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Miao L, Song L, Sun SK, Wang ZG. Meta-analysis of open surgical repair versus hybrid arch repair for aortic arch aneurysm. Interact Cardiovasc Thorac Surg 2016; 24:34-40. [DOI: 10.1093/icvts/ivw305] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 08/03/2016] [Accepted: 08/08/2016] [Indexed: 11/14/2022] Open
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Tokuda Y, Oshima H, Narita Y, Abe T, Mutsuga M, Fujimoto K, Terazawa S, Ito H, Hibino M, Uchida W, Komori K, Usui A. Extended total arch replacement via the L-incision approach: single-stage repair for extensive aneurysms of the aortic arch. Interact Cardiovasc Thorac Surg 2016; 22:750-5. [PMID: 26932664 DOI: 10.1093/icvts/ivw034] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 01/08/2016] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Total arch replacement via the L-incision approach (a combination of left anterior thoracotomy and upper median sternotomy) can be used to achieve more extensive replacement. METHODS In the period between 2002 and 2014, 279 total arch replacement procedures were performed. After excluding cases of acute aortic dissection and cases involving concomitant, hybrid or frozen elephant trunk procedures, patients who underwent isolated total arch replacement via an L-incision (n = 29) and via median sternotomy (n = 143) were identified and the data pertaining to their cases were analysed. RESULTS Operative mortality was higher in the L-incision group than in the median sternotomy group (6.9 vs 2.1%); however, the difference was not statistically significant. The L-incision group displayed a higher rate of respiratory complications, including pneumonia (28 vs 7.0%, P = 0.0034), the need for tracheostomy (17 vs 2.1%, P = 0.0038) and pulmonary haemorrhage (6.9 vs 0%, P = 0.028). The rate of paraplegia was similar between the groups (0 vs 1.4%, P = 1.00), despite the wider range replaced via the L-incision approach (7.3 ± 1.5 vs 4.7 ± 0.8 anatomical zones, P < 0.001). The rates of other complications and functional recovery were similar. The long-term survival (73 vs 84% at 5 years) and aortic event-free rates (94 vs 96% at 5 years) were similar in both groups. CONCLUSIONS A combination of left anterior thoracotomy and upper median sternotomy can be applied to the single-stage repair of extended aneurysms with acceptable results in appropriately selected patients.
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Affiliation(s)
- Yoshiyuki Tokuda
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Aichi, Japan
| | - Hideki Oshima
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Aichi, Japan
| | - Yuji Narita
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Aichi, Japan
| | - Tomonobu Abe
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Aichi, Japan
| | - Masato Mutsuga
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Aichi, Japan
| | - Kazuro Fujimoto
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Aichi, Japan
| | - Sachie Terazawa
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Aichi, Japan
| | - Hideki Ito
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Aichi, Japan
| | - Makoto Hibino
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Aichi, Japan
| | - Wataru Uchida
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Aichi, Japan
| | - Kimihiro Komori
- Department of Vascular Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Aichi, Japan
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Aichi, Japan
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Tokuda Y, Oshima H, Narita Y, Abe T, Araki Y, Mutsuga M, Fujimoto K, Terazawa S, Yagami K, Ito H, Yamamoto K, Komori K, Usui A. Hybrid versus open repair of aortic arch aneurysms: comparison of postoperative and mid-term outcomes with a propensity score-matching analysis. Eur J Cardiothorac Surg 2015; 49:149-56. [DOI: 10.1093/ejcts/ezv063] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 01/23/2015] [Indexed: 11/14/2022] Open
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Patel BN, Gayer G. Imaging of iatrogenic complications of the urinary tract: kidneys, ureters, and bladder. Radiol Clin North Am 2014; 52:1101-16. [PMID: 25173661 DOI: 10.1016/j.rcl.2014.05.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Iatrogenic complications of various severities may arise from many, if not all, forms of medical and surgical treatment. Most of these occur in spite of proper precautions. Every system in the human body may be affected, and the urinary tract is no exception. Radiologists are often the first to suspect and identify such iatrogenic injuries and, therefore, awareness of the pertinent imaging findings is vital. This review explores and illustrates many of the common and less common iatrogenic complications affecting the kidney, ureters, and bladder.
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Affiliation(s)
- Bhavik N Patel
- Division of Abdominal Imaging, Department of Radiology, Duke University Medical Center, 3808, Durham, NC 27710, USA
| | - Gabriela Gayer
- Division of Abdominal Imaging, Department of Radiology, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94304, USA; Department of Radiology, Sheba Medical Center, 2 Derech Sheba, Tel-Hashomer, Ramat-Gan 52621, Israel.
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Saratzis AN, Goodyear S, Sur H, Saedon M, Imray C, Mahmood A. Acute Kidney Injury After Endovascular Repair of Abdominal Aortic Aneurysm. J Endovasc Ther 2013; 20:315-30. [DOI: 10.1583/12-4104mr2.1] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Pisimisis GT, Bechara CF, Barshes NR, Lin PH, Lai WS, Kougias P. Risk factors and impact of proximal fixation on acute and chronic renal dysfunction after endovascular aortic aneurysm repair using glomerular filtration rate criteria. Ann Vasc Surg 2012; 27:16-22. [PMID: 23088805 DOI: 10.1016/j.avsg.2012.05.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 05/12/2012] [Accepted: 05/14/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND The incidence of renal impairment relevant to proximal fixation of aortic endograft devices remains unclear. METHODS Retrospective cohort of 208 consecutive patients that underwent EVAR from 2006 to 2011. Estimated glomerular filtration rate (eGFR) was based on MDRD study equation. Acute kidney injury (AKI) and chronic kidney disease (CKD) were classified with ADIQ/RIFLE criteria and National Kidney Foundation criteria, respectively. Kaplan-Meier curve was applied to evaluate progression to CKD. Multivariate regression model was fit to identify predictors for developing AKI and CKD. RESULTS Suprarenal fixation group (SF) included 110 patients and infrarenal fixation group (IF) included 98 patients. Both groups had similar demographics, baseline eGFR, and renal-protection protocols. There was a trend for decreased use of contrast in IF group (median: 93.5 vs. 103 cc, P = 0.07). AKI occurred in 15% of patients in SF group and 19% of patients in IF group (RR: 1.24, P = 0.47). The freedom from progression to stage 3 or 4 CKD in the SF group was 0.76, 0.72, and 0.49 at 6, 12, and 18 months, respectively, while for IF group was 0.8, 0.73, and 0.68, respectively (P = 0.4). Increasing age (P = 0.07), lengthy procedures (P < 0.001), and baseline renal dysfunction (P < 0.001) were significant predictors for developing CKD. Contrast volume (P < 0.001) and ace-inhibitors (P = 0.07) were predictors for AKI. CONCLUSION Proximal fixation type has no significant effect on both acute and chronic renal function. Identification of modifiable perioperative risk factors may be used to improve renal function outcomes.
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Affiliation(s)
- George T Pisimisis
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
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Placement of endovascular stent across the branching arteries: long-term serial evaluation of stent-tissue responses overlying the arterial orifices in an experimental study. Cardiovasc Intervent Radiol 2011; 35:1154-62. [PMID: 21826575 DOI: 10.1007/s00270-011-0243-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Accepted: 07/22/2011] [Indexed: 10/17/2022]
Abstract
PURPOSE This study was designed to investigate the effects of stenting across the branching arteries on the patency and stent-tissue responses over the branching arterial orifices. METHODS Thirteen dogs were observed after placing aortic stents across the celiac arteries (CA), superior mesenteric arteries (SMA), and renal arteries (RA). The animals were grouped according to stent types: large-cell group (n = 6) and small-cell group (n = 7). Angiography was performed to evaluate the branching artery patency at 2, 6, and 12 months after stent insertion, and the stent-tissue responses covering the orifices were evaluated on histopathologic examination. RESULTS All branching arteries were patent on follow-up angiography; however, three patterns of stent-tissue responses over the orifices were observed: neointimal layering, bridging septa, and papillary hyperplasia. Although neointimal layering and bridging septa were evenly observed, severe papillary hyperplasia was more frequent at SMA and CA than RA. Four RA showed less than 50% ostial patency, and localized infarct was observed in six kidneys (24%). The ostial patency tended to decrease with small-cell stent during the follow-up period. CONCLUSIONS Various stent-tissue responses over the branching artery orifices are induced by the aortic stent covering the branching arteries and may not be easily detected by conventional angiography. Subclinical renal infarct also may occur despite patent renal angiography.
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Kim B, Donayre CE, Hansen CJ, Aziz I, Walot I, Lippmann M, Kopchok GE, White RA. Endovascular Abdominal Aortic Aneurysm Repair Using the AneuRx® Stent Graft: Impact of Excluding Accessory Renal Arteries. Ann Vasc Surg 2004; 18:32-7. [PMID: 14727163 DOI: 10.1007/s10016-003-0093-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of this study was to evaluate clinical sequelae of accessory renal artery exclusion during endo-AAA repair. Medical records and pre- and postoperative CT scans were reviewed from 114 AAA patients treated with the AneuRx stent graft between 1996-2001. Thirty-seven accessory renal arteries were identified in 32/114 patients (28%) with 19/32 patients having infrarenally located accessory renal arteries. In group I (11 patients), the stent graft excluded 11 accessory renal arteries. In group II (8 patients), eight accessory renal arteries were not excluded. Average infrarenal neck length was 24.9 mm in group I vs. 30.7 mm in group II (p = 0.07). The average length of device seal was similar in both groups (19.4 vs. 18.5 mm, p = 0.67). There were no perioperative deaths, significant postoperative hypertension, rise in serum creatinine, or postoperative renal infarctions in either group. Three of eight patients (38%) in the non-excluded group developed type I proximal endoleaks whereas none in the excluded patient group did (p = 0.06). Accessory renal arteries may be safely excluded during endovascular AAA repair and may result in a more secure proximal device fixation.
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Affiliation(s)
- Benjamin Kim
- Department of Surgery, Harbor-UCLA Medical Center, Torrance 90509, CA
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Abstract
Treating patients with renovascular disease is complex, particularly as imaging and medical techniques become more effective. Atherosclerotic renal artery disease is present in 7% of the general population above age 65 and in 20 to 45% of patients with coronary disease or aortoiliac disease. Most patients are treated medically, but when progressive hypertension, renal insufficiency, or circulatory congestion develops, revascularization should be considered. Endovascular procedures with arterial stents are now widely employed. These procedures sometimes offer major benefits in blood pressure control and stabilization of renal function. Stent procedures continue to entail hazards, including atheroemboli, arterial dissections, and thrombosis, in addition to restenosis rates of 14 to 20%. Small, randomized trials to date demonstrate no survival benefit to either endovascular or surgical revascularization as compared with medical management. Recognizing renal artery disease and directing revascularization procedures to those with the most benefit remains a premier challenge for the clinician.
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Affiliation(s)
- Stephen C Textor
- Mayo Medical School, Division of Hypertension, Mayo Clinic Rochester, Minnesota 55905, USA.
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