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Frisiras A, Giannas E, Bobotis S, Kanella I, Arjomandi Rad A, Viviano A, Spiliopoulos K, Magouliotis DE, Athanasiou T. Comparative Analysis of Morbidity and Mortality Outcomes in Elderly and Nonelderly Patients Undergoing Elective TEVAR: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:5001. [PMID: 37568406 PMCID: PMC10420243 DOI: 10.3390/jcm12155001] [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: 06/11/2023] [Revised: 07/14/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
OBJECTIVE Due to an ever-increasing ageing population and limited available data around the use of thoracic endovascular aortic repair (TEVAR) in elderly patients, investigating its efficacy and safety in this age cohort is of vital importance. We thus reviewed the existing literature on this topic to assess the feasibility of TEVAR in elderly patients with severe thoracic aortic pathologies. METHODS We identified all original research studies that assessed TEVAR in elderly patients published up to 2023. Morbidity, as assessed by neurological and respiratory complications, endoleaks, and length of stay, was the primary endpoint. Short-term mortality and long-term survival were the secondary endpoints. The Mantel-Haenszel random and fixed effects methods were used to calculate the odds ratios for each outcome. Further sensitivity and subgroup analyses were performed to validate the outcomes. RESULTS Twelve original studies that evaluated elective TEVAR outcomes in elderly patients were identified. Seven studies directly compared the use of TEVAR between an older and a younger patient group. Apart from a shorter hospital stay in older patients, no statistically significant difference between the morbidity outcomes of the two different cohorts was found. Short-term mortality and long-term survival results favoured the younger population. CONCLUSIONS The present meta-analysis indicates that, due to a safe perioperative morbidity profile, TEVAR should not be contraindicated in patients based purely on old age. Further research using large patient registries to validate our findings in elderly patients with specific aortic pathologies and both elective and emergency procedures is necessary.
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Affiliation(s)
- Angelos Frisiras
- Faculty of Medicine, Imperial College London, Charing Cross Hospital, London W6 8RF, UK; (A.F.); (E.G.); (S.B.); (I.K.)
| | - Emmanuel Giannas
- Faculty of Medicine, Imperial College London, Charing Cross Hospital, London W6 8RF, UK; (A.F.); (E.G.); (S.B.); (I.K.)
| | - Stergios Bobotis
- Faculty of Medicine, Imperial College London, Charing Cross Hospital, London W6 8RF, UK; (A.F.); (E.G.); (S.B.); (I.K.)
| | - Ilektra Kanella
- Faculty of Medicine, Imperial College London, Charing Cross Hospital, London W6 8RF, UK; (A.F.); (E.G.); (S.B.); (I.K.)
| | | | - Alessandro Viviano
- Department of Cardiothoracic Surgery, Imperial College NHS Trust, Hammersmith Hospital, London W12 0HS, UK;
| | - Kyriakos Spiliopoulos
- Department of Cardiothoracic Surgery, University of Thessaly, Biopolis, 41 110 Larissa, Greece;
| | - Dimitrios E. Magouliotis
- Unit of Quality Improvement, Department of Cardiothoracic Surgery, University of Thessaly, Biopolis, 41 110 Larissa, Greece;
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, London W2 1NY, UK
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Nagatomi S, Ichihashi S, Kanamori D, Yamamoto H. Successful Sac Embolization to Eliminate a Type 2 Endoleak After Thoracic Endovascular Aortic Repair by Penetration of a Vascular Plug Implanted in a Left Subclavian Artery. J Endovasc Ther 2021; 29:835-838. [PMID: 34969293 DOI: 10.1177/15266028211067730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To describe a technique of vascular plug penetration by a guidewire with a heavy tip load for additional embolization of a type 2 endoleak after endovascular aortic aneurysm repair (EVAR). TECHNIQUE The technique of vascular plug penetration is effective for additional embolization of a type 2 endoleak, when large arteries such as left subclavian artery (LSA) or hypogastric artery remain patent even after the embolization of the vessel has been performed using a vascular plug and are responsible for the endoleak. A tapered guidewire with a heavy tip load enables the penetration of the disk of the plug, followed by introduction of a microcatheter into the endoleak nidus. In the presented case, the technique successfully eliminated a type 2 endoleak in a thoracic aortic aneurysm for which a patent LSA despite the embolization by a vascular plug was responsible. CONCLUSION The technique of vascular plug penetration allows an access to an endoleak cavity via a vascular plug placed in an aortic side branch for additional embolization of a type 2 endoleak after EVAR.
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Affiliation(s)
| | - Shigeo Ichihashi
- Department of Radiology, Nara Medical University, Kashihara, Japan
| | - Daigo Kanamori
- Department of Radiology, Sumitomo Hospital, Osaka, Japan
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Hybrid Approach in Acute and Chronic Aortic Disease. Medicina (B Aires) 2021; 58:medicina58010049. [PMID: 35056357 PMCID: PMC8777634 DOI: 10.3390/medicina58010049] [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: 11/10/2021] [Revised: 12/20/2021] [Accepted: 12/23/2021] [Indexed: 11/26/2022] Open
Abstract
The management of patients with aortic disease that involves the ascending aorta, the aortic arch, and the descending aorta represent a surgical challenge. Open surgical repair remains the gold standard for aortic arch pathologies. However, this operation requires a cardiopulmonary bypass and a period of profound hypothermia and circulatory arrest, which carries a substantial rate of mortality and morbidity. For these reasons, hybrid arch repair that involves a combination of open surgery with endovascular aortic stent graft placement has been introduced as a therapeutic alternative for those patients deemed unfit for open surgical procedures. Hybrid repair requires varying degrees of invasiveness and can be performed as a single-stage procedure or as a two-stage procedure. The choice of the technique is multifactorial, depending on the characteristics of the diseased arch with regard to position of the stent graft proximal landing zone, patient fitness and comorbid status, as well as surgical expertise and hospital facilities. Among the evolving hybrid procedures is the so-called “frozen” or stented elephant trunk technique. Adapted from the classical elephant trunk technique, this approach facilitates the repair of a concomitant aortic arch and proximal descending aortic aneurysms in a single stage under circulatory arrest. This technique is increasingly being used to treat extensive thoracic aortic disease and has shown promising results.
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Takano T, Katada Y, Komaki N, Onozawa S, Yokoyama H. A technique for creating an experimental type Ia endoleak model in the thoracic aorta of swine. Jpn J Radiol 2021; 39:1127-1132. [PMID: 34057688 DOI: 10.1007/s11604-021-01144-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/24/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE This study aimed to create an animal model of type Ia endoleak that creates persistent problems after thoracic endovascular aortic repair. MATERIALS AND METHODS In six swine, thoracic aortic aneurysms were created using the harvested jugular vein. We created a type Ia endoleak using a composite stent-graft comprising the first stent-graft (reverse-tapered: thicker part, 16 mm; thinner part, 10 mm) and the second stent-graft (tapered: thicker part, 18-20 mm; thinner part, 16 mm). This double-component stent-graft was deployed in the abdominal aorta and then moved upward to the proximal entry site of the thoracic aneurysm using the inflated balloon for precise positioning. After the surgical procedure and on postoperative day 8, aortography was performed to detect residual endoleak, and then the swine were euthanized. RESULTS A stable aneurysm (mean size of all aneurysms, 16.8 ± 1.72 mm × 11.8 ± 2.32 mm) and type Ia endoleak were successfully observed in all swine. A single stent-graft was sufficient in one of the six swine. CONCLUSION A novel technique to create a type Ia endoleak model can be successfully developed in swine.
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Affiliation(s)
- Tomohiro Takano
- Department of Cardiovascular Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan.
| | - Yoshiaki Katada
- Department of Radiology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Naoki Komaki
- Boston Scientific Institute for Advancing Science, Miyazaki Techno Research Park, Miyazaki, Japan
| | - Shiro Onozawa
- Department of Radiology, Teikyo University Mizonokuchi, Kanagawa, Japan
| | - Hitoshi Yokoyama
- Department of Cardiovascular Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan
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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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Tortuosity of the Descending Thoracic Aorta in Patients with Aneurysm and Type B Dissection. World J Surg 2020; 44:1323-1330. [PMID: 31873803 DOI: 10.1007/s00268-019-05328-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Tortuosity in the descending thoracic aorta (DTA) comes with aging and increases the risk of endoleaks after TEVAR. With this report, we would like to define and classify tortuosity in the DTA of patients with thoracic aortic disease. METHODS Retrospective case-control study of two hundred seven patients, comparing sixty-nine controls without aortic disease (CG), to sixty-nine patients with descending thoracic aortic aneurysm (AG) and sixty-nine patients with type B aortic dissection (DG). 3Mensio Vascular software was used to analyze CTA scans and collect the following measurements; tortuosity index, curvature ratio and the maximum tortuosity of the DTA. The DTA was divided into four equal zones. The maximum tortuosity was divided into three groups: low (<30°), moderate (30°-60°) and high tortuosity (>60°). RESULTS Compared to the CG, tortuosity was more pronounced in the DG, and even more in the AG, evidenced by the tortuosity index (1.11 vs. 1.20 vs. 1.31; p < 0.001), curvature ratio (1.00 vs. 1.01 vs. 1.03; p < 0.001), maximum tortuosity in degrees (28.17 vs. 33.29 vs. 43.83; p < 0.001) and group of tortuosity (p < 0.001). The maximum tortuosity was further distal for the DG and AG, evidenced by the zone of maximum tortuosity (4A vs. 4B vs. 4B; p < 0.001). CONCLUSION This study shows that tortuosity in the DTA is more prominent in diseased aortas, especially in aneurysmal disease. This phenomenon needs to be taken into account during planning of TEVAR to prevent stent graft-related complications and to obtain positive long-term outcome.
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Mezzetto L, Scorsone L, Silingardi R, Gennai S, Leone N, Piffaretti G, Veraldi GF. Early and Long-term Results of ePTFE (Gore TAG®) versus Dacron (Relay Plus® Bolton) Grafts in Thoracic Endovascular Aneurysm Repair. Ann Vasc Surg 2020; 71:419-427. [PMID: 32800888 DOI: 10.1016/j.avsg.2020.07.054] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/20/2020] [Accepted: 07/27/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The aim of this study is to compare early and late results of an expanded polytetrafluoroethylene (ePTFE-Gore TAG®, group A) mesh structured endograft versus a Dacron one (Relay Plus® Bolton, group B) in thoracic endovascular aneurysm repair (TEVAR). METHODS A prospective database was used to extract information from anonymous patients who underwent TEVAR for descending thoracic aortic aneurysms (DTAAs) between February 2005 and February 2019 at 3 referral university hospitals. Cases treated by means of ePTFE endograft (Gore TAG, group A) and Dacron graft (Relay Plus Bolton, group B) in elective and urgent settings were included. Early and late outcomes were compared. RESULTS A total of 129 consecutive patients were included (115 men and 14 women). ePTFE-Gore TAG® and Dacron-Relay Plus® Bolton were used in 56 (43.4%) and 73 (56.5%) patients, respectively. Preoperative characteristics of patients were similar. Technical success was 100%. Urgent procedures were 22.4%. Mean aortic coverage and partial debranching were 217.5 ± 91.3 and 37.2%, respectively. Early mortality and spinal cord ischemia (SCI) were 8.5% and 2.3%, respectively, without differences between the 2 groups. Early reintervention was required in 5.4% (group A) and 11% (group B), P = 0.29. Median follow-up was 32 months (interquartile range 12-55 months, range 1-156 months), similar between the 2 groups. Type I endoleak (EL), type II EL, and type III EL were observed in 16.3%, 10.9%, and 3.1% of cases, respectively, without significant differences between the groups. The rate of sac shrinkage was 28.6% in group A vs. 39.7% in group B (P = 0.19). Freedom from reintervention in group A versus group B at 6, 12, 24, and 36 months was 94.0% vs. 97.1%, 94.0% vs. 95.5%, 90.8% vs. 86.9%, and 81.1% vs. 80.4%, respectively (log-rank 0.35, Breslow 0.54). Rate of survival at 6, 12, 24, and 36 months was 96.0% vs. 94.2%, 89.3% vs. 86.8%, 76.5% vs. 77.5%, and 63.3% vs. 64.2%, respectively (log-rank 0.30, Breslow 0.57). CONCLUSIONS ePTFE-Gore TAG and Dacron-Relay Plus Bolton in DTAA presented similar early and late results in terms of mortality, SCI, EL, and TEVAR-related reinterventions. Effectiveness of TEVAR procedure was confirmed by the high rate of sac shrinkage and it was not influenced by endograft fabric.
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Affiliation(s)
- Luca Mezzetto
- Vascular Surgery, University Hospital of Verona, Verona, Italy.
| | | | - Roberto Silingardi
- Vascular Surgery, NOCSAE Nuovo Ospedale Civile di Baggiovara Sant'Agostino Estense, Modena, Italy
| | - Stefano Gennai
- Vascular Surgery, NOCSAE Nuovo Ospedale Civile di Baggiovara Sant'Agostino Estense, Modena, Italy
| | - Nicola Leone
- Vascular Surgery, NOCSAE Nuovo Ospedale Civile di Baggiovara Sant'Agostino Estense, Modena, Italy
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Li CN, Zhu JM, Qi RD, Xing XY, Zhang N, Liu YM, Sun LZ. Repair of Type Ia Endoleaks Involving the Distal Arch Using Left Subclavian Artery-Left Common Carotid Artery Transposition with a Stented Elephant Trunk. Ann Vasc Surg 2020; 67:332-337. [PMID: 32209411 DOI: 10.1016/j.avsg.2020.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 03/01/2020] [Accepted: 03/04/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Type Ia endoleaks are common after thoracic endovascular aortic repair (TEVAR). However, the repair of type Ia endoleaks involving the distal arch is challenging because of the presence of the interventional endografts, potential damage to the aortic arch vessels, and the location and size of the aneurysmal body. We retrospectively reviewed our experience of the surgical treatment of type Ia endoleaks with distal arch involvement using left subclavian artery (LSCA)-left common carotid artery (LCCA) transposition with a stented elephant trunk. METHODS Sixteen patients (male = 16; mean age, 47 ± 9 years, range 31-63 years) with type Ia endoleaks involving the distal arch underwent LSCA-LCCA transposition with a stented elephant trunk from July 2010 to July 2018. TEVAR failure occurred in 12 patients, re-TEVAR was performed in two patients, hybrid aortic arch repair in one patient, and the chimney technique in one patient. RESULTS There were no in-hospital deaths. Fourteen patients required mechanical ventilation for <24 h and one for <48 h. One patient required reintubation after mechanical ventilation for 19 h and continuous renal replacement therapy because of renal failure. One patient received pericardial drainage, and recurrent laryngeal nerve injury occurred in one patient. Three patients died during follow-up. CONCLUSIONS The LSCA-LCCA transposition with a stented elephant trunk can produce satisfactory results in patients with a type Ia endoleak involving the distal arch. Using this technique, it is possible to exclude the aneurysm sac distal to the LCCA origin and seclude the failed interventional endograft. These encouraging outcomes suggested that this technique could be a suitable surgical treatment for this type of lesion.
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Affiliation(s)
- Cheng-Nan Li
- Beijing Aortic Disease Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases & Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jun-Ming Zhu
- Beijing Aortic Disease Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases & Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Rui-Dong Qi
- Beijing Aortic Disease Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases & Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiao-Yan Xing
- Beijing Aortic Disease Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases & Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Nan Zhang
- Department of Radiology, Beijing Institute of Heart, Lung and Blood Vessel Diseases and Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yong-Min Liu
- Beijing Aortic Disease Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases & Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Li-Zhong Sun
- Beijing Aortic Disease Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases & Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
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Belvroy VM, de Beaufort HW, van Herwaarden JA, Trimarchi S, Moll FL, Bismuth J. Type 1b Endoleaks After Thoracic Endovascular Aortic Repair are Inadequately Reported: A Systematic Review. Ann Vasc Surg 2020; 62:474-483. [DOI: 10.1016/j.avsg.2019.06.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/19/2019] [Accepted: 06/20/2019] [Indexed: 11/24/2022]
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Azizzadeh A, Desai N, Arko FR, Panneton JM, Thaveau F, Hayes P, Dagenais F, Lei L, Verzini F. Pivotal results for the Valiant Navion stent graft system in the Valiant EVO global clinical trial. J Vasc Surg 2019; 70:1399-1408.e1. [DOI: 10.1016/j.jvs.2019.01.067] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 01/22/2019] [Indexed: 10/26/2022]
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Uehara K, Inoue T, Matsuo J, Sasaki H, Matsuda H. Type IIIB endoleak from stent suture lines of a thoracic endograft. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2019; 5:214-217. [PMID: 31289766 PMCID: PMC6593207 DOI: 10.1016/j.jvscit.2019.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 02/01/2019] [Indexed: 11/24/2022]
Abstract
We report a case of a patient with type IIIB endoleak after thoracic endovascular aortic repair that remained undetected by computed tomography and was first diagnosed during open conversion surgery. The aneurysm enlarged gradually from 60 to 78 mm without type I and type II endoleaks during 3 to 6 years after thoracic endovascular aortic repair. Type IIIB endoleaks from nitinol stent suture lines were detected, and the endograft was then explanted and replaced by a vascular graft.
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Affiliation(s)
- Kyokun Uehara
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Taishi Inoue
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Jiro Matsuo
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Hiroaki Sasaki
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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Karube N, Uchida K, Cho T, Minami T, Masuda M. Coil embolization of intercostal arteries accessed by surgical exposure for type II endoleak after thoracic endovascular aortic repair. J Vasc Surg 2019; 70:267-271. [PMID: 30852038 DOI: 10.1016/j.jvs.2018.11.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/12/2018] [Indexed: 11/25/2022]
Abstract
Many patients with type II endoleak after thoracic endovascular aortic repair (TEVAR) are closely observed without secondary intervention. Herein, we report a new technique of coil embolization for type II endoleak from intercostal arteries after TEVAR for ruptured acute type B aortic dissection. A hybrid procedure of exposing intercostal arteries via subcostal incision in the prone position and transcatheter technique enables embolization of intercostal arteries at their origin from the aorta. This technique could avoid lung injury and be applicable in multiple intercostal arteries. This technique may be a useful secondary intervention for type II endoleak after TEVAR caused by intercostal arteries.
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Affiliation(s)
- Norihisa Karube
- Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan.
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Tomoki Cho
- Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Tomoyuki Minami
- Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Munetaka Masuda
- Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
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XiaoHui M, Li W, Wei G, XiaoPing L, Xin J, Hongpeng Z, Lijun W. Comparison of supra-arch in situ fenestration and chimney techniques for aortic dissection involving the left subclavian artery. Vascular 2018; 27:153-160. [PMID: 30319067 DOI: 10.1177/1708538118807013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Introduction Endovascular intervention involving the aortic arch, particularly in thoracic aortic dissection, remains challenging and controversial at current time when there is no commercially suitable grafts on most of the international markets. This study compared two endovascular treatments that maintain left subclavian artery perfusion using two modified techniques for type-B aortic dissection patients. Methods Consecutive cases utilizing chimney or in situ fenestration techniques to preserve left subclavian artery in type B AD from 2006 to 2015 in our single institution were retrospectively reviewed. Statistical analyses were performed with Student t-test, Wilcoxon rank sum, and Fisher exact tests when appropriate. Significant statistical differences were determined with p < 0.05. Results A total of 85 cases, including 67 (79.8%) with chimney and 18 (21.2%) with in situ fenestration techniques were identified in this retrospective study. In chimney group, there were 18 (26.9%) acute, 29 (43.3%) sub-acute, and 20 (29.9%) chronic aortic dissections. We implanted 24 Zenith and 43 Talent aortic endografts along with 55 balloon-expandable bare stents and 12 self-expanding covered stents in chimney group. Whereas in in situ fenestration group, there were four (22.2%) acute, six (33.3%) subacute, and eight (44.5%) chronic aortic dissections, all of which received Zenith endografts with 11 balloon-expandable covered and seven self-expanding covered stents, respectively. Demographic variables were similarly distributed with 100% intraoperative technical overall success in both groups. Comparing to in situ fenestration group, chimney group has shorter procedural and fluoroscopy time, less blood loss, and contrast volume used. All patients were followed-up to 52 months (median 38, range 24–52). Overall group mortality is 3.6% (3/84). All deaths were from chimney group. There was no procedure-related stroke observed within the study series. Primary patency was maintained while aortic remodeling with complete false lumen was achieved in all patients except that there were three (4.55%) Type-I endoleak cases in early post-operative period and one (1.5%) stent compression at 3-months follow-up in chimney group. There were no stent-related complications observed in in situ fenestration group. Conclusion Although there were previous studies describing the similar techniques, this study appears to be the first study to compare in situ fenestration and chimney techniques for aortic dissection involving the left subclavian artery according to the MEDLINE search. Although we are unable to establish the superiority between two approaches due to small sample size and relative short period of follow-up, in situ fenestration may represent a more favorable option, especially among aortic dissections with short proximal landing zones in the study.
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Affiliation(s)
- Ma XiaoHui
- Department of Vascular Surgery, General Hospital of People's Liberation Amy, Beijing, China
| | - Wei Li
- Division of Vascular and Endovascular Surgery, Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, NY, USA
| | - Guo Wei
- Department of Vascular Surgery, General Hospital of People's Liberation Amy, Beijing, China
| | - Liu XiaoPing
- Department of Vascular Surgery, General Hospital of People's Liberation Amy, Beijing, China
| | - Jia Xin
- Department of Vascular Surgery, General Hospital of People's Liberation Amy, Beijing, China
| | - Zhang Hongpeng
- Department of Vascular Surgery, General Hospital of People's Liberation Amy, Beijing, China
| | - Wang Lijun
- Department of Vascular Surgery, General Hospital of People's Liberation Amy, Beijing, China
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Results of the VALOR II trial of the Medtronic Valiant Thoracic Stent Graft. J Vasc Surg 2017; 66:335-342. [DOI: 10.1016/j.jvs.2016.12.136] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 12/05/2016] [Indexed: 11/17/2022]
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15
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Bell D, Bassin L, Neale M, Brady P. A Review of the Endovascular Management of Thoracic Aortic Pathology. Heart Lung Circ 2015; 24:1211-5. [DOI: 10.1016/j.hlc.2015.05.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 05/02/2015] [Accepted: 05/06/2015] [Indexed: 11/29/2022]
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16
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Nomura Y, Sugimoto K, Gotake Y, Yamanaka K, Sakamoto T, Muradi A, Okada T, Yamaguchi M, Okita Y. Comparison of Volumetric and Diametric Analysis in Endovascular Repair of Descending Thoracic Aortic Aneurysm. Eur J Vasc Endovasc Surg 2015; 50:53-9. [DOI: 10.1016/j.ejvs.2015.02.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 02/26/2015] [Indexed: 11/25/2022]
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17
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Kamman AV, Jonker FHW, Nauta FJH, Trimarchi S, Moll FL, van Herwaarden JA. A review of follow-up outcomes after elective endovascular repair of degenerative thoracic aortic aneurysms. Vascular 2015; 24:208-16. [DOI: 10.1177/1708538115588648] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Long-term outcomes of elective thoracic endovascular aortic repair (TEVAR) for degenerative thoracic aortic aneurysms (TAA) are not well defined. A review of the literature on the follow-up outcomes of elective TEVAR for degenerative TAA resulted in 22 relevant articles. Two- and five-year freedom from aneurysm-related death varied between 93.0% and 100.0%, and 82.4% to 92.7%, respectively. Two-year and five-year all-cause survival ranged between 68.0% and 97.2% and 47.0% to 78.0%, respectively. Follow-up ranged between 17.3 and 66.0 months. Most common endograft-related complication was endoleak, with reported rate between 1.4% and 14.8% during six months up to five years of follow-up. Endovascular reinterventions were reported in 0.0–32.3%, secondary open surgery was needed in 0.0% to 4.7% during follow-up. Aneurysm-related survival rates after elective TEVAR for degenerative TAA are acceptable. However, reported incidences of endograft-related complications vary considerably in the literature, but the majority can be managed with conservative treatment or additional endovascular procedures.
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Affiliation(s)
- Arnoud V Kamman
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Cardiovascular Surgery, Thoracic Aortic Research Center, Policlinico San Donato IRCCS, Italy
| | - Frederik HW Jonker
- Department of Surgery, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Foeke JH Nauta
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Cardiovascular Surgery, Thoracic Aortic Research Center, Policlinico San Donato IRCCS, Italy
| | - Santi Trimarchi
- Department of Cardiovascular Surgery, Thoracic Aortic Research Center, Policlinico San Donato IRCCS, Italy
| | - Frans L. Moll
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Joost A van Herwaarden
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
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Bosanquet DC, Twine CP, Tang TY, Boyle JR, Bell RE, Bicknell CD, Jenkins MP, Loftus IM, Modarai B, Vallabhaneni SR. Pragmatic Minimum Reporting Standards for Thoracic Endovascular Aortic Repair. J Endovasc Ther 2015; 22:356-67. [DOI: 10.1177/1526602815584925] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- David C. Bosanquet
- South East Wales Regional Vascular Network, Royal Gwent Hospital, Newport, Wales, UK
| | - Christopher P. Twine
- South East Wales Regional Vascular Network, Royal Gwent Hospital, Newport, Wales, UK
| | - Tjun Y. Tang
- Department of General Surgery, Changi General Hospital, Singapore
| | - Jonathan R. Boyle
- Regional Vascular Unit, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
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Kotelis D, Brenke C, Wörz S, Rengier F, Rohr K, Kauczor HU, Böckler D, von Tengg-Kobligk H. Aortic morphometry at endograft position as assessed by 3D image analysis affects risk of type I endoleak formation after TEVAR. Langenbecks Arch Surg 2015; 400:523-9. [PMID: 25702140 DOI: 10.1007/s00423-015-1291-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 02/12/2015] [Indexed: 10/24/2022]
Abstract
PURPOSE The purpose of this study was to identify morphologic factors affecting type I endoleak formation and bird-beak configuration after thoracic endovascular aortic repair (TEVAR). METHODS Computed tomography (CT) data of 57 patients (40 males; median age, 66 years) undergoing TEVAR for thoracic aortic aneurysm (34 TAA, 19 TAAA) or penetrating aortic ulcer (n = 4) between 2001 and 2010 were retrospectively reviewed. In 28 patients, the Gore TAG® stent-graft was used, followed by the Medtronic Valiant® in 16 cases, the Medtronic Talent® in 8, and the Cook Zenith® in 5 cases. Proximal landing zone (PLZ) was in zone 1 in 13, zone 2 in 13, zone 3 in 23, and zone 4 in 8 patients. In 14 patients (25%), the procedure was urgent or emergent. In each case, pre- and postoperative CT angiography was analyzed using a dedicated image processing workstation and complimentary in-house developed software based on a 3D cylindrical intensity model to calculate aortic arch angulation and conicity of the landing zones (LZ). RESULTS Primary type Ia endoleak rate was 12% (7/57) and subsequent re-intervention rate was 86% (6/7). Left subclavian artery (LSA) coverage (p = 0.036) and conicity of the PLZ (5.9 vs. 2.6 mm; p = 0.016) were significantly associated with an increased type Ia endoleak rate. Bird-beak configuration was observed in 16 patients (28%) and was associated with a smaller radius of the aortic arch curvature (42 vs. 65 mm; p = 0.049). Type Ia endoleak was not associated with a bird-beak configuration (p = 0.388). Primary type Ib endoleak rate was 7% (4/57) and subsequent re-intervention rate was 100%. Conicity of the distal LZ was associated with an increased type Ib endoleak rate (8.3 vs. 2.6 mm; p = 0.038). CONCLUSIONS CT-based 3D aortic morphometry helps to identify risk factors of type I endoleak formation and bird-beak configuration during TEVAR. These factors were LSA coverage and conicity within the landing zones for type I endoleak formation and steep aortic angulation for bird-beak configuration.
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Affiliation(s)
- Drosos Kotelis
- Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany,
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Boufi M, Aouini F, Guivier-Curien C, Dona B, Loundou AD, Deplano V, Alimi YS. Examination of factors in type I endoleak development after thoracic endovascular repair. J Vasc Surg 2015; 61:317-23. [DOI: 10.1016/j.jvs.2014.08.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 08/05/2014] [Indexed: 11/16/2022]
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21
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Type IA endoleak embolization after TEVAR via direct transthoracic puncture. Jpn J Radiol 2015; 33:169-72. [DOI: 10.1007/s11604-015-0392-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 01/12/2015] [Indexed: 12/19/2022]
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Zhang P, Sun A, Zhan F, Luan J, Deng X. Hemodynamic study of overlapping bare-metal stents intervention to aortic aneurysm. J Biomech 2014; 47:3524-30. [DOI: 10.1016/j.jbiomech.2014.08.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 06/16/2014] [Accepted: 08/22/2014] [Indexed: 11/25/2022]
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Irisawa Y, Kitamura T, Taketani T, Hanayama N, Oka N, Tomoyasu T, Itatani K, Shibata M, Hayashi H, Inoue T, Miyaji K. Aortic arch rerouting and OPCAB in a patient with situs inversus totalis. Int Heart J 2014; 55:278-9. [PMID: 24814324 DOI: 10.1536/ihj.13-280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Endovascular therapy approaches for aortic aneurysm have lowered the mortality and morbidity rates even in high-risk patients; moreover, these approaches are applied in the management of aortic arch pathologies by transposition of the supra-aortic branches. We present the case of a 75-year-old female patient with situs inversus totalis on hemodialysis. The patient underwent off-pump aortic arch rerouting and thoracic endovascular aortic repair concomitant with coronary artery bypass grafting for distal aortic arch aneurysm and ischemic heart disease.
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Affiliation(s)
- Yusuke Irisawa
- Department of Cardiovascular Surgery, Kitasato University School of Medicine
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24
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Deák Z, Grimm JM, Mueck F, Geyer LL, Treitl M, Reiser MF, Wirth S. Endoleak and In-Stent Thrombus Detection with CT Angiography in a Thoracic Aortic Aneurysm Phantom at Different Tube Energies Using Filtered Back Projection and Iterative Algorithms. Radiology 2014; 271:574-84. [DOI: 10.1148/radiol.13130740] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Comparison of attachment site endoleak rates in Dacron versus native aorta landing zones after thoracic endovascular aortic repair. J Vasc Surg 2014; 59:921-9. [DOI: 10.1016/j.jvs.2013.10.086] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 10/17/2013] [Accepted: 10/17/2013] [Indexed: 11/20/2022]
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Roselli EE, Abdel-Halim M, Johnston DR, Soltesz EG, Greenberg RK, Svensson LG, Sabik JF. Open aortic repair after prior thoracic endovascular aortic repair. Ann Thorac Surg 2014; 97:750-6. [PMID: 24411576 DOI: 10.1016/j.athoracsur.2013.10.033] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 10/05/2013] [Accepted: 10/11/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Thoracic endovascular aortic repair (TEVAR) has been applied to increasingly complex aortic pathology, resulting in an increase in late complications. We characterized patients undergoing open repair after prior TEVAR including indications, operative techniques, and outcomes. METHODS Chart review and query of a prospectively collected database identified 50 patients who underwent thoracic aortic operation after prior TEVAR. Active follow-up was supplemented by Social Security information for vital status. RESULTS From July 2001 to January 2012 open arch (n = 25), descending (n = 6), thoracoabdominal (n = 17), or extra-anatomic bypass (n = 2) operations were performed after previous TEVAR (median interval from TEVAR to open surgical procedure: 13.9 months; interquartile range, 0.5 to 24 months). Indications for open operation included type 1 endoleaks (n = 19), retrograde aortic dissection (n = 9), chronic aortic dissection with persistent growth of the false lumen (n = 16), and graft infection (n = 6). Sixty percent had prior cardiovascular surgical procedures and 18% were done as emergencies. Circulatory support was required in 78% and hypothermic arrest in 48%. Hospital mortality occurred in 3 (6%) patients with no strokes and 1 patient with myocardial infarction; 5 (10%) patients required tracheostomy and 1 required dialysis. Survival was 67% at a median follow-up of 2.9 years. CONCLUSIONS Conversion to open repair after thoracic stent-grafting may be indicated for type 1 endoleak, retrograde dissection, chronic aortic dissection with persistent false lumen growth, or graft infection. These salvage operations are complex but can be completed safely with good early outcomes and preservation of the stent-graft in most cases. Late outcomes are consistent with the chronic disease state of these patients.
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Affiliation(s)
- Eric E Roselli
- Cleveland Clinic Heart and Vascular Institute, Cleveland, Ohio.
| | | | | | | | - Roy K Greenberg
- Cleveland Clinic Heart and Vascular Institute, Cleveland, Ohio
| | - Lars G Svensson
- Cleveland Clinic Heart and Vascular Institute, Cleveland, Ohio
| | - Joseph F Sabik
- Cleveland Clinic Heart and Vascular Institute, Cleveland, Ohio
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Botsios S, Frömke J, Walterbusch G, Schuermann K, Subramanian S, Reinstadler J, Dohmen G. Secondary Interventions After Endovascular Thoracic Aortic Repair. J Card Surg 2013; 29:66-73. [DOI: 10.1111/jocs.12252] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Spiridon Botsios
- Department of Thoracic- and Cardiovascular Surgery; St. Johannes Hospital Dortmund; Dortmund Germany
- Faculty of Health; University Witten/Herdecke; Witten Germany
| | - Johannes Frömke
- Department of Thoracic- and Cardiovascular Surgery; St. Johannes Hospital Dortmund; Dortmund Germany
| | - Gerhard Walterbusch
- Department of Thoracic- and Cardiovascular Surgery; St. Johannes Hospital Dortmund; Dortmund Germany
| | - Karl Schuermann
- Department of Radiology; St. Johannes Hospital Dortmund; Dortmund Germany
| | | | - Jan Reinstadler
- Department of Thoracic- and Cardiovascular Surgery; St. Johannes Hospital Dortmund; Dortmund Germany
| | - Guido Dohmen
- Department of Thoracic- and Cardiovascular Surgery; St. Johannes Hospital Dortmund; Dortmund Germany
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Hogendoorn W, Schlösser FJ, Moll FL, Sumpio BE, Muhs BE. Thoracic endovascular aortic repair with the chimney graft technique. J Vasc Surg 2013; 58:502-11. [DOI: 10.1016/j.jvs.2013.03.043] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 03/08/2013] [Accepted: 03/24/2013] [Indexed: 10/26/2022]
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Bischoff MS, Geisbüsch P, Kotelis D, Müller-Eschner M, Hyhlik-Dürr A, Böckler D. Clinical significance of type II endoleaks after thoracic endovascular aortic repair. J Vasc Surg 2013; 58:643-50. [PMID: 23683377 DOI: 10.1016/j.jvs.2013.03.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Revised: 03/13/2013] [Accepted: 03/18/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND To evaluate the clinical significance of type II endoleaks (ELII) after thoracic endovascular aortic repair (TEVAR). METHODS From January 1997 to June 2012, a total of 344 patients received TEVAR in our institution. ELII was diagnosed in 30 patients (8.7%; 13 males; median age: 65 years, range: 24 to 84 years), representing the study population of this retrospective, single-center analysis. Mean follow-up was 29.5 months (range, 8 months to 9.5 years). RESULTS Primary ELII was observed in all but two cases (28/30; 93.3%). The most common sources of ELII were the left subclavian artery (LSA; 13/30; 43.3%) and intercostal/bronchial vessels (13/30; 43.3%), followed by visceral arteries (4/30; 13.4%). Overall mortality was 33.3% (10/30). ELII-related death (secondary rupture) was observed in 20% (2/10). Reintervention (RI) procedures for ELII were performed in 9 of 30 patients (30.0%); 5 of 9 (55.6%) in cases with ELII via the LSA. Indications for RI were diameter expansion in five and extensive leakage in four cases. Treatment was successful in five patients (55.6%) but failed in four cases (44.4%). In 12 of 21 (57.1%) untreated patients, ELII sealed during follow-up. In conservatively treated patients, an increase in aortic diameter has been only observed in a patient with secondary ELII. CONCLUSIONS The results presented herein suggest that the clinical impact of ELII after TEVAR must not be underestimated. Albeit a transient finding in most cases, ELII is associated with a relevant RI rate, particularly in cases involving the LSA. RI seems indicated in patients with increasing aortic diameter and/or extensive leakage. Careful surveillance of all patients with ELII is recommended.
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Affiliation(s)
- Moritz S Bischoff
- Department of Vascular and Endovascular Surgery, Ruprecht-Karls University Heidelberg, Heidelberg, Germany.
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30
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Secondary interventions after elective thoracic endovascular aortic repair for degenerative aneurysms. J Vasc Surg 2013; 57:1269-74. [DOI: 10.1016/j.jvs.2012.10.124] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 10/23/2012] [Accepted: 10/29/2012] [Indexed: 11/21/2022]
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Hemoptysis as a first symptom of endoleak after thoracic endovascular aortic repair, which caused aortic rupture and required complex management. Wideochir Inne Tech Maloinwazyjne 2013; 8:178-81. [PMID: 23837105 PMCID: PMC3699777 DOI: 10.5114/wiitm.2011.33453] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 02/03/2013] [Accepted: 02/03/2013] [Indexed: 11/17/2022] Open
Abstract
Thoracic endovascular aortic repair (TEVAR) has become the most common procedure in the treatment of thoracic aorta aneurysms. However, potential long-term complications of this technique could be life-threatening. Hemoptysis is a common symptom of lung tumor, especially cancer. On the other hand, hemoptysis can also be caused by bronchitis, tuberculosis, mycosis, and trauma. In this case report, we present a patient with hemoptysis and lung tumor suggesting lung cancer, which was a unique symptom of type IA endoleak after TEVAR and led to rupture of the thoracic aneurysm. It was decided to perform next an endovascular procedure due to the severe state of the patient. Next the thoracotomy was performed because drainage of the left pleural cavity was unsuccessful. In the last stage bronchoscopy was needed to remove the thrombus, which occluded the left main bronchi. Successful management has led to the patient's full recovery. Despite justified popularity of endovascular procedures in the treatment of thoracic aorta aneurysms, we should remember about potential long-term complications. Hemoptysis could be a unique symptom of the endoleak after TEVAR and treatment of such complications could be complex and demanding.
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Yang J, Xiong J, Liu X, Jia X, Zhu Y, Guo W. Endovascular chimney technique of aortic arch pathologies: a systematic review. Ann Vasc Surg 2013; 26:1014-21. [PMID: 22944571 DOI: 10.1016/j.avsg.2012.05.014] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Revised: 01/10/2012] [Accepted: 05/08/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND The aim of this review was to determine the safety and efficacy of endovascular chimney technique for aortic arch pathologies by performing a systematic and pooled analysis of the relevant literature. METHODS Electronic searches were performed in database Medline between 1994 and 2011 to identify studies on endovascular chimney technique for aortic arch pathology. The extracted variables and outcomes were synthesized through pooled analyses. RESULTS Eight articles with 51 patients who underwent endovascular chimney technique for aortic arch pathologies met the inclusion criteria. Chimney grafts were deployed in innominate (n = 11), left common carotid (n = 32), and left subclavian (n = 12) arteries. Single-stent chimney in the deployed artery was used in 37 patients, whereas double-stent chimney was utilized in 14 patients. The overall technical success rate was 90.2%. The overall perioperative mortality and morbidity were 5.9% and 13.7%, respectively. The stroke rate was 7.8%, and the fatal stroke rate accounted for 50%. The rates of primary early endoleaks and type-Ia endoleaks were 21.6% and 11.8%, respectively. The overall late mortality and morbidity were 4.4% and 15.5%, respectively. Of 5 late endoleaks, no secondary type-Ia endoleak occurred. No studies had adequate follow-up to reliably evaluate the long-time durability. CONCLUSIONS Endovascular chimney technique is technically feasible with the high initial technical success rate and relatively favorable rates of perioperative outcomes for aortic arch pathologies. However, further establishment of the role of endovascular chimney necessitates the accumulation of more cases and comparative study with other management as well as prolonged follow-up.
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Affiliation(s)
- Jian Yang
- Department of Vascular Surgery, Clinical Division of Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China
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Katada Y, Kondo S, Takahashi S, Okita Y, Kagoshima A, Rokkaku K, Nozaki M. Direct Percutaneous Puncture Embolization of Type II Endoleaks Using a Coaxial Technique. J Endovasc Ther 2013; 20:34-8. [DOI: 10.1583/12-4065.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Fairman RM, Tuchek JM, Lee WA, Kasirajan K, White R, Mehta M, Lyden S, Mukherjee D, Bavaria J. Pivotal results for the Medtronic Valiant Thoracic Stent Graft System in the VALOR II trial. J Vasc Surg 2012; 56:1222-31.e1. [DOI: 10.1016/j.jvs.2012.04.062] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Revised: 04/11/2012] [Accepted: 04/17/2012] [Indexed: 11/26/2022]
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Tolva VS, Bianchi PG, Cireni LV, Lombardo A, Keller GC, Parati G, Casana RM. Multiple multilayer stents for thoracoabdominal aortic aneurysm: a possible new tool for aortic endovascular surgery. Int J Gen Med 2012; 5:629-32. [PMID: 22866014 PMCID: PMC3410721 DOI: 10.2147/ijgm.s33008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose Endovascular surgery data are confirming the paramount role of modern endovascular tools for a safe and sure exclusion of thoracoabdominal lesions. Case report A 57-year-old female presented with severe comorbidity affected by a 58 mm thoracoabdominal aortic aneurysm (TAAA). After patient-informed consent and local Ethical Committee and Italian Public Health Ministry authorization, three multilayer stents were implanted in the thoracoabdominal aortic tract, obtaining at a 20-month computed tomography scan follow up, a complete exclusion of the TAAA, with normal patency of visceral vessels. Conclusion Multilayer stents can be used in thoracoabdominal aortic aneurysm, with positive results.
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AAA with a challenging neck: early outcomes using the Endurant stent-graft system. Eur J Vasc Endovasc Surg 2012; 44:274-9. [PMID: 22705160 DOI: 10.1016/j.ejvs.2012.04.031] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 04/25/2012] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The efficacy and safety of endovascular aneurysm repair is disputable in aneurysms with a short, angulated, wide, conical, or thrombus-lined neck making a reliable seal difficult to achieve. The influence of a challenging neck on early results using the Endurant stent-graft system in high risk patients was investigated. MATERIALS AND METHODS A retrospective study conducted on a prospectively compiled database of 72 elective patients with challenging neck treated with the Endurant system (Endurant Stent Graft, Medtronic AVE, Santa Rosa, CA, USA). These patients were compared to a control group (n = 65) without significant neck problems. Endpoints were early technical and clinical success, deployment accuracy and differences in operative details at one month follow-up. Data are reported as mean and standard deviation or as absolute frequency and percentage (%). Normality distribution and homogeneity of variances were tested by Shapiro-Wilks and Levene tests, respectively. Inter-group comparisons for each variable were made by t-test or χ2-test or Fisher exact test. A p < 0.05 was considered statistically significant. RESULTS Mean age was 76.12 years; 76.6% were males. Risk factors and pre-operative variables did not differ significantly between the two groups. Mean neck length was 10.56 mm in patients with challenging anatomies and 22.85 mm in controls. Patients with a challenging neck differed significantly (p < 0.001) from controls in terms of mean infrarenal (37.67° vs. 20.12°) and suprarenal angle (19.63° vs. 15.57°); 82% of patients with a challenging neck were ASA III/IV (vs. 86%). Technical success was 100%, with four unplanned proximal extension in challenging group. No type I endoleaks or aneurysm-related deaths occurred in either group; major complications were 1.54% vs. 1.39% (p = 0.942). Operative details were similar in both groups. CONCLUSION Treatment with the Endurant stent-graft is technically feasible and safe, yielding satisfactory results even in challenging anatomies. Medium- and long-term data are needed to verify durability, but early results are promising.
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Lotfi S, Clough RE, Ali T, Salter R, Young CP, Bell R, Modarai B, Taylor P. Hybrid Repair of Complex Thoracic Aortic Arch Pathology: Long-Term Outcomes of Extra-anatomic Bypass Grafting of the Supra-aortic Trunk. Cardiovasc Intervent Radiol 2012; 36:46-55. [DOI: 10.1007/s00270-012-0383-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Accepted: 03/25/2012] [Indexed: 10/28/2022]
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Jonker FHW, van Keulen JW, Schlosser FJV, Indes JE, Moll FL, Verhagen HJM, Muhs BE. Thoracic aortic pulsatility decreases during hypovolemic shock: implications for stent-graft sizing. J Endovasc Ther 2011; 18:491-6. [PMID: 21861735 DOI: 10.1583/10-3374.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE To investigate the thoracic aortic pulsatility during hypovolemic shock in an experimental porcine model. METHODS The circulating blood volume of 7 healthy Yorkshire pigs was gradually lowered until the subjects had lost 40% of their normal blood volume. Intravascular ultrasound was used to assess the aortic pulsatility in normovolemic and hypovolemic state at the level of the ascending and descending thoracic aorta. RESULTS The mean aortic pulsatility at the level of the ascending aorta decreased from 15.9% ± 7.2% (range 6.3%-25.7%) in normovolemia to 6.2% ± 2.8% (range 2.9%-10.7%, p = 0.018) in hypovolemia. At the level of the descending thoracic aorta, the mean aortic pulsatility decreased from 8.7% ± 2.8% (range 4.4%-12.2%) at baseline to 5.6% ± 2.5% (range 1.5%-9.5%, p = 0.028) in hypovolemia. The maximum mean aortic diameter, obtained in cardiac systole, was significantly smaller as well at both evaluated levels during hypovolemic shock compared with the mean diameter in normovolemia. CONCLUSION The thoracic aortic diameter and pulsatility decreased significantly during hypovolemic shock in this porcine model, most impressively at the level of the ascending aorta. Electrocardiographically-gated imaging may not be necessary for hypovolemic patients with acute aortic disease requiring endovascular repair because of the minimal aortic pulsatility.
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Klein S, Picus D. Thoracic type II endoleak embolization using direct percutaneous puncture. Cardiovasc Intervent Radiol 2011; 35:1249-52. [PMID: 22006029 DOI: 10.1007/s00270-011-0283-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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40
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Rouwet E, Torsello G, de Vries JP, Cuypers P, van Herwaarden J, Eckstein HH, Beuk R, Florek HJ, Jentjens R, Verhagen H. Final Results of the Prospective European Trial of the Endurant Stent Graft for Endovascular Abdominal Aortic Aneurysm Repair. Eur J Vasc Endovasc Surg 2011; 42:489-97. [DOI: 10.1016/j.ejvs.2011.06.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Accepted: 06/06/2011] [Indexed: 10/18/2022]
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41
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The influence of gender on mortality in patients after thoracic endovascular aortic repair. Eur J Cardiothorac Surg 2011; 40:e1-5. [DOI: 10.1016/j.ejcts.2011.01.082] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Revised: 01/11/2011] [Accepted: 01/13/2011] [Indexed: 11/19/2022] Open
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Kiefer P, Seeburger J, Lehmkuhl L, Mohr FW. Rescue surgery for bronchial obstruction after endovascular thoracoabdominal stent implantation. J Thorac Cardiovasc Surg 2011; 142:1581-2. [PMID: 21703640 DOI: 10.1016/j.jtcvs.2011.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Revised: 04/26/2011] [Accepted: 05/17/2011] [Indexed: 11/28/2022]
Affiliation(s)
- Philipp Kiefer
- Department of Cardiac Surgery, University of Leipzig, Heart Center, Leipzig, Germany.
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Wang GJ, Jackson BM, Woo EY, Bavaria JE, Desai ND, Pochettino A, Fairman RM. ''Relining'' of thoracic aortic stent grafts for patients presenting with rupture/impending rupture. Vasc Endovascular Surg 2011; 45:438-41. [PMID: 21576209 DOI: 10.1177/1538574411408744] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To report a series of patients following thoracic endovascular aortic repair (TEVAR) presenting with rupture, who were effectively treated with TEVAR relining. METHODS Five patients who underwent repeat TEVAR in an urgent fashion were identified. Chart review was performed to identify demographics, device type, aneurysm characteristics, and postoperative course. RESULTS Mean time to relining procedure was 5.8 (range 2-10) years. All patients had ≥3 device components originally placed. Mean size of the original aneurysm was 7.2 cm (range 6.6-8). All patients underwent relining with proximal and distal extension with immediate technical success. At a mean follow-up of 1.3 years, there was no evidence of endoleak and no patients required repeat intervention. CONCLUSIONS Complete relining with proximal and distal extension was effective in treating patients presenting with rupture. These findings suggest that proximal and distal landing zones provided, relining should be considered the initial management strategy in patients s/p TEVAR re-presenting with rupture.
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Affiliation(s)
- Grace J Wang
- Division of Vascular Surgery and Endovascular Therapy, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
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44
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The Significance of Endoleaks in Thoracic Endovascular Aneurysm Repair. Ann Vasc Surg 2011; 25:345-51. [DOI: 10.1016/j.avsg.2010.08.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Revised: 07/05/2010] [Accepted: 08/16/2010] [Indexed: 11/21/2022]
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Tapping CR, Ettles DF, Renwick PM, Robinson GJ. Three-year follow-up of fenestrated thoracoabdominal stent graft bridging an endovascular thoracic stent graft and a surgical abdominal aortic graft. J Vasc Interv Radiol 2011; 22:385-90. [PMID: 21353989 DOI: 10.1016/j.jvir.2010.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Revised: 10/17/2010] [Accepted: 11/02/2010] [Indexed: 11/19/2022] Open
Abstract
This case report describes repair of a type I endoleak at the distal landing zone of a thoracic aortic stent graft by endovascular placement of a thoracoabdominal fenestrated stent graft (Cook, Brisbane, Australia). The fenestrated stent graft was interposed between a previous abdominal aortic aneurysm (AAA) Gelsoft tube graft (Sulzer Vascutek Ltd, Inchinnan, United Kingdom) and two overlapping Zenith thoracic endografts (Cook Inc, Bloomington, Indiana). Placement was made more complex because the distal thoracic endograft had rotated into a horizontal position. At 3-year clinical and computed tomography (CT) follow-up, continued clinical and radiologic success was shown with no further intervention required.
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Affiliation(s)
- Charles Ross Tapping
- Department of Radiology, Hull Royal Infirmary, Anlaby Road, Hull and East Yorkshire NHS Trust, UK
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Petersen J, Glodny B. The burden of hard atherosclerotic plaques does not promote endoleak development after endovascular aortic aneurysm repair: a risk stratification. Cardiovasc Intervent Radiol 2011; 34:918-25. [PMID: 21271249 DOI: 10.1007/s00270-010-0095-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2010] [Accepted: 12/10/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE To objectify the influence of the atherosclerotic burden in the proximal landing zone on the development of endoleaks after endovascular abdominal aortic aneurysm repair (EVAR) or thoracic endovascular aneurysm repair (TEVAR) using objective aortic calcium scoring (ACS). MATERIALS AND METHODS This retrospective observation study included 267 patients who received an aortic endograft between 1997 and 2010 and for whom preoperative computed tomography (CT) was available to perform ACS using the CT-based V600 method. The mean follow-up period was 2 ± 2.3 years. RESULTS Type I endoleaks persisted in 45 patients (16.9%), type II in 34 (12.7%), type III in 8 (3%), and type IV or V in 3 patients, respectively (1.1% each). ACS in patients with type I endoleaks was not increased: 0.029 ± 0.061 ml compared with 0.075 ± 0.1349 ml in the rest of the patients, (p > 0.05; Whitney-Mann U-Test). There were significantly better results for the indication "traumatic aortic rupture" than for the other indications (p < 0.05). In multivariate logistic regression analyses, age was an independent risk factor for the development of type I endoleaks in the thoracic aorta (Wald 9.5; p = 0.002), whereas ACS score was an independent protective factor (Wald 6.9; p = 0.009). In the abdominal aorta, neither age nor ACS influenced the development of endoleaks. CONCLUSION Contrary to previous assumptions, TEVAR and EVAR can be carried out without increasing the risk of an endoleak of any type, even if there is a high atherosclerotic "hard-plaque" burden of the aorta. The results are significantly better for traumatic aortic.
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Affiliation(s)
- Johannes Petersen
- Department of Radiology, Innsbruck Medical University, 6020 Innsbruck, Austria.
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Ricotta JJ. Endoleak management and postoperative surveillance following endovascular repair of thoracic aortic aneurysms. J Vasc Surg 2010; 52:91S-9S. [DOI: 10.1016/j.jvs.2010.06.149] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Revised: 06/17/2010] [Accepted: 06/17/2010] [Indexed: 11/24/2022]
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Adams JD, Tracci MC, Sabri S, Cherry KJ, Angle JF, Matsumoto AH, Kern JA. Real-world experience with type I endoleaks after endovascular repair of the thoracic aorta. Am Surg 2010; 76:599-605. [PMID: 20583515 DOI: 10.1177/000313481007600623] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Endoleaks are a frequent complication of thoracic endovascular aortic repair (TEVAR) and will likely increase in incidence with application of the technique to more complicated aortic anatomy and a wider range of thoracic aortic pathologies. Management generally consists of aggressive repair of Type I endoleaks; however, the natural history of Type I endoleaks after TEVAR remains largely unknown. The purpose of this study was to examine the incidence and characteristics of Type I endoleaks and to evaluate clinical outcomes of patients with Type I endoleaks after TEVAR. A single-center retrospective review was performed on all patients who underwent TEVAR over a 4-year period. Type I endoleaks were detected in 21 per cent (27 of 129) of patients on post-deployment aortography or CT angiography. During a mean follow-up of 750.63 +/- 483 days, 59 per cent (16 of 27) closed spontaneously; 30 per cent (eight of 27) required secondary endovascular intervention; and 11 per cent (three of 27) have persisted with no increase in maximum aortic diameter. No patients have died or required open surgical conversion as a result of their Type I endoleak. Although accurate predictors of spontaneous resolution of Type I endoleaks have yet to be definitively characterized, our initial results suggest that it may be safe to observe small Type I endoleaks given that a large percentage resolve spontaneously and no endoleak-related deaths have occurred.
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Affiliation(s)
- Joshua D Adams
- Department of Radiology, University of Virginia Health System, Charlottesville, Virginia 22908, USA.
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Jonker FH, Verhagen HJ, Lin PH, Heijmen RH, Trimarchi S, Lee WA, Moll FL, Athamneh H, Muhs BE. Outcomes of Endovascular Repair of Ruptured Descending Thoracic Aortic Aneurysms. Circulation 2010; 121:2718-23. [PMID: 20547930 DOI: 10.1161/circulationaha.109.908871] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Thoracic endovascular aortic repair offers a less invasive approach for the treatment of ruptured descending thoracic aortic aneurysms (rDTAA). Due to the low incidence of this life-threatening condition, little is known about the outcomes of endovascular repair of rDTAA and the factors that affect these outcomes.
Methods and Results—
We retrospectively investigated the outcomes of 87 patients who underwent thoracic endovascular aortic repair for rDTAA at 7 referral centers between 2002 and 2009. The mean age was 69.8±12 years and 69.0% of the patients were men. Hypovolemic shock was present in 21.8% of patients, and 40.2% were hemodynamically unstable. The 30-day mortality rate was 18.4%, and hypovolemic shock (odds ratio 4.75; 95% confidence interval, 1.37 to 16.5;
P
=0.014) and hemothorax at admission (odds ratio 6.65; 95% confidence interval, 1.64 to 27.1;
P
=0.008) were associated with increased 30-day mortality after adjusting for age. Stroke and paraplegia occurred each in 8.0%, and endoleak was diagnosed in 18.4% of patients within the first 30 days after thoracic endovascular aortic repair. Four additional patients died as a result of procedure-related complications during a median follow-up of 13 months; the estimated aneurysm-related mortality at 4 years was 25.4%.
Conclusion—
Endovascular repair of rDTAA is associated with encouraging results. The endovascular approach was associated with considerable rates of neurological complications and procedure-related complications such as endoleak.
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Affiliation(s)
- Frederik H.W. Jonker
- From the Section of Vascular Surgery, Cardiothoracic Surgery and Interventional Radiology, Yale University School of Medicine, New Haven, and VA Connecticut Healthcare System, West Haven, Conn (F.H.W.J., B.E.M.); Erasmus University Medical Center (H.J.M.V.), Rotterdam; St. Antonius Hospital (R.H.H.), Nieuwegein; University Medical Center Utrecht (F.L.M.), Utrecht, the Netherlands; Baylor College of Medicine (P.H.L., H.A.), Houston, Tex; Policlinico San Donato IRCCS, Cardiovascular Center “E. Malan,”
| | - Hence J.M. Verhagen
- From the Section of Vascular Surgery, Cardiothoracic Surgery and Interventional Radiology, Yale University School of Medicine, New Haven, and VA Connecticut Healthcare System, West Haven, Conn (F.H.W.J., B.E.M.); Erasmus University Medical Center (H.J.M.V.), Rotterdam; St. Antonius Hospital (R.H.H.), Nieuwegein; University Medical Center Utrecht (F.L.M.), Utrecht, the Netherlands; Baylor College of Medicine (P.H.L., H.A.), Houston, Tex; Policlinico San Donato IRCCS, Cardiovascular Center “E. Malan,”
| | - Peter H. Lin
- From the Section of Vascular Surgery, Cardiothoracic Surgery and Interventional Radiology, Yale University School of Medicine, New Haven, and VA Connecticut Healthcare System, West Haven, Conn (F.H.W.J., B.E.M.); Erasmus University Medical Center (H.J.M.V.), Rotterdam; St. Antonius Hospital (R.H.H.), Nieuwegein; University Medical Center Utrecht (F.L.M.), Utrecht, the Netherlands; Baylor College of Medicine (P.H.L., H.A.), Houston, Tex; Policlinico San Donato IRCCS, Cardiovascular Center “E. Malan,”
| | - Robin H. Heijmen
- From the Section of Vascular Surgery, Cardiothoracic Surgery and Interventional Radiology, Yale University School of Medicine, New Haven, and VA Connecticut Healthcare System, West Haven, Conn (F.H.W.J., B.E.M.); Erasmus University Medical Center (H.J.M.V.), Rotterdam; St. Antonius Hospital (R.H.H.), Nieuwegein; University Medical Center Utrecht (F.L.M.), Utrecht, the Netherlands; Baylor College of Medicine (P.H.L., H.A.), Houston, Tex; Policlinico San Donato IRCCS, Cardiovascular Center “E. Malan,”
| | - Santi Trimarchi
- From the Section of Vascular Surgery, Cardiothoracic Surgery and Interventional Radiology, Yale University School of Medicine, New Haven, and VA Connecticut Healthcare System, West Haven, Conn (F.H.W.J., B.E.M.); Erasmus University Medical Center (H.J.M.V.), Rotterdam; St. Antonius Hospital (R.H.H.), Nieuwegein; University Medical Center Utrecht (F.L.M.), Utrecht, the Netherlands; Baylor College of Medicine (P.H.L., H.A.), Houston, Tex; Policlinico San Donato IRCCS, Cardiovascular Center “E. Malan,”
| | - W. Anthony Lee
- From the Section of Vascular Surgery, Cardiothoracic Surgery and Interventional Radiology, Yale University School of Medicine, New Haven, and VA Connecticut Healthcare System, West Haven, Conn (F.H.W.J., B.E.M.); Erasmus University Medical Center (H.J.M.V.), Rotterdam; St. Antonius Hospital (R.H.H.), Nieuwegein; University Medical Center Utrecht (F.L.M.), Utrecht, the Netherlands; Baylor College of Medicine (P.H.L., H.A.), Houston, Tex; Policlinico San Donato IRCCS, Cardiovascular Center “E. Malan,”
| | - Frans L. Moll
- From the Section of Vascular Surgery, Cardiothoracic Surgery and Interventional Radiology, Yale University School of Medicine, New Haven, and VA Connecticut Healthcare System, West Haven, Conn (F.H.W.J., B.E.M.); Erasmus University Medical Center (H.J.M.V.), Rotterdam; St. Antonius Hospital (R.H.H.), Nieuwegein; University Medical Center Utrecht (F.L.M.), Utrecht, the Netherlands; Baylor College of Medicine (P.H.L., H.A.), Houston, Tex; Policlinico San Donato IRCCS, Cardiovascular Center “E. Malan,”
| | - Husam Athamneh
- From the Section of Vascular Surgery, Cardiothoracic Surgery and Interventional Radiology, Yale University School of Medicine, New Haven, and VA Connecticut Healthcare System, West Haven, Conn (F.H.W.J., B.E.M.); Erasmus University Medical Center (H.J.M.V.), Rotterdam; St. Antonius Hospital (R.H.H.), Nieuwegein; University Medical Center Utrecht (F.L.M.), Utrecht, the Netherlands; Baylor College of Medicine (P.H.L., H.A.), Houston, Tex; Policlinico San Donato IRCCS, Cardiovascular Center “E. Malan,”
| | - Bart E. Muhs
- From the Section of Vascular Surgery, Cardiothoracic Surgery and Interventional Radiology, Yale University School of Medicine, New Haven, and VA Connecticut Healthcare System, West Haven, Conn (F.H.W.J., B.E.M.); Erasmus University Medical Center (H.J.M.V.), Rotterdam; St. Antonius Hospital (R.H.H.), Nieuwegein; University Medical Center Utrecht (F.L.M.), Utrecht, the Netherlands; Baylor College of Medicine (P.H.L., H.A.), Houston, Tex; Policlinico San Donato IRCCS, Cardiovascular Center “E. Malan,”
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Torsello GB, Torsello GF, Osada N, Teebken OE, Ratusinski CM, Nienaber CA. Midterm Results From the TRAVIATA Registry: Treatment of Thoracic Aortic Disease With the Valiant Stent Graft. J Endovasc Ther 2010; 17:137-50. [PMID: 20426628 DOI: 10.1583/09-2905.1] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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