Stroke Rate After Thoracic Endovascular Aortic Repair May Not Be Equal Among Various Aortic Pathologies

Abstract OBJECTIVES Our goal was to evaluate the outcomes of fenestrated thoracic endovascular aortic repair of thoracic aortic lesions involving the distal aortic arch using single physician-modified stent grafts. METHODS This single-centre, retrospective study included 58 consecutive patients (mean age, 57 ± 14 years; 11 women) who underwent fenestrated thoracic endovascular aortic repair for thoracic aortic pathologies involving the distal aortic arch using single physician-modified stent grafts between November 2015 and December 2018. Indications included complicated acute type B dissection or intramural haematoma with an unfavourable proximal landing zone (n = 49), type Ia endoleak subsequent to thoracic endovascular aortic repair due to acute type B dissection (n = 1) and distal arch degenerative aneurysms <15 mm from the left subclavian artery (n = 8). RESULTS The technical success rate was 94.8%. The 30-day mortality was 1.7%, and the perioperative ischaemic stroke rate was 1.7%. The incidence of perioperative complications was 10.3%. At a mean follow-up of 26.3 months (range, 7–44), all target vessels were patent. All-cause mortality was 5.2%. Estimated 1-, 2- and 3-year survival was 98.3 ± 1.7%, 96.4 ± 2.5% and 93.2 ± 3.9%, respectively. CONCLUSION The single fenestrated stent graft technique is feasible and effective for endovascular repair of thoracic aortic pathologies involving the distal aortic arch.

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Valiant NAVION Stent Graft System Application: First Asian Case Series Analysis

10.22541/au.160700484.46121257/v1 ◽

2020 ◽

Author(s):

Chi Ying Simon Chow ◽

Yan Kit Ho ◽

Takuya Fujikawa ◽

Kevin Lim ◽

Cheuk Man Chu ◽

...

Keyword(s):

Hospital Stay ◽

Stent Graft ◽

Case Series ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Technical Success ◽

Term Survival ◽

Aortic Repair ◽

The Mean ◽

Aortic Pathologies

Background and aim of the study The Valiant NavionTM stent graft system is a third-generation low profile thoracic endograft designed for thoracic endovascular aortic repair. In this population analysis, we report on the first Asian all-comers experience and outcomes who underwent thoracic endovascular aortic repair with the use of this new stent graft system. Methods Between May 2019 and October 2020, 21 patients with different aortic pathologies were prospectively recruited and retrospectively analyzed. Important clinical and device-related outcomes were evaluated. The endpoints included short-term survival, technical success, access failures, major vascular and clinical complications, endoleaks, and hospital stay. Results The commonest indication of stenting was penetrating aortic ulcers (28.6%) and 6 (28.6%) patients had emergency stenting performed for aortic transection or rupture. 30 days of survival post-procedure was recorded and complete. There were no major vascular complications. Deployment accuracy was 100%, and the technical success rate was 94.7% (18/19) with 1 patient having a type 2 endoleak on follow-up imaging. No neurological complications were noted. The mean operative time was 95 +/- 73.6 mins and the mean fluoroscopy time was 16.2 +/- 10.8 mins. Mean hospital stay for elective zone 2, 3 and 4 stenting was 5.3 +/- 3.8 days, and only 1 patient post zone 1 TEVAR required a brief (0.5 days) ICU stay. All procedures were performed via the percutaneous transfemoral route with 100% success in percutaneous closure. Conclusion This first reported Asian case series demonstrated versatility, safety, and efficacy of the Valiant NavionTM stent in Asian patients with different aortic pathologies

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Thoracic Endovascular Aortic Repair for Penetrating Aortic Ulcer in a Patient with Renal Failure: A Case Report

Cardiovascular Journal ◽

10.3329/cardio.v14i1.55382 ◽

2021 ◽

Vol 14 (1) ◽

pp. 88-92

Author(s):

Abul Hasan Muhammad Bashar ◽

Humayun Kabir ◽

Mokhlesur Rahman ◽

Md Ahsanul Alam

Keyword(s):

Renal Failure ◽

State Of The Art ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Descending Thoracic Aorta ◽

Penetrating Aortic Ulcer ◽

Considerable Cost ◽

Aortic Repair ◽

Aneurysm Dissection ◽

Aortic Pathologies

Thoracic Endovascular Aortic Repair (TEVAR) is a state-of-the art endovascular intervention used to treat various thoracic aortic pathologies such as aneurysm, dissection and penetrating aortic ulcers (PAU). The procedure demands significant technical skill and involves considerable cost burden for the patients. The latter is the main reason why the procedure has not yet made it to the routine clinical practice in Bangladesh. We recently performed TEVAR for the successful treatment of an ominous-looking PAU in the descending thoracic aorta in a patient with renal failure. Cardiovasc j 2021; 14(1): 88-92

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Thoracic Endovascular Aortic Repair in the Ascending Aorta

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000193 ◽

2015 ◽

Vol 10 (5) ◽

pp. 363-367 ◽

Cited By ~ 3

Author(s):

Anja Muehle ◽

Aamir Shah ◽

Ali Khoynezhad

Keyword(s):

Treatment Options ◽

Aortic Disease ◽

Ascending Aorta ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Attractive Alternative ◽

Aortic Repair ◽

Alternative Treatment Option ◽

Risk Patients ◽

Aortic Pathologies

Thoracic endovascular aortic repair has become an attractive alternative treatment option for thoracic aortic disease. New devices and advanced image-guided procedures are continuously expanding the indications. This article focuses on technical aspects of transapical stent graft deployment for ascending aortic pathologies. With improving device technology, diverse available stent grafts, and imaging modalities, thoracic endovascular aortic repair has become safer and holds promising potential to expand treatment options, especially for high-risk patients requiring ascending aorta treatment.

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Indications for Thoracic EndoVascular Aortic Repair (TEVAR): A Brief Review

International Journal of Angiology ◽

10.1055/s-0038-1666972 ◽

2018 ◽

Vol 27 (04) ◽

pp. 177-184 ◽

Cited By ~ 10

Author(s):

Joshua Newman ◽

Allan Mattia ◽

Frank Manetta

Keyword(s):

Mortality Rates ◽

Thoracic Endovascular Aortic Repair ◽

Aortic Aneurysms ◽

Endovascular Aortic Repair ◽

Morbidity And Mortality ◽

Thoracic Aortic Aneurysms ◽

Aortic Repair ◽

Aortic Pathologies ◽

The Ideal

The utility of Thoracic EndoVascular Aortic Repair (TEVAR) continues to progress at a very rapid rate. Initially implemented for the treatment of thoracic aortic aneurysms, TEVAR has evolved to treat a variety of aortic pathologies and reduce overall morbidity and mortality rates compared with traditional open surgical repair.Given the rapidly evolving nature of endovascular thoracic intervention, we hereby briefly review the current literature on the evolving applications of TEVAR.TEVAR continues to rapidly evolve and is being applied to a growing number of aortic pathologies. Given the perioperative, short- and mid-term morbidity and mortality rates, TEVAR is quickly surpassing traditional open surgical intervention as the ideal procedure for patients undergoing intervention of the descending thoracic aorta and applicability to ascending and arch pathologies is being explored. However, as more data becomes available TEVAR may be associated with higher rates of reoperative requirements. Data remains limited on the long-term efficacy of the intervention and should continue to be investigated.

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Risk Factors Associated With Reintervention After Thoracic Endovascular Aortic Repair for Descending Aortic Pathologies

Vascular and Endovascular Surgery ◽

10.1177/1538574418814989 ◽

2018 ◽

Vol 53 (3) ◽

pp. 181-188 ◽

Cited By ~ 4

Author(s):

Shin-Ah Son ◽

Deok Heon Lee ◽

Tak-Hyuk Oh ◽

Joon Yong Cho ◽

Young Ok Lee ◽

...

Keyword(s):

Risk Factors ◽

Thoracic Endovascular Aortic Repair ◽

Adverse Outcomes ◽

Aortic Aneurysms ◽

Endovascular Aortic Repair ◽

University Hospital ◽

Aortic Repair ◽

Peripheral Vascular Occlusive Disease ◽

Aortic Pathologies ◽

Aortic Size

Background: Thoracic endovascular aortic repair (TEVAR) is associated with several short-term benefits, including reduced morbidity and mortality; however, the long-term durability of TEVAR and the need for secondary aortic reintervention remain unclear. We aimed to determine the adverse outcomes, including aortic reintervention, after TEVAR for thoracic aortic aneurysms and dissection. Methods: Between October 2009 and July 2016, 130 patients underwent TEVAR at Kyungpook National University Hospital. We excluded 35 patients with traumatic injury and included the remaining 95 patients in our study after TEVAR. The patients included in this study were categorized into 2 groups (reintervention [R] and nonintervention [N] groups) according to the need for reintervention. The mean follow-up period for all 95 patients was 22.4 (20.6) months. Results: The overall actuarial survival rates were 83.7% (4.1%) and 63.6% (8.8%) at 1 and 5 years, respectively. The rates of freedom from aortic reintervention after TEVAR were 94.0% (3.5%), 72.8% (8.2%), and 48.9% (10.5%) at 2, 3, and 5 years, respectively. The independent risk factors for aortic reintervention were endoleaks after TEVAR (odds ratio [OR] 6.13, P = .017), increase in aortic size by over 5% per year (OR 20.40, P = .001), and peripheral vascular occlusive disease (PVOD; OR 13.62, P = .007). Patients with preoperative hemoptysis tended to show a greater need for aortic reintervention ( P = .059). Increase in aortic size by over 5% per year and PVOD were the primary risk factors for endoleaks (OR 3.82, P = .013 and OR 4.37, P = .021, respectively). Conclusion: Survival after TEVAR for thoracic aortic pathologies was satisfactory in most of the patients chosen as candidates for the procedure. However, the occurrence of endoleaks, increase in aortic size by over 5% per year, and PVOD were the primary causes of aortic reintervention.

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