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.

A Five-Year Computed Tomography Follow-up Study of Proximal Aortic Neck Dilatation After Endovascular Aortic Repair Using Four Contemporary Types of Endograft

2021 ◽  
Author(s):  
Mathieu Deltomme ◽  
Steven Van den Berge ◽  
Hozan Mufty ◽  
Annouschka Laenen ◽  
Sabrina Houthoofd ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Endovascular Aortic Repair ◽  
Follow Up Study ◽  
Aortic Repair ◽  
Aortic Neck

Computed tomography angiography of hybrid thoracic endovascular aortic repair of the aortic arch

2013 ◽  
Vol 11 (5) ◽  
pp. 589-606 ◽  
Author(s):  
Nila J Akhtar ◽  
Gustavo S Oderich ◽  
Terri J Vrtiska ◽  
Eric E Williamson ◽  
Philip A Araoz
Keyword(s):  
Computed Tomography ◽  
Aortic Arch ◽  
Computed Tomography Angiography ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Aortic Repair

Non-traumatic thoracic aortic emergencies: imaging diagnosis and management

2020 ◽  
Vol 81 (10) ◽  
pp. 1-12
Author(s):  
Jian Ping Jen ◽  
Akif Malik ◽  
Gareth Lewis ◽  
Benjamin Holloway
Keyword(s):  
Computed Tomography ◽  
Acute Aortic Dissection ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Type B ◽  
Penetrating Atherosclerotic Ulcer ◽  
Aortic Repair ◽  
Acute Aortic Syndromes ◽  
Best Medical Therapy ◽  
Tunica Intima

The major component of non-traumatic thoracic aortic emergencies is the acute aortic syndromes. These include acute aortic dissection, intramural haematoma and penetrating atherosclerotic ulcer, grouped together because they are indistinguishable clinically and highly fatal. All three entities involve disruption to the tunica intima and media and may be complicated by rupture, end-organ ischaemia or aneurysmal transformation. Early diagnosis is vital to allow timely and appropriate management. Paired unenhanced and electrocardiogram-gated computed tomography angiography of the chest, extending more distally if required, is recommended for diagnosis. Specific computed tomography features of all three entities are reviewed, with a focus on morphological features associated with complications. Those with type A pathology are usually managed with open surgery because this has a high risk of complication. Patients with uncomplicated type B pathology are usually managed with best medical therapy whereas those with complicated type B pathology are usually offered either surgery or thoracic endovascular aortic repair. The limited evidence regarding the use of thoracic endovascular aortic repair in patients with subacute uncomplicated type B pathology is briefly discussed.

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 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.

Thoracic Endovascular Aortic Repair: Literature Review With Emphasis on the Role of Multidetector Computed Tomography

2012 ◽  
Vol 33 (3) ◽  
pp. 247-264 ◽  
Author(s):  
Pamela T. Johnson ◽  
James H. Black ◽  
Stefan L. Zimmerman ◽  
Elliot K. Fishman
Keyword(s):  
Computed Tomography ◽  
Literature Review ◽  
Multidetector Computed Tomography ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Aortic Repair
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