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Tinelli G, D'Oria M, Sica S, Mani K, Rancic Z, Resh TA, Beccia F, Azizzadeh A, Da Volta Ferreira MM, Gargiulo M, Lepidi S, Tshomba Y, Oderich GS, Haulon S. The sac evolution imaging follow-up after endovascular aortic repair: An international expert opinion-based Delphi consensus study. J Vasc Surg 2024:S0741-5214(24)00424-5. [PMID: 38462062 DOI: 10.1016/j.jvs.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/29/2024] [Accepted: 03/01/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVE management of follow-up protocols after endovascular aortic repair (EVAR) varies significantly between centers and is not standardized according to sac regression. By designing an international expert-based Delphi consensus, the study aimed to create recommendations on follow-up after EVAR according to sac evolution. METHODS Eight facilitators created appropriate statements regarding the study topic that were voted, using a 4-point Likert scale, by a selected panel of international experts using a three-round modified Delphi consensus process. Based on the experts' responses, only those statements reaching a grade A (full agreement ≥75%) or B (overall agreement ≥80% and full disagreement <5%) were included in the final document. RESULTS One-hundred and seventy-four participants were included in the final analysis, and each voted the initial 29 statements related to the definition of sac regression (Q1-Q9), EVAR follow-up (Q10-Q14), and the assessment and role of sac regression during follow-up (Q15-Q29). At the end of the process, 2 statements (6.9%) were rejected, 9 statements (31%) received a grade B consensus strength, and 18 (62.1%) reached a grade A consensus strength. Of 27 final statements, 15 (55.6%) were classified as grade I, whereas 12 (44.4%) were classified as grade II. Experts agreed that sac regression should be considered an important indicator of EVAR success and always be assessed during follow-up after EVAR. CONCLUSIONS Based on the elevated strength and high consistency of this international expert-based Delphi consensus, most of the statements might guide the current clinical management of follow-up after EVAR according to the sac regression. Future studies are needed to clarify debated issues.
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Affiliation(s)
- Giovanni Tinelli
- Unit of Vascular Surgery, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Mario D'Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste, Trieste, Italy
| | - Simona Sica
- Unit of Vascular Surgery, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Kevin Mani
- Section of Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | | | | | - Flavia Beccia
- Section of Hygiene and Public Health, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ali Azizzadeh
- Division of Vascular Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | - Mauro Gargiulo
- Vascular Surgery University of Bologna, Vascular Surgery Unit IRCCS University Hospital Policlinico S. Orsola, Bologna, Italy
| | - Sandro Lepidi
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste, Trieste, Italy
| | - Yamume Tshomba
- Unit of Vascular Surgery, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gustavo S Oderich
- Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center at Houston, Houston, TX
| | - Stephan Haulon
- Hôpital Marie Lannelongue, GHPSJ, Université Paris Saclay, Paris, France
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Vallée A, Houyel L, To NT, Fels A, Kloeckner M, Blanchard D, Lemann T, Gaillard M, Ramadan R, Genty T, Thomas de Montpreville V, Beaussier H, Chatellier G, Deleuze P, Haulon S, Guihaire J. Doppler echocardiography for surveillance of acute cardiac allograft rejection: a 28-year single-center experience. Cardiovasc Diagn Ther 2024; 14:59-71. [PMID: 38434560 PMCID: PMC10904291 DOI: 10.21037/cdt-23-305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/17/2023] [Indexed: 03/05/2024]
Abstract
Background Endomyocardial biopsies (EMB) are recommended for the detection of acute cardiac rejection (ACR) despite limited sensitivity. We report the long-term post-transplant results of Doppler echocardiography as a noninvasive alternative of routine EMB. Methods Two cohorts of heart transplantation (HT) recipients were chronologically defined as follows: the Dual Monitoring Cohort (DMC) from January 1990 to December 1997 included patients who underwent routine EMB and Doppler echocardiography within 24 hours for ACR surveillance; and the "Echo-First Cohort" (EFC), including patients transplanted from January 1998 to December 2018 with Doppler echocardiography as first-line approach for ACR surveillance. Echocardiographic measurements of interest were collected: early diastolic (E) wave peak velocity; pressure half time (PHT) and isovolumetric relaxation time (IVRT). Post-transplant outcomes were reviewed and the Kaplan-Meier approach was used for survival estimates. Inter-operator variability for ultrasound measurements was investigated. Data were collected from medical records from January 2019 to December 2020. Results A total of 228 patients were included, 99 patients in the DMC and 129 in the EFC. Overall, 5-, 10- and 15-year survival rates were 65.4%, 55.5% and 44.1% respectively, without any significant difference between the two cohorts (log rank test, P=0.71). Echocardiography variables and EMB findings were associated with a mean area under the receiver operating characteristic curve (AUC-ROC) of 0.73 [95% confidence interval (CI): 0.54-0.91], 0.74 (95% CI: 0.54-0.94) and 0.75 (95% CI: 0.57-0.94) respectively for E wave, PHT and IVRT. IVRT and PHT were significantly decreased, and E wave significantly increased, in case of histologically proven ACR. Inter-operator variability was not significant for E wave and IVRT measurements (P=0.13 and 0.30 respectively). Conclusions Doppler echocardiography as a first-line method for surveillance of ACR did not impair long-term results after HT. These findings suggest that this non-invasive approach might be a reasonable alternative to systematic EMB, limiting risk and improving the quality of life.
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Affiliation(s)
- Aurélien Vallée
- Department of Cardiac Surgery, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, Le Plessis Robinson, France
| | - Lucile Houyel
- M3C-Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université de Paris Cité, Paris, France
| | - Ngoc Tram To
- Department of Cardiac Surgery, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, Le Plessis Robinson, France
| | - Audrey Fels
- Clinical Research Department, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Martin Kloeckner
- Department of Cardiac Surgery, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, Le Plessis Robinson, France
| | - David Blanchard
- Department of Cardiac Surgery, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, Le Plessis Robinson, France
| | - Thomas Lemann
- Department of Cardiac Surgery, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, Le Plessis Robinson, France
| | - Maïra Gaillard
- Department of Cardiac Surgery, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, Le Plessis Robinson, France
| | - Ramzi Ramadan
- Department of Cardiac Surgery, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, Le Plessis Robinson, France
| | - Thibaut Genty
- Intensive Care Unit, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, Le Plessis Robinson, France
| | | | - Hélène Beaussier
- Clinical Research Department, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Gilles Chatellier
- Clinical Research Department, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Philippe Deleuze
- Department of Cardiac Surgery, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, Le Plessis Robinson, France
| | - Stephan Haulon
- Department of Cardiac Surgery, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, Le Plessis Robinson, France
| | - Julien Guihaire
- Department of Cardiac Surgery, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, Le Plessis Robinson, France
- INSERM U999, University of Paris Saclay, Le Plessis Robinson, France
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Wanhainen A, Van Herzeele I, Bastos Goncalves F, Bellmunt Montoya S, Berard X, Boyle JR, D'Oria M, Prendes CF, Karkos CD, Kazimierczak A, Koelemay MJW, Kölbel T, Mani K, Melissano G, Powell JT, Trimarchi S, Tsilimparis N, Antoniou GA, Björck M, Coscas R, Dias NV, Kolh P, Lepidi S, Mees BME, Resch TA, Ricco JB, Tulamo R, Twine CP, Branzan D, Cheng SWK, Dalman RL, Dick F, Golledge J, Haulon S, van Herwaarden JA, Ilic NS, Jawien A, Mastracci TM, Oderich GS, Verzini F, Yeung KK. Editor's Choice -- European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Abdominal Aorto-Iliac Artery Aneurysms. Eur J Vasc Endovasc Surg 2024; 67:192-331. [PMID: 38307694 DOI: 10.1016/j.ejvs.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 02/04/2024]
Abstract
OBJECTIVE The European Society for Vascular Surgery (ESVS) has developed clinical practice guidelines for the care of patients with aneurysms of the abdominal aorta and iliac arteries in succession to the 2011 and 2019 versions, with the aim of assisting physicians and patients in selecting the best management strategy. METHODS The guideline is based on scientific evidence completed with expert opinion on the matter. By summarising and evaluating the best available evidence, recommendations for the evaluation and treatment of patients have been formulated. The recommendations are graded according to a modified European Society of Cardiology grading system, where the strength (class) of each recommendation is graded from I to III and the letters A to C mark the level of evidence. RESULTS A total of 160 recommendations have been issued on the following topics: Service standards, including surgical volume and training; Epidemiology, diagnosis, and screening; Management of patients with small abdominal aortic aneurysm (AAA), including surveillance, cardiovascular risk reduction, and indication for repair; Elective AAA repair, including operative risk assessment, open and endovascular repair, and early complications; Ruptured and symptomatic AAA, including peri-operative management, such as permissive hypotension and use of aortic occlusion balloon, open and endovascular repair, and early complications, such as abdominal compartment syndrome and colonic ischaemia; Long term outcome and follow up after AAA repair, including graft infection, endoleaks and follow up routines; Management of complex AAA, including open and endovascular repair; Management of iliac artery aneurysm, including indication for repair and open and endovascular repair; and Miscellaneous aortic problems, including mycotic, inflammatory, and saccular aortic aneurysm. In addition, Shared decision making is being addressed, with supporting information for patients, and Unresolved issues are discussed. CONCLUSION The ESVS Clinical Practice Guidelines provide the most comprehensive, up to date, and unbiased advice to clinicians and patients on the management of abdominal aorto-iliac artery aneurysms.
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Abdelhalim MA, Tenorio ER, Oderich GS, Haulon S, Warren G, Adam D, Claridge M, Butt T, Abisi S, Dias NV, Kölbel T, Gallitto E, Gargiulo M, Gkoutzios P, Panuccio G, Kuzniar M, Mani K, Mees BM, Schurink GW, Sonesson B, Spath P, Wanhainen A, Schanzer A, Beck AW, Schneider DB, Timaran CH, Eagleton M, Farber MA, Modarai B. Multicenter trans-Atlantic experience with fenestrated-branched endovascular aortic repair of chronic post-dissection thoracoabdominal aortic aneurysms. J Vasc Surg 2023; 78:854-862.e1. [PMID: 37321524 DOI: 10.1016/j.jvs.2023.05.053] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVE This multicenter international study aimed to describe outcomes of fenestrated-branched endovascular aortic repairs (FB-EVAR) in a cohort of patients treated for chronic post-dissection thoracoabdominal aortic aneurysms (PD-TAAAs). METHODS We reviewed the clinical data of all consecutive patients treated by FB-EVAR for repair of extent I to III PD-TAAAs in 16 centers from the United States and Europe (2008-2021). Data were extracted from institutional prospectively maintained databases and electronic patient records. All patients received off-the-shelf or patient-specific manufactured fenestrated-branched stent grafts. Endpoints were any cause mortality and major adverse events at 30 days, technical success, target artery (TA) patency, freedom from TA instability, minor (endovascular with <12 Fr sheath) and major (open or ≥12 Fr sheath) secondary interventions, patient survival, and freedom from aortic-related mortality (ARM). RESULTS A total of 246 patients (76% male; median age, 67 years [interquartile range, 61-73 years]) were treated for extent I (7%), extent II (55%), and extent III (35%) PD-TAAAs by FB-EVAR. The median aneurysm diameter was 65 mm (interquartile range, 59-73 mm). Eighteen patients (7%) were octogenarians, 212 (86%) were American Society of Anesthesiologists class ≥3, and 21 (9%) presented with contained ruptured or symptomatic aneurysms. There were 917 renal-mesenteric vessels targeted by 581 fenestrations (63%) and 336 directional branches (37%), with a mean of 3.7 vessels per patient. Technical success was 96%. Mortality and rate of major adverse events at 30 days was 3% and 28%, including disabling complications such as new onset dialysis in 1%, major stroke in 1%, and permanent paraplegia in 2%. Mean follow-up was 24 months. Kaplan-Meier (KM) estimated patient survival at 3 and 5 years was 79% ± 6% and 65% ± 10%. KM estimated freedom from ARM was 95% ± 3% and 93% ± 5% at the same intervals. Unplanned secondary interventions were needed in 94 patients (38%), including minor procedures in 64 (25%) and major procedures in 30 (12%). There was one conversion to open surgical repair (<1%). KM estimated freedom from any secondary intervention was 44% ± 9% at 5 years. KM estimated primary and secondary TA patency were 93% ± 2% and 96% ± 1% at 5 years, respectively. CONCLUSIONS FB-EVAR for chronic PD-TAAAs was associated with high technical success and a low rate of mortality (3%) and disabling complications at 30 days. Although the procedure is effective in the prevention of ARM, patient survival was low at 5 years (65%), likely due to the significant comorbidities in this cohort of patients. Freedom from secondary interventions at 5 years was 44%, although most procedures were minor. The significant rate of reinterventions highlights the need for continued patient surveillance.
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Affiliation(s)
- Mohamed A Abdelhalim
- Academic Department of Vascular Surgery, School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, British Heart Foundation Centre of Research Excellence, London, United Kingdom
| | - Emanuel R Tenorio
- Department of Cardiothoracic and Vascular Surgery, Advanced Aortic Research Program, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX
| | - Gustavo S Oderich
- Department of Cardiothoracic and Vascular Surgery, Advanced Aortic Research Program, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX
| | - Stephan Haulon
- Department of Cardiac and Vascular Surgery, Hôpital Marie Lannelongue, GHPSJ, Université Paris Saclay, Paris, France
| | - Gasper Warren
- Department of Surgery, University of California, San Francisco, San Francisco, CA
| | - Donald Adam
- Birmingham Vascular Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Martin Claridge
- Birmingham Vascular Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Talha Butt
- Vascular Center, Department of Thoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Said Abisi
- Department of Vascular Surgery, Guy's and St. Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Nuno V Dias
- Vascular Center, Department of Thoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Tilo Kölbel
- German Aortic Center, Department of Vascular Medicine, University Heart and Vascular Center Hamburg, University Medical Center Eppendorf, Hamburg, Germany
| | - Enrico Gallitto
- Metropolitan Unit of Vascular Surgery, IRCCS S. Orsola Hospital, Bologna, Italy
| | - Mauro Gargiulo
- Metropolitan Unit of Vascular Surgery, IRCCS S. Orsola Hospital, Bologna, Italy
| | - Panos Gkoutzios
- Department of Interventional Radiology, Guy's and St. Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Giuseppe Panuccio
- German Aortic Center, Department of Vascular Medicine, University Heart and Vascular Center Hamburg, University Medical Center Eppendorf, Hamburg, Germany
| | - Marek Kuzniar
- Section of Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Kevin Mani
- Section of Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Barend M Mees
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Geert W Schurink
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Björn Sonesson
- Vascular Center, Department of Thoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden; Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Paolo Spath
- Metropolitan Unit of Vascular Surgery, IRCCS S. Orsola Hospital, Bologna, Italy
| | - Anders Wanhainen
- Section of Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Andres Schanzer
- Division of Vascular Surgery, University of Massachusetts, Worcester, MA
| | - Adam W Beck
- Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, AL
| | - Darren B Schneider
- Division of Vascular Surgery and Endovascular Therapy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Carlos H Timaran
- Clinical Heart and Vascular Center, University of Texas Southwestern, Dallas, TX
| | - Matthew Eagleton
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA
| | - Mark A Farber
- Division of Vascular Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC
| | - Bijan Modarai
- Academic Department of Vascular Surgery, School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, British Heart Foundation Centre of Research Excellence, London, United Kingdom.
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Abisi S, Elnemr M, Clough R, Alotaibi M, Gkoutzios P, Modarai B, Haulon S. The Development of Totally Percutaneous Aortic Arch Repair With Inner-Branch Endografts: Experience From 2 Centers. J Endovasc Ther 2023:15266028231184687. [PMID: 37401667 DOI: 10.1177/15266028231184687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
OBJECTIVE The main objective of this study is to present the experience of 2 centers undertaking total percutaneous aortic arch-branched graft endovascular repair using combination of femoral and axillary routes. The report summarizes the procedural steps, outcomes achieved, and the benefits of this approach, which eliminates the need for direct open surgical exposure of the carotid, subclavian, or axillary arteries, thereby reducing the unnecessary associated surgical risks. METHODS Retrospectively collected data of 18 consecutive patients (15M:3F) undergoing aortic arch endovascular repair using a branched device between February 2021 and June 2022 at 2 aortic units. Six patients were treated for a residual aortic arch aneurysm following previous type A dissection with size range of (58-67 mm in diameter), 10 were treated for saccular or fusiform degenerative atheromatous aneurysm with size range of (51.5-80 mm in diameter), and 2 were treated for penetrating aortic ulcer (PAU) with size range of (50-55 mm). Technical success was defined as completion of the procedure and satisfactory placement of the bridging stent grafts (BSGs) in the supra-aortic vessels percutaneously including the brachiocephalic trunk (BCT), left common carotid artery (LCCA), and left subclavian artery (LSA) without the need for carotid, subclavian, or axillary cut down. The primary technical success was examined as primary outcome well as any other related complications and reinterventions as secondary outcomes. RESULTS The primary technical success with our alternative approach was achieved in all 18 cases. There was one access site complication (groin haematoma), which was managed conservatively. There was no incidence of death, stroke, or cases of paraplegia. No other immediate complications were noted. Postoperative imaging confirmed supra-aortic branch patency, with satisfactory position of the BSGs and immediate aneurysm exclusion except in 4 patients who had type 1C endoleak (Innominate: 2, LSA 2) detected on the first postoperative scan. Three of them were treated with relining/extension, and 1 spontaneously resolved after 6 weeks. CONCLUSIONS Total percutaneous aortic arch repair with antegrade and retrograde inner-branch endografts can be performed with promising early results. Dedicated steerable sheaths and appropriate BSG would optimize the percutaneous approach for aortic arch endovascular repairs. CLINICAL IMPACT This article provides an alternative and innovative approach to improve the minimally invasive techniques in the endovascular treatment of the aortic arch conditions.
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Affiliation(s)
- Said Abisi
- Guy's and St Thomas' NHS Foundation Trust, London, UK
- Faculty of Life Sciences & Medicine, King's College London, London, UK
| | | | - Rachel Clough
- Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Mohammed Alotaibi
- Aortic Center, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint-Joseph, Université Paris-Saclay, Paris, France
| | | | - Bijan Modarai
- Guy's and St Thomas' NHS Foundation Trust, London, UK
- Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Stephan Haulon
- Aortic Center, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint-Joseph, Université Paris-Saclay, Paris, France
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Sadeghipour P, Mohebbi B, Rabiei P, Firouzi A, Iranian M, Hoseini F, Khajali Z, Saedi S, Haulon S, Moosavi J. First Experiences With Vascular Closure Devices in the Endovascular Treatment of Aortic Coarctation. J Tehran Heart Cent 2023; 18:234-236. [PMID: 38146413 PMCID: PMC10748658 DOI: 10.18502/jthc.v18i3.14121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023] Open
Abstract
The Article Abstract is not available.
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Affiliation(s)
- Parham Sadeghipour
- Associate Professor of Interventional Cardiology, Interventional Cardiology Research Center, Rajaie Cardiovascular Medical and Research Center, Vali-Asr Ave, Tehran, Iran. 1995614331. Tel: +98 2123922092. Fax: +98 21 22042026. E-mail:
| | - Bahram Mohebbi
- Professor of Interventional Cardiology, Interventional Cardiology Research Center, Rajaie Cardiovascular Medical and Research Center, Vali-Asr Ave, Tehran, Iran. 1995614331. Tel: +98 21 23922072. Fax: +98 21 22042026. E-mail:
| | - Parham Rabiei
- Rajaie Cardiovascular Medical and Research Center, Vali-Asr Ave, Tehran, Iran. 1995614331. Tel: +98 2123923153. Fax: +98 21 22042026. E-mail:
| | - Ata Firouzi
- Associate Professor of Interventional Cardiology, Interventional Cardiology Research Center, Rajaie Cardiovascular, Medical and Research Center, Vali-Asr Ave, Tehran, Iran. 1995614331 Tel: +98 21239222174 Fax: +98 21 22042026 E-mail:
| | - Mohammadreza Iranian
- Rajaie Cardiovascular Medical and Research Center, Vali-Asr Ave, Tehran, Iran. 1995614331. Tel: +98 23922056. Fax: +98 21 22042026. E-mail:
| | - Faeghe Hoseini
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Vali-Asr Ave, Tehran, Iran. 1995614331. Fax: +98 21 22042026. E-mail:
| | - Zahra Khajali
- Rajaie Cardiovascular Medical and Research Center, Vali-Asr Ave, Tehran, Iran. 1995614331. Tel: +98 2123922185. Fax: +98 21 22042026. E-mail:
| | - Sedigheh Saedi
- Associate Professor of Adult Congenital Heart Diseases, Heart Research Center, Rajaie Cardiovascular Medical and Research Center, Vali-Asr Ave, Tehran, Iran. 1995614331. Tel: +98 21 2392 2003. Fax: +98 21 22042026. E-mail:
| | - Stephan Haulon
- Aortic Centre, Department of Cardiac and Vascular Surgery, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, Paris, France. 11265. Tel: +331 40 948569. E-mail:
| | - Jamal Moosavi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Vali-Asr Ave, Tehran, Iran. 1995614331. Cell: +98 9123573571. Tel: +98 21 23922062. Fax: +98 21 22042026. E-mail
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Eleshra A, Haulon S, Bertoglio L, Lindsay T, Rohlffs F, Dias N, Tsilimparis N, Panuccio G, Kölbel T. Custom Made Candy Plug for Distal False Lumen Occlusion in Aortic Dissection: International Experience. Eur J Vasc Endovasc Surg 2023; 66:50-56. [PMID: 36958480 DOI: 10.1016/j.ejvs.2023.03.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 02/26/2023] [Accepted: 03/13/2023] [Indexed: 03/25/2023]
Abstract
OBJECTIVE To evaluate early and midterm outcomes of the Candy Plug (CP) technique for distal false lumen (FL) occlusion in thoracic endovascular aortic repair for aortic dissection (AD) in a more real world cohort of patients from an international multicentre registry. METHODS A multicentre retrospective study was conducted of all consecutive patients from the contributing centres with subacute and chronic AD treated with the CP technique from October 2013 to April 2020 at 18 centres. RESULTS A custom made CP was used in 155 patients (92 males, mean age 62 ± 11 years). Fourteen (9%) presented with ruptured false lumen aneurysms. Technical success was achieved in all patients (100%). Clinical success was achieved in 138 patients (89%). The median hospital stay was 7 days (1 - 77). The 30 day mortality rate was 3% (n = 5). Stroke occurred in four patients (3%). Spinal cord ischaemia occurred in three patients (2%). The 30 day computed tomography angiogram (CTA) confirmed successful CP placement at the intended level in all patients. Early complete FL occlusion was achieved in 120 patients (77%). Early (30 day) CP related re-intervention was required in four patients (3%). The early (30 day) stent graft related re-intervention rate was 8% (n = 12). Follow up CTA was available in 142 patients (92%), with a median follow up of 23 months (6 - 87). Aneurysmal regression was achieved in 68 of 142 patients (47%); the aneurysm diameter remained stable in 69 of 142 patients (49%) and increased in five of 142 patients (4%). A higher rate of early FL occlusion was detected in the largest volume centre patients (50 [88%] vs. 70 [71%] from other centres; p = .019). No other differences in outcome were identified regarding volume of cases or learning curve. CONCLUSION This international CP technique experience confirmed its feasibility and low mortality and morbidity rates. Aortic remodelling and false lumen thrombosis rates were high and support the concept of distal FL occlusion in AD using the CP technique.
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Affiliation(s)
- Ahmed Eleshra
- German Aortic Centre, University Heart & Vascular Centre, University Medical Centre Eppendorf, Hamburg, Germany; Department of Vascular Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
| | | | - Luca Bertoglio
- San Raffaele Hospital, Milan, Italy; Division of Vascular Surgery, Department of Sperimental and Clinical Sciences (DSCS), University and ASST Spedali Civili Hospital of Brescia, Brescia, Italy
| | | | - Fiona Rohlffs
- German Aortic Centre, University Heart & Vascular Centre, University Medical Centre Eppendorf, Hamburg, Germany
| | - Nuno Dias
- Skåne University Hospital, Malmö, Sweden
| | - Nikolaos Tsilimparis
- German Aortic Centre, University Heart & Vascular Centre, University Medical Centre Eppendorf, Hamburg, Germany; University Hospital, LMU, Munich, Germany
| | - Giuseppe Panuccio
- German Aortic Centre, University Heart & Vascular Centre, University Medical Centre Eppendorf, Hamburg, Germany
| | - Tilo Kölbel
- German Aortic Centre, University Heart & Vascular Centre, University Medical Centre Eppendorf, Hamburg, Germany
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Nana P, Spanos K, Brotis A, Fabre D, Mastracci T, Haulon S. Systematic Review on Early and Follow-up Mortality Rate in Octogenarians Treated With a Fenestrated and/or Branched Endovascular Aortic Repair. J Endovasc Ther 2023:15266028231182798. [PMID: 37341255 DOI: 10.1177/15266028231182798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
PURPOSE Advanced age has been related to conflicting outcomes after fenestrated/branched endovascular aortic aneurysm repair (F/BEVAR). The aim of this meta-analysis is to compare 30-day mortality, technical success, and 1-year and 5-year survival in octogenarians and non-octogenarians who underwent F/BEVAR for complex aortic aneurysms. MATERIALS AND METHODS This meta-analysis was pre-registered to PROSPERO (CRD42022348659). The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 statement was followed. A search of the English literature, via Ovid, using MEDLINE, Embase, and CENTRAL databases, until August 30, 2022, was executed. Randomized Control Trials and observational studies (2000-2022), with ≥5 patients, reporting on 30-day mortality and 1-year and 5-year survival rates among octogenarians and non-octogenarians after F/BEVAR were eligible. The Risk Of Bias In Non-Randomized Studies of Interventions (ROBINS-I) tool was applied to assess the risk of bias. The primary outcome was 30-day mortality and secondary was 1-year and 5-year survival in octogenarians and non-octogenarians. The outcomes were summarized as odds ratio (OR) with 95% confidence intervals (CIs). A narrative presentation was selected in case of missing outcomes. RESULTS The initial research isolated 3263 articles; 6 retrospective studies were finally included. A total of 7410 patients were managed with F/BEVAR; 1499 patients (20.2%) were ≥80 years old (75.5% males, 259/343). The estimated 30-day mortality was 6% among octogenarians vs 2% in younger patients, with a significantly higher 30-day mortality for patients ≥80 years old (OR 1.21, 95% CI 0.61-1.81; p=0.0.11; Ι2=36.01%). Technical success was similar between the groups (OR -0.83; 95% CI -1.74-0.07, p<0.0.001; Ι2=95.8%). Regarding survival, a narrative approach was decided due to missing data. Two studies reported a statistically significant difference in 1-year survival between groups, with higher mortality in octogenarians (82.5%-90% vs 89.5%-93%), while 3 reported a similar 1-year survival rate in both groups (87.1%-95% vs 88%-89.5%). At 5 years, 3 studies reported a statistically significant lower survival for octogenarians (26.9%-42% vs 61%-71%). CONCLUSIONS Octogenarians treated with F/BEVAR presented higher 30-day mortality while a lower survival rate at 1 and 5 years was reported in the literature. Patient selection is thus mandatory among older patients. Further studies, especially on patient risk stratification, are needed to estimate the F/BEVAR outcomes on elder patients. CLINICAL IMPACT Age may be a factor of increased early and long-term mortality within patients managed for aortic aneurysms. In this analysis, patients over 80 years old were compared to their younger counterparts when managed with fenestrated or branched endovascular aortic repair (F/BEVAR) . The analysis showed that early mortality was acceptable for octogenrains but significantly higher when compared to patients younger than 80 years. One-year survival rates are controversial. At 5-year follow-up, octogenarians present lower survival but data to provide metanalysis are lacking. Patient selection and risk stratification are mandatory in older candidates for F/BEVAR.
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Affiliation(s)
- Petroula Nana
- Aortic Center, Marie Lannelongue Hospital, Paris-Saclay University, Le Plessis-Robinson, France
| | - Konstantinos Spanos
- Vascular Surgery Department, Larissa University Hospital, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Alexandros Brotis
- Department of Neurosurgery, Larissa University Hospital, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Dominique Fabre
- Aortic Center, Marie Lannelongue Hospital, Paris-Saclay University, Le Plessis-Robinson, France
| | - Tara Mastracci
- Department of Surgery and Interventional Science, University College London, London, UK
- Department of Cardiothoracic Surgery, St Bartholomew's Hospital, London, UK
| | - Stephan Haulon
- Aortic Center, Marie Lannelongue Hospital, Paris-Saclay University, Le Plessis-Robinson, France
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Nana P, Kölbel T, Behrendt CA, Kouvelos G, Giannoukas A, Haulon S, Spanos K. Systematic review of reintervention with fenestrated or branched devices after failed previous endovascular aortic aneurysm repair. J Vasc Surg 2023; 77:1806-1814.e2. [PMID: 36375726 DOI: 10.1016/j.jvs.2022.11.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/27/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND A proximal seal extension, after previously failed standard endovascular abdominal aortic aneurysm repair (EVAR), has been described using various endovascular techniques. The aim of the present systematic review was to assess the technical success, 30-day mortality, and mortality and reintervention rates during the available follow-up for patients managed with endovascular methods after failed endovascular repair. METHODS The present systematic review followed the PRISMA (preferred reporting items for systematic reviews and meta-analyses) statement and was preregistered at PROSPERO (no. CRD42022350436). A search of the English literature, via Ovid, using the MEDLINE, EMBASE, and CENTRAL databases, until June 15, 2022, was performed. Observational studies (2000-2022) and case series with at least five patients who had undergone fenestrated/branched EVAR (F/BEVAR) after failed EVAR were considered eligible. Technical success and mortality at 30 days and the mortality and reintervention rates during available follow-up had to have been reported. The Newcastle-Ottawa scale was used to assess the risk of bias. The primary outcome was technical success and mortality at 30 days. RESULTS The initial search yielded 2558 reports. Ten studies were considered eligible, two of which were prospective. A total of 423 patients had undergone F/BEVAR after failed EVAR. The indication for reintervention was the presence of a type Ia endoleak in 44.9%. Technical success was reported in seven studies, and 319 of 336 interventions were considered successful (94.9%), according to each study's criteria. Of the 423 patients, 10 had died within 30 days (2.4%). Seven patients had presented with spinal cord ischemia (2.4%). Twenty-three acute kidney injury events were reported (6.8%). The mean follow-up was 18 months (range, 1-77 months). During follow-up, 47 deaths were reported (14.8%). Finally, 50 reinterventions of 303 procedures (16.5%) had been performed. CONCLUSIONS According to the available literature, F/BEVAR after failed EVAR can be performed with high technical success and low mortality during the perioperative period. The midterm mortality and reintervention rates were acceptable. However, further data are needed to provide firm conclusions regarding the safety and durability of F/BEVAR after failed EVAR.
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Affiliation(s)
- Petroula Nana
- Aortic Center, Marie Lannelongue Hospital, Le Plessis-Robinson, Paris Saclay University, Paris, France.
| | - Tilo Kölbel
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart and Vascular Center, Hamburg, Germany
| | - Christian-Alexander Behrendt
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart and Vascular Center, Hamburg, Germany
| | - George Kouvelos
- Vascular Surgery Department, Larissa University Hospital, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Athanasios Giannoukas
- Vascular Surgery Department, Larissa University Hospital, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Stephan Haulon
- Aortic Center, Marie Lannelongue Hospital, Le Plessis-Robinson, Paris Saclay University, Paris, France
| | - Konstantinos Spanos
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart and Vascular Center, Hamburg, Germany; Vascular Surgery Department, Larissa University Hospital, Faculty of Medicine, University of Thessaly, Larissa, Greece
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Mallios A, Gouëffic Y, Haulon S. Single Cross Filtered Direct Carotid Artery Revascularisation with Selective Flow Reversal. Eur J Vasc Endovasc Surg 2023; 65:916. [PMID: 36863443 DOI: 10.1016/j.ejvs.2023.02.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 02/08/2023] [Accepted: 02/21/2023] [Indexed: 03/04/2023]
Affiliation(s)
- Alexandros Mallios
- Department of Vascular and Endovascular Surgery, Groupe Hospitalier Paris Saint Joseph, Paris, France; Department of Surgery, Centre Hospitalier de Chartres, Chartres, France.
| | - Yann Gouëffic
- Department of Vascular and Endovascular Surgery, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Stephan Haulon
- Department of Vascular and Endovascular Surgery, Groupe Hospitalier Paris Saint Joseph, Paris, France
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Nana P, Spanos K, Brotis A, Fabre D, Mastracci T, Haulon S. Effect of Sarcopenia on Mortality and Spinal Cord Ischaemia After Complex Aortic Aneurysm Repair: Systematic Review and Meta-Analysis. Eur J Vasc Endovasc Surg 2023; 65:503-512. [PMID: 36657704 DOI: 10.1016/j.ejvs.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 12/21/2022] [Accepted: 01/11/2023] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Sarcopenia has been related to higher mortality rates after abdominal aortic aneurysm repair. This analysis aimed to assess sarcopenia related mortality and spinal cord ischaemia (SCI) at 30 days, and mortality during the available follow up, in patients with complex aortic aneurysms, managed with open or endovascular interventions. DATA SOURCES A search of the English literature, via Ovid, using Medline, EMBASE, and CENTRAL up to 15 June 2022 was done. REVIEW METHODS This meta-analysis was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines and preregistered in PROSPERO (CRD42022338079). Observational studies (2000 - 2022), with five or more patients, reporting on sarcopenia related mortality and SCI at 30 days, and midterm mortality after thoraco-abdominal aneurysm repair (open or endovascular), were eligible. The ROBINS-I tool (Risk Of Bias In Non-Randomised Studies of Interventions) was used for risk of bias, and GRADE (Grading of Recommendations, Assessment, Development and Evaluation) for the assessment of evidence quality. The primary outcome was 30 day and midterm mortality, and the secondary outcome was SCI at 30 days, in sarcopenic and non-sarcopenic patients. The outcomes were summarised as odds ratio (OR) with 95% confidence intervals (CIs). RESULTS Four retrospective studies (1 092 patients; 40.0% sarcopenic) were included. Thirty day mortality was similar, with low certainty between groups (6% [95% CI 1 - 11] in sarcopenic vs. 5% [95% CI 1 - 9] non-sarcopenic patients [OR 0.30, 95% CI -0.21 - 0.81; p = .94, Ι2 = 0%). The estimated midterm mortality was statistically significantly higher (very low certainty) in sarcopenic patients (25% [95% CI 0.19 - 0.31] vs. 13% [95% CI -0.03 - 0.29] in non-sarcopenic patients (1.11 OR 0.95, 95% CI -0.21 - 2.44; p < .001, Ι2 = 88.32%). SCI was significantly higher (very low certainty) in sarcopenic patients (19%, 95% CI 4 - 34) vs. 7% (95% CI 5 - 20) in non-sarcopenic patients (OR 1.80, 95% CI -0.17 - 3.78; Ι2 = 82.4%), despite an equal distribution of aneurysm type between the groups. CONCLUSION Early mortality does not appear to be affected by sarcopenia in patients treated for thoraco-abdominal aneurysms. However, sarcopenia may be associated with higher peri-operative SCI and midterm mortality rates.
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Affiliation(s)
- Petroula Nana
- Aortic Centre, Marie Lannelongue Hospital, Le Plessis-Robinson, Paris Saclay University, Paris, France.
| | - Konstantinos Spanos
- Vascular Surgery Department, Larissa University Hospital, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Alexandros Brotis
- Department of Neurosurgery, Larissa University Hospital, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Dominique Fabre
- Aortic Centre, Marie Lannelongue Hospital, Le Plessis-Robinson, Paris Saclay University, Paris, France
| | - Tara Mastracci
- Department of Cardiothoracic surgery, St. Bartholomew's Hospital London and University College London, London UK
| | - Stephan Haulon
- Aortic Centre, Marie Lannelongue Hospital, Le Plessis-Robinson, Paris Saclay University, Paris, France
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Houérou TL, Nana P, Pernot M, Guihaire J, Gaudin A, Lerisson E, Costanzo A, Fabre D, Haulon S. Systematic Review on In Situ Laser Fenestrated Repair for the Endovascular Management of Aortic Arch Pathologies. J Clin Med 2023; 12:jcm12072496. [PMID: 37048580 PMCID: PMC10095564 DOI: 10.3390/jcm12072496] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/12/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023] Open
Abstract
Background: In situ laser-fenestrated thoracic aortic endovascular repair (FTEVAR) has emerged as a valuable alternative for aortic arch management. This review assessed the early and follow-up outcomes of in situ laser-FTEVAR in aortic arch pathologies. Methods: The PRISMA statement was followed. The English literature was searched, via Ovid, until 15 October 2022. Observational studies, published after 2000, reporting on early and follow-up outcomes for the in situ laser-FTEVAR were eligible. The Newcastle–Ottawa Scale was used to assess the risk of bias. Primary outcomes were the technical success, stroke, and mortality at 30-days, and the secondary were the mortality and reintervention during follow-up. Results: Six retrospective studies from 591 and 247 patients were included. Fifty-nine (23.9%) patients were managed for aortic arch aneurysms and 146 (59.1%) for dissections; 22.6% of them for type A. Technical success was at 98% (range 90–100%). Eight patients died (3.2%) and 11 cases presented any type of stroke (4.5%) during the 30-day follow-up. The mean follow-up was 15 months (1–40 months). Ten deaths were reported (4.2%); one was aortic-related (10%). Thirteen re-interventions (6.0%) were performed. Conclusions: In situ laser-FTEVAR for aortic arch repair may be performed with high technical success and low 30-day and midterm follow-up mortality, stroke, and re-intervention rates when applied in well selected patients and performed by experienced teams.
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Mesnard T, Vacirca A, Oderich GS, Haulon S. Patient selection and anatomical considerations for zone 0 endovascular aneurysm arch repair. J Cardiovasc Surg (Torino) 2023; 64:3-8. [PMID: 36763068 DOI: 10.23736/s0021-9509.22.12591-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Endovascular aortic arch repair has been widely used in select patients who are considered high risk for open surgical repair and have suitable anatomy. The anatomical challenges of placement of stent-grafts in the ascending aorta are many, including the curved configuration, short landing zone, proximity to the aortic valve and coronary arteries and need to incorporate the supra-aortic trunks. Stent-graft designs with fenestrations and/or directional branches are applicable to patients who have suitable landing zones in the aorta and supra-aortic trunks, adequate access and absence of significant atheromatous debris. These devices include single and multibranch concepts, which are used in combination or not with cervical debranching procedures. This article summarizes the most commonly used anatomical criterion with currently utilized arch branch stent-grafts.
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Affiliation(s)
- Thomas Mesnard
- The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Andrea Vacirca
- The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Gustavo S Oderich
- The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Stephan Haulon
- Aortic Center, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, University Paris Saclay, Paris, France -
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Mougin J, Schwein A, Postiglione TJ, Guihaire J, Fabre D, Haulon S. Management of the False Lumen in Post Type A Aortic Dissection Arch Aneurysms Treated With Branched Endografts. J Endovasc Ther 2023:15266028221149912. [PMID: 36632664 DOI: 10.1177/15266028221149912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION The treatment of chronic postdissection aneurysms of the aortic arch is a challenge. This study aims to describe false lumen management after aortic arch endovascular repair of post-type A dissection aneurysms treated with a branched endograft. METHODS In this single-center retrospective observational study, all consecutive patients undergoing endovascular treatment of aneurysmal degeneration of chronic type A aortic dissections following open repair were enrolled. The primary endpoint was maximal aortic diameter evolution measured on computed tomography angiography (CTA) performed during follow-up. Secondary endpoints included procedural success, aortic re intervention, and remodeling during follow-up. RESULTS Between January 2017 and June 2020, 22 patients underwent endovascular branched arch repair for post type A dissection aneurysms. Technical success was 100%. Thirteen patients (59%) had dissection involvement of at least 1 supra-aortic vessel. Midterm follow-up CTA was performed for 20 patients, 23.1 (±13.3) months after the procedure. Maximal aortic diameter at the level of the repair was decreasing in 13 (65%) patients, increasing in 2 (10%) patients, and no change was observed in 5 (25%) patients. During follow-up, 7 patients (35%) required aortic reintervention. Thoracic candy plugs were implanted for distal false lumen occlusion in 15 patients and associated with a high rate of complete remodeling (6/15 patients, 40%). CONCLUSION Arch branch endografting of aneurysmal evolution of a post type A dissection aortic arch is a safe and feasible option in experienced hands. Candy plug use in favorable anatomies seems to be associated with accelerated remodeling of the aorta. CLINICAL IMPACT There are currently no recommendations on dissected supra- aortic vessels management and the use of thoracic aorta false lumen occlusion devices during endovascular repair of chronic post dissection aneurysm of the aortic arch with branched endografts. Based on our clinical experience reported in the current manuscript, we propose a treatment algorithm for the management of the false lumen in this setting.
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Affiliation(s)
- J Mougin
- Aortic Center, Department of Cardiac and Vascular Surgery, Hôpital Marie Lannelongue, Groupe hospitalier Paris Saint Joseph, INSERM UMR_S 999, Université Paris-Saclay, Paris, France
| | - A Schwein
- Service de Chirurgie Vasculaire, CHU Strasbourg, Strasbourg, France
| | | | - J Guihaire
- Aortic Center, Department of Cardiac and Vascular Surgery, Hôpital Marie Lannelongue, Groupe hospitalier Paris Saint Joseph, INSERM UMR_S 999, Université Paris-Saclay, Paris, France
| | - D Fabre
- Aortic Center, Department of Cardiac and Vascular Surgery, Hôpital Marie Lannelongue, Groupe hospitalier Paris Saint Joseph, INSERM UMR_S 999, Université Paris-Saclay, Paris, France
| | - S Haulon
- Aortic Center, Department of Cardiac and Vascular Surgery, Hôpital Marie Lannelongue, Groupe hospitalier Paris Saint Joseph, INSERM UMR_S 999, Université Paris-Saclay, Paris, France
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Nana P, Spanos K, Dakis K, Giannoukas A, Kölbel T, Haulon S. Systematic Review on Customized and Non-customized Device Techniques for the Endovascular Repair of the Aortic Arch. J Endovasc Ther 2022:15266028221133701. [PMID: 36346051 DOI: 10.1177/15266028221133701] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
PURPOSE Open repair remains the standard of care for aortic arch pathologies. However, endovascular management became an attractive alternative for high-risk patients. This study aimed to assess the outcomes of the available endovascular techniques for aortic arch pathology management. MATERIALS AND METHODS A search of the English literature (2000-2022) using PubMed, EMBASE, via Ovid, and CENTRAL databases (February 1, 2022) was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Studies reporting on patients with aortic arch pathologies managed with custom-made devices ([CMDs] fenestrated or branched thoracic endovascular aortic repair [F/BTEVAR]) and non-CMDs (parallel graft or surgeon-modified FTEVAR) were eligible. Studies reporting on hybrid or open repair were excluded. Studies' quality was assessed using the Newcastle-Ottawa Scale. Primary outcomes were technical success, 30 day mortality, and cerebrovascular events (CVEs). Secondary outcomes were re-intervention and mortality during follow-up. RESULTS Thirty studies (2135 patients) were included. Treatment indications were mainly dissections (652 cases [48.0%, 652/1358]; 90 type A, 506 type B; 364 acute, 163 chronic) and aneurysms (46.9%, 582/1239). Five studies (211 patients) reported on FTEVAR and 10 (388 patients) on BTEVAR. For FTEVAR, technical success rate was 98.3%. Thirty-day mortality was 3.8% and CVE rate was 12.3%. Ten deaths (9.7%) and 19 re-interventions (9%) were recorded during follow-up (24 months). Regarding BTEVAR, technical success rate was 98.7%, and 30 day mortality and CVE rates were 5.4% and 11.0%, respectively. During follow-up (27 months), 64 deaths (18.7%) and 33 re-interventions (9.6%) were recorded. Parallel graft technique was reported in 11 studies (901 patients). Technical success rate was 76.4%. Thirty-day mortality was 3.9% and 32 (4.3%) CVEs were recorded. Thirty-five deaths (4.4%) and 43 re-interventions (5.5%) were reported during follow-up (27 months). Surgeon-modified FTEVAR was described in 5 studies (635 patients). Technical success rate was 91.6%. At 30 days, 15 deaths (2.3%) and 22 CVEs (3.5%) were recorded. During follow-up (19 months), 26 deaths (4.2%) and 21 re-interventions (3.6%) were detected. CONCLUSIONS Endovascular arch repair presented a variable technical success; >95% for F/BTEVAR; ≤90% for non-CMDs. Acceptable 30 day mortality rates were reported. Cerebrovascular event rates ranged up to 10%. These findings, adjacent to the estimated midterm mortality and re-interventions, set the need for further improvement. CLINICAL IMPACT Endovascular arch repair gains popularity as a valuable alternative, especially in patients considered unfit for open repair. According the available literature, any endovascular technique, including custom-made or off-the-shelf solutions, may be applied successfully, with acceptable early mortality. However, the perio-operative cerebrovascular event rate is still an issue, indicating the need for further advancements.
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Affiliation(s)
- Petroula Nana
- Aortic Centre, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, Le Plessis-Robinson, France
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Konstantinos Spanos
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart & Vascular Center, Hamburg, Germany
| | - Konstantinos Dakis
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Athanasios Giannoukas
- Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Tilo Kölbel
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart & Vascular Center, Hamburg, Germany
| | - Stephan Haulon
- Aortic Centre, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, Le Plessis-Robinson, France
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Lombardi JV, Gleason TG, Panneton JM, Starnes BW, Dake MD, Haulon S, Mossop PJ, Segbefia E, Bharadwaj P. Five-year results of the STABLE II study for the endovascular treatment of complicated, acute type B aortic dissection with a composite device design. Eur J Vasc Endovasc Surg 2022. [DOI: 10.1016/j.ejvs.2022.10.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Nana P, Tyrrell MR, Guihaire J, Le Houérou T, Gaudin A, Fabre D, Haulon S. A review: Single and multi-branch devices for the treatment of aortic arch pathologies with proximal sealing in Ishimaru Zone 0. Ann Vasc Surg 2022:S0890-5096(22)00618-5. [PMID: 36309169 DOI: 10.1016/j.avsg.2022.09.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 09/23/2022] [Accepted: 09/28/2022] [Indexed: 11/27/2022]
Abstract
Recently published experience has shown that endovascular management of the aortic arch, including sealing in the proximal zones, can be a viable option for patients considered unfit for conventional open repair. Endograft designs vary and include single or multibranch devices, with or without the addition of surgical debranching. Initial reports show that both techniques can be performed with high technical success and acceptable perioperative morbidity and mortality rates in high volume centers. Single branch devices, available off-the-shelf, may provide a treatment option for emergent presentations where patients cannot wait for the design and manufacture of a customized endograft. Double or triple branched endografts are now increasingly implanted in high-volume aortic centers. The purpose of this review is to describe the single and multibranched endovascular devices currently available for aortic arch repair, their associated published outcomes, and to discuss their relative advantages and disadvantages.
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Ribreau Z, Mesnard T, Sobocinski J, Sica S, Tinelli G, De Waure C, Haulon S. Results of endovascular treatment and open surgery for juxta/pararenal and type IV thoracoabdominal aortic aneurysms. Ann Vasc Surg 2022. [DOI: 10.1016/j.avsg.2022.06.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Lombardi JV, Gleason TG, Panneton JM, Starnes BW, Dake MD, Haulon S, Mossop PJ, Segbefia E, Bharadwaj P. Five-year results of the STABLE II study for the endovascular treatment of complicated, acute type B aortic dissection with a composite device design. J Vasc Surg 2022; 76:1189-1197.e3. [PMID: 35809819 DOI: 10.1016/j.jvs.2022.06.092] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/20/2022] [Accepted: 06/30/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To provide the five-year outcomes of the use of a composite device (proximal covered stent-graft + distal bare stent) for endovascular repair of patients with acute, type B aortic dissection complicated by aortic rupture and/or malperfusion. METHODS STABLE II was a prospective, multicenter study of the Zenith Dissection Endovascular System (William Cook Europe, Denmark). Patients were enrolled between August 2012 and January 2015 at sites in the United States and Japan. Five-year follow-up was completed by January 2020. RESULTS In total, 73 patients (mean age 60.7±10.9 years; 65.8% male) with acute type B dissection complicated by malperfusion (72.6%), rupture (21.9%), or both (5.5%) were enrolled. Patients were treated with either a composite device (79.5%) or the proximal stent-graft alone (no distal bare stent, 20.5%). Dissections were more extensive in patients who received the composite device (408.9±121.3 mm) than in patients who did not receive a bare stent (315.9±100.1 mm). Mean follow-up was 1209.4±754.6 days. Freedom from all-cause mortality was 80.3%±4.7% at one year and 68.9%± 7.3% at five years. Freedom from dissection-related mortality remained at 97.1%±2.1% from one-year through five-year follow-up. Within the stent-graft region, the rate of either complete thrombosis or elimination of the false lumen increased over time (82.1% of all patients at five years vs. 55.7% at first post-procedure CT), with a higher rate at five years in patients who received the composite device (90.5%) compared with patients without the bare stent (57.1%). Throughout follow-up, overall true lumen diameter increased within the stent-graft region, and overall false lumen diameter decreased. At five years, 20.7% of patients experienced a decrease in maximum transaortic diameter within the stent-graft region, 17.2% experienced an increase, and 62.1% experienced no change. Distal to the treated segment (but within the dissected aorta), 23.1% of patients experience no change in transaortic diameter at five years; a bare stent was deployed in all these patients at the procedure. Five-year freedom from all secondary intervention was 70.7%±7.2%. CONCLUSIONS These five-year outcomes indicate a low rate of dissection-related mortality for the Zenith Dissection Endovascular System in the treatment of patients with acute, complicated type B aortic dissection. Further, these data suggest a positive influence of composite device use on false lumen thrombosis. Continuous monitoring for distal aortic growth is necessary in all patients.
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Affiliation(s)
- Joseph V Lombardi
- Division of Vascular Surgery, Cooper University Hospital, Camden, NJ.
| | - Thomas G Gleason
- Division of Cardiothoracic Surgery, University of Maryland Medical Center, Baltimore, MD
| | - Jean M Panneton
- Division of Vascular Surgery, Eastern Virginia Medical School, Norfolk, VA
| | - Benjamin W Starnes
- Division of Vascular Surgery, Harborview Medical Center, University of Washington, Seattle, WA
| | | | - Stephan Haulon
- Division of Vascular Surgery, Aortic Centre, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris-Saclay, Paris, France
| | - Peter J Mossop
- Division of Interventional Radiology, St. Vincent's Hospital, Melbourne, Australia
| | - Edem Segbefia
- Research Division, Cook Research Incorporated, West Lafayette, IN
| | - Priya Bharadwaj
- Research Division, Cook Research Incorporated, West Lafayette, IN
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Mesnard T, Patterson BO, Azzaoui R, Pruvot L, Haulon S, Sobocinski J. Iliac branch device to treat type IB endoleak with a brachial access or an "up-and-over" transfemoral technique. J Vasc Surg 2022; 76:1537-1547.e2. [PMID: 35760243 DOI: 10.1016/j.jvs.2022.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/12/2022] [Accepted: 06/19/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE This study aimed to review the results of secondary IBD (iliac branch device) implantation in patients with type IB endoleak after prior fenestrated and/or branched or infrarenal endovascular aortic repair (F/B-EVAR or EVAR), using either brachial access or an "up-and-over" transfemoral technique. METHODS A retrospective single centre analysis was conducted between Jan 2016 and Oct 2021 including consecutive patients that underwent IBD to correct a type IB endoleak after prior EVAR or F/B-EVAR. Groups were defined by arterial access which was either brachial (group 1) or transfemoral (group 2). All IBD implanted were manufactured by Cook Medical (INC, Bloomington, IN, USA). Demographics, anatomical features, technical success, and 30-day major adverse events (MAE) were recorded according to the current SVS standards. Survival curves according to Kaplan-Meier were calculated. Branch instability was a composite endpoint of any IIA branch-related complication or reintervention indicated to treat endoleak, kink, disconnection, stenosis, occlusion or rupture. RESULTS Overall, 28 patients (93% male, median age 74 years) receiving 32 IBDs were included, with 14 patients in each group. Prior endovascular aortic repairs were 23 EVAR and 5 F/B-EVAR, with time from initial repair being 58 months [48, 70]. Median pre-IBD maximal aneurysm diameter was 63.5 mm [59.0, 78.0]. Patients' baseline characteristics were similar in both groups except for pulmonary status. All procedures were performed in a hybrid operative room. Median total operating time, fluoroscopy time and dose area product were 120 min [86, 167], 23 min [15, 32] and 54 Gy.cm2 [40, 62], respectively. Total operating time was shorter in group 2 (p=0.006). Technical success rate was 100% and no early death reported. One 30-day MAE occurred including a medically treated colonic ischemia (group 2). Aortic-related secondary interventions were required in 7 patients (5 in group 1 and 2 in group 2) including 3 surgical explantations. Median follow-up was 31 months [24, 42] and 6 months [3, 10] in group 1 and 2, respectively. In group 1, 2-year freedom from aortic-related secondary intervention and IIA branch instability were 84.6% [67.1-100] and 92.3% [78.9-100], respectively. In group 2, 6-month freedom from aortic-related secondary intervention and IIA branch instability were 87.5% [67.3-100] and 91.7% [77.3-100], respectively. CONCLUSION The secondary implantation of IBD to correct distal type I endoleak of previous aortic stent-graft is safe with a high technical success rate. The "up-and-over" technique could be considered as an alternative to the brachial access in patients with suitable anatomy.
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Affiliation(s)
- T Mesnard
- Service de chirurgie vasculaire, Centre de l'Aorte, CHU Lille, France; Univ. Lille, U1008 - Controlled Drug Delivery Systems and Biomaterials, F-59000 Lille, France
| | - B O Patterson
- Department of Vascular Surgery, University Hospital Southampton, United Kingdom
| | - R Azzaoui
- Service de chirurgie vasculaire, Centre de l'Aorte, CHU Lille, France
| | - L Pruvot
- Service de chirurgie vasculaire, Centre de l'Aorte, CHU Lille, France
| | - S Haulon
- Service de chirurgie vasculaire, Centre de l'Aorte, Hôpital Marie-Lannelongue, Le Plessis Robinson
| | - J Sobocinski
- Service de chirurgie vasculaire, Centre de l'Aorte, CHU Lille, France; Univ. Lille, U1008 - Controlled Drug Delivery Systems and Biomaterials, F-59000 Lille, France.
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Lame C, Mougin J, Postiglione TJ, Fabre D, Haulon S. Virtual Reality to Ease Endovascular Repair of Thoracoabdominal Aneurysms Under Local Anesthesia. J Endovasc Ther 2022; 30:312-315. [PMID: 35184605 DOI: 10.1177/15266028221079768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: Virtual reality (VR) has both a non-pharmacological analgesic and anxiolytic action that can be used as an alternative to general anesthesia for very high-risk patients. Case report: We present here the case of a patient treated for a complex endovascular thoracoabdominal aortic aneurysm exclusion using a 4-fenestrated aortic endograft using VR. The patient had no postoperative complications and was safely discharged from the hospital on postoperative day 6. Conclusion: This case demonstrates that the use of VR in addition to local anesthesia can be a safe alternative to general anesthesia
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Affiliation(s)
- Charles Lame
- Aortic Center, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris-Saclay, Le Plessis-Robinson, France
| | - Justine Mougin
- Aortic Center, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris-Saclay, Le Plessis-Robinson, France
| | | | - Dominique Fabre
- Aortic Center, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris-Saclay, Le Plessis-Robinson, France
| | - Stephan Haulon
- Aortic Center, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris-Saclay, Le Plessis-Robinson, France
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Sadeghipour P, Mohebbi B, Firouzi A, Khajali Z, Saedi S, Shafe O, Pouraliakbar HR, Alemzadeh-Ansari MJ, Shahdi S, Samiei N, Sadeghpour A, Babaei M, Ghadrdoost B, Afrooghe A, Rokni M, Dabbagh Ohadi MA, Hosseini Z, Abdi S, Maleki M, Bassiri HA, Haulon S, Moosavi J. Balloon-Expandable Cheatham-Platinum Stents Versus Self-Expandable Nitinol Stents in Coarctation of Aorta: A Randomized Controlled Trial. JACC Cardiovasc Interv 2022; 15:308-317. [PMID: 35144787 DOI: 10.1016/j.jcin.2021.11.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/17/2021] [Accepted: 11/23/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVES This study sought to compare the safety and efficacy of the balloon-expandable stent (BES) and the self-expandable stent (SES) in the endovascular treatment of coarctation of aorta. BACKGROUND Coarctoplasty with stents has conferred promising results. Although several nonrandomized studies have approved the safety and efficacy of the BES and the SES, no high-quality evidence exists for this comparison. METHODS In the present open-label, parallel-group, blinded endpoint randomized pilot clinical trial, adult patients with de novo native aortic coarctation were randomized into Cheatham-platinum BES and uncovered nitinol SES groups. The primary outcome of the study was a composite of procedural and vascular complications. The secondary outcomes of the study consisted of the incidence of aortic recoarctation, thoracic aortic aneurysm/pseudoaneurysm formation, and residual hypertension at a 12-month follow-up. RESULTS Among 105 patients who were screened between January 2017 and December 2019, 92 eligible patients (32 women [34.8%]) with a median age of 30 years (IQR: 20-36 years) were randomized equally into the BES and SES groups. The composite of procedural and vascular complications occurred in 10.9% of the BES group and 2.2% of the SES group (odds ratio: 0.18; 95% CI: 0.02-1.62; P = 0.20). Aortic recoarctation occurred in 5 patients (5.4%), 3 patients (6.5%) in the BES group and 2 patients (4.3%) in the SES group (odds ratio: 0.65; 95% CI: 0.10-4.09; P = 0.64). Only 1 patient (1.1%) was complicated by aortic pseudoaneurysm. Hypertension control was achieved in 50% of the study population, with an equal distribution in the 2 study groups at the 12-month follow-up. CONCLUSIONS Both the BES and the SES were safe and effective in the treatment of native coarctation.
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Affiliation(s)
- Parham Sadeghipour
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. https://twitter.com/psadeghipour
| | - Bahram Mohebbi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ata Firouzi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Khajali
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sedigheh Saedi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Omid Shafe
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Pouraliakbar
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Javad Alemzadeh-Ansari
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Shabnam Shahdi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Niloufar Samiei
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Anita Sadeghpour
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Behshid Ghadrdoost
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Arya Afrooghe
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrad Rokni
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Zahra Hosseini
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Seifollah Abdi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Majid Maleki
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran; Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein-Ali Bassiri
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Stephan Haulon
- Aortic Centre, Hopital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris-Saclay, Paris, France
| | - Jamal Moosavi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
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Lawaetz J, Soenens G, Eiberg J, Van Herzeele I, Weiss S, Konge L, Stavroulakis K, Nesbitt C, Dias N, Vila R, Gentile F, Nayahangan LJ, Debus S, Haulon S, Cieri E, Mansilha A, Ancetti S, Zlatanovic P. Identifying a Big Implementation Gap in Simulation Based Education in Vascular Surgery in Europe: The VASSIM Study. EJVES Vasc Forum 2022. [DOI: 10.1016/j.ejvsvf.2021.12.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Adam C, Fabre D, Mougin J, Zins M, Azarine A, Ardon R, d’Assignies G, Haulon S. Pre-surgical and Post-surgical Aortic Aneurysm Maximum Diameter Measurement: Full Automation by Artificial Intelligence. J Vasc Surg 2022. [DOI: 10.1016/j.jvs.2021.11.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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25
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Karelis A, Haulon S, Sonesson B, Adam D, Kölbel T, Oderich G, Cieri E, Mesnard T, Verhoeven E, Dias N, Marqués P, Tenorio E, Claridge M, Casali F, Tsilimparis N, Sobocinski J, Katsargyris A. Multicentre Outcomes of Redo Fenestrated/Branched Endovascular Aneurysm Repair to Rescue Failed Fenestrated Endografts. J Vasc Surg 2021. [DOI: 10.1016/j.jvs.2021.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Le Houérou T, Fabre D, Mougin J, Alonso CG, Brenot P, Bourkaib R, Angel C, Haulon S. Mid-Term Results of in situ Laser Fenestration of Visceral Arteries in Aortic Endovascular Surgery. Eur J Vasc Endovasc Surg 2021. [DOI: 10.1016/j.ejvs.2021.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Eilenberg W, Bechstein M, Charbonneau P, Rohlffs F, Eleshra A, Panuccio G, Bhangu JS, Fiehler J, Greenhalgh RM, Haulon S, Kölbel T. Cerebral microbleeds following thoracic endovascular aortic repair. Br J Surg 2021; 109:46-52. [PMID: 34694374 DOI: 10.1093/bjs/znab341] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/27/2021] [Accepted: 08/29/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Stroke and neurological injury are a complication of thoracic endovascular aortic repair (TEVAR). Cerebral microbleeds (CMBs) are common in patients with white matter damage to the brain secondary to chronic vasculopathy. The aim of this study was to examine the occurrence of CMBs after TEVAR, and to evaluate their association with patient and procedural factors. METHODS Patients who underwent TEVAR between September 2018 and January 2020 in two specialist European aortic centres were analysed. All patients underwent postoperative susceptibility-weighted MRI. The location and number of CMBs were identified, and analysed with regard to procedural aspects, clinical outcome, and Fazekas score as an indicator of pre-existing vascular leucoencephalopathy. RESULTS Some 91 patients were included in the study. A total of 1531 CMBs were detected in 58 of 91 patients (64 per cent). In the majority of affected patients, CMBs were found bilaterally (79 per cent). Unilateral CMBs in the right or left hemisphere occurred in 16 and 5 per cent of patients respectively (P < 0.001). More CMBs were found in the middle cerebral than in the vertebrobasilar/posterior and anterior cerebral artery territories (mean(s.d.) 3.35(5.56) versus 2.26(4.05) versus 0.97(2.87); P = 0.045). Multivariable analysis showed an increased probability of CMBs after placement of TEVAR stent-grafts with a proximal diameter of at least 40 mm (odds ratio (OR) 6.85, 95 per cent c.i. 1.65 to 41.59; P = 0.007) and in patients with a higher Fazekas score on postoperative T2-weighted MRI (OR 2.62, 1.06 to 7.92; P = 0.037). CONCLUSION CMBs on postoperative MRI are common after endovascular repair in the aortic arch. Their occurrence appears to be associated with key aspects of the procedure and pre-existing vascular leucoencephalopathy.
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Affiliation(s)
- Wolf Eilenberg
- German Aortic Centre, Department of Vascular Medicine, University Heart and Vascular Centre, University Hospital Hamburg-Eppendorf, Hamburg, Germany.,Department of General Surgery, Division of Vascular Surgery, Medical University of Vienna, Vienna, Austria
| | - Matthias Bechstein
- Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Philippe Charbonneau
- Centre de l'Aorte, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, Paris, France
| | - Fiona Rohlffs
- German Aortic Centre, Department of Vascular Medicine, University Heart and Vascular Centre, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Ahmed Eleshra
- German Aortic Centre, Department of Vascular Medicine, University Heart and Vascular Centre, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Giuseppe Panuccio
- German Aortic Centre, Department of Vascular Medicine, University Heart and Vascular Centre, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Jagdeep Singh Bhangu
- Department of General Surgery, Division of Vascular Surgery, Medical University of Vienna, Vienna, Austria
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | | | - Stephan Haulon
- Centre de l'Aorte, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, Paris, France
| | - Tilo Kölbel
- German Aortic Centre, Department of Vascular Medicine, University Heart and Vascular Centre, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Adam C, Fabre D, Mougin J, Zins M, Azarine A, Ardon R, d'Assignies G, Haulon S. Pre-surgical and Post-surgical Aortic Aneurysm Maximum Diameter Measurement: Full Automation by Artificial Intelligence. Eur J Vasc Endovasc Surg 2021; 62:869-877. [PMID: 34518071 DOI: 10.1016/j.ejvs.2021.07.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/04/2021] [Accepted: 07/11/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate an automatic, deep learning based method (Augmented Radiology for Vascular Aneurysm [ARVA]), to detect and assess maximum aortic diameter, providing cross sectional outer to outer aortic wall measurements. METHODS Accurate external aortic wall diameter measurement is performed along the entire aorta, from the ascending aorta to the iliac bifurcations, on both pre- and post-operative contrast enhanced computed tomography angiography (CTA) scans. A training database of 489 CTAs was used to train a pipeline of neural networks for automatic external aortic wall measurements. Another database of 62 CTAs, including controls, aneurysmal aortas, and aortic dissections scanned before and/or after endovascular or open repair, was used for validation. The measurements of maximum external aortic wall diameter made by ARVA were compared with those of seven clinicians on this validation dataset. RESULTS The median absolute difference with respect to expert's measurements ranged from 1 mm to 2 mm among all annotators, while ARVA reported a median absolute difference of 1.2 mm. CONCLUSION The performance of the automatic maximum aortic diameter method falls within the interannotator variability, making it a potentially reliable solution for assisting clinical practice.
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Affiliation(s)
| | - Dominique Fabre
- Aortic Centre, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, Paris, France
| | - Justine Mougin
- Aortic Centre, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, Paris, France
| | - Marc Zins
- Radiology Department, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Arshid Azarine
- Radiology Department, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | | | | | - Stephan Haulon
- Aortic Centre, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, Paris, France.
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Lombardi JV, Gleason T, Panneton JM, Starnes B, Dake MD, Haulon S, Mossop PJ, Segbefia E. Five-Year Results of STABLE II Study for Endovascular Treatment of Complicated, Acute Type B Aortic Dissection With a Composite Device Design. J Vasc Surg 2021. [DOI: 10.1016/j.jvs.2021.06.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chenesseau J, Mitilian D, Sharma G, Mussot S, Boulate D, Haulon S, Fabre D, Mercier O, Fadel E. Superior vena cava prosthetic replacement for non-small cell lung cancer: is it worthwhile? Eur J Cardiothorac Surg 2021; 60:1195-1200. [PMID: 34198335 DOI: 10.1093/ejcts/ezab248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 04/16/2021] [Accepted: 04/16/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Direct involvement of the superior vena cava (SVC) by non-small cell lung cancer (NSCLC) requires en-bloc tumour resection with complete vascular clamping and prosthetic replacement. We report the outcomes of this highly demanding procedure in the largest patient cohort to date. METHODS We searched our institution's database for patients who underwent complete en-bloc resection of NSCLC invading the SVC followed by prosthetic SVC replacement, between 1980 and 2018. Patients with cN2, cN3 or distant metastases were not eligible. RESULTS We identified 48 patients (38 males, 10 females; mean age of 57 years; tumour size, 1.9-17 cm). Neoadjuvant therapy was administered to 17 and adjuvant therapy to 31 patients. R0 resection was achieved in 41 (85%) patients; lymph node involvement was pN0 in 8, pN1 in 23, pN2 in 14 and pN3 in 3 patients. Five patients died within 30 days of surgery. Right pneumonectomy was significantly associated with postoperative death (P = 0.02). Postoperative complications developed in 13 other patients. No neurologic events related to SVC clamping occurred. Graft thrombosis developed in 2 patients. Median survival was 24 months; 3-, 5- and 10-year survival rates were 45%, 40% and 35%, respectively; and corresponding disease-free survival rates were 37%, 37% and 30%, respectively. By univariable analysis, only margin-free (R0) resection was associated with better survival (P = 0.02). CONCLUSIONS In highly selected patients with NSCLC involving the SVC, mortality is acceptable after complete en-bloc resection and prosthetic replacement done in an expert centre. SVC involvement should not preclude consideration of curative resection in selected patients.
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Affiliation(s)
- Josephine Chenesseau
- Department of Thoracic and Vascular Surgery, Marie Lannelongue Hospital and Paris Saclay University, Le Plessis-Robinson, France
| | - Delphine Mitilian
- Department of Thoracic and Vascular Surgery, Marie Lannelongue Hospital and Paris Saclay University, Le Plessis-Robinson, France
| | - Gaurav Sharma
- Department of Thoracic and Vascular Surgery, Marie Lannelongue Hospital and Paris Saclay University, Le Plessis-Robinson, France
| | - Sacha Mussot
- Department of Thoracic and Vascular Surgery, Marie Lannelongue Hospital and Paris Saclay University, Le Plessis-Robinson, France
| | - David Boulate
- Department of Thoracic and Vascular Surgery, Marie Lannelongue Hospital and Paris Saclay University, Le Plessis-Robinson, France
| | - Stephan Haulon
- Department of Thoracic and Vascular Surgery, Marie Lannelongue Hospital and Paris Saclay University, Le Plessis-Robinson, France
| | - Dominique Fabre
- Department of Thoracic and Vascular Surgery, Marie Lannelongue Hospital and Paris Saclay University, Le Plessis-Robinson, France
| | - Olaf Mercier
- Department of Thoracic and Vascular Surgery, Marie Lannelongue Hospital and Paris Saclay University, Le Plessis-Robinson, France
| | - Elie Fadel
- Department of Thoracic and Vascular Surgery, Marie Lannelongue Hospital and Paris Saclay University, Le Plessis-Robinson, France
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Mallios A, Haulon S. Endovascular repair of recurrent aortic coarctation with a custom made hourglass shaped stent graft. J Vasc Surg 2021; 73:1067-1068. [PMID: 33632494 DOI: 10.1016/j.jvs.2020.08.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 08/07/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Alexandros Mallios
- Department of Vascular Surgery, Groupe Hospitalier Paris Saint Joseph, Paris, France.
| | - Stephan Haulon
- Department of Vascular Surgery, Groupe Hospitalier Paris Saint Joseph, Paris, France
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Charbonneau P, Kölbel T, Rohlffs F, Eilenberg W, Planche O, Bechstein M, Ristl R, Greenhalgh R, Haulon S. Silent Brain Infarction After Endovascular Arch Procedures: Preliminary Results from the STEP Registry. J Vasc Surg 2021. [DOI: 10.1016/j.jvs.2021.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Mezzetto L, Scorsone L, Silingardi R, Gennai S, Piffaretti G, Mantovani A, Bush RL, Haulon S, Veraldi GF. Bridging Stents in Fenestrated and Branched Endovascular Aneurysm Repair: A Systematic REVIEW. Ann Vasc Surg 2021; 73:454-462. [PMID: 33359330 DOI: 10.1016/j.avsg.2020.10.052] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 10/28/2020] [Accepted: 10/30/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Concern exists about durability of stent grafts used to bridge aortic grafts to visceral and renal arteries during fenestrated and branched endovascular aneurysm repair (F/B-EVAR). There are no guidelines regarding the ideal technique for joining target vessels (TVs). METHODS We systematically reviewed data published from 2014 to 2019 using PRISMA guidelines and PICO models. Keywords were searched in MEDLINE, EMBASE, and Cochrane Library. All articles were screened by two authors (a third author in case of discrepancies). Only original articles regarding F/B-EVAR in complex aortic aneurysm, reporting the number and type of TVs mated, the onset of bridging stent complications, and reinterventions on TVs were included. Analysis included quality assessment scoring, types of stent grafts, and complications related to bridging stents. RESULTS 19 studies were included with 2,796 patients and 9556 TV; 4,797 renal arteries (50.2%), 4,174 visceral arteries (43.6%), and undefined TV (n = 585; 6.1%) were bridged. Balloon-expandable stent-grafts (B-EXP) were used in 40.9% and self-expandable (S-EXP) in 22.7% and undefined stents in 36.3%. The included studies had quality assessment scores ranging between 11/15 and 15/15, with high grade of accordance on reporting general results, but a low grade of accordance on reporting detailed data. Despite study heterogeneity, high-volume analysis confirmed a higher rate of complication in renal arteries than visceral arteries, 6% (95% CI 4-8) vs. 2% (95% CI 1-3), respectively. The rate of reinterventions was similar, 3% (95% CI 2-4) and 2% (95% CI 1-3). S-EXP versus B-EXP stent complication was 4% (95% CI 2-7) vs. 3% (95% CI 2-5), respectively. CONCLUSIONS This systematic review underlines the low grade of accordance in reporting detailed data of bridging stents in F/B-EVAR. Renal TVs were more prone to complications, with an equivalent reintervention rate to visceral TVs. As to B-EVAR, the choice of B-EXP over S-EXP is still uncertain.
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Affiliation(s)
- Luca Mezzetto
- Vascular Surgery, University Hospital of Verona, Italy.
| | | | - Roberto Silingardi
- Vascular Surgery, NOCSAE Nuovo Ospedale Civile di Baggiovara Sant'Agostino Estense, Baggiovara, Modena, Italy
| | - Stefano Gennai
- Vascular Surgery, NOCSAE Nuovo Ospedale Civile di Baggiovara Sant'Agostino Estense, Baggiovara, Modena, Italy
| | | | - Alessandro Mantovani
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University Hospital of Verona, Italy
| | - Ruth L Bush
- Vascular Surgery, University of Houston College of Medicine, Houston, TX, USA
| | - Stephan Haulon
- Aortic Center, Hôpital Marie Lannelongue, Université Paris Sud, France
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Doumenc B, Mesnard T, Patterson BO, Azzaoui R, De Préville A, Haulon S, Sobocinski J. Management of Type IA Endoleak After EVAR by Explantation or Custom Made Fenestrated Endovascular Aortic Aneurysm Repair. Eur J Vasc Endovasc Surg 2021; 61:571-578. [PMID: 33414067 DOI: 10.1016/j.ejvs.2020.10.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 06/08/2020] [Accepted: 10/26/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Proximal type 1 endoleak after endovascular abdominal aortic aneurysmal repair (EVAR) remains challenging to solve with no existing consensus. This work aims to compare two different surgical strategies to remedy type IA endoleak: endograft explantation (EXP) and aortic reconstruction or relining by custom made fenestrated EVAR (F-EVAR). METHODS A retrospective single centre analysis between 2009 and 2018 was conducted including patients treated for type IA endoleak after EVAR with either EXP or F-EVAR. The choice of surgical technique was based on morphological factors (F-EVAR eligibility), sac growth rate, emergency presentation and/or patient symptoms. Technical success, morbidity, secondary interventions, 30 day mortality, and long term survival according to Kaplan-Meier were determined for each group and compared. RESULTS Fifty-nine patients (91% male, mean age 79 years) underwent either EXP (n = 26) or F-EVAR (n = 33) during the study period. The two groups were equivalent in terms of comorbidity and age at the time of procedure. The median time from initial EVAR was 60.4 months (34-85 months), with no difference between groups. The maximum aneurysm diameter was greater in the EXP group compared with the F-EVAR group, 86 mm (65-100) and 70 mm (60-80), respectively (p = .008). Thirty day secondary intervention (EXP: 11.5% vs. F-EVAR: 9.1%) and mortality (EXP: 3.8% vs. F-EVAR: 3.3%) rates did not differ between groups, while major adverse events at 30 days, defined by the current SVS guidelines, were lower in the F-EVAR group (2.4% vs. 13.6%; p = .016). One year survival rates were similar between the groups (EXP: 84.0% vs. F-EVAR: 86.6%). CONCLUSION Open explantation and endovascular management with a fenestrated device for type IA endoleak after EVAR can be achieved in high volume centres with satisfactory results. F-EVAR is associated with decreased early morbidity. Open explantation is a relevant option because of acceptable outcomes and the limited applicability of F-EVAR.
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Affiliation(s)
- Benoit Doumenc
- Service de chirurgie vasculaire, Centre de l'Aorte, CHU, Lille, France
| | - Thomas Mesnard
- Service de chirurgie vasculaire, Centre de l'Aorte, CHU, Lille, France; University of Lille, U1008 - Controlled Drug Delivery Systems and Biomaterials, Lille, France
| | | | - Richard Azzaoui
- Service de chirurgie vasculaire, Centre de l'Aorte, CHU, Lille, France
| | | | - Stephan Haulon
- Service de chirurgie vasculaire, Centre de l'Aorte, Hôpital Marie-Lannelongue, Le Plessis Robinson, France
| | - Jonathan Sobocinski
- Service de chirurgie vasculaire, Centre de l'Aorte, CHU, Lille, France; University of Lille, U1008 - Controlled Drug Delivery Systems and Biomaterials, Lille, France.
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Charbonneau P, Kölbel T, Rohlffs F, Eilenberg W, Planche O, Bechstein M, Ristl R, Greenhalgh R, Haulon S. Silent Brain Infarction After Endovascular Arch Procedures: Preliminary Results from the STEP Registry. Eur J Vasc Endovasc Surg 2020; 61:239-245. [PMID: 33358103 DOI: 10.1016/j.ejvs.2020.11.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 10/28/2020] [Accepted: 11/12/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Few data exist concerning the rate of silent cerebral ischaemic events following endovascular treatment of the aortic arch. The objective of this work was to quantify these lesions using the STEP registry (NCT04489277). METHODS This multicentre retrospective cohort study included consecutive patients treated with an aortic endoprosthesis deployed in Ishimaru zone 0-3 and brain diffusion weighted magnetic resonance imaging (DW-MRI) within seven days following the procedure. DW-MRI was performed to identify the location and number of new silent brain infarctions (SBI). All endografts were carbon dioxide flushed prior to implantation. RESULTS The study population included 91 patients (mean age, 69 years; men, 64%) from two academic centres treated between September 2018 and January 2020. The procedure was elective in 71 patients (78%). The treatment was performed for a dissection, degenerative aneurysm, or other aortic disease in 44 (49%), 34 (37%), and 13 (14%) patients, respectively. Endografts were deployed in zone 0, 1, 2 or 3 in 23 (25%), 10 (11%), 47 (52%), and 11 (12%) patients, respectively. Endografts were branched (25%), fenestrated (17%), or tubular (58%). At 30 days, there were no deaths or clinical strokes. On cerebral DW-MRI, a total of 245 SBI were identified in 45 patients (50%). Lesions were in the left hemisphere in 63% of the patients (153/245), predominantly in the middle territory (94/245). Deployment in zone 0-1 (p = .026), placement of a branched or fenestrated endograft (p = .038), a proximal endoprosthesis diameter ≥ 40 mm (p = .038), and an urgent procedure (p = .005) were significantly associated with the presence of SBI on univariable analysis, while urgent procedure was found to be an independent predictor on multivariable analysis (binary logistic regression) (p = .002). CONCLUSION SBI following endovascular repair of the aortic arch is frequent, although there were no clinical strokes. Innovative strategies to reduce the risk of embolisation need to be developed.
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Affiliation(s)
- Philippe Charbonneau
- Aortic Centre, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, Paris, France
| | - Tilo Kölbel
- German Aortic Centre, Department of Vascular Medicine, University Heart and Vascular Centre, Hamburg, Germany
| | - Fiona Rohlffs
- German Aortic Centre, Department of Vascular Medicine, University Heart and Vascular Centre, Hamburg, Germany
| | - Wolf Eilenberg
- German Aortic Centre, Department of Vascular Medicine, University Heart and Vascular Centre, Hamburg, Germany
| | - Olivier Planche
- Radiology Department, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Matthias Bechstein
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Hamburg-Eppendorf, Germany
| | - Robin Ristl
- German Aortic Centre, Department of Vascular Medicine, University Heart and Vascular Centre, Hamburg, Germany
| | | | - Stephan Haulon
- Aortic Centre, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, Paris, France.
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Fabre D, Mougin J, Mitilian D, Cochennec F, Garcia Alonso C, Becquemin JP, Desgranges P, Allaire E, Hamdi S, Brenot P, Bourkaib R, Haulon S. Prospective, Randomised Two Centre Trial of Endovascular Repair of Abdominal Aortic Aneurysm With or Without Sac Embolisation. Eur J Vasc Endovasc Surg 2020; 61:201-209. [PMID: 33342658 DOI: 10.1016/j.ejvs.2020.11.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 10/28/2020] [Accepted: 11/16/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The benefit of aneurysm sac coil embolisation (ASCE) during endovascular aortic repair (EVAR) of abdominal aortic aneurysm (AAA) remains unclear. This prospective randomised two centre study (SCOPE 1: Sac COil embolisation for Prevention of Endoleak) compared the outcomes of standard EVAR in patients with AAA at high risk of type II endoleak (EL with EVAR with ASCE during the period 2014-2019. METHODS Patients at high risk of type II EL were randomised to standard EVAR (group A) or EVAR with coil ASCE (group B). The primary endpoint was the rate of all types of EL during follow up. Secondary endpoints included freedom from type II EL related re-interventions, and aneurysm sac diameter and volume variation at two year follow up. Adverse events included type II EL and re-interventions. CTA and Duplex ultrasound scans were scheduled at 30 days, six months, one year, and two years after surgery. RESULTS Ninety-four patients were enrolled, 47 in each group. There were no intra-operative complications. At M1, 16/47 early type II EL occurred (34%) in group A vs. 2/47 (4.3%) in group B (p < .001). At M6, 15/36 type II EL (41.7%) occurred in group A vs. 2/39 (4.26%) in group B (p < .001). At M12, 15/37 type II El (40.5%) occurred in group A vs. 5/35 (14.3%) in group B (p = .018). At 24 months, 8/32 type 2 El (25%) occurred in group A vs. 3/29 (6.5%) in group B (p = .19). Kaplan-Meier curves of survival free from EL and re-interventions were significantly in favour of group B (p < .001). Aneurysm sac volume decreased significantly in group B compared with group A at M6 (p = .081), at M12 (p = .004), and M24 (p = .001). CONCLUSION For selected patients at risk of EL, ASCE seems effective in preventing EL at one, six, and at 12 months. However, the difference was not statistically significant at 24 months. ASCE decreases the re-intervention rate two years after EVAR. A significantly faster aneurysm volume shrinkage was observed at one and two years following surgery. (SCOPE 1 trial: NCT01878240).
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Affiliation(s)
- Dominique Fabre
- Vascular Centre, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, France.
| | - Justine Mougin
- Vascular Centre, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, France
| | - Delphine Mitilian
- Vascular Centre, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, France
| | | | - Carlos Garcia Alonso
- Vascular Centre, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, France
| | | | | | - Eric Allaire
- Henri Mondor Hospital, University Paris XII, Creteil, France
| | - Sarah Hamdi
- Vascular Centre, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, France
| | - Philippe Brenot
- Vascular Centre, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, France
| | - Riyad Bourkaib
- Vascular Centre, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, France
| | - Stephan Haulon
- Vascular Centre, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, France
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Gallitto E, Sobocinski J, Mascoli C, Pini R, Fenelli C, Faggioli G, Haulon S, Gargiulo M. Fenestrated and Branched Thoraco-abdominal Endografting after Previous Open Abdominal Aortic Repair. Eur J Vasc Endovasc Surg 2020; 60:843-852. [DOI: 10.1016/j.ejvs.2020.07.071] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 07/03/2020] [Accepted: 07/22/2020] [Indexed: 12/13/2022]
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Konstantinou N, Kölbel T, Dias NV, Verhoeven E, Wanhainen A, Gargiulo M, Oikonomou K, Verzini F, Heidemann F, Sonesson B, Katsargyris A, Mani K, Prendes CF, Gallitto E, Pfister K, Ruffino MA, Tenorio ER, Speziale F, Haulon S, Oderich GS, Tsilimparis N. Revascularization of occluded renal artery stent grafts after complex endovascular aortic repair and its impact on renal function. J Vasc Surg 2020; 73:1566-1572. [PMID: 33091514 DOI: 10.1016/j.jvs.2020.09.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 09/30/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND Acute occlusion of renal bridging stent grafts after fenestrated/branched endovascular aortic repair (F/B-EVAR) is an acknowledged complication with high morbidity that often results in chronic dialysis dependence. The feasibility and effect of timely or late (≥6 hours of ischemia) renal artery revascularization has not been adequately reported. METHODS We performed a retrospective, multicenter study across 11 tertiary institutions of all consecutive patients who had undergone revascularization of renal artery stent graft occlusions after complex EVAR. The end points were technical success, association between ischemia time and renal function salvage, interventional complications, mortality, and mid-term outcomes. RESULTS From 2009 to 2019, 38 patients with 46 target vessels (TVs; eight bilateral occlusions) were treated for renal artery occlusions after complex EVAR (mean age, 63.5 ± 10 years; 63.2% male). Six patients had a solitary kidney (15.8%). Of the 38 patients, 16 (42.1%) had undergone FEVAR and 22 (57.9%) had undergone BEVAR. The technical success rate was 95.7% (44 of 46 TVs). The recanalization technique used was sole aspiration thrombectomy in 5.3%, aspiration thrombectomy and stent graft relining in 52.6%, and sole stent graft relining in 36.8%. The median renal ischemia time was 27.5 hours (range, 4-720 hours; interquartile range, 4-36 hours). Most patients (94.4%) had been treated after ≥6 hours of renal ischemia time, and 55.6% had been treated after 24 hours. In 14 patients (36.8%), renal function had improved after intervention (mean glomerular filtration rate improvement, 14.2 ± 9 mL/min/1.73 m2). However, 24 patients (63.2%) showed no improvement. Improvement of renal function did not correlate with the length of renal ischemia time. Of the 14 patients with bilateral renal artery occlusion or a solitary kidney, 9 experienced partial recovery of renal function and no longer required hemodialysis. In-hospital mortality was 2.6%. The cause of renal stent graft occlusion could not be identified in 50% of the TVs (23 of 46). However, in 19 (41.3%), significant stenosis or a kink of the renal stent graft was found. The median follow-up was 11 months (interquartile range, 0-28 months). The estimated 1-year patient survival and patency rate of the renal stent grafts was 97.4% and 83.8%, respectively. CONCLUSIONS Revascularization of occluded renal bridging stent grafts after F/B-EVAR is a safe and feasible technique and can lead to significant improvement of renal function, even after long ischemia times (>24 hours) of the renal parenchyma or bilateral occlusion, as long as residual perfusion of the renal parenchyma has been preserved. Also, the long-term patency rates justify aggressive management of renal artery occlusion after F/B-EVAR.
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Affiliation(s)
| | - Tilo Kölbel
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart and Vascular Center, Hamburg, Germany
| | - Nuno V Dias
- Vascular Center, Skåne University Hospital, Malmö, Sweden
| | - Eric Verhoeven
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University Nuremberg, General Hospital Nuremberg, Nuremberg, Germany
| | - Anders Wanhainen
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Mauro Gargiulo
- Section of Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University Hospital of Bologna, Bologna, Italy
| | - Kyriakos Oikonomou
- Department of Vascular Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Fabio Verzini
- Department of Surgical Sciences, Torino University Hospital, Turin, Italy
| | - Franziska Heidemann
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart and Vascular Center, Hamburg, Germany
| | - Bjorn Sonesson
- Vascular Center, Skåne University Hospital, Malmö, Sweden
| | - Athanasios Katsargyris
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University Nuremberg, General Hospital Nuremberg, Nuremberg, Germany
| | - Kevin Mani
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Carlota F Prendes
- Department of Vascular Surgery, University Hospital, LMU Munich, Munich, Germany; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Enrico Gallitto
- Section of Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University Hospital of Bologna, Bologna, Italy
| | - Karin Pfister
- Department of Vascular Surgery, University Hospital Regensburg, Regensburg, Germany
| | | | - Emanuel R Tenorio
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
| | | | | | - Gustavo S Oderich
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Nikolaos Tsilimparis
- Department of Vascular Surgery, University Hospital, LMU Munich, Munich, Germany
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Jan S, Raux M, Ghoroubi N, Haulon S, Fabre D, Goueffic Y, le Meur N. Re-hospitalization after the ambulatory endovascular treatment of the arteries of the lower extremities: Data of the SNDS (National System of Health Data) between 2013 and 2016. Ann Vasc Surg 2020. [DOI: 10.1016/j.avsg.2020.08.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wanhainen A, Haulon S, Kolh P. Centralisation of Abdominal Aortic Aneurysm Repair - We Can No Longer Ignore the Benefits! Eur J Vasc Endovasc Surg 2020; 60:500-501. [DOI: 10.1016/j.ejvs.2020.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/27/2020] [Accepted: 08/05/2020] [Indexed: 10/23/2022]
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Bonnet M, Hertault A, Tinelli G, Sica S, Lerisson E, Haulon S, Sobocinski J. Contribution of hybrid rooms on the results of fenestrated and branched stentgrafts. Ann Vasc Surg 2020. [DOI: 10.1016/j.avsg.2020.08.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Spanos K, Haulon S, Eleshra A, Rohlffs F, Tsilimparis N, Panuccio G, Kölbel T. Anatomical Suitability of the Aortic Arch Arteries for a 3-Inner-Branch Arch Endograft. J Endovasc Ther 2020; 28:14-19. [PMID: 32869719 DOI: 10.1177/1526602820953634] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To analyze aortic arch anatomy of patients who were already treated with a 2-inner-branch arch endograft (2-IBAE) in order to assess the anatomical suitability of the supra-aortic arteries as target vessels for a 3-IBAE. MATERIALS AND METHODS Three different configurations of the Cook Zenith Arch endograft were designed with distances of 110 mm (model 1), 90 mm (model 2), and 70 mm (model 3) between the orifices of the first and third inner branches. Preoperative measurements of the aortic arch anatomy from 104 consecutive patients treated electively with custom-made 2-IBAEs at 2 European centers between 2014 and 2019 were analyzed. A previously described standard methodology with a planning sheet was used. Data and measurements included the treatment indication for the aortic arch pathology, the type of landing zone, the type of arch, and the inner and outer lengths of the ascending aorta from the sinotubular junction to the innominate artery (IA). Additionally, the diameters and clock positions of the IA, left common carotid artery (LCCA), and left subclavian artery (LSA) were assessed, along with the distances between the IA and the LCCA, the IA and the LSA, and the distal landing zone. RESULTS Type I was the most common arch configuration (75/104, 72%). The mean clock positions were 12:30±00:28 for the IA, 12:00±00:23 for the LCCA, and 12:15±00:29 for the LSA. The mean diameters were 14.2±2.2 mm for the IA, 8.8±1.8 mm for the LCCA, and 10.5±2 mm for the LSA. The mean distances between the IA and LCCA and between the IA and LSA were 14.7±5.8 mm and 33±9.4 mm, respectively. Model 2 (branch distance 90 mm) had the highest suitability (79%), while models 1 and 3 showed suitability rates of 73% and 68%, respectively. The most frequent exclusion criterion in all models was the diameter of the LSA, followed by the IA to LSA distance. CONCLUSION The suitability for a 3-IBAE among patients who had a 2-IBAE implanted is high, favoring a 90-mm distance between the retrograde LSA branch and baseline.
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Affiliation(s)
- Konstantinos Spanos
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart & Vascular Center, Hamburg, Germany
| | - Stephan Haulon
- Aortic Centre, Groupe Hospitalier Paris Saint Joseph, Hôpital Marie Lannelongue, Université Paris Saclay, Le Plessis-Robinson, Paris, France
| | - Ahmed Eleshra
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart & Vascular Center, Hamburg, Germany
| | - Fiona Rohlffs
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart & Vascular Center, Hamburg, Germany
| | - Nikolaos Tsilimparis
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart & Vascular Center, Hamburg, Germany
| | - Giuseppe Panuccio
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart & Vascular Center, Hamburg, Germany
| | - Tilo Kölbel
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart & Vascular Center, Hamburg, Germany
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Multon S, Denier C, Charbonneau P, Sarov M, Boulate D, Mitilian D, Mougin J, Chassin O, Legris N, Fadel E, Haulon S, Fabre D. Carotid webs management in symptomatic patients. J Vasc Surg 2020; 73:1290-1297. [PMID: 32889072 DOI: 10.1016/j.jvs.2020.08.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 08/02/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Atypical fibromuscular dysplasia (AFMD), also known as carotid web, is a rare underdiagnosed shelf-like fibrous tissue arising from the posterior carotid artery bulb that is a cause of cryptogenic stroke of the anterior cerebral vascularization. Despite the recurrence and severity of strokes caused by embolization associated with AFMD, there are no recommendations on the best strategy to manage single and bilateral lesions, which have unsatisfactory outcomes when treated with medical treatment exclusively. METHODS From January 2016 to April 2019, 365 patients were operated on for a carotid stenosis in our institution. This cohort included 11 patients (3%), with a median age of 41 years (range, 39-51 years), referred by a stroke unit, treated for a symptomatic (10 strokes and 1 recurrent transient ischemic attack) AFMD lesion. Preoperative workup revealed a contralateral similar lesion in 45% of patients (5/11), which all also underwent surgery during a subsequent hospitalization. The diagnosis was confirmed by histologic examination when open surgery was performed. The 30-day and 1-year outcomes were retrospectively reviewed. RESULTS Of the 16 AFMD lesions operated, 13 were treated by open surgery (2 by classic endarterectomy and 11 by internal carotid resection-anastomosis) and 3 by carotid artery stenting, respectively, with a mean delay of 85.5 days and 20.5 days after the latest stroke. There was one complication after stenting (external iliac rupture) that was treated by a covered stent, and no perioperative complications after open surgery. The follow-ups at 30 days and 1 year were uneventful for all patients, without any deaths or stroke recurrences. CONCLUSIONS Symptomatic AFMD is a rare cause of cryptogenic stroke. Bilateral lesions are frequent. Early intervention is associated with favorable perioperative and 1-year outcomes. Open surgery is the first-line therapeutic option in this young patient population.
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Affiliation(s)
- Sébastien Multon
- Vascular Center, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, Paris, France
| | - Christian Denier
- Stroke Unit, Hôpital Bicêtre, Le Kremlin-Bicêtre, Université Paris Sud, Paris, France
| | - Phillippe Charbonneau
- Vascular Center, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, Paris, France
| | - Mariana Sarov
- Stroke Unit, Hôpital Bicêtre, Le Kremlin-Bicêtre, Université Paris Sud, Paris, France
| | - David Boulate
- Vascular Center, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, Paris, France
| | - Delphine Mitilian
- Vascular Center, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, Paris, France
| | - Justine Mougin
- Vascular Center, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, Paris, France
| | - Olivier Chassin
- Stroke Unit, Hôpital Bicêtre, Le Kremlin-Bicêtre, Université Paris Sud, Paris, France
| | - Nicolas Legris
- Stroke Unit, Hôpital Bicêtre, Le Kremlin-Bicêtre, Université Paris Sud, Paris, France
| | - Elie Fadel
- Vascular Center, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, Paris, France
| | - Stephan Haulon
- Vascular Center, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, Paris, France
| | - Dominique Fabre
- Vascular Center, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Université Paris Saclay, Paris, France.
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Rohlffs F, Haulon S, Kölbel T, Greenhalgh R. Stroke From Thoracic Endovascular Procedures (STEP) Collaboration. Eur J Vasc Endovasc Surg 2020; 60:5-6. [DOI: 10.1016/j.ejvs.2019.12.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 12/23/2019] [Indexed: 11/25/2022]
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Tenorio ER, Oderich GS, Kolbel T, Dias N, Farber M, Timaran C, Tsilimparis N, Haulon S. Multicenter Global Early Feasibility Study to Evaluate Total Endovascular Arch Repair Using Three-vessel Inner Branch Stent-grafts for Aneurysms and Dissections. J Vasc Surg 2020. [DOI: 10.1016/j.jvs.2020.04.312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Tsilimparis N, Haulon S, Spanos K, Rohlffs F, Heidemann F, Resch T, Dias N, Kölbel T. Combined fenestrated-branched endovascular repair of the aortic arch and the thoracoabdominal aorta. J Vasc Surg 2020; 71:1825-1833. [DOI: 10.1016/j.jvs.2019.08.261] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/16/2019] [Indexed: 11/17/2022]
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Loftus I, Haulon S, Boyle J. NICE Abdominal Aortic Aneurysm Guidelines Finally Published: How Will They Influence Aortic Practice in the UK and Beyond? Eur J Vasc Endovasc Surg 2020; 59:697-698. [DOI: 10.1016/j.ejvs.2020.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Witheford M, Chong DS, Martin-Gonzalez T, Van Calster K, Davis M, Prent A, Haulon S, Mastracci TM. Women undergoing endovascular thoracoabdominal aortic aneurysm repair differ significantly from their male counterparts preoperatively and postoperatively. J Vasc Surg 2020; 71:748-757. [DOI: 10.1016/j.jvs.2019.05.053] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 05/19/2019] [Indexed: 12/18/2022]
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Freycon-Tardy L, Verscheure D, Fadel E, Mussot S, Mercier O, Brenot P, Bourkaib R, Fabre D, Haulon S. Secondary Extra-anatomic Infrainguinal Bypass following Lower Limb Tumoral Resection. Ann Vasc Surg 2020; 66:609-613. [PMID: 31978484 DOI: 10.1016/j.avsg.2020.01.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/06/2020] [Accepted: 01/12/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Soft tissue malignancy of lower limb can involve femoral triangle by direct tumoral invasion or secondary to ganglionic metastasis. Secondary arterial complications can appear during follow-up after initial tumoral resection and local radiation therapy. The aim of this study is to report our experience of secondary extra-anatomical lower limb revascularization following lower limb oncological resection with femoral bifurcation involvement. METHODS This is a retrospective monocentric study including patients who underwent extra-anatomical iliopopliteal bypass, with a previous treated neoplasia involving homolateral femoral bifurcation. Proximal anastomosis was performed on the iliac artery, tunnelization was made through iliac wing, and distal anastomosis was done on distal superficial femoral or popliteal artery. RESULTS Five patients underwent extra-anatomic iliopopliteal bypass for oncological purpose from 2008 to 2018 at our institution. Mean age at surgery time was 52 years (standard deviation = 19.3). Prosthetic graft was used in all cases. Primitive tumor involved Scarpa triangle in 3 cases (soft tissue sarcomas) and ganglionic metastasis involved Scarpa triangle in 2 cases (epidermoid carcinoma). Clinical presentation was ischemic in 4 cases and hemorrhagic in 1 case. One patient died during hospitalization. Of the 4 survivors, 3 patients had a patent bypass at the end of follow-up (2 had bypass thrombectomy, 1 patient had major amputation). CONCLUSIONS Secondary iliopopliteal bypasses through the iliac wing following lower limb tumoral resection have acceptable results. It is a valid option for limb salvage especially after local radiation therapy and tumoral resection. Multidisciplinary management is necessary to obtain acceptable results and follow-up is mandatory.
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Affiliation(s)
- Léonore Freycon-Tardy
- Aortic Centre, Hôpital Marie Lannelongue, Université Paris Sud, Plessis-Robinson, France
| | - Dorian Verscheure
- Aortic Centre, Hôpital Marie Lannelongue, Université Paris Sud, Plessis-Robinson, France
| | - Elie Fadel
- Aortic Centre, Hôpital Marie Lannelongue, Université Paris Sud, Plessis-Robinson, France
| | - Sacha Mussot
- Aortic Centre, Hôpital Marie Lannelongue, Université Paris Sud, Plessis-Robinson, France
| | - Olaf Mercier
- Aortic Centre, Hôpital Marie Lannelongue, Université Paris Sud, Plessis-Robinson, France
| | - Philippe Brenot
- Aortic Centre, Hôpital Marie Lannelongue, Université Paris Sud, Plessis-Robinson, France
| | - Ryad Bourkaib
- Aortic Centre, Hôpital Marie Lannelongue, Université Paris Sud, Plessis-Robinson, France
| | - Dominique Fabre
- Aortic Centre, Hôpital Marie Lannelongue, Université Paris Sud, Plessis-Robinson, France.
| | - Stephan Haulon
- Aortic Centre, Hôpital Marie Lannelongue, Université Paris Sud, Plessis-Robinson, France
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Rhee R, Oderich G, Hertault A, Tenorio E, Shih M, Honari S, Jacob T, Haulon S. Multicenter experience in translumbar type II endoleak treatment in the hybrid room with needle trajectory planning and fusion guidance. J Vasc Surg 2019; 72:1043-1049. [PMID: 31882316 DOI: 10.1016/j.jvs.2019.10.076] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 10/14/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the efficacy of treating type II endoleaks (T2Ls) after aortic endovascular repair with image guidance translumbar puncture using intraoperative cone beam computed tomography with preprocedure computed tomography angiography fusion in hybrid operating rooms. METHODS Twenty-six consecutive T2L patients in three different institutions were treated between March 2015 and September 2017 by direct translumbar puncture of the abdominal aortic aneurysm (AAA) sac after previous endovascular aortic repair. All patients were treated at a single setting in a cardiovascular hybrid operating room with a workstation featuring needle trajectory planning and guidance software. Aneurysm sac size change from the index treatment, freedom from recurrent endoleak after treatment, demographics, risk factors, and procedure factors were analyzed with univariate analysis. RESULTS All patients (N = 26; 19 male, 7 female; age range, 59-95 years; mean body mass index, 27.44 ± 3.06 kg/m2) underwent treatment for AAA sac expansion or symptoms. Four patients had failed to respond to previous catheter-directed T2L treatment. The most common risk factors included hypertension, hypercholesterolemia, coronary artery disease, tobacco use, and diabetes. Time to initial endoleak diagnosis ranged from 2 to 1914 days (average, 404 days). Aneurysm size after initial repair was 60.3 ± 7.5 mm; sac size had increased 10.1 ± 6.5 mm at the time of treatment. Onyx (Medtronic, Irvine, Calif) or glue (n-butyl cyanoacrylate) and coil embolization was used in 20 cases, and 6 patients were treated with coiling alone. There was no difference between the patients treated with coils alone and those treated with coils or glue (P > .05) in terms of freedom from failure. Total procedure time was 75.9 ± 40.7 minutes; contrast material volume, 19.9 ± 29 mL; fluoroscopy time, 13.74 ± 12.2 minutes; and radiation dose, 121.16 ± 167.7 mGy. After embolization, the mean sac diameter decreased by 2.2 mm to 67.5 ± 9.8 mm. Average follow-up period was 214 days. In 19 patients, the sac reduced in size between 0.2 and 19.1 mm per 100 days; in 2 patients, there was continued AAA expansion (3.4-4.3 mm per 100 days); there was no change in the sac size in 5 patients after the procedure. There were no AAA ruptures during the study period. Once T2L was treated, the recurrence rate was low at 11.5%. CONCLUSIONS This initial multicenter evaluation of the effectiveness of fusion image-guided translumbar obliteration of T2L demonstrated that the technique was effective at all three study centers and showed excellent efficacy to reduce AAA sac size. This may become a more effective and efficient method of treating T2L compared with transarterial or transcaval embolization because of its high success rate and technical ease.
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Affiliation(s)
- Robert Rhee
- Division of Vascular and Endovascular Surgery, Maimonides Medical Center, Brooklyn, NY.
| | - Gustavo Oderich
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Adriene Hertault
- Department of Vascular Surgery, University Hospital of Lille, Lille, France
| | - Emmanuel Tenorio
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Michael Shih
- Division of Vascular and Endovascular Surgery, Maimonides Medical Center, Brooklyn, NY
| | - Sara Honari
- Division of Vascular and Endovascular Surgery, Maimonides Medical Center, Brooklyn, NY
| | - Theresa Jacob
- Division of Vascular and Endovascular Surgery, Maimonides Medical Center, Brooklyn, NY
| | - Stephan Haulon
- Aortic Center, Hôpital Marie Lannelongue, Université Paris Sud, Le Plessis-Robinson, France
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