Pseudoaneurysm of the Aortic Arch After Aortosubclavian Bypass Treated with Endoluminal Stent Grafting

Background . Complete resection of the intimal tear in aortic arch is one of the most complicated tasks in the treatment of aortic dissections. We introduced open stent grafting technique to complete this task with technical easiness. In this study we evaluated the long term efficacy of this procedure from our 12 years experience. Patients and Method. Form January 1994 to December 2004, 59 aortic dissections with intimal tear in aortic arch or proximal descending aorta were operated with open stent grafting technique (age 61.7yrs, 41 type A and 18 type B). Thirty three (55.9%) were in emergency status. All these cases were morphologically excluded from the indication of transluminal endovascular repair. Under deep hypothermic circulatory arrest with antegrade cerebral perfusion, the hybrid prosthesis was inserted into descending aorta through the transected proximal aortic arch in order to achieve intimal tear exclusion. Results. Complete exclusion of the aortic arch intimal tear was achieved in all cases. Operative mortality within 30 days was 3.4%. Major postoperative complications included 4(6.8%) cerebral infarctions, 2 (3.4%) paraplegia, 2 (3.4%) transient paraparesis. Median follow up was 71.2 months (maximum 153 months). One patient (1.7%) showed type I endoleak from the distal end. In 6 patients (10.2%) additional endovascular repair for other thoracic lesions were performed, and only one case with Marfan syndrome required open surgical repair for thoracoabdominal aorta because of expansion of the remaining thoracic dissection. CT scan showed shrinkage of the false channel in 78.6% of the patients. There were no rupture of the remaining dissected aorta and the freedom from aortic related death was 94.7%, 94.7%, and 88.8% at 1,5, and 8 years respectively. Conclusion. This study suggested that open stent grafting is a safe and effective technique with good long-term results. This procedure could be an alternative and standard method to repair aortic dissections with aortic arch intimal tear.

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Stent grafting technique using Matsui-Kitamura (MK) stent for patients with aortic arch aneurysm

European Journal of Cardio-Thoracic Surgery ◽

10.1016/j.ejcts.2004.12.040 ◽

2005 ◽

Vol 27 (4) ◽

pp. 649-653 ◽

Cited By ~ 13

Author(s):

J AKASAKA ◽

K TABAYASHI ◽

Y SAIKI ◽

K ODA ◽

K KUMAGAI ◽

...

Keyword(s):

Aortic Arch ◽

Aortic Arch Aneurysm ◽

Stent Grafting ◽

Grafting Technique ◽

Arch Aneurysm

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Branch stent-grafting for endovascular repair of chronic aortic arch dissection

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2019.10.184 ◽

2019 ◽

Cited By ~ 3

Author(s):

Lei Zhang ◽

Qingsheng Lu ◽

Hongqiao Zhu ◽

Zaiping Jing

Keyword(s):

Aortic Arch ◽

Endovascular Repair ◽

Stent Grafting

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Delayed Aortic Stent Collapse in Blunt Traumatic Aortic Injury Repair

Aorta ◽

10.1055/s-0039-3401022 ◽

2019 ◽

Vol 07 (05) ◽

pp. 129-136

Author(s):

Abdullah Alhaizaey ◽

Badr Aljabri ◽

Musaad Alghamdi ◽

Ali AlAhmari ◽

Ahmed Abulyazied ◽

...

Keyword(s):

Aortic Arch ◽

Age Groups ◽

Young Patients ◽

Aortic Injury ◽

Stent Grafts ◽

Mortality And Morbidity ◽

Technical Success Rate ◽

Stent Grafting ◽

Blunt Traumatic Aortic Injury

Abstract Background Endovascular stent grafting has emerged as an option to treat traumatic aorta injuries with reported significantly low mortality and morbidity. Stent collapse is one of the complications that can occur in this type of treatment. The aim of this article is to analyze the expected cause of stent collapse and to draw attention to the importance of the surveillance follow-up, as this phenomenon may occur late postdeployment. Methods A retrospectively collected dataset from the two highest volume trauma centers in Saudi Arabia was analyzed between April 2007 and October 2012. A total of 66 patients received stent grafts for traumatic aortic injury and were included in the study. We apply Ishimaru's anatomical aortic arch zones and Benjamin's aortic injury grading systems. There were 35 patients with aortic injury at zone 2, 26 patients in zone 3, and 5 patients in zone 4. About 96% (63) of the injuries were grades 2 and 3, including large intimal flap or aortic wall pseudoaneurysm with change in wall contour. The technical success rate, as defined by complete exclusion of lesions without leaks, stroke, arm ischemia or stent-related complications, was 90%. Results Proximal stent collapse occurred in 4.5% of patients (3 of 66 inserted stents) during follow-up of 4 to 8 years (mean, 6 years). Patients with stent collapse tended to have an acute aortic arch angle with long-intraluminal stent lip, when compared with patients with noncollapsed stents. Intraluminal lip protrusion more than 10-mm increased collapse (p < 0.001). Stent-grafts sizes larger than 28 mm also demonstrated a higher collapse rate (p < 0.001). Conclusions The risk of stent collapse appears related to poor apposition of the stent due to severe aortic arch angulation in young patients and to large stent sizes (>28 mm). Such age groups may have more anatomical and aortic size changes during the growth. Clinical and radiological surveillance is essential in follow-up after stent-graft treatment for traumatic aortic injury.

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