Long-term results of endoluminal grafting for descending thoracic aortic aneurysms

Background Replacement of the descending thoracic aorta is traditionally performed via a left thoracotomy. Endovascular treatment of descending thoracic aortic aneurysms has recently evolved as an alternative treatment for selected patients, yet no long-term results are available. The authors replaced the descending thoracic aorta in a group of pigs with an interposition Dacron graft using a closed-chest, totally robotic technique. Methods Ten pigs, weighing 25 to 45 kg, underwent surgery using the DaVinci robotic surgical system. Under single-lung ventilation and CO2 insufflation, the descending thoracic aorta was completely mobilized. Proximal and distal cross-clamps were applied through separate accessory stab wounds. The mid-descending thoracic aorta was excised. An interposition Dacron graft was robotically sewn in an end-to-end fashion to the descending thoracic aorta using interrupted nitinol clips. Results All animals survived the procedure. Mean aortic clamp time was 55 ± 14 minutes. All anastomoses were completed without difficulty with a mean total anastomotic time of 42 ± 11 minutes. The anastomoses were challenged for bleeding by administrating α1-adrenergic receptor agonists to a systolic blood pressure of 200 mm Hg with no evidence of leak. Discussion Robotic replacement of the thoracic aorta is feasible and reproducible. This procedure provides the standard Dacron graft repair with its known long-term results. The added value of robotic technology to the therapeutic armamentarium in the treatment of thoracic aortic aneurysms may be worth the effort required for procedural development. Furthermore, it may serve as a valid alternative to endovascular treatment of thoracic aortic aneurysms.

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Long-Term Results of Endovascular Repair for Distal Arch and Descending Thoracic Aortic Aneurysms Treated by Custom-Made Endografts: Usefulness of Fenestrated Endografts

Annals of Vascular Diseases ◽

10.3400/avd.oa.14-00057 ◽

2014 ◽

Vol 7 (4) ◽

pp. 383-392 ◽

Cited By ~ 3

Author(s):

Masakazu Matsuyama ◽

Kunihide Nakamura ◽

Hiroyuki Nagahama ◽

Katsuhiko Nina ◽

Jouji Endou ◽

...

Keyword(s):

Endovascular Repair ◽

Aortic Aneurysms ◽

Long Term Results ◽

Thoracic Aortic Aneurysms ◽

Custom Made

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Open heart surgery and repair of complex abdominal aortic aneurysms – early and long-term results of a simultaneous approach

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-2007-967411 ◽

2007 ◽

Vol 55 (S 1) ◽

Author(s):

A Rastan ◽

M Luduena ◽

R Battelini ◽

T Walther ◽

J Kempfert ◽

...

Keyword(s):

Heart Surgery ◽

Open Heart Surgery ◽

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Long Term Results ◽

Open Heart ◽

Simultaneous Approach ◽

Abdominal Aortic

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The first commercial use of the Valiant Navion stent graft system for endovascular repair of a descending thoracic aortic aneurysm

Vascular ◽

10.1177/1708538120981127 ◽

2020 ◽

pp. 170853812098112

Author(s):

Cassra N Arbabi ◽

Navyash Gupta ◽

Ali Azizzadeh

Keyword(s):

Stent Graft ◽

Standard Of Care ◽

Aortic Aneurysms ◽

Descending Thoracic Aortic Aneurysm ◽

Thoracic Aortic Aneurysms ◽

Commercial Use ◽

Early Results ◽

Multiple Configuration ◽

One Year

Objectives Thoracic endovascular aortic repair (TEVAR) is the standard of care for descending thoracic aortic aneurysms (DTAA), and newer generation stent grafts have significant design improvements compared to earlier generation devices. Methods We report the first commercial use of the Medtronic Valiant Navion stent graft for treatment of an 85-year-old woman with a 5.8 cm DTAA and a highly tortuous thoracic aorta. Results A percutaneous TEVAR was performed using a two-piece combination of the Valiant Navion FreeFlo and CoveredSeal stent graft configurations for zones 2–5 coverage. The devices were successfully delievered through highly tortuous anatomy and deployed, excluding the entire length of the aneurysm with precise landing, excellent apposition and no evidence of endoleak. The patient tolerated the procedure well and has had no stent graft-related complications through one-year follow-up. Conclusions Design enhancements such as a lower profile delivery system, better conformability, and a shorter tapered tip are some of the improvements to this third-generation TEVAR device. Coupled with the multiple configuration options available, this gives physicians a better tool to treat thoracic aortic pathologies in patients with challenging anatomy. The early results are encouraging, and evaluation of long-term outcomes will continue.

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Gefäßchirurgie an der Jahrtausendwende

VASA ◽

10.1024/0301-1526.29.1.17 ◽

2000 ◽

Vol 29 (1) ◽

pp. 17-27 ◽

Cited By ~ 1

Author(s):

Polterauer ◽

Nanobachvili ◽

Fuegl ◽

Huk

Keyword(s):

Gene Therapy ◽

Vascular Surgery ◽

Intimal Hyperplasia ◽

Surgical Techniques ◽

Aortic Aneurysms ◽

Long Term Results ◽

Prosthetic Material ◽

Vascular Medicine ◽

The Future

Modern diagnostic modalities as well as ongoing improvement of vascular prosthetic material and surgical techniques have stimulated progress in vascular surgery. New discoveries concerning the mechanism of endothelial function, atherosclerosis, developments in gene therapy and endovascular techniques will expand the future therapeutic spectrum of vascular surgery. Endoluminal implantation of stent grafts for the treatment of aortic aneurysm may be a reasonable alternative to conventional surgery, especially in high-risk patients. Long-term results of this procedure, however, are not yet available. Stenting of internal carotid artery stenosis may be considered as an experimental method of treatment. Its feasibility, efficacy, safety and long-term results must be analyzed before the application of the method may be restricted or recommended. Endoluminal irradiation (brachytherapy) reduces intimal hyperplasia/restenosis and can improve the long-term results of percutaneous transluminal angioplasty. Anti-atherosclerotic and anti-aggregatory therapy (with statins, estrogens, antibiotics, nitric oxide precursor/donors, glycoprotein IIb/IIIa receptor inhibitors) will play an important role in the prevention of ischemic diseases and improve the results of surgical/interventional treatment by reducing intimal hyperplasia and restenosis. Gene therapy opens new vistas in vascular medicine. Angiogenetic factors can be used for the treatment of patients with distal occlusion of the peripheral arteries. Gene transfer may be useful in the conservative treatment of progressive aortic aneurysms. A more unified vision toward vascular medicine might be the key for research and development in the future.

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