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Okamoto T, Yokoi Y, Sato N, Suzuki S, Enomoto T, Onishi R, Nakamura N, Okubo Y, Nagasawa A, Mishima T, Shiraishi S, Tsuchida M. Outcomes of thoracic endovascular aortic repair using fenestrated stent grafts in patients with thoracic aortic distal arch aneurysms. Eur J Cardiothorac Surg 2024; 65:ezae062. [PMID: 38439540 DOI: 10.1093/ejcts/ezae062] [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] [Received: 09/21/2023] [Revised: 12/28/2023] [Accepted: 02/06/2024] [Indexed: 03/06/2024] Open
Abstract
OBJECTIVES Thoracic endovascular aortic repair (TEVAR) for aortic arch aneurysms is challenging because of anatomical restrictions and the presence of cervical branches. Revascularization of the cervical branch is required when conventional commercial stent grafts are used. TEVAR using fenestrated stent grafts (FSG) often does not require additional procedures to revascularize cervical branches. This study aimed to evaluate the features and initial and midterm outcomes of TEVAR using fenestrated stent grafts. METHODS From April 2007 to December 2016, 101 consecutive patients underwent TEVAR using fenestrated stent grafts for distal aortic arch aneurysms at a single centre. Technical success, complications, freedom from aneurysm-related death, secondary intervention and aneurysm progression were retrospectively investigated. RESULTS All the patients underwent TEVAR using fenestrated stent grafts. The 30-day mortality rate was zero. Cerebral infarction, access route problems and spinal cord injury occurred in 4, 3 and 2 patients, respectively. Each type of endoleak was observed in 38 of the 101 patients during the course of the study; 20/38 patients had minor type 1 endoleaks at the time of discharge. The endoleak disappeared in 2 patients and showed no significant change in 8 patients; however, the aneurysm expanded over time in 10 patients. Additional treatment was performed in 8 of the 10 patients with type 1 endoleaks and dilatation of the aneurysm. The rate of freedom from aneurysm-related death during the observation period was 98%. CONCLUSIONS TEVAR with FSG is a simple procedure, with few complications. Additional treatment has been observed to reduce aneurysm-related deaths, even in patients with endoleaks and enlarged aneurysms. Based on this study, the outcomes of endovascular repair of aortic arch aneurysms using a fenestrated stent graft seem acceptable.
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Affiliation(s)
- Takeshi Okamoto
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yoshihiko Yokoi
- Division of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Noriaki Sato
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Shuhei Suzuki
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takashi Enomoto
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Ryo Onishi
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Norihito Nakamura
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yuka Okubo
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Ayako Nagasawa
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takehito Mishima
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Shuichi Shiraishi
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masanori Tsuchida
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Hori D, Fujimori T, Kusadokoro S, Yamamoto T, Kimura N, Yamaguchi A. Treatment Site Does Not Affect Changes in Pulse Wave Velocity but Treatment Length and Device Selection Are Associated With Increased Pulse Wave Velocity After Thoracic Endovascular Aortic Repair. Front Physiol 2021; 12:739185. [PMID: 34744781 PMCID: PMC8569554 DOI: 10.3389/fphys.2021.739185] [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: 07/10/2021] [Accepted: 09/21/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Endovascular treatment of aortic aneurysm is associated with an increase in pulse wave velocity (PWV) after surgery. However, the effect of different types of endovascular devices on PWV at different sites of the thoracic aorta remains unclear. Objectives: The purposes of this study were (1) to investigate the changes in PWV after endovascular treatment of thoracic aortic aneurysm; (2) to evaluate whether there is a difference in the changes in PWV at different treatment sites; and (3) to evaluate the effect of treatment length on changes in PWV. Methods: From July 2008 to July 2021, 276 patients underwent endovascular treatment of the true thoracic aortic aneurysm. Of these patients, 183 patients who underwent preoperative and postoperative PWV measurement within 1 year of surgery were included in the study. The treatment length index was calculated by treatment length divided by the height of the patients. Results: Five different types of endovascular devices were used (Najuta, Kawasumi Laboratories, Inc., Tokyo, Japan; TAG, W.L. Gore & Associates, Inc., AZ, USA; Relay, Bolton Medical, Inc., FL, USA; Talent/Valiant, Medtronic, MN, USA; and Zenith, Cook Medical, IN, USA). There was no significant change in PWV in patients receiving Najuta (Before: 2,040 ± 346.8 cm/s vs. After: 2,084 ± 390.5 cm/s, p = 0.14). However, a significant increase was observed in other devices: TAG (Before: 2,090 ± 485.9 cm/s vs. After: 2,300 ± 512.1 cm/s, p = 0.025), Relay (Before: 2,102 ± 465.3 cm/s vs. After: 2,206 ± 444.4 cm/s, p = 0.004), Valiant (Before: 1,696 ± 330.2 cm/s vs. After: 2,186 ± 378.7 cm/s, p < 0.001), and Zenith (Before: 2,084 ± 431.7 cm/s vs. After: 2,321 ± 500.6 cm/s, p < 0.001). There was a significant increase in PWV in patients treated from aortic arch (Before: 2,006 ± 333.7 cm/s vs. After: 2,132 ± 423.7 cm/s, p < 0.001) and patients treated from descending thoracic aorta (Before: 2,116 ± 460.9 cm/s vs. After: 2,292 ± 460.9 cm/s, p < 0.001). Multivariate analysis showed that treatment site was not an independent factor associated with changes in PWV. However, Najuta (Coef −219.43, 95% CI −322.684 to −116.176, p < 0.001) and treatment index (Coef 147.57, 95% CI 24.826 to 270.312, p = 0.019) were independent factors associated with changes in PWV. Conclusion: Najuta did not show a significant increase in PWV, while other commercially available devices showed a significant increase. The treatment site did not have a different effect on PWV. However, the treatment length was an independent factor associated with an increase in PWV.
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Affiliation(s)
- Daijiro Hori
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Tomonari Fujimori
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Sho Kusadokoro
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Takahiro Yamamoto
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Naoyuki Kimura
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Atsushi Yamaguchi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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Sato H, Fukada J, Tamiya Y, Mikami T, Sibata T, Harada R, Naraoka S, Kamada T, Kawaharada N, Kurimoto Y. Long-Term Clinical Outcomes of Thoracic Endovascular Aortic Repair for Arch Aneurysms with the Najuta Thoracic Stent-Graft System. Ann Vasc Dis 2020; 13:384-389. [PMID: 33391555 PMCID: PMC7758573 DOI: 10.3400/avd.oa.20-00102] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: The treatment for arch aneurysms by endovascular repair is often difficult. This study evaluated the long-term outcomes of thoracic endovascular aortic repair for aortic arch aneurysms treated with the Najuta stent-graft system. Materials and Methods: From January 2009 to December 2019, 37 patients underwent treatment for aortic aneurysms with the Najuta stent graft system at two institutes, including our hospital. We retrospectively analyzed the short- and long-term clinical outcomes. Results: Of all 37 cases, the technical success rate was 97.3% (36 of 37). The mean proximal neck length was 20.1±5.3 mm. The postoperative results revealed 10 patients with type Ia endoleaks (27.8%), 6 with stroke (16.7%), and one with paraplegia (2.8%). In the chronic phase, the overall survival rates and the rates of freedom from aorta-related events at 7 years were 71.3% and 50.7%, respectively. Between two groups divided based on the proximal neck diameter of 20 mm, the <20-mm group had significantly higher rates of aorta-related events in terms of freedom from aortic events (P=0.046). Conclusion: The fenestrated stent graft can be a less invasive option for the treatment of high-risk patients with aortic aneurysms.
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Affiliation(s)
- Hiroshi Sato
- Department of Cardiovascular Surgery, Otaru General Hospital, Otaru, Hokkaido, Japan
| | - Joji Fukada
- Department of Cardiovascular Surgery, Otaru General Hospital, Otaru, Hokkaido, Japan
| | - Yukihiko Tamiya
- Department of Cardiovascular Surgery, Otaru General Hospital, Otaru, Hokkaido, Japan
| | - Takuma Mikami
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Tsuyoshi Sibata
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Ryo Harada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Syuichi Naraoka
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Takeshi Kamada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Yoshihiko Kurimoto
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
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Hori D, Yuri K, Kusadokoro S, Shimizu T, Kimura N, Yamaguchi A. Effect of endoprostheses on pulse wave velocity and its long-term outcomes after thoracic endovascular aortic repair. Gen Thorac Cardiovasc Surg 2020; 68:1134-1141. [PMID: 32232780 DOI: 10.1007/s11748-020-01343-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 03/15/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the changes in pulse wave velocity and left ventricular dimensions in patients undergoing stent-graft treatment for aortic arch aneurysm. METHODS From July 2008 to February 2019, 86 patients underwent thoracic endovascular aortic repair of an aortic arch aneurysm. Changes in pulse wave velocity (PWV), echocardiogram findings, and long-term outcomes were compared between endoskeleton type (n = 60) and exoskeleton type stent-graft (n = 26). RESULTS There was no significant difference in patient demographics except for diabetes which was more observed in endoskeleton type (p = 0.017). There was a significant increase in PWV in exoskeleton type after surgery, which further progressed at a median follow-up of 32 months (before: 2047 cm/s vs. after: 2259 cm/s vs. follow-up: 2486 cm/s, p = 0.010, p = 0.017). No significant difference was observed in endoskeleton type (before: 1980 cm/s vs. after: 2058 cm/s, vs. follow-up: 2042 cm/s, p = 0.25, p = 0.34). Echocardiogram performed at a median period of 46.3 months, revealed a significant increase in left ventricular diastolic volume (LVDV) (before: 107.4 ± 20.6 ml vs. follow-up: 127.7 ± 27.5 ml, p = 0.003) and decrease in e' (before: 5.5 ± 1.78 cm/s vs. follow-up: 4.7 ± 1.72 cm/s, p = 0.012) in exoskeleton type, while no significant change was observed in endoskeleton type (LVDV: before: 102.6 ± 32.3 ml vs. follow-up: 96.9 ± 35.4 ml, p = 0.74; e': before: 4.4 ± 1.21 cm/s vs. follow-up: 4.8 ± 1.40 cm/s, p = 0.68). At the median period of 61.3 months, there was no significant difference in long-term mortality (p = 0.89). However, the endoskeleton type was associated with a lower incidence of a cardiac event (p = 0.034) and cerebrovascular event (p = 0.029). CONCLUSION Types of endoprosthesis might affect differently on physiological changes and its accommodated risk factors after surgery.
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Affiliation(s)
- Daijiro Hori
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan.
| | - Koichi Yuri
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Sho Kusadokoro
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Toshikazu Shimizu
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Naoyuki Kimura
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Atsushi Yamaguchi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
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Fukushima S, Ohki T, Toya N, Shukuzawa K, Ito E, Murakami Y, Akiba T. Initial results of thoracic endovascular repair for uncomplicated type B aortic dissection involving the arch vessels using a semicustom-made thoracic fenestrated stent graft. J Vasc Surg 2019; 69:1694-1703. [PMID: 30786986 DOI: 10.1016/j.jvs.2018.09.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 09/03/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Thoracic endovascular aortic repair (TEVAR) for selected type B aortic dissection (TBAD) is a standard treatment; however, TBAD involving the aortic arch is difficult to treat because of the need for arch vessel reconstruction. We report our initial results of TEVAR for uncomplicated TBAD involving the arch vessels using a semicustom-made fenestrated stent graft. METHODS This is a retrospective study of 24 patients treated by fenestrated (F group) or debranching (D group) TEVAR from August 2011 to July 2017. The patients in the F group received the Najuta semicustom-made fenestrated stent graft (Kawasumi Laboratories, Tokyo, Japan). The fenestrated graft ensures sufficient sealing at the proximal healthy aorta without the need for arch vessel reconstruction. The primary end point was aorta-related mortality; the secondary end points were technical success and major adverse events (stroke, type IA endoleak, retrograde type A aortic dissection, and secondary intervention). RESULTS During the study period, we treated 65 TBAD cases by TEVAR, including 17 complicated cases. Of the 48 uncomplicated cases, 24 underwent TEVAR with arch vessel involvement (13 in the F group and 11 in the D group). The technical success rates in the F and D groups were 92.3% and 100.0%, respectively (P > .99, NS). The mean operation time was significantly shorter in the F group (158 minutes) than in the D group (202 minutes; P = .0426), and the mean postoperative hospital stay was also significantly shorter in the F group (7 days) than in the D group (22 days; P = .0168). The primary patency rate of the reconstructed branch vessel was 100%, and there were no aorta-related deaths or retrograde type A aortic dissection in either group. One patient had a type IA endoleak in the F group. In the D group, one patient had a postoperative stroke and two patients required secondary interventions for stent graft-induced new entry at the descending aorta. The median follow-up period was 14.1 months (range, 1-37 months). The rate of freedom from aorta-related death was 100% in both groups (P > .99, NS); the rate of freedom from major adverse events at 24 months was 92.3% in the F group and 72.7% in the D group (P = .749, NS). CONCLUSIONS The initial results of TEVAR with aortic arch vessel reconstruction for uncomplicated TBAD were acceptable. The fenestrated graft may be a less invasive option for the treatment of TBAD involving the aortic arch.
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Affiliation(s)
- Soichiro Fukushima
- Division of Vascular Surgery, Department of Surgery, The Jikei University Kashiwa Hospital, Chiba, Japan.
| | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Naoki Toya
- Division of Vascular Surgery, Department of Surgery, The Jikei University Kashiwa Hospital, Chiba, Japan
| | - Kota Shukuzawa
- Division of Vascular Surgery, Department of Surgery, The Jikei University Kashiwa Hospital, Chiba, Japan
| | - Eisaku Ito
- Division of Vascular Surgery, Department of Surgery, The Jikei University Kashiwa Hospital, Chiba, Japan
| | - Yuri Murakami
- Division of Vascular Surgery, Department of Surgery, The Jikei University Kashiwa Hospital, Chiba, Japan
| | - Tadashi Akiba
- Department of Surgery, The Jikei University Kashiwa Hospital, Chiba, Japan
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Adiarto S, Kang SG, Sunu I, Siddiq T, Andriantoro H, Dakota I, Uberoi R. Two Wire System and Modified Olive Tip to Facilitate Implantation of Fenestrated TEVAR in Patient with Proximal Descending Aortic Pathology: First Two Cases. Cardiovasc Intervent Radiol 2019; 42:763-769. [PMID: 30767146 PMCID: PMC6435606 DOI: 10.1007/s00270-019-02183-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 02/06/2019] [Indexed: 12/01/2022]
Abstract
Introduction Although Fenestrated TEVAR (F-TEVAR) has been considered to be a more physiologic approach to treat proximal descending aortic pathology, its application is still limited due to availability, cost and technical difficulties. We introduce a new design of fenestrated stent graft with a new delivery system and successfully performed first in human implantation in two patients, one with an aortic aneurysm and one with an acute aortic dissection. Materials and Methods The design of these two wires fenestrated stent graft include creation of an additional lumen at the side of the olive tip during manufacture, from which an additional wire can be introduced for a side branch passing into the fenestration, running inside the stent graft and exit the delivery sheath through additional hub. The two wires will facilitate delivery and deployment of the stent graft. One patient with descending aortic aneurysm and another with Stanford B aortic dissection is included in this first in human study. Results The aneurysm and dissection were completely excluded immediately after the TEVAR. Six month follow up CT showed good position of the stent graft and patent LSA in both patients. In the patient with aortic dissection, expansion of the true lumen and partial thrombosis of the false lumen was seen. Conclusions This is a report of a two wire system in 2 patients with distal aortic arch pathology demonstrating a good technical and clinical success using pre-cannulated fenestrations through a modified nose cone olive. Level of Evidence Level 4, report of two cases.
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Affiliation(s)
- Suko Adiarto
- Department of Cardiology and Vascular Medicine, Universitas Indonesia/Harapan Kita National Cardiovascular Center, Jl. Letjend S Parman kav. 87 Slipi, 11420, Jakarta, Indonesia.
| | - Sung Gwon Kang
- Department of Radiology, Chosun University, 365 Pilmundaero, Dong-gu, Gwangju-Si, 61453, South Korea
| | - Ismoyo Sunu
- Department of Cardiology and Vascular Medicine, Universitas Indonesia/Harapan Kita National Cardiovascular Center, Jl. Letjend S Parman kav. 87 Slipi, 11420, Jakarta, Indonesia
| | - Taofan Siddiq
- Department of Cardiology and Vascular Medicine, Universitas Indonesia/Harapan Kita National Cardiovascular Center, Jl. Letjend S Parman kav. 87 Slipi, 11420, Jakarta, Indonesia
| | - Hananto Andriantoro
- Department of Cardiology and Vascular Medicine, Universitas Indonesia/Harapan Kita National Cardiovascular Center, Jl. Letjend S Parman kav. 87 Slipi, 11420, Jakarta, Indonesia
| | - Iwan Dakota
- Department of Cardiology and Vascular Medicine, Universitas Indonesia/Harapan Kita National Cardiovascular Center, Jl. Letjend S Parman kav. 87 Slipi, 11420, Jakarta, Indonesia
| | - Raman Uberoi
- Department of Radiology, John Redcliffe Hospital, Oxford, OX3 9DU, UK
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Case Series of Aortic Arch Aneurysm in Patients with Bovine Arch Treated with Proximal Scalloped and Fenestrated Stent Graft. Cardiovasc Intervent Radiol 2018; 41:1648-1653. [PMID: 30120530 DOI: 10.1007/s00270-018-2058-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 08/09/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The bovine arch is the most common variant of the aortic arch and occurs when the innominate artery shares a common origin with the left common carotid artery. We report an endovascular repair of aortic arch aneurysm in patients with a bovine arch using the Najuta proximal scalloped and fenestrated stent graft. MATERIALS AND METHODS Thoracic endovascular aneurysm repairs using the Najuta stent graft were performed at our facility. It was inserted and deployed at a zone 0 with precise positional adjustment of the scallop of the stent graft to the brachiocephalic trunk. RESULTS Overall, eight patients with bovine aortic arch were treated with fenestrated endovascular aneurysm repair. Technical success was 100% with no 30-day death. The follow-up period ranged from 7 to 29 (median 12) months. None of the patients had a stroke or paraplegia, and no endoleak was observed. All brachiocephalic trunks scalloped, and the left subclavian artery fenestrated vessels remained patent during the follow-up period. CONCLUSION The Najuta stent graft repair of aortic arch aneurysms in patients with a bovine arch is a safe and effective treatment option, with good immediate and short-term results.
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Leung AD, Yamanouchi D. Case report of retrograde in situ fenestration of the thoracic stent graft with reentry device in a patient with aortobronchial fistula. Medicine (Baltimore) 2018; 97:e11050. [PMID: 29901605 PMCID: PMC6025473 DOI: 10.1097/md.0000000000011050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE In situ fenestration may be necessary to preserve branch arteries during thoracic endovascular aortic repair (TEVAR) when there is an inadequate landing zone. PATIENT CONCERNS We report the case of a 74-year-old man presenting with recurrent hemoptysis. DIAGNOSES Based on computed tomography (CT) angiogram and bronchoscopy, diagnosis was aorto-bronchial fistula. INTERVENTIONS We performed retrograde in situ fenestration with reentry catheter (Pioneer Plus, Volcano Corporation, San Diego, CA) to preserve the left subclavian artery following TEVAR for aorto-bronchial fistula. OUTCOMES Following this procedure, the patient had a patent left subclavian artery and no evidence of endoleak. The patient had no further episodes of hemoptysis. LESSONS The retrograde in situ fenestration with reentry catheter strategy is an option for patients when carotid-subclavian bypass is deemed unsafe.
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Toya N, Ohki T, Fukushima S, Shukuzawa K, Ito E, Akiba T. Fenestrated endovascular repair of aortic arch aneurysm in patients with bovine arch using the Najuta stent graft. J Vasc Surg Cases Innov Tech 2018; 4:148-151. [PMID: 29942907 PMCID: PMC6012989 DOI: 10.1016/j.jvscit.2018.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 01/24/2018] [Indexed: 11/05/2022] Open
Abstract
We describe the case of a 74-year-old man with a thoracic aortic aneurysm with a bovine arch who underwent fenestrated endovascular repair of aortic arch aneurysm using the Najuta stent graft (Kawasumi Laboratories, Inc, Tokyo, Japan). He has had a previous endovascular aneurysm repair and femoropopliteal bypass for abdominal aortic aneurysm combined with peripheral arterial disease. The Najuta stent graft was inserted and deployed at zone 0 with delicate positional adjustment of the fenestration of the stent graft to the brachiocephalic trunk. There was no endoleak or complication. His postoperative course was uneventful. At 7-month follow-up, complete exclusion of the aneurysm was noted. The Najuta stent graft repair of aortic arch aneurysms is a safe and effective treatment option for patients with a bovine arch.
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Affiliation(s)
- Naoki Toya
- Division of Vascular Surgery, Department of Surgery, The Jikei University Kashiwa Hospital, Kashiwa, Japan
| | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Soichiro Fukushima
- Division of Vascular Surgery, Department of Surgery, The Jikei University Kashiwa Hospital, Kashiwa, Japan
| | - Kota Shukuzawa
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Eisaku Ito
- Division of Vascular Surgery, Department of Surgery, The Jikei University Kashiwa Hospital, Kashiwa, Japan
| | - Tadashi Akiba
- Department of Surgery, The Jikei University Kashiwa Hospital, Kashiwa, Japan
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Zhu J, Zhao L, Dai X, Luo Y, Fan H, Feng Z, Zhang Y, Hu F. Fenestrated Thoracic Endovascular Aortic Repair Using Physician Modified Stent Grafts for Acute Type B Aortic Dissection with Unfavourable Landing Zone. Eur J Vasc Endovasc Surg 2018; 55:170-176. [DOI: 10.1016/j.ejvs.2017.11.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 11/10/2017] [Indexed: 12/23/2022]
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Hori D, Okamura H, Yamamoto T, Nishi S, Yuri K, Kimura N, Yamaguchi A, Adachi H. Early and mid-term outcomes of endovascular and open surgical repair of non-dissected aortic arch aneurysm†. Interact Cardiovasc Thorac Surg 2017; 24:944-950. [PMID: 28329032 DOI: 10.1093/icvts/ivx031] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 01/03/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES With the introduction of endovascular stent graft technology, a variety of surgical options are available for patients with aortic aneurysms. We sought to evaluate early-term and mid-term outcomes of patients undergoing endovascular and open surgical repair for non-dissected aortic arch aneurysm. METHODS Overall, 200 patients underwent treatment for isolated non-dissected aortic arch aneurysm between January 2008 and February 2016: 133 patients had open surgery and 67, endovascular repair. Early-term and mid-term outcomes were compared. RESULTS Seventy percent ( n = 47) needing endovascular repair underwent fenestrated stent graft and 30% ( n = 20) underwent the debranched technique. Patients in the open surgery group were younger (71 vs 75 years, P < 0.001) and had a lower prevalence of ischaemic heart disease (11% vs 35%, P < 0.001). Intensive care unit stay (1 vs 3 days, P < 0.001), hospital stay (11 vs 17 days, P < 0.001) and surgical time (208 vs 390 min, P < 0.001) were lower in the endovascular repair group than in the open surgery group. There were 3 in-hospital deaths each in the open surgery and endovascular groups (2% vs 5%, respectively, P = 0.40). Mid-term survival ( P < 0.001) and freedom from reintervention ( P = 0.009) were better in the open surgery than in the endovascular repair group. No aneurysm-related deaths were observed. The propensity-matched comparison ( n = 58) demonstrated that survival was better in the open surgery group ( P = 0.011); no significant difference was seen in the reintervention rate ( P = 0.28). CONCLUSIONS Close follow-up for re-intervention may reduce the risk for aneurysm-related deaths and provide acceptable outcomes in patients undergoing endovascular repair.
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Affiliation(s)
- Daijiro Hori
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Homare Okamura
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Takahiro Yamamoto
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Satoshi Nishi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Koichi Yuri
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Naoyuki Kimura
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Atsushi Yamaguchi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hideo Adachi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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Faulds J, Sandhu HK, Estrera AL, Safi HJ. Minimally Invasive Techniques for Total Aortic Arch Reconstruction. Methodist Debakey Cardiovasc J 2017; 12:41-4. [PMID: 27127562 DOI: 10.14797/mdcj-12-1-41] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The cumulative experience with endovascular aortic repair in the descending thoracic and infrarenal aorta has led to increased interest in endovascular aortic arch reconstruction. Open total arch replacement is a robust operation that can be performed with excellent results. However, it requires cardiopulmonary bypass and circulatory arrest and, therefore, may not be tolerated by all patients. Minimally invasive techniques have been considered as an alternative and include hybrid arch debranching, parallel stent graft deployment in the chimney and snorkel configurations, and complete endovascular branched reconstruction with multi-branched devices. This review discusses the evolving use of endovascular techniques in the management of aortic arch pathology and considers their relevance in an era of safe and durable open aortic arch reconstruction.
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Affiliation(s)
- Jason Faulds
- McGovern Medical School at UTHealth and Memorial Hermann Heart & Vascular Institute, Houston, Texas
| | - Harleen K Sandhu
- McGovern Medical School at UTHealth and Memorial Hermann Heart & Vascular Institute, Houston, Texas
| | - Anthony L Estrera
- McGovern Medical School at UTHealth and Memorial Hermann Heart & Vascular Institute, Houston, Texas
| | - Hazim J Safi
- McGovern Medical School at UTHealth and Memorial Hermann Heart & Vascular Institute, Houston, Texas
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13
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Soeda T, Saitoh Y, Yokoi Y, Yuri K, Katayama H, Konegawa Y. Use of stent-grafts for the ductus arteriosus and its related lesions. Asian Cardiovasc Thorac Ann 2016; 26:622-624. [PMID: 28008764 DOI: 10.1177/0218492316686478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Five cases of ductal lesions with various anatomies have been successfully treated by thoracic endovascular aortic replacement in recent years; 4 using mainly fenestrated stent-grafts, and one using a non-fenestrated stent-graft. Considering the invasive nature of open surgery and the anatomical limitations of the catheter technique for occluding a patent ductus in many adult cases, thoracic endovascular aortic replacement should be the first option because of its broad applicability for ductal lesions.
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Affiliation(s)
- Takeshi Soeda
- 1 Department of Cardiovascular Surgery, Matsue Red Cross Hospital, Shimane, Japan
| | - Yuhei Saitoh
- 1 Department of Cardiovascular Surgery, Matsue Red Cross Hospital, Shimane, Japan
| | - Yoshihiko Yokoi
- 2 Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Koichi Yuri
- 3 Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hideyuki Katayama
- 1 Department of Cardiovascular Surgery, Matsue Red Cross Hospital, Shimane, Japan
| | - Yasushi Konegawa
- 1 Department of Cardiovascular Surgery, Matsue Red Cross Hospital, Shimane, Japan
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14
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Iwakoshi S, Ichihashi S, Itoh H, Tabayashi N, Sakaguchi S, Yoshida T, Nakao Y, Kichikawa K. Clinical outcomes of thoracic endovascular aneurysm repair using commercially available fenestrated stent graft (Najuta endograft). J Vasc Surg 2015; 62:1473-8. [DOI: 10.1016/j.jvs.2015.06.224] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 06/26/2015] [Indexed: 10/23/2022]
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15
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Joseph G, Premkumar P, Thomson V, Varghese M, Selvaraj D, Sahajanandan R. Externalized Guidewires to Facilitate Fenestrated Endograft Deployment in the Aortic Arch. J Endovasc Ther 2015; 23:160-71. [PMID: 26511895 PMCID: PMC4712411 DOI: 10.1177/1526602815614557] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To describe a precannulated fenestrated endograft system utilizing externalized guidewires to facilitate aortic arch endovascular repair and to report its use in 2 patients with challenging anatomy. Technique: For distal arch repair, a fenestration for the left subclavian artery (LSA) is made onsite in a standard thoracic endograft tailored to the patient anatomy; it is precannulated with a nitinol guidewire (NGw), which is passed from the femoral artery and externalized from the left brachial artery prior to endograft delivery system introduction over a parallel stiff guidewire. Steps are then taken to remove guidewire intertwining, prevent NGw wrapping around the delivery system, and orient the LSA fenestration superiorly when the delivery system moves into the arch. Gentle traction on the ends of the NGw during endograft deployment facilitates proper fenestration alignment. A covered stent is deployed in the LSA fenestration. The technique is illustrated in a patient with congenital coarctation of the aorta and descending aortic aneurysm. For total arch repair, endograft fenestrations are made for all 3 arch branches; the left common carotid artery (LCCA) and LSA fenestrations are each cannulated with NGws, which travel together from the femoral artery, pass through a LSA snare loop, and are exteriorized from the LCCA. After endograft deployment, the innominate artery fenestration is separately cannulated using right brachial access. Placement of a parallel externalized hydrophilic guidewire passing through the LCCA fenestration (but not the LSA snare loop) and removal of the LCCA fenestration NGw allows exteriorization of the LSA fenestration NGw from the left brachial artery by pulling the LSA snare. Covered stents are deployed in all 3 fenestrations. The technique is presented in a patient with type B aortic dissection. Conclusion: Use of the precannulated fenestrated endograft system described is feasible and has the potential to make aortic arch endovascular repair simpler, more reliable, and safer.
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Affiliation(s)
- George Joseph
- Department of Cardiology, Christian Medical College, Vellore, India
| | - Prabhu Premkumar
- Department of Vascular Surgery, Christian Medical College, Vellore, India
| | - Viji Thomson
- Department of Cardiology, Christian Medical College, Vellore, India
| | - Mithun Varghese
- Department of Cardiology, Christian Medical College, Vellore, India
| | - Dheepak Selvaraj
- Department of Vascular Surgery, Christian Medical College, Vellore, India
| | - Raj Sahajanandan
- Department of Anesthesiology, Christian Medical College, Vellore, India
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Kimura N, Itoh S, Yuri K, Adachi K, Matsumoto H, Yamaguchi A, Adachi H. Reoperation for enlargement of the distal aorta after initial surgery for acute type A aortic dissection. J Thorac Cardiovasc Surg 2015; 149:S91-8.e1. [DOI: 10.1016/j.jtcvs.2014.08.008] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 08/02/2014] [Accepted: 08/07/2014] [Indexed: 10/24/2022]
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Endovascular repair of thoracic aortic aneurysm associated with right-sided aortic arch: report of two cases. Gen Thorac Cardiovasc Surg 2014; 64:552-7. [PMID: 25547542 DOI: 10.1007/s11748-014-0514-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 12/23/2014] [Indexed: 10/24/2022]
Abstract
Right-sided aortic arch (RAA) is a rare congenital disorder. We describe herein two cases of thoracic aortic aneurysm with a right aortic arch and right-sided descending aorta treated with thoracic endovascular aortic repair (TEVAR). In one case, a 70-year-old man with Edwards type 1 RAA underwent TEVAR using a Relay stent-graft (Bolton Medical, Barcelona, Spain). In another case, a 72-year-old woman with Edwards type 3 RAA underwent TEVAR using a Kawasumi Najuta stent-graft (Kawasumi Laboratories, Inc., Tokyo, Japan) with the "buffalo horn chimney technique", our original method for left subclavian artery flow preservation. The postoperative courses were uneventful. Postoperative computed tomography showed complete exclusion of the aneurysm without endoleakage. Compared to conventional open surgical repair, TEVAR is challenging in patients with a RAA and right-sided descending aorta. However, our results showed that TEVAR might be feasible and a treatment option even in a patient with a RAA and right-sided descending aorta.
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