1
|
Wang Q, Wei H, He C, Liu Y. Atrial septal defect occluder combined with stent graft for the management of post-dissection aortic aneurysm previously treated with unsuccessful coils: a case report. CVIR Endovasc 2023; 6:58. [PMID: 38019332 PMCID: PMC10686903 DOI: 10.1186/s42155-023-00405-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/14/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Although the candy-plug technique has been reported to be useful for the treatment of post-dissection aortic aneurysm, the stent graft needs be to customized to accommodate the size of vascular occluders. CASE PRESENTATION We present a case of a persistent false lumen successfully treated with endovascular stent-graft and atrial septal defect occluder in a patient with Stanford Type B dissection. A covered stent graft was implanted into the false cavity through a distal rupture, and an atrial septal defect occluder was inserted into the covered stent to seal of the false cavity. Decreased aneurysmal diameter and false lumen thrombosis were noted by CT scan at 6-month follow-up. CONCLUSIONS Our case showed that combined use of a stent graft and atrial septal defect occluder is safe, technically feasible and effective in sealing of the false lumen in post-dissection aortic aneurysm patients with previously failed false lumen thrombosis.
Collapse
Affiliation(s)
- Qiqi Wang
- Department of Vascular Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Haijun Wei
- Department of Vascular Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Chunshui He
- Department of Vascular Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yang Liu
- Department of Vascular Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
| |
Collapse
|
2
|
Zhang Y, Lu Q, Zhang S, Liang Z, Cui J, Jing Z. Endovascular treatment of complicated aortic aneurysms using a modified flow-diverting strategy: Mid- to long-term outcome from a multicenter cohort study. Br J Radiol 2022; 95:20210859. [PMID: 35180007 PMCID: PMC10993961 DOI: 10.1259/bjr.20210859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 01/29/2022] [Accepted: 02/07/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Frequently reported adverse events following flow-diverting stents' treatment of aortic aneurysms indicate further refinements of this technique are required. This study aims at evaluating the clinical efficacy of an improved flow-diverting strategy. METHODS A modified flow-diverting procedure was utilized in selected patients, in which stent-grafts were used to cover the non-branched segment of the aneurysmal lesion while flow-diverting multilayered bare metal stents were applied to cover the reno-visceral segment. The safety and efficacy of this joint procedure were assessed by regular follow-up. RESULTS We screened 497 patients and included 67 cases (mean age: 67.07 ± 12.14 years; 53 males) between February 2012 and March 2018. The median number of stent-grafts and bare metal stents used in the procedure were 1 (range: 1 to 3) and 3 (range: 2 to 4), respectively. During a mean follow-up period of 34.54 ± 20.28 months, aneurysm maximum diameter decreased from 64.79 ± 10.31 to 59.32 ± 10.20 mm (p = 0.002), while sac thrombosis ratio increased from 26.01±10.99% to 98.46±4.84% (p<0.001). Aneurysm-related death or conversion to open repair was documented in three patients. The majority side-branches (198/201) remained patent during follow-up. Overall clinical success rate reached 91.04% (61/67). CONCLUSIONS The joint procedure is characterized by significant aneurysm thrombosis along with high aneurysm stabilization/shrinkage and side-branches' patency rate. It might represent a potential improvement of the flow-diverting strategy in treating complex aortic lesions, yet large-scale, prospective, and randomized trials are anticipated to draw a robust conclusion. ADVANCES IN KNOWLEDGE The joint procedure could potentially exclude complex aortic aneurysms from circulation while maintaining the collateral branches.
Collapse
Affiliation(s)
- Yongxue Zhang
- Department of Vascular Surgery, Changhai
Hospital, Shanghai,
China
- Department of Interventional Radiology, Bethune International
Peace Hospital, Shijiazhuang,
China
| | - Qingsheng Lu
- Department of Vascular Surgery, Changhai
Hospital, Shanghai,
China
| | - Simeng Zhang
- Department of Pediatric Cardiac Surgery, State Key Laboratory
of Cardiovascular Disease, Fuwai Hospital,
Beijing, China
| | - Zhihui Liang
- Department of Interventional Radiology, Bethune International
Peace Hospital, Shijiazhuang,
China
| | - Jinguo Cui
- Department of Interventional Radiology, Bethune International
Peace Hospital, Shijiazhuang,
China
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai
Hospital, Shanghai,
China
| |
Collapse
|
3
|
Yuan X, Mitsis A, Mozalbat D, Nienaber CA. Alternative management of proximal aortic dissection: concept and application. Indian J Thorac Cardiovasc Surg 2021; 38:183-192. [PMID: 35463707 PMCID: PMC8980987 DOI: 10.1007/s12055-021-01281-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 11/17/2022] Open
Abstract
Open surgery remains the mainstay of treatment for acute type A aortic dissection and should be offered to most patients. However, there are elderly patients in which surgical treatment may be deemed extremely high risk or futile. Endovascular treatment approaches have been applied to a small number of these patients and data are limited to case reports and small series. The application of endovascular therapies to ascending aorta is currently limited by anatomical and technical challenges posed by the dynamic motion of the ascending aorta and the proximity of vital structures to intended landing zones (aortic valve, coronary arteries, and supra-aortic branches) and lack of specially designed endografts to address these issues. While thoracic endovascular aortic repair (TEVAR) has replaced open aortic repair for a suitable lesion in distal aortic dissection, some selected patients with type A aortic dissection at high surgical may be candidates. Hence, there is potential because, in proximal (Stanford type A) dissections, 10–30% of patients are not accepted for surgery, and 30–50% are technically amenable for TEVAR. Recent experience has shown that carefully selected patients with favorable anatomical characteristics may be subject to endovascular stent-graft treatment as a last resort with mixed results. Technical improvement is necessary to offer. satisfactory endovascular options in non-surgical candidates.
Collapse
|
4
|
Bissacco D, Calliari FM, Viani MP. Irrelevant Endoleak after Multilayer Stent Treatment for an Iliac Artery Aneurysm. Vasc Specialist Int 2020; 36:266-267. [PMID: 33208549 PMCID: PMC7790691 DOI: 10.5758/vsi.200059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/21/2020] [Accepted: 10/26/2020] [Indexed: 11/22/2022] Open
Affiliation(s)
- Daniele Bissacco
- Vascular Surgery Unit, ASST Fatebenefratelli-Sacco, Milan, Italy.,School of Vascular Surgery, University of Milan, Milan, Italy
| | | | | |
Collapse
|
5
|
Yuan X, Mitsis A, Semple T, Rubens M, Nienaber CA. Dual lumen intervention for aortic dissection: long-term impact on aortic remodeling. ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2020. [DOI: 10.23736/s1824-4777.20.01441-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|
6
|
Dai Y, Luo G, Dai X, Liu H. Hemodynamic Effects of Multiple Overlapping Uncovered Stents on Aortic Dissection: Surgical Strategies and Implications for False Lumen Thrombosis. Cardiovasc Eng Technol 2019; 11:24-35. [PMID: 31820352 DOI: 10.1007/s13239-019-00443-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 11/20/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Multiple overlapping uncovered stents (MOUS) are employed to promote false lumen thrombosis in the aortic dissections (AD), when the tears are in close vicinity to the branch vessels. However, the overall rate of false lumen thrombosis remains unsatisfactory. This study was performed to investigate the hemodynamic influence of MOUS on aortic dissection to shed some light on the mechanism of post-stenting false lumen thrombosis. METHODS An anatomically accurate computational fluid dynamics model was developed to investigate the hemodynamics of AD. A parametric study was carried out to demonstrate the hemodynamic influence of MOUS in various post-surgery scenarios featuring the representative surgical strategies involving MOUS. RESULTS The use of reduced-porosity MOUS slowed the blood flow in the false lumen and decreased the wall shear stress. MOUS depressed the false lumen and enlarged the true lumen, without significantly altering the blood outflow distribution among the branch vessels. Compared with MOUS-alone and stent graft-alone scenarios, the combination of MOUS and stent graft generated a substantially large region of stagnant flow. The active flow was confined to an area in close vicinity to the tears covered by the MOUS, which perfuse the right renal artery in the false lumen. CONCLUSIONS MOUS helps to generate a favored hemodynamic environment for thrombus formation in the false lumen. Application of MOUS along with covered stent grafts may represent a more effective treatment for AD than utilizing MOUS or stent graft alone.
Collapse
Affiliation(s)
- Yanan Dai
- Department of Mechanics, Tianjin University, 92 Weijin Road, Tianjin, 300072, China
| | - Guangze Luo
- Department of Surgery, Tianjin Medical University General Hospital, 154 Anshan Road, Tianjin, 300052, China
| | - Xiangchen Dai
- Department of Surgery, Tianjin Medical University General Hospital, 154 Anshan Road, Tianjin, 300052, China.
| | - Haofei Liu
- Department of Mechanics, Tianjin University, 92 Weijin Road, Tianjin, 300072, China.
| |
Collapse
|
7
|
Dai M, Liu T, Luo Y, Zhou F, Fan H, Zhu J, Zhang Y, Hu F, Dai X. Treatment of aortic dissecting aneurysm involving visceral arteries with multi-layer bare stents. Rev Assoc Med Bras (1992) 2019; 65:216-221. [PMID: 30892447 DOI: 10.1590/1806-9282.65.2.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 05/27/2018] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Aortic dissecting aneurysms involving visceral arteries are difficult for clinical treatment. This study aimed to explore the clinical efficacy and safety of multi-layer bare stents technique in the treatment of aortic dissecting aneurysms involving visceral arteries. METHOD The clinical data of 16 patients of aortic dissecting aneurysm involving visceral artery treated with multi-layer bare stents technique from March 2013 to March 2017 in Tianjin Medical University General Hospital were retrospectively analyzed. To explore the clinical efficacy, the number of stents applied, postoperative aortic dissecting thrombosis and postoperative cumulative branch arterial patency of the16 patients. RESULTS The operations of the 16 patients were successfully completed without peri-operative death cases. The 16 patients were implanted with 39 bare stents with an average of 2.44 per person. There were 2 cases with 1 stent, 8 cases with 2 stents and 7 cases with 3 stents. One month after the operation, CTA showed complete thrombosis in the arterial dissection in 4 cases (25.0%), partial thrombosis in 12 cases (75.0%); CTA showed that celiac artery, left and right renal arteries, and superior mesenteric artery were all unobstructed. There were 4 cases (25.0%) of dissecting artery with reduced diameter, 12 patients (75.0%) without changes in the diameter, and no diameter expanding cases. CONCLUSION The treatment for aortic dissecting aneurysm involving the visceral arteries using multi-layer bare stents technique is safe and reliable with a higher patency rate of postoperative accumulated branch arteries.
Collapse
Affiliation(s)
- Mingsheng Dai
- Department of Vascular Surgery, Tianjin Medical University General Hospital, Tianjin 300052 PR China.,Department of General Surgery, Tinjin Huanghe Hospital, Tianjin 300101 PR China
| | - Tong Liu
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin 300052 PR China
| | - Yudong Luo
- Department of Vascular Surgery, Tianjin Medical University General Hospital, Tianjin 300052 PR China
| | - Feng Zhou
- Department of Vascular Surgery, Tianjin Medical University General Hospital, Tianjin 300052 PR China
| | - Hailun Fan
- Department of Vascular Surgery, Tianjin Medical University General Hospital, Tianjin 300052 PR China
| | - Jiechang Zhu
- Department of Vascular Surgery, Tianjin Medical University General Hospital, Tianjin 300052 PR China
| | - Yiwei Zhang
- Department of Vascular Surgery, Tianjin Medical University General Hospital, Tianjin 300052 PR China
| | - Fanguo Hu
- Department of Vascular Surgery, Tianjin Medical University General Hospital, Tianjin 300052 PR China
| | - Xiangchen Dai
- Department of Vascular Surgery, Tianjin Medical University General Hospital, Tianjin 300052 PR China
| |
Collapse
|
8
|
Hemodynamic analysis of a novel stent graft design with slit perforations in thoracic aortic aneurysm. J Biomech 2019; 85:210-217. [DOI: 10.1016/j.jbiomech.2019.01.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/08/2018] [Accepted: 01/08/2019] [Indexed: 01/11/2023]
|
9
|
Jia Z, Su H, Chen W, Ni G, Qi C, Gu J. Endovascular Treatment of Patients with Isolated Mesenteric Artery Dissection Aneurysm: Bare Stents Alone Versus Stent Assisted Coiling. Eur J Vasc Endovasc Surg 2018; 57:400-406. [PMID: 30316568 DOI: 10.1016/j.ejvs.2018.08.057] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 08/31/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The aim was to evaluate the outcomes of endovascular treatment with bare stents alone versus stent assisted coiling in isolated mesenteric artery dissection (IMAD) aneurysms. METHODS Patients with an IMAD aneurysm who underwent endovascular stenting between February 2010 and February 2017 at one of three institutions were included in this study. Data regarding technical success, procedure time, symptom resolution, complications, changes in IMAD aneurysm, and stent patency were recorded. RESULTS A total of 38 patients (35 men) were included, 27 treated with bare stents alone and 11 treated with stent assisted coiling. Technical success was achieved in 100% of patients treated with bare stents and in 81.8% of those treated with stent assisted coiling (p = 0.078). The mean procedure times were 62.6 ± 5.3 min for treatment with bare stents and 116.4 ± 8.4 min for stent assisted coiling (p < 0.001). A total of 23 patients had persistent symptoms before stenting; all symptoms were resolved within 3.0 ± 0.7 days. No procedure related major complications occurred. Over 30.2 ± 18.1 months of follow up, complete resolution of the IMAD aneurysm was achieved in all patients; good stent patency and in stent re-stenosis were achieved in 65.8% and 34.2% patients, respectively. There were no occlusions of the stented arteries. CONCLUSIONS Bare stents alone and stent assisted coiling have high technical success rates and demonstrate good intermediate patency in patients with an IMAD aneurysm. Bare stents alone may serve as an alternative to stent assisted coiling for the management of IMAD aneurysm.
Collapse
Affiliation(s)
- Zhongzhi Jia
- Department of Interventional Radiology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China; The Centre of Medical Physics with Nanjing Medical University, Changzhou, China
| | - Haobo Su
- Department of Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Wenhua Chen
- Department of Interventional Radiology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Guoqing Ni
- Department of Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Chunjian Qi
- Medical Research Centre, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China.
| | - Jianping Gu
- Department of Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
| |
Collapse
|
10
|
False lumen intervention to promote remodelling and thrombosis-The FLIRT concept in aortic dissection. Catheter Cardiovasc Interv 2018; 92:732-740. [DOI: 10.1002/ccd.27599] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 02/01/2018] [Accepted: 02/23/2018] [Indexed: 01/16/2023]
|
11
|
Komarov RN, Vinokurov IA, Karavaykin PA, Abdulmutalibov IM, Belov YV. [Staged approach for hybrid thoracoabdominal aortic replacement]. Khirurgiia (Mosk) 2018:21-27. [PMID: 29460875 DOI: 10.17116/hirurgia2018221-27] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
AIM To generalize our experience of step-by-step hybrid thoracoabdominal aortic replacement. MATERIAL AND METHODS Twenty-three patients were enrolled who underwent staged hybrid treatment of thoracoabdominal aortic aneurysm. There were 5 (21.7%) women and 18 (78.3%) men aged 61.4±8.3 years (37-74 years). The first stage was proximal debranching, the second - distal (abdominal) procedure and the third - stenting of the thoracoabdominal aorta. RESULTS There were no any complications after proximal debranching and aortic stenting. Abdominal debranching was followed by lethal outcome in 3 (13.0%) patients and early postoperative occlusion of the prosthesis brunch in 3 out of 87 cases. CONCLUSION Staged approach for hybrid surgical treatment is optimal solution, especially in high risk patients. In our opinion no necessity for cardiopulmonary bypass is the main advantage of this technique.
Collapse
Affiliation(s)
- R N Komarov
- Sechenov First Moscow State Medical University Cardiac Surgery Department #2, Moscow, Russia
| | - I A Vinokurov
- Sechenov First Moscow State Medical University Cardiac Surgery Department #2, Moscow, Russia
| | - P A Karavaykin
- Sechenov First Moscow State Medical University Cardiac Surgery Department #2, Moscow, Russia
| | - I M Abdulmutalibov
- Sechenov First Moscow State Medical University Cardiac Surgery Department #2, Moscow, Russia
| | - Yu V Belov
- Sechenov First Moscow State Medical University Cardiac Surgery Department #2, Moscow, Russia
| |
Collapse
|