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Li S, Wang W, Sun X, Liu Z, Zeng R, Shao J, Liu B, Chen Y, Ye W, Zheng Y. Monocentric Evaluation of Physician-Modified Fenestrations or Parallel Endografts for Complex Aortic Diseases. J Endovasc Ther 2024; 31:936-948. [PMID: 36647195 DOI: 10.1177/15266028221149918] [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: 01/18/2023]
Abstract
PURPOSE This study aimed to investigate the demographic and anatomic characteristics, as well as perioperative and follow-up results of fenestration and parallel techniques for the endovascular repair of complex aortic diseases. MATERIALS AND METHODS A retrospective study was conducted on 67 consecutive patients underwent endovascular treatment for complex aortic diseases including abdominal aortic aneurysm (AAA), thoracoabdominal aneurysm (TAAA), aortic dissection, or prior endovascular repair with either fenestrated and parallel endovascular aortic repair (f-EVAR or ch-EVAR) at a single institute from 2013 to 2021. Choices of intervention were made by the disease' emergency, patients' general condition, the anatomic characteristics, as well as following the recommendation from the devices' guidelines. Patients' clinical demographics, aortic disease characteristics, perioperative details, and disease courses were discussed. Short- and mid-term follow-up results were obtained and analyzed. Endpoints were aneurysm-related and unrelated mortality, branch instability, and renal function deterioration. RESULTS Totally, 34 and 27 patients received f-EVAR and ch-EVAR, while 6 patients received a combination of both. Fenestrated endovascular aortic repair was conducted mainly in AAA affecting visceral branches and TAAA, whereas ch-EVAR was normally utilized for infrarenal AAA. Regarding the average number of reconstructed arteries per patient, there was a significant difference among f-EVAR, ch-EVAR, and the combination group (mean = 2.3 ± 0.9, 1.4 ± 0.6, 3.5 ± 0.5, p<0.001). Primary technical success was achieved in 28 (82.4%), 22 (81.5%), and 3 (50.0%) patients for each group. Besides operational time (5.77 ± 2.58, 4.47 ± 1.44, p=0.033), no significant difference was observed for blood transfusion, intensive care unit (ICU) or hospital stay, blood creatinine level, 30-day complications, or follow-up complications between patients undergoing f-EVAR or ch-EVAR. Patients receiving combination of both techniques had a higher rate of blood transfusion (p=0.044), longer operational time (p=0.008) or hospital stay (p=0.017), as well as more stent occlusion (p=0.001), endoleak (p=0.004) at short-term and a higher rate of endoleak (p=0.023) at mid-term follow-up. CONCLUSION In conclusion, this study demonstrated that f-EVAR and ch-EVAR techniques had acceptable perioperative and follow-up results and should be considered viable alternatives when encountering complex aortic diseases. CLINICAL IMPACT This study sought to investigate the baseline and pathological characteristics, as well as perioperative and follow-up results of f-EVAR and ch-EVAR at a single Chinese institution. F-EVAR (mostly physician-modified f-EVAR) was applied in patients with a wide range of etiologies and disease types, while ch-EVAR was preferred for AAA in older patients with an average higher ASA grade. Our experience suggested acceptable safety and efficacy both for techniques, and no significant difference was observed between the two groups regarding any short or mid-term adverse events.
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Affiliation(s)
- Siting Li
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
- Department of State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, P.R. China
| | - Wei Wang
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
- Department of State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, P.R. China
| | - Xiaoning Sun
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
- Department of State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, P.R. China
| | - Zhili Liu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
- Department of State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, P.R. China
| | - Rong Zeng
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
- Department of State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, P.R. China
| | - Jiang Shao
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
- Department of State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, P.R. China
| | - Bao Liu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
- Department of State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, P.R. China
| | - Yuexin Chen
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
- Department of State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, P.R. China
| | - Wei Ye
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
- Department of State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, P.R. China
| | - Yuehong Zheng
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
- Department of State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, P.R. China
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Zhao WX, Wu ZY, Zhao N, Diao YP, Lan Y, Li YJ. Novel Systemic Inflammatory Markers Predict All-Cause Mortality in Patients Undergoing Endovascular Abdominal Aortic Aneurysm Repair. Rev Cardiovasc Med 2024; 25:202. [PMID: 39076323 PMCID: PMC11270096 DOI: 10.31083/j.rcm2506202] [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: 11/10/2023] [Revised: 01/01/2024] [Accepted: 01/11/2024] [Indexed: 07/31/2024] Open
Abstract
Background Clinically useful predictors for risk stratification of long-term survival may assist in selecting patients for endovascular abdominal aortic aneurysm (EVAR) procedures. This study aimed to analyze the prognostic significance of peroperative novel systemic inflammatory markers (SIMs), including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), hemoglobin-to-red cell distribution width ratio (HRR), systemic immune-inflammatory index (SIII), and systemic inflammatory response index (SIRI), for long-term mortality in EVAR. Methods A retrospective analysis was performed on 147 consecutive patients who underwent their first EVAR procedure at the Department of Vascular Surgery, Beijing Hospital. The patients were divided into the mortality group (n = 37) and the survival group (n = 110). The receiver operating characteristic curves were used to ascertain the threshold value demonstrating the most robust connection with mortality. The Kaplan-Meier survival analysis was performed between each SIM and mortality. The relationship between SIMs and survival was investigated using restricted cubic splines and multivariate Cox regression analysis. Results The study included 147 patients, with an average follow-up duration of 34.28 ± 22.95 months. Deceased patients showed significantly higher NLR (p < 0.001) and reduced HRR (p < 0.001). The Kaplan-Meier estimates of mortality were considerably greater in the higher-NLR group (NLR > 2.77) and lower-HRR group (HRR < 10.64). The hazard ratio (HR) of 0.833 (95% confidence interval (95% CI): 0.71-0.97, p < 0.021) was determined to be statistically significant in predicting death in the multivariable analysis. Conclusions Preoperative higher-NLR and lower-HRR have been associated with a lower long-term survival rate in abdominal aortic aneurysm (AAA) patients undergoing elective EVAR. Multivariate Cox regression showed that decreased preoperative HRR is an independent risk factor that increases mortality risk following EVAR. SIMs, such as the NLR and HRR, could be used in future clinical risk prediction methodologies for AAA patients undergoing EVAR. However, additional prospective cohort studies are needed to identify these findings.
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Affiliation(s)
- Wen-Xin Zhao
- Department of Vascular Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, 100010 Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, 100010 Beijing, China
| | - Zhi-Yuan Wu
- Department of Vascular Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, 100010 Beijing, China
| | - Ning Zhao
- Department of Vascular Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, 100010 Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, 100010 Beijing, China
| | - Yong-Peng Diao
- Department of Vascular Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, 100010 Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, 100010 Beijing, China
| | - Yong Lan
- Department of Vascular Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, 100010 Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, 100010 Beijing, China
| | - Yong-Jun Li
- Department of Vascular Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, 100010 Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, 100010 Beijing, China
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Premnath S, Hostalery A, Bungay P, Saggu G, Rowlands T, Singh S. Transrenal Endovascular Aneurysm Repair-A Novel Approach for Abdominal Aortic Aneurysms with Difficult Neck Anatomy. Ann Vasc Surg 2023; 96:186-194. [PMID: 37068625 DOI: 10.1016/j.avsg.2023.03.036] [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: 11/07/2022] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND The endovascular approach to treating ruptured or symptomatic abdominal aortic aneurysms (AAAs) with difficult neck anatomy still poses a major challenge. This study proposes and evaluates the outcomes of a novel technique, Transrenal Endovascular Aneurysm Repair (Tr-EVAR) which utilizes the top ring 'valley' and 'peak' configuration of the Anaconda stent graft to achieve proximal seal in AAAs with an unfavourable neck. METHODS All patients treated with Tr-EVAR over a period of 10 years were identified retrospectively. Demographic, clinical and outcome data were collected, and survival analysis was performed. The time-to-event was analyzed using Kaplan-Meier curves for complication-free survival, reintervention-free survival, and overall survival. RESULTS During the study period, 36 patients ruptured, symptomatic or large AAAs having unfavorable necks and not fit for open repair underwent Tr-EVAR. Two patients died in the first 30 days postprocedure (5.6%). The overall survival at 1 year, 3 years and 5 years were 86%, 72% and 54% respectively with a mean overall survival of 74.0 months (SE 7.8, 95% confidence interval 58.7-89.3) which was comparable to chimney endovascular aneurysm repair (EVAR). The complication-free survival and reintervention-free survival at 1 year, 3 years, and 5 years were 75%, 61%, 42%, 78%, 64%, and 45%, respectively. CONCLUSIONS Tr-EVAR can be considered as an off-the-shelf solution for urgent cases not fit for open repair with unfavourable neck features for standard EVAR. Careful patient selection and planning have generated acceptable immediate, midterm and long-term results comparable to those presented by chimney EVAR in the literature.
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Affiliation(s)
- Sivaram Premnath
- Department of Vascular Surgery, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK.
| | - Aurelien Hostalery
- Department of Vascular Surgery, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Peter Bungay
- Department of Interventional Radiology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Greta Saggu
- Department of Vascular Surgery, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Timothy Rowlands
- Department of Vascular Surgery, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Sanjay Singh
- Department of Vascular Surgery, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
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Mantripragada K, Abadi K, Echeverry N, Shah S, Snelling B. Transbrachial Access Site Complications in Endovascular Interventions: A Systematic Review of the Literature. Cureus 2022; 14:e25894. [PMID: 35844321 PMCID: PMC9278800 DOI: 10.7759/cureus.25894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 06/06/2022] [Indexed: 11/05/2022] Open
Abstract
The transfemoral approach (TFA) or transradial approach (TRA) serves as the primary technique for most endovascular cases; however, the transbrachial (TBA) route is an alternative access site used when TFA and TRA are contraindicated. Although TBA has advantages over TRA, such as the ability to accommodate large guide catheters and devices, there is some apprehension in implementing TBA due to perceived access site complication rates. This article aims to glean the rate of access site complication from current literature. Relevant studies were identified using the following search terms: ((access site complications) AND ((endovascular AND brachial) OR (percutaneous brachial access) OR (brachial))) OR (endovascular AND (percutaneous brachial access)); endovascular + brachial artery; endovascular + brachial artery + access site; and endovascular + brachial artery + access site complications. Articles published after 2008 addressing major complication rates from percutaneous TBA interventions were included. Fifteen studies out of 992 total articles met the inclusion criteria. The major access site complication rate was 75/1,424 (5.27%). Patients who underwent hemostasis with a vascular closure device (VCD) had a major complication rate of 13/309 (4.21%) compared to a major complication rate of 65/1122 (5.79%) for patients who underwent hemostasis with manual compression (MC). The major access site complication rate associated with TBA was 5.27%, which is relatively high compared to the complication rate in TFA or TRA. More prospective trials are needed to fully understand the access site complication rate in TBA interventions.
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Affiliation(s)
| | - Kevin Abadi
- Emergency Medicine, Memorial Healthcare, Pembroke Pines, USA
| | - Nikolas Echeverry
- College of Medicine, Charles E. Schmidt College of Medicine at Florida Atlantic University, Boca Raton, USA
| | - Sumedh Shah
- Department of Neurosurgery, University of Miami, Miami, USA
| | - Brian Snelling
- Neurosurgery, Boca Raton Regional Hospital, Boca Raton, USA
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Bath J, Fazzini S, Ippoliti A, Vogel TR, Singh P, Donas KP, Torsello G. Chimney endovascular aneurysm repair (ChEVAR) for hostile neck complex aneurysm. Vascular 2022; 30:1058-1068. [PMID: 35199611 DOI: 10.1177/17085381211043951] [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
OBJECTIVE Recent guidelines recognize the role of chimney endovascular aneurysm repair (ChEVAR) in the treatment of complex aortic disorders. The optimal configuration and number of visceral vessels that can be incorporated is still controversial. We aim to review outcomes from a multi-institutional decade-long experience with ChEVAR. METHODS Patients undergoing ChEVAR with multiple (≥2) chimney branches were selected from a prospectively maintained database at the two academic university hospitals. All patients were poorly suited for fenestrated or branched endograft repair (F/BEVAR) and deemed poor-risk for open surgery. RESULTS Forty-nine multiple ChEVAR were performed in 44 men and 5 women, with complete outcome data at a mean follow-up of 18 months. Overall, 2 patients died during follow-up (4%) with no aneurysm-related mortality and two ruptures after ChEVAR (4.1%) due to a type Ib endoleak from iliac limb pullout and persistent gutter-flow, both repaired with endovascular means. No stroke or spinal cord ischemia was noted during the follow-up period. Reintervention was undertaken in eight patients (16.3%) with five reinterventions for persistent gutter-flow and four chimney graft-associated. Three-vessel ChEVAR was performed in 16 patients, with two-vessel ChEVAR in 33 patients for a total of 114 chimney branches (mean 2.3 chimneys per patient). There were 21 superior mesenteric artery (SMA), 45 right renal, 46 left renal artery (LRA), and two accessory LRA chimneys placed. Antegrade configuration of chimney branches was chosen in 43 patients (88%). There were no significant differences between three-vessel and two-vessel ChEVAR upon univariate analysis in aneurysm size (65.6 vs 60.5 mm; p = 0.059), iliac diameter (7.3 vs 7.1 mm; p = 0.85), or endograft oversizing (30 vs 32.5%; p = 0.43). Three-vessel ChEVAR was associated with a larger aneurysm neck diameter (28.4 vs 25.0 mm; p = 0.021), shorter native infrarenal neck (0.5 vs 3.37 mm; p = 0.002) as well as longer seal zone (36.33 vs 22.67 mm; p = 0.005) compared with two-vessel ChEVAR. At follow-up, there were no significant differences in gutter area between three-vessel and two-vessel ChEVAR (18.9 vs 15.7 mm3; p = 0.73) nor the rate of persistent gutter-flow (12.5 vs 9.1%; p = 0.71). CONCLUSION Reintervention to multiple chimney grafts and for persistent gutter-flow is higher compared to single chimneys and demands close surveillance. However, based upon this combined transantlantic experience, we believe multiple ChEVAR provides a reasonable and safe option for complex aortic aneurysm repair when open or custom endografts are not available or indicated based on their Instructions For use, even when triple chimney grafts are required. The optimal configuration for multiple ChEVAR still warrants further study, although theoretical preliminary advantages may exist for a combination of antegrade and retrograde chimneys.
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Affiliation(s)
- Jonathan Bath
- Division of Vascular Surgery, 209318University of Missouri, Columbia, MO, USA
| | | | | | - Todd R Vogel
- Division of Vascular Surgery, 209318University of Missouri, Columbia, MO, USA
| | - Priyanka Singh
- Division of Vascular Surgery, 209318University of Missouri, Columbia, MO, USA
| | | | - Giovanni Torsello
- 2039612St Franziskus Hospital University of Münster, Münster, Germany
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Yan S, Wu ZY, Ma L, Chen ZG, Diao YP, Li YJ. Total Aortic and Branches Repair with Hybrid Therapy in the setting of Marfan Syndrome: A Case Report. Ann Vasc Surg 2021; 80:396.e1-396.e5. [PMID: 34808262 DOI: 10.1016/j.avsg.2021.10.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/03/2021] [Accepted: 10/28/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Currently, no standard treatment has been established for the total lesion in patient with Marfan Syndrome (MFS). This case report aims to present a total aortic and branches repair with hybrid therapy in a young patient with MFS. METHODS Clinical data including imaging manifestation, surgical document, and follow-up results were retrospectively collected and presented. RESULTS A young patient with MFS underwent multi-stage endovascular aortic management and open surgical repair. On-the-table fenestration technique was applied to reconstruct the branches of the abdominal aorta. A bypass from superior mesenteric artery to celiac trunk was performed. A Bentall operation was conducted to repair his ascending aorta and aortic valves. Finally, in situ fenestration technique was adopted to recanalize the branches of aortic arch. The 18 month follow-up computed tomography angiography demonstrated patency of all the aorta branches. CONCLUSION It may be feasible to perform the total aortic and branches repair with hybrid therapy in patients with MFS.
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Affiliation(s)
- Sheng Yan
- Department of Vascular Surgery, Beijing Hospital, National Centre of Gerontology; Institute of Geriatric Medicine, Chines Academy of Medical Sciences, Beijing, P.R. China; Chinese Academy of Medical Science and Peking Union Medical College, Beijing, PR China; Department of Vascular Surgery, Taiyuan Central Hospital, Taiyuan, China
| | - Zhi-Yuan Wu
- Department of Vascular Surgery, Beijing Hospital, National Centre of Gerontology; Institute of Geriatric Medicine, Chines Academy of Medical Sciences, Beijing, P.R. China
| | - Li Ma
- Department of Vascular Surgery, Taiyuan Central Hospital, Taiyuan, China
| | - Zuo-Guan Chen
- Department of Vascular Surgery, Beijing Hospital, National Centre of Gerontology; Institute of Geriatric Medicine, Chines Academy of Medical Sciences, Beijing, P.R. China
| | - Yong-Peng Diao
- Department of Vascular Surgery, Beijing Hospital, National Centre of Gerontology; Institute of Geriatric Medicine, Chines Academy of Medical Sciences, Beijing, P.R. China
| | - Yong-Jun Li
- Department of Vascular Surgery, Beijing Hospital, National Centre of Gerontology; Institute of Geriatric Medicine, Chines Academy of Medical Sciences, Beijing, P.R. China; Chinese Academy of Medical Science and Peking Union Medical College, Beijing, PR China.
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Multiple Chimney Endografts (ChEVAR) for Ruptured Pararenal Aortic Aneurysm. Ann Vasc Surg 2021; 75:531.e1-531.e6. [PMID: 33836225 DOI: 10.1016/j.avsg.2021.01.119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 12/31/2020] [Accepted: 01/24/2021] [Indexed: 11/21/2022]
Abstract
We present a ruptured pararenal abdominal aortic aneurysm repaired with a complex three-vessel chimney EVAR . This technique allows for rapid sealing of the aneurysm with branch preservation and avoids complex open aortic surgery. This case report highlights techniques and pitfalls from complex three-vessel chimney EVAR repair in the emergency setting.
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Pedrajas FG, Carvajal RR, Martín-Palanca A, Verdes RMP, Carbonell TH, Lainez Rube R. Endovascular Rescue of Simultaneous Renal Stent Thrombosis: Case Report. VASCULAR AND ENDOVASCULAR REVIEW 2018. [DOI: 10.15420/ver.2018.1.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The chimney/periscope technique has been used to address complex aortic pathologies. This case report aims to report the outcomes of the endovascular management of the acute and simultaneous thrombosis of both renal covered stent grafts after bilateral renal arteries chimney technique for endovascular repair (CH-EVAR) of a juxtarenal abdominal aortic aneurysm. The cause of this early occlusion of stent grafts may be related to how procedures and devices combinations alter the native anatomy. The authors aimed to compare renal artery geometry before and after CH-EVAR to find a possible cause of stent thrombosis.
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Affiliation(s)
| | | | | | | | | | - Rocio Lainez Rube
- Department of Vascular Surgery, Hospital Quirónsalud Marbella, Spain
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9
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Valdés DC, Karkos CD, Moy Petersen JC, Fernández JR, González RF. Emergency Endovascular Management of a Symptomatic Pseudoaneurysm of the Left Subclavian Artery Ostium Using a Combination of an Abdominal Aortic Stent-Graft Extension Cuff and a Periscope Stent Graft. Ann Vasc Surg 2018; 55:307.e13-307.e17. [PMID: 30217702 DOI: 10.1016/j.avsg.2018.06.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/28/2018] [Accepted: 06/21/2018] [Indexed: 11/30/2022]
Abstract
A pseudoaneurysm located at the subclavian artery ostium is an infrequent but life-threatening pathology that usually requires major thoracic surgery with a high risk of mortality and morbidity. Endovascular therapy applied to the aortic arch branches is a recent alternative technique, which is still in its early stages because dedicated endovascular devices for the aortic arch are lacking. In this article, we present the emergency endovascular management of a symptomatic pseudoaneurysm of the left subclavian artery ostium which was presumably secondary to an atherosclerotic plaque rupture. Endovascular exclusion required a combination of an abdominal aortic stent-graft extension cuff, which was placed via a retroperitoneal iliac access, and a subclavian artery periscope stent graft.
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Affiliation(s)
- Diego Caicedo Valdés
- Angiology and Vascular Surgery Department, Complexo Hospitalario de Pontevedra, Pontevedra, Spain.
| | - Christos D Karkos
- Vascular Surgery Unit, 5th Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Juan Carlos Moy Petersen
- Angiology and Vascular Surgery Department, Hospital Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - Julia Requena Fernández
- Angiology and Vascular Surgery Department, Complexo Hospitalario de Pontevedra, Pontevedra, Spain
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10
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Wu ZY, Chen ZG, Diao YP, Sun R, Liu CW, Chen YX, Zheng YH, Liu B, Li YJ. Endovascular Repair of Complex Aortoiliac Aneurysm with the Sandwich Technique in Sixteen Patients. Ann Vasc Surg 2018; 54:233-239. [PMID: 30053551 DOI: 10.1016/j.avsg.2018.05.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 04/10/2018] [Accepted: 05/04/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND This study aimed to evaluate the safety and efficiency of the sandwich technique in endovascular repair of complex aortoiliac aneurysm. METHODS Sixteen patients (mean age 69.6 years, ranging from 58 to 78 years) with complex aortoiliac aneurysm were studied retrospectively from October 2013 to September 2017 in two vascular centers of teaching hospitals. Computed tomography angiography (CTA) was performed to make individual therapy. They were all performed endovascular repair with sandwich technique, including one with the sandwich, chimney, and fenestrated techniques during the same procedure. All patients were followed up at 1 month, 3 months, 6 months, 12 months, and yearly thereafter with X-ray, ultrasound, and/or CTA. RESULTS The initial technical success was 81.25%, and the assisted technical success was 100%. At final angiography, little flow of a type I and a type III endoleak was found in two patients with observation. Two type II endoleaks were also detected. During the perioperative period, two patients suffered myocardial infarction. One pulmonary infection and one urinary infection happened. No death or cerebrovascular events occurred. During the follow-up (mean 18 months, ranging from 2 to 45 months), three stent occlusions were detected. One case got reintervened for his external iliac artery stent thrombosis in the first month postoperatively. The other two were under observation. A readmission happened to one man for his right brachial artery pseudoaneurysm in the third month postoperatively. One patient died of nonaneurysmal related reason in the eighth month. No aneurysmal related death, rupture, or new endoleak was found. No paralysis, claudication, or bowel ischemia was complained of. The primary patency of the preserved branches were 94.7%, 92.0%, 92.0%, 92.0%, 92.0% separately in first, sixth, 12th, 24th, and 36th month. CONCLUSIONS For patients who are not candidates for open surgery or conventional endovascular repair with complex aortoiliac aneurysm, the sandwich technique is a feasible alternative to management.
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Affiliation(s)
- Zhi-Yuan Wu
- Department of Vascular Surgery, Beijing Hospital, National Center of Gerontology, Beijing, China; Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Zuo-Guan Chen
- Department of Vascular Surgery, Beijing Hospital, National Center of Gerontology, Beijing, China; Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yong-Peng Diao
- Department of Vascular Surgery, Beijing Hospital, National Center of Gerontology, Beijing, China; Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Rui Sun
- Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China; Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Chang-Wei Liu
- Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China; Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Yue-Xin Chen
- Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China; Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Yue-Hong Zheng
- Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China; Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Bao Liu
- Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China; Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Yong-Jun Li
- Department of Vascular Surgery, Beijing Hospital, National Center of Gerontology, Beijing, China; Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
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Kwon JS, Hwang JK, Park SC, Kim SD. Hybrid Management for Supraceliac Aortic Aneurysm in a High-Risk Patient. Chin Med J (Engl) 2018; 131:1757-1758. [PMID: 29998902 PMCID: PMC6048927 DOI: 10.4103/0366-6999.235885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Jun Seong Kwon
- Department of Surgery, Division of Vascular and Transplant Surgery, College of Medicine, The Catholic University of Korea, Seoul 403-720, Korea
| | - Jeong Kye Hwang
- Department of Surgery, Division of Vascular and Transplant Surgery, College of Medicine, The Catholic University of Korea, Seoul 403-720, Korea
| | - Sun Cheol Park
- Department of Surgery, Division of Vascular and Transplant Surgery, College of Medicine, The Catholic University of Korea, Seoul 403-720, Korea
| | - Sang Dong Kim
- Department of Surgery, Division of Vascular and Transplant Surgery, College of Medicine, The Catholic University of Korea, Seoul 403-720, Korea
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