Comparison of the Outcomes of Total Endovascular Aortic Arch Repair Between Branched Endograft and Chimney Endograft Technique in Zone 0 Landing

2021 ◽  
pp. 152660282110599
Author(s):  
Tomoaki Kudo ◽  
Toru Kuratani ◽  
Yukitoshi Shirakawa ◽  
Kazuo Shimamura ◽  
Keiwa Kin ◽  
...  
Keyword(s):  
Risk Factor ◽  
High Risk ◽  
Aortic Arch ◽  
Preoperative Evaluation ◽  
Landing Zone ◽  
High Risk Patients ◽  
Risk Patients ◽  
Aortic Arch Repair ◽  
Open Surgical Treatment ◽  
Free Rate

Purpose: Zone 0 landing in thoracic endovascular aortic repair (TEVAR) has recently gained increasing attention for the treatment of high-risk patients. The aim of this study was to compare the outcomes of total endovascular aortic arch repair between branched TEVAR (bTEVAR) and chimney TEVAR (cTEVAR) in the landing zone (LZ) 0. Materials and Methods: This was a single-center, retrospective, and observational cohort study. From January 2010 to March 2020, 40 patients (bTEVAR, n=25; cTEVAR, n=15; median age: 79 years) were enrolled in this study, with a median follow-up period of 4.1 years. These patients were considered unsuitable for open surgical treatment. Results: All procedures were successful and no cases of conversion to open repair were noted during the 30-day postoperative period. The 30-day mortality was 2.5% (n=1; bTEVAR [0 of 25, 0%] vs cTEVAR [1 of 15, 6.7%]; p=0.375), the perioperative stroke rate was 10.0% (n=4; bTEVAR [4 of 25, 16.0%] vs cTEVAR [0 of 15, 0%], p=0.278), and type 1a endoleak rate was 15.0% (n=6; bTEVAR [0 of 25, 0%] vs cTEVAR [6 of 15, 40.0%], p=0.001). The risk factor for stroke was atheroma grade of ≥2 in the brachiocephalic artery (p<0.001). The risk factor for type 1a endoleak was cTEVAR (p=0.001). The 8-year survival rate was 49.9%. The aorta-related death-free rate and aortic event-free rate at 8 years were 94.4% (bTEVAR: 95.5% vs cTEVAR: 93.3%, p=0.504) and 60.7% (bTEVAR: 70.7% vs cTEVAR: 40.0%, p=0.048), respectively. Conclusions: Total endovascular aortic arch repair using bTEVAR and cTEVAR is feasible for the treatment of aortic arch diseases in high-risk patients who are unsuitable for open surgery. However, as the rate of stroke is high, strict preoperative evaluation to prevent stroke is needed. No rupture of the aneurysm was observed in cTEVAR, but patients should be selected carefully because of the high incidence of type 1a endoleak.

Efficacy of ascending aortic banding technique concomitant with type I hybrid aortic arch repair in high-risk patients

2019 ◽  
Vol 34 (9) ◽  
pp. 1524-1532
Author(s):  
Hung-Lung Hsu ◽  
Chun-Yang Huang ◽  
Po-Lin Chen ◽  
Yin-Yin Chen ◽  
Chiao-Po Hsu ◽  
...  
Keyword(s):  
High Risk ◽  
Aortic Arch ◽  
Banding Technique ◽  
Type I ◽  
Aortic Banding ◽  
High Risk Patients ◽  
Risk Patients ◽  
Aortic Arch Repair

Results after aortic arch repair without cardiopulmonary bypass in high-risk patients

2008 ◽  
Vol 56 (S 1) ◽  
Author(s):  
M Czerny ◽  
R Gottardi ◽  
D Zimpfer ◽  
M Dorfmeister ◽  
J Holfeld ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
High Risk ◽  
Aortic Arch ◽  
High Risk Patients ◽  
Risk Patients ◽  
Aortic Arch Repair

Association of infrapopliteal medial arterial calcification with lower-limb amputations in high-risk patients: A systematic review and meta-analysis

2020 ◽  
pp. 1358863X2097973
Author(s):  
Fabrizio Losurdo ◽  
Roberto Ferraresi ◽  
Alessandro Ucci ◽  
Anna Zanetti ◽  
Giacomo Clerici ◽  
...  
Keyword(s):  
Risk Factor ◽  
High Risk ◽  
Lower Limb ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Arterial Calcification ◽  
High Risk Patients ◽  
Patients With Diabetes ◽  
Risk Patients ◽  
Medial Arterial Calcification

Medial arterial calcification (MAC) is a known risk factor for cardiovascular morbidity. The association between vascular calcifications and poor outcome in several vascular districts suggest that infrapopliteal MAC could be a risk factor for lower-limb amputation (LLA). This study’s objective is to review the available literature focusing on the association between infrapopliteal MAC and LLA in high-risk patients. The PubMed and Embase databases were systematically searched. We selected original studies reporting the association between infrapopliteal MAC and LLAs in patients with diabetes and/or peripheral artery disease (PAD). Estimates were pooled using either a fixed-effects or a random-effects model meta-analysis. Heterogeneity was evaluated using the Q and I2 statistics. Publication bias was investigated with a funnel plot and Egger test. The trim-and-fill method was designed to estimate the possibly missing studies. Influence analysis was conducted to search studies influencing the final result. Test of moderators was used to compare estimates in good versus non-good-quality studies. Fifteen articles satisfied the selection criteria ( n = 6489; median follow-up: 36 months). MAC was significantly associated with LLAs (pooled adjusted risk ratio (RR): 2.27; 95% CI: 1.89–2.74; I2 = 25.3%, Q-test: p = 0.17). This association was kept in the subgroup of patients with diabetes (RR: 2.37; 95% CI: 1.76–3.20) and patients with PAD (RR: 2.48; 95% CI: 1.72–3.58). The association was maintained if considering as outcome only major amputations (RR: 2.11; 95% CI: 1.46–3.06). Our results show that infrapopliteal MAC is associated with LLAs, thus suggesting MAC as a possible new marker of the at-risk limb.

scholarly journals Open aortic arch replacement in high-risk patients: the gold standard

2015 ◽  
Vol 49 (2) ◽  
pp. 646-651 ◽  
Author(s):  
Mauro Iafrancesco ◽  
Aaron M. Ranasinghe ◽  
Vamsidhar Dronavalli ◽  
Donald J. Adam ◽  
Martin W Claridge ◽  
...  
Keyword(s):  
High Risk ◽  
Aortic Arch ◽  
Gold Standard ◽  
Aortic Arch Replacement ◽  
High Risk Patients ◽  
Risk Patients

scholarly journals Endovascular repair of aortic arch lesions in high-risk patients or after previous aortic surgery: Midterm results

2010 ◽  
Vol 140 (1) ◽  
pp. 52-58 ◽  
Author(s):  
Ludovic Canaud ◽  
Kheira Hireche ◽  
Jean-Philippe Berthet ◽  
Pascal Branchereau ◽  
Charles Marty-Ané ◽  
...  
Keyword(s):  
High Risk ◽  
Aortic Arch ◽  
Endovascular Repair ◽  
Aortic Surgery ◽  
Midterm Results ◽  
High Risk Patients ◽  
Risk Patients

scholarly journals A selective antibiotic prophylaxis policy for laparoscopic cholecystectomy is effective in minimising infective complications

2013 ◽  
Vol 95 (5) ◽  
pp. 345-348 ◽  
Author(s):  
F Yanni ◽  
P Mekhail ◽  
G Morris-Stiff
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Laparoscopic Cholecystectomy ◽  
High Risk ◽  
Antibiotic Prophylaxis ◽  
Gallstone Disease ◽  
Anaerobic Growth ◽  
Current Evidence ◽  
High Risk Patients ◽  
Risk Patients

Introduction It has been demonstrated previously that the identification of bactibilia during cholecystectomy is associated with the presence of one or more risk factors: acute cholecystitis, common duct stones, emergency surgery, intraoperative findings and age >70 years. Current evidence-based guidance on antibiotic prophylaxis during laparoscopic cholecystectomy (LC) is based on elective procedures and does not take into account these factors. The aim of this study was to assess the effectiveness of a selective antibiotic prophylaxis policy limited to high risk patients undergoing LC with the development of port site infections as the primary endpoint. Methods One hundred consecutive patients undergoing LC under the care of a single consultant surgeon during a one-year period were studied prospectively. Data collected included patient demographics (age, sex) as well as details of the history of gallstone disease to determine those with complex disease and risk factors for bactibilia. A single dose of antibiotics (second generation cephalosporin and metronidazole) was administered on induction to patients with a risk factor present. Information relating to all radiologically or microbiologically confirmed infections was documented. Results Eighty-four of the patients were female and the mean age was 47.7 ±16.0 years. Nineteen LCs were performed as emergencies and the remainder were elective procedures. A risk factor for bactibilia was present in 35 patients. A wound infection was identified in four cases, two of which were Staphylococcus aureus (one methicillin resistant), one was a coagulase negative Staphylococcus and one wound cultured a mixed anaerobic growth. Three of the infections occurred in patients receiving prophylaxis (2 staphylococcal and 1 anaerobic) at intervals of 7, 14 and 19 days respectively. One patient with a body mass index of 32kg/m2 in the ‘no prophylaxis’ group developed a coagulase negative staphylococcal infection at 10 days. No intra or extra-abdominal abdominal infections were identified. Conclusions This study has demonstrated that restricting antibiotic prophylaxis to high risk patients has no detrimental effects in terms of increasing the rate of infections in those with no risk factors. Furthermore, the act of not prescribing to low risk patients will limit costs and the risk of adverse events. It will also reduce the risk of resistance and clostridial infections in this cohort.

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