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Lee J, Kim DY, Lim HA, Hong SB, Kim YH, Kim HW. Successful open surgical treatment for persistent type II endoleak following thoracic endovascular aortic repair: a case report. J Cardiothorac Surg 2024; 19:416. [PMID: 38961402 PMCID: PMC11221121 DOI: 10.1186/s13019-024-02843-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 06/14/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND The occurrence of type II endoleaks after endovascular repair of aortic aneurysm has gradually gained increasing attention. We present a case of a patient with an expanding aneurysm after thoracic endovascular aortic repair (TEVAR) for a type II endoleak, in which successful direct ligations of the intercostal artery were performed using a sac incision without cardiopulmonary bypass (CPB) or graft replacement. CASE PRESENTATION A 62-year-old male patient, previously treated with TEVAR for a descending thoracic aortic aneurysm, presented with ongoing chest discomfort. Based on the diagnosis of a growing aneurysm and type II endoleak, the patient was prepared for CPB and aortic cross-clamping, as a precautions against the possibility of a type I endoleak. A longitudinal opening of the thoracic aortic aneurysm sac was performed following left thoracotomy. Visual confirmation identified the T5 level intercostal artery as the source of the endoleak, and after confirming the absence of a type I endoleak, multiple ligations were applied to the intercostal artery. Follow-up computed tomography confirmed the absence of endoleaks or sac growth. CONCLUSION In a case involving TEVAR for a thoracic aortic aneurysm, open suture ligations were used to treat type II endoleaks without having to resort to CPB, resulting in successful outcomes.
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Affiliation(s)
- June Lee
- Department of Thoracic and Cardiovascular Surgery, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu-si, Republic of Korea
| | - Do Yeon Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
| | - Hyun Ah Lim
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Seok Beom Hong
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Yong Han Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Hwan Wook Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
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De Masi M, Guivier-Curien C, Cortaredona S, Omnes V, Bal L, Muselier B, Bartoli A, Gaudry M, Piquet P, Deplano V. The Value of Aortic Volume and Intraluminal Thrombus Quantification for Predicting Aortic Events after Endovascular Thoracic Aneurysm Repair. J Clin Med 2024; 13:2981. [PMID: 38792522 PMCID: PMC11122356 DOI: 10.3390/jcm13102981] [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: 03/28/2024] [Revised: 05/10/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024] Open
Abstract
Objectives: To assess the ability of the aortic aneurysm volume (AAV), aneurysmal lumen volume (ALV), and aneurysmal thrombus volume (ATV) to predict the need for aortic reintervention when using the maximal aortic diameter as a reference. Methods: This monocentric retrospective study included 31 consecutive patients who underwent successful thoracic endovascular aortic repair (TEVAR) to treat an atheromatous thoracic aortic aneurysm. All patients underwent clinical and computed tomography angiography (CTA) for 3 years after TEVAR. The patients were categorized into group 0 if no aortic reintervention was required during the follow-up period and categorized into group 1 if they experienced a type I or III endoleak or aneurysm diameter increase requiring intervention. The maximum aneurysm sac diameter and the AAV, ALV, and ATV were calculated using CTA images obtained preoperatively (T0) and at 6-12 months (T1), 24 months (T2), and 36 months (T3) postoperatively, and their changes over time were analyzed. Correlations between diameter and changes in AAV, ALV, and ATV were assessed, and the association between diameter and volume changes and reintervetion was examined. The cutoff values for predicting the need for reintervention was determined using a receiver operating characteristic (ROC) curve. The accuracy of volume change versus diameter change for predicting the need for reintervention was analyzed. Results: There were no significant differences in terms of the mean aneurysm diameter or AAV, ALV or ATV between the groups at preoperative CTA or after one year of follow-up imaging. The mean ATV was higher in group 1 than in group 0 at 2 years (187.6 ± 86.3 mL vs. 114.7 ± 64.7 mL; p = 0.057) and after 3 years (195.0 ± 86.7 mL vs. 82.1 ± 39.9 mL; p = 0.013). The maximal diameter was greater in group 1 than in group 0 at 3 years (67.3 ± 9.5 mm vs. 55.3 ± 12.6 mm; p = 0.044). The rate of AAV change between T0 and T1 was significantly higher in group 1 (7 ± 4.5%) than in group 0 (-6 ± 6.8%; p < 0.001). The rate of ATV change between T1-T3 was significantly higher in group 1 than in group 0 (34 ± 40.9% vs. -13 ± 14.4% (p = 0.041)); similar results were observed for the rate of ATV change between T2 and T3 (27 ± 50.1% for group 1 vs. -8 ± 49.5% in group 0 (p < 0.001)). According to our multivariate analysis, the annual growth rate for AAV between T0 and T1 was the only independent factor that was significantly associated with aortic reintervention (area under the curve (AUC) = 0.84, OR = 1.57, p = 0.025; optimal cutoff +0.4%). An increase in the annual growth rate of the ATV between T0 and T3 was independently associated with the need for aortic reintervention (area under the curve (AUC) = 0.90, OR = 1.11, p = 0.0347; optimal cutoff +10.1%). Conclusions: Aortic volume analysis can predict the need for aortic reintervention more accurately and earlier than maximal aortic diameter.
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Affiliation(s)
- Mariangela De Masi
- Timone Aortic Center, Department of Vascular Surgery, APHM, Timone Hospital, 13005 Marseille, France; (V.O.); (L.B.); (M.G.); (P.P.)
| | - Carine Guivier-Curien
- CNRS, École Centrale Marseille, IRPHE UMR 7342, Aix-Marseille University, 13384 Marseille, France; (C.G.-C.); (V.D.)
| | - Sébastien Cortaredona
- IRD, AP-HM, SSA, VITROME, Aix-Marseille University, 13009 Marseille, France;
- IHU-Méditerranée Infection, 13385 Marseille, France
| | - Virgile Omnes
- Timone Aortic Center, Department of Vascular Surgery, APHM, Timone Hospital, 13005 Marseille, France; (V.O.); (L.B.); (M.G.); (P.P.)
| | - Laurence Bal
- Timone Aortic Center, Department of Vascular Surgery, APHM, Timone Hospital, 13005 Marseille, France; (V.O.); (L.B.); (M.G.); (P.P.)
| | - Baptiste Muselier
- Department of Radiology, APHM, Timone Hospital, 13005 Marseille, France; (B.M.); (A.B.)
| | - Axel Bartoli
- Department of Radiology, APHM, Timone Hospital, 13005 Marseille, France; (B.M.); (A.B.)
| | - Marine Gaudry
- Timone Aortic Center, Department of Vascular Surgery, APHM, Timone Hospital, 13005 Marseille, France; (V.O.); (L.B.); (M.G.); (P.P.)
| | - Philippe Piquet
- Timone Aortic Center, Department of Vascular Surgery, APHM, Timone Hospital, 13005 Marseille, France; (V.O.); (L.B.); (M.G.); (P.P.)
| | - Valérie Deplano
- CNRS, École Centrale Marseille, IRPHE UMR 7342, Aix-Marseille University, 13384 Marseille, France; (C.G.-C.); (V.D.)
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Stilo F, Catanese V, Montelione N, Nenna A, Pilato F, Gabellini T, Chello M, DI Lazzaro V, Spinelli F. Subclavian artery revascularization with subclavian-carotid transposition for TEVAR and non-TEVAR patients. THE JOURNAL OF CARDIOVASCULAR SURGERY 2024; 65:147-154. [PMID: 37162237 DOI: 10.23736/s0021-9509.23.11473-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND Subclavian artery revascularization (SAR) has become an increasingly performed technique in patients undergoing thoracic endovascular aortic aneurysm repair (TEVAR), in order to optimize the proximal landing zone, or in patients with significant atherosclerotic diseases. SAR was usually achieved through carotid-subclavian bypass (CSB) which is daunted by graft and patency-related issues, or through subclavian carotid transposition (SCT) which has recently been reconsidered as a potential solution. Nowadays, multiple endovascular strategies including parallel grafts, chimney graft and branch-fenestrated repair, are available in patients unfit for open SAR. However, there is no consensus on the preferable technique in both TEVAR- and non TEVAR-patients. The purpose of this study was to evaluate our experience with SCT in terms of overall postoperative adverse events and mid-term patency rate. METHODS We performed a retrospective cohort study, including all patients who underwent SCT between June 2014 and March 2020 at our Division. Preoperative risk factors, symptoms, intraoperative details, postoperative outcomes and follow-up data were collected. RESULTS A total of 27 patients were included in this study. Indications for SCT included aortic arch debranching for TEVAR for thoracic aortic aneurysm and type B dissection and symptomatic subclavian steal syndrome (SSS). There were no major perioperative adverse events or major neurological complications; five minor adverse events occurred (18.5%) (3 Horner' Syndrome, 1 hematoma requiring reoperation,1 pneumothorax). Peripheral nerve injuries and lymphatic lesions were not recorded. On a mean follow-up of 21±16 months, SCT patency was confirmed in all patients and no deaths occurred. Comparison of baseline and operative characteristics and intraoperative details between groups of patients with or without adverse events did not found differences. CONCLUSIONS SCT should be considered a feasible, effective and safe technique for SAR, with low perioperative complications and optimal mid-term patency. This surgical technique appears to provide a lower risk of neurological events and mortality, particularly in TEVAR patients, reducing the complications caused by the coverage of the left subclavian artery.
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Affiliation(s)
- Francesco Stilo
- Department of Vascular Surgery, Campus Bio-Medico University, Rome, Italy
| | - Vincenzo Catanese
- Department of Vascular Surgery, Campus Bio-Medico University, Rome, Italy -
| | - Nunzio Montelione
- Department of Vascular Surgery, Campus Bio-Medico University, Rome, Italy
| | - Antonio Nenna
- Department of Cardiovascular Surgery, Campus Bio-Medico University, Rome, Italy
| | - Fabio Pilato
- Department of Neurology, Institute of Neurology, Sacred Heart Catholic University, Rome, Italy
| | | | - Massimo Chello
- Department of Cardiovascular Surgery, Campus Bio-Medico University, Rome, Italy
| | - Vincenzo DI Lazzaro
- Department of Neurology, Institute of Neurology, Campus Bio-Medico University, Rome, Italy
| | - Francesco Spinelli
- Department of Vascular Surgery, Campus Bio-Medico University, Rome, Italy
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4
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Nooromid M, Creisher BA, Abai B. Treatment of Uncomplicated Type B Aortic Dissection: Optimal Medical Therapy vs TEVAR + Optimal Medical Therapy. Vasc Endovascular Surg 2024; 58:115-122. [PMID: 37365809 DOI: 10.1177/15385744231184671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Optimal Medical Therapy (OMT) has been the accepted mode of treatment for uncomplicated Type B Aortic Dissection (uTBAD). There is growing evidence that despite the short-term benefits of OMT, patients suffer deleterious consequences in the long-term with OMT alone. Thoracic Endovascular Aortic Repair (TEVAR) along with OMT has emerged as an alternative option for patients with uTBAD. This study evaluates the available literature for TEVAR + OMT as an alternative to OMT for treatment of uTBAD. In addition, issues related to TEVAR as a treatment for uTBAD are discussed.
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Affiliation(s)
- Michael Nooromid
- Division of Vascular and Endovascular Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Brandon A Creisher
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Babak Abai
- Division of Vascular and Endovascular Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Onishi Y, Shimizu H, Kawatou M, Minatoya K, Nakamoto Y. Transarterial Embolization of Type 2 Endoleak Post Thoracic Endovascular Aortic Repair (TEVAR) Using a Triaxial System With a 1.3-F Microcatheter: A Case Report. Cureus 2024; 16:e51694. [PMID: 38318551 PMCID: PMC10839416 DOI: 10.7759/cureus.51694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2024] [Indexed: 02/07/2024] Open
Abstract
Although transarterial embolization is recognized as a treatment for type 2 endoleaks, it can occasionally be challenging. We report the case of an 86-year-old man who presented with an enlarging thoracoabdominal aortic aneurysm following thoracic endovascular aortic repair. Using a triaxial system with a 1.3-F microcatheter, transarterial embolization of a type 2 endoleak was successfully performed through a long and tortuous arterial route comprising the thoracodorsal and ninth intercostal arteries. The postoperative clinical course was uneventful, and computed tomography obtained six days later showed no endoleak in the thoracoabdominal aortic aneurysm. This case suggests the usefulness of a triaxial system with a 1.3-F microcatheter for transarterial embolization of type 2 endoleaks.
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Affiliation(s)
- Yasuyuki Onishi
- Diagnostic Imaging and Nuclear Medicine, Kyoto University, Kyoto, JPN
| | - Hironori Shimizu
- Diagnostic Imaging and Nuclear Medicine, Kyoto University, Kyoto, JPN
| | | | | | - Yuji Nakamoto
- Diagnostic Imaging and Nuclear Medicine, Kyoto University, Kyoto, JPN
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Bayfield NGR, Bennett A, Ritter JC. Stent-Assisted Balloon-Induced Intimal Disruption and Relamination in Aortic Dissection Repair (STABILISE): A Meta-Analysis of Early Outcomes. Ann Vasc Surg 2024; 98:146-154. [PMID: 37454893 DOI: 10.1016/j.avsg.2023.06.028] [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: 04/16/2023] [Revised: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND This meta-analysis aims to determine the early clinical outcomes and rate of complete false lumen obliteration associated with the stent-assisted balloon-induced intimal disruption and relamination in aortic dissection repair (STABILISE) technique in the management of aortic dissection. METHODS Electronic databases searches were performed on PubMed, Embase, and the Cochrane Library to identify studies reporting early outcomes of the STABILISE technique. In addition, we retrospectively analyzed all patients treated with the STABILISE technique for aortic dissection at our institution. The case series data were pooled with relevant studies to perform a meta-analysis of proportions using random-effects models. RESULTS One hundred and ninety two patients from 9 relevant studies were pooled with an additional 13 patients undergoing STABILISE at our institution over a 3-year period. Pooled in-hospital mortality rate was 6% [95% confidence interval (CI); 3%-10%, I2 = 0.00%] and the overall rate of intraoperative aortic rupture was 4% [95% CI; 2%-8%, I2 = 0.00%]. The rate of in-hospital reintervention was 8% [95% CI; 5%-14%, I2 = 13.37%]. Median follow-up ranged from 8 to 36 months. Pooled cumulative mortality at follow-up was 8% [95% CI; 4%-18%, I2 = 23.15%]. The overall rate of late reintervention was 11% [95% CI; 7%-17%, I2 = 0.00%]. Complete obliteration of the false lumen in the thoracic aorta was achieved in 93% of patients [95% CI; 84%-97%, I2 = 47.49%] and in the abdominal aorta in 86% of patients [95% CI; 79%-91%, I2 = 0.00%]. CONCLUSIONS The STABILISE technique carries an acceptable operative safety profile with low in-hospital morbidity and mortality and excellent complete false lumen obliteration.
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Affiliation(s)
| | - Amy Bennett
- Department of Vascular Surgery, Fiona Stanley Hospital, Perth, Australia
| | - Jens Carsten Ritter
- Department of Vascular Surgery, Fiona Stanley Hospital, Perth, Australia; Curtin University, School of Medicine, Perth, Australia
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Onishi M, Onishi Y, Noda T, Yasuo S, Kobiki J, Arai Y, Taniguchi T. Transcatheter arterial embolization of a type 2 endoleak through the dorsal pancreatic artery after the hybrid repair of a thoracoabdominal aortic aneurysm: A case report. Radiol Case Rep 2023; 18:2845-2849. [PMID: 37388261 PMCID: PMC10300486 DOI: 10.1016/j.radcr.2023.05.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/11/2023] [Accepted: 05/15/2023] [Indexed: 07/01/2023] Open
Abstract
An 83-year-old woman with a history of hybrid repair of thoracoabdominal aortic aneurysm presented with enlargement of the aneurysm due to a type 2 endoleak from the celiac artery. The endoleak cavity was accessed via the dorsal pancreatic artery, and embolization using N-butyl cyanoacrylate and coils was successfully performed. When celiac artery branches are embolized during hybrid repair of a thoracoabdominal aortic aneurysm, attention should be paid to the dorsal pancreatic artery to appropriately determine which branches are to be embolized, because a nonembolized dorsal pancreatic artery may lead to type 2 endoleaks.
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Affiliation(s)
- Motofumi Onishi
- Department of Radiology, Tenri Hospital, 200 Mishimacho, Tenri, Nara 632-8552, Japan
| | - Yasuyuki Onishi
- Department of Radiology, Tenri Hospital, 200 Mishimacho, Tenri, Nara 632-8552, Japan
| | - Toshiyuki Noda
- Department of Radiology, Tenri Hospital, 200 Mishimacho, Tenri, Nara 632-8552, Japan
| | - Shunsuke Yasuo
- Department of Radiology, Tenri Hospital, 200 Mishimacho, Tenri, Nara 632-8552, Japan
| | - Jumpei Kobiki
- Department of Cardiovascular Surgery, Tenri Hospital, Tenri, Nara, Japan
| | - Yoshio Arai
- Department of Cardiovascular Surgery, Tenri Hospital, Tenri, Nara, Japan
| | - Takanori Taniguchi
- Department of Radiology, Tenri Hospital, 200 Mishimacho, Tenri, Nara 632-8552, Japan
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Frisiras A, Giannas E, Bobotis S, Kanella I, Arjomandi Rad A, Viviano A, Spiliopoulos K, Magouliotis DE, Athanasiou T. Comparative Analysis of Morbidity and Mortality Outcomes in Elderly and Nonelderly Patients Undergoing Elective TEVAR: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:5001. [PMID: 37568406 PMCID: PMC10420243 DOI: 10.3390/jcm12155001] [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: 06/11/2023] [Revised: 07/14/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
OBJECTIVE Due to an ever-increasing ageing population and limited available data around the use of thoracic endovascular aortic repair (TEVAR) in elderly patients, investigating its efficacy and safety in this age cohort is of vital importance. We thus reviewed the existing literature on this topic to assess the feasibility of TEVAR in elderly patients with severe thoracic aortic pathologies. METHODS We identified all original research studies that assessed TEVAR in elderly patients published up to 2023. Morbidity, as assessed by neurological and respiratory complications, endoleaks, and length of stay, was the primary endpoint. Short-term mortality and long-term survival were the secondary endpoints. The Mantel-Haenszel random and fixed effects methods were used to calculate the odds ratios for each outcome. Further sensitivity and subgroup analyses were performed to validate the outcomes. RESULTS Twelve original studies that evaluated elective TEVAR outcomes in elderly patients were identified. Seven studies directly compared the use of TEVAR between an older and a younger patient group. Apart from a shorter hospital stay in older patients, no statistically significant difference between the morbidity outcomes of the two different cohorts was found. Short-term mortality and long-term survival results favoured the younger population. CONCLUSIONS The present meta-analysis indicates that, due to a safe perioperative morbidity profile, TEVAR should not be contraindicated in patients based purely on old age. Further research using large patient registries to validate our findings in elderly patients with specific aortic pathologies and both elective and emergency procedures is necessary.
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Affiliation(s)
- Angelos Frisiras
- Faculty of Medicine, Imperial College London, Charing Cross Hospital, London W6 8RF, UK; (A.F.); (E.G.); (S.B.); (I.K.)
| | - Emmanuel Giannas
- Faculty of Medicine, Imperial College London, Charing Cross Hospital, London W6 8RF, UK; (A.F.); (E.G.); (S.B.); (I.K.)
| | - Stergios Bobotis
- Faculty of Medicine, Imperial College London, Charing Cross Hospital, London W6 8RF, UK; (A.F.); (E.G.); (S.B.); (I.K.)
| | - Ilektra Kanella
- Faculty of Medicine, Imperial College London, Charing Cross Hospital, London W6 8RF, UK; (A.F.); (E.G.); (S.B.); (I.K.)
| | | | - Alessandro Viviano
- Department of Cardiothoracic Surgery, Imperial College NHS Trust, Hammersmith Hospital, London W12 0HS, UK;
| | - Kyriakos Spiliopoulos
- Department of Cardiothoracic Surgery, University of Thessaly, Biopolis, 41 110 Larissa, Greece;
| | - Dimitrios E. Magouliotis
- Unit of Quality Improvement, Department of Cardiothoracic Surgery, University of Thessaly, Biopolis, 41 110 Larissa, Greece;
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, London W2 1NY, UK
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Robb CL, Bhalla S, Raptis CA. Subclavian Artery: Anatomic Review and Imaging Evaluation of Abnormalities. Radiographics 2022; 42:2149-2165. [PMID: 36053845 DOI: 10.1148/rg.220064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The subclavian artery is an important structure that may be overlooked at CT of the chest and neck, in part because of its anatomic location at the periphery of the field of view but also because the clinical indication for CT examinations infrequently directs attention specifically to evaluation of the subclavian artery. As with all arteries, the subclavian artery has the potential to be involved in a variety of abnormalities, including pseudoaneurysms, dissections, stenosis or thrombosis, and vasculopathies. In addition, the subclavian artery can be secondarily involved as a collateral pathway because of an abnormality elsewhere. The subclavian artery may also be involved in surgical procedures to supply blood to other sites in the body or as an arterial access site. In these cases, recognizing the postsurgical appearance of the subclavian artery has become increasingly complex because of the use of the artery in an increasing number of procedures. Recognizing expected postoperative changes remains important to avoid mistaking them for abnormalities. The authors describe the imaging appearance of the normal anatomy of the subclavian artery and its anatomic variants, related abnormalities, and important postsurgical considerations. ©RSNA, 2022.
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Affiliation(s)
- Caroline L Robb
- From the Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110
| | - Sanjeev Bhalla
- From the Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110
| | - Constantine A Raptis
- From the Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, CB 8131, St Louis, MO 63110
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10
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Zhang H, Xiao Z, Peng W, Hu J. Progressive dysphagia and dyspnea after thoracic endovascular aortic repair due to a rare cause of type II endoleak. J Vasc Surg 2022; 76:579-580. [PMID: 35870850 DOI: 10.1016/j.jvs.2021.09.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/21/2021] [Indexed: 02/08/2023]
Affiliation(s)
- Hongwei Zhang
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
| | - Zhenghua Xiao
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
| | - Wanlin Peng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
| | - Jia Hu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
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11
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Mezzetto L, Mastrorilli D, Bravo G, Scorsone L, Gennai S, Leone N, D'Oria M, Veraldi E, Veraldi GF. Celiac Artery Coverage After Thoracic Endovascular Aortic Procedure: A Meta-Analysis of Early and Late Results. J Endovasc Ther 2022:15266028221090443. [PMID: 35466769 DOI: 10.1177/15266028221090443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND/AIM Clinical outcomes of celiac artery (CA) coverage during aortic procedures are often contradicting and the fate of this additional maneuver is still unclear. This study summarizes the results of available literature and aims to clarify the impact of CA coverage during thoracic endovascular aneurysm repair (TEVAR) in patients with inadequate distal sealing zone. METHODS Prospective and retrospective, observational original articles focused on CA coverage during elective/urgent TEVAR for descending thoracic aortic pathology (DTAP) were included. PubMed/MEDLINE, Embase, and Cochrane Central Register of Controlled Trials database were examined to identify articles published from January 2007 to December 2020, according to PRISMA guidelines. Early and late visceral (any sign or symptom reported) and neurological (both transient and permanent) complications were considered as primary outcomes. Onset of any endoleak, type IB endoleak, need of reintervention, and TEVAR-related mortality were considered as secondary outcomes. RESULTS A total of 5618 articles were extracted for analysis and 13 studies were finally included in the synthesis. A total of 178 CAs were covered during 2653 TEVAR (7%). Spinal cord ischemia was 8% (95% CI, 5-14%, I2 0%) Any endoleak and type IB endoleak was observed in 12% (95% CI, 6-21%, I2 17%) and 5% (95% CI, 2-11%, I2 0%), respectively. Thoracic endovascular aneurysm repair-related reoperation was necessary in 8% (95% CI, 4-14%, I2 0%), the majority of which (14/18, 78%) performed for distal sealing failure; mortality rate was 9% (95% CI, 5-14%, I2 0%). Out of 178 patients, 168 (94%) were available for follow-up, ranged 12 to 42 months. Visceral complications, any endoleak, and type IB endoleak were identified in 15% (95% CI, 10-23%, I2 45%), 20% (95% CI, 13-29%, I2 8%), and 8% (95% CI, 4-15%, I2 0%), respectively. Thoracic endovascular aneurysm repair-related reintervention was required in 8% (95% CI, 4-14%, I2 0%). Mortality rate was 17% (95% CI, 12-25%, I2 4%). CONCLUSIONS Celiac artery coverage in DTAP should be regarded as a "bailout" procedure especially in urgent/emergent settings but requires caution in elective cases. Even if transient visceral ischemia is frequent, life-threatening complications are rare. Early and late mortality rates are similar to standard TEVAR although the risk of type IB endoleak and reintervention may be an issue.
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Affiliation(s)
- Luca Mezzetto
- Vascular Surgery, Integrated University Hospital of Verona, Verona, Italy
| | - Davide Mastrorilli
- Vascular Surgery, Integrated University Hospital of Verona, Verona, Italy
| | - Giulia Bravo
- Department of Medicine, University of Udine, Udine, Italy
| | - Lorenzo Scorsone
- Vascular Surgery, Integrated University Hospital of Verona, Verona, Italy
| | - Stefano Gennai
- Vascular Surgery, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Nicola Leone
- Vascular Surgery, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Mario D'Oria
- Vascular and Endovascular Surgery, Trieste University Hospital, Trieste, Italy
| | - Edoardo Veraldi
- Vascular Surgery, Integrated University Hospital of Verona, Verona, Italy
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12
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Nagatomi S, Ichihashi S, Kanamori D, Yamamoto H. Successful Sac Embolization to Eliminate a Type 2 Endoleak After Thoracic Endovascular Aortic Repair by Penetration of a Vascular Plug Implanted in a Left Subclavian Artery. J Endovasc Ther 2021; 29:835-838. [PMID: 34969293 DOI: 10.1177/15266028211067730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To describe a technique of vascular plug penetration by a guidewire with a heavy tip load for additional embolization of a type 2 endoleak after endovascular aortic aneurysm repair (EVAR). TECHNIQUE The technique of vascular plug penetration is effective for additional embolization of a type 2 endoleak, when large arteries such as left subclavian artery (LSA) or hypogastric artery remain patent even after the embolization of the vessel has been performed using a vascular plug and are responsible for the endoleak. A tapered guidewire with a heavy tip load enables the penetration of the disk of the plug, followed by introduction of a microcatheter into the endoleak nidus. In the presented case, the technique successfully eliminated a type 2 endoleak in a thoracic aortic aneurysm for which a patent LSA despite the embolization by a vascular plug was responsible. CONCLUSION The technique of vascular plug penetration allows an access to an endoleak cavity via a vascular plug placed in an aortic side branch for additional embolization of a type 2 endoleak after EVAR.
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Affiliation(s)
| | - Shigeo Ichihashi
- Department of Radiology, Nara Medical University, Kashihara, Japan
| | - Daigo Kanamori
- Department of Radiology, Sumitomo Hospital, Osaka, Japan
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13
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Benz RM, Makaloski V, Brönnimann M, Mertineit N, von Tengg-Kobligk H. [Diagnostics and treatment of traumatic aortic injuries]. Unfallchirurg 2021; 124:601-609. [PMID: 34254152 PMCID: PMC8370906 DOI: 10.1007/s00113-021-01044-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 11/30/2022]
Abstract
Hintergrund Traumatische Aortenverletzungen (TAV) sind seltene Folgen von stumpfen Traumata, die eine hohe Mortalität und Morbidität aufweisen. Die schnelle und akkurate Diagnostik sowie die Wahl der korrekten Therapie sind für das Patientenüberleben elementar. Fragestellung Bestimmung des aktuellen Standards der Abklärung von TAV im akuten Trauma-Setting und Evaluation der aktuellen Leitlinien zur Therapie. Material und Methode Eine Literaturrecherche wurde durchgeführt, mit der Suche nach Publikationen, die die Abklärung und Diagnostik der TAV beschreiben. Außerdem wurden Leitlinien für die Behandlung und Nachsorge von TAV zusammengefasst. Ergebnisse In der Literatur wird trotz geringer Spezifität eine konventionelle Thoraxröntgenaufnahme als Initialdiagnostik genannt. Es sollte primär, als Modalität der Wahl, zur Diagnostik und zur Therapiestratifizierung eine Computertomographie (CT) aufgrund der hohen Sensitivität und Spezifität nachfolgen. In allen Leitlinien ist die thorakale endovaskuläre Aortenrekonstruktion („thoracic endovascular aortic repair“, TEVAR) die Therapie der Wahl bei höhergradigen TAV (Grade II–IV) und hat die offene Chirurgie in dem meisten Fällen abgelöst. Schlussfolgerung Nach einer kurzfristig erfolgten CT-Diagnostik und Einteilung wird die TEVAR der offenen Chirurgie bei therapiebedürftigen TAV vorgezogen.
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Affiliation(s)
- R M Benz
- Diagnostische, Interventionelle und Pädiatrische Radiologie, Inselspital, Universität Bern, Freiburgstr. 18, 3010, Bern, Schweiz.
| | - V Makaloski
- Universitätsklinik für Herz- und Gefäßchirurgie, Inselspital, Universität Bern, Freiburgstr. 18, 3010, Bern, Schweiz
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14
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Meisenbacher K, Hagedorn M, Grond-Ginsbach C, Weber D, Böckler D, Bischoff MS. Outcomes of thoracic endovascular aortic repair in thoracic aortic aneurysm and penetrating aortic ulcer using the Conformable Gore TAG within and outside the instructions for use. Vascular 2020; 29:486-498. [PMID: 33131466 DOI: 10.1177/1708538120970033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe the outcome of thoracic endovascular aortic repair (TEVAR) in thoracic aortic aneurysm and penetrating aortic ulcer with respect to instructions for use status. METHODS Between October 2009 and September 2017, a total of 532 patients underwent TEVAR; of which 195 have been treated using the Conformable GORE® TAG® thoracic endoprosthesis (CTAG). Fifty-six patients of this cohort underwent TEVAR for thoracic aortic aneurysm/penetrating aortic ulcer using the CTAG. Depending on the preoperative computed tomography angiography findings, patients were classified as inside or outside the device's instructions for use. All inside instruction for use patients underwent postoperative reclassification regarding the instructions for use status. Study endpoints included TEVAR-related reintervention, exclusion of the pathology (endoleak type I/III), TEVAR-related mortality, and graft-related serious adverse events. The median duration of follow-up was 29.7 months (range: 0-109.4 months). RESULTS Of the 56 patients, 17 were primarily classified as outside instruction for use, and in additional 13 patients, TEVAR was performed outside instruction for use, leading to 30 outside instruction for use patients (53.6%). Twenty-six patients (46.4%) were treated inside instruction for use. Reintervention-free survival was lower in outside instruction for use patients (P = 0.016) with a hazard ratio of 9.74 (confidence interval 1.2-80.2; P = 0.034) for TEVAR-related reintervention. With respect to endoleak type I/III, relevant difference was detected between inside/outside instruction for use status (P = 0.012). The serious adverse event rate was 30.4%, mainly in outside instruction for use patients (P = 0.004). Logistic regression analysis indicated an association between graft-related serious adverse event/instructions for use status (odds ratio 6.11; confidence interval 1.6-30.06; P = 0.012). In-hospital death was seen more frequently in outside instruction for use patients (P = 0.12) as was procedure-related death (log-rank test: P = 0.21). CONCLUSION TEVAR for thoracic aortic aneurysm/penetrating aortic ulcer is frequently performed outside instruction for use despite preoperative inside instruction for use eligibility, leading to important consequences for technical/clinical outcome. Instructions for use adherence in TEVAR should be of interest for further large-scale studies.
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Affiliation(s)
- Katrin Meisenbacher
- Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Germany
| | - Matthias Hagedorn
- Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Germany
| | - Caspar Grond-Ginsbach
- Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Germany
| | - Dorothea Weber
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Dittmar Böckler
- Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Germany
| | - Moritz S Bischoff
- Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Germany
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15
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Sharafuddin MJ, Reece TB, Papia G, Pozeg ZI, Peterson BG, Shafi B, Man J, Milner R. Proposed classification of endoleaks after endovascular treatment of Stanford type-B aortic dissections. Vascular 2019; 27:585-594. [PMID: 31067206 DOI: 10.1177/1708538119847394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives Despite two decades of experience, no dedicated classification system exists to document and prognosticate patterns of endoleak encountered after endovascular therapy of type-B aortic dissection. This nomenclature gap has led to inconsistent management and underreporting of significant findings associated with adverse outcomes after endovascular treatment of type-B aortic dissection. Our goal was to propose a reproducible and prognostically relevant classification. Methods A multidisciplinary team of seven experienced open and endovascular aortic surgeons was assembled to provide consensus opinion. Extensive literature review was conducted. Deficiencies in the current classification approach of the various patterns of persistent filling of false lumen after endovascular therapy were identified. Results Our focus was to categorize high-risk and low-risk subgroups within endoleaks after endovascular treatment of type-B aortic dissection. In this classification, type-Ia endoleak refers to persistent filling of the false lumen in an antegrade manner. Causes include failure to cover the primary entry tear and sizing or technical related proximal seal failure. False lumen filling via distal entry tears is classified as type Ib endoleak, which is further sub-classified into b1 (major branch-related tears), and b2 (multiple small branches related tears). Retrograde ascending aortic dissection and stent graft-induced new entry were classified as type-I endoleaks (type-Ir and type-Is, respectively). Another focus was reclassification type-II endoleaks, with type-IIa endoleak referring to conventional retroleak from one or more posterior branches and type-IIx referring to retroleak from major branches (visceral or left subclavian arteries). Conclusions The majority of endoleaks after endovascular treatment of type-B aortic dissection are related to persistent or new filling of the false lumen. We propose a new false lumen-based classification schema for endoleaks occurring after endovascular therapy of type-B aortic dissection.
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Affiliation(s)
- Mel J Sharafuddin
- Department of Surgery, University of Iowa Hospitals and Clinics, USA
| | - T Brett Reece
- Department of Cardiothoracic Surgery, University of Colorado School of Medicine, USA
| | - Giuseppe Papia
- Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | - Zlatko I Pozeg
- Department of Cardiothoracic Surgery, University of Manitoba School of Medicine, St. Boniface Hospital, Canada
| | - Brian G Peterson
- Department of Vascular Surgery, SSM Health St. Louis University Hospital, USA
| | - Bilal Shafi
- Department of Cardiothoracic Surgery, Sutter Health/Palo Alto Medical Foundation, USA
| | - Jeanette Man
- Department of Surgery, University of Iowa Hospitals & Clinics, USA
| | - Ross Milner
- University of Chicago Pritzker School of Medicine, USA
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16
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Karube N, Uchida K, Cho T, Minami T, Masuda M. Coil embolization of intercostal arteries accessed by surgical exposure for type II endoleak after thoracic endovascular aortic repair. J Vasc Surg 2019; 70:267-271. [PMID: 30852038 DOI: 10.1016/j.jvs.2018.11.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/12/2018] [Indexed: 11/25/2022]
Abstract
Many patients with type II endoleak after thoracic endovascular aortic repair (TEVAR) are closely observed without secondary intervention. Herein, we report a new technique of coil embolization for type II endoleak from intercostal arteries after TEVAR for ruptured acute type B aortic dissection. A hybrid procedure of exposing intercostal arteries via subcostal incision in the prone position and transcatheter technique enables embolization of intercostal arteries at their origin from the aorta. This technique could avoid lung injury and be applicable in multiple intercostal arteries. This technique may be a useful secondary intervention for type II endoleak after TEVAR caused by intercostal arteries.
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Affiliation(s)
- Norihisa Karube
- Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan.
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Tomoki Cho
- Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Tomoyuki Minami
- Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Munetaka Masuda
- Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
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17
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Tan GJS, Khoo PLZ, Chan KMJ. A review of endovascular treatment of thoracic aorta disease. Ann R Coll Surg Engl 2018; 100:1-6. [PMID: 30286634 PMCID: PMC6204499 DOI: 10.1308/rcsann.2018.0143] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2018] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION The development of thoracic endovascular aortic repair has altered the approach and reduced the risk of treating the majority of descending thoracic aortic conditions. Primarily developed for the exclusion of thoracic aortic aneurysms, it is now used in place of open repair surgery for most descending thoracic aortic diseases, and has also been used to treat aortic arch diseases in selected cases. METHODS A literature search was conducted of Medline and Embase databases from January 2007 to February 2017, using the key words 'aortic disease', 'thoracic aorta' and 'endovascular repair'; 205 articles were identified, of which 25 studies were selected for review based on their relevance. FINDINGS The key findings of the indications, techniques, outcomes, complications and comparisons with open surgical repair were extracted from the published studies and are summarised in this review. Thoracic endovascular aortic repair is the preferred choice of intervention for patients with descending thoracic aortic disease. With time, it has improved to be safer and has the potential to expand aortic treatment choices in future.
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Affiliation(s)
- GJS Tan
- Faculty of Medical Sciences, Newcastle University Medical School, Newcastle Upon Tyne, UK
| | - PLZ Khoo
- Faculty of Medical Sciences, Newcastle University Medical School, Newcastle Upon Tyne, UK
| | - KMJ Chan
- National Heart and Lung Institute, Imperial College London, London, UK
- Cardiac Vascular Sentral Kuala Lumpur (CVSKL) Hospital, Kuala Lumpur, Malaysia
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18
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Sood R, Salaskar A, Chun AK, Sarin S. Posterior Cerebral Circulation Approach for Left Vertebral Artery Endoleak Embolization. J Vasc Interv Radiol 2018; 29:744-745. [PMID: 29685667 DOI: 10.1016/j.jvir.2017.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 11/03/2017] [Accepted: 11/03/2017] [Indexed: 11/25/2022] Open
Affiliation(s)
- Rishi Sood
- Department of Radiology, George Washington University, Washington, DC, 20037
| | - Abhijit Salaskar
- Department of Radiology, George Washington University, Washington, DC, 20037
| | - Albert K Chun
- Department of Radiology, George Washington University, Washington, DC, 20037
| | - Shawn Sarin
- Department of Radiology, George Washington University, Washington, DC, 20037
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19
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Results of the VALOR II trial of the Medtronic Valiant Thoracic Stent Graft. J Vasc Surg 2017; 66:335-342. [DOI: 10.1016/j.jvs.2016.12.136] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 12/05/2016] [Indexed: 11/17/2022]
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20
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Andrási TB, Grossmann M, Zenker D, Danner BC, Schöndube FA. Supra-aortic interventions for endovascular exclusion of the entire aortic arch. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2017.04.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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Bischoff MS, Meisenbacher K, Wehrmeister M, Böckler D, Kotelis D. Treatment indications for and outcome of endovascular repair of type B intramural aortic hematoma. J Vasc Surg 2016; 64:1569-1579.e2. [DOI: 10.1016/j.jvs.2016.05.078] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 05/10/2016] [Indexed: 01/16/2023]
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22
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Bischoff MS, Müller-Eschner M, Meisenbacher K, Peters AS, Böckler D. Device Conformability and Morphological Assessment After TEVAR for Aortic Type B Dissection: A Single-Centre Experience with a Conformable Thoracic Stent-Graft Design. Med Sci Monit Basic Res 2015; 21:262-70. [PMID: 26718893 PMCID: PMC4725445 DOI: 10.12659/msmbr.897010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background The aim of this study was to analyze device conformability in TEVAR of acute and chronic (a/c) type B aortic dissections (TBAD) using the Gore Conformable Thoracic Aortic Stent-graft (CTAG). Material/Methods From January 1997 to February 2014, a total of 90 out of 405 patients in our center received TEVAR for TBAD. Since November 2009, 23 patients (16 men; median age: 62 years) were treated with the CTAG. Indications were complicated aTBAD in 15 (65%) and expanding cTBAD in 8 (35%) patients. Primary endpoints were the assessment of device conformability by measuring the distance (D) from the radiopaque gold band marker (GM) at the proximal CTAG end to the inner curvature (IC) of the arch on parasagittal multiplanar reformations of CT angiography, as well as the evaluation of aortic diameter changes following TEVAR. Median follow-up was 13.3 months (range: 2 days to 35 months). Results Primary and secondary success rates were 91.3% (21/23) and 95.6% (22/23), respectively. There was 1 type Ia endoleak, retrograde dissection or primary conversion was not observed. Median GM-IC-D was 0 mm (range: 0 mm to 10 mm). GM-IC-D was associated with zone 2 placement compared to zone 3 (P=0.036). There was no association between GM-IC-D formation and arch type. In aTBAD cases the true lumen significantly increased after TEVAR (P=0.017) and the false lumen underwent shrinkage (P=0.025). In cTBAD patients the false lumen decreased after TEVAR (P=0.036). Conclusions The CTAG shows favorable conformability and wall apposition in challenging arch pathologies such as TBAD.
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Affiliation(s)
- Moritz S Bischoff
- Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Matthias Müller-Eschner
- Department of Radiodiagnostics and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Katrin Meisenbacher
- Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas S Peters
- Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Dittmar Böckler
- Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Heidelberg, Germany
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23
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Müller-Eschner M, Peters AS, Meisenbacher K, Böckler D, Bischoff MS. Type IIIb Endoleak after Thoracic Endovascular Aortic Repair Caused by Endoanchor Dislocation. Ann Vasc Surg 2015; 29:1019.e7-1019.e10. [DOI: 10.1016/j.avsg.2015.01.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 01/13/2015] [Accepted: 01/14/2015] [Indexed: 11/30/2022]
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24
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Bosanquet DC, Twine CP, Tang TY, Boyle JR, Bell RE, Bicknell CD, Jenkins MP, Loftus IM, Modarai B, Vallabhaneni SR. Pragmatic Minimum Reporting Standards for Thoracic Endovascular Aortic Repair. J Endovasc Ther 2015; 22:356-67. [DOI: 10.1177/1526602815584925] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- David C. Bosanquet
- South East Wales Regional Vascular Network, Royal Gwent Hospital, Newport, Wales, UK
| | - Christopher P. Twine
- South East Wales Regional Vascular Network, Royal Gwent Hospital, Newport, Wales, UK
| | - Tjun Y. Tang
- Department of General Surgery, Changi General Hospital, Singapore
| | - Jonathan R. Boyle
- Regional Vascular Unit, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
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25
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Abstract
The incidence and operations of thoracic and thoracoabdominal aortic aneurysms have significantly increased. The indications for repair are considered to be a diameter of 6 cm or more and 5.5 cm for patient groups with increased risk of rupture. Complex open surgical repair is associated with significant mortality and complication rates. Total or hybrid endovascular repair seems to reduce early postoperative complications and mortality. The endovascular approach has evolved to be a good and predominant alternative to open repair of these aneurysms for older and high-risk patients as well as for aneurysms with optimal morphological suitability. Notwithstanding, at present a complete paradigm shift from open to endovascular repair for all patients, especially those with complex aneurysms, cannot yet be established.
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Affiliation(s)
- J Zanow
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Erlanger Allee 101, 07740, Jena, Deutschland,
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Esposito G, Pennesi M, Bichi S, Patrini D, Pellegrino P, Redaelli M, Poloni C, Gerometta P, Gentinetta F, Cappabianca G. Hybrid multistep approach to mega-aortic syndrome: the Lupiae technique. Eur J Cardiothorac Surg 2014; 47:126-33; discussion 133. [PMID: 24674908 DOI: 10.1093/ejcts/ezu102] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES Several techniques have been described for the treatment of thoraco-abdominal aneurysms in patients with mega-aortic syndrome (MAS), but the incidence of stroke, spinal cord injury and endoleaks remains significant. We present the mid-term results of a new hybrid, multistep technique to treat patients with MAS. METHODS From November 2005 to November 2012, 118 patients with MAS underwent surgical repair of thoracic and thoraco-abdominal aneurysms with the Lupiae technique. Fifty-five patients presented chronic aneurysms and 63 patients Type A acute dissections. Eighty-three patients underwent ascending aorta and arch replacement with a multibranched Dacron graft and epiaortic vessels rerouting (thoracic Lupiae procedure). Twenty patients had the thoracic Lupiae procedure plus partial visceral debranching (coeliac trunk and superior mesenteric artery [SMA]) through an upper mini-laparotomy. Fifteen patients had the thoracic Lupiae procedure plus a complete visceral debranching (coeliac trunk, SMA and renal arteries) using a second multibranched Dacron graft to replace the infrarenal aorta. All the patients with chronic aneurysms and 34 of 63 patients with Type A dissections underwent implant of endovascular stent grafts. RESULTS In-hospital mortality was 8.4%. No patients had stroke or spinal cord injury. The incidence of temporary renal failure was 5.2%. No patients presented endoleaks immediately and at follow-up CT scans. No death or reoperation occurred during the follow-up. CONCLUSIONS These results evidence that the Lupiae technique is a safe and effective option for the treatment of patients with MAS, achieving the complete exclusion of thoraco-abdominal aneurysms and of the residual false lumen in patients with acute aortic dissections.
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Affiliation(s)
| | - Matteo Pennesi
- Cardiovascular Department, Humanitas Gavazzeni, Bergamo, Italy
| | - Samuele Bichi
- Cardiovascular Department, Humanitas Gavazzeni, Bergamo, Italy
| | - Davide Patrini
- Cardiovascular Department, Humanitas Gavazzeni, Bergamo, Italy
| | | | | | - Camillo Poloni
- Cardiovascular Department, Humanitas Gavazzeni, Bergamo, Italy
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