scholarly journals Spinal ischaemia after thoracic endovascular aortic repair with left subclavian artery sacrifice: is there a critical stent graft length?

2017 ◽  
Vol 53 (2) ◽  
pp. 385-391 ◽  
Author(s):  
Fabian A Kari ◽  
Babak Saravi ◽  
Sonja Krause ◽  
Luisa Puttfarcken ◽  
Karin Wittmann ◽  
...  
Keyword(s):  
Stent Graft ◽  
Subclavian Artery ◽  
Left Subclavian Artery ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Aortic Repair ◽  
Graft Length

Effects of in situ fenestration stent-graft of left subclavian artery on the hemodynamics after thoracic endovascular aortic repair

Vascular ◽  
2019 ◽  
Vol 27 (4) ◽  
pp. 369-377 ◽  
Author(s):  
Yonghui Qiao ◽  
Le Mao ◽  
Ying Ding ◽  
Jianren Fan ◽  
Kun Luo ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Stent Graft ◽  
Subclavian Artery ◽  
Left Subclavian Artery ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Windkessel Model ◽  
Aortic Repair ◽  
The Ideal

Objectives The left subclavian artery during thoracic endovascular aortic repair could be reconstructed by in situ fenestration. This study aims to evaluate the effects of thoracic endovascular aortic repair with in situ fenestration thoracic endovascular aortic repair on the hemodynamics. Methods A male patient suffering from aortic dissection is treated by in situ fenestration thoracic endovascular aortic repair and the fenestration stent implanted in the left subclavian artery is partially protruding in the aortic arch for the stability. Two-phase non-Newtonian blood model is applied and three-element Windkessel model is implemented to reproduce physiological pressure waves. Simulations are carried out in three postoperative models to analyze different in situ fenestration thoracic endovascular aortic repair strategies; Case A: the protrusion length of fenestration stent is 23.2 mm representing the clinical postthoracic endovascular aortic repair aorta; Case B: the protrusion length is reduced by half simulating the improved surgery; Case C: the protruding portion is removed to simulate the ideal fenestration. Results In Case A, a pressure difference is found on the fenestration stent surface and a blood acceleration phenomenon around the stent is observed. Only 2.36% of the inlet blood flow is assigned to the left subclavian artery. In the improved surgery, the blood supply to the left subclavian artery is elevated to 4.01%. As for the ideal fenestration, a further improvement is observed (6.14%). Moreover, the aortic arch surface exposed to low time-averaged wall shear stress expands significantly when the protrusion length is shortened. Conclusions Overall, we conclude that appropriately shortening the protrusion length of the stent-graft may improve the efficacy of in situ fenestration thoracic endovascular aortic repair from the perspective of hemodynamics.

scholarly journals Results With a Selective Revascularization Strategy for Left Subclavian Artery Coverage During Thoracic Endovascular Aortic Repair

2011 ◽  
Vol 92 (1) ◽  
pp. 97-103 ◽  
Author(s):  
Teng C. Lee ◽  
Nicholas D. Andersen ◽  
Judson B. Williams ◽  
Syamal D. Bhattacharya ◽  
Richard L. McCann ◽  
...  
Keyword(s):  
Subclavian Artery ◽  
Left Subclavian Artery ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Aortic Repair

scholarly journals Management of the Left Subclavian Artery During Thoracic Endovascular Aortic Repair

2016 ◽  
Vol 64 (5) ◽  
pp. 1535
Author(s):  
Kyle A. Arsenault ◽  
Jason Faulds ◽  
Darren Klass ◽  
Joel Price ◽  
Michael T. Janusz
Keyword(s):  
Subclavian Artery ◽  
Left Subclavian Artery ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Aortic Repair

scholarly journals Handmade stent graft fenestration to preserve left subclavian artery in thoracic endovascular aortic repair†

2019 ◽  
Vol 56 (3) ◽  
pp. 587-594 ◽  
Author(s):  
Huey-Shiuan Kuo ◽  
Jih-Hsin Huang ◽  
Jer-Shen Chen
Keyword(s):  
Carotid Artery ◽  
Stent Graft ◽  
Subclavian Artery ◽  
Common Carotid Artery ◽  
Left Subclavian Artery ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Technical Success ◽  
Aortic Stent Graft ◽  
Aortic Pathologies

Abstract OBJECTIVES This study aimed to evaluate the efficacy and safety of a handmade fenestrated stent graft over an aortic stent graft for preserving the left subclavian artery (LSA) in thoracic endovascular aortic repair (TEVAR). METHODS From July 2015 to October 2018, a total of 32 consecutive patients with various thoracic aortic pathologies who underwent TEVAR in which handmade fenestration over a thoracic aortic stent graft was used for LSA were included. Outcomes including technical success, procedure-related complications, perioperative mortality and morbidity and graft patency were analysed. RESULTS Twenty-four patients (75.00%) presented with aortic dissection, 5 patients (15.63%) with thoracic aortic aneurysm and 2 patients (6.25%) with penetrating aortic ulcer; 1 patient (3.13%) required re-TEVAR due to endoleak and sac expansion from previous TEVAR for thoraco-abdominal aneurysm. TEVAR was performed in a zone 2 landing with single fenestration for LSA (26 patients, 81.25%), zone 1 landing with double fenestration for both LSA and left common carotid artery (5 patients, 15.63%) or zone 1 landing with single fenestration for LSA and a chimney graft for left common carotid artery (1 patient, 3.13%). The technical success rate, defined as the successful alignment of fenestration to LSA, was 93.75%. At a mean follow-up of 17.3 months, 4 cases of endoleak and 2 cases of stent graft-induced new entry were noted, 3 of which were treated endovascularly. CONCLUSIONS Our preliminary results demonstrate the viability of preserving LSA blood flow in TEVAR using a handmade stent graft fenestration to treat various aortic pathologies in various clinical situations and the technical feasibility and short-term results that may justify the use of this method in emergency cases.

scholarly journals Thoracic Endovascular Aortic Repair With Left Subclavian Artery Coverage Is Associated With a High 30-Day Stroke Incidence With or Without Concomitant Revascularization

2020 ◽  
Vol 27 (5) ◽  
pp. 769-776
Author(s):  
Rens R. B. Varkevisser ◽  
Nicholas J. Swerdlow ◽  
Livia E. V. M. de Guerre ◽  
Kirsten Dansey ◽  
Chun Li ◽  
...  
Keyword(s):  
Subclavian Artery ◽  
Real World ◽  
Left Subclavian Artery ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Stroke Incidence ◽  
Perioperative Stroke ◽  
Factors Associated ◽  
Real World Setting ◽  
Aortic Repair

Purpose: To evaluate the perioperative stroke incidence following thoracic endovascular aortic repair (TEVAR) with differing left subclavian artery (LSA) coverage and revascularization approaches in a real-world setting of a nationwide clinical registry. Materials and Methods: The National Surgical Quality Improvement Program registry was interrogated from 2005 to 2017 to identify all nonemergent TEVAR and/or open LSA revascularization procedures. In this time frame, 2346 TEVAR cases met the selection criteria for analysis. The 30-day stroke incidence was compared between patients undergoing TEVAR with (n=888) vs without (n=1458) LSA coverage, for those with (n=228) vs without (n=660) concomitant LSA revascularization among those with coverage, and following isolated LSA revascularization for occlusive disease (n=768). Multivariable logistic regression was employed for risk-adjusted analyses and to identify factors associated with stroke following TEVAR. Results of the regression analyses are presented as the adjusted odds ratio (OR) with 95% confidence interval (CI). Results: The stroke incidence was 2.3% following TEVAR without vs 5.2% with LSA coverage (p<0.001). In TEVARs with LSA coverage, the stroke incidence was 7.5% when the LSA was concomitantly revascularized and 4.4% without concomitant revascularization, while stroke occurred in 0.5% of isolated LSA revascularizations. Of 33 TEVAR patients experiencing a perioperative stroke, 8 (24%) died within 30 days. LSA coverage was associated with stroke both with concomitant revascularization (OR 4.0, 95% CI 2.2 to 7.5, p<0.001) and without concomitant revascularization (OR 2.2, 95% CI 1.3 to 3.8, p=0.002). Other preoperative factors associated with stroke were dyspnea (OR 1.8, 95% CI 1.1 to 3.0, p=0.014), renal dysfunction (OR 2.2, 95% CI 1.0 to 3.8, p=0.049), and international normalized ratio ≥2.0 (OR 3.6, 95% CI 1.0 to 13, p=0.045). Conclusion: Stroke following TEVAR with LSA coverage occurs frequently in the real-world setting, and concurrent LSA revascularization was not associated with a lower stroke incidence.

Sign in / Sign up

Export Citation Format

Share Document