Technical Aspects of Branched Thoracic Arch Graft Implantation for Aortic Arch Pathologies

2020 ◽  
Vol 27 (5) ◽  
pp. 792-800 ◽  
Author(s):  
Konstantinos Spanos ◽  
Giuseppe Panuccio ◽  
Fiona Rohlffs ◽  
Franziska Heidemann ◽  
Nikolaos Tsilimparis ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Innominate Artery ◽  
Distal Segment ◽  
Implantation Technique ◽  
Sinotubular Junction ◽  
Descending Aorta ◽  
Type A Aortic Dissection ◽  
Aortic Arch Repair ◽  
High Level ◽  
Arch Aneurysm

Purpose: To describe the implantation steps and tips and tricks for the Inner Branch Arch Endograft designed to treat aortic arch aneurysm and chronic type A aortic dissection. Technique: Anatomical suitability criteria should be met in order to use this device. The proximal segment of the graft lands in the ascending aorta distally to the sinotubular junction and the distal segment lands in the descending aorta. The device includes 2 inner branches; the proximal branch is used for a connection to the innominate artery (positioned slightly posterior at 12:30 o’clock), while the second branch is positioned slightly anterior at 11:30 o’clock and is used as a connection to the left common carotid artery. Access, implantation technique, deployment of the device, and catheterization of the branches are described thoroughly. Conclusion: This Inner Branch Arch Endograft is an appealing alternative to treat aortic arch pathology, especially in patients unsuitable for open repair. Nevertheless, complex aortic arch repair is associated with a learning curve. Meticulous preoperative planning and a high level of concentration intraoperatively are mandatory.

scholarly journals Antegrade transapical branch deployment for endovascular aortic-arch repair by in situ fenestration

2019 ◽  
Author(s):  
Takashi Murakami ◽  
Noriaki Kishimoto ◽  
Etsuji Sohgawa ◽  
Toshihiko Shibata
Keyword(s):  
Aortic Arch ◽  
Carotid Arteries ◽  
Stent Grafts ◽  
Descending Aorta ◽  
Bilateral Carotid ◽  
Aortic Arch Repair ◽  
Sheath Insertion ◽  
Arch Aneurysm ◽  
Transapical Access

Abstract A 76-year-old man presented with an aortic arch aneurysm and was considered a candidate for endovascular aortic arch repair by in situ fenestration. Alternative access routes were explored because of atherosclerotic disease of the descending aorta and bilateral carotid arteries. Transapical deployment of both an aortic and a branched stent grafts was successfully conducted without cerebral complications. The transapical access might have the potential to reduce the risks of complications related to large bore-sheath insertion to the carotid arteries.

scholarly journals Complete endovascular debranching of the aortic arch: A report of two cases

Vascular ◽  
2014 ◽  
Vol 23 (3) ◽  
pp. 310-315
Author(s):  
Joseph Anderson ◽  
Madeline Nykamp ◽  
Tyler Remund ◽  
Patrick Kelly
Keyword(s):  
Aortic Arch ◽  
Treatment Options ◽  
Endovascular Aneurysm Repair ◽  
Sinotubular Junction ◽  
Descending Aorta ◽  
Great Vessels ◽  
Endovascular Approach ◽  
Aneurysm Repair ◽  
Arch Aneurysm ◽  
Repair Techniques

Patients suffering from aortic arch aneurysms continue to encounter few treatment options. Because of co-morbidities, most are deemed to not be open surgical candidates. The two cases presented here demonstrate a novel endovascular approach in the care of an arch aneurysm complicated by dissection. Even though final graft configurations differed slightly between the two cases, all three great vessels were successfully de-branched through the combination of standard endovascular aneurysm repair techniques and modifications to off-the-shelf devices. Aortic flow was compartmentalized in the ascending aorta at or near the level of the sinotubular junction. This was done with a physician-assembled endografts. One of these lumens was dedicated to the descending aorta, while the other was further divided into three channels used to stent the great vessels. Completion angiography demonstrated patency in the arch, great vessels, and descending aorta. No endoleaks have been reported. Although data is limited, this approach appears promising.

Hybrid Procedure with Debranching from the Descending Aorta for Aortic Arch Aneurysm after Previous Open Repair

2017 ◽  
Vol 38 ◽  
pp. 319.e7-319.e10 ◽  
Author(s):  
Juergen Zanow ◽  
Martin Breuer ◽  
Eric Lopatta ◽  
Christoph Schelenz ◽  
Utz Settmacher
Keyword(s):  
Aortic Arch ◽  
Open Repair ◽  
Hybrid Procedure ◽  
Aortic Arch Aneurysm ◽  
Descending Aorta ◽  
Arch Aneurysm

scholarly journals Thoracic Endovascular Aortic Repair for Aortoesophageal Fistula after Covered Rupture of Aortic Homograft

Aorta ◽  
2017 ◽  
Vol 05 (03) ◽  
pp. 96-100 ◽  
Author(s):  
Michal Nozdrzykowski ◽  
Jens Garbade ◽  
Steffen Leinung ◽  
Andrej Schmidt ◽  
Friedrich-Wilhelm Mohr ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Aortic Rupture ◽  
Aortoesophageal Fistula ◽  
Endovascular Stent ◽  
Post Discharge ◽  
Endovascular Stent Graft ◽  
Descending Aorta ◽  
Type A Aortic Dissection ◽  
Esophageal Lesion ◽  
Aortic Homograft

AbstractA 63-year-old woman underwent replacement of the aortic root, ascending aorta, and partial arch due to Type A aortic dissection. Shortly thereafter, a replacement of the distal aortic arch and descending aorta was performed. Three years later, the patient developed an aortoesophageal fistula (AEF) resulting in re-replacement of the distal aortic arch and proximal descending aorta with a cryopreserved aortic homograft. Six weeks post-discharge, the patient was readmitted due to recurrent AEF. A thoracic endovascular stent graft was implanted to cover the aortic rupture, followed by correction of an esophageal lesion. The patient was monitored closely over time.

Anatomical Suitability of the Aortic Arch Arteries for a 3-Inner-Branch Arch Endograft

2020 ◽  
pp. 152660282095363
Author(s):  
Konstantinos Spanos ◽  
Stephan Haulon ◽  
Ahmed Eleshra ◽  
Fiona Rohlffs ◽  
Nikolaos Tsilimparis ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Left Subclavian Artery ◽  
Innominate Artery ◽  
Exclusion Criterion ◽  
Type I ◽  
Sinotubular Junction ◽  
Landing Zone ◽  
Custom Made ◽  
The Mean ◽  
Aortic Arch Arteries

Purpose: To analyze aortic arch anatomy of patients who were already treated with a 2-inner-branch arch endograft (2-IBAE) in order to assess the anatomical suitability of the supra-aortic arteries as target vessels for a 3-IBAE. Materials and Methods: Three different configurations of the Cook Zenith Arch endograft were designed with distances of 110 mm (model 1), 90 mm (model 2), and 70 mm (model 3) between the orifices of the first and third inner branches. Preoperative measurements of the aortic arch anatomy from 104 consecutive patients treated electively with custom-made 2-IBAEs at 2 European centers between 2014 and 2019 were analyzed. A previously described standard methodology with a planning sheet was used. Data and measurements included the treatment indication for the aortic arch pathology, the type of landing zone, the type of arch, and the inner and outer lengths of the ascending aorta from the sinotubular junction to the innominate artery (IA). Additionally, the diameters and clock positions of the IA, left common carotid artery (LCCA), and left subclavian artery (LSA) were assessed, along with the distances between the IA and the LCCA, the IA and the LSA, and the distal landing zone. Results: Type I was the most common arch configuration (75/104, 72%). The mean clock positions were 12:30±00:28 for the IA, 12:00±00:23 for the LCCA, and 12:15±00:29 for the LSA. The mean diameters were 14.2±2.2 mm for the IA, 8.8±1.8 mm for the LCCA, and 10.5±2 mm for the LSA. The mean distances between the IA and LCCA and between the IA and LSA were 14.7±5.8 mm and 33±9.4 mm, respectively. Model 2 (branch distance 90 mm) had the highest suitability (79%), while models 1 and 3 showed suitability rates of 73% and 68%, respectively. The most frequent exclusion criterion in all models was the diameter of the LSA, followed by the IA to LSA distance. Conclusion: The suitability for a 3-IBAE among patients who had a 2-IBAE implanted is high, favoring a 90-mm distance between the retrograde LSA branch and baseline.

Endoluminal Repair of a Thoracic Arch Aneurysm Using a Scallop-Edged Stent-Graft

2003 ◽  
Vol 10 (5) ◽  
pp. 936-939 ◽  
Author(s):  
Allan J. Kruger ◽  
Andrew H. Holden ◽  
Andrew A. Hill
Keyword(s):  
Aortic Arch ◽  
Stent Graft ◽  
Artery Bypass ◽  
Treatment Options ◽  
High Risk Patient ◽  
Innominate Artery ◽  
Endoluminal Repair ◽  
A New Technique ◽  
Aneurysm Repair ◽  
Arch Aneurysm

Purpose: To report a new technique of endoluminal thoracic aortic arch aneurysm repair using a scalloped stent-graft. Case Report: A 79-year-old man presented with a 7.5-cm thoracic aneurysm involving the inner curve of the aortic arch. Endoluminal repair was performed with a scalloped stent-graft that allowed perfusion of the brachiocephalic (innominate) artery. Preliminary extra-anatomical left common carotid and subclavian artery bypass grafting had been performed to allow coverage of the origins of these vessels. Conclusions: The use of fenestrated endoluminal grafts in the aortic arch can be achieved safely and may increase the treatment options for the high-risk patient.

Giant Aortic Arch Aneurysm After Interrupted Aortic Arch Repair

2010 ◽  
Vol 31 (7) ◽  
pp. 1104-1106
Author(s):  
Alakananda Ghosh ◽  
Amy Liu ◽  
Bassem Mora ◽  
Brojendra Agarwala
Keyword(s):  
Aortic Arch ◽  
Interrupted Aortic Arch ◽  
Aortic Arch Aneurysm ◽  
Aortic Arch Repair ◽  
Arch Aneurysm

Development of a Branched Stent-Graft for Endovascular Repair of Aortic Arch Aneurysms

2003 ◽  
Vol 10 (5) ◽  
pp. 940-945 ◽  
Author(s):  
Timothy A.M. Chuter ◽  
David G. Buck ◽  
Darren B. Schneider ◽  
Linda M. Reilly ◽  
Louis M. Messina
Keyword(s):  
Aortic Arch ◽  
Stent Graft ◽  
Endovascular Repair ◽  
Insertion Site ◽  
High Risk Patient ◽  
Innominate Artery ◽  
Short Side ◽  
Short Branch ◽  
Aortic Stent Graft ◽  
Arch Aneurysm

Purpose: To develop a branched stent-graft for endovascular repair of aortic arch aneurysm. Methods: Four different prototypes of a branched aortic stent-graft were inserted into a rubber model of the human aortic arch under fluoroscopic guidance. Each prototype was tested, modified, and tested again through a series of 4 iterations. The first 3 prototypes had multiple short side branches, as docking sites for extensions into the branches of the aortic arch. The last iteration had only 1 short branch for an extension into the distal aorta and 1 long branch for direct perfusion of the innominate artery. Results: With every re-design, the prototype aortic stent-graft became shorter, and its insertion site moved to a more proximally located arch artery. Stent-graft insertion, orientation, and extension also became quicker and easier with each change in device design. However, the only system to perform reliably was the last, which was subsequently used to treat a large, symptomatic pseudoaneurysm of the aortic arch in a high-risk patient. Conclusions: None of our multibranched systems was simple, safe, or durable enough for insertion into the aortic arch; only an iteration that had a short branch for an extension into the distal aorta and a long branch for direct perfusion of the innominate artery could be deployed without difficulty or delay.

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