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Luo MY, Zhang X, Fang K, Guo YY, Chen D, Lee JT, Shu C. Endovascular aortic arch repair with chimney technique for pseudoaneurysm. BMC Cardiovasc Disord 2023; 23:86. [PMID: 36782127 PMCID: PMC9926684 DOI: 10.1186/s12872-023-03091-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 01/24/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Aortic pseudoaneurysm is a life-threatening clinical condition, and thoracic endovascular aortic repair (TEVAR) has been reported to have a relatively satisfactory effect in aortic pathologies. We summarized our single-centre experience using chimney TEVAR for aortic arch pseudoaneurysms with inadequate landing zones. METHODS A retrospective study was conducted from October 2015 to August 2020, 32 patients with aortic arch pseudoaneurysms underwent chimney TEVAR to exclude an aortic lesion and reconstruct the supra-aortic branches, including 3 innominate artery, 12 left common carotid arteries and 29 left subclavian arteries. Follow-up computed tomography was suggested before discharge; at 3, 6, 12 months and yearly thereafter. RESULTS The median age of 32 patients was 68.0 years (range, 28-81) with the mean max diameter of aneurysm of 47.9 ± 12.0 mm. Forty-four related supra-aortic branches were well preserved, and the technical success rate was 100%. The Type Ia endoleaks occurred in 3 (9%) patients. Two patients were lost to follow-up and 4 patients died during the follow-up period. The mean follow-up times was 46.5 ± 14.3 months. One patient died due to acute myocardial infarction just 10 days after chimney TEVAR and the other 3 patients passed away at 1.5 months, 20 months, and 31 months with non-aortic reasons. The 4.5-year survival estimate was 84.4%. The primary patency rate of the target supra-arch branch vessels was 97.7% (43/44), and no other aorta-related reinterventions and severe complications occurred. CONCLUSION For aortic arch pseudoaneurysms with inadequate landing zones for TEVAR, the chimney technique seems to be feasible, with acceptable mid-term outcomes, and it could serve as an alternative minimally invasive approach to extend the landing zone. Slow flow type Ia endoleak could be treated conservatively after chimney TEVAR. Additional experience is needed, and the long-term durability of chimney TEVAR requires further follow-up.
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Affiliation(s)
- Ming-yao Luo
- grid.506261.60000 0001 0706 7839State Key Laboratory of Cardiovascular Disease, Center of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167, Beilishi Road, Xicheng District, Beijing, 100037 China ,grid.285847.40000 0000 9588 0960Department of Vascular Surgery, Fuwai Yunnan Cardiovascular Hospital, Affiliated Cardiovascular Hospital of Kunming Medical University, Kunming, 650102 China
| | - Xiong Zhang
- grid.506261.60000 0001 0706 7839State Key Laboratory of Cardiovascular Disease, Center of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167, Beilishi Road, Xicheng District, Beijing, 100037 China ,grid.452708.c0000 0004 1803 0208Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410013 China
| | - Kun Fang
- grid.506261.60000 0001 0706 7839State Key Laboratory of Cardiovascular Disease, Center of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167, Beilishi Road, Xicheng District, Beijing, 100037 China
| | - Yuan-yuan Guo
- grid.285847.40000 0000 9588 0960Department of Vascular Surgery, Fuwai Yunnan Cardiovascular Hospital, Affiliated Cardiovascular Hospital of Kunming Medical University, Kunming, 650102 China
| | - Dong Chen
- grid.506261.60000 0001 0706 7839State Key Laboratory of Cardiovascular Disease, Center of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167, Beilishi Road, Xicheng District, Beijing, 100037 China
| | - Jason T. Lee
- grid.168010.e0000000419368956Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305 USA
| | - Chang Shu
- State Key Laboratory of Cardiovascular Disease, Center of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167, Beilishi Road, Xicheng District, Beijing, 100037, China. .,Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410013, China.
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Mital T, Kapoor PM. The Importance of TEE Examination in Patients with Pseudoaneurysm of Arch of Aorta Post-TEVAR Procedure. JOURNAL OF CARDIAC CRITICAL CARE TSS 2022. [DOI: 10.1055/s-0042-1756473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
AbstractA 57-year-old male patient presented to the emergency department with acute onset severe and tearing pain in the back. He was a chronic smoker and was a known hypertensive. He was admitted in view of type B aortic dissection with entry tear distal to left subclavian artery (LSCA) and underwent thoracic endovascular aortic repair (TEVAR) procedure for the same. Two stents (34–30–200mm size, Ankura, Lifetech, Nanshan District, Shenzhen, China) were placed overlapping each other to cover the dissection flap starting from distal end of left common carotid artery to proximal part of celiac artery. Post-stenting, patient developed recurrent episodes of melena, abdominal distension, and fever that were managed conservatively. Two months later, a routine follow-up computed tomographic aortic angiography revealed a focal contrast filled outpouching (2.1*1.9cm) extending from the proximal part of endovascular stent with surrounding thrombosis from anterior wall of the aortic arch. On inspecting the arch vessels, an ostial occlusion of LSCA was also discovered. Routine blood investigations were all within normal limits. Two-dimensional echocardiography showed a normal biventricular function with concentric left ventricular hypertrophy. All valves were normal.
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Affiliation(s)
- Tanya Mital
- Department of Cardiac Anaesthesia and Critical Care, CTC, All India Institute of Medical Sciences, New Delhi, India
| | - Poonam Malhotra Kapoor
- Department of Cardiac Anaesthesia and Critical Care, CTC, All India Institute of Medical Sciences, New Delhi, India
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Geana RC, Stiru O, Raducu L, Tulin A, Parasca C, Chioncel O, Bacalbasa N, Iliescu VA. Successful concomitant open surgical repair of aortic arch pseudoaneurysm and percutaneous myocardial revascularization in a high risk patient: A case report. Int J Surg Case Rep 2020; 74:86-90. [PMID: 32829016 PMCID: PMC7452561 DOI: 10.1016/j.ijscr.2020.07.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/27/2020] [Accepted: 07/27/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION We present a case of open surgical repair of an aortic arch pseudoaneurysm (AAP) without the use of hypothermic circulatory arrest in a patient with low ejection fraction and associated coronary artery disease (CAD) and discuss some issues regarding the management of this case. PRESENTATION OF THE CASE A 69-year-old male with multiple pathologies and history of angina pectoris was transferred to our center from a local hospital with an initial diagnosis of non-ST-segment elevation myocardial infarction. Coronary angiography revealed stenotic lesions affecting all three coronary arteries. Multislice 3D contrast-enhanced computed tomography (CT-scan) revealed a 36 × 27 mm AAP. Endovascular stent-grafting was deemed to be unsuitable due to hostile landing zone. Therefore, the heart team decided for simultaneou treatment of the AAP and percutaneous therapy of CAD. The AAP was excised, and repair was performed with a Dacron patch on beating heart. After the surgical procedure, PCI with drug-eluting stents (DES) was performed on the right coronary artery (RCA) and the left circumflex artery (LCx) in the operating room. The patient's postprocedural course was uneventful and after thirteen days, he was discharged in good shape. 3D CT-scan performed after three month showed no residual AAP. DISCUSSION We established this approach as being the most suitable for our case based on favorable circumstances such as: stable CAD, beating heart procedure with low impact on myocardial ischemia, the impossibility of successful placement of an endovascular stent-graft, the presence of a pseudoaneurysm neck with minimum calcification. CONCLUSION We consider the best approach for individual cases is tailoring the treatment plan and the procedure to the patient's specific anatomy and pathology.
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Affiliation(s)
- Roxana Carmen Geana
- Emergency Institute for Cardiovascular Diseases Bucharest, Romania; University of Medicine and Pharmacy, Bucharest, Romania
| | - Ovidiu Stiru
- Emergency Institute for Cardiovascular Diseases Bucharest, Romania; University of Medicine and Pharmacy, Bucharest, Romania.
| | - Laura Raducu
- Emergency Institute for Cardiovascular Diseases Bucharest, Romania; University of Medicine and Pharmacy, Bucharest, Romania
| | - Adrian Tulin
- Emergency Institute for Cardiovascular Diseases Bucharest, Romania; University of Medicine and Pharmacy, Bucharest, Romania
| | - Catalina Parasca
- Emergency Institute for Cardiovascular Diseases Bucharest, Romania; University of Medicine and Pharmacy, Bucharest, Romania
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases Bucharest, Romania; University of Medicine and Pharmacy, Bucharest, Romania
| | - Nicolae Bacalbasa
- Emergency Institute for Cardiovascular Diseases Bucharest, Romania; University of Medicine and Pharmacy, Bucharest, Romania
| | - Vlad Anton Iliescu
- Emergency Institute for Cardiovascular Diseases Bucharest, Romania; University of Medicine and Pharmacy, Bucharest, Romania
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Fallatah R, Elasfar AA, Alzubaidi S, Alraddadi M, Abuelatta R. Endovascular repair of a leaking aortic-arch pseudoaneurysm using graft stent combined with chimney protection to left common carotid artery: Case report and review of literature. J Saudi Heart Assoc 2017; 30:254-259. [PMID: 29983500 PMCID: PMC6026385 DOI: 10.1016/j.jsha.2017.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 10/13/2017] [Indexed: 11/17/2022] Open
Abstract
Aortic pseudoaneurysm (PsA) is a rare but serious condition that has high mortality and morbidity rates if untreated. We report a rare case of leaking aortic-arch PsA repaired by thoracic endovascular aortic repair using graft stent with the chimney technique to protect the left common carotid artery. Unlike other cases in the literature, our case was unique, having leaking PsA not related to previous cardiac surgery or aortic dissection. The successful management of this patient using thoracic endovascular aortic repair combined with the chimney technique suggests that this approach may be an attractive therapeutic alternative to treat aortic-arch PsA.
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Affiliation(s)
- Raneem Fallatah
- Madina Cardiac Center, Madina, Saudi Arabia
- King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdelfatah A. Elasfar
- Madina Cardiac Center, Madina, Saudi Arabia
- Cardiology Department, Tanta University, Egypt
- Corresponding author at: Madina Cardiac Center, Madina, Saudi Arabia.
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Tourmousoglou C, Nikoloudakis N, Pitsis A. eComment: Expanding aortic arch pseudoaneurysm in a high-risk patient with previous coronary surgery: a treatment strategy. Interact Cardiovasc Thorac Surg 2017; 24:473. [PMID: 28364437 DOI: 10.1093/icvts/ivw447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | - Antonis Pitsis
- St. Luke's Cardiac Surgery Institute, Thessaloniki, Greece
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Abstract
BACKGROUND Pseudoaneurysm of the aortic arch is uncommonly associated with cancer, and is extremely rare in pulmonary cancer. Here, we report an unusual and successfully treated case of aortic arch pseudoaneurysm in a male patient with lung squamous cell carcinoma. METHODS A 64-year-old male patient was admitted to the Emergency Department, presenting with massive hemoptysis (>500 mL blood during the 12 hours prior to treatment). The diagnosis of aortic arch pseudoaneurysm was confirmed after inspection of computed tomographic angiography and three-dimensional reconstruction. We processed the immediate endovascular stent-grafting for this patient. RESULTS This patient recovered with no filling or enlargement of the pseudoaneurysm, no episodes of hemoptysis, and no neurological complications during the 4-week follow-up period. CONCLUSION Herein, we compare our case with other cancer-related pseudoaneurysms in the medical literature and summarize the clinical features and treatment of this unusual case.
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Affiliation(s)
- Yuan-Qiang Lu
- Department of Emergency Medicine, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
- Correspondence: Yuan-Qiang Lu, Department of Emergency Medicine, First Affiliated Hospital, School of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou 310003, People's Republic of China (e-mail: or )
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Zhou W, Zhou W, Qiu J, Zeng Q. Hybrid procedure to treat aortic arch aneurysm combined with aortic arch coarctation and left internal carotid artery aneurysm (Case Report). J Cardiothorac Surg 2014; 9:3. [PMID: 24387673 PMCID: PMC3898389 DOI: 10.1186/1749-8090-9-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 12/30/2013] [Indexed: 11/14/2022] Open
Abstract
Aortic arch aneurysm is a rare condition but carries a high risk of rupture. We report one case of aortic arch aneurysm combined with aortic arch coarctation and left internal carotid artery aneurysm, which is extremely rare. Left internal carotid artery aneurysm resection and revascularization, carotid and carotid graft bypass combined with endovascular stent graft and embolization with coils were successfully performed. There were no any complaints and complications at 8 months follow-up. The follow-up CTA demonstrated thrombus formation in the aneurysm lumen, no endoleak and the aortic arch and bypass graft were all patent. We feel that hybrid procedure may be a valuable therapeutic alternative when treating this type of lesion. However, long-term clinical efficacy and safety have yet to be confirmed.
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Affiliation(s)
- Weimin Zhou
- Department of Vascular Surgery, the second affiliated hospital of Nanchang University, No 1#, Minde Road, Nanchang, China.
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Moulakakis KG, Mylonas SN, Dalainas I, Sfyroeras GS, Markatis F, Kotsis T, Kakisis J, Liapis CD. The chimney-graft technique for preserving supra-aortic branches: a review. Ann Cardiothorac Surg 2013; 2:339-46. [PMID: 23977603 DOI: 10.3978/j.issn.2225-319x.2013.05.14] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 05/24/2013] [Indexed: 11/14/2022]
Abstract
Evolution in the endovascular era has influenced the management of aortic arch pathologies. "Chimney" or "snorkel" graft technique has been used as an alternative in high risk patients unfit for open repair. We reviewed the published literature on the chimney graft technique for preservation of the supra-aortic branches in order to provide an extensive insight of its feasibility and efficacy and investigate its outcomes. 18 reports were identified, with a total of 124 patients and 136 chimney. Primary technical success was achieved in 123/124 patients (99.2%). The perioperative mortality rate was 4.8% and the stroke rate was 4%, while events of spinal cord ischemia were rare. The overall endoleak rate was 18.5%; 13 patients (10.5%) developed a type I endoleak and 10 (8%) patients a type II endoleak. During a median follow-up period of 11.4 months (range, 0.87-20.1 months) all implanted chimney grafts remained patent. From this, we conclude that endovascular aortic arch repair with chimney grafts is associated with a lower mortality rate compared to totally open or hybrid reconstruction. However, the stroke rate remains noteworthy, and requires longterm data to elucidate.
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Affiliation(s)
- Konstantinos G Moulakakis
- Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece; ; The Systematic Review Unit, The Collaborative Research (CORE) Group, Sydney, Australia
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