyclinic, University of Bologna, Bologna, Italy.,Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Anne Lejay
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Salomé Kuntz
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Stefano Ancetti
- Unit of Vascular Surgery, Department of Experimental Diagnostic and Specialty Medicine (DIMES), S. Orsola-Malpighi Polyclinic, University of Bologna, Bologna, Italy
| | - Frédéric Heim
- Laboratory of Physics and Textile Mechanics, University of Upper Alsace, Mulhouse, France
| | - Nabil Chakfé
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Mauro Gargiulo
- Unit of Vascular Surgery, Department of Experimental Diagnostic and Specialty Medicine (DIMES), S. Orsola-Malpighi Polyclinic, University of Bologna, Bologna, Italy -
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Hori D, Yuri K, Kusadokoro S, Katayama H, Kimura N, Yamaguchi A. Long-Term Outcomes of Open Surgery and Stent Graft Treatment in Patients Undergoing Repeat Thoracic Aortic Aneurysm Repair from Previous Anastomosis Site. Ann Vasc Dis 2019; 12:500-506. [PMID: 31942208 PMCID: PMC6957898 DOI: 10.3400/avd.oa.19-00052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: The purpose of this study was to compare the long-term outcomes of open surgery and thoracic endovascular aortic repair (TEVAR) in patients undergoing repeat thoracic aortic repair from previous anastomosis site. Methods: From January 2009 to December 2017, 68 patients needed repeat aortic surgery from previous anastomosis site. Twenty-three patients had dissected distal aorta and 45 patients had non-dissected distal aorta. Early and long-term outcomes of open surgery and TEVAR were compared in both groups. Results: There were no significant differences in patient background between the two treatments in both groups. Open surgery was associated with longer intensive care unit stay, but there was no significant difference in in-hospital mortality in both groups. In patients with dissected distal aorta, there was no significant difference in long-term mortality (p=0.73). However, TEVAR was associated with higher risk of reintervention (p=0.038). In non-dissected distal aorta patients, acute kidney injury (p=0.002) and prolonged ventilation (p=0.032) were more often observed in open surgery. However, there were no significant differences in long-term mortality (p=0.23) and freedom from reintervention (p=0.13). Conclusions: Long-term outcomes were similar between open surgery and TEVAR in both groups. However, TEVAR in patients with dissected distal aorta was associated with higher risk, for reintervention.
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Affiliation(s)
- Daijiro Hori
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Saitama, Japan
| | - Koichi Yuri
- 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
| | - Hiroyasu Katayama
- 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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10
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van Noort K, Schuurmann RCL, Post Hospers G, van der Weijde E, Smeenk HG, Heijmen RH, de Vries JPPM. A New Methodology to Determine Apposition, Dilatation, and Position of Endografts in the Descending Thoracic Aorta After Thoracic Endovascular Aortic Repair. J Endovasc Ther 2019; 26:679-687. [DOI: 10.1177/1526602819859891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To validate computed tomography angiography (CTA)–applied software to assess apposition, dilatation, and position of endografts in the proximal and distal landing zones after thoracic endovascular aortic repair (TEVAR) of thoracic aortic aneurysm. Materials and Methods: Twenty-two patients (median age 75.5 years; 11 men) with a degenerative descending thoracic aortic aneurysm treated with TEVAR with at least one postoperative CTA were selected from a single center’s database. New CTA-applied software was used to determine the available apposition surface in the proximal and distal landing zones, apposition of the endograft fabric with the aortic wall, shortest apposition length, endograft inflow and outflow diameters, shortest distance between the left subclavian artery and the proximal endograft fabric, and shortest distance between the celiac trunk and the distal endograft fabric on each CTA. Interobserver variability for these parameters was assessed with the repeatability coefficient and the intraclass correlation coefficient. Results: Excellent interobserver agreement was found for all measurements. Interobserver variability of surface and shortest apposition length calculations was larger for the distal site compared with the proximal site, with a mean difference of 10% vs 2% of the mean available apposition surface, 12% vs 5% of the endograft apposition surface, and 16% vs 8% of the shortest apposition length, respectively. Inflow and outflow diameters of the endograft showed low variability, with a mean difference of 0.1 mm with 95% of the interobserver difference within 1.8 mm. Mean interobserver differences of the proximal and distal shortest fabric distances were 1.0 and 0.9 mm (both 2% of the mean lengths). Conclusion: Assessment of apposition, dilatation, and position of the proximal and distal parts of an endograft in the descending thoracic aorta is feasible after TEVAR with the new software. Interobserver agreement for all measured parameters was excellent for the proximal and distal landing zones. The new method allows detection of subtle changes during follow-up. However, a larger study is needed to quantify how parameters change over time in complicated and uncomplicated TEVAR cases and to define the real added value of the new methodology.
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Affiliation(s)
- Kim van Noort
- Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, the Netherlands
| | - Richte C. L. Schuurmann
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, the Netherlands
| | - Gersom Post Hospers
- Department of Vascular Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Emma van der Weijde
- Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Hans G. Smeenk
- Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Robin H. Heijmen
- Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Jean-Paul P. M. de Vries
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, the Netherlands
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11
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Hayashi K, Kimura N, Ohno M, Yamashita K, Izumida H, Inaba Y, Takahashi T, Yamazaki M, Ito T, Shimizu H. Thoracic Endovascular Aortic Repair for Pseudoaneurysm after Interrupted Aortic Arch Repair. Ann Vasc Dis 2018; 11:549-552. [PMID: 30637014 PMCID: PMC6326041 DOI: 10.3400/avd.cr.18-00079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Here we describe the case of a 33-year-old woman who was diagnosed with interrupted aortic arch (IAA) type A and who underwent radical surgery in her infancy. She developed a 42-mm anastomotic pseudoaneurysm in the distal aortic arch. We decided to perform thoracic endovascular aortic repair because of the patient’s special request to avoid open surgery. We selected a reversed taper-type leg stent graft for the iliac artery and successfully implanted it without problems. However, the long-term outcomes of the stent graft in young people remain unclear, and careful regular follow-up for a long period is mandatory.
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Affiliation(s)
- Kanako Hayashi
- Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Naritaka Kimura
- Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masatoshi Ohno
- Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kentaro Yamashita
- Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Hiroaki Izumida
- Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yu Inaba
- Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Tatsuo Takahashi
- Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masataka Yamazaki
- Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Tsutomu Ito
- Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Hideyuki Shimizu
- Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan
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12
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Georgakarakos E, Koutsoumpelis A, Popidis S, Tasopoulou KM, Georgiadis GS. A Complex Case of Synchronous Thoracic and Abdominal Endoleak Repair with Custom-Made Relay NBS Thoracic Stent Graft and Abdominal Open Reconstruction. Ann Vasc Surg 2018; 56:345-349. [PMID: 30496897 DOI: 10.1016/j.avsg.2018.08.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 08/13/2018] [Accepted: 08/21/2018] [Indexed: 10/27/2022]
Abstract
A 71-year old man with previous thoracic aneurysm endovascular repair and endovascular abdominal aneurysm repair presented with simultaneous type III endoleak from the thoracic components and type Ia endoleak from migration of the abdominal endograft, leading to enlargement of both aneurysms. A custom-made reverse tapered Relay NBS thoracic endograft was used to bridge the thoracic stent grafts. While a low-flow type III endoleak persisted in the immediate postoperative phase, because of incomplete apposition of the new stent graft, further deployment of its nitinol skeleton resulted in resolution of the endoleak at 1-week follow-up. The abdominal aneurysm enlargement was corrected via excision of the central segment of the abdominal endograft, preservation of the distal main body and limbs, and interposition of a short Dacron tube graft.
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Affiliation(s)
- Efstratios Georgakarakos
- Democritus University of Thrace, Department of Vascular Surgery, University Hospital of Alexandroupolis, Alexandroupolis, Greece.
| | - Andreas Koutsoumpelis
- Democritus University of Thrace, Department of Vascular Surgery, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Stefanos Popidis
- Democritus University of Thrace, Department of Vascular Surgery, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Kalliopi-Maria Tasopoulou
- Democritus University of Thrace, Department of Vascular Surgery, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - George S Georgiadis
- Democritus University of Thrace, Department of Vascular Surgery, University Hospital of Alexandroupolis, Alexandroupolis, Greece
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13
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Monnot A, Pochulu B, Doguet F, Godier S, Scherrer V, Plissonnier D. Operated descending thoracic and thoracoabdominal atherosclerotic aortic aneurysm prognosis. JOURNAL DE MÉDECINE VASCULAIRE 2018; 43:288-292. [PMID: 30217342 DOI: 10.1016/j.jdmv.2018.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 06/30/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The long-term survival of patients treated from descending thoracic aneurysm (DTA) is well known, more than those treated from a thoracoabdominal aortic aneurysm (TAAA). Moreover, studies are rarely focused on the aneurysmal etiology and include both degenerative and post dissecting aneurysms. The aim of this study is to compare the long-term survival of patients operated from DTA or TAAA due to degenerative atherosclerosis. METHODS Thirty-nine atherosclerotic aneurysm patients were operated between January 2007 and July 2015 at Rouen University Hospital. Eighteen DTA patients were operated by TEVAR and 21 TAAA patients (8 type I and 13 type III) by open approach. The main endpoint was remote survival patients. RESULTS Overall, the initial population was similar in the two groups. However, one third of DTA were treated in context of emergency for painful aneurysm versus 9.5% of patients with TAAA (P=0.066). Survival median of 18 DTA was 18 months (1-68). Survival median of 21 TAAA followed was 66 months (1-91). Survival in both groups was statistically different with the log-rank test (P=0.044). CONCLUSIONS Long-term prognosis of atherosclerotic DTA may be worse than that of TAAA's. This retrospective study reflects experience in the management of DTA and TAAA in a single-center. Prospective data in patients treated with endovascular procedures for DTA or TAAA, with fenesterated or branched endoprosthesis, are warranted to confirm these results.
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Affiliation(s)
- Antoine Monnot
- Service de chirurgie vasculaire, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - Bruno Pochulu
- Service de chirurgie vasculaire, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - Fabien Doguet
- Service de chirurgie cardiaque, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - Sylvie Godier
- Service d'anesthésie réanimation, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - Vincent Scherrer
- Service d'anesthésie réanimation, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - Didier Plissonnier
- Service de chirurgie vasculaire, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France.
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14
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Intraoperative Detection of Persistent Endoleak by Detecting Residual Spontaneous Echocardiographic Contrast in the Aneurysmal Sac During Thoracic Endovascular Aortic Repair. Anesth Analg 2017; 125:417-420. [PMID: 28737517 DOI: 10.1213/ane.0000000000002207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Persistent endoleaks may lead to adverse events after endovascular aortic repair. We prospectively examined the relationship between intraoperative residual spontaneous echocardiographic contrast (SEC) within the aneurysmal sac and the incidence of postoperative endoleaks in 60 patients undergoing thoracic endovascular aortic repair. Patients with SEC had a higher incidence of postoperative endoleaks than did patients without SEC within a few days postoperatively (60.0% vs 12.5%, respectively; P < .001) and at 6 months postoperatively (40.0% vs 2.5%, respectively; P < .001). Intraoperative confirmation of the absence of SEC may identify patients at low risk for persistent endoleaks after thoracic endovascular aortic repair.
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15
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Bischoff MS, Ante M, Meisenbacher K, Böckler D. Outcome of thoracic endovascular aortic repair in patients with thoracic and thoracoabdominal aortic aneurysms. J Vasc Surg 2016; 63:1170-1181.e1. [DOI: 10.1016/j.jvs.2015.11.045] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 11/12/2015] [Indexed: 01/16/2023]
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16
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Nozdrzykowski M, Luehr M, Garbade J, Schmidt A, Leontyev S, Misfeld M, Mohr FW, Etz CD. Outcomes of secondary procedures after primary thoracic endovascular aortic repair. Eur J Cardiothorac Surg 2015; 49:770-7. [DOI: 10.1093/ejcts/ezv279] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 06/30/2015] [Indexed: 11/14/2022] Open
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