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Blakeslee-Carter J, Novak Z, Jansen JO, Schanzer A, Eagleton MJ, Farber MA, Gasper W, Lee WA, Oderich GS, Timaran CH, Schneider DB, Sweet MP, Beck AW. Prospective randomized pilot trial comparing prophylactic vs therapeutic cerebrospinal fluid drainage during complex endovascular thoracoabdominal aortic aneurysm repair. J Vasc Surg 2024:S0741-5214(24)00429-4. [PMID: 38614137 DOI: 10.1016/j.jvs.2024.02.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/07/2024] [Accepted: 02/09/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Endovascular techniques have transformed the management of thoracoabdominal aortic aneurysms (TAAAs). However, spinal cord ischemia (SCI) remains a prevalent and devastating complication. Prophylactic drainage of cerebrospinal fluid (CSF) is among the proposed strategies for prevention of SCI. Although prophylactic CSF drainage is widely used and conceptually attractive, prophylactic CSF drains have not been demonstrated to definitively prevent the occurrence nor mitigate the severity of SCI in endovascular TAAA repair. Whether or not outcomes of prophylactic drains are superior to therapeutic drains remains unknown. This pilot study was performed to determine the feasibility of a randomized clinical trial designed to investigate the role of prophylactic vs therapeutic CSF drains in the prevention of SCI in patients undergoing endovascular TAAA repair using branched and fenestrated endovascular aortic repair (FBEVAR). METHODS This was a prospective multicenter randomized pilot clinical trial conducted at The University of Alabama at Birmingham and The University of Massachusetts. Twenty patients were enrolled and randomized to either the prophylactic drainage or therapeutic drainage groups, prior to undergoing FBEVAR for extensive TAAAs and arch aortic aneurysms. This was a pilot feasibility study that was not powered to detect statistical differences in clinical outcomes. The primary outcome was feasibility of randomization and compliance with a shared lumbar drain protocol. Secondary outcomes included rate of drain complications and SCI. RESULTS Twenty patients were enrolled and successfully randomized, without any crossovers, to either the control cohort (n = 10), without prophylactic drains, or the experimental cohort (n = 10), with prophylactic drains. There were no differences in age, comorbidities, or history of prior aortic surgery across the cohorts. All patients were treated with FBEVAR. Aneurysm classifications were as follows: Extent I (10%), Extent II (50%), Extent III (35%), and Extent IV (5%). The average length of aortic coverage was 207 ± 21.6 mm. The length of aortic coverage did not vary across cohorts, nor did procedural times or blood loss volume. Compliance with the SCI prevention protocol was 100% across both groups. Within the prophylactic drain cohort, one patient experienced an adverse event related to lumbar drain placement, manifested as an epidural hematoma requiring laminectomy, without neurologic deficit (n = 1/10; 10%). There was one SCI event (n = 1/20; 5%), which occurred in the prophylactic drain cohort on postoperative day 9 following an episode of hypotension related to a gastrointestinal bleed. CONCLUSIONS The role of prophylactic CSF drains for the prevention of SCI following endovascular TAAA repair is a topic of ongoing research, with many current practices based on expert opinion and experience, rather than rigorous scientific data. This study demonstrates the feasibility of a multicenter randomized clinical trial to evaluate the role of prophylactic vs therapeutic CSF drains in the prevention of SCI in patients undergoing endovascular TAAA repair.
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Affiliation(s)
| | - Zdenek Novak
- Division of Vascular Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Jan O Jansen
- Division of Vascular Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Andres Schanzer
- Division of Vascular Surgery, University of Massachusetts (UMass) Memorial Medical Center, Worcester, MA
| | - Matthew J Eagleton
- Division of Vascular Surgery, Massachusetts General Hospital, Boston, MA
| | - Mark A Farber
- Division of Vascular Surgery, University of North Carolina, Chapel Hill, NC
| | - Warren Gasper
- Division of Vascular Surgery, University of California at San Francisco, San Franscisco, CA
| | - W Anthony Lee
- Division of Vascular Surgery, Baptist Health Medical Group, Boca Raton, FL
| | - Gustavo S Oderich
- Division of Vascular Surgery, University of Texas Health Science Center, Houston, TX
| | - Carlos H Timaran
- Division of Vascular Surgery, UT Southwestern Medical Center, Dallas, TX
| | - Darren B Schneider
- Division of Vascular Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Matthew P Sweet
- Division of Vascular Surgery, University of Washington Medical Center, Seattle, WA
| | - Adam W Beck
- Division of Vascular Surgery, University of Alabama at Birmingham, Birmingham, AL.
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Finnesgard EJ, Beck AW, Eagleton MJ, Farber MA, Gasper WJ, Lee WA, Oderich GS, Schneider DB, Sweet MP, Timaran CH, Simons JP, Schanzer A. Severity of acute kidney injury is associated with decreased survival after fenestrated and branched endovascular aortic aneurysm repair. J Vasc Surg 2023; 78:892-901. [PMID: 37330702 DOI: 10.1016/j.jvs.2023.05.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 05/19/2023] [Accepted: 05/22/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE Acute kidney injury (AKI) occurs frequently in complex aortic surgery and has been implicated in perioperative and long-term survival. This study sought to characterize the relationship between AKI severity and mortality after fenestrated and branched endovascular aortic aneurysm repair (F/B-EVAR). METHODS Consecutive patients enrolled by the US Aortic Research Consortium in 10, prospective, nonrandomized, physician-sponsored investigational device exemption studies evaluating F/B-EVAR, between 2005 and 2023, were included in this study. Perioperative AKI during hospitalization was defined by and staged using the 2012 Kidney Disease Improving Global Outcomes criteria. Determinants of AKI were evaluated with backward stepwise mixed effects multivariable ordinal logistic regression. Survival was analyzed with conditionally adjusted survival curves and backward stepwise mixed effects Cox proportional hazards modelling. RESULTS In the study period, 2413 patients with a median (interquartile range [IQR]) age of 74 years (IQR, 69-79 years) underwent F/B-EVAR. The median follow-up duration was 2.2 years (IQR, 0.7-3.7 years). The median baseline estimated glomerular filtration rate (eGFR) and creatinine were 68 mL/min/1.73 m2 (IQR, 53-84 mL/min/1.73 m2) and 1.1 mg/dL (IQR, 0.9-1.3 mg/dL), respectively. Stratification of AKI identified 316 patients (13%) with stage 1 injury, 42 (2%) with stage 2 injury, and 74 (3%) with stage 3 injury. Renal replacement therapy was initiated during the index hospitalization in 36 patients (1.5% of cohort, 49% of stage 3 injuries). Thirty-day major adverse events were associated with AKI severity (all P ≤ .0001). Multivariable predictors of AKI severity included baseline eGFR (proportional odds ratio, 0.9 per 10 mL/min/1.73 m2 [95% confidence interval (CI), 0.85-0.95 per 10 mL/min/1.73 m2]; P < .0001), baseline serum hematocrit (0.58 per 10% [95% CI, 0.48-0.71 per 10%]; P < .0001), renal artery technical failure during aneurysm repair (3 [95% CI,1.61-5.72]; P = .0006), and total operating time (1.05 per 10 minutes [95% CI, 1.04-1.07 per 10 minutes]; P < .0001). One-year unadjusted survivals for AKI severity strata were 91% (95% CI, 90%-92%) for no injury, 80% (95% CI, 76%-85%) for stage 1 injury, 72% (95% CI, 59-87%) for stage 2 injury, and 46% (95% CI, 35-59%) for stage 3 injury (P<.0001). Multivariable determinants of survival included AKI severity (stage 1, hazard ratio [HR], 1.6 [95% CI, 1.3-2]); stage 2, HR, 2.2 [95% CI, 1.4-3.4]); stage 3 HR, 4 [95% CI, 2.9-5.5]; P < .0001), decreased eGFR (HR, 1.1 [95% CI, 0.9-1.3]; P = .4), patient age (HR, 1.6 per 10 years [95% CI, 1.4-1.8 per 10 years]; P < .0001), baseline chronic obstructive pulmonary disease (HR, 1.5 [95% CI, 1.3-1.8]; P < .0001), baseline congestive heart failure (HR, 1.7 [95% CI, 1.6-2.1]; P < .0001), postoperative paraplegia (HR, 2.1 [95% CI, 1.1-4]; P = .02), and procedural technical success (HR, 0.6 [95% CI, 0.4-0.8]; P = .003). CONCLUSIONS AKI, as defined by the 2012 Kidney Disease Improving Global Outcomes criteria, occurred in 18% of patients after F/B-EVAR. Greater severity of AKI after F/B-EVAR was associated with decreased postoperative survival. The predictors of AKI severity identified in these analyses suggest a role for improved preoperative risk mitigation and staging of interventions in complex aortic repair.
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Affiliation(s)
- Eric J Finnesgard
- Division of Vascular and Endovascular Surgery, University of Massachusetts Chan Medical School, Worcester, MA
| | - Adam W Beck
- Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, AL
| | - Matthew J Eagleton
- Divison of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA
| | - Mark A Farber
- Division of Vascular Surgery, University of North Carolina, Chapel Hill, NC
| | - Warren J Gasper
- Division of Vascular and Endovascular Surgery, University of California, San Francisco, CA
| | - W Anthony Lee
- Christine E. Lynn Heart & Vascular Institute, Boca Raton Regional Hospital, Boca Raton, FL
| | - Gustavo S Oderich
- Division of Vascular and Endovascular Surgery, McGovern Medical School at UTHealth, Houston, TX
| | - Darren B Schneider
- Division of Vascular and Endovascular Therapy, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Matthew P Sweet
- Divison of Vascular and Endovascular Surgery, University of Washington, Seattle, WA
| | - Carlos H Timaran
- Division of Vascular Surgery, University of Texas Southwestern, Dallas, TX
| | - Jessica P Simons
- Division of Vascular and Endovascular Surgery, University of Massachusetts Chan Medical School, Worcester, MA
| | - Andres Schanzer
- Division of Vascular and Endovascular Surgery, University of Massachusetts Chan Medical School, Worcester, MA.
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Jackson CB, Desai J, Lee WA, Renfro LA. Utility of Continuous Paravertebral Block after Retroperitoneal Abdominal Aortic Aneurysm Repair. Ann Vasc Surg 2023:S0890-5096(23)00504-6. [PMID: 37454895 DOI: 10.1016/j.avsg.2023.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/09/2023] [Accepted: 06/17/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Open abdominal aortic aneurysm (AAA) repairs can be associated with significant pain and morbidity. Previous studies have demonstrated utility of adjunctive epidural analgesia (EA) in addition to general anesthesia (GA) to reduce pain and blunt the maladaptive surgical stress response. However, EA may be complicated by epidural hematomas and severe hypotension. Recently, we started using continuous paravertebral block (PVB) for perioperative analgesia after retroperitoneal AAA repair. PVB has some distinct advantages over EA such as unilateral localization, reduced risk of hypotension, and minimal risk of epidural hematoma in the setting of systemic heparinization. This study aimed to examine the utility of PVB by comparing total opioid consumption in the postoperative period among patients who received GA+PVB and those who received GA alone. METHODS This retrospective, matched cohort study included 62 patients who underwent elective retroperitoneal AAA repair between January 2019 and August 2022. Thirty-one subjects managed with GA+PVB were compared with 31 control subjects treated with GA alone, matched on following criteria: age, sex, and cross clamp location. Outcome measures included total opioid analgesics administered during their in-hospital postoperative course, time to extubation, time to return to baseline activity, time to normal bowel function, and length of stay. Opioid doses were converted to morphine milligram equivalents (MME). RESULTS The GA+PVB group required significantly less opioid analgesics (81±53 MME) than the GA group (171±121 MME) (p<0.001). Compared to GA alone, GA+PVB was superior in every clinical metric examined: time to extubation (3 vs. 1 hours, p<0.001), recovery of bowel function (3 vs. 2 days, p=0.002), recovery of baseline physical activity (4 vs. 2 days, p=0.019), and length of stay (5 vs. 3 days, p<0.001). CONCLUSION Continuous paravertebral block provides better pain management with significantly decreased opioid requirements in the postoperative period compared to GA alone for patients undergoing elective retroperitoneal AAA repair.
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Affiliation(s)
- Cody B Jackson
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Jamshed Desai
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - W Anthony Lee
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA; Baptist Health Medical Group-Vascular Surgery, Boca Raton Regional Hospital, Boca Raton, FL, USA
| | - Leslie A Renfro
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA; Department of Anesthesiology, Boca Raton Regional Hospital, Boca Raton, FL, USA.
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Lee WA. Sac expansion and type II endoleaks-the Achilles heel of endovascular aneurysm repair. J Vasc Surg 2023; 77:769. [PMID: 36822763 DOI: 10.1016/j.jvs.2022.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 10/17/2022] [Indexed: 02/23/2023]
Affiliation(s)
- W Anthony Lee
- Boca Raton Regional Hospital, Baptist Health South Florida and Florida Atlantic University Schmidt College of Medicine, Boca Raton, FL.
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Lee WA. “The False Lumen Problem”. J Vasc Surg Cases Innov Tech 2023; 9:101109. [PMID: 37168700 PMCID: PMC10164887 DOI: 10.1016/j.jvscit.2023.101109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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Negmadjanov U, Dedwylder M, Gaisinskaya P, Forcione D, Lee WA. Duodenocaval Fistula from an Inferior Vena Cava Filter Perforation. EJVES Vasc Forum 2022; 56:24-31. [PMID: 35812073 PMCID: PMC9260443 DOI: 10.1016/j.ejvsvf.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 05/11/2022] [Accepted: 06/07/2022] [Indexed: 12/01/2022] Open
Abstract
Background Case report Conclusions Duodenal perforation from IVC filter strut perforation is a rare complication. Patients typically present with abdominal pain and upper gastrointestinal bleeding. Both endovascular and open surgical techniques can be used to retrieve a filter Endovascular retrieval has the potential for development of peri-operative sepsis. Open surgical removal is preferred in patients with significant filter dwell time.
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Affiliation(s)
- Ulugbek Negmadjanov
- Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Michael Dedwylder
- Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Polina Gaisinskaya
- Department of Internal Medicine, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - David Forcione
- Department of Internal Medicine, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - W. Anthony Lee
- Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
- Corresponding author. 670 Glades Road, Suite 100, Boca Raton, FL 33431, USA.
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Negmadjanov U, Motta JC, De Grandis E, Lee WA. A Hybrid Approach in the Management of a Large Pancreaticoduodenal Artery Aneurysm. Ann Vasc Surg 2021; 79:441.e1-441.e5. [PMID: 34653641 DOI: 10.1016/j.avsg.2021.07.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 11/01/2022]
Abstract
Pancreaticoduodenal artery aneurysms (PDAA) are rare and represent a small fraction of known visceral aneurysms. We describe a case of a 79-year-old male with an 82 mm PDAA in the setting of chronic celiac artery occlusion. The patient was treated with an open repair. Due to the large size of the aneurysm and the dense adhesions to the surrounding tissues, vascular control of the superior mesenteric artery (SMA) was achieved by endovascular balloon occlusion and the aneurysm repaired with resection and primary aneurysmorrhaphy. The patient had an uneventful postoperative course.
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Affiliation(s)
- Ulugbek Negmadjanov
- Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL
| | - John C Motta
- Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL
| | - Eileen De Grandis
- Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL
| | - W Anthony Lee
- Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL.
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Kovacs T, El Haddi S, Lee WA. Internal jugular venous aneurysm-A report of two cases with literature review. J Vasc Surg Cases Innov Tech 2020; 6:326-330. [PMID: 32715165 PMCID: PMC7371612 DOI: 10.1016/j.jvscit.2020.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 04/15/2020] [Indexed: 02/04/2023]
Abstract
Internal jugular venous aneurysm (IJVA) is a rare entity that usually remains asymptomatic with only rare complications. We report two cases of IJVA. Both patients presented with a palpable soft tissue mass in the neck and were found to have IJVA on imaging with associated lymphadenopathy. In both cases, the aneurysms and involved lymph nodes were resected, with the jugular vein being primarily reconstructed. There are only a few case reports involving IJVA, and treatment guidelines are not well established. Whereas nonoperative management is frequently chosen, the most common indication for surgery is cosmetic; both management options have favorable outcomes.
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Affiliation(s)
- Tamas Kovacs
- Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Fla
| | - Salah El Haddi
- Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Fla
| | - W Anthony Lee
- Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Fla
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Farber MA, Lee WA, Szeto WY, Panneton JM, Kwolek CJ. Initial and midterm results of the Bolton Relay Thoracic Aortic Endovascular Pivotal Trial. J Vasc Surg 2017; 65:1556-1566.e1. [PMID: 28527926 DOI: 10.1016/j.jvs.2016.11.061] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 11/25/2016] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To report the initial and midterm results of the Bolton Relay Thoracic Stent Graft for the endovascular treatment of thoracic aortic lesions [thoracic endovascular aortic repair (TEVAR)]. METHODS The Bolton Relay Thoracic Aortic Endovascular Pivotal Trial was a prospective, nonrandomized, multicenter, U.S. Investigational Device Exemption study conducted at 27 U.S. investigational sites. One hundred twenty TEVAR subjects were treated with the Relay device between January 2007 and May 2010, with 13 patients enrolled during the continued access phase through September 2012. TEVAR outcomes were compared with a prospectively and retrospectively enrolled surgical cohort consisting of 60 patients enrolled under similar inclusion/exclusion criteria. Follow-up examinations were prescribed at 1 month, 6 months, and yearly thereafter for 5 years. Major adverse events (MAEs) included stroke, paralysis/paraplegia, myocardial infarction, procedural bleeding, respiratory failure, renal failure, wound healing complications, and aneurysm-related mortality. RESULTS Stent grafts were successfully delivered and deployed in 129 of 133 patients (97.0%). At 30 days, a lower rate of mortality was observed in the TEVAR arm (5.3% vs 10.0%; P = .230), and TEVAR was associated with a significantly lower rate of MAEs (20.3% vs 48.3%; P < .001), primarily driven by a lower frequency of respiratory failure in the cohort (5.5% vs 21.6%; P = .007) and procedural bleeding. Freedom from aneurysm-related mortality through 5 years was similar at 91.3% for the TEVAR cohort and 89.4% for the surgical cohort (P = .406); with 5-year freedom from all-cause mortality at 57.1% and 50.2% (P = .289), respectively. Freedom from MAEs through 5 years was significantly higher in the TEVAR cohort (65.7% vs 44.7%; P = .001). Six TEVAR patients (4.5%) experienced core laboratory-reported type I or III endoleaks, and secondary procedures were performed in 10 patients (7.5%), with seven procedures to correct endoleak and one surgical conversion. Endograft migration occurred in three patients (2.3%) and wireform fractures were assessed in two patients (1.5%). Aneurysm sac size decreased or remained stable in 113 patients (85.0%) over 5-year follow-up. There were no instances of rupture or endograft occlusion. A 38-subject subset treated with the newer Relay Plus Delivery System had a significantly reduced MAE rate (15.8% vs 35.8%; P = .035), and fewer perioperative strokes (2.6% vs 12.6%; P = .108). CONCLUSIONS Data from the Relay TEVAR clinical trial demonstrate safety and effectiveness of the Relay device compared with surgical controls, indicating continued device durability with a low rate of device-related complications through 5 years.
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Affiliation(s)
- Mark A Farber
- Division of Vascular Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC.
| | | | - Wilson Y Szeto
- Department of Surgery, University of Pennsylvania, Philadelphia, Pa
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Abstract
The gold standard for preoperative evaluation of an aortic aneurysm is a computed tomography angiogram (CTA). Three-dimensional reconstruction and analysis of the computed tomography data set is enormously helpful, and even sometimes essential, in proper sizing and planning for endovascular stent graft repair. To a large extent, it has obviated the need for conventional angiography for morphologic evaluation. The TeraRecon Aquarius workstation (San Mateo, Calif) represents a highly sophisticated but user-friendly platform utilizing a combination of task-specific hardware and software specifically designed to rapidly manipulate large Digital Imaging and Communications in Medicine (DICOM) data sets and provide surface-shaded and multiplanar renderings in real-time. This article discusses the basics of sizing and planning for endovascular abdominal aortic aneurysm repair and the role of 3-dimensional analysis using the TeraRecon workstation.
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Affiliation(s)
- W Anthony Lee
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL 32610, USA.
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Abstract
Endovascular repair of thoracic aortic aneurysms offers a less invasive alternative to conventional surgery, similar to its counterpart in the abdominal aorta. Although its long-term durability and outcome remain relatively unknown, published midterm results from clinical trials suggest comparable rates of aneurysm-related mortality and significant reductions in early morbidity compared with open repair. The Zenith TX2 stent graft (Cook Endovascular, Bloomington, IN) is an investigational endovascular device that is designed to treat aneurysms and other degenerative pathologies of the thoracic aorta. At the time of this writing, it is nearing completion of its pivotal trial. Clinical experience with this device is limited to countries outside the United States and to sites participating in the clinical trials. The purpose of this article is to provide a description of the Zenith TX2 device and its application in the repair of thoracic aortic aneurysms and dissections.
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Affiliation(s)
- W Anthony Lee
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, FL 32610-0286, USA.
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Bavaria JE, Brinkman WT, Hughes GC, Khoynezhad A, Szeto WY, Azizzadeh A, Lee WA, White RA. Outcomes of Thoracic Endovascular Aortic Repair in Acute Type B Aortic Dissection: Results From the Valiant United States Investigational Device Exemption Study∗. Ann Thorac Surg 2015. [DOI: 10.1016/j.athoracsur.2015.03.108] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Langdon SE, Motta JC, Kulik A, Imami I, Kernicky L, Lee WA. Branched endograft repair of an aortic stump aneurysm. J Vasc Surg Cases 2015; 1:177-179. [PMID: 31724587 PMCID: PMC6849909 DOI: 10.1016/j.jvsc.2015.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 05/02/2015] [Indexed: 11/28/2022] Open
Abstract
We present a patient with an aortic stump aneurysm that was repaired with a custom-made, four-branched thoracoabdominal endograft. The repair was performed in two stages using a special delivery system designed to be introduced in an antegrade manner through a median sternotomy due to a lack of iliofemoral access. At 1 year, the patient remains in good health, with his aneurysm completely excluded and decreased in size, without migration, and all branch vessels patent. This report represents a unique endovascular repair of a complex aortic pathology in a patient without other surgical options.
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Affiliation(s)
- Sarah E. Langdon
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Fla
| | - John C. Motta
- Christine E. Lynn Heart and Vascular Institute, Boca Raton, Fla
| | - Alexander Kulik
- Christine E. Lynn Heart and Vascular Institute, Boca Raton, Fla
| | - Irfan Imami
- Holmes Regional Medical Center, Melbourne, Fla
| | | | - W. Anthony Lee
- Christine E. Lynn Heart and Vascular Institute, Boca Raton, Fla
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Matsumura JS, Stroupe KT, Lederle FA, Kyriakides TC, Ge L, Freischlag JA, Ketteler ER, Kingsley DD, Marek JM, Massen RJ, Matteson BD, Pitcher JD, Langsfeld M, Corson JD, Goff JM, Kasirajan K, Paap C, Robertson DC, Salam A, Veeraswamy R, Milner R, Kasirajan K, Guidot J, Lal BK, Busuttil SJ, Lilly MP, Braganza M, Ellis K, Patterson MA, Jordan WD, Whitley D, Taylor S, Passman M, Kerns D, Inman C, Poirier J, Ebaugh J, Raffetto J, Chew D, Lathi S, Owens C, Hickson K, Dosluoglu HH, Eschberger K, Kibbe MR, Baraniewski HM, Matsumura J, Endo M, Busman A, Meadows W, Evans M, Giglia JS, El Sayed H, Reed AB, Ruf M, Ross S, Jean-Claude JM, Pinault G, Kang P, White N, Eiseman M, Jones R, Timaran CH, Modrall JG, Welborn MB, Lopez J, Nguyen T, Chacko JK, Granke K, Vouyouka AG, Olgren E, Chand P, Allende B, Ranella M, Yales C, Whitehill TA, Krupski WC, Nehler MR, Johnson SP, Jones DN, Strecker P, Bhola MA, Shortell CK, Gray JL, Lawson JH, McCann R, Sebastian MW, Tetterton JK, Blackwell C, Prinzo PA, Lee N, Padberg FT, Cerveira JJ, Lal BK, Zickler RW, Hauck KA, Berceli SA, Lee WA, Ozaki CK, Nelson PR, Irwin AS, Baum R, Aulivola B, Rodriguez H, Littooy FN, Greisler H, O'Sullivan MT, Kougias P, Lin PH, Bush RL, Guinn G, Cagiannos C, Pillack S, Guillory B, Cikrit D, Lalka SG, Lemmon G, Nachreiner R, Rusomaroff M, O'Brien E, Cullen JJ, Hoballah J, Sharp WJ, McCandless JL, Beach V, Minion D, Schwarcz TH, Kimbrough J, Ashe L, Rockich A, Warner-Carpenter J, Moursi M, Eidt JF, Brock S, Bianchi C, Bishop V, Gordon IL, Fujitani R, Kubaska SM, Behdad M, Azadegan R, Agas CM, Zalecki K, Hoch JR, Carr SC, Acher C, Schwarze M, Tefera G, Mell M, Dunlap B, Rieder J, Stuart JM, Weiman DS, Abul-Khoudoud O, Garrett HE, Walsh SM, Wilson KL, Seabrook GR, Cambria RA, Brown KR, Lewis BD, Framberg S, Kallio C, Barke RA, Santilli SM, d'Audiffret AC, Oberle N, Proebstle C, Lee Johnson L, Jacobowitz GR, Cayne N, Rockman C, Adelman M, Gagne P, Nalbandian M, Caropolo LJ, Pipinos II, Johanning J, Lynch T, DeSpiegelaere H, Purviance G, Zhou W, Dalman R, Lee JT, Safadi B, Coogan SM, Wren SM, Bahmani DD, Maples D, Thunen S, Golden MA, Mitchell ME, Fairman R, Reinhardt S, Wilson MA, Tzeng E, Muluk S, Peterson NM, Foster M, Edwards J, Moneta GL, Landry G, Taylor L, Yeager R, Cannady E, Treiman G, Hatton-Ward S, Salabsky B, Kansal N, Owens E, Estes M, Forbes BA, Sobotta C, Rapp JH, Reilly LM, Perez SL, Yan K, Sarkar R, Dwyer SS, Kohler TR, Hatsukami TS, Glickerman DG, Sobel M, Burdick TS, Pedersen K, Cleary P, Kansal N, Owens E, Estes M, Forbes BA, Sobotta C, Back M, Bandyk D, Johnson B, Shames M, Reinhard RL, Thomas SC, Hunter GC, Leon LR, Westerband A, Guerra RJ, Riveros M, Mills JL, Hughes JD, Escalante AM, Psalms SB, Day NN, Macsata R, Sidawy A, Weiswasser J, Arora S, Jasper BJ, Dardik A, Gahtan V, Muhs BE, Sumpio BE, Gusberg RJ, Spector M, Pollak J, Aruny J, Kelly EL, Wong J, Vasilas P, Joncas C, Gelabert HA, DeVirgillio C, Rigberg DA, Cole L. Costs of repair of abdominal aortic aneurysm with different devices in a multicenter randomized trial. J Vasc Surg 2015; 61:59-65. [DOI: 10.1016/j.jvs.2014.08.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 08/01/2014] [Indexed: 10/24/2022]
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Lee WA, McBride C. Discussion. J Vasc Surg 2014; 61:79. [PMID: 25080880 DOI: 10.1016/j.jvs.2014.05.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kim JY, Park JY, Cho SG, Jin CI, Lee WA, Jeon YS, Hong KC. Endovascular repair with chimney technique of abdominal aortic aneurysm with hostile aortic neck. Vascular 2013; 21:323-9. [PMID: 23539067 DOI: 10.1177/1708538113478743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2012] [Indexed: 11/17/2022]
Abstract
Abdominal aortic aneurysm (AAA) with hostile aortic neck is not a good candidate for conventional endovascular aneurysm repair (EVAR), and a recent paper showed that EVAR with chimney technique (Ch-EVAR) yielded reasonable outcome. We report here a case of successful Ch-EVAR treatment of AAA with hostile neck. An 81-year-old man presented with a 71-mm AAA during evaluation of a gastric ulcer. Aortic neck was 30 mm in diameter, 10-15 mm in length and angulated by 100°. EVAR was performed with chimney stenting to both renal arteries, and the patient recovered after transient hematuria. At one-year follow-up, AAA had increased by 7 mm with delayed type I endoleak control without renal insufficiency. The patient needed close follow-up.
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Affiliation(s)
- Jang Yong Kim
- Division of Vascular and Endovascular Surgery, Department of Surgery, School of Medicine, The Catholic University of Korea, Seoul 137-040, Korea
| | | | | | - Chan Ik Jin
- Department of Anestheology, Inha University College of Medicine, Incheon 400-711, Korea
| | - W Anthony Lee
- Vascular Surgery, Christine E Lynn Heart and Vascular Institute, Boca Raton, FL 33431, USA
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Fairman RM, Tuchek JM, Lee WA, Kasirajan K, White R, Mehta M, Lyden S, Mukherjee D, Bavaria J. Pivotal results for the Medtronic Valiant Thoracic Stent Graft System in the VALOR II trial. J Vasc Surg 2012; 56:1222-31.e1. [DOI: 10.1016/j.jvs.2012.04.062] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Revised: 04/11/2012] [Accepted: 04/17/2012] [Indexed: 11/26/2022]
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Foley PJ, Criado FJ, Farber MA, Kwolek CJ, Mehta M, White RA, Lee WA, Tuchek JM, Fairman RM. Results with the Talent thoracic stent graft in the VALOR trial. J Vasc Surg 2012; 56:1214-21.e1. [PMID: 22925732 DOI: 10.1016/j.jvs.2012.04.071] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 04/13/2012] [Accepted: 04/27/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We report the 5-year outcomes of thoracic endovascular aneurysm repair (TEVAR) using the Medtronic Vascular Talent Thoracic Stent Graft System (Medtronic Vascular, Santa Rosa, Calif) in patients considered low or moderate risk for open surgical repair. METHODS The Evaluation of the Medtronic Vascular Talent Thoracic Stent Graft System for the Treatment of Thoracic Aortic Aneurysms (VALOR) trial was a prospective, nonrandomized, multicenter, pivotal study conducted at 38 U.S. sites. Between December 2003 and June 2005, VALOR enrolled 195 patients who were low or moderate risk (0, 1, and 2) per the modified Society for Vascular Surgery and American Association for Vascular Surgery criteria. The patients had fusiform thoracic aortic aneurysms (TAAs) and/or focal saccular TAAs/penetrating atherosclerotic ulcers. Standard follow-up interval examinations were conducted at 1 month, 6 months, 1 year, and annually thereafter. RESULTS Over the 5-year follow-up, 76 deaths occurred (43.9%). Freedom from all-cause mortality was 83.9% at 1 year and 58.5% at 5 years. Most deaths were due to cardiac, pulmonary or cancer-related causes. Freedom from aneurysm-related mortality (ARM) was 96.9% at 1 year and 96.1% at 5 years. There was only 1 case of ARM after the first year of follow-up. Over the 5-year follow-up period, four patients were converted to open surgery and four patients experienced aneurysm rupture. The 5-year freedom from aneurysm rupture was 97.1% and the 5-year freedom from conversion to surgery was 97.1%. The incidence of stent graft migration (>10 mm) was ≤ 1.8% in each year of follow-up. The rate of type I endoleak was 4.6% at 1 month, 6.3% from 1 month to 1 year, and 3.8% during year 5. The rate of type III endoleak was 1.3% at 1 month, 1.9% from 1 month to 1 year, and 1.9% during year 5. Through 5 years, 28 patients (14.4%) underwent 31 additional endovascular procedures on the original target lesion. The 5-year freedom from secondary endovascular procedures was 81.5%. CONCLUSIONS Through 5-year follow-up in patients who were candidates for open surgical repair, TEVAR using the Talent Thoracic Stent Graft System has demonstrated sustained protection from ARM, aneurysm rupture, and conversion to surgery, and durable stent graft performance. Close patient follow-up remains essential after TEVAR.
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Affiliation(s)
- Paul J Foley
- Hospital of the University of Pennsylvania, Philadelphia, Pa, USA.
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Waterman AL, Feezor RJ, Lee WA, Hess PJ, Beaver TM, Martin TD, Huber TS, Beck AW. Endovascular treatment of acute and chronic aortic pathology in patients with Marfan syndrome. J Vasc Surg 2012; 55:1234-40; disucssion 1240-1. [DOI: 10.1016/j.jvs.2011.11.089] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 11/08/2011] [Accepted: 11/14/2011] [Indexed: 11/24/2022]
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Lee WA, Daniels MJ, Beaver TM, Klodell CT, Raghinaru DE, Hess PJ. Late Outcomes of a Single-Center Experience of 400 Consecutive Thoracic Endovascular Aortic Repairs. Circulation 2011; 123:2938-45. [DOI: 10.1161/circulationaha.110.965756] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
In this study, we report the late outcomes of a large, decade-long single-center thoracic endovascular aortic repair experience.
Methods and Results—
A prospectively maintained registry and the electronic medical records of 400 consecutive thoracic endovascular aortic repair performed at a tertiary care center were reviewed. The distribution of pathologies treated included aneurysms (198, 49%), dissections (100, 25%), penetrating ulcers (54, 14%), traumatic transections (25, 6%), and other pathologies (23, 6%). Spinal drains were placed prophylactically in 127 cases (32%) of planned extended aortic coverage. There were no acute surgical conversions. Adjunctive surgical procedures were performed on 94 patients (24%). Subclavian revascularizations were performed selectively in only 15% of zone 0 to 2 deployments. The median length of stay was 5 days (limits, 1 and 79 days). Overall 30-day mortality was 6.5% (elective, 2.6%; urgent, 9.5%; and emergent, 20%). Permanent spinal cord ischemia occurred in 4.5% and stroke in 3%. Kaplan-Meier estimates of survival were 82%, 76%, 68%, and 60% and freedom from secondary intervention was 90%, 86%, 81%, and 78% at 6, 12, 24, and 36 months, respectively. Risk factors for mortality included stroke, urgent/emergent repair, age ≥80 years, general anesthesia, and dissection pathology.
Conclusions—
Thoracic endovascular aortic repair may be used to treat a variety of thoracic aortic pathologies with a very low risk of intraoperative conversion. Overall rates of mortality and neurological complications were relatively low but significantly increased in emergent repairs. There appeared to be a substantial number of late deaths, which may represent a combination of poor patient selection and treatment failures.
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Affiliation(s)
- W. Anthony Lee
- From the Christine E. Lynn Heart and Vascular Institute, Boca Raton, FL (W.A.L.), and Department of Statistics (M.J.D., D.E.R.) and Division of Thoracic and Cardiovascular Surgery (T.M.B., C.T.K., P.J.H.), University of Florida, Gainesville
| | - Michael J. Daniels
- From the Christine E. Lynn Heart and Vascular Institute, Boca Raton, FL (W.A.L.), and Department of Statistics (M.J.D., D.E.R.) and Division of Thoracic and Cardiovascular Surgery (T.M.B., C.T.K., P.J.H.), University of Florida, Gainesville
| | - Thomas M. Beaver
- From the Christine E. Lynn Heart and Vascular Institute, Boca Raton, FL (W.A.L.), and Department of Statistics (M.J.D., D.E.R.) and Division of Thoracic and Cardiovascular Surgery (T.M.B., C.T.K., P.J.H.), University of Florida, Gainesville
| | - Charles T. Klodell
- From the Christine E. Lynn Heart and Vascular Institute, Boca Raton, FL (W.A.L.), and Department of Statistics (M.J.D., D.E.R.) and Division of Thoracic and Cardiovascular Surgery (T.M.B., C.T.K., P.J.H.), University of Florida, Gainesville
| | - Dan E. Raghinaru
- From the Christine E. Lynn Heart and Vascular Institute, Boca Raton, FL (W.A.L.), and Department of Statistics (M.J.D., D.E.R.) and Division of Thoracic and Cardiovascular Surgery (T.M.B., C.T.K., P.J.H.), University of Florida, Gainesville
| | - Philip J. Hess
- From the Christine E. Lynn Heart and Vascular Institute, Boca Raton, FL (W.A.L.), and Department of Statistics (M.J.D., D.E.R.) and Division of Thoracic and Cardiovascular Surgery (T.M.B., C.T.K., P.J.H.), University of Florida, Gainesville
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Jonker FH, Verhagen HJ, Lin PH, Heijmen RH, Trimarchi S, Lee WA, Moll FL, Atamneh H, Rampoldi V, Muhs BE. Open surgery versus endovascular repair of ruptured thoracic aortic aneurysms. J Vasc Surg 2011; 53:1210-6. [DOI: 10.1016/j.jvs.2010.10.135] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Revised: 10/27/2010] [Accepted: 10/31/2010] [Indexed: 11/30/2022]
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Lee CW, Beaver TM, Klodell CT, Hess PJ, Martin TD, Feezor RJ, Lee WA. Arch debranching versus elephant trunk procedures for hybrid repair of thoracic aortic pathologies. Ann Thorac Surg 2011; 91:465-71. [PMID: 21256293 DOI: 10.1016/j.athoracsur.2010.10.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Revised: 09/30/2010] [Accepted: 10/04/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND We compared outcomes of arch debranching (AD) and elephant trunk (ET) techniques when used with thoracic endovascular aortic repair. METHODS A review was performed of consecutive patients with proximal thoracic aortic pathologies repaired with a hybrid approach. RESULTS Between 2005 and 2009, 58 patients underwent first-stage ET (n = 21) or AD (n = 37). Cardiopulmonary bypass was utilized in 100% of ET procedures and 68% of AD procedures (p < 0.01). Circulatory arrest was used in 86% of ET and 27% of AD cases (p < 0.01). The second stage was completed in 76% of ET and 76% of AD patients. Rates of spinal cord ischemia (ET 0 of 21, AD 0 of 37, p = 1.0), stroke (ET 2 of 21, AD 4 of 37, p = 1.0), and 30-day mortality (ET 4 of 21, AD 6 of 37, p = 1.0) were similar. Each group had one major aortic complication between the two stages. Type Ia endovascular leak at 1 and 12 months occurred in 13% ET patients and 4% AD patients at 1 month (p = 0.54) and in 0% ET patients and 4% AD patients at 12 months (p = 1.0). Kaplan-Meier estimates of survival at 1 and 12 months were 90.5% ± 6.4% and 73.1% ± 10% in the ET group, and 86.5% ± 5.6 and 71.6% ± 8.5 in the AD group, respectively (p = 0.68). The risk of a secondary procedure at 1 and 12 months was 76.2% ± 9.3% and 58.7% ± 12% in the ET group, and 71.0% ± 7.8% and 52.8% ± 10% in the AD group, respectively (p = 0.86). CONCLUSIONS Arch debranching achieves equivalent results to standard elephant trunk repair but with a decreased need for cardiopulmonary bypass and circulatory arrest.
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Affiliation(s)
- Constance W Lee
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, Florida, USA.
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Bruen KJ, Feezor RJ, Daniels MJ, Beck AW, Lee WA. Endovascular chimney technique versus open repair of juxtarenal and suprarenal aneurysms. J Vasc Surg 2011; 53:895-904; discussion 904-5. [PMID: 21211934 DOI: 10.1016/j.jvs.2010.10.068] [Citation(s) in RCA: 162] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 09/29/2010] [Accepted: 10/09/2010] [Indexed: 11/19/2022]
Affiliation(s)
- Kevin J Bruen
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla., USA
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Bruen KJ, Feezor RJ, Lee WA. Hybrid management of proximal right subclavian artery aneurysms. J Vasc Surg 2011; 53:528-30. [DOI: 10.1016/j.jvs.2010.07.050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Revised: 07/13/2010] [Accepted: 07/17/2010] [Indexed: 11/15/2022]
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Murad MH, Rizvi AZ, Malgor R, Carey J, Alkatib AA, Erwin PJ, Lee WA, Fairman RM. Comparative effectiveness of the treatments for thoracic aortic transaction. J Vasc Surg 2011; 53:193-199.e1-21. [DOI: 10.1016/j.jvs.2010.08.028] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2010] [Revised: 08/10/2010] [Accepted: 08/10/2010] [Indexed: 11/15/2022]
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Lee WA. Invited commentary. J Vasc Surg 2010; 53:13. [PMID: 21184930 DOI: 10.1016/j.jvs.2010.08.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2010] [Revised: 08/24/2010] [Accepted: 08/24/2010] [Indexed: 11/30/2022]
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Lee WA, Martin TD, Hess PJ, Beaver TM, Klodell CT. First United States experience of the TX2 Pro-Form thoracic delivery system. J Vasc Surg 2010; 52:1459-63. [DOI: 10.1016/j.jvs.2010.07.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 07/01/2010] [Accepted: 07/06/2010] [Indexed: 11/30/2022]
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Waterman AL, Feezor RJ, Nelson PR, Lee WA, Hess PJ, Martin TD, Huber TS, Beck AW. Endovascular Treatment of Acute and Chronic Aortic Pathology in Patients With Marfan's Syndrome. J Vasc Surg 2010. [DOI: 10.1016/j.jvs.2010.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Beale EO, Lee WA, Chan LS. Efficacy of a staged diabetes management programme in achieving glycaemic goal in a low socio-economic Hispanic population. ACTA ACUST UNITED AC 2010. [DOI: 10.1002/pdi.1506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Jonker FH, Verhagen HJ, Lin PH, Heijmen RH, Trimarchi S, Lee WA, Moll FL, Athamneh H, Muhs BE. Outcomes of Endovascular Repair of Ruptured Descending Thoracic Aortic Aneurysms. Circulation 2010; 121:2718-23. [PMID: 20547930 DOI: 10.1161/circulationaha.109.908871] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Thoracic endovascular aortic repair offers a less invasive approach for the treatment of ruptured descending thoracic aortic aneurysms (rDTAA). Due to the low incidence of this life-threatening condition, little is known about the outcomes of endovascular repair of rDTAA and the factors that affect these outcomes.
Methods and Results—
We retrospectively investigated the outcomes of 87 patients who underwent thoracic endovascular aortic repair for rDTAA at 7 referral centers between 2002 and 2009. The mean age was 69.8±12 years and 69.0% of the patients were men. Hypovolemic shock was present in 21.8% of patients, and 40.2% were hemodynamically unstable. The 30-day mortality rate was 18.4%, and hypovolemic shock (odds ratio 4.75; 95% confidence interval, 1.37 to 16.5;
P
=0.014) and hemothorax at admission (odds ratio 6.65; 95% confidence interval, 1.64 to 27.1;
P
=0.008) were associated with increased 30-day mortality after adjusting for age. Stroke and paraplegia occurred each in 8.0%, and endoleak was diagnosed in 18.4% of patients within the first 30 days after thoracic endovascular aortic repair. Four additional patients died as a result of procedure-related complications during a median follow-up of 13 months; the estimated aneurysm-related mortality at 4 years was 25.4%.
Conclusion—
Endovascular repair of rDTAA is associated with encouraging results. The endovascular approach was associated with considerable rates of neurological complications and procedure-related complications such as endoleak.
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Affiliation(s)
- Frederik H.W. Jonker
- From the Section of Vascular Surgery, Cardiothoracic Surgery and Interventional Radiology, Yale University School of Medicine, New Haven, and VA Connecticut Healthcare System, West Haven, Conn (F.H.W.J., B.E.M.); Erasmus University Medical Center (H.J.M.V.), Rotterdam; St. Antonius Hospital (R.H.H.), Nieuwegein; University Medical Center Utrecht (F.L.M.), Utrecht, the Netherlands; Baylor College of Medicine (P.H.L., H.A.), Houston, Tex; Policlinico San Donato IRCCS, Cardiovascular Center “E. Malan,”
| | - Hence J.M. Verhagen
- From the Section of Vascular Surgery, Cardiothoracic Surgery and Interventional Radiology, Yale University School of Medicine, New Haven, and VA Connecticut Healthcare System, West Haven, Conn (F.H.W.J., B.E.M.); Erasmus University Medical Center (H.J.M.V.), Rotterdam; St. Antonius Hospital (R.H.H.), Nieuwegein; University Medical Center Utrecht (F.L.M.), Utrecht, the Netherlands; Baylor College of Medicine (P.H.L., H.A.), Houston, Tex; Policlinico San Donato IRCCS, Cardiovascular Center “E. Malan,”
| | - Peter H. Lin
- From the Section of Vascular Surgery, Cardiothoracic Surgery and Interventional Radiology, Yale University School of Medicine, New Haven, and VA Connecticut Healthcare System, West Haven, Conn (F.H.W.J., B.E.M.); Erasmus University Medical Center (H.J.M.V.), Rotterdam; St. Antonius Hospital (R.H.H.), Nieuwegein; University Medical Center Utrecht (F.L.M.), Utrecht, the Netherlands; Baylor College of Medicine (P.H.L., H.A.), Houston, Tex; Policlinico San Donato IRCCS, Cardiovascular Center “E. Malan,”
| | - Robin H. Heijmen
- From the Section of Vascular Surgery, Cardiothoracic Surgery and Interventional Radiology, Yale University School of Medicine, New Haven, and VA Connecticut Healthcare System, West Haven, Conn (F.H.W.J., B.E.M.); Erasmus University Medical Center (H.J.M.V.), Rotterdam; St. Antonius Hospital (R.H.H.), Nieuwegein; University Medical Center Utrecht (F.L.M.), Utrecht, the Netherlands; Baylor College of Medicine (P.H.L., H.A.), Houston, Tex; Policlinico San Donato IRCCS, Cardiovascular Center “E. Malan,”
| | - Santi Trimarchi
- From the Section of Vascular Surgery, Cardiothoracic Surgery and Interventional Radiology, Yale University School of Medicine, New Haven, and VA Connecticut Healthcare System, West Haven, Conn (F.H.W.J., B.E.M.); Erasmus University Medical Center (H.J.M.V.), Rotterdam; St. Antonius Hospital (R.H.H.), Nieuwegein; University Medical Center Utrecht (F.L.M.), Utrecht, the Netherlands; Baylor College of Medicine (P.H.L., H.A.), Houston, Tex; Policlinico San Donato IRCCS, Cardiovascular Center “E. Malan,”
| | - W. Anthony Lee
- From the Section of Vascular Surgery, Cardiothoracic Surgery and Interventional Radiology, Yale University School of Medicine, New Haven, and VA Connecticut Healthcare System, West Haven, Conn (F.H.W.J., B.E.M.); Erasmus University Medical Center (H.J.M.V.), Rotterdam; St. Antonius Hospital (R.H.H.), Nieuwegein; University Medical Center Utrecht (F.L.M.), Utrecht, the Netherlands; Baylor College of Medicine (P.H.L., H.A.), Houston, Tex; Policlinico San Donato IRCCS, Cardiovascular Center “E. Malan,”
| | - Frans L. Moll
- From the Section of Vascular Surgery, Cardiothoracic Surgery and Interventional Radiology, Yale University School of Medicine, New Haven, and VA Connecticut Healthcare System, West Haven, Conn (F.H.W.J., B.E.M.); Erasmus University Medical Center (H.J.M.V.), Rotterdam; St. Antonius Hospital (R.H.H.), Nieuwegein; University Medical Center Utrecht (F.L.M.), Utrecht, the Netherlands; Baylor College of Medicine (P.H.L., H.A.), Houston, Tex; Policlinico San Donato IRCCS, Cardiovascular Center “E. Malan,”
| | - Husam Athamneh
- From the Section of Vascular Surgery, Cardiothoracic Surgery and Interventional Radiology, Yale University School of Medicine, New Haven, and VA Connecticut Healthcare System, West Haven, Conn (F.H.W.J., B.E.M.); Erasmus University Medical Center (H.J.M.V.), Rotterdam; St. Antonius Hospital (R.H.H.), Nieuwegein; University Medical Center Utrecht (F.L.M.), Utrecht, the Netherlands; Baylor College of Medicine (P.H.L., H.A.), Houston, Tex; Policlinico San Donato IRCCS, Cardiovascular Center “E. Malan,”
| | - Bart E. Muhs
- From the Section of Vascular Surgery, Cardiothoracic Surgery and Interventional Radiology, Yale University School of Medicine, New Haven, and VA Connecticut Healthcare System, West Haven, Conn (F.H.W.J., B.E.M.); Erasmus University Medical Center (H.J.M.V.), Rotterdam; St. Antonius Hospital (R.H.H.), Nieuwegein; University Medical Center Utrecht (F.L.M.), Utrecht, the Netherlands; Baylor College of Medicine (P.H.L., H.A.), Houston, Tex; Policlinico San Donato IRCCS, Cardiovascular Center “E. Malan,”
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Bruen KJ, Feezor RJ, Nelson PR, Beck AW, Huber TS, Lee WA. SS29. Endovascular Chimney (Snorkel) Technique vs Open Surgery for Repair of Juxtarenal and Suprarenal Aneurysms. J Vasc Surg 2010. [DOI: 10.1016/j.jvs.2010.02.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Walker KL, Lipori P, Lee WA, Beaver TM. Cost of thoracic endovascular aortic repair versus open repair and implications for the US health care system. J Thorac Cardiovasc Surg 2010; 139:231-2. [DOI: 10.1016/j.jtcvs.2009.07.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Revised: 06/16/2009] [Accepted: 07/05/2009] [Indexed: 11/25/2022]
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Abstract
Iliac aneurysms can occur concomitantly in 15 to 20% of abdominal aortic aneurysms. The common iliac arteries serve as the distal landing zones for the iliac limbs of abdominal aortic stent grafts, and for most currently available devices, the maximum treatable iliac size is 20 mm. When the iliac artery diameter exceeds this, alternative landing zones or adjunctive techniques are required to achieve an adequate distal seal and fixation, which typically involves occlusion of the hypogastric artery origin and extension to the external iliac artery. The clinical sequelae of acute hypogastric occlusion mostly involve symptoms of hip and buttock ischemia (claudication), which can occur in up to 40% of cases. In this article, a novel method of endovascular management of common iliac artery aneurysms in the setting of endovascular aortic aneurysm repair is described using an investigational (United States only) iliac branch device that preserves antegrade perfusion to the hypogastric artery to decrease the potential risks of pelvic ischemia.
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Affiliation(s)
- W. Anthony Lee
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, FL
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Almond BA, Hess PJ, Martin TD, Beaver TM, Klodell CT, Lee WA. Midterm Outcomes of a Single-Center Experience of 400 Consecutive Thoracic Endovascular Aortic Repair. J Vasc Surg 2009. [DOI: 10.1016/j.jvs.2009.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hong MS, Feezor RJ, Lee WA, Nelson PR. Thoracic Endovascular Aortic Repair Broadens Treatment Eligibility and Decreases Overall Mortality in Traumatic Thoracic Aortic Injury. J Vasc Surg 2009. [DOI: 10.1016/j.jvs.2009.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Cambria RP, Crawford RS, Cho JS, Bavaria J, Farber M, Lee WA, Ramaiah V, Kwolek CJ. A multicenter clinical trial of endovascular stent graft repair of acute catastrophes of the descending thoracic aorta. J Vasc Surg 2009; 50:1255-64.e1-4. [PMID: 19958982 DOI: 10.1016/j.jvs.2009.07.104] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2009] [Revised: 07/03/2009] [Accepted: 07/25/2009] [Indexed: 11/19/2022]
Affiliation(s)
- Richard P Cambria
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Mass, USA.
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Matsumura JS, Lee WA, Mitchell RS, Farber MA, Murad MH, Lumsden AB, Greenberg RK, Safi HJ, Fairman RM. The Society for Vascular Surgery Practice Guidelines: Management of the left subclavian artery with thoracic endovascular aortic repair. J Vasc Surg 2009; 50:1155-8. [DOI: 10.1016/j.jvs.2009.08.090] [Citation(s) in RCA: 292] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Revised: 08/19/2009] [Accepted: 08/19/2009] [Indexed: 11/17/2022]
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Lee WA. Nearly two decades have passed since the seminal reporting of the first endovascular repair of an infrarenal aortic aneurysm using a homemade stent graft in 1991. Semin Vasc Surg 2009; 22:125-6. [PMID: 19765520 DOI: 10.1053/j.semvascsurg.2009.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
Iliac artery aneurysms are a frequent finding in patients with abdominal aortic aneurysms. The decision of whether to perform a tubular or bifurcated repair rests on a balance between the natural history of the iliac arteries during the lifetime of the patient versus the risk of symptomatic pelvic ischemia and the increased complexity of a bifurcated repair. The relatively recent increase in the use of cross-sectional imaging, especially in the setting of long-term endograft surveillance, has provided useful data on which to base these clinical decisions. A tube graft repair appears to be safe and durable in patients undergoing open aneurysm repair, when suitable distal aortic anatomy and normal iliac arteries are present. A bifurcated graft should be considered in younger patients with moderate sized iliac aneurysms (<30 mm in diameter), as well as in almost all patients with larger iliac aneurysms.
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Affiliation(s)
- Kevin J Bruen
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, FL 32610-0286, USA
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Feezor RJ, Martin TD, Hess PJ, Beaver TM, Klodell CT, Lee WA. Early outcomes after endovascular management of acute, complicated type B aortic dissection. J Vasc Surg 2009; 49:561-6; discussion 566-7. [PMID: 19268759 DOI: 10.1016/j.jvs.2008.09.071] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2008] [Revised: 09/17/2008] [Accepted: 09/17/2008] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Surgical management of acute, complicated type B aortic dissection is associated with significant morbidity and mortality. This study examined the feasibility and safety of endovascular treatment of this pathology. METHODS We reviewed a prospectively maintained thoracic endovascular database and medical records at a single institution from 2005 to 2007. The study group comprised of acute, complicated type B dissections, defined as duration of symptoms <or=14 days and involving either false lumen rupture, malperfusion, intractable pain, or uncontrolled hypertension. All repairs were performed using the TAG device (W. L. Gore and Associates, Flagstaff, Ariz). Select 30-day or in-hospital outcomes were reported. RESULTS Of the 216 thoracic endovascular aortic aneurysm repairs performed during the study period, 33 (15%) were for acute, complicated type B dissections. There were eight women (24%). The mean age was 61 +/- 15 years. The average duration of symptoms was 2.9 +/- 4.1 (median, 1) days. The indications for repair included rupture in 15 patients (46%) and mesenteric/renal/lower extremity malperfusion in 11 (33%). Mean fluoroscopy time and contrast volume were 30 +/- 16 minutes and 176 +/- 55 mL, respectively. Eight (73%) of 11 patients with malperfusion required branch vessel stenting. The 30-day in-hospital mortality was 21% (7 of 33). Causes of death included cardiac arrest in 3, progressive multisystem organ failure in 2, rupture in 1 and unknown in 1. At least one major complication occurred in 76% of the patients, including respiratory failure in 11 (33%), permanent spinal cord ischemia in 5 (15%), renal failure requiring dialysis in 4 (12%), and stroke in 4 (12%). The mean postoperative length of stay was 17.2 +/- 16.5 days, and only 14 (42%) were discharged to home. CONCLUSIONS Emergency endovascular repair of acute, complicated type B dissection is associated with significant mortality and morbidity. The overall role of this therapy in the treatment of this lethal problem should be better defined and compared with other surgical or interventional options before being generally adopted.
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Affiliation(s)
- Robert J Feezor
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, Fla., USA
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Abstract
Failure modes of thoracic endografts can be broadly categorized as those that typically occur early in the perioperative period and those that occur during late follow-up. In the former category, failures principally involve delivery, deployment, and conformation to the local anatomy. In the postoperative period, failures can manifest as endograft collapse, component separations, and metallic fractures and fabric tears. Some of these events are preventable with careful case selection, planning, and procedural technique, but others require active management with advanced endovascular or surgical adjuncts. No endograft system is immune from these problems. Endograft failure is an equal-opportunity hazard, which underscores the absolute need for diligent, long-term follow-up.
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Affiliation(s)
- W Anthony Lee
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla. 32610-0286, USA.
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Kim T, Martin TD, Lee WA, Hess PJ, Klodell CT, Tribble CG, Feezor RJ, Beaver TM. Evolution in the management of the total thoracic aorta. J Thorac Cardiovasc Surg 2009; 137:627-34. [DOI: 10.1016/j.jtcvs.2008.11.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Revised: 10/06/2008] [Accepted: 11/15/2008] [Indexed: 11/26/2022]
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Feezor RJ, Hess PJ, Lee WA. Endovascular treatment of a malignant aortoesophageal fistula. J Vasc Surg 2009; 49:778. [DOI: 10.1016/j.jvs.2008.05.066] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2008] [Revised: 05/19/2008] [Accepted: 05/19/2008] [Indexed: 01/14/2023]
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Martin DJ, Martin TD, Hess PJ, Daniels MJ, Feezor RJ, Lee WA. Spinal cord ischemia after TEVAR in patients with abdominal aortic aneurysms. J Vasc Surg 2009; 49:302-6; discussion 306-7. [DOI: 10.1016/j.jvs.2008.08.119] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2008] [Revised: 08/25/2008] [Accepted: 08/29/2008] [Indexed: 11/27/2022]
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Feezor RJ, Martin TD, Hess PJ, Daniels MJ, Beaver TM, Klodell CT, Lee WA. Extent of Aortic Coverage and Incidence of Spinal Cord Ischemia After Thoracic Endovascular Aneurysm Repair. Ann Thorac Surg 2008; 86:1809-14; discussion 1814. [DOI: 10.1016/j.athoracsur.2008.09.022] [Citation(s) in RCA: 141] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2008] [Revised: 09/02/2008] [Accepted: 09/04/2008] [Indexed: 11/28/2022]
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Lee WA, Martin TD, Gravenstein N. Partial right atrial inflow occlusion for controlled systemic hypotension during thoracic endovascular aortic repair. J Vasc Surg 2008; 48:494-8. [DOI: 10.1016/j.jvs.2008.03.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Revised: 03/04/2008] [Accepted: 03/04/2008] [Indexed: 11/28/2022]
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Lee WA, Brown MP, Nelson PR, Huber TS, Seeger JM. Midterm outcomes of femoral arteries after percutaneous endovascular aortic repair using the Preclose technique. J Vasc Surg 2008; 47:919-23. [PMID: 18328666 DOI: 10.1016/j.jvs.2007.12.029] [Citation(s) in RCA: 124] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2007] [Revised: 12/02/2007] [Accepted: 12/10/2007] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Percutaneous access during endovascular aortic repair has been shown to be feasible and safe using a suture-mediated closure device ("Preclose" technique) for closure of up to 24F introducer sheaths. The purpose of this study is to examine the late outcomes of those femoral arteries repaired in this manner. METHODS The Preclose technique has been previously described. Briefly, the technique involves two Perclose Proglide devices deployed in the femoral artery prior to insertion of the large diameter introducer sheath and then closure of the arteriotomy by tying down knots of the Proglide following removal of the sheath. The medical records of all patients who underwent endovascular aortic repairs using the Preclose technique between December 2004 and August 2007 were reviewed. Follow-up protocol consisted of computed tomography (CT) angiograms performed at 1, 6, and 12 months, and annually thereafter. All Preclose patients who had at least a 6-month postoperative scan were included in the study. For each patient, the most recent postoperative scan was compared with the preoperative scan for evidence of any new anatomic abnormalities of the femoral artery such as dissection, stenosis, or pseudoaneurysm. Three-dimensional post processing with multiplanar reconstructions was also performed as necessary to confirm axial scan findings. RESULTS A total of 292 patients underwent percutaneous endovascular aortic repairs (TEVAR-125, EVAR-167). Four hundred thirty-two femoral arteries were closed with 870 devices. Four hundred eighteen vessels were approximated with two devices, while 30 arteries required three devices for hemostasis and an additional four vessels only required a single device. Two hundred seventy-eight (64.3%) vessels were accessed with sheaths 18 to 24F. Four hundred eight femoral arteries (94.4%) were closed successfully with the Preclose technique. There were 100 patients (TEVAR-35, EVAR-65) who had adequate postoperative CT scan at 6-months or later. The mean follow up was 11.6 +/- 5.0 months. Of the 156 femoral arteries in these 100 patients repaired using the Preclose technique, there were 3 late complications in 3 patients, 1 asymptomatic femoral artery dissection, and 2 femoral artery pseudoaneurysms requiring surgical repair, resulting in a late complication rate of 1.92% (3/156). CONCLUSION Percutaneous closure of femoral arteries after large diameter introducer sheaths using the Preclose technique has a low incidence of early and late complications related to the closure site.
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Affiliation(s)
- W Anthony Lee
- University of Florida, Division of Vascular Surgery and Endovascular Therapy, Gainesville, FL 32610-0286, USA.
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