Temporal pattern of aortic remodelling after endovascular treatment for chronic DeBakey IIIb dissection

Abstract OBJECTIVES Endovascular treatment has emerged as a safe procedure for treating chronic DeBakey IIIb dissection. The objective of this study was to investigate the mid-term outcome and temporal pattern of aortic remodelling after endovascular treatment for DeBakey IIIb dissection. METHODS From 2012 to 2017, 85 patients who underwent endovascular aortic repair for DeBakey IIIb dissection were enrolled. The temporal pattern of aortic remodelling in terms of false lumen (FL) thrombosis [level 1 (∼T7), level 2 (T7 ∼ coeliac axis) and level 3 (coeliac trunk ∼ aortic bifurcation)] and aortic diameter [mid-thoracic level (T7), coeliac axis and the largest infrarenal abdominal aorta] was investigated on serial follow-up computed tomography scan. RESULTS Eighty-five patients underwent endovascular treatment during the study period. Male sex was a significant risk factor for repetitive reintervention and segments 2 and 3 FL thrombosis. The preoperative FL diameter at T7 was significantly associated with FL diameter regression. The number of visceral vessels from the FL and residual DeBakey IIIb dissection after type A repair were significant factors for FL growth at the coeliac trunk and at the largest infrarenal abdominal aorta. The overall mortality was 3 (3.6%). CONCLUSIONS Endovascular treatment is a safe strategy in the management of DeBakey IIIb dissection. However, unfavourable aortic remodelling and repetitive reintervention were expected in male patients with a large number of visceral vessels from the FL and residual DeBakey IIIb dissection after type A repair. Endovascular treatment should be cautiously considered, and close follow-up is required for these patients.

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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

Journal of Endovascular Therapy ◽

10.1177/1526602820985270 ◽

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.

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

Aorta ◽

10.12945/j.aorta.2017.16.035 ◽

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.

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Endovascular Treatment of Spontaneous and Isolated Infrarenal Acute Aortic Syndrome with Unibody Aortic Stent-Grafts

World Journal of Surgery ◽

10.1007/s00268-020-05754-1 ◽

2020 ◽

Vol 44 (12) ◽

pp. 4267-4274

Author(s):

Felice Pecoraro ◽

Ettore Dinoto ◽

Domenico Mirabella ◽

Francesca Ferlito ◽

Arduino Farina ◽

...

Keyword(s):

Endovascular Treatment ◽

Stent Graft ◽

Abdominal Aorta ◽

Infrarenal Aorta ◽

Acute Aortic Syndrome ◽

Technical Success ◽

Stent Grafts ◽

Femoral Access ◽

Persistent Symptoms

Abstract Introduction Spontaneous acute aortic syndrome (IAAS) is rarely localized in the infrarenal aorta. The endovascular approach is preferred over conventional open surgery with fewer complications. However, dedicated endovascular devices for IAAS treatment are unavailable. The aim was to report a large single-center experience using unibody stent-grafts to address IAAS. Methods From April 2016 to March 2019, a retrospective analysis of patients presenting spontaneous and isolated IAAS was performed. Patients addressed with the unibody stent-graft (AFX endovascular AAA system; Endologix Inc., Irvine, CA) were included in the study. Indications to IAAS treatment were persistent symptoms and/or dilated abdominal aorta (>3 cm). The measured outcomes were technical success; early outcomes (<30 days) including mortality, morbidity, symptoms recurrence, and endoleak occurrence; and late outcomes (>30 days) including mortality, symptoms recurrence, endoleak occurrence, stent-graft patency, and survival. Median follow-up was 23.77 ± 10 months. Results Twenty-one patients with IAAS were included. Indications to treatment were symptoms in 14 (67%) patients and dilated abdominal aorta in 7 (33%). Technical success was achieved in all cases. No perioperative mortality and 1 (4.8%) early femoral access complication was encountered. During the follow-up were registered 1 (4.8%) aortic unrelated death and 1 (4.8%) stent-graft limb stenosis. The 36 months estimated survival and freedom from reintervention were 92% (CI: 37–43; SE: 1.7) and 94% (CI: 37–44; SE: 1.7), respectively. Conclusions The endovascular treatment of IAAS with unibody stent-graft (AFX endovascular AAA system; Endologix Inc.) is safe and effective with promising mid-term outcomes. The use of unibody stent-grafts expands the endovascular indication, despite the usual anatomic IAAS features. Larger studies with longer follow-up are required to validate the outcomes of the reported technique.

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Endovascular Treatment of Complex Aneurysms at the Vertebrobasilar Junction With Flow-Diverting Stents

Neurosurgery ◽

10.1227/01.neu.0000431472.71913.07 ◽

2013 ◽

Vol 73 (3) ◽

pp. 386-394 ◽

Cited By ~ 45

Author(s):

Stephan Meckel ◽

William McAuliffe ◽

David Fiorella ◽

Christian A. Taschner ◽

Constantine Phatouros ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Endovascular Treatment ◽

Significant Risk ◽

Mass Effect ◽

Complex Aneurysms ◽

Brainstem Compression ◽

Ischemic Complications ◽

Vertebrobasilar Junction ◽

Alternative Approaches

Abstract BACKGROUND: Large or giant complex vertebrobasilar junction aneurysms have a dismal natural history and are often challenging to treat with standard endovascular or neurosurgical techniques. OBJECTIVE: To report initial experience with endovascular treatment of these aneurysms using flow-diverting stents (FDS). METHODS: Ten patients with FDS treatment of complex vertebrobasilar junction aneurysms were collected from 4 large cerebrovascular centers. Clinical/angiographic presentation and outcome were retrospectively analyzed. RESULTS: Of 10 aneurysms, 7 presented with brainstem compression, 2 with ischemia, and 1 with subarachnoid hemorrhage, and 3 were recurrent after stent-assisted treatments. Eight were giant. Morphology was fusiform in 5, fusiform dissecting in 1, and multilobulated saccular in 4. Six were partially thrombosed. In addition to FDS (mean number of devices, 3.9; range, 1-9), contralateral vertebral artery sacrifice and adjunctive coiling were performed in 9 and 5 of the 10 patients, respectively. At follow-up, 5 of 10 were completely occluded, 4 showed minimal residual filling, and 1 was retreated with an additional FDS. Postinterventionally, worsening mass effect and ischemic complications were seen in 2 and 4 of 10, respectively. Clinical outcome was good in 6 (modified Rankin Scale score, 0-2). Four fatalities were related to sequelae of subarachnoid hemorrhage, late FDS thrombosis, progressive mass effect, and delayed intracranial hemorrhage. CONCLUSION: FDS may be used to treat complex vertebrobasilar junction aneurysms with overall good angiographic outcome. A combined reconstructive/deconstructive approach appears useful to avoid endoleaks. FDS strategies, like other endovascular and neurosurgical approaches to these lesions, are associated with significant risk and therefore should be reserved for those cases in which alternative approaches either are deemed unsafe or are likely to be ineffective.

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Percutaneous, endovascular treatment of innominate artery lesions is a safe and effective procedure

Orvosi Hetilap ◽

10.1556/oh.2011.29221 ◽

2011 ◽

Vol 152 (43) ◽

pp. 1745-1750 ◽

Cited By ~ 2

Author(s):

Tamás Mirkó Paukovits ◽

Balázs Nemes ◽

Kálmán Hüttl ◽

Viktor Bérczi

Keyword(s):

Endovascular Treatment ◽

Upper Limb ◽

Balloon Angioplasty ◽

Stent Implantation ◽

Neurological Complication ◽

Innominate Artery ◽

Safe Procedure ◽

Duplex Scan ◽

Excellent Outcome

Percutaneous endovascular treatment (transluminar balloon angioplasty with or without stent implantation) of innominate artery lesions has become the treatment of choice prior to surgery in the past decades. Authors present the diagnostics, treatment and follow-up of two patients as examples from their largest series in the literature. A 74-year-old male patient with a history of hyperlipidemia, hypertension, nicotine abuse and lower limb claudication was admitted because of acute upper limb claudication and dizziness. Physical examination revealed blood pressure difference of 30 mmHg between his arms, and poststenotic flow pattern in the common carotid artery with retrograde flow in the vertebral artery on carotid duplex scan. Diagnostic angiography showed 80% stenosis of the innominate artery, which was treated with percutaneous transluminar balloon angioplasty with stent implantation. Follow-up examination at 5 months showed no significant restenosis or neurological complication. The second patient was a 59-year-old smoker female patient with hypertension and type 2 diabetes mellitus, who was evaluated for her upper limb claudication. Initial finding was the absence of radial pulse in the right side. Color duplex scan revealed proximal subocclusion, which was confirmed by angiography. In one stage, balloon angioplasty was made, with immediate pain relief. After 15 months the patient was symptom-free. These two cases demonstrate an excellent outcome of endovascular treatment of innominate artery lesions, as authors already reported in two retrospective studies. Balloon angioplasty with, or without stent deployment appears to be a safe procedure with excellent primary success rate. Review of international studies also indicates that endovascular therapy of the innominate artery is safe and effective. Orv. Hetil., 2011, 152, 1745–1750.

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Endovascular treatment of steno-occlusions of the infrarenal abdominal aorta

La radiologia medica ◽

10.1007/s11547-006-0093-5 ◽

2006 ◽

Vol 111 (7) ◽

pp. 949-958 ◽

Cited By ~ 18

Author(s):

D. Laganà ◽

G. Carrafiello ◽

M. Mangini ◽

D. Lumia ◽

R. Caronno ◽

...

Keyword(s):

Endovascular Treatment ◽

Abdominal Aorta ◽

Infrarenal Abdominal Aorta

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Endovascular Treatment of Focally Dissected Infrarenal Abdominal Aorta with Self-expandable Closed Cell Design Bare Metal Stents

International Journal of Clinical & Medical Imaging ◽

10.4172/2376-0249.1000365 ◽

2015 ◽

Vol 02 (08) ◽

Author(s):

Kratovska A Ivanova P ◽

Ponomarjova S Staudzs K

Keyword(s):

Endovascular Treatment ◽

Abdominal Aorta ◽

Bare Metal Stents ◽

Metal Stents ◽

Cell Design ◽

Bare Metal ◽

Closed Cell ◽

Infrarenal Abdominal Aorta

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Extended-arch repair for acute type-A aortic dissection: perioperative and mid-term results

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezz071 ◽

2019 ◽

Vol 56 (4) ◽

pp. 714-721 ◽

Cited By ~ 4

Author(s):

Akash Fichadiya ◽

Alexander J Gregory ◽

Vamshi K Kotha ◽

Eric J Herget ◽

Holly N Smith ◽

...

Keyword(s):

Aortic Dissection ◽

False Lumen ◽

Type A ◽

Acute Type ◽

Cross Sectional ◽

Acute Setting ◽

Type A Aortic Dissection ◽

Surgical Complexity ◽

Permanent Neurological Deficit

Abstract OBJECTIVES: Extended-arch techniques offer the potential to comprehensively treat acute type-A aortic dissection (ATAAD), but add surgical complexity compared to the standard hemiarch technique. This study describes both perioperative and mid-term outcomes following the introduction of an extended-arch technique for ATAAD. METHODS: Ours is a retrospective single-centre observational study of 95 consecutive patients with ATAAD from 2011 to 2016. The decision to perform extended-arch or hemiarch repair was individualized based on clinical and radiological features. Extended-arch repair was defined as replacement of the ascending aorta and arch with reimplantation of head vessels with or without distal endovascular extension. Clinical follow-up was 100% complete. Cross-sectional double-oblique measurements were performed for aortic remodelling analysis. RESULTS: Extended-arch (n = 28) and hemiarch (n = 67) repair resulted in a in-hospital mortality of 10% (n = 3) and 10%, (n = 7), and permanent neurological deficit rate of 7% and 12%, respectively. At a mean imaging follow-up duration of 2.7 ± 1.5 years, false lumen thrombosis was achieved in 57% and 9% of patients undergoing extended-arch and hemiarch repair, respectively. Rate of growth in the proximal descending aorta was 0.7 ± 2.3 mm/year in the extended-arch group vs 2.7 ± 3.9 mm/year in the hemiarch group. At a mean clinical follow-up time of 3.0 ± 1.6 years, open surgical aortic reoperation was 0% in the extended-arch group and 22% in the hemiarch group. CONCLUSIONS: Extended-arch repair of ATAAD can be introduced in the acute setting without increase in perioperative mortality or morbidity. At mid-term follow-up, extended-arch for ATAAD improves aortic remodelling and reduces the need for open surgical reoperation.

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Management of endovascular treatment in spontaneous iliac artery dissections: Applications enabling classical surgery

Turkish Journal of Thoracic and Cardiovascular Surgery ◽

10.5606/tgkdc.dergisi.2020.19668 ◽

2020 ◽

Vol 28 (4) ◽

pp. 601-608

Author(s):

Fehim Can Sevil

Keyword(s):

Endovascular Treatment ◽

Iliac Artery ◽

False Lumen ◽

Arterial Occlusion ◽

Primary Patency ◽

Artery Dissection ◽

Acute Ischemia ◽

Entry Site ◽

Stent Occlusion

Background: This study aims to investigate the effectiveness of endovascular applications for the treatment of spontaneous iliac artery dissections. Methods: The medical records of 13 patients (12 males, 1 female; mean age 67.9±5.7 years; range, 58 to 75 years) with spontaneous iliac artery dissection between January 2017 and December 2019 were retrospectively reviewed. The diagnosis of spontaneous iliac artery dissection was made based on contrast-enhanced computed tomography. Demographic and clinical characteristics of the patients, physical examination and imaging findings, and hybrid treatments applied during endovascular treatment were analyzed. Results: The mean follow-up was 12.5±1.1 (range, 6 to 16) months. Five patients received hybrid treatment during endovascular treatment. The re-entry site was closed by a patch plasty over the common femoral artery in one of these patients. Embolectomy was performed in the remaining four patients for the treatment of acute ischemia of the extremities. Since no patency could be achieved in two of the patients undergoing embolectomy, a femoropopliteal bypass was performed. The technical success and primary patency rates were 100%. No new false lumen formation, intra-stent occlusion or arterial occlusion was observed during the hospital stay and follow-up. Conclusion: Endovascular methods can be safely used in the treatment of spontaneous iliac artery dissections; however, hybrid treatments may be also required in selected cases. We believe that it is effective and safe to apply endovascular and hybrid treatments without preventing possible surgical treatments which may be required in the future.

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