scholarly journals Elective endovascular aortic repair conversion for type Ia endoleak is not associated with increased morbidity or mortality compared with primary juxtarenal aneurysm repair

2014 ◽  
Vol 60 (2) ◽  
pp. 286-294.e1 ◽  
Author(s):  
Salvatore T. Scali ◽  
Michael M. McNally ◽  
Robert J. Feezor ◽  
Catherine K. Chang ◽  
Alyson L. Waterman ◽  
...  
Keyword(s):  
Endovascular Aortic Repair ◽  
Aortic Repair ◽  
Type Ia ◽  
Aneurysm Repair ◽  
Juxtarenal Aneurysm

scholarly journals Chimney technique with endoanchors in treatment of late type 1a endoleak after endovascular aortic repair

2020 ◽  
Vol 8 ◽  
pp. 2050313X2095301
Author(s):  
Emanuele Gatta ◽  
Gabriele Pagliariccio ◽  
Sara Schiavon ◽  
Carlo Grilli Cicilioni ◽  
Luciano Carbonari
Keyword(s):  
Open Repair ◽  
Endovascular Aortic Repair ◽  
Late Type ◽  
Stent Grafts ◽  
Computed Tomographic ◽  
Chimney Technique ◽  
Aortic Repair ◽  
Computed Tomographic Scan ◽  
Type Ia ◽  
Long Time

The late type Ia endoleak after endovascular aortic repair could be a challenging issue. Over the last years, in case of short or enlarged neck, fenestrated and branched stent grafts have been increasingly employed with improving results. However, these devices have limited use in urgent/emergent cases as custom graft manufacturing takes long time, and may not be fit in patients with particular anatomic features. In this setting, chimney and relining remain an alternative but sometimes may not be adequate. According to literature, the use of the endoanchors associated to chimney technique can improve the procedure results in primary endovascular aortic repair. We treated two patients with a late type Ia endoleak after endovascular aortic repair with a simultaneous relining, single renal chimney, and endoanchors implant. These patients were valuated unfit for open repair with neck configuration unadapt for a simple relining, ballooning, or stenting. The patient conditions were unfavorable for an endovascular repair with branched endovascular aortic repair–fenestrated endovascular aortic repair. The same procedure was performed in both patients. Postoperative angio-computed tomographic scan demonstrated the resolution of the endoleak with patency of renal graft. Our preliminary experience, in these selected cases, demonstrate the feasibility of the technique in late type Ia endoleak.

scholarly journals Can a trainee perform endovascular aortic repair as effectively and safely as an experienced specialist?

2020 ◽  
Vol 31 (6) ◽  
pp. 841-846
Author(s):  
Kinga Kosiorowska ◽  
Mikołaj Berezowski ◽  
Friedhelm Beyersdorf ◽  
Marek Jasinski ◽  
Maximilian Kreibich ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Clinical Success ◽  
Cumulative Risk ◽  
Skills Training ◽  
Endovascular Aortic Repair ◽  
X Ray ◽  
Aortic Repair ◽  
Type Ia ◽  
Hospital Stays ◽  
Baseline Characteristics

Abstract OBJECTIVES Endovascular aortic repair (EVAR) is a technically demanding procedure usually carried out by highly experienced surgeons. However, in this era of modern endovascular surgery with growing numbers of patients qualifying for the procedure, the need to enhance surgical training has emerged. Our aim was to compare the technical results of EVAR in patients operated on by trainees to that of those operated on by an endovascular expert. METHODS Between 2016 and 2018, a total of 119 patients diagnosed with an abdominal aorta disease requiring EVAR were admitted to our clinic. Overall, we included 96 patients who underwent preoperative and postoperative computed tomography angiography and EVAR performed either by an endovascular expert (N = 51) or a trainee (N = 45). RESULTS We detected no difference in the baseline characteristics, indication for EVAR and preoperative anatomy between patients operated on by trainees and our endovascular expert. We noted the same incidence of endoleak type Ia occurrence (n = 2 vs n = 2, P = 1.00), reintervention rate (n = 0 vs n = 0, P = 1.00) and in-hospital mortality (n = 0 vs n = 1, P = 1.00) for operations done by trainees and the expert, respectively. There was no difference in X-ray doses or time between the 2 groups. Despite longer median operation times [112 (first quartile: 84; third quartile: 129) vs 89 (75–104) min; P = 0.03] and in-hospital stays [10 (8–13) vs 8 (7–10) days, P = 0.007] of the patients operated on by trainees, the overall clinical success of EVAR was satisfactory in both groups. CONCLUSIONS An EVAR planned and performed by a trainee need not raise the cumulative risk of the procedure. Trainees who have undergone both mind and hand skills training can therefore carry out EVAR under the supervision of an experienced specialist as effectively and safely as experts do.

scholarly journals The surgical management of type IA endoleak after thoracic endovascular aortic repair

2020 ◽  
Vol 31 (3) ◽  
pp. 346-353
Author(s):  
Yaojun Dun ◽  
Yi Shi ◽  
Hongwei Guo ◽  
Yanxiang Liu ◽  
Xiangyang Qian ◽  
...  
Keyword(s):  
Surgical Management ◽  
Circulatory Arrest ◽  
Artery Bypass ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Elephant Trunk ◽  
Direct Closure ◽  
Aortic Repair ◽  
Type Ia

Abstract OBJECTIVES Our goal was to investigate the surgical strategy for type Ia endoleak after thoracic endovascular aortic repair (TEVAR) by reporting our experiences. METHODS From November 2012 to September 2019, a total of 23 patients received surgical management for type Ia endoleak after TEVAR. RESULTS The operations included total arch replacement with the frozen elephant trunk technique in 15 patients, direct closure of the endoleak in 2 patients, hybrid aortic arch repair in 4 patients, arch debranching with TEVAR in 1 patient and left common carotid artery to left subclavian artery bypass with TEVAR in 1 patient. Among 21 patients with cardiopulmonary bypass (CPB), the mean CPB and aortic cross-clamp times were 146.7 ± 42.2 and 81.0 ± 43.3 min, respectively. The selective cerebral perfusion time was 18.8 ± 8.2 min in 17 patients with hypothermic circulatory arrest. The in-hospital mortality was 8.7% (2/23). Type Ia endoleak was sealed successfully after surgery in 95.5% (21/22) of patients. The follow-up data were available for all 21 survivors. The median follow-up period was 18 months (range 1–84 months). During the follow-up period, a total of 8 patients died or had aortic events, including 5 deaths and 6 aortic events. CONCLUSIONS Different surgical strategies could be selected to treat patients with type Ia endoleak after TEVAR, with acceptable early and late outcomes.

Unplanned stents in thoracic endovascular aortic repair for type B aortic dissection: A 16-year single-center report

Vascular ◽  
2017 ◽  
Vol 26 (4) ◽  
pp. 400-409
Author(s):  
Junjun Liu ◽  
Rongjie Zhang ◽  
Rui Feng ◽  
Jiaxuan Feng ◽  
Zhiqing Zhao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Aortic Dissection ◽  
Operation Time ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Rank Test ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Aortic Repair ◽  
Type Ia

Background Unplanned stents in thoracic endovascular aortic repair mean additional stents implantation beyond the preoperative planning to achieve operation success. This study aimed to reveal the prevalence and consequences of unplanned stents in thoracic endovascular aortic repair for type B aortic dissection and explore the reasons, risk factors and solutions for unplanned stents. Methods Retrospectively analysis consecutive patients diagnosed as type B aortic dissection with initial tear originating distal from the left subclavian artery and underwent thoracic endovascular aortic repair from September 1998 to June 2014 in our center. Results Under the criteria, this study enrolled 322 patients, with 83 (25.8%) patients in unplanned group. The incidence rate of unplanned stents in thoracic endovascular aortic repair for type B aortic dissection in each year demonstrates as a bimodal curve. The curve showed that, 2003 and, 2004 was the first and highest peak and 2007 was the second peak. There was no difference in five-year survival rate between planned and unplanned patients (log-rank test, p = 0.994). The unplanned group had higher hospitalization expenses (142,699.08 ± 78,446.75 yuan vs. 175,238.58 ± 34,838.01 yuan; p = 0.019), longer operation time (104.50 ± 93.24 min vs. 179.08 ± 142.47 min; p < 0.001) and hospitalization time (17.07 ± 16.62 d vs. 24.00 ± 15.34 d; p = 0.001). The reasons for unplanned stents were type Ia endoleak (46 patients, 55.4%), bird beak (25 patients, 30.1%), and inappropriate shaping of stent (9 patients, 10.8%). Asymptomatic aortic dissection patients had higher incidence of unplanned stents. Short proximal neck length (2.66 ± 0.59 mm vs. 2.50 ± 0.51 mm; p = 0.016), short stent coverage length (154.62 ± 41.12 mm vs. 133.60 ± 44.33 mm; p = 0.002), and large distal stent oversize (75.44±10.77% vs. 82.68±15.80%; p <0.001) were risk factors for unplanned stents in thoracic endovascular aortic repair. Conclusion There are some special risk factors and reasons for unplanned stents in thoracic endovascular aortic repair for type B aortic dissection. Knowing these can we reduce the utilization of unplanned stents with appropriate methods.

Evaluation of EndoAnchor Aortic Wall Penetration After Thoracic Endovascular Aortic Repair

2020 ◽  
Vol 27 (2) ◽  
pp. 240-247
Author(s):  
Andrés Reyes Valdivia ◽  
Sara Busto Suárez ◽  
África Duque Santos ◽  
Ahmad Amer Zanabili Al-Sibbai ◽  
Claudio Gandarias Zúñiga ◽  
...  
Keyword(s):  
Thoracic Aorta ◽  
Aortic Wall ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Descending Thoracic Aorta ◽  
Aortic Repair ◽  
Type Ia ◽  
Endograft Infection ◽  
Academic Vascular Surgery

Purpose: To analyze aortic wall penetration of Heli-FX EndoAnchors after use in seal zones in the aortic arch or descending thoracic aorta during thoracic endovascular aortic repair (TEVAR). Materials and Methods: From May 2014 to May 2019, 25 patients (mean age 70.5±10 years; 16 women) were treated with TEVAR and adjunctive use of the Heli-FX device in 3 academic vascular surgery departments. Computed tomography scans were retrospectively reviewed to determine the location [arch or descending thoracic aorta (DTA)] of the EndoAnchors and the adequacy of aortic wall penetration, defined as adequate (≥2 mm), partial (<2 mm), or inadequate wall penetration (including loss). Endoleaks, reinterventions, and mortality were assessed. Results: A total of 161 EndoAnchors were deployed (median 7 per patient, range 4–9). Twenty-two EndoAnchors were place in the arch (zones 0–2) and 139 in the DTA (zones 3–5). A larger proportion of arch deployments (27%) had suboptimal penetration compared with the DTA (6.5%; p<0.005), resulting in a 91% adequate wall penetration rate for the series overall. Three EndoAnchors were lost (and only 1 retrieved) in 3 different patients, with no additional morbidity; thus, an overall deployment success rate of 88% was achieved. At a mean follow-up of 16.6±14 months, 4 patients required 5 (successful) reinterventions, including one for a type Ia endoleak treated with chimney TEVAR. One patient died 10 months after treatment due to endograft infection, without an opportunity for surgical correction. Conclusion: EndoAnchors have a higher risk of maldeployment in the arch, though this may be attributable to the small learning curve experience in this location. The best aortic wall penetration for this series was in the DTA, where EndoAnchors proved useful for distal endograft fixation during TEVAR.

Predictive Factors for Endoleaks and Aneurysm Enlargement after Thoracic Endovascular Aortic Repair of Thoracic Aortic Aneurysm

2021 ◽  
Vol 104 (5) ◽  
pp. 733-739
Keyword(s):  
Aortic Aneurysm ◽  
Ct Angiography ◽  
Predictive Factors ◽  
Thoracic Aortic Aneurysm ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Neck Length ◽  
Aortic Repair ◽  
Type Ia

Objective: To analyze the incidence and predictive factors of endoleaks and associated increased aneurysm size after thoracic endovascular aortic repair (TEVAR). Materials and Methods: The medical records and computed tomography (CT) angiography imaging of 69 patients with thoracic aortic aneurysm that underwent thoracic endovascular aortic repair at a single institute between June 2012 and May 2019 were reviewed. The incidences of endoleak were calculated. The patients’ demographic data, operative details, and imaging data were collected. The risk factors of endoleak occurrence were analyzed between endoleak and non-endoleak groups. The association between endoleak and aneurysm enlargement was also evaluated. Results: Endoleaks were noted in twenty-nine cases (42.0%) including four type Ia (5.8%), six type Ib (8.7%), seventeen type II (24.6%), and two type III (2.9%). Fifty-nine percent of the patients with endoleak were found with aneurysm enlargement. The predictive factors of endoleak were bird beak configuration and distal neck length of less than 20 mm (p=0.014 and 0.019, respectively). For type Ia, endoleak presented with short proximal neck length (p=0.031). Short distal neck and angulation of distal stent less than 160 degrees were the predictive factors of type Ib endoleak (p=0.045 and <0.001, respectively). Increased number of intercostal arteries is the only significant risk factor of type II endoleak (p=0.005). The other complications were endograft migration in about 5.8%, endograft infection in 2.9%, cerebrovascular complications in 5.8%, and ruptured aortic aneurysm in 2.9%. Conclusion: Interval follow up CT angiography is recommended to detect endoleak and other late complications after TEVAR. Special considerations are noted in the underlying renal insufficiency and the young patient for radiation dose in long term follow up. Keywords: Endoleak, Thoracic endovascular aortic repair, Thoracic aortic aneurysm, CT angiography, Aneurysm enlargement

scholarly journals Salvage endovascular septectomy in patients with chronic abdominal aortic dissection after failed endovascular aneurysm repair

2019 ◽  
Vol 29 (4) ◽  
pp. 621-624
Author(s):  
Hui Zhuang ◽  
Fanggang Cai ◽  
Zhixian Wu ◽  
Tenghui Zhan ◽  
Hongyu Chen ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Abdominal Aorta ◽  
Endovascular Aneurysm Repair ◽  
False Lumen ◽  
Endovascular Aortic Repair ◽  
Study Cohort ◽  
Aortic Repair ◽  
Abdominal Aortic ◽  
Abdominal Aortic Dissection ◽  
Aneurysm Repair

Abstract This study aimed to investigate the efficacy and safety of salvage endovascular septectomy in patients with abdominal chronic aortic dissection (CAD) after endovascular aneurysm repair. A study cohort comprising 6 patients with chronic abdominal aortic dissection after failed endovascular aortic repair [mean age 62.5 (36–69) years] were enrolled to undergo salvage endovascular septectomy. The procedure involved entering the false lumen via the intrinsic visceral entry to perform a confined septectomy using a ‘Gigli wire’ to merge the true and false lumens. The outcomes were assessed by Digital angiography and computed tomography angiography. All 6 patients were successfully operated on; the diameters of the visceral abdominal aorta and the infrarenal abdominal aorta were similar at 1, 3, 6 and 12 months compared with the baseline; the patency of the visceral branch arteries was also stable at 1, 3, 6 and 12 months compared with the baseline; no occlusion of the visceral branch arteries was noted; no major vascular adverse events or deaths were observed. In this preliminary study, it was proven that salvage endovascular septectomy is a potentially advantageous technique that is safe and effective in the treatment of patients with CAD after failed endovascular aortic repair.

Trends of vascular surgery procedures in Marfan syndrome and Ehlers-Danlos syndrome

Vascular ◽  
2020 ◽  
Vol 28 (6) ◽  
pp. 834-841 ◽  
Author(s):  
Senthil N Jayarajan ◽  
Brandon D Downing ◽  
Luis A Sanchez ◽  
Jeffrey Jim
Keyword(s):  
Length Of Stay ◽  
Connective Tissue ◽  
Vascular Surgery ◽  
Marfan Syndrome ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Ehlers Danlos Syndrome ◽  
Aortic Repair ◽  
Aneurysm Repair ◽  
Danlos Syndrome

Objectives Marfan syndrome and Ehlers-Danlos syndrome represent two connective tissue vascular diseases requiring unique consideration in their vascular surgical care. A comprehensive national review encompassing all hospitalizations for the Marfan Syndrome and Ehlers-Danlos syndrome patient population is lacking. Methods The National (Nationwide) Inpatient Sample from 2010 to 2014 was reviewed for all inpatient vascular surgery procedures including those with a diagnosis of Marfan syndrome and Ehlers-Danlos syndrome. National estimates of vascular surgery rates were generated from provided weights. Patient demographics, procedure type, and outcomes were assessed. Results There were 3103 Marfan syndrome and 476 Ehlers-Danlos syndrome vascular procedures identified as well as 3,895,381 vascular procedures in the remainder of population (control group). The percent of aortic procedures from all vascular procedures in Marfan syndrome (23.5%) and Ehlers-Danlos syndrome (23.5%) were 2.5-fold higher than controls (9.1%), p < 0.0001. Open aortic aneurysm repair was also significantly greater in both Marfan syndrome (16.8%) and Ehlers-Danlos syndrome (11.2%) compared to controls (4.4%), p < 0.0001. Endovascular aortic repair ( p < 0.2302) was similar among the groups. Marfan syndrome (7.7%) and Ehlers-Danlos syndrome (5.1%) had more thoracic endovascular aortic repair performed than controls (0.7%), p < 0.0001. Percutaneous procedures were fewer in Marfan syndrome (6.3%) than controls (31.3%) and Ehlers-Danlos syndrome (26.3%), p < 0.0001, while repair of peripheral arteries was greater in Marfan syndrome (5.9%) and Ehlers-Danlos syndrome (4.1%) than controls (1.5%), p < 0.0001. For total aortic procedures, the mean age of aortic procedures was 68.2 years in controls vs 45.8 years in Marfan syndrome and 55.3 years in Ehlers-Danlos syndrome, p < 0.0001. Marfan syndrome and Ehlers-Danlos syndrome had fewer comorbidities overall, while controls had significantly higher rates of coronary artery disease (controls 39.9% vs Marfan syndrome 8.3% and Ehlers-Danlos syndrome 13.0%, p < 0.0001), peripheral vascular disease (controls 34.5% vs Marfan syndrome 4.2% and Ehlers-Danlos syndrome 8.7%, p < 0.0001), and diabetes (controls 20.6% vs Marfan syndrome 6.6 and Ehlers-Danlos syndrome 4.4%, p < 0.0001). Marfan syndrome and Ehlers-Danlos syndrome had higher overall complication rate (65.5% and 52.2%) compared to controls (44.6%), p < 0.0001. Postoperative hemorrhage was more likely in Marfan syndrome (42.9%) and Ehlers-Danlos syndrome (39.1%) than controls (22.2%), p < 0.0001. Increased respiratory failure was noted in Marfan syndrome (20.2%) vs controls (10.7%) and Ehlers-Danlos syndrome (8.7%), p = .0003. Finally, length of stay was increased in Marfan syndrome 12.5 days vs Ehlers-Danlos syndrome 7.4 days and controls 7.2 days ( p < 0.0001) as well as a higher median costs of index hospitalization in Marfan syndrome ($57,084 vs Ehlers-Danlos syndrome $22,032 and controls $26,520, p < 0.0001). Conclusions Patients with Marfan syndrome and Ehlers-Danlos syndrome differ from other patients undergoing vascular surgical procedures, with a significantly higher proportion of aortic procedures including open aneurysm repair and thoracic endovascular aortic repair. While they are younger with fewer comorbidities, due to the unique pathogenesis of their underlying connective tissue disorder, there is an overall higher rate of procedural complications and increased length of stay and cost for Marfan syndrome patients undergoing aortic surgery.

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