Clinical outcomes in hybrid repair procedures for pathologies involving the aortic arch

Objective Fifty patients with complex aortic disease, who received hybrid treatment of the aortic arch with supra-aortic debranching and endovascular stent-graft repair, were evaluated in regard to events of primary (survival and technical success) and secondary (procedure-related complications) interest. Methods The single-center study was conducted over an eight-year period from December 2004 to December 2012. Treated medical conditions included 23 aortic aneurysms (46%), 21 aortic dissections (42%), and six penetrating aortic ulcers (12%). Procedures were divided into groups of elective, urgent, and emergent. Results Twenty-eight (56%) patients were operated electively, 15 (30%) urgently, and seven (14%) emergently. Sternotomy, cardiopulmonary bypass, and deep hypothermic circulatory arrest were required in 12 (24%) patients. The primary technical success rate was 86% and raised to 92% ( n = 46) of secondary technical success rate after therapy of three type I endoleaks. The 30-day mortality added up to 16.0%, and the mean time of survival was 49.3 months. In a total of eight (16%) patients, an endoleak occurred (five endoleaks type I, three endoleaks type II), while nine (18%) of patients suffered a perioperative stroke. Conclusions In severely ill patients with complex aortic diseases, hybrid therapy may offer a promising alternative to conventional open repair.

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Pre-fenestration endovascular repair of aortic diseases in patients with zone 2 segment: A single-center experience

Vascular ◽

10.1177/1708538120979874 ◽

2020 ◽

pp. 170853812097987

Author(s):

Yu-Jing Zhang ◽

Lei Bai ◽

Liang Wang ◽

Hong-Rui Shi ◽

Jiang-Long Liu ◽

...

Keyword(s):

Aortic Arch ◽

Stent Graft ◽

Endovascular Repair ◽

Aortic Rupture ◽

Type I ◽

Aortic Diseases ◽

Technical Success Rate ◽

Thoracic Endovascular Repair ◽

Aortic Lesions

Objective The present study aims to analyze the outcomes of three cases of pre-fenestration and branch stent-graft endovascular repair of aortic disease with zone 2 aortic lesions. Methods From August 2017 to June 2018, three patients with zone 2 aortic lesions underwent thoracic endovascular repair with innominate artery, left common carotid artery, and left subclavian artery recannulation using pre-fenestration and branched stent-grafts to preserve the patency of the aortic arch branches. Results The technical success rate was 100%. One patient had a proximal type I endoleak with no need for additional treatment. The overall mortality was 0%. All branches were patent. The follow-up period lasted for 2–15 months, with one patient lost to follow-up. There were no conversions to open surgical repair, aortic rupture, paraplegia, or retrograde type A aortic dissection. Conclusion The use of a pre-fenestration and branch stent-graft for the thoracic endovascular repair of zone 2 aortic lesions is a feasible and effective method for aortic arch branch revascularization. The risk of this surgical procedure is high, requiring significant expertise. The procedure should be conducted only in experienced centers. Durability concerns should be assessed in future studies with long-term follow-up.

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Preliminary Dual-Center Experience with the Bolton Treovance Endograft

Vascular and Endovascular Surgery ◽

10.1177/1538574417729264 ◽

2017 ◽

Vol 51 (8) ◽

pp. 533-537 ◽

Cited By ~ 8

Author(s):

Arron Thind ◽

Dhruv Sarma ◽

Abdel Kader Allouni ◽

Feras Abdallah ◽

David Murray ◽

...

Keyword(s):

Aortic Aneurysm ◽

Success Rate ◽

Stent Graft ◽

Type I ◽

Complication Rates ◽

Technical Success ◽

Technical Success Rate ◽

Average Maximum ◽

Aneurysm Repair

Purpose: To present the performance and safety of the Treovance stent graft for endovascular aortic aneurysm repair in a “real-world” patient cohort. Methods: Patients from 2 centers, deemed unfit for open repair, were electively treated with the Treovance endograft. Clinical preoperative, operative, and up to 1-year postoperative follow-up data of patients were retrospectively analyzed. Results: This study included 46 patients with abdominal aortic aneurysm (44 male), mean age of 78 years ± 8 standard deviation (SD; range: 58-93 years). All met the manufacturer’s recommended anatomical requirements: average maximum sac diameter 63 mm ± 10 SD (range: 52-86 mm), proximal neck length 29 mm ± 12 SD (range: 11-60 mm), and neck angulation 30° ± 21 SD (range: 0°-70°). Fourteen had moderate to severe iliac tortuosity. A primary technical success rate of 80% was achieved (100% assisted primary technical success rate): 7 patients required adjunctive procedures intraoperatively and 2 successful treatments for type I endoleaks, which occurred within 24 hours postoperatively. There was 100% survival at 1-year follow-up; however, 4 (8.7%) patients required reintervention: 1 for a type I endoleak, 2 for limb stenosis, and 1 for a type II endoleak with an enlarging sac. No other device-related complications were identified. Reintervention and complication rates in hostile versus nonhostile anatomies were not statistically significant ( P = .28 and P = .42, respectively). Conclusion: The Treovance stent graft has a comparable safety profile to other next-generation stent grafts during the first year after endovascular aneurysm repair, which provides a rationale for further interrogation of its outcomes through clinical trials.

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Endovascular recanalization for symptomatic non-acute middle cerebral artery occlusion: proposal of a new angiographic classification

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2020-016692 ◽

2020 ◽

pp. neurintsurg-2020-016692

Author(s):

Feng Gao ◽

Xu Guo ◽

Ju Han ◽

Xuan Sun ◽

Zhenhua Zhou ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Success Rate ◽

Complication Rate ◽

Type I ◽

Technical Success ◽

Technical Success Rate ◽

Endovascular Recanalization ◽

Mca Occlusion ◽

Perioperative Complication

BackgroundEndovascular recanalization for medically refractory non-acute middle cerebral artery (MCA) occlusion remains a clinical dilemma, and limited data are available. We report the multicenter clinical results of endovascular recanalization for symptomatic non-acute MCA occlusion and propose a new angiographic classification to explore which subgroups of patients are most suitable for this treatment.MethodsFrom January 2015 to December 2019, 50 consecutive patients who underwent endovascular recanalization for recurrent symptomatic non-acute MCA occlusion were analyzed retrospectively. All patients were divided into three types according to the angiographic classification. The technical success rate, periprocedural complications, rate of stroke or death within 30 days, and follow-up results were evaluated.ResultsThe overall technical success rate was 84.0% (42/50). The perioperative complication rate was 14.0% (7/50), and the rate of stroke or death within 30 days was 12.0% (6/50). The revascularization success rate was higher in patients with type I occlusion than in those with type II or type III occlusion (95.5%, 83.3%, and 60%, respectively; p=0.014), and the opposite was true for the perioperative complication rate (4.5%, 11.1%, and 40.0%, respectively; p=0.013). The median clinical follow-up period was 13.4 months (IQR 12.5–15.6), and the rate of stroke or death beyond 30 days was 8.3%.ConclusionsEndovascular recanalization for non-acute MCA occlusion is technically feasible in reasonably selected patients, especially type I patients, and has potential as an alternative option for patients with recurrent stroke or transient ischemic attack in the short term despite optimal medical therapy.

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Chimney technique in the endovascular management of complex aortic disease

Vascular ◽

10.1258/vasc.2011.ra0056 ◽

2012 ◽

Vol 20 (5) ◽

pp. 251-261 ◽

Cited By ~ 11

Author(s):

George A Antoniou ◽

Andrew Schiro ◽

Stavros A Antoniou ◽

Finn Farquharson ◽

David Murray ◽

...

Keyword(s):

Success Rate ◽

Type I ◽

Early Type ◽

Technical Success ◽

Conversion To Open Surgery ◽

Technical Success Rate ◽

Chimney Technique ◽

Aortic Pathology ◽

Type I Endoleak

The objective of this study was to systematically review the literature reporting on the chimney technique and perform an analysis of the outcomes. A search of electronic databases was undertaken to identify all studies reporting on the outcome of the chimney technique. The selected articles were divided into those reporting on the treatment of aortic pathology involving the visceral and those involving the supra-aortic branches. Twenty-one articles reporting on the treatment of juxta/supra-renal aorta and aortic arch disease in 102 and 37 patients, respectively, were identified. In the visceral group, an overall technical success rate of 91% was achieved, the perioperative major morbidity and mortality rates were 17 and 5%, respectively, and an early type I endoleak developed in 13 patients (13%). During follow-up, one patient died of intestinal ischemia. In the supra-aortic group, the technical success rate was recorded in 95%, and three patients (8%) developed an early type I endoleak. Three patients (13%) required conversion to open surgery during follow-up. In conclusion, this technique may be viewed as a complementary technique in high-surgical-risk patients.

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Hybrid Approach in Acute and Chronic Aortic Disease

Medicina ◽

10.3390/medicina58010049 ◽

2021 ◽

Vol 58 (1) ◽

pp. 49

Author(s):

Michele Murzi ◽

Pier Andrea Farneti ◽

Antonio Rizza ◽

Silvia Di Sibio ◽

Cataldo Palmieri ◽

...

Keyword(s):

Aortic Arch ◽

Stent Graft ◽

Circulatory Arrest ◽

Hybrid Approach ◽

Aortic Disease ◽

Aortic Aneurysms ◽

Single Stage ◽

Elephant Trunk ◽

Profound Hypothermia ◽

Elephant Trunk Technique

The management of patients with aortic disease that involves the ascending aorta, the aortic arch, and the descending aorta represent a surgical challenge. Open surgical repair remains the gold standard for aortic arch pathologies. However, this operation requires a cardiopulmonary bypass and a period of profound hypothermia and circulatory arrest, which carries a substantial rate of mortality and morbidity. For these reasons, hybrid arch repair that involves a combination of open surgery with endovascular aortic stent graft placement has been introduced as a therapeutic alternative for those patients deemed unfit for open surgical procedures. Hybrid repair requires varying degrees of invasiveness and can be performed as a single-stage procedure or as a two-stage procedure. The choice of the technique is multifactorial, depending on the characteristics of the diseased arch with regard to position of the stent graft proximal landing zone, patient fitness and comorbid status, as well as surgical expertise and hospital facilities. Among the evolving hybrid procedures is the so-called “frozen” or stented elephant trunk technique. Adapted from the classical elephant trunk technique, this approach facilitates the repair of a concomitant aortic arch and proximal descending aortic aneurysms in a single stage under circulatory arrest. This technique is increasingly being used to treat extensive thoracic aortic disease and has shown promising results.

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Evaluation of percutaneous transcatheter embolization for pulmonary arteriovenous malformations

BMC Pulmonary Medicine ◽

10.1186/s12890-021-01448-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

ZhengZhong Wu ◽

JunQing Lin ◽

WeiZhu Yang ◽

Na Jiang ◽

Ning Huang ◽

...

Keyword(s):

New York ◽

Success Rate ◽

Arteriovenous Malformations ◽

Heart Association ◽

Transcatheter Embolization ◽

Pulmonary Arteriovenous Malformations ◽

Technical Success ◽

Arterial Blood Gas ◽

Technical Success Rate ◽

Arterial Blood

Abstract Background The purpose of this study was to assess the safety and efficacy of percutaneous transcatheter embolization (TCE) for the treatment of pulmonary arteriovenous malformations (PAVMs). Methods Forty-three consecutive patients (n = 17 males; n = 26 females) with 72 untreated PAVMs underwent coil and/or plug embolization between January 2010 and February 2018. The mean patient age was 42 ± 14 years (range 19–71 years). The median size of the feeding artery was 7.9 ± 2.9 mm (range 3.5–14.0 mm). The arterial blood gas level and cardiac function of all patients were analysed. The technical success rate, recanalization rate, and complications were evaluated. Computed tomography angiography (CTA) examinations were scheduled for 12 months after treatment and every 2–4 years thereafter. Results Twenty-five PAVMs were treated with coils alone, twenty-one were treated with plugs alone, and twenty-six were treated with both coils and plugs. The technical success rate was 100%. There were no complications during operation. However, one patient (2.3%) had pulmonary thrombosis and embolism post-operation. The patients’ pre-operative and post-operative PaO2 and SaO2 levels were significantly different (p < 0.01). A comparison of the New York Heart Association (NYHA) grade before and after embolization in all patients showed a significant decrease in the post-operative grade (p < 0.01). The 72 PAVMs were divided into three groups (coils only group [n = 25], plugs only group [n = 21], and coils/plugs combined group [n = 26]). After 12 months of follow-up, there were seven reperfusion PAVMs in the coil group, seven reperfusion PAVMs in the plug group, and 1 reperfusion PAVM in the combined group. There were significant differences between the two groups and the combined group. Conclusion Percutaneous TCE is safe and effective for the treatment of PAVMs. A combination of coils and vascular plugs may be useful for preventing recanalization after the embolization of PAVMs.

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Modified percutaneous radiologic gastrostomy technique without endoscopic or nasogastric access

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-019-0086-8 ◽

2019 ◽

Vol 50 (1) ◽

Author(s):

Reda Tabashy ◽

Amira Darwish ◽

Ashraf Ibrahim ◽

Mohamed Gad El-Mola

Keyword(s):

Esophageal Cancer ◽

Success Rate ◽

Nasogastric Tube ◽

Conventional Technique ◽

Fluoroscopic Guidance ◽

Efficacy And Safety ◽

Technical Success ◽

Technical Success Rate ◽

Major Complications ◽

Percutaneous Radiologic Gastrostomy

Abstract Background The aim of this study is to evaluate the efficacy and safety of a modified percutaneous radiologic gastrostomy (MPRG) technique under ultrasound and fluoroscopic guidance without endoscopic or nasogastric access. Results The study included 24 patients: 10 males and 14 females whose ages ranged from 44 to 80 years old. Ten patients had esophageal cancer and 14 patients had neck cancer. Technical success was achieved in 23 out of the 25 procedures (92%). Two procedures failed (8%) and were converted to the conventional technique by using the nasogastric tube. No major complications were reported. Minor complications were observed in 5 patients (20%): intraperitoneal air and contrast leakage in 4 patients and focal mucosal dissection by the contrast in 1 patient. Conclusion The MPRG has high technical success rate, is safe with no major complications, and is most feasible when endoscopic or nasogastric access cannot be performed.

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Feasibility and Techniques of Securing 3D-Safety Margin in Superselective Transarterial Chemoembolization to Improve Local Tumor Control for Small Hepatocellular Carcinoma: An Intend-to-Treat Analysis

Liver Cancer ◽

10.1159/000512337 ◽

2021 ◽

Vol 10 (1) ◽

pp. 63-71

Author(s):

Ching Charoenvisal ◽

Toshihiro Tanaka ◽

Hideyuki Nishiofuku ◽

Hiroshi Anai ◽

Takeshi Sato ◽

...

Keyword(s):

Success Rate ◽

Tumor Recurrence ◽

Safety Margin ◽

Small Hepatocellular Carcinoma ◽

Technical Success ◽

Local Tumor ◽

Local Tumor Recurrence ◽

3D Images ◽

Technical Success Rate ◽

Treat Analysis

Introduction: The aim of this study was to investigate the technical success rate of obtaining 3D-safety margin in superselective conventional transarterial chemoembolization (cTACE) using 3D images for small hepatocellular carcinoma (HCC). Methods: Consecutive 48 HCC nodules (diameter, 1–3 cm) in 44 patients were intentionally treated by superselective cTACE in an attempt to achieve 3D-safety margin. Superselective CT during hepatic arteriography (CTHA) was obtained before cTACE. When negative 3D-safety margin was found, branches supplied into the margin area were detected by using a 3D workstation. The technical success rate to obtain 3D-safety margin was investigated by intend-to-treat analysis. Local tumor recurrence rate and adverse events were also evaluated. Result: Nine of 48 tumors (18.8%) had 3D-safety margin in the initial superselective CTHA. After pulling back of the catheter and/or selection of another branch based on 3D images, 3D-safety margin was finally achieved in 45 (93.8%). There were 8 of 46 tumors (17.4%) with local recurrence after 5-year follow-up. Grade 3–4 of aspartate aminotransferase, alanine aminotransferase, and total bilirubin were found in 38.6, 36.4, and 2.3%, respectively. One portal vein thrombus and 3 biliary dilation or biloma were developed. Conclusion: Superselective cTACE obtaining 3D-safety margin in small HCC was feasible with a high success rate by using 3D images, which could be tolerable and prevent local tumor recurrence.

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Packing Technique with or without Remodeling for Endovascular Coil Embolization of Renal Artery Aneurysms: Safety, Efficacy and Mid-Term Outcomes

Journal of Clinical Medicine ◽

10.3390/jcm10020326 ◽

2021 ◽

Vol 10 (2) ◽

pp. 326

Author(s):

Grégory Secco ◽

Olivier Chevallier ◽

Nicolas Falvo ◽

Kévin Guillen ◽

Pierre-Olivier Comby ◽

...

Keyword(s):

Renal Artery ◽

Success Rate ◽

Coil Embolization ◽

Preventive Treatment ◽

Parent Artery ◽

Technical Success ◽

Technical Success Rate ◽

Endovascular Coil Embolization ◽

Lower Morbidity

The endovascular treatment of renal artery aneurysms (RAAs) has lower morbidity and shorter stay lengths compared to surgical repair. Here, we describe coil packing with or without remodeling and assess outcomes and complications. We retrospectively identified the 19 consecutive preventive endovascular RAA coil embolizations done in 18 patients at our center in 2010–2020. Patient and aneurysm characteristics, technical success rate, complications, and recurrences were recorded. Mean patient age was 63 ± 13 years. The RAA was >1.5 cm in 11 cases, and in four cases, the aneurysm-to-parent artery size ratio was >2. Simple coiling was performed for 11 (57.9%) aneurysms, stent-assisted coiling for seven (36.8%) aneurysms, and balloon-assisted coiling for one (5.3%) aneurysm. Technical success rate was 100%. Complete definitive RAA exclusion was achieved with a single procedure for 17 (89.5%) aneurysms, whereas two (10.5%) aneurysms required a repeat procedure. Four minor complications occurred but resolved with no long-term consequences. No major complications occurred during the mean follow-up of 41.1 ± 29.7 months. Coil embolization by sac packing or remodeling proved very safe and effective. Together with the known lower morbidity and shorter stay length compared to open surgery, these data indicate that this endovascular procedure should become the preventive treatment of choice for RAAs.

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Technical approach and outcomes of failed infrarenal endovascular aneurysm repairs rescued with fenestrated and branched endografts

CVIR Endovascular ◽

10.1186/s42155-019-0075-z ◽

2019 ◽

Vol 2 (1) ◽

Cited By ~ 1

Author(s):

Jesse Manunga ◽

Larissa I. Stanberry ◽

Peter Alden ◽

Jason Alexander ◽

Nedaa Skeik ◽

...

Keyword(s):

Adverse Events ◽

Stent Graft ◽

Graft Patency ◽

Hospital Length ◽

Aortic Aneurysms ◽

Hospital Length Of Stay ◽

Type I ◽

Technical Success ◽

Vessel Patency ◽

Major Adverse Events

Abstract Background Endovascular rescue of failed infrarenal repair (EVAR) has emerged as an attractive option to stent graft explantation. The procedure, however, is underutilized due to limited devices accessibility and the challenges associated with their implantation in this patient population. The purpose of this study was to report our outcomes and discuss our approach to rescuing previously failed infrarenal endovascular aneurysm repairs (EVAR) with fenestrated/branched endografts (f/b-EVAR). Methods A retrospective analysis of prospectively collected data of consecutive patients with failed EVAR rescued with f/b-EVAR at our institution from November 2013 to March 2019 was conducted. The study primary end point was technical success; defined as the implantation of the device with no type I a/b or type III endoleak or conversion to open repair. Secondary endpoints included major adverse events (MAEs), graft patency and reintervention rates. Results During this time, 202 patients with complex aortic aneurysms were treated with f/b-EVAR. Of these, 19 patients (Male: 17, mean age 79 ± 7 years) underwent repair for failed EVAR. The median time from failed repair to f/b-EVAR was 48 (30, 60) months. Treatment failure was attributed to stent graft migration in 9 (47.4%) patients, disease progression in 5 (26.3%), short initial neck in 3 (15.8%) and unable to be determined in 2 (10.5%). Three patients were treated urgently with surgeon modified stent graft. Technical success was achieved in 18 patients (95%), including two who had undergone emergent repair for rupture. Seventy-two targeted vessels (97.3%) were successfully incorporated. Sixteen (84.2%) patients required a thoracoabdominal repair to achieve a durable seal. Major adverse events (MAEs) occurred in 3 patients (15.7%) including paralysis and death in one (5.3%), compartment syndrome and temporary dialysis in another and laparotomy with snorkeling of one renal and bypass of the other in the third patient. Median (IQR) hospital length of stay was 3 (2, 4) days. Late reintervention, primary target vessel patency and primary assisted patency rates were 5.3%, 98.6% and 100%, respectively. Conclusion Implantation of f/b-EVAR in patients with failed previous EVAR is a challenging undertaking that can be performed safely with a high technical success and low reintervention rates.

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