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Gao F, Zeng Q, Lin F, Ge X. Sandwich Technique for Endovascular Repair of Acute Type A Aortic Dissection. J Endovasc Ther 2017; 24:647-653. [PMID: 28747077 DOI: 10.1177/1526602817721674] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Overview: To describe a new endovascular procedure for acute type A aortic dissection (TAAD) repair. Methods: Between 2013 and 2016, 12 patients (average age 54±9.6 years; 10 men) with acute TAAD (mean EURO score 11.4%±3.2%, range 5–17) and unfit for surgery underwent thoracic endovascular aortic repair (TEVAR) with 2 periscope grafts to preserve blood supply to supra-aortic branches plus bypass grafting as needed. If the ascending aorta was dilated to >40 mm, sternotomy was performed to wrap the ascending aorta and reduce its diameter to accommodate the aortic stent-grafts. Results: All patients were successfully treated. Seven patients required bypass grafting, and most of the patients had periscope grafts to the innominate/right common carotid artery and left common carotid artery; only 3 patients had the left subclavian artery preserved. All patients exhibited good hemodynamics and normal pressures after the procedure. The mean procedure time and blood loss were 4.5±1.0 hours and 217±111.5 mL, respectively. Two patients treated emergently died shortly after surgery from multiorgan failure. The average follow-up duration was 17±14.5 months (range 2–42) in the 10 survivors. The remaining patients recovered and none experienced stent-graft thrombosis, stroke, or peripheral artery embolism during follow-up. Conclusion: A procedure that combines sandwich/periscope grafting with TEVAR, wrapping of the aorta, and supra-arch bypass grafting can be used to treat patients with acute TAAD.
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Affiliation(s)
- Feng Gao
- Department of Cardiovascular Surgery, Xiangya Haikou Hospital of Central South University, Haikou Municipal Hospital, Haikou Vascular Disease Research Institute, Haikou City, China
| | - Qian Zeng
- Department of Cardiovascular Surgery, Xiangya Haikou Hospital of Central South University, Haikou Municipal Hospital, Haikou Vascular Disease Research Institute, Haikou City, China
| | - Fangming Lin
- Department of Cardiovascular Surgery, Xiangya Haikou Hospital of Central South University, Haikou Municipal Hospital, Haikou Vascular Disease Research Institute, Haikou City, China
| | - Xiaohu Ge
- Department of Vascular Surgery, Municipal Hospital of XinJiang Province, China
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