1
|
Estrera G, Han S. Endovascular Treatment Options for Chronic Dissections. Cardiol Clin 2025; 43:287-306. [PMID: 40268357 DOI: 10.1016/j.ccl.2024.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2025]
Abstract
Aortic dissections are classified based on the location of the entry tear. A major concern in chronic aortic dissections is aneurysmal degeneration. Aneurysmal degeneration can lead to aortic expansion and potentially death. False lumen patency is a predictor of outcomes in type B aortic dissections. Thoracic endovascular aortic repair (TEVAR) can be used to treat chronic aortic dissections. TEVAR aims to occlude the false lumen to promote thrombosis and favorable aortic remodeling. However, its benefit may be limited in chronic dissection. Several techniques have been developed to treat chronic dissections with TEVAR.
Collapse
Affiliation(s)
- Gregory Estrera
- Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Surgery Section, McGovern School of Medicine, University of Texas, Houston, TX, USA
| | - Sukgu Han
- Division of Vascular Surgery and Endovascular Therapy, Keck Medical Center of University of Southern California, 1520 San Pablo Street, Suite 4300, Los Angeles, CA 90033, USA.
| |
Collapse
|
2
|
DiBartolomeo AD, Miranda E, Han SM, Magee GA. In situ laser fenestration of aortic septum to bridge false and true lumen during endovascular repair of aortic dissection. J Vasc Surg Cases Innov Tech 2024; 10:101312. [PMID: 38559376 PMCID: PMC10981118 DOI: 10.1016/j.jvscit.2023.101312] [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: 06/16/2023] [Accepted: 08/14/2023] [Indexed: 04/04/2024] Open
Abstract
Fenestration of the septum between the true and false lumen might be necessary after aortic dissection. We report the technical aspects of in situ laser fenestration of the aortic dissection septum. Two illustrative cases are provided: a 56-year-old man with false lumen deployment of a frozen elephant trunk graft, and a 67-year-old man who underwent fenestrated endovascular aortic repair with a target branch vessel off the false lumen. In both cases, the septum was crossed using in situ laser fenestration. This technique is a precise option to enable passage between true and false lumens during endovascular repair of an aortic dissection.
Collapse
Affiliation(s)
- Alexander D. DiBartolomeo
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA
| | - Elizabeth Miranda
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA
| | - Sukgu M. Han
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA
| | - Gregory A. Magee
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA
| |
Collapse
|
3
|
Hsu A, Segal MS, Sturt C, Brener B. Cutting balloon septotomy for repair of right common iliac artery aneurysm in the setting of type B aortic dissection. J Vasc Surg Cases Innov Tech 2024; 10:101448. [PMID: 38495218 PMCID: PMC10944100 DOI: 10.1016/j.jvscit.2024.101448] [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: 11/30/2023] [Accepted: 01/30/2024] [Indexed: 03/19/2024] Open
Abstract
We report a case of using cutting balloon septotomy for a 5-cm right common iliac artery aneurysm repair in a patient with a chronic type B aortic dissection after open repair 10 years before. This technique uses intravenous ultrasound to facilitate deployment of a cutting balloon to shear through the dissection flap, allowing for optimization of the landing zone for endovascular repair of a right common iliac artery aneurysm. Various methods are available for performing septotomy, and the use of a cutting balloon is one that helps with stent placement and position.
Collapse
Affiliation(s)
- Angel Hsu
- Department of General Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Michael S. Segal
- Department of Vascular Surgery, Newark Beth Israel Medical Center, Newark, NJ
| | - Cindy Sturt
- Department of Vascular Surgery, Newark Beth Israel Medical Center, Newark, NJ
| | - Bruce Brener
- Department of Vascular Surgery, Newark Beth Israel Medical Center, Newark, NJ
| |
Collapse
|
4
|
Baghbani-Oskouei A, Savadi S, Mesnard T, Sulzer T, Mirza AK, Baig S, Timaran CH, Oderich GS. Transcatheter electrosurgical septotomy technique for chronic postdissection aortic aneurysms. J Vasc Surg Cases Innov Tech 2024; 10:101402. [PMID: 38304296 PMCID: PMC10830870 DOI: 10.1016/j.jvscit.2023.101402] [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] [Indexed: 02/03/2024] Open
Abstract
Aortic dissection often results in chronic aneurysmal degeneration due to progressive false lumen expansion. Thoracic endovascular aortic repair and other techniques of vessel incorporation such as fenestrated-branched or parallel grafts have been increasingly used to treat chronic postdissection aneurysms. True lumen compression or a vessel origin from the false lumen can present considerable technical challenges. In these cases, the limited true lumen space can result in inadequate stent graft expansion or restrict the ability to reposition the device or manipulate catheters. Reentrance techniques can be used selectively to assist with target vessel catheterization. Transcatheter electrosurgical septotomy is a novel technique that has evolved from the cardiology experience with transseptal or transcatheter aortic valve procedures. This technique has been applied in select patients with chronic dissection to create a proximal or distal landing zone, disrupt the septum in patients with an excessively compressed true lumen, or connect the true and false lumen in patients with vessels that have separate origins. In the present report, we summarize the indications and technical pitfalls of transcatheter electrosurgical septotomy in patients treated by endovascular repair for chronic postdissection aortic aneurysms.
Collapse
Affiliation(s)
- Aidin Baghbani-Oskouei
- Advanced Aortic Research Program, Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Safa Savadi
- Advanced Aortic Research Program, Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Thomas Mesnard
- Advanced Aortic Research Program, Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Titia Sulzer
- Advanced Aortic Research Program, Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Aleem K. Mirza
- Advanced Aortic Research Program, Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Shadman Baig
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Carlos H. Timaran
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Gustavo S. Oderich
- Advanced Aortic Research Program, Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| |
Collapse
|
5
|
Shen J, Mastrodicasa D, Al Bulushi Y, Lin MC, Tse JR, Watkins AC, Lee JT, Fleischmann D. Thoracic Endovascular Aortic Repair for Chronic Type B Aortic Dissection: Pre- and Postprocedural Imaging. Radiographics 2022; 42:1638-1653. [PMID: 36190862 DOI: 10.1148/rg.220028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Aortic dissection is a chronic disease that requires lifelong clinical and imaging surveillance, long after the acute event. Imaging has an important role in prognosis, timing of repair, device sizing, and monitoring for complications, especially in the endovascular therapy era. Important anatomic features at preprocedural imaging include the location of the primary intimal tear and aortic zonal and branch vessel involvement, which influence the treatment strategy. Challenges of repair in the chronic phase include a small true lumen in conjunction with a stiff intimal flap, complex anatomy, and retrograde perfusion from distal reentry tears. The role of thoracic endovascular aortic repair (TEVAR) remains controversial for treatment of chronic aortic dissection. Standard TEVAR is aimed at excluding the primary intimal tear to decrease false lumen perfusion, induce false lumen thrombosis, promote aortic remodeling, and prevent aortic growth. In addition to covering the primary intimal tear with an endograft, several adjunctive techniques have been developed to mitigate retrograde false lumen perfusion. These techniques are broadly categorized into false lumen obliteration and landing zone optimization strategies, such as the provisional extension to induce complete attachment (PETTICOAT), false lumen embolization, cheese-wire fenestration, and knickerbocker techniques. Familiarity with these techniques is important to recognize expected changes and complications at postintervention imaging. The authors detail imaging options, provide examples of simple and complex endovascular repairs of aortic dissections, and highlight complications that can be associated with various techniques. Online supplemental material is available for this article. ©RSNA, 2022.
Collapse
Affiliation(s)
- Jody Shen
- From the Departments of Radiology (J.S., D.M., Y.A.B., M.C.L., J.R.T., D.F.); Cardiothoracic Surgery (A.C.W.), and Vascular Surgery (J.T.L.), Stanford University School of Medicine, 453 Quarry Rd, Mail Code 5659, Palo Alto, CA 94304
| | - Domenico Mastrodicasa
- From the Departments of Radiology (J.S., D.M., Y.A.B., M.C.L., J.R.T., D.F.); Cardiothoracic Surgery (A.C.W.), and Vascular Surgery (J.T.L.), Stanford University School of Medicine, 453 Quarry Rd, Mail Code 5659, Palo Alto, CA 94304
| | - Yarab Al Bulushi
- From the Departments of Radiology (J.S., D.M., Y.A.B., M.C.L., J.R.T., D.F.); Cardiothoracic Surgery (A.C.W.), and Vascular Surgery (J.T.L.), Stanford University School of Medicine, 453 Quarry Rd, Mail Code 5659, Palo Alto, CA 94304
| | - Margaret C Lin
- From the Departments of Radiology (J.S., D.M., Y.A.B., M.C.L., J.R.T., D.F.); Cardiothoracic Surgery (A.C.W.), and Vascular Surgery (J.T.L.), Stanford University School of Medicine, 453 Quarry Rd, Mail Code 5659, Palo Alto, CA 94304
| | - Justin R Tse
- From the Departments of Radiology (J.S., D.M., Y.A.B., M.C.L., J.R.T., D.F.); Cardiothoracic Surgery (A.C.W.), and Vascular Surgery (J.T.L.), Stanford University School of Medicine, 453 Quarry Rd, Mail Code 5659, Palo Alto, CA 94304
| | - Amelia C Watkins
- From the Departments of Radiology (J.S., D.M., Y.A.B., M.C.L., J.R.T., D.F.); Cardiothoracic Surgery (A.C.W.), and Vascular Surgery (J.T.L.), Stanford University School of Medicine, 453 Quarry Rd, Mail Code 5659, Palo Alto, CA 94304
| | - Jason T Lee
- From the Departments of Radiology (J.S., D.M., Y.A.B., M.C.L., J.R.T., D.F.); Cardiothoracic Surgery (A.C.W.), and Vascular Surgery (J.T.L.), Stanford University School of Medicine, 453 Quarry Rd, Mail Code 5659, Palo Alto, CA 94304
| | - Dominik Fleischmann
- From the Departments of Radiology (J.S., D.M., Y.A.B., M.C.L., J.R.T., D.F.); Cardiothoracic Surgery (A.C.W.), and Vascular Surgery (J.T.L.), Stanford University School of Medicine, 453 Quarry Rd, Mail Code 5659, Palo Alto, CA 94304
| |
Collapse
|
6
|
Han T, Wu Y, Jin C, Wei X, Zhao Z. Reverse "cheese wire" fenestration for abdominal aortic dissection repair: a case report and literature review. BMC Surg 2022; 22:145. [PMID: 35449045 PMCID: PMC9022330 DOI: 10.1186/s12893-022-01581-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/30/2022] [Indexed: 11/29/2022] Open
Abstract
Background Aortic dissection is one of the most common emergency condition leading to internal organs or lower limb ischemia and aortic rupture. Herein, we described a reverse “cheese wire” endovascular fenestration repair (CWFER) in a patient with complicated abdominal aortic dissection which had never been reported. Case presentation A 62-year-old male presented abdominal tear-like pain and acute ischemia of the right lower extremity during the endovascular treatment of celiac trunk aneurysms. Computed tomography angiography (CTA) and digital subtraction angiography (DSA) showed abdominal aortic type B dissection with acute ischemia of the right lower extremity preoperatively. After a detailed preoperative examination, the patient then was performed a reverse CWFER. So far, the patient has been followed-up for 6 months, postoperative CTA demonstrated good stent-graft expansion and perfusion of bilateral common iliac arteries; also, no endoleak was detected. Conclusions The right iliac artery in this patient supplied by false lumen, which lead to acute ischemia of the right lower extremity, needed to be treated as an emergency and dealt with promptly. CWFER is a very high-risk treatment that requires the rich experience of vascular surgeon and accurate assessment of aortic dissection. After interventional treatment, the patient recovered uneventfully after 6 months’ follow-up. Supplementary information The online version contains supplementary material available at 10.1186/s12893-022-01581-4.
Collapse
Affiliation(s)
- Tonglei Han
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, 200433, Shanghai, China
| | - Yani Wu
- Department of Breast and Thyroid Surgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Chong Jin
- Department of General Surgery, Taizhou Central Hospital, Taizhou University Hospital, No. 999 Donghai Avenue, Taizhou, 318000, Zhejiang, China.
| | - Xiaolong Wei
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, 200433, Shanghai, China.
| | - Zhiqing Zhao
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, 200433, Shanghai, China
| |
Collapse
|
7
|
Yagi N, Nakagami T, Yamaguchi S, Hamaoka T, Fukai K. Novel method for endovascular fenestration using radiofrequency transseptal needle for aortic dissection with malperfusion syndrome. Radiol Case Rep 2020; 15:1437-1441. [PMID: 32642013 PMCID: PMC7334550 DOI: 10.1016/j.radcr.2020.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/04/2020] [Accepted: 06/04/2020] [Indexed: 12/02/2022] Open
Abstract
Malperfusion syndrome is considered one of the most significant adverse events in aortic dissection disease and often requires invasive strategies to improve ischemia. We report the case of a patient who was presented with worsening claudication and leg rest pain due to malperfusion syndrome of type B aortic dissection. We successfully performed endovascular fenestration therapy to relieve the symptom by using a NRG radiofrequency transseptal needle (Baylis Medical, Montreal, Canada). We suggest that this novel method would be available for the patients with malperfusion syndrome of aortic dissection
Collapse
Affiliation(s)
- N Yagi
- Department of Cardiovascular Medicine, University Hospital, Kyoto Prefectural University of Medicine, 465 Kaji-cho, Kamigyo-ku, Kyoto-shi, Kyoto, 602-8566, Japan.,Department of Cardiovascular Medicine, Omihachiman Community Medical Center, 1379 Tsuchidacho, Omihachiman, Shiga, 523-0082, Japan
| | - T Nakagami
- Department of Cardiovascular Medicine, Omihachiman Community Medical Center, 1379 Tsuchidacho, Omihachiman, Shiga, 523-0082, Japan
| | - S Yamaguchi
- Department of Cardiovascular Medicine, Omihachiman Community Medical Center, 1379 Tsuchidacho, Omihachiman, Shiga, 523-0082, Japan
| | - T Hamaoka
- Department of Cardiovascular Medicine, Omihachiman Community Medical Center, 1379 Tsuchidacho, Omihachiman, Shiga, 523-0082, Japan
| | - K Fukai
- Department of Cardiovascular Medicine, Omihachiman Community Medical Center, 1379 Tsuchidacho, Omihachiman, Shiga, 523-0082, Japan
| |
Collapse
|
8
|
Iwakoshi S, Watkins CA, Ogawa Y, Fischbein M, Lee A, Lee JT, Hiesinger W, Dake MD. “Cheese Wire” Fenestration of Dissection Intimal Flap to Facilitate Thoracic Endovascular Aortic Repair in Chronic Dissection. J Vasc Interv Radiol 2020; 31:150-154.e2. [DOI: 10.1016/j.jvir.2019.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/07/2019] [Accepted: 06/08/2019] [Indexed: 10/26/2022] Open
|
9
|
Zhuang H, Cai F, Wu Z, Zhan T, Chen H, Chen C, Zhang H, Guo P. Salvage endovascular septectomy in patients with chronic abdominal aortic dissection after failed endovascular aneurysm repair. Interact Cardiovasc Thorac Surg 2019; 29:621-624. [PMID: 31173085 DOI: 10.1093/icvts/ivz128] [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: 02/19/2019] [Revised: 04/13/2019] [Accepted: 04/23/2019] [Indexed: 11/13/2022] Open
Abstract
This study aimed to investigate the efficacy and safety of salvage endovascular septectomy in patients with abdominal chronic aortic dissection (CAD) after endovascular aneurysm repair. A study cohort comprising 6 patients with chronic abdominal aortic dissection after failed endovascular aortic repair [mean age 62.5 (36-69) years] were enrolled to undergo salvage endovascular septectomy. The procedure involved entering the false lumen via the intrinsic visceral entry to perform a confined septectomy using a 'Gigli wire' to merge the true and false lumens. The outcomes were assessed by Digital angiography and computed tomography angiography. All 6 patients were successfully operated on; the diameters of the visceral abdominal aorta and the infrarenal abdominal aorta were similar at 1, 3, 6 and 12 months compared with the baseline; the patency of the visceral branch arteries was also stable at 1, 3, 6 and 12 months compared with the baseline; no occlusion of the visceral branch arteries was noted; no major vascular adverse events or deaths were observed. In this preliminary study, it was proven that salvage endovascular septectomy is a potentially advantageous technique that is safe and effective in the treatment of patients with CAD after failed endovascular aortic repair.
Collapse
Affiliation(s)
- Hui Zhuang
- Department of Vascular Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Fanggang Cai
- Department of Vascular Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Zhixian Wu
- Department of Hepatobiliary Disease, Fuzhou General Hospital (Dongfang Hospital), Xiamen University, Fuzhou, China.,Department of Hepatobiliary Disease, The 900th Hospital of the People's Liberation Army Joint Service Support Force, Fuzhou, Fujian, China
| | - Tenghui Zhan
- Department of Vascular Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Hongyu Chen
- Department of Vascular Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Cheng Chen
- Department of Vascular Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Hanyue Zhang
- Department of Hepatobiliary Disease, Fuzhou General Hospital (Dongfang Hospital), Xiamen University, Fuzhou, China.,Department of Hepatobiliary Disease, The 900th Hospital of the People's Liberation Army Joint Service Support Force, Fuzhou, Fujian, China
| | - Pingfan Guo
- Department of Vascular Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| |
Collapse
|
10
|
Endovascular Neck Stabilization Before EVAR for Infrarenal Aortic Aneurysm in Chronic Aortic Dissection. Cardiovasc Intervent Radiol 2019; 42:1483-1487. [PMID: 31254039 DOI: 10.1007/s00270-019-02277-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 06/25/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Endovascular treatment of infrarenal abdominal aortic aneurysm (AAA) with proximal chronic aortic dissection is challenging as a false and true lumen at the level of the infra-renal neck does not allow a sufficient landing zone. We describe staged endovascular neck stabilization prior to standard endovascular aortic repair (EVAR) for AAA with chronic aortic dissection. TECHNIQUE To create a stable proximal neck (PN) by closing entry tears, thereby resulting in total false lumen thrombosis (FLT) prior to standard EVAR. Case 1 false lumen fenestrations were present at the descending aorta, the right renal artery orifice and PN. After closing the entry tear by thoracic EVAR, an aortic cuff was placed in the true lumen of the PN and renal stenting for the right renal artery was performed. After 2 months, total FLT was achieved, and EVAR was performed. Case 2 false lumen fenestrations were present at the descending, super celiac aorta and PN. After closing the entry by TEVAR, aortic cuffs were placed at infrarenal aorta to close residual entries. After 1 month of achieving total FLT, EVAR was performed. Both cases had no type 1 endoleak during follow-up. CONCLUSION The endovascular neck stabilization is a useful treatment option that facilitates standard EVAR for AAA in chronic aortic dissection.
Collapse
|
11
|
Chung J, Ouzounian M. Tearing it up: Addressing the septum during endovascular repair of chronic distal aortic dissections. J Thorac Cardiovasc Surg 2018; 157:99-100. [PMID: 30195596 DOI: 10.1016/j.jtcvs.2018.07.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 07/21/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Jennifer Chung
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Maral Ouzounian
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
12
|
Stern JR, Cafasso DE, Schneider DB, Meltzer AJ. Totally Percutaneous Fenestration via the "Cheese-Wire" Technique to Facilitate Endovascular Aneurysm Repair in Chronic Aortic Dissection. Vasc Endovascular Surg 2018; 52:218-221. [PMID: 29334863 DOI: 10.1177/1538574417753006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Here, we describe a totally percutaneous technique for longitudinal fenestration of a chronic dissection flap in the setting of endovascular aneurysm repair (EVAR), where the septum would otherwise preclude proper endograft sealing. This technique is demonstrated in a 65-year-old man with a history of open surgical repair of a Stanford type A aortic dissection, with a type B component that was managed nonoperatively. The patient developed aneurysmal degeneration of the infrarenal aorta during follow-up, and his anatomy was well suited for EVAR with the exception of a chronic dissection flap dividing the proximal seal zone. Using bilateral percutaneous access, a wire was passed through an existing fenestration in the septum from true to false lumen and snared from the contralateral side. Downward traction on this through-wire was then used as a "cheese-wire" to divide the septum longitudinally and clear it from the proximal fixation site. Removal of the septum provided an adequate proximal seal zone for the endograft, and standard infrarenal EVAR was then performed with a good technical result. Longitudinal fenestration using this technique is a useful adjunctive maneuver to facilitate EVAR in the setting of chronic aortic dissection and is safely achievable via a totally percutaneous approach.
Collapse
Affiliation(s)
- Jordan R Stern
- 1 New York-Presbyterian Hospital, Weill Cornell Medicine, NY, USA
| | | | | | - Andrew J Meltzer
- 1 New York-Presbyterian Hospital, Weill Cornell Medicine, NY, USA
| |
Collapse
|
13
|
Percutaneous Septectomy in Chronic Dissection with Abdominal Aortic Aneurysm Creates Uniluminal Neck for EVAR. Cardiovasc Intervent Radiol 2017; 40:1522-1528. [PMID: 28493108 DOI: 10.1007/s00270-017-1668-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 04/24/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE The intent of this report is to describe the technical details and rationale of endovascular septectomy using a wire saw maneuver in cases of chronic aortic dissection and associated infra-renal aortic aneurysm to allow standard endovascular abdominal aortic graft placement; preliminary clinical experience is also retrospectively reviewed. MATERIALS AND METHODS Between June 2013 and June 2016, four consecutive patients (mean age 55.3 years; range 52-58 years) with chronic type B aortic dissection and isolated infra-renal abdominal aortic aneurysm (AAA) underwent endovascular aneurysm repair (EVAR) following guidewire septectomy to create a suitable proximal aortic landing zone. Technical success was evaluated by angiography performed at the end of the procedure. Procedural safety was determined by assessing any major adverse events through 30 days of follow-up. Endoleaks and longer-term efficacy were evaluated. RESULTS Four patients with chronic aortic dissections had associated AAA with a mean maximum diameter of 60 ± 13 mm (range 50-77 mm). All underwent guidewire saw septectomy to facilitate EVAR. Following successful septectomy, standard abdominal bifurcated endografts were implanted uneventfully. No major adverse events and no endoleaks were noted on CT angiographic examinations through 30 days following the procedure. Also, no rupture, re-intervention or endoleak has been noted during follow-up at a mean of 21.8 ± 15 months (range 4-39 months). CONCLUSIONS Guidewire saw septectomy is a technique that has the potential to create an anatomically suitable proximal neck for successful EVAR management of AAA in select patients with associated chronic aortic dissection.
Collapse
|
14
|
Goldberg JB, Lansman SL, Kai M, Tang GH, Malekan R, Spielvogel D. Malperfusion in Type A Dissection: Consider Reperfusion First. Semin Thorac Cardiovasc Surg 2017; 29:181-185. [DOI: 10.1053/j.semtcvs.2016.10.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2016] [Indexed: 11/11/2022]
|
15
|
Endovascular rescue after inadvertent false lumen stent graft implantation. J Vasc Surg 2016; 63:518-22. [DOI: 10.1016/j.jvs.2014.11.072] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 11/12/2014] [Indexed: 11/24/2022]
|
16
|
Cheese Wire Fenestration of a Chronic Juxtarenal Dissection Flap to Facilitate Proximal Neck Fixation during EVAR. Ann Vasc Surg 2015; 29:124.e1-5. [DOI: 10.1016/j.avsg.2014.07.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 07/09/2014] [Accepted: 07/27/2014] [Indexed: 11/17/2022]
|