scholarly journals What are the endovascular options and outcomes for repair of ascending aortic or aortic arch pathology?

2020 ◽  
Vol 32 (1) ◽  
pp. 106-110
Author(s):  
Varun J Sharma ◽  
Minesh Prakash ◽  
Zaw Lin ◽  
Casey Lo
Keyword(s):  
High Risk ◽  
Aortic Arch ◽  
Case Series ◽  
High Risk Population ◽  
Period Range ◽  
Technical Success Rate ◽  
Aortic Pathology ◽  
Hybrid Repair ◽  
Retrospective Cohort Studies ◽  
Study Type

Summary A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was ‘in patients with ascending aortic or aortic arch disease what are the outcomes with endovascular repair in terms of survival, complications and reintervention?’ Altogether 585 papers were found using the reported search, of which 9 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We found that the endovascular operative techniques with the greatest evidence were ascending aortic chimney grafts (AACs), branched thoracic endovascular aortic repair (bTEVAR) aortic grafts and fenestrated TEVAR (fTEVAR) aortic grafts. The best evidence available were small case-series or retrospective cohort studies (n < 100), with 1 systematic review, at a short follow-up period (range 0–5 years). Intraoperatively, these techniques have a high technical success rate (84–100%). We found rates of endoleak comparable between AAC (7.4–16%) and bTEVAR/fenestrated TEVAR (11.1–21.4%). Stroke rates are higher in bTEVAR (3.1–42% vs 1–26% in AACs), attributed to more proximal pathology and technically challenging procedures. Following the immediate postoperative period, the 30-day mortality is 0–10.8% and patency is 97–100%. Stroke and reintervention rates remain higher in the bTEVAR group (3.1–42.0% and 0.5–33.3%) compared to the AAC group (1.0–11.1% and 6.7–16.7%). The 3- and 5-year survival ranges from 59% to 90%, but is driven by non-aortic pathology in a high-risk population; 3-year freedom from aortic death is 93–97%. Patency is 97–100% at up to 3 years, conformation and supra-aortic occlusions thereafter remain unknown. We conclude that AACs, bTEVARs and fenestrated TEVARs are safe endovascular options in high-risk elective patients, with results comparable to open or hybrid repair. They remain unverified in acute settings or in patients fit for open intervention.

A Case Series of a Hybrid Approach to Aortic Arch Disease

2013 ◽  
Vol 16 (4) ◽  
pp. 225 ◽  
Author(s):  
Robert E. Michler ◽  
Evan Lipsitz ◽  
Siyamek Neragi-Miandoab
Keyword(s):  
Aortic Arch ◽  
Aortic Surgery ◽  
Hybrid Approach ◽  
Case Series ◽  
Chronic Obstructive ◽  
Type I ◽  
Endovascular Stent ◽  
Technical Success Rate ◽  
The Mean

<p><b>Objective:</b> Debranching of the aortic arch and endovascular stent placement as a combination therapy for complex aortic arch pathology has emerged over the past few years as an alternative to traditional repair. This hybrid approach is a viable option for patients who would not tolerate conventional arch replacement, as well as for patients with a failed stent graft of the descending aorta and a subsequent type I endoleak.</p><p><b>Methods:</b> We retrospectively reviewed the preoperative characteristics and postoperative outcomes of 5 patients who underwent debranching of the aortic arch and implantation of an endovascular stent across the aortic arch between 2008 and 2011. Data were analyzed with the Student t test and the Kaplan-Meyer method.</p><p><b>Results:</b> The mean age was 70.6 � 18 years; 4 men and 1 woman were evaluated. One patient had previous aortic surgery for dissection. The preoperative morbidities included arrhythmia (1 patient), chronic obstructive pulmonary disease (2 patients), cerebrovascular accident (1 patient), diabetes mellitus (2 patients), coronary artery disease (2 patients), and active angina (1 patient). One patient had a myocardial infarction 3 weeks before surgery. The primary technical-success rate was 100%, and none of the patients died in the perioperative phase. The mean follow-up time was 22 � 18.4 months, and the median follow-up time was 13.8 months (range, 7.13-50.7 months). Two patients died during follow-up. The pathology of the aorta in the patients who died was arch aneurysm; the 3 remaining patients are alive and regularly followed at our institution.</p><p><b>Conclusion:</b> The combination of surgery and simultaneous endovascular stenting in the operating room is an alternative approach for patients who are poor candidates for traditional arch repair under circulatory arrest.</p>

Underrepresentation of genitourinary cancers in studies of venous thromboembolism (VTE) prophylaxis.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e17115-e17115
Author(s):  
Max S Perlmutt ◽  
Tracy L Rose ◽  
Vaibhav Kumar ◽  
Matthew I. Milowsky
Keyword(s):  
High Risk ◽  
Case Reports ◽  
Meta Analysis ◽  
Case Series ◽  
Best Supportive Care ◽  
Bleeding Complications ◽  
High Risk Population ◽  
Vte Prophylaxis ◽  
Full Text Review ◽  
Diagnosis Of Cancer

e17115 Background: Significant advances in the management of VTE in cancer have led to a recent ASCO clinical practice update for VTE prophylaxis and treatment in patients with cancer. Genitourinary (GU) cancers (including bladder, kidney, prostate, testicular) have a high incidence of VTE, but also frequent bleeding complications, and it is not clear if patients with GU cancers are adequately represented in studies of VTE prophylaxis. We sought to determine the frequency of inclusion of patients with GU cancers in prospective studies of VTE prophylaxis. Methods: A systematic review of the literature using MEDLINE (inception to January 2020) was conducted. We included randomized controlled trials that compared thromboprophylaxis to placebo or best supportive care in patients with an established diagnosis of cancer. Observational studies, case series, and case reports were excluded. The primary outcome was proportion of patients with GU malignancies included within the trials. Results: A total of 137 articles were identified under the original search and 7 underwent full text review. A total of 6066 patients were included in 7 thromboprophylaxis trials, of which only 119 (2.0%) had a defined GU malignancy (Table). Given the heterogeneity of the GU cancers represented in each study, and the small numbers of patients included with GU cancers, a patient-level meta-analysis among GU patients in this population was not performed. Conclusions: In spite of the high risk for VTE in GU cancers, in particular bladder and testicular cancer, GU cancers are underrepresented in prospective randomized trials investigating VTE prophylaxis. To ensure appropriate decision making for each individual patient, future prospective trials must ensure adequate representation of patients with GU cancers to better understand the potential role for VTE prophylaxis in this high-risk population.[Table: see text]

Hybrid repair of aortic arch aneurysm in high-risk patients

2011 ◽  
Vol 12 (2) ◽  
pp. 138-144 ◽  
Author(s):  
Antonio Campanella ◽  
Mauro Rinaldi ◽  
Pietro Rispoli ◽  
Giovanni Gandini
Keyword(s):  
High Risk ◽  
Aortic Arch ◽  
Aortic Arch Aneurysm ◽  
High Risk Patients ◽  
Hybrid Repair ◽  
Risk Patients ◽  
Arch Aneurysm

scholarly journals The Transcranial Doppler Sonography for Optimal Monitoring and Optimization of Cerebral Perfusion in Aortic Arch Surgery: A Case Series

2017 ◽  
Vol 20 (3) ◽  
pp. 085 ◽  
Author(s):  
Tamer Ghazy ◽  
Ayham Darwisch ◽  
Torsten Schmidt ◽  
Phong Nguyen ◽  
Zuzana Fajfrova ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Transcranial Doppler ◽  
Cerebral Perfusion ◽  
Doppler Sonography ◽  
Aortic Surgery ◽  
Transcranial Doppler Sonography ◽  
Case Series ◽  
Neurological Deficits ◽  
Air Bubble ◽  
Aortic Pathology

Objective: To analyze the feasibility and advantages of transcranial doppler sonography (TCD) for monitoring and optimization of selective cerebral perfusion (SCP) in aortic arch surgery.Methods: From April 2013 to April 2014, nine patients with extensive aortic pathology underwent surgery under moderate hypothermic cardiac arrest with unilateral antegrade SCP under TCD monitoring in our institution. Adequate sonographic window and visualization of circle of Willis were to be confirmed. Intraoperatively, a cerebral cross-filling of the contralateral cerebral arteries on the unilateral SCP was to be confirmed with TCD. If no cross-filling was confirmed, an optimization of the SCP was performed via increasing cerebral flow and increasing PCO2. If not successful, the SCP was to be switched to bilateral perfusion. Air bubble hits were recorded at the termination of SCP.Results: A sonographic window was confirmed in all patients. Procedural success was 100%. The mean operative time was 298 ± 89 minutes. Adequate cross-filling was confirmed in 8 patients. In 1 patient, inadequate cross-filling was detected by TCD and an optimization of cerebral flow was necessary, which was successfully confirmed by TCD. There was no conversion to bilateral perfusion. Extensive air bubble hits were confirmed in 1 patient, who suffered a postoperative stroke. The 30-day mortality rate was 0. Conclusion: The TCD is feasible for cerebral perfusion monitoring in aortic surgery. It enables a confirmation of adequacy of cerebral perfusion strategy or the need for its optimization. Documentation of calcific or air-bubble hits might add insight into patients suffering postoperative neurological deficits.

scholarly journals Alternative Approach for Cerebral Protection during Complex Aortic Arch and Redo Surgery

2021 ◽  
Vol 8 (8) ◽  
pp. 86
Author(s):  
Massimo Capoccia ◽  
Christoph A. Nienaber ◽  
Maziar Mireskandari ◽  
Michael Sabetai ◽  
Christopher Young ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Perioperative Complications ◽  
Case Series ◽  
Cerebral Protection ◽  
Technical Success Rate ◽  
Relative Safety ◽  
Safe Management ◽  
Complex Patients ◽  
Alternative Approach

Total arch replacement remains a very demanding surgical procedure. It can be associated with reasonable long-term outcomes but carries serious perioperative complications. Aortic arch surgery has progressed in recent years to a wider adoption of reproducible and reliable techniques. Conventional open, surgical aortic arch replacement is currently offered to the majority of patients, although hybrid and wholly endovascular techniques are gaining popularity. With regards to open arch replacement, the nuances of surgical technique, the mode of cannulation and the optimal cerebral protection protocols remain a matter of debate. We propose an alternative cannulation approach facilitated by the cooperation between cardiac and vascular surgeons. A three-way arterial cannulation including both carotid arteries and the femoral artery (or ascending aorta) is the key feature of this approach. A case series of complex patients is presented to show both the feasibility and relative safety of a standardised new approach with a 100% technical success rate and a 16% 30-day mortality. The three-way cannulation approach may have a role to play for complex and extensive procedures requiring prolonged cerebral protection. We believe that a shared skill set from cardiac and vascular specialists is essential for the safe management and successful outcomes using this adaptive technique.

Hybrid repair of aortic arch with zone zero endografting—Case series with review of the literature

2021 ◽  
Author(s):  
Petar Zlatanovic ◽  
Igor Koncar ◽  
Milos Sladojevic ◽  
Ivan Tomic ◽  
Perica Mutavdzic ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Case Series ◽  
Review Of The Literature ◽  
Hybrid Repair
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