Physician-modified endograft with left subclavian artery fenestration for ruptured type B aortic dissection

2021 ◽  
Author(s):  
Fei Mei ◽  
Mingkui Huang ◽  
Kewei Wang ◽  
Jianfeng Sun ◽  
Wenfei Guan ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Subclavian Artery ◽  
Left Subclavian Artery ◽  
Type B ◽  
Type B Aortic Dissection

Complications after Endovascular Repair of Type B Aortic Dissection

2002 ◽  
Vol 9 (6) ◽  
pp. 822-828 ◽  
Author(s):  
Reinhard S. Pamler ◽  
Thomas Kotsis ◽  
Johannes Görich ◽  
Xaver Kapfer ◽  
Karl-Heinz Orend ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Stent Graft ◽  
Subclavian Artery ◽  
Left Subclavian Artery ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Stent Grafting ◽  
Stent Graft Implantation ◽  
Graft Implantation

Purpose: To outline the complications encountered after endoluminal treatment in patients with type B aortic dissection. Methods: Between 1999 and 2001, 14 patients (12 men; mean age 60.3 years, range 39–79) with isolated type B aortic dissection (13 chronic, 1 acute) underwent aortic stent-grafting. Three patients with chronic dissection presented an acute clinical picture and were managed emergently. The left subclavian artery was intentionally covered by the prosthesis in 9 patients. Follow-up studies were performed at 6-month intervals. Results: Stent-graft implantation was technically successful in all patients, but incomplete sealing (endoleak) of the entry site required additional proximal stent-graft implantation in 4. The left subclavian artery remained patent in 5 patients. Secondary conversion was required in 3 patients: 2 for acute type A dissection resulting from injury to the aortic arch by Talent endografts and a sustained hemorrhage (left hemothorax). In another patient, a secondary intramural hematoma subsided spontaneously. Anterior spinal artery syndrome in 1 patient persisted at 1 month. No bypass was necessary for the 9 patients with the covered left subclavian arteries. Mean follow-up was 14 months (range 1–23). Conclusions: Stent-grafting is feasible in patients with type B aortic dissection, although it is associated with a considerable rate of complications. Frank reporting of these sequelae for a variety of stent-grafts is of paramount importance to clarifying the limitations of the method.

scholarly journals Surgeon-modified fenestrated stent graft deployment in type B aortic dissection

2021 ◽  
Vol 29 (2) ◽  
pp. 285-289
Author(s):  
Hakkı Zafer İşcan ◽  
Ertekin Utku Ünal
Keyword(s):  
Aortic Dissection ◽  
Stent Graft ◽  
Subclavian Artery ◽  
Left Subclavian Artery ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Landing Zone ◽  
Ischemic Complications ◽  
Fenestrated Stent Graft ◽  
Aortic Dissections

The treatment of aortic dissections and aneurysms may be challenging for vascular surgeons. Currently, thoracic endovascular aortic repair is usually the first treatment option for descending aortic pathologies. Left subclavian artery coverage during this procedure is often required to achieve a sufficient proximal landing zone. Most surgeons agree that the left subclavian artery can be selectively covered, but revascularization is preferred to reduce the risk of neurological or ischemic complications. The chimney method, hybrid operations with extra-anatomic bypass, back table or in situ fenestrations are assistive techniques in this procedure. Herein, we present a surgeon-modified fenestrated stent graft for a type B aortic dissection patient.

Management of the Left Subclavian Artery in TEVAR for Chronic Type B Aortic Dissection

2020 ◽  
Vol 54 (7) ◽  
pp. 586-591
Author(s):  
Allan M. Conway ◽  
Khalil Qato ◽  
N. Nhan Nguyen Tran ◽  
Gary Giangola ◽  
Alfio Carroccio
Keyword(s):  
Aortic Dissection ◽  
Subclavian Artery ◽  
Left Subclavian Artery ◽  
Spinal Cord Ischemia ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Chronic Type ◽  
Perioperative Morbidity ◽  
P 16 ◽  
Aneurysm Diameter

Objectives: Left subclavian artery (LSA) revascularization in thoracic endovascular aortic repair (TEVAR) remains controversial. Left subclavian artery coverage without revascularization can cause stroke and death. TEVAR has gained popularity for the treatment of chronic type B aortic dissection (cTBD). Using the Vascular Quality Initiative (VQI) database, we reviewed outcomes of LSA revascularization in TEVAR for cTBD. Methods: The VQI registry identified 5683 patients treated with TEVAR from July 2010 to July 2016, including 208 repairs for cTBD. We analyzed outcomes per the Society for Vascular Surgery reporting standards. Results: Of the 208 patients, 150 (72.1%) were male with a median age of 65.0 years (interquartile range [IQR], 55.0-72.0). Median aneurysm diameter was 5.7 cm (IQR, 5.0-6.5 cm). Data on the patency of the LSA was available in 131 (63.0%) patients. Twenty-five (19.1%) had occlusion of the LSA without revascularization, while 106 (80.9%) maintained patency or had revascularization. Successful device delivery occurred in all 131 (100%) patients. Maintaining LSA patency did not affect the rate of cerebrovascular accident ( P = .16), spinal cord ischemia ( P = 1.00), or death ( P = 1.00). This was also nonsignificant when analyzing the subgroup of 98 elective cases. There was no difference in the rates of endoleak. Any intervention for the LSA (revascularization or occlusion) led to a longer procedure time (203.6 minutes vs 163.7 minutes, P = .04). Conclusions: Maintaining LSA patency during TEVAR for cTBD offers no advantage in perioperative morbidity or endoleak. Occlusion of LSA may be performed safely in this cohort and revascularization reserved for those who have anatomy that compromises perfusion to critical organs.

scholarly journals Custom-made endograft with left subclavian artery branch in a patient with Takayasu aortitis complicated by type-B dissection and inflammatory involvement of the epiaortic vessels

2020 ◽  
Author(s):  
Antonio Rizza ◽  
Alberto R De Caterina ◽  
Cataldo Palmieri ◽  
Sergio Berti
Keyword(s):  
Aortic Dissection ◽  
Vertebral Artery ◽  
Subclavian Artery ◽  
Left Subclavian Artery ◽  
Left Vertebral Artery ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Custom Made ◽  
Type B Dissection ◽  
Artery Branch

Abstract Type-B aortic dissection in a patient affected by Takayasu disease is a rarely described condition and its management can be challenging. A 47-year-old woman with Takayasu aortitis and previous aortic valve and ascending aorta replacement was admitted to hospital for type-B aortic dissection. The recent instabilization of aortic disease, the persistence of episodes of transient chest pain and the largest size of the aneurismatic tract of thoracic descending aorta rendered an invasive approach mandatory. Since the patient presented a complete bilateral occlusion of the subclavian artery just after the origin of the vertebral artery and a subcritical, smooth, bilateral stenosis of the common carotid artery, a custom-made endograft with left subclavian artery branch was successfully positioned, thus allowing the preservation of antegrade left vertebral circulation. This is the first case reporting an entirely endovascular exclusion of type-B dissection in a patient affected by Takayasu aortitis using a custom-made endograft with a subclavian branch allowing the preservation of the antegrade flow to left vertebral artery.

A Primary Computational Fluid Dynamics Study of Pre- and Post-TEVAR With Intentional Left Subclavian Artery Coverage in a Type B Aortic Dissection

2019 ◽  
Vol 141 (11) ◽  
Author(s):  
Yonghui Qiao ◽  
Jianren Fan ◽  
Ying Ding ◽  
Ting Zhu ◽  
Kun Luo
Keyword(s):  
Blood Flow ◽  
Aortic Dissection ◽  
Subclavian Artery ◽  
Left Subclavian Artery ◽  
Model Parameters ◽  
Acute Type ◽  
Type B ◽  
Type B Aortic Dissection ◽  
True Lumen ◽  
The Impact

The impact of left subclavian artery (LSA) coverage during thoracic endovascular aortic repair (TEVAR) on the circulatory system is not fully understood. Here, we coupled a single-phase non-Newtonian model with fluid–structure interaction (FSI) technique to simulate blood flow in an acute type B aortic dissection. Three-element Windkessel model was implemented to reproduce physiological pressure waves, where a new workflow was designed to determine model parameters with the absence of measured data. Simulations were carried out in three geometric models to demonstrate the consequence of TEVAR with the LSA coverage; case A: pre-TEVAR aorta; case B: post-TEVAR aorta with the disappearance of LSA; case C: post-TEVAR aorta with virtually adding LSA. Results show that the blood flow through the compressed true lumen is only 8.43%, which may lead to ischemia in related organs. After TEVAR, the wall pressure on the stented segment increases and blood flow in the supra-aortic branches and true lumen is improved. Meantime, the average deformation of the aorta is obviously reduced due to the implantation of the stent graft. After virtually adding LSA, significant changes in the distribution of blood flow and two indices based on wall shear stress are observed. Moreover, the movement of residual false lumen becomes stable, which could contribute to patient recovery. Overall, this study quantitatively evaluates the efficacy of TEVAR for acute type B aortic dissection and demonstrates that the coverage of LSA has a considerable impact on the important hemodynamic parameters.

scholarly journals Primary Tear Distance From Left Subclavian Artery Predicts Growth in Chronic Type B Aortic Dissection

2018 ◽  
Vol 67 (1) ◽  
pp. e8
Author(s):  
Jesse A. Codner ◽  
Xiaoying Lou ◽  
Yazan M. Duwayri ◽  
William D. Jordan ◽  
Edward P. Chen ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Subclavian Artery ◽  
Left Subclavian Artery ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Chronic Type
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