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Cui C, Wang B, Liu W. Outcomes of fenestrated endovascular abdominal aortic repair in distal entry tears of chronic debakey IIIb aortic dissection. PLoS One 2024; 19:e0288218. [PMID: 38412141 PMCID: PMC10898741 DOI: 10.1371/journal.pone.0288218] [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: 07/10/2023] [Accepted: 01/23/2024] [Indexed: 02/29/2024] Open
Abstract
Currently, there have been very few reports within the literature which specifically address using fenestrated and branched stent grafts to completely isolate and repair distal entry tears of chronic DeBakey IIIb aortic dissection. This study aimed to evaluate the clinical outcomes of a 3-dimensional (3D) printed aortic model-guided fenestrated stent in the treatment of distal tears of chronic DeBakey IIIb aortic dissection after thoracic endovascular aortic repair (TEVAR). The study was a one-center retrospective study comprising 36 patients who underwent TEVAR and fenestrated endovascular abdominal aortic repair (F-EVAR) between April 2014 and December 2022. Patient data was compiled and analysed for preoperative, intraoperative, and perioperative characteristics. In total, 36 patients (12 females and 24 males) were incorporated into this study. All of the patients included in this study had hypertension, and among them, the leading cause for undergoing II-stage F-EVAR was the progression of a false lumen, accounting for 24 cases (66.7% of the total). The technical success rate was 97.2% and there were no cases of 30-day mortality, myocardial infarction, permanent paraparesis, or organ failure. One year post-F-EVAR treatment, surviving patients showed significant false and true lumen remodelling with 100% complete false-lumen thrombosis. A total of five patients died during the follow-up, two patients died related to aorta complications and three patients died of heart failure, multiple organ failure, or septic shock. II-stage F-EVAR was safe and feasible operation to repair all distal tears of chronic DeBakey IIIb aortic dissection.
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Affiliation(s)
- Chi Cui
- Center of Vascular and Interventional Surgery, Department of General Surgery, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University & The Second Affiliated Hospital of Chengdu, Chongqing Medical University, Chengdu, China
| | - Bisi Wang
- Center of Vascular and Interventional Surgery, Department of General Surgery, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University & The Second Affiliated Hospital of Chengdu, Chongqing Medical University, Chengdu, China
| | - Wei Liu
- Center of Vascular and Interventional Surgery, Department of General Surgery, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University & The Second Affiliated Hospital of Chengdu, Chongqing Medical University, Chengdu, China
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Vecchini F, Haupert G, Baudry A, Mancini J, Dumur L, Martinez R, Piquet P, Picquet J, Gaudry M. Risk Factors for Incomplete Aortic Remodeling With Stent-Assisted Balloon-Induced Intimal Disruption and Relamination in Aortic Dissection Repair for Complicated Aortic Dissection: Results of a Multicenter Study. J Endovasc Ther 2024; 31:69-79. [PMID: 35880296 DOI: 10.1177/15266028221111984] [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: 11/16/2022]
Abstract
PURPOSE The STABILISE technique has extended the treatment of aortic dissection to the thoracoabdominal aorta to achieve complete aortic remodeling. The aim of this multicenter study was to analyze the short- and midterm anatomical results of the STABILISE technique. MATERIALS AND METHODS We retrospectively analyzed patients treated with the STABILISE technique for complicated aortic dissection at 3 French academic centers. The aortic diameter at different levels was measured preoperatively, postoperatively, and at 1 year. RESULTS Between 2018 and 2020, 58 patients, including 47 men (average patient age: 60±11 years), were treated for type B aortic dissection in 34 cases and residual aortic dissection after type A repair in 24 cases. Three (5.2%) patients died postoperatively. Complete aortic remodeling (false lumen thrombosis and complete reapposition of the intimal flap) was achieved in 45/55 patients (81.8%), and false lumen thrombosis in the thoracic aorta was achieved in 52/55 patients (94.5%). At 1 year, with a computed tomographic (CT) scan available for 98.2% (54/55) of patients, we observed a significant decrease in the maximal thoracic aortic diameter and a significant increase in the aortic diameter at the bare-stent level compared with the preoperative CT scan. Severe aortic angulation (p=0.024) was a risk factor for incomplete aortic remodeling and significantly increased the aortic diameter (p=0.032). Chronic aortic dissection was associated with an increased risk of incomplete aortic remodeling (p=0.002). CONCLUSIONS STABILISE for complicated aortic dissection results in false lumen thrombosis, complete reapposition of the intimal flap, and a decrease in the maximum aortic diameter in most cases. Incomplete reapposition of the intimal flap, which is more frequent in cases of chronic aortic dissection and severe aortic angulation, is a risk factor for a significant increase in the aortic diameter at the bare-stent level, and this risk justifies close follow-up and better patient selection. CLINICAL IMPACT STABILISE technique for complicated aortic dissection results in false lumen thrombosis, complete aortic remodeling and a decrease in the maximum aortic diameter in most cases. At the bare-stent level, incomplete reapposition of the intimal flap, more frequent in chronic aortic dissection and severe aortic angulation, is a risk factor for an increased aortic diameter. This finding justifies close follow-up and better patient selection; thus, the STABILISE technique should be used with care in chronic aortic dissection and severe aortic angulation.
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Affiliation(s)
- Fabien Vecchini
- Department of Vascular Surgery, APHM, Timone Hospital, Marseille, France
- Aortic Center, APHM, Timone Hospital, Marseille, France
| | - Gautier Haupert
- Department of Vascular Surgery, Tours Academic Center, Tours, France
| | - Anna Baudry
- Department of Vascular Surgery, Angers Academic Center, Angers, France
| | - Julien Mancini
- APHM, INSERM, IRD Biostatistics Department, SESSTIM, BIOSTIC, Aix-Marseille University, Marseille, France
| | - Lucie Dumur
- Department of Vascular Surgery, Tours Academic Center, Tours, France
| | - Robert Martinez
- Department of Vascular Surgery, Tours Academic Center, Tours, France
| | - Philippe Piquet
- Department of Vascular Surgery, APHM, Timone Hospital, Marseille, France
- Aortic Center, APHM, Timone Hospital, Marseille, France
| | - Jean Picquet
- Department of Vascular Surgery, Angers Academic Center, Angers, France
| | - Marine Gaudry
- Department of Vascular Surgery, APHM, Timone Hospital, Marseille, France
- Aortic Center, APHM, Timone Hospital, Marseille, France
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Eleshra A, Haulon S, Bertoglio L, Lindsay T, Rohlffs F, Dias N, Tsilimparis N, Panuccio G, Kölbel T. Custom Made Candy Plug for Distal False Lumen Occlusion in Aortic Dissection: International Experience. Eur J Vasc Endovasc Surg 2023; 66:50-56. [PMID: 36958480 DOI: 10.1016/j.ejvs.2023.03.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 02/26/2023] [Accepted: 03/13/2023] [Indexed: 03/25/2023]
Abstract
OBJECTIVE To evaluate early and midterm outcomes of the Candy Plug (CP) technique for distal false lumen (FL) occlusion in thoracic endovascular aortic repair for aortic dissection (AD) in a more real world cohort of patients from an international multicentre registry. METHODS A multicentre retrospective study was conducted of all consecutive patients from the contributing centres with subacute and chronic AD treated with the CP technique from October 2013 to April 2020 at 18 centres. RESULTS A custom made CP was used in 155 patients (92 males, mean age 62 ± 11 years). Fourteen (9%) presented with ruptured false lumen aneurysms. Technical success was achieved in all patients (100%). Clinical success was achieved in 138 patients (89%). The median hospital stay was 7 days (1 - 77). The 30 day mortality rate was 3% (n = 5). Stroke occurred in four patients (3%). Spinal cord ischaemia occurred in three patients (2%). The 30 day computed tomography angiogram (CTA) confirmed successful CP placement at the intended level in all patients. Early complete FL occlusion was achieved in 120 patients (77%). Early (30 day) CP related re-intervention was required in four patients (3%). The early (30 day) stent graft related re-intervention rate was 8% (n = 12). Follow up CTA was available in 142 patients (92%), with a median follow up of 23 months (6 - 87). Aneurysmal regression was achieved in 68 of 142 patients (47%); the aneurysm diameter remained stable in 69 of 142 patients (49%) and increased in five of 142 patients (4%). A higher rate of early FL occlusion was detected in the largest volume centre patients (50 [88%] vs. 70 [71%] from other centres; p = .019). No other differences in outcome were identified regarding volume of cases or learning curve. CONCLUSION This international CP technique experience confirmed its feasibility and low mortality and morbidity rates. Aortic remodelling and false lumen thrombosis rates were high and support the concept of distal FL occlusion in AD using the CP technique.
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Affiliation(s)
- Ahmed Eleshra
- German Aortic Centre, University Heart & Vascular Centre, University Medical Centre Eppendorf, Hamburg, Germany; Department of Vascular Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
| | | | - Luca Bertoglio
- San Raffaele Hospital, Milan, Italy; Division of Vascular Surgery, Department of Sperimental and Clinical Sciences (DSCS), University and ASST Spedali Civili Hospital of Brescia, Brescia, Italy
| | | | - Fiona Rohlffs
- German Aortic Centre, University Heart & Vascular Centre, University Medical Centre Eppendorf, Hamburg, Germany
| | - Nuno Dias
- Skåne University Hospital, Malmö, Sweden
| | - Nikolaos Tsilimparis
- German Aortic Centre, University Heart & Vascular Centre, University Medical Centre Eppendorf, Hamburg, Germany; University Hospital, LMU, Munich, Germany
| | - Giuseppe Panuccio
- German Aortic Centre, University Heart & Vascular Centre, University Medical Centre Eppendorf, Hamburg, Germany
| | - Tilo Kölbel
- German Aortic Centre, University Heart & Vascular Centre, University Medical Centre Eppendorf, Hamburg, Germany
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Kuo CY, Huang CY, Chen TW, Hsu HL, Shih CC, Hsu CP. Outcomes of abdominal false lumen embolization for chronic aortic dissection after prior proximal repair with stent-graft. J Chin Med Assoc 2023; 86:633-640. [PMID: 37185220 DOI: 10.1097/jcma.0000000000000934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Persistent false lumen (FL) perfusion with aneurysmal formation is common after thoracic endovascular aortic repair (TEVAR) for typical extended aortic dissection and is associated with poor outcomes. Endovascular FL embolization (FLE) has recently been tried for treatment of postdissection aortic aneurysm (PDAA). However, most reports address thoracic rather than abdominal FLE. In this study, we present the results of abdominal FLE in patients with residual patent abdominal FL following stent-graft repair for aortic dissection. METHODS Between 2015 and 2019, 24 patients (mean age: 56.7 ± 11.8 years, range: 40-84 years, 18 male) received endovascular abdominal FLE using vascular plugs, coils, or candy plugs as the main surgery (5 patients) or auxiliary procedure (19 patients) after earlier stent-graft repair for aortic dissection (Type A: 9, Type B: 15). The medical records were reviewed and aortic remodeling was examined comparing the preembolization computed tomography (CT) and the most recent CT before reintervention. RESULTS Technical success was achieved without any intraoperative complications, early morbidity, or mortality. Median follow-up was 34.4 months (range: 12-71). Regarding thoracic FL, 15 patients exhibited complete thrombosis before the procedure and did not change status thereafter except for 1 patient with distal stent-graft-induced new entry. In the other 9 patients, 6 exhibited increased thrombosis. With regard to the abdominal aorta, increased FL thrombosis only occurred in 8 patients with 3 (12.5%) achieving complete thrombosis. The maximal thoracic aortic diameter did not change (1.4 ± 5.6 mm) statistically, but the abdominal diameter increased significantly (4.3 ± 3.7 mm, p < 0.005). CONCLUSION From our results, abdominal FLE is a safe procedure. However, covering all the re-entry tears is complex and the possibility of complete FL thrombosis is low. The abdominal aortic diameter appears to become enlarged in these patients. Continuous follow-up is necessary after FLE.
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Affiliation(s)
- Ching-Yuan Kuo
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taiwan, ROC
| | - Chun-Yang Huang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taiwan, ROC
| | - Tai-Wei Chen
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taiwan, ROC
| | - Hung-Lung Hsu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Cardiovascular Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
| | - Chun-Che Shih
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Cardiovascular Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, ROC
| | - Chiao-Po Hsu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taiwan, ROC
- Department of Surgery, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan, ROC
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Tang QH, Chen J, Long Z, Wang YL, Su XA, Qiu JY, Lin QN, Zhang JF, Qin X. Factors affecting distal false lumen enlargement after thoracic endovascular aortic repair for type B aortic dissection. Heliyon 2023; 9:e17248. [PMID: 37383200 PMCID: PMC10293708 DOI: 10.1016/j.heliyon.2023.e17248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 06/30/2023] Open
Abstract
Objective To investigate the factors influencing distal false lumen enlargement after thoracic endovascular aortic repair (TEVAR) for type B aortic dissection. Materials and methods Data were collected on patients with type B aortic dissection who underwent TEVAR from January 2008 to August 2022. Patients were divided into a distal aortic segmental enlargement (DSAE) group and a non-DSAE group based on whether the distal false lumen was dilated more than 5 mm on computed tomographic angiography (CTA) images. To analyze the independent influences on distal false lumen dilatation after TEVAR, the variables with a P value < 0.05 during univariate analysis were included in the binary logistic regression analysis model. Results A total of 335 patients were included in this study, with 85 in the DSAE group and 250 in the non-DSAE group. The mean age was 52.40 ± 11.34 years, 289 (86.27%) were male patients, and the median follow-up time was 6.41 (11.99-29.99) months. There were significant differences in Marfan syndrome, chronic obstructive pulmonary disease (COPD), and follow-up time between the two groups. In terms of morphology, there were statistically significant differences in the number of tears, the size of the primary tear, and the length of dissection between the two groups. Binary logistic regression analysis indicated that Marfan syndrome, COPD, and the primary tear size were associated with distal false lumen dilatation. Conclusions Marfan syndrome, COPD, and the primary tear size influence distal aortic segmental enlargement after TEVAR in type B aortic dissection patients.
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Chiba K, Nishimaki H, Ogawa Y, Tomita M, Nakamura R, Kinebuchi S, Kita S, Komagamine M, Nawata K, Chikada M, Miyairi T. Midterm Results of Thoracic Endovascular Aortic Repair with Reentry Closure for Chronic Type B Aortic Dissection with Aneurysmal Dilatation. Ann Vasc Dis 2022; 15:308-316. [PMID: 36644254 PMCID: PMC9816023 DOI: 10.3400/avd.oa.22-00065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 10/13/2022] [Indexed: 11/26/2022] Open
Abstract
Objectives: This study aims to discuss the midterm results of thoracic endovascular aortic repair (TEVAR) with reentry closure for chronic type B aortic dissection (CTBAD). Materials and Methods: This retrospective study analyzed 13 patients with CTBAD who underwent TEVAR with reentry closure between July 2014 and December 2020. We evaluated the false lumen (FL) cross-sectional area using computed tomography images of the descending aorta at the level of the bronchial bifurcation, Valsalva sinus, celiac artery, and infrarenal abdominal aorta pre- and postoperation. The study endpoints were technical and clinical success rates, freedom from additional aortic reintervention or surgery, and survival. Results: Technical success was obtained in 12 patients (92.3%) with no hospital mortality and neurological complications. The postoperative observation period was 49.2±21.5 months. The clinical success rate was 76.9% (10 cases), and a postoperative reduction of the FL cross-sectional area was obtained in 53.8% of patients. The 5-year overall survival rate was 64.8% with no aortic-related deaths while the 5-year freedom from additional aortic surgery rate was 66.7%. Conclusions: TEVAR with reentry closure suggests preventing FL dilatation or rupture in CTBAD, but the revision of our devices and further research with more patients and longer follow-up periods are required.
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Affiliation(s)
- Kiyoshi Chiba
- Department of Cardiovascular Surgery, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan,Corresponding author: Kiyoshi Chiba, MD, PhD. Department of Cardiovascular Surgery, St Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan Tel: +81-44-977-8111, Fax: +81-44-976-5792, E-mail:
| | - Hiroshi Nishimaki
- Department of Cardiovascular Surgery, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Yukihisa Ogawa
- Department of Radiology, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Masahiro Tomita
- Department of Cardiovascular Surgery, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Ryuji Nakamura
- Department of Cardiovascular Surgery, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Satoshi Kinebuchi
- Department of Cardiovascular Surgery, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Shota Kita
- Department of Cardiovascular Surgery, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Masahide Komagamine
- Department of Cardiovascular Surgery, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Kan Nawata
- Department of Cardiovascular Surgery, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Masahide Chikada
- Department of Cardiovascular Surgery, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Takeshi Miyairi
- Department of Cardiovascular Surgery, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
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Yi JA, Magee GA, Potter HA, Kuwayama DP. False lumen intercostal artery embolization to halt type R entry flow in chronic type B aortic dissection. Ann Vasc Surg 2022; 88:1-8. [DOI: 10.1016/j.avsg.2022.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/15/2022] [Accepted: 07/21/2022] [Indexed: 11/01/2022]
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Langouet Q, Marchand E, Nauta A, Loreille F, Aupart M, Bourguignon T, Martinez R. Initial Study of the Extended STABILISE Technique for Complete Remodeling in Aortic Dissection. Ann Vasc Surg 2022; 86:373-379. [PMID: 35395379 DOI: 10.1016/j.avsg.2022.03.024] [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: 01/07/2022] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Thoracic endovascular aortic repair (TEVAR) is the standard treatment for acute complicated type B aortic dissection (TBAD). However, long-term results reveal that TEVAR does not achieve a complete aortic remodeling and poses a risk of aneurysmal aortic degeneration. Distal reentry treatment at the abdominal level seems to be necessary to obtain a complete remodeling in TBAD. Moreover, it is necessary to treat the aortoiliac bifurcation in patients with persistent true lumen collapse or limb ischemia. METHODS Between January 2018 and October 2019, 11 patients with acute or sub-acute complicated TBAD or non-A non-B aortic dissection were treated in our institution in an endovascular fashion. We performed the stent-assisted balloon-induced intimal disruption and relamination in aortic dissection repair (STABLISE) technique in all cases, but two cases required complementary treatment of the aortoiliac bifurcation with a bifurcated AFX endograft system for limb ischemia due to true lumen collapse. RESULTS Technical success was obtained in all patients. No procedural complications occurred. No postoperative deaths, stroke, paraplegia, mesenteric, or renal ischemia were observed, and no secondary intervention was necessary. Satisfactory aortic remodeling was obtained after the follow-up periods with a 57.5% mean true lumen expansion. CONCLUSION Our initial experience using the extended STABILISE (e-STABILISE) technique using a bifurcated AFX endograft did not result in any postoperative mortality or complications. Without additional data, this technique should be reserved for specific patients who require revascularization of the aortoiliac bifurcation.
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Affiliation(s)
- Quentin Langouet
- Department of Cardio-Vascular and Thoracic Surgery. CHRU Tours, Chambray-lès-Tours, Avenue de la République, Loire Valley. France.
| | - Etienne Marchand
- Department of Cardio-Vascular and Thoracic Surgery. CHRU Tours, Chambray-lès-Tours, Avenue de la République, Loire Valley. France
| | - Anapa Nauta
- Department of Cardio-Vascular and Thoracic Surgery. CHRU Tours, Chambray-lès-Tours, Avenue de la République, Loire Valley. France
| | - Frederic Loreille
- Department of Cardio-Vascular and Thoracic Surgery. CHRU Tours, Chambray-lès-Tours, Avenue de la République, Loire Valley. France
| | - Michel Aupart
- Department of Cardio-Vascular and Thoracic Surgery. CHRU Tours, Chambray-lès-Tours, Avenue de la République, Loire Valley. France
| | - Thierry Bourguignon
- Department of Cardio-Vascular and Thoracic Surgery. CHRU Tours, Chambray-lès-Tours, Avenue de la République, Loire Valley. France
| | - Robert Martinez
- Department of Cardio-Vascular and Thoracic Surgery. CHRU Tours, Chambray-lès-Tours, Avenue de la République, Loire Valley. France
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Hl L, Yc C, Hy J, Sw C. Methods and outcomes of endovascular false lumen embolization for thoracic aortic dissection. Ann Vasc Surg 2022; 85:371-382. [PMID: 35339592 DOI: 10.1016/j.avsg.2022.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 02/08/2022] [Accepted: 03/12/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To provide a contemporary review on endovascular false lumen (FL) embolization for thoracic aortic dissection (AD) and evaluate its early outcome. METHODS A systematic literature review on FL embolization for thoracic AD from January 2003 to December 2020 was performed under the instruction of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. Each article was analyzed using a standardized protocol including predefined demographic characteristics, perioperative mortality and major complications. RESULTS A total of 29 papers with 229 patients were included into the analysis. The methods of FL occlusion used were: the Candy-Plug technique, the knickerbocker technique, the "cork in the bottleneck" technique and direct FL embolization with combination of stent-grafts, coils, onyx, plugs and glue. FL embolization procedure was performed in 79 patients (34.5%) with type A AD and 150 (65.5%) with type B AD. FL direct embolization was the most frequently used technique, and it was applied in 198 (86.5%) patients. Candy-plug, knickerbocker and "cork in the bottleneck" techniques were used in 26 (11.4%), 3 (1.3%) and 2 (0.9%) patients, respectively. Technical success was achieved in all patients except one (228/229, 99.6%) in which implantation of a stent to celiac trunk was not possible. There were four hospital deaths (1.7%). Neurological complications occurred in 6 patients (2.6%), including 4 (1.7%) spinal cord ischemia and 2 (0.9%) ischemic stroke. There were 1 (0.4%) iatrogenic retrograde dissection and 2 (0.9%) renal failure reported. The mean duration of follow-up was 16.5 months. There were 21 deaths (9.3%) during follow-up, and 8 (3.6%) were aorta-related. Thirty-three (14.7%) secondary intervention were performed. Five patients (2.2%) required open completion thoracoabdominal procedure incorporating the stent-graft into the repair. Complete FL thrombosis was observed in 181 (80.4%) patients, 34 (15.1%) had partial thrombosis, and 10 (4.4%) had FL progression. CONCLUSIONS FL embolization of the distal thoracic aorta is a promising technique in a group of patients to promote FL thrombosis and aortic remodeling in thoracic aorta.
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Affiliation(s)
- Li Hl
- Division of Vascular Surgery, Department of Surgery, University of Hong Kong- Shenzhen Hospital, Shenzhen, China
| | - Chan Yc
- Division of Vascular Surgery, Department of Surgery, University of Hong Kong- Shenzhen Hospital, Shenzhen, China; Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, South Wing, 14(th) Floor K Block, Queen Mary Hospital, Hong Kong, China.
| | - Jia Hy
- Department of Vascular Surgery & Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Cheng Sw
- Division of Vascular Surgery, Department of Surgery, University of Hong Kong- Shenzhen Hospital, Shenzhen, China; Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, South Wing, 14(th) Floor K Block, Queen Mary Hospital, Hong Kong, China
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Yuan X, Mitsis A, Mozalbat D, Nienaber CA. Alternative management of proximal aortic dissection: concept and application. Indian J Thorac Cardiovasc Surg 2021; 38:183-192. [PMID: 35463707 PMCID: PMC8980987 DOI: 10.1007/s12055-021-01281-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 11/17/2022] Open
Abstract
Open surgery remains the mainstay of treatment for acute type A aortic dissection and should be offered to most patients. However, there are elderly patients in which surgical treatment may be deemed extremely high risk or futile. Endovascular treatment approaches have been applied to a small number of these patients and data are limited to case reports and small series. The application of endovascular therapies to ascending aorta is currently limited by anatomical and technical challenges posed by the dynamic motion of the ascending aorta and the proximity of vital structures to intended landing zones (aortic valve, coronary arteries, and supra-aortic branches) and lack of specially designed endografts to address these issues. While thoracic endovascular aortic repair (TEVAR) has replaced open aortic repair for a suitable lesion in distal aortic dissection, some selected patients with type A aortic dissection at high surgical may be candidates. Hence, there is potential because, in proximal (Stanford type A) dissections, 10–30% of patients are not accepted for surgery, and 30–50% are technically amenable for TEVAR. Recent experience has shown that carefully selected patients with favorable anatomical characteristics may be subject to endovascular stent-graft treatment as a last resort with mixed results. Technical improvement is necessary to offer. satisfactory endovascular options in non-surgical candidates.
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Zhou M, Liu F, Shu X, Shi Z, Guo D, Wang L, Fu W. Spot Stenting Combined With False Lumen Endovascular Occlusive Repair for Post-dissection Abdominal Aortic Aneurysm. J Endovasc Ther 2021; 29:705-710. [PMID: 34872378 DOI: 10.1177/15266028211062564] [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: 11/16/2022]
Abstract
PURPOSE To introduce a new spot stenting, combined with a false lumen endovascular occlusive repair (SS-FLEVOR) technique for treating post-dissection abdominal aortic aneurysms. TECHNIQUE This technique is demonstrated in a 74-year-old man who received an initial thoracic endovascular aortic repair 7 years ago and suffered from distal aortic expansion during the follow-up session. All the tears located more than 15 mm away from the orifice of visceral arteries were excluded by spot stenting in the aortic true lumen. Then, a compliant stent-graft was implanted in the false lumen to seal the tears near the visceral arteries orifice from the outside. In addition, coils were deployed to block the potential backflow from the intercostal arteries and to induce false lumen thrombosis. Moreover, visceral arteries originated from false lumen were repaired by covered-stents implanted from the true lumen. The distal iliac arteries were sealed either with iliac extensions or cover-stents. This new technique has been applied in 5 patients, resulting in 100% technical success and encouraging intermediate outcomes. CONCLUSION SS-FLEVOR is a feasible and safe technique to promote false lumen thrombosis in selected cases.
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Affiliation(s)
- Min Zhou
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, Shanghai, China.,Institute of Vascular Surgery, Fudan University, Shanghai, China
| | - Fei Liu
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, Shanghai, China.,Institute of Vascular Surgery, Fudan University, Shanghai, China
| | - Xiaolong Shu
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, Shanghai, China.,Institute of Vascular Surgery, Fudan University, Shanghai, China
| | - Zhenyu Shi
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, Shanghai, China.,Institute of Vascular Surgery, Fudan University, Shanghai, China
| | - Daqiao Guo
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, Shanghai, China.,Institute of Vascular Surgery, Fudan University, Shanghai, China
| | - Lixin Wang
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, Shanghai, China.,Institute of Vascular Surgery, Fudan University, Shanghai, China.,Department of Vascular Surgery, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China
| | - Weiguo Fu
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, Shanghai, China.,Institute of Vascular Surgery, Fudan University, Shanghai, China.,Department of Vascular Surgery, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China
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12
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Chronic Chest Pain After Uncomplicated Type B Aortic Dissection: An Unusual Application of Embolotherapy. Cardiovasc Intervent Radiol 2021; 45:261-263. [PMID: 34853871 DOI: 10.1007/s00270-021-03009-7] [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: 07/19/2021] [Accepted: 11/11/2021] [Indexed: 10/19/2022]
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13
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Logghe G, Trachet B, Segers P, De Backer J, Mulorz J, Dueppers P, Vermassen F, Schelzig H, Van Herzeele I, Wagenhäuser MU. Outflow Through Aortic Side Branches Drives False Lumen Patency in Type B Aortic Dissection. Front Cardiovasc Med 2021; 8:710603. [PMID: 34485410 PMCID: PMC8414589 DOI: 10.3389/fcvm.2021.710603] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 07/02/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD) aims to induce false lumen (FL) thrombosis by sealing intimal tears between the true (TL) and the FL, and blocking the inflow into the FL. Incomplete thrombosis of the FL is correlated with poor clinical outcome. We hypothesize that the number of major and minor branches arising from the FL affects FL patency and may negatively influence TEVAR induced FL thrombosis. Methods: Computed tomography (CT)-scans from 89 patients diagnosed with TBAD [best medical treatment (BMT) n = 52, TEVAR n = 37] from two high-volume vascular surgery centers were analyzed retrospectively. Analysis included evaluation of the FL patency status, the number, location and size of intimal tears, and the presence of minor and major side branches originating from the FL. Multiple regression analysis was conducted to evaluate obtained parameters as predictors for FL thrombosis status. Results: In univariate analysis, the strongest correlation for FL patency was found for the number of major (R = 0.79) and minor (R = 0.86) side branches originating from the FL. When applying a multiple linear regression model, the number of major (normalized beta 0.37; P < 0.001) and minor (normalized beta 0.41; P < 0.01) side branches arising from the FL were valid predictors for the axial length of the patent and non-patent FL, and additionally determined the length of the patent FL at 12-month follow-up in patients that underwent TEVAR. Conclusions: Our data suggest that the number of minor side branches that originate from the FL in TBAD is an important determinant of FL patency, to a greater degree than previously assumed.
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Affiliation(s)
- Gerlinde Logghe
- Institute for Biomedical Engineering and Technology, Ghent University, Ghent, Belgium
| | - Bram Trachet
- Institute for Biomedical Engineering and Technology, Ghent University, Ghent, Belgium
| | - Patrick Segers
- Institute for Biomedical Engineering and Technology, Ghent University, Ghent, Belgium
| | - Julie De Backer
- Department of Cardiology and Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Joscha Mulorz
- Department of Vascular- and Endovascular Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Philip Dueppers
- Department of Vascular- and Endovascular Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,Department of Vascular Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Frank Vermassen
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Hubert Schelzig
- Department of Vascular- and Endovascular Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Markus U Wagenhäuser
- Department of Vascular- and Endovascular Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
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14
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Eleshra A, Rohlffs F, Spanos K, Panuccio G, Heidemann F, Tsilimparis N, Kölbel T. Aortic Remodeling After Custom-Made Candy-Plug for Distal False Lumen Occlusion in Aortic Dissection. J Endovasc Ther 2021; 28:399-406. [PMID: 33634714 DOI: 10.1177/1526602821996722] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To report a single-center experience with the use of a custom-made Candy-Plug (CP) for distal false-lumen (FL) occlusion in subacute and chronic aortic dissection (AD). MATERIALS AND METHODS A retrospective single-center analysis was conducted on consecutive patients with subacute and chronic AD who were treated with a custom-made CP for distal FL occlusion using 3 design generations (CP I to CP III) from October 2013 to September 2019. RESULTS A custom-made CP was used in 57 patients. Of these, 34 patients (29 males, mean age 62±10 years) were treated with a CP I vs 23 patients (16 males, mean age 59±17 years) with CP II/III. Technical success was achieved in 57 (100%) patients. Clinical success was achieved in 54 (95%) patients; 33 (97%) in CP I group vs 21 (91%) patients in CP II/III group, p=0.116. The mean hospital stay was 10±8 days (9±5 days in CP I group vs 13±9 days in CP II/III, p=0.102). The 30-day computed tomography angiography (CTA) confirmed successful CP placement at the intended level in all patients within both groups. Early complete FL occlusion was achieved in 50 (88%) patients; 30 (88%) patients in CP I group vs 20 (87%) in CP II/III group, p=0.894. Follow up CTA was available in 44 (77%) patients. Of these; 30/34 (88%) patients in CP I group with mean follow-up 29±17 months) vs. 14/23 (61%) patients with mean follow-up 14±5 months in CP II/III group. Thoracic aortic remodeling was achieved in 34/44 (77%) patients; 25/30 (83%) patients in CP I group vs 9/14 (64%) patients in CP II/III group, p=0.197. The aneurysm size remained stable in 9/44 (20%) patients; 5/30 (17%) patients in CP I group vs 4/14 (29%) patients in CP II/III group, p=0.741. The thoracic aneurysm increased size was seen in 1/44 (2%) patient. This patient was in CPII/III group. CONCLUSION CP technique using custom-made devices is technically feasible with a low mortality and morbidity, and a high rate of aortic remodeling. Both, the original design (CP I) and newer designs with a self-closing central sleeve (CP II and CP III) showed similar excellent outcomes.
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Affiliation(s)
- Ahmed Eleshra
- German Aortic Center, Department of Vascular Medicine, University Heart & Vascular Center Hamburg, Germany
| | - Fiona Rohlffs
- German Aortic Center, Department of Vascular Medicine, University Heart & Vascular Center Hamburg, Germany
| | - Konstantinos Spanos
- German Aortic Center, Department of Vascular Medicine, University Heart & Vascular Center Hamburg, Germany
| | - Giuseppe Panuccio
- German Aortic Center, Department of Vascular Medicine, University Heart & Vascular Center Hamburg, Germany
| | - Franziska Heidemann
- German Aortic Center, Department of Vascular Medicine, University Heart & Vascular Center Hamburg, Germany
| | - Nikolaos Tsilimparis
- German Aortic Center, Department of Vascular Medicine, University Heart & Vascular Center Hamburg, Germany
| | - Tilo Kölbel
- German Aortic Center, Department of Vascular Medicine, University Heart & Vascular Center Hamburg, Germany
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15
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Jansen AJS, van Schaik PM, Martens JM, Reijnen MMPJ. Embolization of the false lumen using IMPEDE-FX embolization plugs as part of treatment of an infrarenal post-dissection aneurysm: a case report. CVIR Endovasc 2020; 3:91. [PMID: 33275193 PMCID: PMC7718367 DOI: 10.1186/s42155-020-00183-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/26/2020] [Indexed: 01/02/2023] Open
Abstract
Background This case report demonstrates the value of IMPEDE-FX plugs in an embolization procedure of a false lumen of an infrarenal post-dissection aneurysm. Case presentation A 69-year-old patient was treated with mitral valve replacement, complicated by a Stanford type-A dissection. After 9 years he presented with an enlarging infrarenal post-dissection aneurysm. The false lumen was embolized using multiple IMPEDE-FX plugs as part of the treatment in addition to embolization of the inferior mesenteric artery and overstenting of the re-entry in the right iliac artery. At 15 months the CTA showed a fully thrombosed false lumen and remodeling of the true lumen. Conclusions The false lumen of an infrarenal post-dissection aneurysm can successfully be embolized using IMPEDE-FX embolization plugs as part of the treatment strategy. Prospective trials on patients with non-thrombosed false lumina are indicated.
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Affiliation(s)
- Anne-Jet S Jansen
- Department of Surgery, Rijnstate, P.O. Box 9555, 6800, TA, Arnhem, The Netherlands
| | - Paul M van Schaik
- Department of Surgery, Rijnstate, P.O. Box 9555, 6800, TA, Arnhem, The Netherlands
| | | | - Michel M P J Reijnen
- Department of Surgery, Rijnstate, P.O. Box 9555, 6800, TA, Arnhem, The Netherlands. .,Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, The Netherlands.
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16
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Zeng Z, Zhao Y, Wu M, Bao X, Li T, Feng J, Feng R, Jing Z. Endovascular strategies for post-dissection aortic aneurysm (PDAA). J Cardiothorac Surg 2020; 15:287. [PMID: 33004048 PMCID: PMC7528487 DOI: 10.1186/s13019-020-01331-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 09/22/2020] [Indexed: 11/23/2022] Open
Abstract
Residual patent false lumen (FL) after type B aortic dissection (TBAD) repair is independently associated with poor long-term survival. Open surgery and endovascular repair result in good clinical outcomes in patients with AD. However, both treatments focus on proximal dissection but not distal dissection. About 13.4–62.5% of these patients present with different degrees of distal aneurysmal dilatation after primary repair. Although open surgery is the first-choice treatment for post-dissection aortic aneurysm (PDAA), there is a need for high technical demand since open surgery is associated with high mortality and morbidity. As a treatment strategy with minimal invasion, endovascular repair shows early benefits and low morbidity. For PDAA, the narrow true lumen (TL), rigid initial flap and branch arteries originating from FL have increased difficulties in operation. The aim of endovascular treatment is to promote FL thrombosis and aortic remodeling. Endovascular repair includes intervention from FL and TL sides. TL intervention techniques (parallel stent-graft, branched and fenestrated stent-graft among others) have been proven to be safe and effective in PDAA. Other FL intervention techniques that have been used in selected patients include FL embolization and candy-plug techniques. This article introduces available endovascular techniques and their outcomes for the treatment of PDAA.
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Affiliation(s)
- Zhaoxiang Zeng
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Yuxi Zhao
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Mingwei Wu
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Xianhao Bao
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Tao Li
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Jiaxuan Feng
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China.
| | - Rui Feng
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China.
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China.
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17
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Magee GA, Yi JA, Kuwayama DP. Intercostal artery embolization to induce false lumen thrombosis in type B aortic dissection. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:433-437. [PMID: 32775849 PMCID: PMC7396825 DOI: 10.1016/j.jvscit.2020.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 05/14/2020] [Indexed: 11/16/2022]
Abstract
Persistent false lumen flow is common after thoracic endovascular aortic repair of type B aortic dissection and may contribute to continued aortic aneurysmal degeneration. We report an innovative technique of intercostal artery embolization within the false lumen for a patient who had incomplete false lumen thrombosis and progressive aortic enlargement after thoracic endovascular aortic repair of chronic type B aortic dissection. Technical success was facilitated by use of on-table cone beam computed tomography angiography, virtual vessel marking, and modern endovascular tools. The patient had no complications from the procedure. Postoperative imaging demonstrated complete thoracic false lumen thrombosis and favorable aortic remodeling with reduction in maximal aortic diameter.
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Affiliation(s)
- Gregory A. Magee
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck Medical Center of University of Southern California, Los Angeles, Calif
- Correspondence: Gregory A. Magee, MD, MSc, Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck Medical Center of University of Southern California, 1520 San Pablo St, Ste 4300, Los Angeles, CA 90033
| | - Jeniann A. Yi
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Colorado, Aurora, Colo
| | - David P. Kuwayama
- Section of Vascular Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
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18
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Yuan X, Mitsis A, Semple T, Rubens M, Nienaber CA. Dual lumen intervention for aortic dissection: long-term impact on aortic remodeling. ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2020. [DOI: 10.23736/s1824-4777.20.01441-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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19
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Wang L, Liu F, Fu W. Commentary: Techniques for Treating Postdissection Thoracoabdominal Aortic Aneurysm: Can Parallel Stent-Grafts Challenge Fenestrated/Branched Technology for Total Endovascular Repair? J Endovasc Ther 2019; 26:676-678. [PMID: 31402732 DOI: 10.1177/1526602819866436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Lixin Wang
- Department of Vascular Surgery, Zhongshan Hospital, and Vascular Surgery Institute of Fudan University, Shanghai, China.,Department of Vascular Surgery, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China
| | - Fei Liu
- Department of Vascular Surgery, Zhongshan Hospital, and Vascular Surgery Institute of Fudan University, Shanghai, China
| | - Weiguo Fu
- Department of Vascular Surgery, Zhongshan Hospital, and Vascular Surgery Institute of Fudan University, Shanghai, China.,Department of Vascular Surgery, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China
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20
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Moore MJ, Malaxos L, Doyle BJ. Development of a shear-thinning biomaterial as an endovascular embolic agent for the treatment of type B aortic dissection. J Mech Behav Biomed Mater 2019; 99:66-77. [PMID: 31344524 DOI: 10.1016/j.jmbbm.2019.07.016] [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: 12/19/2018] [Revised: 05/10/2019] [Accepted: 07/18/2019] [Indexed: 11/30/2022]
Abstract
False lumen embolisation is a promising treatment strategy in type B aortic dissection (TBAD) but it is limited by the lack of a disease-specific embolic agent. Our aim was to develop a biomaterial that could be delivered minimally-invasively into the TBAD false lumen and embolise the region. We created 24 shear-thinning biomaterials from blends of gelatin, silicate nanoparticles and silk fibroin, and evaluated their suitability as a false lumen embolic agent in TBAD. We determined the stability of mechanical properties by measuring the compressive modulus of samples stored in physiological conditions over a 21 day period. We quantified injectability by measuring the force required to inject each biomaterial through catheters of varying diameter. We also assessed in vitro degradation rates by measuring weight change over 30 days. Finally, we developed an in vitro experimental pulsatile flow setup with two different anatomically-correct TBAD geometries and performed 78 false lumen occlusion experiments under different operating conditions. We found that the compressive moduli changed rapidly on exposure to 37 °C before stabilising by Day 7. A high silicate nanoparticle to gelatin ratio resulted in greater compressive moduli, with a maximum of 117.6 ± 15.2 kPa. By reducing the total solid concentration, we could improve injectability and biomaterials with 8% (w/v) solids required <80 N force to be injected through a 4.0 mm catheter. Our in vitro degradation rates showed that the biomaterial only degraded by 1.5-8.4% over a 30 day period. We found that the biomaterial could occlude flow to the false lumen in 99% of experiments. In conclusion, blends with high silicate nanoparticle and low silk fibroin content warrant further investigation for their potential as false lumen embolic agents and could be a promising alternative to current TBAD repair methods.
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Affiliation(s)
- Matthew J Moore
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Australia; School of Biomedical Science, The University of Western Australia, Perth, Australia
| | - Lauren Malaxos
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Australia; School of Engineering, The University of Western Australia, Perth, Australia
| | - Barry J Doyle
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Australia; School of Engineering, The University of Western Australia, Perth, Australia; Australian Research Council Centre for Personalised Therapeutics Technologies, Australia; BHF Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK.
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21
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Molinari AC, Leo E, Ferraresi M, Ferrari SA, Terzi A, Sommaruga S, Rossi G. Distal Extended Endovascular Aortic Repair PETTICOAT: A Modified Technique to Improve False Lumen Remodeling in Acute Type B Aortic Dissection. Ann Vasc Surg 2019; 59:300-305. [PMID: 31075476 DOI: 10.1016/j.avsg.2019.02.053] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 02/11/2019] [Accepted: 02/25/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Data from the literature suggest that in patients with acute, complicated type B aortic dissection (cTBAD), initial successful treatment with thoracic endovascular aneurysm repair (TEVAR) is not necessarily associated with favorable remodeling of the dissected aorta during follow-up, and long-term results indicate that TEVAR failed to completely suppress false lumen patency. Sealing of all relevant distal reentries, infrarenal and/or iliac, seems to be the key issue to induce total false lumen thrombosis in abdominal aorta as well as the iliac arteries, especially in complicated patients presenting with malperfusion or complete true lumen collapse. MATERIALS AND METHODS Of the 34 consecutive patients diagnosed with cTBAD at our hospital from January 2015 to April 2018, 30 had complicated dissections receiving endovascular treatment according to the standard Provisional ExTension To Induce COmplete ATtachment (PETTICOAT) technique and were excluded from this study, whereas 4 patients with radiologic evidence of multiple reentry tears at detached lumbar arteries and iliac bifurcation with complete true lumen collapse and clinical evidence of malperfusion were treated with a modified PETTICOAT technique with distal extension of the aortic stent, balloon expansion of the stented true lumen, and use of the AFX bifurcated endograft system to preserve the natural aortic bifurcation and provide complete distal sealing of reentry tears. RESULTS Primary technical success was achieved in all patients. No postoperative deaths were observed, but 1 patient experienced an hemorrhagic shock on the second postoperative day. No patient suffered postoperative stroke, paraplegia, paraparesis, or acute renal failure. CONCLUSIONS Using an abdominal aortic bifurcated endograft with PETTICOAT to treat acute cTBAD seems to be a feasible approach in high-risk patients to improve aortic remodeling. The AFX bifurcated endograft system meets the requirements of anatomical fixation and sealing of distal tears.
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Affiliation(s)
- Alessandro C Molinari
- Division of Vascular Surgery, Department of Cardiovascular Diseases, A. Manzoni Hospital, Lecco, Italy
| | - Enrico Leo
- Division of Vascular Surgery, Department of Cardiovascular Diseases, A. Manzoni Hospital, Lecco, Italy.
| | - Marco Ferraresi
- Division of Vascular Surgery, Department of Cardiovascular Diseases, A. Manzoni Hospital, Lecco, Italy
| | - Stefano A Ferrari
- Division of Vascular Surgery, Department of Cardiovascular Diseases, A. Manzoni Hospital, Lecco, Italy
| | - Angelo Terzi
- Division of Vascular Surgery, Department of Cardiovascular Diseases, A. Manzoni Hospital, Lecco, Italy
| | - Simona Sommaruga
- Division of Vascular Surgery, Department of Cardiovascular Diseases, A. Manzoni Hospital, Lecco, Italy
| | - Giovanni Rossi
- Division of Vascular Surgery, Department of Cardiovascular Diseases, A. Manzoni Hospital, Lecco, Italy
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22
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Coil Embolization for Persistent Thoracic False Lumen of Type B Aortic Dissection after Thoracic Endovascular Aortic Repair. Ann Vasc Surg 2019; 57:60-68. [DOI: 10.1016/j.avsg.2018.09.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 09/26/2018] [Accepted: 09/28/2018] [Indexed: 11/18/2022]
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23
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Kuo TT, Huang CY, Chen PL, Chen IM, Shih CC. Impact of Renal Artery Stent-Graft Placement on Renal Function in Chronic Aortic Dissection. J Vasc Interv Radiol 2019; 30:979-986. [PMID: 30982639 DOI: 10.1016/j.jvir.2018.12.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 12/09/2018] [Accepted: 12/11/2018] [Indexed: 01/03/2023] Open
Abstract
PURPOSE To evaluate the effect of renal stent-graft placement on kidney function and size alternation in chronic aortic dissection. MATERIALS AND METHODS Twenty-five consecutive patients with chronic aortic dissection after thoracic endovascular aortic repair who underwent renal stent-graft placement between January 2015 and December 2016 were retrospectively reviewed. Forty-three patients with chronic aortic dissection who received thoracic endovascular aortic repair in the same period were reviewed as a control group for kidney volume comparison. RESULTS Twenty-five stent-grafts were deployed over 25 renal arteries. Overall renal function was assessed by the slope of the regression line constructed from the plots of creatinine clearance versus time within 2 years after the procedure (-0.2810 vs -0.3146 mL/min-1/mo-1, P = .868), kidney volume at 12 months (129.4 ± 40.9 vs 137.0 ± 44.2 cm2, P = .193) and effective renal plasma flow at 6 months (106.3 ± 46.9 vs 124.4 ± 55.5 mL/min, P = .050) and was not significantly deteriorated. Seven treated patients (87.5%) with a renal artery supplied by a false lumen had a decrease in kidney volume, as did 14 patients (56%) in the control group (P = .206). Three patients with a dissected renal artery (75%) in the stent-graft group had an increase in kidney volume compared with 1 patient (11.1%) in the control group (P = .052). CONCLUSIONS Occlusion of the re-entry tear by a stent-graft in the renal artery remains a safe strategy to promote false lumen thrombosis. The stent-graft poses a potential risk of reducing the kidney volume in kidneys supplied by the false lumen but may provide a positive effect in kidney volume with a concomitant dissected renal artery in chronic aortic dissection.
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Affiliation(s)
- Tzu-Ting Kuo
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taiwan; Department of Medicine, School of Medicine, National Yang Ming University, No. 201, Section 2, Shipai Road, Beitou District, Taipei City, Taiwan
| | - Chun-Yang Huang
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taiwan; Department of Medicine, School of Medicine, National Yang Ming University, No. 201, Section 2, Shipai Road, Beitou District, Taipei City, Taiwan
| | - Po-Lin Chen
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taiwan; Department of Medicine, School of Medicine, National Yang Ming University, No. 201, Section 2, Shipai Road, Beitou District, Taipei City, Taiwan
| | - I-Ming Chen
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taiwan; Institute of Clinical Medicine, School of Medicine, National Yang Ming University, No. 201, Section 2, Shipai Road, Beitou District, Taipei City, Taiwan
| | - Chun-Che Shih
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taiwan; Institute of Clinical Medicine, School of Medicine, National Yang Ming University, No. 201, Section 2, Shipai Road, Beitou District, Taipei City, Taiwan.
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24
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Intentional Targeted False Lumen Occlusion after Aortic Dissection: A Systematic Review of the Literature. Ann Vasc Surg 2019; 56:317-329. [DOI: 10.1016/j.avsg.2018.08.086] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/20/2018] [Accepted: 08/21/2018] [Indexed: 11/15/2022]
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25
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Pellenc Q, Roussel A, De Blic R, Girault A, Cerceau P, Ben Abdallah I, Milleron O, Jondeau G, Castier Y. False lumen embolization in chronic aortic dissection promotes thoracic aortic remodeling at midterm follow-up. J Vasc Surg 2019; 70:710-717. [PMID: 30850289 DOI: 10.1016/j.jvs.2018.11.038] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 11/11/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Failure of thoracic endovascular aortic repair (TEVAR) in chronic aortic dissections can be partially explained by retrograde false lumen (FL) flow through distal re-entry tears. After implantation of a thoracic stent graft, FL thrombosis occurs in less than 50% of the cases. The objectives of this study were to describe the feasibility and outcomes of FL embolization in patients with chronic aortic dissections. METHODS Between June 2015 and January 2018, 27 patients (mean age, 61 ± 14 years) with chronic aortic dissection underwent FL embolization as an adjunct during or after TEVAR placement procedure. Indications for embolization were (1) symptomatic chronic aortic dissections with pain or rapid growth of aortic diameter (≥5 mm/y) requiring rapid exclusion of the aneurysm, (2) aneurysmal dilatation with persistent FL retrograde flow after TEVAR, and (3) large FL aneurysms (≥55 mm) that might lead to persistent retrograde flow. Twenty patients presented with type B chronic aortic dissections (74.1%) and seven presented a residual type A chronic aortic dissections (25.9%). Eight patients had a previous aortic arch replacement (29.6%). Six patients had previous repair with TEVAR (22.2%). The delay between the onset of dissection and the first endovascular repair was 47 months (range, 3-144). Spinal fluid drainage was used in 74.1% of cases (20/27 patients). Embolization devices included coils and vascular plugs. RESULTS The technical success rate was 100% (27/27). Complete spinal cord ischemia was observed in one patient (3.7%). There was one hospital death from pneumonia after zone 1 supra-aortic trunk debranching with TEVAR and embolization. After the index procedure, FL thrombosis was observed in 81.5% of patients (22/27) on late phase computed tomography angiography. Five patients required two or more embolization procedures, leading to a high rate of complete FL thrombosis (92.6%). One patient presented a type IB endoleak and one patient presented a type II endoleak. Radiologic follow-up was 20 ± 10 months. The maximum thoracic aortic diameter significantly decreased from 63 mm to 54 ± 10 mm (P < .001). CONCLUSIONS Embolization of the FL of chronic aortic dissections is technically feasible with a low morbidity rate. The FL thrombosis is observed in the majority of case and promotes favorable thoracic aortic remodeling. Longer follow-up is needed to confirm these good results on the thoracic aorta and this technique may, therefore, improve the results of TEVAR in chronic aortic dissections.
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Affiliation(s)
- Quentin Pellenc
- Vascular Surgery Department, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France; Paris-Diderot University, Paris, France.
| | - Arnaud Roussel
- Vascular Surgery Department, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France; Paris-Diderot University, Paris, France
| | - Romain De Blic
- Vascular Surgery Department, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Antoine Girault
- Vascular Surgery Department, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France; Paris-Diderot University, Paris, France
| | - Pierre Cerceau
- Vascular Surgery Department, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Iannis Ben Abdallah
- Vascular Surgery Department, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France; Paris-Diderot University, Paris, France
| | - Olivier Milleron
- Paris-Diderot University, Paris, France; Cardiology Department, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Guillaume Jondeau
- Paris-Diderot University, Paris, France; Cardiology Department, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Yves Castier
- Vascular Surgery Department, Bichat Hospital, Assistance Publique-Hopitaux de Paris, Paris, France; Paris-Diderot University, Paris, France
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Rohlffs F, Tsilimparis N, Mogensen J, Makaloski V, Debus S, Kölbel T. False Lumen Occlusion in Chronic Aortic Dissection: The New Generation Candy-Plug II. Ann Vasc Surg 2019; 57:261-265. [PMID: 30690161 DOI: 10.1016/j.avsg.2018.10.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 10/08/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND To introduce the new generation Candy-Plug II with a self-closing channel construction inside the plug. METHODS The technique of the Candy-Plug II was demonstrated in a 50-year-old patient with residual chronic aortic dissection and thoracic false lumen aneurysm with false lumen backflow after open surgical repair of the ascending aorta for acute type A aortic dissection. The Candy-Plug Technique was applied in addition to a branched arch procedure using a new generation Candy-Plug II for false lumen occlusion. The Candy-Plug II is a short tubular stent graft with a small open channel inside the graft to accommodate the central cannula and allow retrieval of the dilator tip, which closes itself as soon as the dilator tip is removed. The channel inside the graft is unsupported and will collapse and thereby close. This new design obviates additional placement of a plug to occlude the midsection of the first-generation Candy-Plug. After deployment of the Candy-Plug, distal false lumen occlusion was confirmed on final angiogram and postoperative computed tomography scans without any leakage through the Candy-Plug. CONCLUSIONS The new generation Candy-Plug II is a useful refinement of the previously available model. It reduces the procedural steps and provides a longer sealing segment.
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Affiliation(s)
- Fiona Rohlffs
- Department of Vascular Medicine, German Aortic Center, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
| | - Nikolaos Tsilimparis
- Department of Vascular Medicine, German Aortic Center, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | | | - Vladimir Makaloski
- Department of Vascular Medicine, German Aortic Center, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Sebastian Debus
- Department of Vascular Medicine, German Aortic Center, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Tilo Kölbel
- Department of Vascular Medicine, German Aortic Center, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Modified Candy-Plug Technique for Rescue Type B Aortic Dissection with False Lumen Rupture. Ann Vasc Surg 2018; 56:355.e7-355.e9. [PMID: 30500653 DOI: 10.1016/j.avsg.2018.08.109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 08/11/2018] [Indexed: 11/23/2022]
Abstract
Despite recent advances in surgical techniques and endovascular devices, the management of ruptured type B aortic dissection remains challenging. Herein, we describe a patient with a history of chronic type B aortic dissection who presented to the emergency department with a massive left hemothorax and profound shock. Computed tomography demonstrated a thoracic dissecting aneurysm with false lumen rupture. He underwent emergent thoracic endovascular aortic repair and carotid-carotid crossover bypass in a hybrid operating room. Although the thoracic endovascular aortic repair resulted in suitable sealing over the primary entry tear, aortography revealed prominent retrograde flow through the distal re-entry tear into the false lumen. To depressurize the ruptured aortic segment fully, we implanted a modified candy-plug device in the false lumen and successfully occluded the retrograde flow. This case report illustrates the preliminary experience of using modified candy-plug device to rescue a critical patient with ruptured type B aortic dissection.
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Kim TH, Song SW, Lee KH, Baek MY, Yoo KJ, Cho BK. The effect of false lumen procedures during thoracic endovascular aortic repair in patients with chronic DeBakey type IIIB dissections. J Vasc Surg 2018; 68:976-984. [DOI: 10.1016/j.jvs.2018.01.045] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 01/20/2018] [Indexed: 11/25/2022]
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Rohlffs F, Spanos K, Tsilimparis N, Debus ES, Kölbel T. Techniques and outcomes of false lumen embolization in chronic type B aortic dissection. THE JOURNAL OF CARDIOVASCULAR SURGERY 2018; 59:784-788. [PMID: 29943961 DOI: 10.23736/s0021-9509.18.10638-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Endovascular strategies have been increasingly used for the treatment of chronic type B aortic dissection (cTBAD) offering better outcomes in terms of mortality and morbidity compared to open surgical repair. Aortic remodeling after standard TEVAR is less likely in cTBAD due to rigidity of the dissection membrane. Another limitation of endovascular therapy is continued retrograde false lumen perfusion with back-flow from distal entry tears. Treatment strategies in cTBAD should aim at false lumen thrombosis. There are many approaches to achieve this goal of false lumen thrombosis, but concepts as open surgery or fenestrated and branched endovascular repair are limited by either high technical and logistic demands to the surgeon or high rates of mortality and morbidity. False lumen embolization techniques offer less invasive treatment strategies with promising early results. The main strategies for false lumen embolization include the "cork in the bottle neck" technique, the Candy-Plug technique or the Knickerbocker-technique. This article describes technical aspects and early results of these new endovascular techniques of false lumen embolization in chronic aortic dissection.
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Affiliation(s)
- Fiona Rohlffs
- Department of Vascular Medicine, German Aortic Center, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany -
| | - Konstantinos Spanos
- Department of Vascular Medicine, German Aortic Center, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Nikolaos Tsilimparis
- Department of Vascular Medicine, German Aortic Center, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Eike S Debus
- Department of Vascular Medicine, German Aortic Center, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Tilo Kölbel
- Department of Vascular Medicine, German Aortic Center, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Marques de Marino P, Oikonomou K, Verhoeven EL, Katsargyris A. Techniques and outcomes of secondary endovascular repair for postdissection TAA/TAAA. THE JOURNAL OF CARDIOVASCULAR SURGERY 2018; 59:767-774. [PMID: 29790721 DOI: 10.23736/s0021-9509.18.10591-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Postdissection aortic aneurysms (PDAA) affect 20-40% of patients with aortic dissection. Open repair remains the first line therapy of PDAA, but is still associated with high mortality and morbidity rates. Endovascular repair is increasingly being used as a less invasive treatment option. Thoracic endovascular aneurysm repair (TEVAR) covering only the proximal entry tear has proven to be insufficient in most patients with chronic PDAA and has a limited role only for PDAA with distal sealing zone in the thoracic aorta. In PDAA extending to the thoracoabdominal aorta, a more complex repair is needed to achieve aneurysm exclusion. Fenestrated and branched stent-grafts have been used lately in some expert centres to treat PDAA of the thoracoabdominal aorta with good preliminary results despite the technical difficulties in these patients (narrow true lumen, stiff chronic dissection flap, target vessels that originate from the false lumen [FL]). A subset of patients with aneurysmal degeneration mainly in the descending thoracic aorta, can be treated with TEVAR landing proximal to the celiac artery along with adjuvant techniques such as coils, plugs, glue or "Candy-Plug" and "Knickerbocker" concepts to occlude the FL, preventing retrograde flow and reducing the pressure in the aneurysm. Other options that have been used in limited numbers of patients with PDAA include the PETTICOAT (provisional extension to induce complete attachment) and STABILISE (Stent-Assisted Balloon-Induced Intimal Disruption and Relamination in Aortic Dissection Repair) techniques. This article aims to review the outcomes of different endovascular techniques and strategies available for the repair of PDAA.
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Affiliation(s)
- Pablo Marques de Marino
- Department of Vascular and Endovascular Surgery, Klinikum Nuremberg, Paracelsus Medical University, Nuremberg, Germany
| | - Kyriakos Oikonomou
- Department of Vascular and Endovascular Surgery, Klinikum Nuremberg, Paracelsus Medical University, Nuremberg, Germany.,Department of Vascular Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Eric L Verhoeven
- Department of Vascular and Endovascular Surgery, Klinikum Nuremberg, Paracelsus Medical University, Nuremberg, Germany -
| | - Athanasios Katsargyris
- Department of Vascular and Endovascular Surgery, Klinikum Nuremberg, Paracelsus Medical University, Nuremberg, Germany
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False lumen intervention to promote remodelling and thrombosis-The FLIRT concept in aortic dissection. Catheter Cardiovasc Interv 2018; 92:732-740. [DOI: 10.1002/ccd.27599] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 02/01/2018] [Accepted: 02/23/2018] [Indexed: 01/16/2023]
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Kinoshita R, Ganaha F, Ito J, Ohyama N, Abe N, Yamazato T, Munakata H, Mabuni K, Kugai T. Multiple Re-entry Closures After TEVAR for Ruptured Chronic Post-dissection Thoraco-abdominal Aortic Aneurysm. EJVES Short Rep 2018; 38:15-18. [PMID: 29780894 PMCID: PMC5956622 DOI: 10.1016/j.ejvssr.2018.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 01/09/2018] [Accepted: 01/17/2018] [Indexed: 11/21/2022] Open
Abstract
Introduction Although thoracic endovascular aortic repair (TEVAR) has become a promising treatment for complicated acute type B dissection, its role in treating chronic post-dissection thoraco-abdominal aortic aneurysm (TAA) is still limited owing to persistent retrograde flow into the false lumen (FL) through abdominal or iliac re-entry tears. Report A case of chronic post-dissection TAA treatment, in which a dilated descending FL ruptured into the left thorax, is described. The primary entry tear was closed by emergency TEVAR and multiple abdominal re-entries were closed by EVAR. In addition, major re-entries at the detached right renal artery and iliac bifurcation were closed using covered stents. To close re-entries as far as possible, EVAR was carried out using the chimney technique, and additional aortic extenders were placed above the coeliac artery. A few re-entries remained, but complete FL thrombosis of the rupture site was achieved. Follow-up computed tomography showed significant shrinkage of the FL. Discussion In treating post-dissection TAA, entry closure by TEVAR is sometimes insufficient, owing to persistent retrograde flow into the FL from abdominal or iliac re-entries. Adjunctive techniques are needed to close these distal re-entries to obtain complete FL exclusion, especially in rupture cases. Recently, encouraging results of complete coverage of the thoraco-abdominal aorta with fenestrated or branched endografts have been reported; however, the widespread employment of such techniques appears to be limited owing to technical difficulties. The present method with multiple re-entry closures using off the shelf and immediately available devices is an alternative for the endovascular treatment of post-dissection TAA, especially in the emergency setting. A case of ruptured post-dissection thoraco-abdominal aneurysm was treated. Following entry closure by TEVAR, EVAR was performed to close multiple re-entries. Re-entries at the renal artery ostium and iliac artery were closed by covered stents. Complementary re-entry closure techniques are essential to treat false lumen rupture. This report demonstrates successful re-entry closure techniques following TEVAR.
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Affiliation(s)
- R Kinoshita
- Department of Radiology, Okinawa Prefectural Nanbu Medical Centre, Okinawa, Japan
| | - F Ganaha
- Department of Radiology, Okinawa Prefectural Nanbu Medical Centre, Okinawa, Japan
| | - J Ito
- Department of Radiology, Okinawa Prefectural Nanbu Medical Centre, Okinawa, Japan
| | - N Ohyama
- Cardiovascular Surgery, Okinawa Prefectural Nanbu Medical Centre, Okinawa, Japan
| | - N Abe
- Cardiovascular Surgery, Okinawa Prefectural Nanbu Medical Centre, Okinawa, Japan
| | - T Yamazato
- Cardiovascular Surgery, Okinawa Prefectural Nanbu Medical Centre, Okinawa, Japan
| | - H Munakata
- Cardiovascular Surgery, Okinawa Prefectural Nanbu Medical Centre, Okinawa, Japan
| | - K Mabuni
- Cardiovascular Surgery, Okinawa Prefectural Nanbu Medical Centre, Okinawa, Japan
| | - T Kugai
- Cardiovascular Surgery, Okinawa Prefectural Nanbu Medical Centre, Okinawa, Japan
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Jin J, Bai J, Wu Y, Zhi K, Wang X, Wen X, Wu J, Qu L. A Novel Reverse Branch Technique for Reconstruction of a Renal Artery Perfused by the False Lumen After Thoracic Endovascular Aortic Repair. J Endovasc Ther 2017; 24:814-818. [PMID: 28814170 DOI: 10.1177/1526602817725265] [Citation(s) in RCA: 2] [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 an innovative endovascular technique that successfully reconstructs a renal artery completely perfused by the false lumen after thoracic endovascular aortic repair (TEVAR). CASE REPORT A 65-year-old patient diagnosed with acute Stanford type B aortic dissection underwent successful TEVAR 4 years ago. Regular follow-up found that the thoracic aorta was well repaired, but the false lumen in the abdominal aorta had enlarged year by year. The left renal artery was supplied entirely by the false lumen, which caused kidney hypoperfusion. The abdominal aorta was successfully remodeled using endovascular aneurysm repair with reconstruction of the left renal artery using Viabahn stent-grafts inserted through the patent false lumen. At 6 months, computed tomography showed false lumen thrombosis and patent Viabahn stent-grafts in the false lumen. CONCLUSION The false lumen reverse branch technique was feasible in our case, which provides a new idea for dealing with distal dissection involving the renovisceral arteries after TEVAR.
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Affiliation(s)
- Jie Jin
- 1 Department of Vascular and Endovascular Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jun Bai
- 1 Department of Vascular and Endovascular Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yongfa Wu
- 1 Department of Vascular and Endovascular Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Kangkang Zhi
- 1 Department of Vascular and Endovascular Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Xiaomin Wang
- 1 Department of Vascular and Endovascular Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Xingzhu Wen
- 1 Department of Vascular and Endovascular Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jianjin Wu
- 1 Department of Vascular and Endovascular Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Lefeng Qu
- 1 Department of Vascular and Endovascular Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
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Rohlffs F, Tsilimparis N, Fiorucci B, Heidemann F, Debus ES, Kölbel T. The Candy-Plug Technique: Technical Aspects and Early Results of a New Endovascular Method for False Lumen Occlusion in Chronic Aortic Dissection. J Endovasc Ther 2017; 24:549-555. [PMID: 28490232 DOI: 10.1177/1526602817709252] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To describe the technical aspects and early results of the Candy-Plug technique for endovascular false lumen occlusion in chronic aortic dissection. METHODS A retrospective single-center study analyzing 18 consecutive patients (mean age 63 years, range 44-76; 16 men) with thoracic false lumen aneurysm in chronic aortic dissection. All patients underwent thoracic endovascular aortic repair with false lumen occlusion using the Candy-Plug technique. Primary endpoints consisted of technical success (successful deployment) and clinical success (no false lumen backflow). Secondary endpoints included 30-day mortality and morbidity as well as aortic remodeling during follow-up. RESULTS Technical success was 100%. Additional intraprocedural false lumen embolization at the Candy-Plug level was needed in 1 patient due to persisting false lumen backflow on the final angiogram (clinical success 94%). There were no intraprocedural complications. In the perioperative period, there were 3 minor complications: transient mild spinal cord ischemia, cervical hematoma after carotid-subclavian bypass, and a common femoral artery pseudoaneurysm. No deaths or reinterventions occurred. Complete distal false lumen occlusion was present on postoperative computed tomography in 15 patients, while 3 had minor contrast enhancement in the distal false lumen. Over a mean 9-month follow-up (range 0-26), 1 patient died due to rupture. Follow-up >6 months was available in 10 patients (mean 14.7 months, range 7-26): 7 patients showed aortic remodeling, while aneurysm size was stable in 3 patients. CONCLUSION The Candy-Plug technique is a feasible endovascular method to achieve false lumen occlusion and aortic remodeling in chronic aortic dissection. It is associated with low morbidity and mortality due to its minimal invasiveness.
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Affiliation(s)
- Fiona Rohlffs
- 1 German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Nikolaos Tsilimparis
- 1 German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Beatrice Fiorucci
- 1 German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.,2 Unit of Vascular and Endovascular Surgery, Hospital S. Maria della Misericordia, University of Perugia, Italy
| | - Franziska Heidemann
- 1 German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Eike Sebastian Debus
- 1 German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Tilo Kölbel
- 1 German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Tripodi P, Mestres G, Briceño M, Monterrosas OG, Riambau V. New Indications for Vascular Occluders in Secondary Repairs of Complex Aortic Pathologies. Ann Vasc Surg 2017; 39:285.e9-285.e15. [DOI: 10.1016/j.avsg.2016.06.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 05/28/2016] [Accepted: 06/12/2016] [Indexed: 12/01/2022]
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Kim TH, Song SW, Lee KH, Baek MY, Yoo KJ. Effects of False Lumen Procedures on Aorta Remodeling of Chronic DeBakey IIIb Aneurysm. Ann Thorac Surg 2016; 102:1941-1947. [DOI: 10.1016/j.athoracsur.2016.05.036] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 04/27/2016] [Accepted: 05/09/2016] [Indexed: 11/28/2022]
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Wojtaszek M, Wnuk E, Maciag R, Lamparski K, Korzeniowski K, Rowinski O. Promoting False-Lumen Thrombosis after Thoracic Endovascular Aneurysm Repair in Type B Aortic Dissection by Selectively Excluding False-Lumen Distal Entry Tears. J Vasc Interv Radiol 2016; 28:168-175. [PMID: 27645464 DOI: 10.1016/j.jvir.2016.07.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 06/29/2016] [Accepted: 07/08/2016] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To evaluate the efficacy and clinical outcomes of ancillary endovascular procedures in promoting false-lumen (FL) thrombosis (FLT) and preventing aortic expansion in patients after thoracic endografting for type B dissections. MATERIALS AND METHODS This retrospective review included 15 patients (12 men and 3 women; mean age, 59.6 y). Mean aortic diameter at the time of ancillary treatment was 47.4 mm. Different techniques were used as single procedures or sequentially: covered stent occlusion of detached visceral artery entry tears, occlusion of single entry tears with vascular plugs, or aortic endograft occlusion of multiple FL entry tears. FL embolization with ethylene vinyl alcohol copolymer was performed when selective occlusion was considered insufficient to close distal entry tears. Apart from endovascular aneurysm repair, all procedures were performed percutaneously under local anesthesia. If FL diameter increase persisted after 6-month follow-up computed tomographic (CT) angiography, another intervention was planned; otherwise, yearly follow-up was performed. RESULTS Mean clinical follow-up duration was 43.8 months (range, 8 d to 86.8 mo), with no in-hospital mortality. Estimated overall survival rates were 93.3%, 86.6%, and 77% at 12, 24, and 48 months, respectively. Three late deaths occurred, one of which was dissection-related at 40 months. Eight surviving patients (53%) had total FLT and 3 had partial FLT with stable aortic diameter on follow-up CT angiography. FL diameter increased in one patient, requiring further intervention. CONCLUSIONS Selective exclusion of new distal entry tears remaining after thoracic endovascular aneurysm repair can stabilize abdominal aortic expansion and promote FLT.
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Affiliation(s)
- Mikolaj Wojtaszek
- Second Department of Clinical Radiology, Medical University of Warsaw, Banacha 1A, Warsaw 02-097, Poland.
| | - Emilia Wnuk
- Second Department of Clinical Radiology, Medical University of Warsaw, Banacha 1A, Warsaw 02-097, Poland
| | - Rafal Maciag
- Second Department of Clinical Radiology, Medical University of Warsaw, Banacha 1A, Warsaw 02-097, Poland
| | - Krzysztof Lamparski
- Second Department of Clinical Radiology, Medical University of Warsaw, Banacha 1A, Warsaw 02-097, Poland
| | - Krzysztof Korzeniowski
- Second Department of Clinical Radiology, Medical University of Warsaw, Banacha 1A, Warsaw 02-097, Poland
| | - Olgierd Rowinski
- Second Department of Clinical Radiology, Medical University of Warsaw, Banacha 1A, Warsaw 02-097, Poland
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Nauta FJH, Conti M, Kamman AV, van Bogerijen GHW, Tolenaar JL, Auricchio F, Figueroa CA, van Herwaarden JA, Moll FL, Trimarchi S. Biomechanical Changes After Thoracic Endovascular Aortic Repair in Type B Dissection. J Endovasc Ther 2015; 22:918-33. [DOI: 10.1177/1526602815608848] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Thoracic endovascular aortic repair (TEVAR) has evolved into an established treatment option for type B aortic dissection (TBAD) since it was first introduced 2 decades ago. Morbidity and mortality have decreased due to the minimally invasive character of TEVAR, with adequate stabilization of the dissection, restoration of true lumen perfusion, and subsequent positive aortic remodeling. However, several studies have reported severe setbacks of this technique. Indeed, little is known about the biomechanical behavior of implanted thoracic stent-grafts and the impact on the vascular system. This study sought to systematically review the performance and behavior of implanted thoracic stent-grafts and related biomechanical aortic changes in TBAD patients in order to update current knowledge and future perspectives.
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Affiliation(s)
- Foeke J. H. Nauta
- Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Italy
- Departments of Surgery and Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
- Department of Vascular Surgery, University Medical Center Utrecht, the Netherlands
| | - Michele Conti
- Department of Civil Engineering and Architecture, University of Pavia, Italy
| | - Arnoud V. Kamman
- Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Italy
- Departments of Surgery and Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
- Department of Vascular Surgery, University Medical Center Utrecht, the Netherlands
| | | | - Jip L. Tolenaar
- Department of General Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
| | | | - C. Alberto Figueroa
- Departments of Surgery and Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | | | - Frans L. Moll
- Department of Vascular Surgery, University Medical Center Utrecht, the Netherlands
| | - Santi Trimarchi
- Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Italy
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Coil Embolization of the False Lumen in Complicated Type B Aortic Dissection. Ann Vasc Surg 2015; 29:125.e13-7. [DOI: 10.1016/j.avsg.2014.07.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 06/29/2014] [Accepted: 07/26/2014] [Indexed: 11/23/2022]
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40
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Outcomes after false lumen embolization with covered stent devices in chronic dissection. J Vasc Surg 2014; 60:1507-13. [DOI: 10.1016/j.jvs.2014.08.094] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 08/22/2014] [Indexed: 11/24/2022]
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41
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Hofferberth SC, Nixon IK, Boston RC, McLachlan CS, Mossop PJ. Stent-Assisted Balloon-Induced Intimal Disruption and Relamination in Aortic Dissection Repair: The STABILISE concept. J Thorac Cardiovasc Surg 2014; 147:1240-5. [DOI: 10.1016/j.jtcvs.2013.03.036] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 03/08/2013] [Accepted: 03/19/2013] [Indexed: 11/16/2022]
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42
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Kölbel T, Carpenter SW, Lohrenz C, Tsilimparis N, Larena-Avellaneda A, Debus ES. Addressing Persistent False Lumen Flow in Chronic Aortic Dissection: The Knickerbocker Technique. J Endovasc Ther 2014; 21:117-22. [DOI: 10.1583/13-4463mr-r.1] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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San Norberto EM, Taylor J, Vaquero C. Commentary: aortic false lumen thrombosis and remodeling: the paradigm for endovascular repair of aortic dissection. J Endovasc Ther 2012; 19:546-8. [PMID: 22891839 DOI: 10.1583/12-3844c.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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