Graft endoclamping with brachio-femoral wire conduit for elephant trunk retrieval in open thoraco-abdominal aortic repair

Abstract Staged repair involving aortic arch replacement with elephant trunk (ET) technique and thoraco-abdominal aorta (TAA) replacement is the treatment of choice for patients with extensive aortic disease. The ET graft serves as a proximal platform for subsequent distal aortic repair as it allows one to avoid hazardous dissection of the distal arch and facilitate proximal anastomosis. However, in patients with large proximal descending aorta aneurysm, identifying and retrieving the ET during the second-stage TAA intervention can be challenging because of an unclampable aorta. Here, we present our brachio-femoral wire conduit technique for a safe ET clamping and retrieval during second-stage TAA procedures.

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Frozen elephant trunk infection: to defrost or to debranch?

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa466 ◽

2020 ◽

Author(s):

Joseph Nader ◽

Yuthiline Chabry ◽

Houda Nazih ◽

Thierry Caus

Keyword(s):

Proximal Part ◽

Acute Type ◽

Frozen Elephant Trunk ◽

Elephant Trunk ◽

Aortic Arch Replacement ◽

Descending Aorta ◽

Type A Aortic Dissection ◽

Hybrid Prosthesis

Abstract Infections of frozen elephant trunk hybrid prosthesis (HP) are not well documented in the literature and their management is not standardized yet. We report herein the case of a 59-year-old patient who benefited from a Thoraflex™ HP aortic arch replacement for an acute type A aortic dissection. He presented a year later with a Staphylococcus aureus infection of the proximal part of this prosthesis. We performed a replacement of the proximal compound of the HP accompanied by a complete debranching of the 3 supra-aortic vessels with an inter-carotidal retro-oesophageal bypass. As we left in situ the endovascular graft within the descending aorta, a life-long antibiotic therapy was introduced. The postoperative follow-up was uneventful, and the patient discharged home 2 weeks after his surgery. As an alternative to a more radical redo surgery with major risk, a hybrid medical and surgical treatment of infected frozen elephant trunk could be considered.

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Chimney Grafts in Acute Endovascular Aortic Repair Due to Ruptured Abdominal Aorta Aneurysm

Journal of Endovascular Resuscitation and Trauma Management ◽

10.26676/jevtm.v5i2.200 ◽

2021 ◽

Vol 5 (2) ◽

Author(s):

Tal M Hörer

Keyword(s):

Abdominal Aorta ◽

Left Kidney ◽

Endovascular Aortic Repair ◽

Abdominal Aorta Aneurysm ◽

Acute Case ◽

Aorta Aneurysm ◽

Aortic Repair

Parallel grafts, or chimney grafts, are at times a good solutions for EndoVascular Aorta repair (EVAR) in ruptured cases. These photoes shows an acute case with uni-chimney left kidney with succesful outcome.

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Computed tomography angiography findings of abdominal aortic disease: A review of emergencies

Medicinski pregled ◽

10.2298/mpns2012393j ◽

2020 ◽

Vol 73 (11-12) ◽

pp. 393-400

Author(s):

Mirela Jukovic ◽

Aleksandra Mijatovic ◽

Ivana Stojic ◽

Ljiljana Drazetin ◽

Maja Stankov ◽

...

Keyword(s):

Computed Tomography ◽

Abdominal Aorta ◽

Computed Tomography Angiography ◽

Clinical Manifestations ◽

Aortic Disease ◽

Occlusive Disease ◽

Tunica Media ◽

Abdominal Aortic ◽

Wide Range ◽

Life Threatening

Introduction. The aorta is a major blood vessel that supplies all segments of the human body. Acute aortic syndrome is a term that implies a life-threatening aortic disease. Due to the speed of examination and widespread availability, computed tomography angiography is a front-line diagnostic modality for emergencies and diseases of the abdominal aorta. The aim of this study was to provide a wide range of potentially life-threatening abnormalities of the abdominal aorta in daily clinical and radiological practice through a series of computed tomography angiography images and three-dimensional virtual reconstruction. Abdominal aortic aneurysm is defined as a 50% increase in diameter more than the normal arterial diameter. One of the most important complications of an aneurysm is a rupture that can be acute or chronic, presenting with various clinical manifestations. Aortic dissections are caused by abnormality of the tunica media layer, forming an intimal-medial flap and two types of lumen. A penetrating aortic ulcer may erode through the internal elastic lamina of the aortic wall and allow formation of hematoma within the tunica media. Occlusive disease of the abdominal aorta may refer to the late stage of chronic aortoiliac occlusive disease, whereas the acute and/or subacute form occurs due to sudden thrombosis or occlusion. Conclusion. The recognition of specific radiological signs of abdominal aortic disease using computed tomography angiography contributes to optimal treatment of patients and reduces mortality.

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Extra-anatomic thoracic aortic bypass operations

Medicina ◽

10.3390/medicina44050048 ◽

2008 ◽

Vol 44 (5) ◽

pp. 373

Author(s):

Arūnas Valaika ◽

Gediminas Norkūnas ◽

Gintaras Kalinauskas ◽

Giedrė Nogienė ◽

Jurgis Verižnikovas ◽

...

Keyword(s):

Aortic Dissection ◽

Abdominal Aorta ◽

Bypass Graft ◽

Emergency Operation ◽

Aortic Aneurysms ◽

Major Surgery ◽

Descending Aorta ◽

Aorta Aneurysm ◽

Aortic Bypass ◽

Thoracic Aneurysms

Objective. When the patient condition contraindicates major surgery for descending thoracic aneurysms, the surgeon should consider using an ascending aorta to abdominal aorta bypass graft, leaving the diseased segment undisturbed. Our experience with eight patients is presented. Material and methods. Between 1988 and 2008, eight patients were treated for the following indications: reoperation for coarctation (two patients), complicated descending aortic aneurysms (five patients), and posttraumatic descending aorta dissection (one patient). The mean age of the patients was 44±8 years (range, 27–53 years). There were 6 (75%) males and 2 (25%) females. Emergency operations were performed in three patients (two with aortic recoarctation, one with posttraumatic aortic dissection). Two cases were reoperations (both after recoarctation). Descending aorta was ligated in seven cases. Distal anastomosis was connected with abdominal aorta in four cases and with iliac arteries in four patients. Results. Three early deaths occurred. Two patients died after emergency operation after recoarctation and posttraumatic aortic dissection, and one patient died after descending aorta aneurysm correction because of bleeding. Conclusions. In complex aortic coarctation, extra-anatomic bypass operation remains an effective procedure. The usage of these procedures in patients with descending aortic aneurysms remains complicated.

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The frozen elephant trunk technique for aortic dissection is safe after previous aortic repair

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa288 ◽

2020 ◽

Vol 59 (1) ◽

pp. 130-136

Author(s):

Tim Berger ◽

Maximilian Kreibich ◽

Felix Mueller ◽

Bartosz Rylski ◽

Stoyan Kondov ◽

...

Keyword(s):

Aortic Dissection ◽

Aortic Arch ◽

Aortic Surgery ◽

Frozen Elephant Trunk ◽

Elephant Trunk ◽

Aortic Arch Replacement ◽

Mortality And Morbidity ◽

Aortic Repair ◽

Aortic Replacement ◽

Aortic Interventions

Abstract OBJECTIVES The goal of this study was to evaluate outcomes of aortic arch replacement using the frozen elephant trunk (FET) technique after previous proximal and/or distal open or endovascular thoracic aortic repair. METHODS Sixty-three patients [median age: 63 (55–74) years; 65% men] were operated on for acute or chronic aortic dissection after previous proximal and/or distal open or endovascular thoracic aortic repair. Intraoperative details, clinical outcome and follow-up results were evaluated. RESULTS The median time between the index and the FET procedure was 81 (40–113) months. Fifty-eight (92%) patients had already undergone proximal aortic surgery; supracoronary ascending aortic replacement was the most frequent index procedure [n = 25 (40%)]. Distal aortic interventions had been done in 8 (13%) patients including endovascular thoracic aortic repair in 6 patients (10%). In-hospital mortality was 3% (n = 2). Postoperative strokes occurred in 5 patients (8%); of those, 1 stroke was dissection-related (2%). Subsequent aortic reinterventions after the FET procedure had to be done in 33% (n = 21). CONCLUSIONS Outcomes of aortic arch replacement using the FET technique after previous proximal and/or distal open or endovascular thoracic aortic repair are associated with low mortality and morbidity. Still, postoperative stroke remains an issue. After the successful accomplishments, the approach serves as an ideal platform for the secondary surgical or endovascular downstream aortic procedures, which are frequently needed.

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Bail-out thoracic endovascular aortic repair for incorrect deployment of frozen elephant trunk into the false lumen

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivaa043 ◽

2020 ◽

Vol 30 (6) ◽

pp. 947-949

Author(s):

Motoharu Kawashima ◽

Yoshikatsu Nomura ◽

Masamichi Matsumori ◽

Hirohisa Murakami

Keyword(s):

Computed Tomography ◽

False Lumen ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Frozen Elephant Trunk ◽

Elephant Trunk ◽

Descending Aorta ◽

Aortic Repair ◽

Enhanced Computed Tomography ◽

Bail Out

Abstract We report a rare case of bail-out thoracic endovascular aortic repair after incorrect deployment of a frozen elephant trunk into the false lumen. A 54-year-old man presented to our department complaining of chest pain. Enhanced computed tomography revealed Stanford type A acute aortic dissection, which had a large entry site at the mid-descending aorta. Emergency total aortic arch replacement with a frozen elephant trunk was performed. Progressive intraoperative acidosis was observed. Immediate postoperative enhanced computed tomography showed that the distal end of the frozen elephant trunk was deployed into the false lumen through the initial tear at the proximal descending aorta. We performed emergency thoracic endovascular aortic repair through a fenestration made into the intimal flap using an Outback LTD re-entry device. The patient was discharged home on postoperative day 67 after a complete recovery.

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TEVAR Following FET: Current Outcomes of Rendezvous Procedures in Clinical Practice

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0040-1722732 ◽

2021 ◽

Author(s):

Katrin Meisenbacher ◽

Anja Osswald ◽

Moritz Sebastian Bischoff ◽

Dittmar Böckler ◽

Matthias Karck ◽

...

Keyword(s):

Aortic Surgery ◽

Neurological Complications ◽

Aortic Disease ◽

Hospital Death ◽

Elephant Trunk ◽

Technical Success Rate ◽

Second Stage ◽

Morphological Findings ◽

Cord Injury ◽

Feasible Option

Abstract Background The treatment of extensive thoracic/thoracoabdominal aortic pathologies with arch involvement remains a challenging task in aortic surgery. The introduction of the frozen elephant trunk (FET) technique offered a link between open surgery and thoracic endovascular aortic repair (TEVAR). Despite a decade of experience, data on the complementary use of these techniques are scant. The aim of this study was to evaluate TEVAR following FET in clinical reality. Methods Between November 2006 and June 2018, 20 patients (9 females; median age of 69 years) underwent endovascular second-stage completion after FET. The clinical outcomes, technical feasibility, and morphological findings were analyzed retrospectively. Results Eleven of the 20 interventions were intended “rendezvous procedures” in a multistage approach; 4 were elective reinterventions, and 5 were emergency complication repairs. The median interval between FET and TEVAR was 231 days (11 days–7.4 years). The technical success rate was 100%. During a median follow-up (FU) period of 58.3 months, the overall survival rate was 95%, with one in-hospital death. Neurological complications occurred in three cases (spinal cord injury: n = 1; stroke: n = 2). Computed tomography angiography showed overall regression in the median diameter of the proximal descending aorta (from 57 to 48.5 mm). Conclusion TEVAR as a second-stage intervention after FET is a feasible option, with satisfactory results at medium-term FU. In extensive thoracoabdominal aortic disease without proximal landing zones, the complementary use of both techniques in a multistage approach should be considered.

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Endovascular Aortic Repair as Second-Stage Surgery after Hybrid Open Arch Repair by the Frozen Elephant Trunk Technique for Extended Thoracic Aneurysm

Annals of Thoracic and Cardiovascular Surgery ◽

10.5761/atcs.nm.12.01918 ◽

2013 ◽

Vol 19 (3) ◽

pp. 257-261 ◽

Cited By ~ 10

Author(s):

Naomichi Uchida ◽

Hiroshi Kodama ◽

Keijiro Katayama ◽

Taiichi Takasaki ◽

Akira Katayama ◽

...

Keyword(s):

Endovascular Aortic Repair ◽

Thoracic Aneurysm ◽

Frozen Elephant Trunk ◽

Elephant Trunk ◽

Second Stage ◽

Aortic Repair ◽

Elephant Trunk Technique ◽

Frozen Elephant Trunk Technique ◽

Open Arch

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

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivz128 ◽

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.

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