Hybrid Off-pump Second-Stage Aortic Arch Repair after Type A Dissection

2018 ◽  
Vol 67 (05) ◽  
pp. 385-392 ◽  
Author(s):  
Mario Lescan ◽  
Mateja Andic ◽  
Tobias Krüger ◽  
Vedran Ivosevic ◽  
Christian Schlensak
Keyword(s):  
Aortic Arch ◽  
Stent Graft ◽  
Endovascular Aneurysm Repair ◽  
False Lumen ◽  
Type A ◽  
Hybrid Technique ◽  
Elephant Trunk ◽  
Off Pump ◽  
Type A Dissection

Background Ascending aorta or hemi-arch repair are common in the acute phase of type A dissection. Postdissection aneurysms can develop with antegrade perfusion of the false lumen in the dissected aortic arch and require reoperation. Methods From 2012 to 2018, we reoperated nine patients with postdissection aneurysms using a hybrid technique without cardiopulmonary bypass. The patients had a EuroSCORE II of 13% and a logistic EuroSCORE I of 45% and were not candidates for frozen elephant trunk surgery. The median interval since the acute ascending repair was 184 (92; 528) days. All patients were treated by median resternotomy, ascending to carotid bypass on a partially clamped ascending graft, and transfemoral endovascular repair with a Relay NBS (nonbare stent) or conformable Gore C-TAG stent graft. Results Technical success was achieved in all cases. Mean follow-up was 405 (220; 672) days. There was no disabling stroke, endoleak, paraplegia, in-hospital, or late mortality. In all patients, the false lumen was completely thrombosed at the aortic arch level with a median aneurysm shrinkage of 13 mm in the distal arch. There was no bird beak or stent graft migration. Distal stent-induced new entry was observed in one case. Reinterventions were not necessary due to diameter stability. Conclusion Complete debranching with transfemoral thoracic endovascular aneurysm repair showed encouraging results in patients with relevant comorbidities. The used stent grafts performed well in the mid-term follow-up period with no endoleaks or migration.

scholarly journals En Bloc Arch Reconstruction With the Frozen Elephant Trunk Technique for Acute Type a Aortic Dissection

2021 ◽  
Vol 8 ◽  
Author(s):  
Penghong Liu ◽  
Bing Wen ◽  
Chao Liu ◽  
Huashan Xu ◽  
Guochang Zhao ◽  
...  
Keyword(s):  
False Lumen ◽  
Type A ◽  
Acute Type ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
En Bloc ◽  
Type A Aortic Dissection ◽  
Type A Dissection ◽  
Arch Reconstruction

Objective: The study objective was to evaluate the effect of en bloc arch reconstruction with frozen elephant trunk (FET) technique for acute type A aortic dissection.Methods: 41 patients with acute Stanford type A dissection underwent en bloc arch reconstruction combined with FET implantation between April 2018 and August 2020. The mean age of the patients was 46 ± 13 years, and 9 patients were female. One patient had Marfan syndrome. Six patients had pericardial tamponade, 9 had pleural effusion, 5 had transient cerebral ischemic attack, and 3 had chronic kidney disease.Results: The hospital mortality rate was 9.8% (4 patients). 2 (4.9%) patients had stroke, 23 (56.1%) had acute kidney injury, and 5 (12.2%) had renal failure requiring hemodialysis. During follow-up, the rate of complete false lumen thrombosis was 91.6% (33/36) around the FET, 69.4% (25/36) at the diaphragmatic level, and 27.8% (10/36) at the superior mesenteric artery level. The true lumen diameter at the same three levels of the descending aorta increased significantly while the false lumen diameter reduced at the two levels: pulmonary bifurcation and the diaphragm. The 1-, 2-and 3-year actuarial survival rates were 90.2% [95% confidence interval (CI), 81.2–99.2], 84.2% (95% CI, 70.1–98.3) and 70.2% (95% CI, 42.2–98), respectively.Conclusions: In patients with acute type A dissection, en bloc arch reconstruction with FET technique appeared to be feasible and effective with early clinical follow-up results. Future studies including a large sample size and long-term follow-up are required to evaluate the efficacy.

Emergent Triple-Branched TEVAR and Redistribution of the Branches to the Supra-Aortic Target Vessels for Treatment of a Contained Ruptured Descending Aortic Aneurysm Associated With a Chronic Type A Aortic Dissection

2021 ◽  
pp. 152660282098527
Author(s):  
Jan Stana ◽  
Carlota Fernandes Prendes ◽  
Ramin Banafsche ◽  
Nikolaos Konstantinou ◽  
Barbara Rantner ◽  
...  
Keyword(s):  
False Lumen ◽  
Type A ◽  
Emergency Setting ◽  
Chronic Type ◽  
Type A Aortic Dissection ◽  
Custom Made ◽  
Descending Aortic Aneurysm ◽  
Type A Dissection ◽  
Open Surgical Approach

Purpose: To demonstrate the feasibility of urgent endovascular treatment of a chronic type A dissection and contained rupture of the false lumen using a noncustomized triple-branched arch endograft, which necessitated reassignment of the branches to the supra-aortic vessels. Case Report:: A 57-year-old patient with a contained rupture of the descending thoracic aorta, in the setting of a chronic type A dissection and a maximum aortic diameter of 85 mm, was converted to endovascular repair after failure of an open surgical approach. A custom-made triple-branched arch endograft designed for another patient was employed, with concomitant occlusion of the false lumen using a Candy Plug occluder. To adjust the graft’s configuration to the patient’s anatomy, the supra-aortic vessels were not assigned to the originally planned branches. The 12-month follow-up angiography demonstrated a satisfactory result. Conclusion: A noncustomized triple-branched arch endograft can be used in an emergency setting to treat chronic type A dissection, reassigning the branches to the supra-aortic vessels as needed.

scholarly journals Complete Shrinkage of the Obliterated False Lumen After Open and Endovascular Chronic Aortic Dissection Stanford Type A Repair

Aorta ◽  
2017 ◽  
Vol 05 (02) ◽  
pp. 61-63
Author(s):  
George Samanidis ◽  
Meletios Kanakis ◽  
Constantinos Ieromonachos ◽  
George Stavridis
Keyword(s):  
Aortic Dissection ◽  
Circulatory Arrest ◽  
False Lumen ◽  
Type A ◽  
Frozen Elephant Trunk ◽  
Descending Thoracic Aorta ◽  
Elephant Trunk ◽  
Chronic Aortic Dissection ◽  
Antegrade Cerebral Perfusion

AbstractA 48-year-old man was admitted to our hospital with chronic aortic dissection Stanford Type A. His diagnosis was confirmed by chest multi-detector computed tomography (CT). The patient underwent combined (i.e., hybrid) open and endovascular repair (frozen elephant trunk) in a one-stage operation with moderate hypothermic circulatory arrest and antegrade cerebral perfusion. His postoperative course was uneventful, and he was discharged home on postoperative day 9. At 2-year follow-up, chest CT angiography revealed complete shrinkage of the obliterated false lumen in the distal aortic arch and descending thoracic aorta.

scholarly journals Different aortic arch surgery methods for type A aortic dissection: clinical outcomes and follow-up results

2020 ◽  
Vol 31 (2) ◽  
pp. 254-262
Author(s):  
Yunxing Xue ◽  
Jun Pan ◽  
Hailong Cao ◽  
Fudong Fan ◽  
Xuan Luo ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Clinical Outcomes ◽  
Type A ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Type A Aortic Dissection ◽  
Aortic Arch Surgery

Abstract OBJECTIVES The aim of this study was to investigate the clinical outcomes and follow-up results among 5 main aortic arch surgery methods for type A aortic dissection in a single centre. METHODS From 2002 to 2018, 958 type A aortic dissection patients who received surgical repair were divided into 5 groups according to the arch surgery method: hemiarch replacement (n = 206), island arch replacement (n = 54), total arch replacement with frozen elephant trunk (n = 425), triple-branched stent (n = 39) and fenestrated stent (n = 234). The indications for the different arch methods were related to the patient’s preoperative status, the location and extent of the dissection and the surgical ability of the surgeons. A comparative study was performed to identify the differences in the perioperative data, and the Kaplan–Meier analysis was used to assess the long-term survival and reintervention rates. Thirty matched surviving patients that were included in each group completed Computed tomography angiography to determine long-term reshaping effect. RESULTS The 30-day mortality rate was 15.8%, and there was no difference among the 5 groups (P = 0.848). The follow-up survival rates were similar among the 5 groups (P = 0.130), and the same was true for patients without reintervention (P = 0.471). In the propensity matching study, patients with stents (frozen elephant trunk, triple-branched stent, fenestrated stent) had a slower aortic dilation rate and a higher ratio of thrombosis in the false lumen at the descending aortic and abdominal aortic levels than patients without stents. CONCLUSIONS No standard method is available for arch surgery, and indications and long-term effects should be identified with clinical data. In our experiences, simpler surgical procedures could reduce mortality in critically ill patients and stents in the distal aorta could improve long-term reshape effects.

scholarly journals Reversed Frozen Elephant Trunk Technique to Treat a Type II Thoracoabdominal Aortic Aneurysm

2016 ◽  
Vol 24 (2) ◽  
pp. 277-280 ◽  
Author(s):  
E. Sebastian Debus ◽  
Tilo Kölbel ◽  
Sabine Wipper ◽  
Holger Diener ◽  
Beate Reiter ◽  
...  
Keyword(s):  
Stent Graft ◽  
Spinal Cord Ischemia ◽  
False Lumen ◽  
Thoracoabdominal Aortic Aneurysm ◽  
Aortic Aneurysms ◽  
Hybrid Technique ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Elephant Trunk Technique ◽  
Frozen Elephant Trunk Technique

Purpose: To describe a hybrid technique of reversed frozen elephant trunk to treat thoracoabdominal aortic aneurysms (TAAA) through an abdominal only approach. Technique: The technique is demonstrated in a 29-year-old Marfan patient with a chronic type B aortic dissection previously treated with a thoracic stent-graft who presented with a thoracoabdominal false lumen aneurysm. Through an open distal retroperitoneal approach to the abdominal aorta, a frozen elephant trunk graft was implanted over a super-stiff wire upside down with the stent-graft component in the thoracic aorta. Following deployment of the stent-graft proximally and preservation of renovisceral perfusion in a retrograde manner, the renovisceral vessels were sequentially anastomosed to the elephant trunk graft branches, thus reducing the ischemia time of the end organs. The aortic sac was then opened, and the distal part of the hybrid graft was anastomosed with a further bifurcated graft to the iliac vessels. Conclusion: The reversed frozen elephant trunk technique is feasible for hybrid treatment of TAAAs via an abdominal approach only. This has the benefit of substantially reducing the trauma of thoracic exposure, thus preserving major benefits of open thoracoabdominal surgery, such as the presence of short bypasses to the renovisceral vessels and reimplantation of lumbar arteries to reduce spinal cord ischemia.

scholarly journals One-stage aortic replacement for type A aortic dissection: using a Vasoring and a conventional elephant trunk graft

2019 ◽  
Vol 56 (1) ◽  
pp. 189-196
Author(s):  
Jeng Wei ◽  
Yung-Tsai Lee ◽  
Ching-Wen Wu
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Vascular Graft ◽  
Open Surgery ◽  
Vascular Ring ◽  
False Lumen ◽  
Type A ◽  
Elephant Trunk ◽  
Type A Aortic Dissection ◽  
Aortic Replacement

AbstractOBJECTIVESWe used a vascular ring connector (Vasoring) and a conventional elephant trunk graft for complete repair in open surgery for type A aortic dissection. This report described the immediate and mid-term results of this new technique.METHODSWe used a rigid titanic ring as a stent in the vascular graft for rapid sutureless anastomosis in the reconstruction of type A aortic dissection.RESULTSA total of 65 consecutive patients with Stanford type A aortic dissection underwent open surgery performed by a single surgeon from November 2007 to February 2017. All patients underwent aortic reconstruction with vascular grafts and Vasorings (21 patients in the ascending aorta and 44 patients in the total aortic arch). For total aortic arch replacement, we implanted the conventional vascular graft in the proximal descending thoracic aorta as an elephant trunk graft. Concomitant procedures included the Bentall procedure (9 patients), the David operation (6 patients), coronary artery bypass grafting (9 patients), heart transplantation (1 patient), mitral valve replacement (2 patients) and endovascular aortic repair (1 patient). The mean duration of postoperative endotracheal intubation was 17.0 ± 11.8 h. The average blood loss was 520 ± 743 ml, and 25% of patients required no blood transfusion. The in-hospital mortality rate was 6%.CONCLUSIONSThe combined use of the vascular ring connector and the conventional elephant trunk graft may reduce bleeding and pump time, stop the blood flow in the false lumen and allow the 1-stage total arch replacement to be performed safely. The conventional elephant trunk graft is free from stent graft-induced new entry.

scholarly journals Transcarotid Artery Endovascular Reconstruction of the Aortic Arch by Modified Bifurcated Stent Graft for Stanford Type A Dissection

2007 ◽  
Vol 30 (4) ◽  
pp. 290-295 ◽  
Author(s):  
Wei Guo ◽  
Xiaoping Liu ◽  
Faqi Liang ◽  
Daihua Yang ◽  
Guohua Zhang ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Stent Graft ◽  
Type A ◽  
Type A Dissection

scholarly journals A Case Report: Is the Lack of Sufficient Radial Force Unfreezing the “Frozen Elephant Trunk”?

2021 ◽  
pp. 152660282110319
Author(s):  
Tugce Öz ◽  
Carlota F. Prendes ◽  
Jan Stana ◽  
Nikolaos Konstantinou ◽  
Maximillian Pichlmaier ◽  
...  
Keyword(s):  
Stent Graft ◽  
Endovascular Repair ◽  
Radial Force ◽  
Long Term Results ◽  
Hybrid Technique ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Proximal Migration ◽  
Longitudinal Stiffness

The “frozen elephant trunk” is a hybrid technique to treat aortic arch and proximal descending aortic pathologies in a single step. Despite its encouraging early and long-term results, some stent-graft-related adverse events have been reported. Here, we describe a possible treatment option to “re-freeze” the FET in case of loss of landing zone. We report a patient who developed significant kinking of the FET over the course of the first 2 postoperative years. The 1-year follow-up computed tomography angiography (CTA) showed significant kinking and proximal migration of the endograft portion of the FET, resulting in new thrombus formation. Due to kinking and thrombus progression in subsequent CTA follow-ups (2 years and 2½ years) with risk for peripheral embolization, a secondary endovascular repair was indicated. Transfemoral relining of the stent component with a thoracic aortic endovascular repair (Zenith®TX2®30142) stent-graft was performed. In the context of postoperative aneurysm sac shrinkage, the low radial force and lack of longitudinal stiffness of the hybrid graft may lead to proximal migration, thus secondary kinking, emphasizing the importance of an adequate degree of oversizing of the primary graft and an appropriate follow-up. Selection of a suitable graft for a particular pathology concerning the radial force and longitudinal stiffness is furthermore important.

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