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Skrypnik D, Kalmykov E, Bischoff MS, Meisenbacher K, Klotz R, Hagedorn M, Kalkum E, Probst P, Dammrau R, Böckler D. Late Endograft Migration After Thoracic Endovascular Aortic Repair: A Systematic Review and Meta-analysis. J Endovasc Ther 2024; 31:7-18. [PMID: 35822261 PMCID: PMC10773166 DOI: 10.1177/15266028221109455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The objective of this systematic review was to report the cumulative incidence of endograft migration (EM), as well as the morbidity, reintervention rates, and mortality related to EM. This study aimed to provide evidence-based data on patient-relevant sequelae of EM after thoracic endovascular aortic repair (TEVAR) performed using contemporary aortic endografts. MATERIALS AND METHODS A systematic electronic search of literature in MEDLINE (via PubMed), Web of Science, and Cochrane Central Register of Controlled Trials was performed. The pooled synthesis of outcomes was performed using the inverse variance method. RESULTS Seven prospective non-randomized and 4 retrospective studies, including a total of 1783 patients presenting 70 EMs, were considered for the quantitative analysis. The pooled rate of EM was 4% (95% CI, 2%-7%; range, 0.2%-11%; I2=82%); pooled morbidity rate was 31% (95% CI, 12%-59%; range, 0%-100%; I2=64%) and pooled reintervention rate was 32% (95% CI, 15%-56%; range, 0%-100%; I2=55%). The pooled mortality rate due to EM was 5% (95% CI, 1%-21%; range, 0%-40%; I2=24%). CONCLUSION For the first time, this meta-analysis provides pooled reference estimates of EM after TEVAR. Thus, the results hold the potential to further characterize EM after TEVAR. The clinical relevance of EM is underlined by its association with high rates of endoleak-related morbidity, reintervention, and mortality. Close standardized surveillance after TEVAR for early detection of EM and prophylaxis of its sequelae is essential.
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Affiliation(s)
- Denis Skrypnik
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Egan Kalmykov
- Department of Vascular and Endovascular Surgery, University Clinic of Brandenburg/Havel, Brandenburg, Germany
- Department of Vascular and Endovascular Surgery, Helios University Clinic, Wuppertal, Germany
| | - Moritz S. Bischoff
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Katrin Meisenbacher
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Rosa Klotz
- Study Center of the German Society of Surgery, University Heidelberg, Heidelberg, Germany
| | - Matthias Hagedorn
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Eva Kalkum
- Study Center of the German Society of Surgery, University Heidelberg, Heidelberg, Germany
| | - Pascal Probst
- Study Center of the German Society of Surgery, University Heidelberg, Heidelberg, Germany
- Department of Surgery, Cantonal Hospital Thurgau, Frauenfeld, Switzerland
| | - Rolf Dammrau
- Department of Vascular and Endovascular Surgery, Helios University Clinic, Wuppertal, Germany
| | - Dittmar Böckler
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
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Torsello GF. [Update on thoracic endovascular aneurysm repair : New stent graft designs]. RADIOLOGIE (HEIDELBERG, GERMANY) 2022; 62:551-555. [PMID: 35759018 DOI: 10.1007/s00117-022-01032-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/31/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND In the last decade, new stent graft designs have evolved to tackle challenges in thoracic endovascular aortic repair. A specific focus on access vessel issues has led to the introduction of new low-profile endograft designs for most of the major products. OBJECTIVE The main objective of this article is to provide an overview of the available publications on new stent graft designs. MATERIALS AND METHODS Assessing recent publications on the major reiterations of thoracic endografts, benefits and drawbacks are discussed. RESULTS Recent reiterations of major endografts for thoracic aortic endovascular repair have focused mainly on the development of low-profile devices. Through alterations on graft fabric as well as stent material and design, delivery systems were reduced in profile, thus, reducing access vessel complications or enabling an endovascular procedure altogether. Long-term data are already available for one endoprosthesis. Other refinements include in situ adaptation of the stent graft to the aortic arch curvature as well as the option of staged deployment to allow more precision and reduce manipulation close to supra-aortic branches. CONCLUSIONS Especially in the case of low-profile endografts, preliminary and long-term results of access vessel complications are promising. In order to draw final conclusions as to how durable the results of aneurysm exclusion are, more long-term studies are warranted.
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Affiliation(s)
- Giovanni Federico Torsello
- Ärztliche Leitung Angiographie/Interventionsradiologie CCM, Klinik für Radiologie - Arbeitsbereich Interventionelle Radiologie, Campus Charité Mitte, Campus Virchow-Klinikum, CC 06 Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland.
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3
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Böckler D, Bischoff MS, Kronsteiner D, Skrypnik D, Meisenbacher K. Outcome analysis of the Gore Conformable Thoracic Stent Graft with active control system for the treatment of arch and descending thoracic aortic disease. Eur J Cardiothorac Surg 2021; 60:1455-1463. [PMID: 34337659 DOI: 10.1093/ejcts/ezab289] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/20/2021] [Accepted: 05/13/2021] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES The aim of this study was to evaluate technical/clinical outcomes of the Gore TAG Conformable Thoracic Stent Graft with Active Control System (CTAG with ACS) in thoracic aortic disease since its introduction in Europe in 2017. METHODS Patients undergoing thoracic endovascular aortic repair (TEVAR) with the device between 2017 and 2020 were identified from a prospectively maintained single-centre database and retrospectively analysed. Predominant indications were aortic dissection (n = 46), thoracic/thoraco-abdominal aneurysm (n = 20/n = 7), penetrating ulcer (n = 14) and intramural haematoma (n = 12). Emergency procedures were performed in 47% (54/115). The primary outcome was technical success. Secondary outcomes were clinical success, serious adverse events and procedure-related reintervention. ACS was assessed regarding angulation, accuracy and apposition. The median follow-up was 8.46 months (interquartile range: 3.18-16.89 months). RESULTS A total of 115 consecutive patients (82 males, median age 63; interquartile range: 53-74 years) have been included. Technical success was achieved in 95.7% (110/115). Clinical success rate was 80.9% (93/115); mostly due to procedure-related death (n = 14). Overall mortality was 19.1% (22/115), with significant differences between elective/emergency procedures (log-rank: P < 0.001). Procedure-related serious adverse event rate was 44.3% (51/115). Procedure-related reintervention was performed in 20.9% (24/115). The cumulative incidence for reintervention differed significantly between elective/emergency cases (Gray's test: P = 0.0033). Angulation was used in 40.9% of patients (47/115), mostly in type II arches (52.7%). Deployment accuracy was 87.8% (101/115). Sufficient apposition was present in 93.0% (107/115). CONCLUSIONS This single-centre study shows encouraging performance of the CTAG with ACS in an array of aortic pathologies. Although longer-term data must be awaited, ACS leads to overall favourable device placement. Despite ongoing advances in device technology, TEVAR remains challenging and is associated with significant burden inherent to the underlying disease.
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Affiliation(s)
- Dittmar Böckler
- Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Moritz S Bischoff
- Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Dorothea Kronsteiner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Denis Skrypnik
- Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Katrin Meisenbacher
- Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Heidelberg, Germany
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Monga A, Patil SB, Cherian M, Poyyamoli S, Mehta P. Thoracic Trauma: Aortic Injuries. Semin Intervent Radiol 2021; 38:84-95. [PMID: 33883805 DOI: 10.1055/s-0041-1724009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Thoracic aortic injuries caused by high impact trauma are life-threatening and require emergent diagnosis and management. With improvement in the acute care services, an increasing number of such injuries are being managed such that patients survive to undergo definitive therapies. A high index of clinical suspicion is required to order appropriate imaging. Computed tomography angiography is used to classify the injuries and guide treatment strategy. While low-grade injuries might be managed conservatively, high-grade injuries require urgent surgical or endovascular intervention. Over the past decade, endovascular repair of the thoracic aorta with or without a surgical bypass has become the preferred treatment with reduced mortality and morbidity. Rapid advancements in the stent graft technology have reduced the anatomic barriers to endovascular therapy and increased the confidence of the operators. Detailed planning prior to the procedure, understanding of the anatomy, correct choice of hardware, and adherence to technical protocol are essential for a successful endovascular procedure. These patients are often young and the limited data on the long-term outcome of aortic stent grafts make a case for a robust follow-up protocol.
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Affiliation(s)
- Akhil Monga
- Department of Radiology, Kovai Medical Centre and Hospitals, Coimbatore, Tamil Nadu, India
| | - Santosh B Patil
- Department of Radiology, Kovai Medical Centre and Hospitals, Coimbatore, Tamil Nadu, India
| | - Mathew Cherian
- Department of Radiology, Kovai Medical Centre and Hospitals, Coimbatore, Tamil Nadu, India
| | - Santhosh Poyyamoli
- Department of Radiology, Kovai Medical Centre and Hospitals, Coimbatore, Tamil Nadu, India
| | - Pankaj Mehta
- Department of Radiology, KMCH IHSR, Coimbatore, Tamil Nadu, India
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Kohler C, Wyss TR, Mertineit N, Makaloski V, Schmidli J. Emergent open conversion for stent-graft deployment failure in a ruptured thoracic aneurysm. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 7:180-182. [PMID: 33748558 PMCID: PMC7966836 DOI: 10.1016/j.jvscit.2020.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/30/2020] [Indexed: 11/30/2022]
Abstract
Thoracic endovascular aortic repair (TEVAR) is the standard of care for ruptured thoracic aortic aneurysms. A 92-year-old man had presented in stable condition but with acute severe back pain. Computed tomography revealed a ruptured thoracic aortic aneurysm. TEVAR (Valiant; Medtronic Vascular, Santa Rosa, Calif) into zone 2 with intentional coverage of the left subclavian artery was planned. After release of the stent-graft body, proximal release of the bare springs was impossible. Troubleshooting techniques were applied; but tip capture could not be released. Emergent conversion to open repair was performed. Intraoperative device deployment failure in TEVAR is rare. The findings from the present report have demonstrated the advantages of having in-house cardiac surgery backup available.
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Affiliation(s)
- Corinne Kohler
- Department of Cardiovascular Surgery, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas R Wyss
- Department of Cardiovascular Surgery, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nando Mertineit
- Division of Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Vladimir Makaloski
- Department of Cardiovascular Surgery, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Juerg Schmidli
- Department of Cardiovascular Surgery, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Torsello GF, Argyriou A, Stavroulakis K, Bosiers MJ, Austermann M, Torsello GB. One-Year Results From the SURPASS Observational Registry of the CTAG Stent-Graft With the Active Control System. J Endovasc Ther 2020; 27:421-427. [PMID: 32193990 PMCID: PMC7288855 DOI: 10.1177/1526602820913007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Purpose: To report the outcomes from the observational SURPASS
registry, which was created to assess the performance of the Conformable TAG
(CTAG) stent-graft with the Active Control System (ACS) in patients undergoing
thoracic endovascular aortic repair (TEVAR) in a real-world setting.
Materials and Methods: The SURPASS registry
(ClinicalTrials.gov; identifier NCT03286400) was an
observational, prospective, single-arm, post-market, international study that
enrolled patients undergoing TEVAR using the CTAG with ACS for both acute and
chronic thoracic aortic disease between October 2017 and July 2018. The CTAG
with ACS features 2-stage deployment of the stent-graft and an optional
angulation mechanism that modifies only the proximal end of the stent-graft.
During the observation period, 127 patients (mean age 67.1±12.1 years, range
27–86; 92 men) were enrolled and treated for an array of aortic pathologies,
including chronic and acute lesions and 4 ruptured descending thoracic
aneurysms. The primary outcome of this study was technical success; secondary
outcomes were clinical success and major adverse events at 30 days and 12
months. The numbers of 2-stage device deployments and applications of the
angulation mechanism were recorded, along with the reasons for use.
Results: Technical success of the TEVAR was 97.6% owing to
unintentional partial coverage of supra-aortic branches in 3 cases (the vessels
were patent on imaging). The stent-graft was repositioned at its intermediate
diameter in 79 patients (62.2%), and the angulation feature was applied in 64
cases (50.4%), mainly to improve proximal wall apposition and orthogonality in
the aorta. The desired effect was achieved in 60 cases (93.8%). There was no
device compression, bird-beak configuration, fracture, or graft occlusion. The
30-day and 12-month clinical success rates were 97.6% and 92.9%, respectively.
There were 3 aorta-related deaths at 30 days and a further 3 at 12 months.
Fatalities were due to a retrograde type A dissection (0.8%), paraplegia, bowel
ischemia, sepsis in the setting of a mycotic aneurysm, aneurysm rupture post
aortoesophageal fistula, and multiorgan dysfunction syndrome. Three endoleaks (2
type Ia and 1 type III) required reintervention. Conclusion: In the
SURPASS registry, the use of the CTAG device with ACS showed promising outcomes
despite the challenging pathologies. The new delivery system enables a
controlled staged delivery with in situ adjustments during positioning,
facilitating the treatment of complex aortic disease.
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Affiliation(s)
- Giovanni Federico Torsello
- Department of Vascular Surgery, St Franziskus Hospital Münster, University of Münster, Germany.,Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Charité Campus Virchow-Klinikum, Charité University Medicine Berlin, Germany
| | - Angeliki Argyriou
- Department of Vascular Surgery, St Franziskus Hospital Münster, University of Münster, Germany
| | | | - Michel J Bosiers
- Department of Vascular Surgery, St Franziskus Hospital Münster, University of Münster, Germany
| | - Martin Austermann
- Department of Vascular Surgery, St Franziskus Hospital Münster, University of Münster, Germany
| | - Giovanni B Torsello
- Department of Vascular Surgery, St Franziskus Hospital Münster, University of Münster, Germany
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Thakkar D, Dake MD. Management of Type B Aortic Dissections: Treatment of Acute Dissections and Acute Complications from Chronic Dissections. Tech Vasc Interv Radiol 2018; 21:124-130. [PMID: 30497546 DOI: 10.1053/j.tvir.2018.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Aortic dissection is one of the most catastrophic vascular challenges faced by interventionalists, often misdiagnosed and frequently associated with devastating consequences. Stanford type B aortic dissections affects the descending thoracic aorta without any involvement of the ascending aorta. Dissections associated with refractory pain, rapid aneurysm formation, malperfusion syndromes, rupture, or impending rupture are categorized as complicated and distinct from initially uncomplicated type B dissections without the aforementioned complications. Traditionally, uncomplicated type B dissection is managed medically whereas complicated type B dissection requires intervention to limit mortality. Over the last two decades, thoracic endovascular aortic repair (TEVAR) has emerged as an alternative to open surgical repair for treatment of complicated type B dissection. Various societal guidelines now unanimously propose TEVAR as the treatment of choice for management of complicated disease based on its relatively low morbidity and mortality compared to open surgical outcomes. As the consensually acknowledged standard of care for management of patients with complicated lesions, TEVAR is currently being considered for select patients with initially uncomplicated dissection to mitigate the risks of mid and late-term disease progression and aortic-related mortality. This article describes the decision-making treatment algorithm for management of type B aortic dissection. It also provides a comprehensive review of the indications and procedural recommendations for performing TEVAR based on current evidence in the literature. Additionally, the article guides the readers through step-by-step practical considerations, from choosing the optimal graft to insuring its ideal deployment in type B dissection, as well as providing advice on how to handle a variety of procedure-related complications.
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Affiliation(s)
- Dolly Thakkar
- Department of Cardiothoracic Surgery, Falk Cardiovascular Research Center, Stanford University School of Medicine, Stanford, CA
| | - Michael D Dake
- Department of Cardiothoracic Surgery, Falk Cardiovascular Research Center, Stanford University School of Medicine, Stanford, CA.
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8
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Tozzi P. Thoracic endovascular aortic repair to treat uncomplicated Stanford type B aortic dissection: The surgeon's dilemma to preventing future complications. Eur J Prev Cardiol 2018; 25:24-31. [PMID: 29708037 DOI: 10.1177/2047487318758100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Uncomplicated type B aortic dissections have traditionally been managed non-operatively with aggressive blood pressure control. However, the best medical treatment is associated with a considerable risk of disease progression to complicated dissection or aneurysmal degeneration of the affected aortic segment. Thoracic endovascular aortic repair could prevent long-term complications but, because the dissected aorta is vulnerable, it is a high-risk procedure performed in asymptomatic patient. Therefore, endovascular treatment is not a solution for all patients and it should be performed only in the subgroup prone to developing progression of the disease and future complications. A number of studies have suggested several prognostic factors of early or late adverse events such as the patency of the false lumen in the follow-up, an initial aortic diameter ≥4 cm with a patent false lumen, an initial false lumen diameter ≥22 mm in the proximal descending aorta, visceral involvement and recurrent or refractory pain or hypertension. Partial false lumen thrombosis and a proximal entry tear size >10 mm have also been suggested to be associated with an increased rate of aortic growth. We need randomised trials focused on these prognostic factors to reach level 1, class A recommendation for the optimal timing of intervention. Meanwhile, we have to discuss with the patient the pro and cons of this prophylactic, low-invasive but high-risk treatment to personalise medical care and provide the optimal risk-to-benefit ratio.
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Affiliation(s)
- Piergiorgio Tozzi
- Department of Cardiovascular Surgery, Centre Hospitalier Universitaire Vaudois, Switzerland
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9
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Gombert A, Kotelis D, Griepenkerl UM, Fraedrich G, Klocker J, Glodny B, Jacobs MJ, Greiner A, Grommes J. Functional Assessment and Evaluation of Outcome After Endovascular Therapy With Coverage of the Left Subclavian Artery in Case of Blunt Thoracic Aortic Injury. Ann Vasc Surg 2016; 40:98-104. [PMID: 27903474 DOI: 10.1016/j.avsg.2016.07.089] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 07/29/2016] [Accepted: 07/29/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Patients suffering blunt thoracic aortic injury (BTAI) can be treated by use of thoracic endovascular aortic repair (TEVAR). In this setting, the coverage of the left subclavian artery (LSA) is frequently necessary. Nevertheless, the functionality of the upper left extremity after TEVAR had been rarely analyzed. Thus, this study intends to underline the safety of TEVAR as well as to determine the functionality of the left arm after coverage of the LSA. METHODS All patients suffering from BTAI treated by endovascular means in 3 centers (Aachen [Germany], Maastricht [Netherlands], and Innsbruck [Austria]) between 1996 and 2009 were retrospectively analyzed. The safety of the procedure had been assessed by the morbidity and mortality rate. The mid-term functional status of the upper left extremity was evaluated by using the DASH score (disabilities of the arm shoulder and hand). RESULTS Forty-six patients (40 male, 6 female), mean age 39.4 ± 16.9 years suffered from BTAI caused by traffic accident (n = 31 [67.39%]), by skiing injury (n = 8 [17.39%]), and by fall (n = 7 [15.21%]). All patients underwent TEVAR, the technical success rate was 100%; 1 carotid-carotid subclavian bypass implantation was necessary. LSA coverage was performed in 76% (35/46) of the cases. Total complication rate was 17.3% (8/46); the endoleak rate was 8.6% (4/46) (2 × Ib, 1 × IIa, 1 × IV). Further complications were bypass and endograft occlusion. The postoperative mortality rate was 6% (3/46), the DASH score was completed in 65% (30/46). The study population reached a mean value of 17 ± 20, which is comparable to a nonharmed reference group (10.10 ± 14.68). A significant correlation between the DASH score and patients age could be demonstrated (2-sided P value: 0.0213). CONCLUSIONS Endovascular therapy of BTAI revealed a good primary success rate. An adequate mid-term functional status of the upper left extremity could be assessed in comparison to a nonharmed reference group.
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Affiliation(s)
- Alexander Gombert
- European Vascular Center Aachen-Maastricht, University Hospital RWTH Aachen, Aachen, Germany.
| | - Drosos Kotelis
- European Vascular Center Aachen-Maastricht, University Hospital RWTH Aachen, Aachen, Germany
| | - Ulrike M Griepenkerl
- European Vascular Center Aachen-Maastricht, University Hospital RWTH Aachen, Aachen, Germany
| | - Gustav Fraedrich
- Department of Vascular Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Josef Klocker
- Department of Vascular Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Bernhard Glodny
- Institute for Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Michael J Jacobs
- European Vascular Center Aachen-Maastricht, University Hospital RWTH Aachen, Aachen, Germany; Department of Vascular Surgery, European Vascular Center Aachen-Maastricht, Medical University Maastricht, Maastricht, The Netherlands
| | - Andreas Greiner
- Gefäßchirurgische Klinik Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jochen Grommes
- European Vascular Center Aachen-Maastricht, University Hospital RWTH Aachen, Aachen, Germany
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10
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Ueno K, Samura M, Nakamura T, Tanaka Y, Takeuchi Y, Kawamura D, Takahashi M, Hosoyama T, Morikage N, Hamano K. Increased plasma VEGF levels following ischemic preconditioning are associated with downregulation of miRNA-762 and miR-3072-5p. Sci Rep 2016; 6:36758. [PMID: 27905554 PMCID: PMC5131337 DOI: 10.1038/srep36758] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 10/21/2016] [Indexed: 12/16/2022] Open
Abstract
Ischemic preconditioning (IPC) has protective effects against ischemia-perfusion injury of organs. In the present study, we investigated the associated mechanisms after performing remote IPC (rIPC) of lower limbs by clamping abdominal aorta in mice. Subsequent experiments showed decreased damage and paralysis of lower limbs following spinal cord injury (SCI). Concomitantly, plasma vascular endothelial growth factor (VEGF) levels were increased 24 h after rIPC compared with those in sham-operated animals. In subsequent microRNA analyses, thirteen microRNAs were downregulated in exosomes 24 h after rIPC. Further studies of femoral CD34-positive bone marrow (BM) cells confirmed downregulation of these seven microRNAs 24 h after rIPC compared with those in sham-operated controls. Subsequent algorithm-based database searches suggested that two of the seven microRNAs bind to the 3′ UTR of VEGF mRNA, and following transfection into CD34-positive BM cells, anti-miR-762, and anti-miR-3072-5p inhibitors led to increased VEGF concentrations. The present data suggest that rIPC transiently increases plasma VEGF levels by downregulating miR-762 and miR-3072-5p in CD34-positive BM cells, leading to protection against organ ischemia.
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Affiliation(s)
- Koji Ueno
- Department of Surgery and Clinical Sciences, Yamaguchi University Graduate School of Medicine, Ube, Japan.,Center for Regenerative Medicine, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Makoto Samura
- Department of Surgery and Clinical Sciences, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Tamami Nakamura
- Department of Surgery and Clinical Sciences, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Yuya Tanaka
- Department of Surgery and Clinical Sciences, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Yuriko Takeuchi
- Department of Surgery and Clinical Sciences, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Daichi Kawamura
- Department of Surgery and Clinical Sciences, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Masaya Takahashi
- Department of Surgery and Clinical Sciences, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Tohru Hosoyama
- Department of Surgery and Clinical Sciences, Yamaguchi University Graduate School of Medicine, Ube, Japan.,Center for Regenerative Medicine, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Noriyasu Morikage
- Department of Surgery and Clinical Sciences, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Kimikazu Hamano
- Department of Surgery and Clinical Sciences, Yamaguchi University Graduate School of Medicine, Ube, Japan
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11
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Weber TF, Böckler D, Müller-Eschner M, Bischoff M, Kronlage M, von Tengg-Kobligk H, Kauczor HU, Hyhlik-Dürr A. Frequency of abdominal aortic expansion after thoracic endovascular repair of type B aortic dissection. Vascular 2016; 24:567-579. [DOI: 10.1177/1708538115627249] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Purpose To determine abdominal aortic expansion after thoracic endovascular aortic repair (TEVAR) in patients with aortic dissection type B and 36 months minimum follow-up. Methods Retrospective study of 18 TEVAR patients with follow-up >36 months. Abdominal aortic diameters at celiac trunk (location B) and infrarenal aorta (location C) were recorded on the first and last imaging after TEVAR. False lumen thrombosis was determined at level of endograft (A) and at B and C. Aortic expansion was defined as diameter increase of 5 mm or 15%. Correlation analyses were performed to investigate potential determinants of expansion. Results Median follow-up was 75.2 months. Sixteen of 18 patients (88.9%) demonstrated abdominal expansion. Mean expansion was 9.9 ± 6.1 mm at B and 11.7 ± 6.5 mm at C, without a difference between acute and chronic dissections. Critical diameters of 55 mm were reached in two patients treated for chronic dissection (11.1%). Annual diameter increase was significantly greater at locations with baseline diameters >30 mm (2.1 ± 1.1 mm vs. 1.0 ± 0.6 mm, p = 0.009). Baseline diameters were greater in patients with chronic dissections. Conclusion Abdominal aortic expansion can be frequently recognized after TEVAR for aortic dissection type B and occurs independently from thoracic false lumen thrombosis. Clinical significant abdominal aortic expansion may occur more frequently in patients treated with TEVAR for chronic dissection.
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Affiliation(s)
- Tim F Weber
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Dittmar Böckler
- Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Matthias Müller-Eschner
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Moritz Bischoff
- Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Moritz Kronlage
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Hendrik von Tengg-Kobligk
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Institute for Diagnostic, Interventional and Pediatric Radiology, Inselspital, University Medical Center Bern, Bern, Switzerland
| | - Hans-Ulrich Kauczor
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Alexander Hyhlik-Dürr
- Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
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Der Aortenbogen – was ist bei der endovaskulären Versorgung zu beachten? GEFASSCHIRURGIE 2016. [DOI: 10.1007/s00772-016-0164-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Böckler D, Brunkwall J, Taylor P, Mangialardi N, Hüsing J, Larzon T, Hyhlik-Dürr A, Gawenda M, Clough R, Ronchey S, Örman L. Thoracic Endovascular Aortic Repair of Aortic Arch Pathologies with the Conformable Thoracic Aortic Graft: Early and 2 year Results from a European Multicentre Registry. Eur J Vasc Endovasc Surg 2016; 51:791-800. [DOI: 10.1016/j.ejvs.2016.02.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 02/05/2016] [Indexed: 10/21/2022]
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Waterford SD, Chou D, Bombien R, Uzun I, Shah A, Khoynezhad A. Left Subclavian Arterial Coverage and Stroke During Thoracic Aortic Endografting: A Systematic Review. Ann Thorac Surg 2016; 101:381-9. [DOI: 10.1016/j.athoracsur.2015.05.138] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 04/22/2015] [Accepted: 05/14/2015] [Indexed: 11/26/2022]
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Moulakakis KG, Mylonas SN, Dalainas I, Kakisis J, Kotsis T, Liapis CD. Management of complicated and uncomplicated acute type B dissection. A systematic review and meta-analysis. Ann Cardiothorac Surg 2014; 3:234-46. [PMID: 24967162 DOI: 10.3978/j.issn.2225-319x.2014.05.08] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 05/21/2014] [Indexed: 01/25/2023]
Abstract
BACKGROUND The management of acute type B dissection represents a clinical challenge. We undertook a systematic review of the available literature regarding medical, surgical and endovascular treatments of acute type B aortic dissection and combined the eligible studies into a meta-analysis. METHODS An extensive electronic health database search was performed on all articles published from January 2006 up to November 2013 describing the management of acute type B aortic dissection. Studies including less than 15 patients were excluded. RESULTS ACUTE COMPLICATED TYPE B DISSECTION: overall, 2,531 patients were treated with endovascular repair (TEVAR) and the pooled rate for 30-day/in-hospital mortality was 7.3%. The pooled estimates for cerebrovascular events, spinal cord ischemia (SCI) and total neurologic events were 3.9%, 3.1% and 7.3%, respectively. A total of 1,276 patients underwent open surgical repair and the pooled rate for 30-day/in-hospital mortality was 19.0%. The pooled rate for cerebrovascular events was 6.8%, for SCI 3.3% and for total neurologic complications 9.8%. Acute uncomplicated type B dissection: outcome of 2,347 patients who underwent conservative medical management were analyzed. The pooled 30-day/in-hospital mortality rate was 2.4%. The pooled rate for cerebrovascular events was 1%, for SCI 0.8% and for overall neurologic complications 2%. CONCLUSIONS Endovascular repair provides a superior 30-day/in-hospital survival for acute complicated type B aortic dissection compared to surgical aortic reconstruction. However, open repair still has a significant role as endovascular repair is not applicable in all patients and there remains concerns regarding the durability of this technique. TEVAR seems to have a more favorable outcome regarding aortic remodeling and the aortic-specific survival rate when compared with medical therapy alone. Randomized controlled trials focusing on the prognostic factors of early and late complications in uncomplicated type B dissections are needed.
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Affiliation(s)
- Konstantinos G Moulakakis
- 1 Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece ; 2 The Collaborative Research Group, Macquarie University, Sydney, Australia ; 3 Vascular Unit, 2nd Clinic of Surgery, Aretaieion Hospital, Medical School, University of Athens, Athens, Greece
| | - Spyridon N Mylonas
- 1 Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece ; 2 The Collaborative Research Group, Macquarie University, Sydney, Australia ; 3 Vascular Unit, 2nd Clinic of Surgery, Aretaieion Hospital, Medical School, University of Athens, Athens, Greece
| | - Ilias Dalainas
- 1 Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece ; 2 The Collaborative Research Group, Macquarie University, Sydney, Australia ; 3 Vascular Unit, 2nd Clinic of Surgery, Aretaieion Hospital, Medical School, University of Athens, Athens, Greece
| | - John Kakisis
- 1 Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece ; 2 The Collaborative Research Group, Macquarie University, Sydney, Australia ; 3 Vascular Unit, 2nd Clinic of Surgery, Aretaieion Hospital, Medical School, University of Athens, Athens, Greece
| | - Thomas Kotsis
- 1 Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece ; 2 The Collaborative Research Group, Macquarie University, Sydney, Australia ; 3 Vascular Unit, 2nd Clinic of Surgery, Aretaieion Hospital, Medical School, University of Athens, Athens, Greece
| | - Christos D Liapis
- 1 Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece ; 2 The Collaborative Research Group, Macquarie University, Sydney, Australia ; 3 Vascular Unit, 2nd Clinic of Surgery, Aretaieion Hospital, Medical School, University of Athens, Athens, Greece
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Matsumoto AH, Angle JF, Secic M, Carlson GA, Fisher L, Fairman RM. Secondary procedures following thoracic aortic stent grafting in the first 3 years of the VALOR test and VALOR II trials. J Vasc Interv Radiol 2014; 25:685-692.e5. [PMID: 24529546 DOI: 10.1016/j.jvir.2013.12.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 12/05/2013] [Accepted: 12/13/2013] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To compare the durability of thoracic endovascular aortic repair (TEVAR) in two similar clinical trials that used early- and later-generation stent grafts. MATERIALS AND METHODS Secondary procedures from the prospective, nonrandomized, multicenter, clinical trial databases of the test arm of the VALOR and VALOR II trials were analyzed at 3 years. Descriptive and statistical analyses were employed to compare the rate of and potential predictors for secondary procedures. RESULTS A total of 127 and 96 patients were available for a minimum of 3 years of follow-up in the test arm of VALOR and VALOR II, respectively. By the first year after the index procedure, VALOR II patients were significantly less likely to have undergone a secondary procedure versus patients in the test arm of VALOR (odds ratio [OR], 0.08; 95% confidence interval [CI], 0.01-0.63; P = .02), with most procedures performed for type I endoleak. Multivariate predictors at 3 years for the need for a secondary procedure in the VALOR test arm were maximum aneurysm diameter (P = .002) and aneurysm length (P = .01), both of which remained significant at the end of the study period. The estimated freedoms from secondary procedures in the VALOR test arm and VALOR II at 3 years were 85.1% (95% CI, 78.5%-89.8%) and 94.9% (95% CI, 88.8%-97.7%), respectively (P < .001). CONCLUSIONS The rate of secondary procedures after TEVAR differed between the two cohorts, being substantially lower in the VALOR II trial at 1 year of follow-up. This finding suggests significant benefit from advances in some combination of operator experience, imaging systems, treatment planning, and device design.
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Affiliation(s)
- Alan H Matsumoto
- Department of Radiology and Medical Imaging, University of Virginia Health System, 1215 Lee St., Box 800170, Room 1839, Charlottesville, VA 22908.
| | - John F Angle
- Department of Radiology and Medical Imaging, University of Virginia Health System, 1215 Lee St., Box 800170, Room 1839, Charlottesville, VA 22908
| | | | - Grace A Carlson
- Office of Medical Affairs, Medtronic Vascular, Santa Rosa, California
| | - Lois Fisher
- Office of Medical Affairs, Medtronic Vascular, Santa Rosa, California
| | - Ronald M Fairman
- Division of Vascular Surgery and Endovascular Therapy, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Kiguchi M, Chaer RA. Endovascular repair of thoracic aortic pathology. Expert Rev Med Devices 2014; 8:515-25. [DOI: 10.1586/erd.11.17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Hybrid arch debranching and proximal endograft extension to repair a type I endoleak after endovascular thoracic aneurysm repair. Ann Vasc Surg 2014; 28:740.e7-12. [PMID: 24378243 DOI: 10.1016/j.avsg.2013.06.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 06/12/2013] [Accepted: 06/12/2013] [Indexed: 11/20/2022]
Abstract
Endovascular repair of complex aortic disease has emerged over the past decade as an alternative to traditional open repair, especially for patients with significant medical comorbidities and/or anatomic challenges, such as reoperative fields. However, the possibility of graft migration and endoleak mandates long-term follow-up of these grafts. We present a patient who underwent hybrid repair after stent graft migration and proximal type I endoleak after thoracic endovascular aneurysm repair. This approach allowed us to avoid extensive surgery that would also necessitate circulatory arrest.
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Endovascular Treatment of Thoracic Aortic Aneurysm: A Single-Center Experience. Ann Vasc Surg 2013; 27:1020-8. [DOI: 10.1016/j.avsg.2012.07.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 07/05/2012] [Accepted: 07/31/2012] [Indexed: 11/21/2022]
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20
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Khoynezhad A, White RA. Pathogenesis and Management of Retrograde Type A Aortic Dissection After Thoracic Endovascular Aortic Repair. Ann Vasc Surg 2013; 27:1201-6. [DOI: 10.1016/j.avsg.2012.08.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Revised: 07/13/2012] [Accepted: 08/07/2012] [Indexed: 11/28/2022]
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21
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Michler RE, Lipsitz E, Neragi-Miandoab S. A Case Series of a Hybrid Approach to Aortic Arch Disease. Heart Surg Forum 2013; 16:E225-31. [DOI: 10.1532/hsf98.20131022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
<p><b>Objective:</b> Debranching of the aortic arch and endovascular stent placement as a combination therapy for complex aortic arch pathology has emerged over the past few years as an alternative to traditional repair. This hybrid approach is a viable option for patients who would not tolerate conventional arch replacement, as well as for patients with a failed stent graft of the descending aorta and a subsequent type I endoleak.</p><p><b>Methods:</b> We retrospectively reviewed the preoperative characteristics and postoperative outcomes of 5 patients who underwent debranching of the aortic arch and implantation of an endovascular stent across the aortic arch between 2008 and 2011. Data were analyzed with the Student t test and the Kaplan-Meyer method.</p><p><b>Results:</b> The mean age was 70.6 � 18 years; 4 men and 1 woman were evaluated. One patient had previous aortic surgery for dissection. The preoperative morbidities included arrhythmia (1 patient), chronic obstructive pulmonary disease (2 patients), cerebrovascular accident (1 patient), diabetes mellitus (2 patients), coronary artery disease (2 patients), and active angina (1 patient). One patient had a myocardial infarction 3 weeks before surgery. The primary technical-success rate was 100%, and none of the patients died in the perioperative phase. The mean follow-up time was 22 � 18.4 months, and the median follow-up time was 13.8 months (range, 7.13-50.7 months). Two patients died during follow-up. The pathology of the aorta in the patients who died was arch aneurysm; the 3 remaining patients are alive and regularly followed at our institution.</p><p><b>Conclusion:</b> The combination of surgery and simultaneous endovascular stenting in the operating room is an alternative approach for patients who are poor candidates for traditional arch repair under circulatory arrest.</p>
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Eggebrecht H, Schmermund A, Voigtländer T. Clinical safety and efficacy of a next-generation stent-graft device for thoracic endovascular aortic repair. Expert Rev Cardiovasc Ther 2013; 11:27-30. [PMID: 23259442 DOI: 10.1586/erc.12.164] [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: 11/08/2022]
Abstract
Thoracic endovascular aortic repair has significantly improved the treatment of patients with acute and chronic diseases of the descending thoracic aorta. Retrograde transarterial implantation of a membrane-covered stent graft aims at excluding the aortic pathology at risk for complications (e.g., aneurysm, dissection) from the circulation to prevent expansion and ultimately rupture. Today, several stent grafts from different manufacturers are approved by the respective authorities and thus commercially available. The Medtronic Talent® stent graft used to be one of the initially available devices and has been broadly used to become the world-wide market leader at its time. In 2005, it has been replaced by the second-generation Medtronic Valiant® device, which features several technical improvements. In this article, we evaluate a recent publication investigating the clinical performance of this second-generation stent graft device, and discuss the results in the view of the current literature and developments.
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Fattori R, Cao P, De Rango P, Czerny M, Evangelista A, Nienaber C, Rousseau H, Schepens M. Interdisciplinary Expert Consensus Document on Management of Type B Aortic Dissection. J Am Coll Cardiol 2013; 61:1661-78. [PMID: 23500232 DOI: 10.1016/j.jacc.2012.11.072] [Citation(s) in RCA: 316] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 10/30/2012] [Accepted: 11/08/2012] [Indexed: 11/15/2022]
Affiliation(s)
- Rossella Fattori
- Department of Interventional Cardiology, San Salvatore Hospital, Pesaro, Italy.
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Wong S, Mastracci TM, Katsargyris A, Verhoeven ELG. The role of mandatory lifelong annual surveillance after thoracic endovascular repair. J Vasc Surg 2013. [PMID: 23182490 DOI: 10.1016/j.jvs.2012.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Thoracic endovascular aortic repair (TEVAR) has become an attractive and well-accepted option for the management of the various thoracic aortic pathologies that vascular surgeons are confronted with. As in the abdominal aorta, current management trends include the treatment of younger patients with longer life expectancies, raising the issue of postoperative surveillance. There are several relevant differences between these anatomic areas when it comes to surveillance, including the relative inaccessibility of the thoracic aorta to ultrasound interrogation and the increased variability of thoracic aortic pathologies and post-TEVAR complications. In addition, concerns regarding radiation-induced carcinogenesis and contrast-induced nephropathy reduce the enthusiasm of many surgeons for regular computed tomography surveillance. Most agree that surveillance is important after TEVAR, but the method, duration, and frequency of that surveillance is much less clear and is the topic of this debate.
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Affiliation(s)
- Shen Wong
- Department of Vascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio 44106, USA
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Li W, Xu K, Ni Y, Zhong H, Bi Y. A Canine Model of Proximal Descending Thoracic Aortic Aneurysm Created with an Autologous Pericardial Patch. Ann Thorac Cardiovasc Surg 2013; 19:131-5. [DOI: 10.5761/atcs.oa.12.01948] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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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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Katsargyris A, Verhoeven ELG. Part Two: Against the motion. All TEVAR patients do not require lifelong follow-up by annual CTA/MRA.[Con]. Eur J Vasc Endovasc Surg 2012; 44:538-41. [PMID: 23017647 DOI: 10.1016/j.ejvs.2012.09.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- A Katsargyris
- Department of Vascular and Endovascular Surgery, Klinikum Nurnberg, Nurnberg, Germany
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Risk factors associated with surgical site infections following vascular surgery at a German university hospital. Epidemiol Infect 2012; 141:1207-13. [DOI: 10.1017/s095026881200180x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
SUMMARYSurgical site infection (SSI) after vascular surgery is a serious complication increasing morbidity, mortality, and costs for healthcare systems. A 4-year retrospective cohort study was performed in a university hospital with patients who had undergone arterial vascular surgery below the aortic arch. Investigated variables included demographics and clinical data. Forty-four of 756 patients experienced SSI, 29 of which were superficial, five were deep, and 10 had organ/space infections. Coagulase-negative staphylococci (22%), enterococci (20%), and Staphylococcus aureus (18%) were the most common pathogens. Independent risk factors for SSIs were femoral grafting [odds ratio (OR) 6·7], peripheral atherosclerotic disease, Fontaine stages III–IV (OR 4·1), postoperative drainage >5 days (OR 3·6), immunosuppression (OR 2·8), duration of operation >214 min (OR 2·8), and body mass index >29 (OR 2·6). The application of perioperative antibiotic prophylaxis was an independent protective factor (OR 0·2). Patients with certain risk factors for SSIs warrant special attention for infection prevention.
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Heijmen RH, Thompson MM, Fattori R, Goktay Y, Teebken OE, Orend KH. Valiant Thoracic Stent-Graft Deployed With the New Captivia Delivery System:Procedural and 30-Day Results of the Valiant Captivia Registry. J Endovasc Ther 2012; 19:213-25. [DOI: 10.1583/11-3652mr.1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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30
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Murphy EH, Stanley GA, Ilves M, Knowles M, Dimaio JM, Jessen ME, Arko FR. Thoracic Endovascular Repair (TEVAR) in the Management of Aortic Arch Pathology. Ann Vasc Surg 2012; 26:55-66. [DOI: 10.1016/j.avsg.2011.08.009] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Revised: 08/02/2011] [Accepted: 08/20/2011] [Indexed: 12/20/2022]
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Tadakoshi M, Ishibashi H, Ishiguchi T, Sugimoto I, Iwata H, Yamada T, Hida N, Ohta T. Stent strut penetration during thoracic endovascular aortic repair: report of a case. Surg Today 2011; 42:493-6. [PMID: 22094436 DOI: 10.1007/s00595-011-0050-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 05/08/2011] [Indexed: 11/26/2022]
Abstract
We experienced a serious complication of proximal stent strut penetration (PSSP) during thoracic endovascular aortic repair in a 74-year-old man who underwent two-stage hybrid treatment for a distal arch thoracic aortic aneurysm. First, a debranching right common carotid-left common carotid-left subclavian artery bypass was performed. Second, a TALENT Thoracic Stent Graft (Medtronic, Tokyo, Japan) was inserted at Zone 1 (Ishimaru). At deployment, a proximal bare strut accidentally everted and penetrated the aortic wall vertically. Postoperative computed tomography revealed that one crown of the proximal strut had penetrated the aortic wall vertically and had produced an intramural hematoma around the strut. The patient was observed carefully and discharged from the hospital without any sequelae. Seven months after the procedure, there was no remarkable change and his aneurysm was well excluded. PSSP can cause retrograde type-A aortic dissections. A bare strut tends to cause proximal strut penetration more frequently than a covered strut. More caution should be taken in the deployment of a stent graft with a bare strut.
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Affiliation(s)
- Masao Tadakoshi
- Department of Vascular Surgery, Aichi Medical University, Nagakute, Aichi, 480-1195, Japan.
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Endovascular management of thoracic aortic aneurysms. Cardiovasc Intervent Radiol 2011; 34:1137-42. [PMID: 21290125 DOI: 10.1007/s00270-011-0101-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Accepted: 12/31/2010] [Indexed: 10/18/2022]
Abstract
The overall survival of patients with thoracic aortic aneurysm (TAA) has improved significantly in the past few years. Endovascular treatment, proposed as an alternative to surgery, has been considered a therapeutic innovation because of its low degree of invasiveness, which allows the treatment of even high-surgical risk patients with limited complications and mortality. A major limitation is the lack of adequate evidence regarding long-term benefit and durability because follow-up has been limited to just a few years even in the largest series. The combination of endovascular exclusion with visceral branch revascularization for the treatment of thoraco-abdominal aortic aneurysms involving the visceral aorta has also been attempted. As an alternative, endografts with branches represent a technological evolution that allows treatment of complex anatomy. Even if only small numbers of patients and short follow-up are available, this technical approach, which has with limited mortality (<10%) and paraplegia rates, to expand endovascular treatment to TAA seems feasible. With improved capability to recognize proper anatomy and select clinical candidates, the choice of endovascular stent-graft placement may offer a strategy to optimize management and improve prognosis.
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Dagenais F. Commentary: the valiant thoracic stent graft for endovascular repair of thoracic aortic aneurysms and dissections: looking good so far. J Endovasc Ther 2010; 17:151-2. [PMID: 20426629 DOI: 10.1583/09-2905c.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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