Avoiding Arch Manipulation with Catheterization of Left Subclavian Artery for Endovascular Repair of Distal Descending Aorta: Acibadem Technique

2020 ◽  
Vol 15 (2) ◽  
pp. 163-165
Author(s):  
Sahin Senay ◽  
Serdar Akansel ◽  
Ahmet Ümit Güllü ◽  
Cem Alhan
Keyword(s):  
Subclavian Artery ◽  
Endovascular Repair ◽  
Open Surgery ◽  
Stroke Risk ◽  
Left Subclavian Artery ◽  
Ascending Aorta ◽  
Thoracic Endovascular Aortic Repair ◽  
Descending Aorta ◽  
Aortic Repair ◽  
A New Technique

Although thoracic endovascular aortic repair (TEVAR) is associated with reduced mortality and shorter hospital stay compared to open surgery, the decrease in stroke risk did not reach the desired rates. Aortic arch manipulation is one of the main concerns leading to stroke during TEVAR. Here, we describe a new technique called “Acibadem Technique” to avoid arch and ascending aorta manipulation with catheterization of left subclavian artery for endovascular distal descending aortic repair.

Endovascular repair of ascending aortic diseases with custom-made endografts

2021 ◽  
Author(s):  
Gabriele Piffaretti ◽  
Martin Czerny ◽  
Vicente Riambau ◽  
Roman Gottardi ◽  
Thomas Wolfgruber ◽  
...  
Keyword(s):  
Endovascular Repair ◽  
Open Surgery ◽  
Ascending Aorta ◽  
Thoracic Endovascular Aortic Repair ◽  
Interquartile Range ◽  
Endovascular Aortic Repair ◽  
Aortic Lesion ◽  
Aortic Repair ◽  
Custom Made

Abstract OBJECTIVES The aim of this article is to report the mid-term results of ascending thoracic endovascular aortic repair using a custom-made device (CMD). METHODS This was a retrospective study performed at tertiary centres. Nine patients considered unfit for open surgery received elective total endovascular repair of the ascending aorta with a Relay® (Terumo Aortic, Sunrise; FL, USA) CMD: pseudoaneurysn (n = 5), localized dissection (n =3) and contained rupture (n = 1). RESULTS Primary clinical success was achieved in all patients with no major complications and no early conversion to open surgery. All patients were discharged home and independent: median length of stay was 7 days (interquartile range, 6–18). No patient was lost to follow-up at a median 26 months (interquartile range, 12–36). Three patients died 2, 6 and 24 months after intervention; 1 was aorta related (late aorto-atrial fistula due to infection that required open surgery). At the last follow-up available, no endoleaks, migrations, fractures or ruptures were observed in the remaining 6 patients. CONCLUSIONS Ascending thoracic endovascular aortic repair with Terumo Aortic CMDs was technically feasible, effective and safe in very selected lesions. CMDs showed good ascending aorta conformability with different configurations and diameters, and satisfactory mid-term durability as shown by both structural integrity and aortic lesion exclusion.

scholarly journals Results With a Selective Revascularization Strategy for Left Subclavian Artery Coverage During Thoracic Endovascular Aortic Repair

2011 ◽  
Vol 92 (1) ◽  
pp. 97-103 ◽  
Author(s):  
Teng C. Lee ◽  
Nicholas D. Andersen ◽  
Judson B. Williams ◽  
Syamal D. Bhattacharya ◽  
Richard L. McCann ◽  
...  
Keyword(s):  
Subclavian Artery ◽  
Left Subclavian Artery ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Aortic Repair

scholarly journals Management of the Left Subclavian Artery During Thoracic Endovascular Aortic Repair

2016 ◽  
Vol 64 (5) ◽  
pp. 1535
Author(s):  
Kyle A. Arsenault ◽  
Jason Faulds ◽  
Darren Klass ◽  
Joel Price ◽  
Michael T. Janusz
Keyword(s):  
Subclavian Artery ◽  
Left Subclavian Artery ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Aortic Repair

scholarly journals Thoracic Endovascular Aortic Repair With Left Subclavian Artery Coverage Is Associated With a High 30-Day Stroke Incidence With or Without Concomitant Revascularization

2020 ◽  
Vol 27 (5) ◽  
pp. 769-776
Author(s):  
Rens R. B. Varkevisser ◽  
Nicholas J. Swerdlow ◽  
Livia E. V. M. de Guerre ◽  
Kirsten Dansey ◽  
Chun Li ◽  
...  
Keyword(s):  
Subclavian Artery ◽  
Real World ◽  
Left Subclavian Artery ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Stroke Incidence ◽  
Perioperative Stroke ◽  
Factors Associated ◽  
Real World Setting ◽  
Aortic Repair

Purpose: To evaluate the perioperative stroke incidence following thoracic endovascular aortic repair (TEVAR) with differing left subclavian artery (LSA) coverage and revascularization approaches in a real-world setting of a nationwide clinical registry. Materials and Methods: The National Surgical Quality Improvement Program registry was interrogated from 2005 to 2017 to identify all nonemergent TEVAR and/or open LSA revascularization procedures. In this time frame, 2346 TEVAR cases met the selection criteria for analysis. The 30-day stroke incidence was compared between patients undergoing TEVAR with (n=888) vs without (n=1458) LSA coverage, for those with (n=228) vs without (n=660) concomitant LSA revascularization among those with coverage, and following isolated LSA revascularization for occlusive disease (n=768). Multivariable logistic regression was employed for risk-adjusted analyses and to identify factors associated with stroke following TEVAR. Results of the regression analyses are presented as the adjusted odds ratio (OR) with 95% confidence interval (CI). Results: The stroke incidence was 2.3% following TEVAR without vs 5.2% with LSA coverage (p<0.001). In TEVARs with LSA coverage, the stroke incidence was 7.5% when the LSA was concomitantly revascularized and 4.4% without concomitant revascularization, while stroke occurred in 0.5% of isolated LSA revascularizations. Of 33 TEVAR patients experiencing a perioperative stroke, 8 (24%) died within 30 days. LSA coverage was associated with stroke both with concomitant revascularization (OR 4.0, 95% CI 2.2 to 7.5, p<0.001) and without concomitant revascularization (OR 2.2, 95% CI 1.3 to 3.8, p=0.002). Other preoperative factors associated with stroke were dyspnea (OR 1.8, 95% CI 1.1 to 3.0, p=0.014), renal dysfunction (OR 2.2, 95% CI 1.0 to 3.8, p=0.049), and international normalized ratio ≥2.0 (OR 3.6, 95% CI 1.0 to 13, p=0.045). Conclusion: Stroke following TEVAR with LSA coverage occurs frequently in the real-world setting, and concurrent LSA revascularization was not associated with a lower stroke incidence.

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