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Obrand J, Jones M, Mirakhur A, Rommens K, Moore R. A hybrid approach to complex bilateral common iliac artery and internal iliac artery aneurysm repair. J Vasc Surg Cases Innov Tech 2024; 10:101410. [PMID: 38379612 PMCID: PMC10877432 DOI: 10.1016/j.jvscit.2023.101410] [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: 09/14/2023] [Accepted: 12/14/2023] [Indexed: 02/22/2024] Open
Abstract
A case of a young patient with incidental bilateral internal iliac artery aneurysms and common iliac artery aneurysms is described. A staged hybrid surgical approach was performed to preserve pelvic perfusion, with bilateral stent grafts deployed into an ipsilateral anterior division branch and contralateral posterior division branch of the internal iliac arteries. One week later, an open infrarenal aorto-bi-iliac graft was performed with distal anastomoses to the previously deployed stent grafts. The findings from the present case add to the growing number of reported cases of hybrid repair of bilateral internal iliac and common iliac artery aneurysms with preservation of pelvic perfusion.
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Affiliation(s)
- Jeremy Obrand
- Undergraduate Medical Education, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Melissa Jones
- Division of Vascular Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Anirudh Mirakhur
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kenton Rommens
- Division of Vascular Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Randy Moore
- Division of Vascular Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Frola E, Mortola L, Ferrero E, Ferri M, Apostolou D, Quaglino S, Maione M, Gaggiano A. Multicenter Comparison of Aortic Arch Aneurysms and Dissections Zone 0 Hybrid and Total Endovascular Repair. Cardiovasc Intervent Radiol 2023; 46:1674-1683. [PMID: 37978065 DOI: 10.1007/s00270-023-03607-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 10/26/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE Comparison of hybrid and total endovascular aortic arch repair at two tertiary vascular surgery centers. MATERIALS AND METHODS Consecutive patients undergoing hybrid (HG) or total endovascular (TEG) total aortic arch repair for aneurysms or dissections were included (2008-2022). Primary outcome measure was 30-day mortality. Secondary outcomes were major complications, technical success (defined as absence of surgical conversion/mortality, high-flow endoleaks or branch/limb occlusion), clinical success (defined as absence of disabling clinical sequelae), late and aortic-related mortality/reinterventions, freedom from endoleaks, aortic diameter growth > 5 mm, graft migration and supra-aortic trunks (SAT) patency. RESULTS In total, 30 patients were included, 17 in HG and 13 in TEG. TEG presented shorter intervention time (240.5 vs 341 min, p = 0.01), median ICU stay (1 vs 4.5 days, p < 0.01) and median length of stay (8 vs 17.5 days, p < 0.01). No intraoperative deaths occurred. Technical success was 100%; clinical success was 70.6% in HG and 100% in TEG (p = 0.05). Thirty-day mortality was 13.3%, exclusively in HG (p = 0.11). Nine major complications occurred in 8 patients, 5 in HG and 3 in TEG (p = 0.99), among which five strokes, two in HG and three in TEG (p = 0.62). Late mortality was 38.5%, six patients in HG and four in TEG, p = 0.6. Two late aortic-related deaths occurred in HG (p = 0.9). Two aortic-related reinterventions, no graft migration or SAT occlusion was observed. CONCLUSIONS Total endovascular repair seems to shorten operative times and provide higher clinical success compared with hybrid solutions, without significant 30-day mortality differences. The most common major complication is stroke.
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Affiliation(s)
- Edoardo Frola
- Vascular and Endovascular Surgery Unit, S. Croce e Carle Hospital, Via Coppino 26, 12100, Cuneo, Italy.
| | - Lorenzo Mortola
- Vascular and Endovascular Surgery Unit, S. Croce e Carle Hospital, Via Coppino 26, 12100, Cuneo, Italy
| | - Emanuele Ferrero
- Vascular and Endovascular Surgery Unit, Mauriziano Umberto I Hospital, Turin, Italy
| | - Michelangelo Ferri
- Vascular and Endovascular Surgery Unit, Mauriziano Umberto I Hospital, Turin, Italy
| | - Dimitrios Apostolou
- Vascular and Endovascular Surgery Unit, S. Croce e Carle Hospital, Via Coppino 26, 12100, Cuneo, Italy
| | - Simone Quaglino
- Vascular and Endovascular Surgery Unit, Mauriziano Umberto I Hospital, Turin, Italy
| | - Massimo Maione
- Vascular and Endovascular Surgery Unit, S. Croce e Carle Hospital, Via Coppino 26, 12100, Cuneo, Italy
| | - Andrea Gaggiano
- Vascular and Endovascular Surgery Unit, Mauriziano Umberto I Hospital, Turin, Italy
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Muramatsu K, Naganuma H, Kawada N, Amagaya S. Successful hybrid repair of a giant coronary artery aneurysm after previous coronary artery bypass grafting. J Cardiol Cases 2023; 28:28-31. [PMID: 37360833 PMCID: PMC10287993 DOI: 10.1016/j.jccase.2023.03.006] [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: 06/02/2022] [Revised: 02/19/2023] [Accepted: 03/01/2023] [Indexed: 06/28/2023] Open
Abstract
A 64-year-old woman had undergone coronary artery bypass grafting (CABG) for right coronary occlusion and the Dor procedure for a left ventricular apex aneurysm 10 years previously. A follow-up computed tomography scan showed the evolution of a giant coronary artery aneurysm (CAA) located on the proximal left circumflex artery (CX). It also revealed a previous saphenous vein graft (SVG) that was patent and located on the midline. Surgical exclusion was regarded as invasive, and isolated percutaneous intervention was unsuitable for a wide-necked CAA. Thus, a hybrid approach was planned. First, CABG (SVG-CX) via left thoracotomy was performed. Following the surgery, stent-assisted coil embolization was performed. A coronary angiogram revealed complete CAA exclusion. Learning objective Many authors have reported successful repair for coronary artery aneurysm (CAA) with a percutaneous approach or surgery. Although there is no consensus for giant CAA repair, surgical repair including resection, ligation, and coronary artery bypass grafting have been recommended in previous reports. However, every decision should be tailored to suit each condition. In this case with the history of previous cardiovascular surgery, our hybrid approach was thought to be less invasive and feasible than isolated surgical or percutaneous repair.
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Affiliation(s)
- Koichi Muramatsu
- Corresponding author at: 163-1, Kashiwa-shita, Kashiwa-city, Chiba 277-8567, Japan.
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Roselli EE, Kramer B, Germano E, Toth A, Vargo PR, Bakaeen F, Menon V, Blackstone EH. The modified frozen elephant trunk may outperform limited and extended-classic repair in acute type I dissection. Eur J Cardiothorac Surg 2023; 63:ezad122. [PMID: 37018150 PMCID: PMC10234761 DOI: 10.1093/ejcts/ezad122] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/16/2023] [Accepted: 04/04/2023] [Indexed: 04/06/2023] Open
Abstract
OBJECTIVES A better surgical approach for acute DeBakey type I dissection has been sought for decades. We compare operative trends, complications, reinterventions and survival after limited versus extended-classic versus modified frozen elephant trunk (mFET) repair for this condition. METHODS From 1 January 1978 to 1 January 2018, 879 patients underwent surgery for acute DeBakey type I dissection at Cleveland Clinic. Repairs were limited to the ascending aorta/hemiarch (701.79%) or extended through the arch [extended classic (88.10%) or mFET (90.10%)]. Weighted propensity score matched established comparable groups. RESULTS Among weighted propensity-matched patients, mFET repair had similar circulatory arrest times and postoperative complications to limited repair, except for postoperative renal failure, which was twice as high in the limited group [25% (n = 19) vs 12% (n = 9), P = 0.006]. Lower in-hospital mortality was observed following limited compared to extended-classic repair [9.1% (n = 7) vs 19% (n = 16), P = 0.03], but not after mFET repair [12% (n = 9) vs 9.5% (n = 8), P = 0.6]. Extended-classic repair had higher risk of early death than limited repair (P = 0.0005) with no difference between limited and mFET repair groups (P = 0.9); 7-year survival following mFET repair was 89% compared to 65% after limited repair. Most reinterventions following limited or extended-classic repair underwent open reintervention. All reinterventions following mFET repair were completed endovascularly. CONCLUSIONS Without increasing in-hospital mortality or complications, less renal failure and a trend towards improved intermediate survival, mFET may be superior to limited or extended-classic repair for acute DeBakey type I dissections. mFET repair facilitates endovascular reintervention, potentially reducing future invasive reoperations and warranting continued study.
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Affiliation(s)
- Eric E Roselli
- Aorta Center, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Thoracic and Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Benjamin Kramer
- Department of Thoracic and Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Emidio Germano
- Department of Thoracic and Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Andrew Toth
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Patrick R Vargo
- Aorta Center, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Thoracic and Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Faisal Bakaeen
- Aorta Center, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Thoracic and Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Venu Menon
- Aorta Center, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
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Wakasa S, Sato K, Ishigaki T, Watabe Y, Abe S. Chunnel debranching for hybrid repair of thoracoabdominal aortic aneurysm. Gan To Kagaku Ryoho 2022. [PMID: 35312908 DOI: 10.1007/s11748-022-01805-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/09/2022] [Indexed: 11/04/2022]
Abstract
Hybrid repair of a thoracoabdominal aortic aneurysm comprising thoracic endovascular aortic repair and total renovisceral debranching is a feasible alternative to open repair, especially for high-risk patients. However, transperitoneal debranching is a relatively complicated procedure that requires deep dissection around vital abdominal organs. Therefore, we developed a new debranching technique called Chunnel debranching, which was characterized by transaortic tunneling using a covered stent between the target artery and the prosthetic graft anastomosed on the aneurysmal wall using an inclusion technique. This procedure increases the feasibility of renovisceral debranching with fewer dissections than conventional transperitoneal debranching.
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Kishimoto Y, Yoshikawa Y, Morimoto K, Onohara T, Horie H, Kumagai K, Nii R, Nishimura M. Impact of frailty on early and mid-term outcomes of hybrid aortic arch repair. Surg Today 2022; 52:1194-1201. [PMID: 34984573 DOI: 10.1007/s00595-021-02443-x] [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: 05/12/2021] [Accepted: 11/22/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of this study was to investigate the impact of frailty on the clinical outcomes of hybrid aortic arch repair with debranching of the supra-aortic arteries. METHODS Consecutive patients ≥ 75 years old who underwent hybrid aortic arch repair from January 2010 to December 2019 were retrospectively analyzed. Using the Canadian Study of Health and Aging (CSHA) scale, all patients with a CSHA scale score > 4 were defined as frail. The frail patients (FP) group and the non-frail patients (NFP) group were compared regarding the early and mid-term outcomes of hybrid aortic arch repair. RESULTS A total of 84 patients were included. The early postoperative results were not markedly different between the groups, except that the rate of transfer to a rehabilitation hospital was higher in the FP group than in the NFP group. The survival at 5 years was significantly lower in the FP group at 43.0% than in the NFP group at 67.7% (P = 0.015). However, the freedom from aorta-related death was not significantly different between the two groups. CONCLUSION Frailty did not affect the short-term outcomes of hybrid aortic arch repair; however, the mid-term outcomes, including the survival, of the frail patients were significantly worse than those of the non-frail patients, mostly because of non-aorta-related causes.
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Affiliation(s)
- Yuichiro Kishimoto
- Division of Cardiovascular Surgery, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Yasushi Yoshikawa
- Division of Cardiovascular Surgery, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan.
| | - Kenichi Morimoto
- Division of Cardiovascular Surgery, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Takeshi Onohara
- Division of Cardiovascular Surgery, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Hiromu Horie
- Division of Cardiovascular Surgery, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Kunitaka Kumagai
- Division of Cardiovascular Surgery, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Rikuto Nii
- Division of Cardiovascular Surgery, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Motonobu Nishimura
- Division of Cardiovascular Surgery, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
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Li T, Zou L, Feng Y, Fan G, Xin Y. Hybrid repair of aberrant right subclavian artery with aortic dissection caused by Kommerell diverticulum. BMC Cardiovasc Disord 2021; 21:562. [PMID: 34809569 PMCID: PMC8607728 DOI: 10.1186/s12872-021-02340-8] [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: 06/21/2021] [Accepted: 10/22/2021] [Indexed: 11/22/2022] Open
Abstract
Background Aberrant right subclavian artery (ARSA) with associated Kommerell diverticulum (KD) is a rare congenital aortic disease. KD patients have a high risk of rupture, dissection, and compression of adjacent structures. Although several treatment options have been proposed (traditional surgery, hybrid operation, and endovascular intervention), a consensus regarding optimal surgical management has not yet been established. Case presentation A case of successful hybrid repair of distal aortic arch dissection aneurysm by dissecting KD and ARSA with debranching of right and left common carotid arteries, left subclavian artery, and stent grafting was presented. Conclusions The hybrid operation is suitable for elderly patients or those with high risks. Along with intervention, the hybrid operation needs to be developed as a minimally invasive method.
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Affiliation(s)
- Tieyan Li
- Department of Cardiovascular Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, People's Republic of China.,Shanghai Engineering Research Center of Artificial Heart and Heart Failure Medicine, Shanghai, 200120, People's Republic of China
| | - Lin Zou
- Department of Endocrinology, Shanghai Pudong New Area Gongli Hospital, Shanghai, 200135, People's Republic of China
| | - Yunzhen Feng
- Department of Cardiovascular Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, People's Republic of China
| | - Guoliang Fan
- Department of Cardiovascular Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, People's Republic of China
| | - Yuanfeng Xin
- Department of Cardiovascular Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, People's Republic of China.
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Sobhi M, Mohamed BH, Imtinène BM, Rim M, Taoufik K, Melek BM, Ihsène Z, Raouf D. [ Hybrid repair of aortic arch aneurysm]. Ann Cardiol Angeiol (Paris) 2021; 70:196-198. [PMID: 34517974 DOI: 10.1016/j.ancard.2021.07.001] [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: 01/02/2021] [Accepted: 07/01/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The management of aortic arch aneurysms is challenging. If conventional surgery cannot be performed in high risk patients, endovascular treatment is confronted to the problem of endoleaks at long term. However, the hybrid repair combining a first surgical step and a second endovascular step is a new technique recently introduced in the therapeutic alternatives of aortic arch aneurysm but its long-term results are not well known. METHODS We report a series of four patients who received hybrid treatment for aortic arch aneurysms in our department between 2016 and 2018. RESULTS These were 3 men and 1 woman with an average age of 63 years [55-80 years]. All were hypertensive and only one patient had diabetes. The aneurysm was symptomatic of chest pain in all cases and it was ruptured in only one case. Preoperatively, the hemodynamic state was stable in the four patients with a mean aneurysm diameter of 60 mm [48-79 mm] on CT angiography and the landing zone was zone 0 in all cases. Under general anesthesia, the 1st step was surgical with the performance of an aorto-bicarotid bypass associated with a re-implantation of the left subclavian artery and a disconnection of the supraortic trunks. The 2nd stage was endovascular by the femoral route; with release of an aortic stent graft covering the ostia of all supraortic trunks. The final angiographic check-up showed complete exclusion of the aneurysm in all cases. The immediate postoperative follow-up was straightforward except for the onset of septic shock and death in a patient with an aneurysm ruptured in the left pulmonary branch initially. The mean follow-up was 12 months with a CT scan control which confirms the complete exclusion of the aneurysm and the absence of endoleak.
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Affiliation(s)
- Mleyhi Sobhi
- University of Tunis El Manar, Faculty of Medicine of Tunis, La Rabta Hospital, Cardiovascular surgery Department, Tunis, Tunisia.
| | - Ben Hammamia Mohamed
- University of Tunis El Manar, Faculty of Medicine of Tunis, La Rabta Hospital, Cardiovascular surgery Department, Tunis, Tunisia
| | - Ben Mrad Imtinène
- University of Tunis El Manar, Faculty of Medicine of Tunis, HabibThameur Hospital, Cardiology Department, Tunis, Tunisia
| | - Miri Rim
- University of Tunis El Manar, Faculty of Medicine of Tunis, La Rabta Hospital, Cardiovascular surgery Department, Tunis, Tunisia
| | - Kalfat Taoufik
- University of Tunis El Manar, Faculty of Medicine of Tunis, La Rabta Hospital, Cardiovascular surgery Department, Tunis, Tunisia
| | - Ben Mrad Melek
- University of Tunis El Manar, Faculty of Medicine of Tunis, HabibThameur Hospital, Cardiology Department, Tunis, Tunisia
| | - Zairi Ihsène
- University of Tunis El Manar, Faculty of Medicine of Tunis, HabibThameur Hospital, Cardiology Department, Tunis, Tunisia
| | - Denguir Raouf
- University of Tunis El Manar, Faculty of Medicine of Tunis, La Rabta Hospital, Cardiovascular surgery Department, Tunis, Tunisia
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Naiem AA, Doonan RJ, Steinmetz OK. Hybrid Repair of a Thoraco-abdominal Aortic Aneurysm Associated with Loeys-Dietz Syndrome. EJVES Vasc Forum 2021; 51:23-6. [PMID: 34136878 DOI: 10.1016/j.ejvsvf.2021.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 04/18/2021] [Accepted: 04/27/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction Loeys-Dietz syndrome (LDS) is a genetic syndrome caused by mutations in transforming growth factor beta receptors (TGFBR) 1 and 2. It can manifest with craniofacial, musculoskeletal, cognitive abnormalities, and vascular pathologies including early onset aortic root aneurysms, extensive aortic dissections, and TAAA. Open repair is considered the gold standard treatment but carries morbidity risks, especially in patients with multiple previous aortic procedures. Endovascular treatment is associated with treatment failure when used in the native aorta, because of inherent wall weakness precluding seal. This case report adds to the available literature on hybrid treatment of LDS associated aortic pathologies. Report This is the report of staged hybrid TAAA treatment in a 24 year old male patient with multiple previous aortic procedures via sternotomy and thoracotomy. Retrograde infrarenal aortic visceral debranching was performed using 14 mm by 7 mm bifurcated Dacron grafts. These emerged from the limbs of an 18 mm by 9 mm bifurcated Dacron graft in an aortobi-iliac reconstruction. This was followed by staged thoracic endovascular aortic repair (TEVAR) seven days later using three endografts (26 mm–22 mm × 150 mm distal, 30 mm × 200 mm bridging, then 32 mm × 100 mm proximal). The endograft landed in an old thoracic aortic graft proximally and the new infrarenal aortic graft distally. Follow up at 11 months showed patency and no sac expansion. Conclusion Hybrid TAAA repair was a valid treatment option in this patient with LDS and multiple previous aortic procedures. It minimised the morbidity of revision surgery and mitigated potential treatment failure by achieving an endovascular seal in surgical grafts. Short term surveillance showed no complications. Limitations to making recommendations include lack of long term follow up. This is the report of the hybrid treatment of a thoraco-abdominal aortic aneurysm in a patient with Loeys-Dietz Syndrome and a hostile thoracic cavity. Repair involved open retrograde abdominal aortic visceral debranching followed by thoracic endovascular aortic repair landing in grafts proximally and distally. Follow up at 11 months showed no complications.
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Gaudry M, Porto A, Blanchard A, Chazot JV, Bal L, De Masi M, Bartoli A, Barral PA, Jacquier A, Gariboldi V, Collart F, Deplano V, Piquet P. A 10-Year Aortic Center Experience with Hybrid Repair of Chronic "Residual" Aortic Dissection After Type A Repair. Cardiovasc Drugs Ther 2021. [PMID: 33528720 DOI: 10.1007/s10557-021-07150-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Hybrid aortic arch repair in patients with chronic residual aortic dissection (RAD) is a less invasive alternative to conventional surgical treatment. The aim of this study was to describe the short-term and long-term results of hybrid treatment for RAD after type A repair. METHODS In this retrospective single-center cohort study, all patients treated for chronic RAD with hybrid aortic arch repair were included. Indications for treatment were rapid aortic growth, aortic diameter > 55 mm, or aortic rupture. RESULTS Between 2009 and 2020, we performed 29 hybrid treatments for chronic RAD. Twenty-four patients were treated for complete supra-aortic debranching in zones 0 and 5 with left subclavian artery debranching alone in zone 2. There was 1 perioperative death (3.4%): The patient was treated for an aortic rupture. There was no spinal cord ischemia and 1 minor stroke (3.4%). After a median follow-up of 25.4 months (range 3-97 months), the long-term mortality was 10.3% (3/29) with no late aortic-related deaths. Twenty-seven patients (93.1%) developed FL thrombosis of the descending thoracic aorta; the rate of aneurysmal progression on thoraco-abdominal aorta was 41.4% (12/29), and the rate of aortic reintervention was 34.5% (10/29). CONCLUSION In a high-volume aortic center, hybrid repair of RAD is associated with good anatomical results and a low risk of perioperative morbidity and mortality, including that of patients treated in zone 0. A redo replacement of the ascending aortic segment is sometimes necessary to provide a safer proximal landing zone and reduce the risk of type 1 endoleak after TEVAR.
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Wang J, Wang T, Zhao J, Ma Y, Huang B, Yang Y, Yuan D. Comparison of Clinical Outcomes Following One versus Two Stage Hybrid Repair of Thoraco-Abdominal Aortic Aneurysms: A Comprehensive Meta-Analysis. Eur J Vasc Endovasc Surg 2021; 61:396-406. [PMID: 33358102 DOI: 10.1016/j.ejvs.2020.11.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 10/29/2020] [Accepted: 11/18/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVE For thoraco-abdominal aortic aneurysms (TAAA), it is unclear whether it is better to perform hybrid repair in one (single) or two stages (staged). This study aimed to compare the clinical outcomes of single vs. staged hybrid repair of TAAA. METHODS The Medline, Embase, and Cochrane Databases (1 January 1994 to 11 May 2020) were searched for studies on hybrid repair of TAAA. Cohort studies and case series reporting outcomes of single and staged hybrid repair of TAAA were eligible for inclusion. The Newcastle-Ottawa scale and an 18 item tool were used to assess the risk of bias. The primary outcome was 30 day mortality, and the secondary outcomes included post-operative complications, overall survival, and other mid term events. A random effects model was used to calculate pooled estimates. RESULTS A total of 37 studies was included in the meta-analysis. The quality assessment of the included studies suggested low or moderate risk of bias. The pooled estimates for aneurysm rupture and death during stage interval were 2% (95% CI 0%-4%, I2 = 0%) and 4% (95% CI 2%-7%, I2 = 0%), respectively. Single repair was associated with a significantly higher 30 day risk of death when compared with patients who completed staged procedures successfully (OR 2.64, 95% CI 1.36-5.12, I2 = 0%). Staged repair also had lower incidence of major adverse cardiac events (MACE) (single: 10%, 95% CI 5%-16%; staged: 2%, 95% CI 0%-5%) and intestinal complications (single: 15%, 95% CI 8%-25%; staged: 3%, 95% CI 1%-6%). For mid term outcomes, single and staged repair had comparable 12 month overall survival, aneurysm related mortality, rate of re-intervention, and graft patency. CONCLUSION Two stage hybrid repair may represent a better choice for patients with controlled risk of aneurysm rupture, because it can provide lower 30 day mortality risks, MACE, and intestinal complications, as well as comparable mid term outcomes. Randomised controlled trials are needed to ascertain the effect of repair staging in patients for elective TAAA.
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Teratani H, Matsumura H, Sukehiro Y, Hayashida Y, Minematsu N, Wada H. Hybrid zone zero debranching thoracic endovascular aortic repair of ascending aortic injury after surgery and radiotherapy for breast cancer. J Vasc Surg Cases Innov Tech 2020; 7:93-96. [PMID: 33718674 PMCID: PMC7921190 DOI: 10.1016/j.jvscit.2020.12.007] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/15/2020] [Indexed: 11/06/2022]
Abstract
Thoracic endovascular aortic repair of the ascending aorta remains challenging. We have reported the case of an 81-year-old woman with ascending aortic injury who underwent a life-saving hybrid repair. The patient had previously undergone extended radical mastectomy and postoperative radiotherapy for breast cancer, which had resulted in a right thoracic wall defect and bone exposure and osteonecrosis of the sternum. Therefore, the ascending aorta was directly compressed by the sternum at the level of the brachiocephalic artery bifurcation, causing persistent bleeding from the thoracic wall. Hybrid zone 0 debranching thoracic endovascular aortic repair with a left subclavian artery inflow was emergently performed and achieved hemostasis.
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Affiliation(s)
- Hiromitsu Teratani
- Department of Cardiovascular Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Hitoshi Matsumura
- Department of Cardiovascular Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Yuta Sukehiro
- Division of Cardiovascular Surgery, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Yoshio Hayashida
- Department of Cardiovascular Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Noritoshi Minematsu
- Department of Cardiovascular Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Hideichi Wada
- Department of Cardiovascular Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
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Mutsuga M, Tokuda Y, Narita Y, Terazawa S, Ito H, Usui A. Is Hybrid Repair for an Entire Shaggy Aorta Feasible? Heart Lung Circ 2021; 30:765-72. [PMID: 33139174 DOI: 10.1016/j.hlc.2020.09.923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 09/13/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This paper reviewed clinical experiences to evaluate the feasibility of a surgical strategy for an entire shaggy aorta. METHODS Fifty-two (52) surgeries (47 men, average age 72±7 years) were performed for an entire shaggy aorta at the current institution from 2002-2017. Open surgery was performed in 30 cases, including total arch replacement in 12, extended aortic arch replacement via L-shaped thoracotomy in 10 and median sternotomy combined with left thoracotomy in two, and thoracoabdominal aortic replacement in six. Hybrid procedures were performed in 22 cases: type I hybrid arch repair in six, type II hybrid arch repair in seven and type III hybrid arch repair in nine. RESULTS Hospital mortality was significantly higher with a hybrid repair: surgical, one case (3%); hybrid, six cases (27%), (p=0.0125). Stroke occurred at relatively high rates in both groups: surgical, seven cases (23%); hybrid, six cases (27%) (p=0.75). Spinal cord injury was significantly higher in hybrid repair: surgical, one case (3%); hybrid, seven cases (32%), (p=0.004). Open surgery revealed a better long-term survival rate than the hybrid procedure at 5 and 10 years: surgical, 82%, 65.7%; hybrid, 53%, 35.1%, respectively (p=0.0452). The rate of freedom from aortic events was significantly better with open surgery than a hybrid procedure at 5 and 10 years: surgical, 96%, 85%; hybrid, 83%, 41.3%, respectively (p=0.0082). CONCLUSIONS Surgery for an entire shaggy aorta was frequently associated with embolic complications such as stroke, paraplegia, renal failure, and bowel necrosis. However, open surgical repair may produce better early and late outcomes and freedom from aortic events compared with hybrid repair.
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García-Domínguez LJ, Falcón M, Ribé L, Hernández A, Miralles M. Trans-popliteal hybrid retrograde technique for revascularization of chronic total occlusions of the superficial femoral artery. Vascular 2020; 29:582-588. [PMID: 33086943 DOI: 10.1177/1708538120966130] [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: 11/16/2022]
Abstract
OBJECTIVES We present the technical description and preliminary results of a hybrid approach for the treatment of chronic total occlusions of superficial femoral artery in the setting of critical limb-threatening ischemia (CLTI). METHODS A retrospective analysis of selected case series was performed. A trans-popliteal hybrid technique was carried out in seven limbs (six patients). Open exposure of above-the-knee popliteal artery was performed over its maximum calcification zone. After retrograde recanalization and graft-stenting of the entire superficial femoral artery, endarterectomy of the popliteal artery was performed for debulking and widening of the distal landing zone of the endoprosthesis. The latter is included in the bovine patch suture to avoid leaving a segment untreated. RESULTS Technical success, haemodynamic and clinical improvement were achieved in all procedures. Median length of treated occlusion was 19.8 cm. After a mean follow-up of 12 months (range 6-26 months), the primary patency was 85.7% (only one asymptomatic occlusion occurred). There were no major cardiovascular or limb adverse events. No re-interventions were required. CONCLUSION This less-invasive, one-incision technique is safe and effective for the restoration of in-line flow from groin to ankle, currently recommended in CLTI revascularization. It could be especially useful in highly calcified popliteal artery lesions, hostile groins or those at high risk of infection and in cases of vein absence for bypass surgery.
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Affiliation(s)
- Luis J García-Domínguez
- Department of Vascular Surgery, Hospital Universitario y Politécnico la Fe. Department of Surgery. University of Valencia. Valencia, Spain
| | - Moisés Falcón
- Department of Vascular Surgery, Hospital Universitario y Politécnico la Fe. Department of Surgery. University of Valencia. Valencia, Spain
| | - Lucas Ribé
- Department of Vascular Surgery, Hospital Universitario y Politécnico la Fe. Department of Surgery. University of Valencia. Valencia, Spain
| | - Ana Hernández
- Department of Vascular Surgery, Hospital Universitario y Politécnico la Fe. Department of Surgery. University of Valencia. Valencia, Spain
| | - Manuel Miralles
- Department of Vascular Surgery, Hospital Universitario y Politécnico la Fe. Department of Surgery. University of Valencia. Valencia, Spain
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Sousa J, Oliveira-Pinto J, Soares T, Lachat M, Teixeira J. Symptomatic Distal Anastomotic Pseudo-aneurysm After the Bentall Procedure Successfully Treated by Supra-aortic Trunk Debranching and Zone 0 Thoracic Endovascular Aneurysm Repair. EJVES Vasc Forum 2020; 47:90-6. [PMID: 33078160 DOI: 10.1016/j.ejvssr.2019.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 12/08/2019] [Accepted: 12/09/2019] [Indexed: 01/16/2023] Open
Abstract
Introduction Post-operative anastomotic pseudo-aneurysms are rare but potentially lethal complications after the Bentall procedure. When symptomatic or ruptured, expedited repair is warranted, and open surgery may carry significant bleeding risk, particularly when these lesions project anteriorly. As totally endovascular techniques are frequently limited owing to hostile anatomies, complex hybrid interventions are an alternative option in such scenarios. Report A 53 year old man with a previous Bentall procedure performed 10 years previously for DeBakey type 1 dissection was admitted with chest pain. Computed tomography angiography revealed a distal anastomotic pseudo-aneurysm. Percutaneous pseudo-aneurysm occlusion with a septal occluder plug was performed initially, with significant clinical improvement but without total sac thrombosis. The patient was discharged under strict surveillance, but six months later was re-admitted owing to hoarseness and new onset of chest pain. As the patient developed acute pain and compressive symptoms, urgent treatment was required. As the pseudo-aneurysm projected anteriorly into the posterior aspect of sternum, significantly bleeding risk was anticipated with redo sternotomy. A hybrid repair was then planned, with a full supra-aortic trunk debranching (carotid–carotid and left carotid–subclavian bypass) and zone 0 TEVAR with a single parallel graft to the brachiocephalic trunk. The patient was discharged 10 days later. Total aneurysm exclusion was achieved, with no complications reported after six months follow up. Discussion Hybrid procedures may represent a safe and feasible alternative to open surgery in symptomatic ascending aortic pseudo-aneurysms. However, long term follow up studies are required to confirm the durability of these procedures. Anastomotic aortic pseudo-aneurysms are potentially lethal complications. When projected anteriorly, open surgical repair may carry an unacceptable bleeding risk. Hybrid solutions may represent a safer option, when feasible. Long term results are unavailable, and strict surveillance is advised.
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Bell KT, McKinney MR, Salazar PA, Esper E. Hybrid repair of an adult with a double aortic arch, coarctation of the aorta, and left subclavian artery aneurysm. J Vasc Surg Cases Innov Tech 2019; 5:535-537. [PMID: 31799482 PMCID: PMC6883313 DOI: 10.1016/j.jvscit.2019.06.006] [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] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 06/13/2019] [Indexed: 11/05/2022]
Abstract
We report the repair of a double aortic arch, coarctation of the aorta, and left subclavian artery (LSCA) aneurysm using a hybrid procedure in a 47-year-old woman. The patient underwent repair through a median sternotomy incision to bypass the left common carotid artery and LSCA. An endovascular approach was used to repair the coarctation of the aorta and to occlude the right aortic arch. Repair of this anomaly was advised because of worsening clinical symptoms and potential for fatal rupture or dissection of the LSCA aneurysm. Hybrid repair simplified what would have required a multistage open repair.
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Affiliation(s)
- Kameron T Bell
- Indiana State University Rural Health Scholar B/MD Program, Terre Haute, Ind
| | - Maranda R McKinney
- Cardiothoracic and Vascular Surgery, Regional Hospital Healthcare Partners, Terre Haute, Ind
| | - Paul A Salazar
- Department of General Surgery, University of Colorado School of Medicine, Aurora, Colo
| | - Eduardo Esper
- Cardiothoracic and Vascular Surgery, Regional Hospital Healthcare Partners, Terre Haute, Ind
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17
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Castro-Ferreira R, Dias PG, Sampaio SM, Teixeira JF, Lachat M. Simplified hybrid repair with true lumen recycling for retrograde renovisceral perfusion in a complex chronic aortic dissection. J Vasc Surg Cases Innov Tech 2018; 4:226-230. [PMID: 30175296 PMCID: PMC6116411 DOI: 10.1016/j.jvscit.2018.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 01/15/2018] [Accepted: 03/16/2018] [Indexed: 01/16/2023] Open
Abstract
A 59-year-old man was referred with complicated chronic type B aortic dissection. Despite the false lumen's being dominant in terms of caliber and limb perfusion, visceral arteries originated in a 9-mm true lumen. A staged approach was performed: open aortobi-iliac bypass with preservation of both lumens to the infrarenal aorta, with reinforcement of the aorta and anastomosis with Dacron (wrap technique); exclusion of the dissection by endografting all of the false lumen with three successive thoracic endoprostheses; and maintenance of true lumen perfusion using two periscopes with self-expanding nitinol stents. The patient remains asymptomatic after 1 year of follow-up.
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Affiliation(s)
- Ricardo Castro-Ferreira
- Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar de São João, Porto, Portugal.,Departamento de Cirurgia e Fisiologia, Unidade de Investigação Cardiovascular, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Paulo Gonçalves Dias
- Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar de São João, Porto, Portugal
| | - Sérgio Moreira Sampaio
- Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar de São João, Porto, Portugal.,Centro de Investigação em Tecnologias e Serviços de Saúde, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - José Fernando Teixeira
- Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar de São João, Porto, Portugal
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Debus ES, Kölbel T, Duprée A, Daum G, Sandhu HK, Manzoni D, Wipper SH. Feasibility Study of a Novel Thoraco-abdominal Aortic Hybrid Device (SPIDER-graft) in a Translational Pig Model. Eur J Vasc Endovasc Surg 2017; 55:196-205. [PMID: 29290476 DOI: 10.1016/j.ejvs.2017.11.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 04/26/2017] [Accepted: 11/15/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND The hybrid SPIDER-graft consists of a proximal descending aortic stent graft and a conventional six branched Dacron graft for open abdominal aortic repair. Technical feasibility with regard to avoiding thoracotomy and extracorporeal circulation (ECC) during thoraco-abdominal aortic hybrid repair and peri-procedural safety of this novel device are unknown. MATERIAL AND METHODS This was a feasibility and safety study in domestic pigs (75-85 kg). The abdominal aorta including iliac bifurcation, left renal artery, and visceral arteries were exposed via retroperitoneal access. The right iliac branch was first temporarily anastomosed end to side to the distal aorta via partial clamping. During inflow reduction and infra-coeliac cross-clamping, the coeliac trunk (CT) was divided and the proximal stent graft portion of the SPIDER-graft was deployed into the descending aorta via the CT ostium. Retrograde visceral and antegrade aorto-iliac blood flow was maintained via the iliac side branch. The visceral, renal, and iliac arteries were sequentially anastomosed, finally replacing the first iliac end to side anastomosis. Technical success, blood flow, periods of ischaemia, and peri-procedural complications were evaluated after intra-operative completion angiography and post-operative computed tomography angiography. RESULTS Six animals underwent successful thoracic stent graft deployment and distal open reconstruction without peri-operative death. The median thoracic graft implantation time was 4.5 min, and the median ischaemia times before reperfusion were 10 min for the CT, 8 min for the superior mesenteric artery, 13 min for the right renal artery, and 22 min for the left renal artery. Angiography demonstrated appropriate graft implantation and blood flow measurements confirmed sufficient blood flow through all side branches. CONCLUSION In this translational pig model, thoraco-abdominal hybrid repair using the novel SPIDER-graft was successful in avoiding thoracotomy and ECC. Technical feasibility and safety appear promising, but need to be reassessed in humans.
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Affiliation(s)
- Eike S Debus
- Department for Vascular Medicine, University Heart Centre, University Hospital Eppendorf, Hamburg, Germany.
| | - Tilo Kölbel
- Department for Vascular Medicine, University Heart Centre, University Hospital Eppendorf, Hamburg, Germany
| | - Anna Duprée
- Department of General and Visceral Surgery, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Günter Daum
- Department for Vascular Medicine, University Heart Centre, University Hospital Eppendorf, Hamburg, Germany
| | - Harleen K Sandhu
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Daniel Manzoni
- Department for Vascular Medicine, University Heart Centre, University Hospital Eppendorf, Hamburg, Germany
| | - Sabine H Wipper
- Department for Vascular Medicine, University Heart Centre, University Hospital Eppendorf, Hamburg, Germany
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Hinojosa CA, Anaya-Ayala JE, Laparra-Escareno H, Lizola R, Torres-Machorro A. Sequential Hybrid Repair of Aorta and Bilateral Common Iliac Arteries Secondary to Chronic Aortic Dissection with Extensive Aneurysmal Degeneration in a Marfan Patient. Vasc Specialist Int 2017; 33:112-116. [PMID: 28955701 PMCID: PMC5614380 DOI: 10.5758/vsi.2017.33.3.112] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 06/09/2017] [Accepted: 06/19/2017] [Indexed: 11/20/2022] Open
Abstract
Marfan syndrome is a connective tissue disorder associated with aortic dissection, aneurysmal degeneration and rupture. These cardiovascular complications represent the main cause of mortality, therefore repair is indicated. We present a 35-year-old woman who experienced acute onset of chest pain. Her imaging revealed a chronic DeBakey type I dissection with aortic root dilation and descending thoracic aneurysmal degeneration. She underwent a Bentall procedure and endovascular exclusion of the descending thoracic aortic aneurysm. She was closely followed and 2 years later a computed tomography angiography (CTA) revealed the aneurysmal degeneration of the thoracoabominal aorta and bilateral iliac arteries. The patient underwent a composite reconstruction using multi-visceral branched and bifurcated Dacron grafts. At 5 years from her last surgery, a CTA revealed no new dissection or further aneurysmal degenerations. Aortic disease in Marfan patients is a complex clinical problem that may lead to secondary or tertiary aortic reconstructions; close follow-up is mandatory.
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Affiliation(s)
- Carlos A Hinojosa
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Javier E Anaya-Ayala
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Hugo Laparra-Escareno
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Rene Lizola
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Adriana Torres-Machorro
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Abstract
Thoracic aortic aneurysms are associated with significant morbidity and mortality. There are multiple underlying etiologies, including genetic abnormalities, that have important implications in their natural history. The variable histologic, anatomic, and clinical presentations necessitate careful consideration of available treatment options. Surgical repair of these aneurysms has been the mainstay of treatment; however, these approaches can carry a relatively high risk of morbidity and mortality. Endovascular approaches have now become first-line therapy for descending thoracic aneurysms, and with advancements in graft technology, endovascular approaches are being increasingly employed for hybrid repairs of the aortic arch and even the ascending aorta. However, to date, clinical outcomes from randomized trials and long-term follow-up are limited. As technology continues to advance, there is the potential for further integration of surgical and endovascular treatments so that patients have the best opportunity for a favorable outcome.
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Affiliation(s)
- Ryan Clare
- Kaiser Permanente, Los Angeles Medical Center, 4867 Sunset Blvd., 3rd Floor, Cardiac Cath Lab, Rm. 3755, Los Angeles, CA, 90027, USA
| | - Julianne Jorgensen
- Kaiser Permanente, Los Angeles Medical Center, 4867 Sunset Blvd., 3rd Floor, Cardiac Cath Lab, Rm. 3755, Los Angeles, CA, 90027, USA
| | - Somjot S Brar
- Kaiser Permanente, Los Angeles Medical Center, 4867 Sunset Blvd., 3rd Floor, Cardiac Cath Lab, Rm. 3755, Los Angeles, CA, 90027, USA. .,Kaiser Permanente Research, Department of Research and Evaluations, Pasadena, CA, USA. .,UCLA School of Medicine, Los Angeles, CA, USA.
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21
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Seike Y, Nishibe T, Ogino H, Koizumi N. Hybrid repair of rare type IIIb endoleaks from an abdominal endograft: repeatedly undetected endoleaks. Interact Cardiovasc Thorac Surg 2015; 21:129-31. [PMID: 25851231 DOI: 10.1093/icvts/ivv069] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 03/04/2015] [Indexed: 11/14/2022] Open
Abstract
We report a rare case of massive type IIIb endoleaks from an abdominal endograft, which were difficult to diagnose and required hybrid repair (including open surgery). The patient had previously undergone three catheter interventions for type Ia and II endoleaks after abdominal endografting. However, the abdominal aortic aneurysm gradually enlarged and required hybrid treatment (including an open repair), to successfully perform aneurysmorrhaphy and additional endograft insertions for the massive type IIIb endoleaks.
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Affiliation(s)
- Yoshimasa Seike
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
| | - Nobusato Koizumi
- Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan
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Tanaka K, Yoshitaka H, Chikazawa G, Sakaguchi T, Totsugawa T, Tamura K. Hybrid repair of right aortic arch aneurysm with a Kommerell's diverticulum. Asian Cardiovasc Thorac Ann 2014; 22:725-7. [PMID: 24887812 DOI: 10.1177/0218492313481465] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We describe the case of a 74-year-old man who underwent a hybrid open and endovascular approach for repair of dissecting thoracic aortic aneurysm of a right aortic arch with aberrant left subclavian artery arising from a Kommerell's diverticulum. Total debranching using a tailored quadrifurcated graft and thoracic endovascular aneurysm repair for the transverse aortic lesion were performed. The procedures were successfully accomplished with complete exclusion of the aneurysm. This hybrid procedure for complex aortic arch disease may reduce perioperative complications compared to challenging conventional open approaches.
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Affiliation(s)
- Koyu Tanaka
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Hidenori Yoshitaka
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Genta Chikazawa
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Taichi Sakaguchi
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Toshinori Totsugawa
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Kentaro Tamura
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, Okayama, Japan
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23
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Esposito G, Pennesi M, Bichi S, Patrini D, Pellegrino P, Redaelli M, Poloni C, Gerometta P, Gentinetta F, Cappabianca G. Hybrid multistep approach to mega-aortic syndrome: the Lupiae technique. Eur J Cardiothorac Surg 2014; 47:126-33; discussion 133. [PMID: 24674908 DOI: 10.1093/ejcts/ezu102] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES Several techniques have been described for the treatment of thoraco-abdominal aneurysms in patients with mega-aortic syndrome (MAS), but the incidence of stroke, spinal cord injury and endoleaks remains significant. We present the mid-term results of a new hybrid, multistep technique to treat patients with MAS. METHODS From November 2005 to November 2012, 118 patients with MAS underwent surgical repair of thoracic and thoraco-abdominal aneurysms with the Lupiae technique. Fifty-five patients presented chronic aneurysms and 63 patients Type A acute dissections. Eighty-three patients underwent ascending aorta and arch replacement with a multibranched Dacron graft and epiaortic vessels rerouting (thoracic Lupiae procedure). Twenty patients had the thoracic Lupiae procedure plus partial visceral debranching (coeliac trunk and superior mesenteric artery [SMA]) through an upper mini-laparotomy. Fifteen patients had the thoracic Lupiae procedure plus a complete visceral debranching (coeliac trunk, SMA and renal arteries) using a second multibranched Dacron graft to replace the infrarenal aorta. All the patients with chronic aneurysms and 34 of 63 patients with Type A dissections underwent implant of endovascular stent grafts. RESULTS In-hospital mortality was 8.4%. No patients had stroke or spinal cord injury. The incidence of temporary renal failure was 5.2%. No patients presented endoleaks immediately and at follow-up CT scans. No death or reoperation occurred during the follow-up. CONCLUSIONS These results evidence that the Lupiae technique is a safe and effective option for the treatment of patients with MAS, achieving the complete exclusion of thoraco-abdominal aneurysms and of the residual false lumen in patients with acute aortic dissections.
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Affiliation(s)
| | - Matteo Pennesi
- Cardiovascular Department, Humanitas Gavazzeni, Bergamo, Italy
| | - Samuele Bichi
- Cardiovascular Department, Humanitas Gavazzeni, Bergamo, Italy
| | - Davide Patrini
- Cardiovascular Department, Humanitas Gavazzeni, Bergamo, Italy
| | | | | | - Camillo Poloni
- Cardiovascular Department, Humanitas Gavazzeni, Bergamo, Italy
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Shimizu H, Nakahara T, Ohkuma K, Kawaguchi S, Yoshitake A, Yozu R. Cerebral blood flow after hybrid distal hemiarch repair. Interact Cardiovasc Thorac Surg 2013; 17:73-8. [PMID: 23513003 DOI: 10.1093/icvts/ivt100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 11/14/2022] Open
Abstract
OBJECTIVES Aortic arch disease can be treated with hybrid repair (extra-anatomic bypass plus placement of aortic endoprostheses), but there is controversy about whether a bypass from one relatively small vessel will provide adequate blood flow to the entire brachiocephalic system. We, therefore, compared flow volumes before and after hybrid repair. METHODS We reviewed the records of 16 patients who underwent a hybrid distal hemiarch repair between October 2010 and May 2012. The procedure consisted of debranching of the left subclavian and left common carotid arteries, creation of a bypass to these vessels from the right subclavian artery by using a T-shaped synthetic graft, and placement of a stent graft. Preoperative and postoperative measurements of blood flow volume in the carotid and vertebral arteries and of regional cerebral blood flow were performed in ~70% of the patients. RESULTS Perioperative complications were one new-onset, fatal acute aortic dissection and two minor strokes. No major endoleaks occurred. Postoperatively, mean flow volumes in the right and left common carotid arteries, right and left internal carotid arteries, and right and left vertebral arteries were 423 and 393, 271 and 189, and 87 and 80 ml/min, respectively. Regional cerebral blood flow in the territories of the anterior, middle and posterior cerebral arteries was not significantly different from preoperative levels, as assessed both with and without administration of acetazolamide. CONCLUSIONS Hybrid distal hemiarch repair preserved regional cerebral blood flow and vasoreactivity, although flow in the common and internal carotid arteries was right-side dominant postoperatively.
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Affiliation(s)
- Hideyuki Shimizu
- Department of Cardiovascular Surgery, Keio University, Shinjuku-ku, Tokyo, Japan.
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