Application of an extracorporeal prefenestrated stent graft in endovascular repair of ascending aorta and aortic arch lesions

Vascular ◽  
2020 ◽  
pp. 170853812095087
Author(s):  
Liang Wang ◽  
Lei Bai ◽  
Yujing Zhang ◽  
Jianglong Liu ◽  
Xiaodong Li
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Endovascular Repair ◽  
Spinal Cord Ischemia ◽  
False Lumen ◽  
Ascending Aorta ◽  
Type I ◽  
Stent Grafting ◽  
Surgical Methods ◽  
Type I Endoleak

Objectives Aortic dissection involving the ascending aorta and aortic arch is a serious condition. Treatment using traditional surgical methods has certain disadvantages. This study investigated the effectiveness of thoracic endovascular repair of aortic dissection using an external prefenestrated stent. Methods We present a series of aortic dissection cases involving the ascending aorta and aortic arch treated with an external prefenestrated stent. Results Postoperative follow-up of the patients showed that all stents were released at the proper position and that branch vessels were not occluded, and there were no instances of type I endoleak. One patient died suddenly one week after surgery; another experienced retrograde type A aortic dissection in the second week; and type I endoleak occurred in one patient in the first week, although this resolved within six months. No serious complications such as cerebrovascular events, acute spinal cord ischemia, and paraplegia occurred during the perioperative period. All patients had false lumen thrombosis in the ascending aorta and aortic arch. Conclusion Prefenestrated stent grafting is a feasible treatment option for repairing an entry tear in the ascending aorta.

scholarly journals Replacement of ascending aorta and aortic arch combined with implantation of bare stent Djumbodis® Dissection System as a treatment of type I aortic dissection

2016 ◽  
Vol 20 (4) ◽  
pp. 66 ◽  
Author(s):  
R. N. Komarov ◽  
Yu. V. Belov ◽  
P. A. Karavaykin ◽  
M. A. Soborov
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Conflict Of Interest ◽  
Prolonged Mechanical Ventilation ◽  
Circulatory Arrest ◽  
False Lumen ◽  
Operation Time ◽  
Ascending Aorta ◽  
Type I ◽  
Cardiovascular Failure

<p><strong>Aim.</strong> The aim of this study is to show the outcomes of an open intervention on the ascending aorta and arch combined with stenting of aorta in type I aortic dissection.<br /><strong>Methods.</strong> 6 patients with type I aortic dissection underwent implantation of Djumbodis® Dissection System bare stents at I.M. Sechenov First Moscow Medical University’s Aortic and Cardiovascular Surgery Clinic. In 4 patients, aortic stenting was combined with ascending aorta replacement, in 1 patient, hemiarch ascending aorta and arch replacement was performed and in 1 patient aorta and arch replacement was complemented with a Sun procedure.<br /><strong>Results.</strong> Total operation time, cardiopulmonary bypass time, cross clamp time and hypothermic circulatory arrest time were just similar to those performed in conventional open surgery. There were no intraoperative deaths in this series. 30-day mortality was 16.7 % (1 patient). The patient died because of progressive respiratory and cardiovascular failure, encephalopathy, and gastrointestinal bleeding. 1 patient had acute renal failure and left leg ischemia because of the false lumen thrombosis, 1 patient suffered from cardiac tamponade and 1 patient underwent prolonged mechanical ventilation. Total false lumen thrombosis developed in 1 patient, 4 patients had partial false lumen thrombosis, and in 1 patient the false lumen remained patent.<br /><strong>Conclusion.</strong> Stenting of aortic arch and descending aorta is a good alternative to aortic arch replacement in type I aortic dissection. It promotes stabilization of false and true lumen diameters and global aortic diameter.</p><p>Received 18 October 2016. Accepted 7 November 2016.</p><p><strong>Funding:</strong> The study had no sponsorship.<br /><strong>Conflict of interest:</strong> The authors declare no conflict of interest.<br /><strong>Author contributions</strong><br />Conceptualization and study design: Komarov R.N., Soborov M.A.<br />Material acquisition and analysis: Karavaykin P.A. <br />Project curation: Komarov R.N., Belov Yu.V.<br />Article writing: Karavaykin P.A. <br />Review &amp; editing: Komarov R.N., Belov Yu.V., Soborov M.A.</p>

scholarly journals Aortic Geometric Alteration Associated With Acute Type B Aortic Dissection: Angulation, Tortuosity, and Arch Type

2021 ◽  
Vol 12 ◽  
Author(s):  
Likun Sun ◽  
Jiehua Li ◽  
Lunchang Wang ◽  
Quanming Li ◽  
Hao He ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
False Lumen ◽  
Ascending Aorta ◽  
Acute Type ◽  
Type B ◽  
Type B Aortic Dissection ◽  
True Lumen ◽  
Factors Associated ◽  
Geometric Factors

Background: Acute type B aortic dissection is a highly serious aortic pathology. Aortic geometric parameters may be useful variables related to the occurrence of acute type B aortic dissection (aTBAD). The aim of the study is to delineate the alteration in aortic geometric parameters and analyze the specific geometric factors associated with aTBAD.Methods: The propensity score matching method was applied to control confounding factors. The aortic diameter, length, angulation, tortuosity, and type of aortic arch of the aTBAD and control group were retrospectively analyzed via three-dimensional computed tomography imaging created by the 3mensio software (version 10.0, Maastricht, The Netherlands). The geometric variables of true lumen and false lumen in the descending aorta were measured to estimate the severity of aortic dissection. Multivariable logistic regression models were used to investigate the significant and specific factors associated with aTBAD occurrence. The area under the receiver operating characteristic curve (AUC) was used to estimate the performance of the model.Results: After propensity score matching, 168 matched pairs of patients were selected. The ascending aorta and aortic arch diameters were dilated, and the ascending aorta and total aorta lengths were elongated in aTBAD group significantly (P &lt; 0.001). The ascending aorta and aortic arch angulations in the aTBAD group were sharper than those of the controls (P = 0.01, P &lt; 0.001, respectively). The aortic arch and total aorta tortuosities were significantly higher in the aTBAD group (P = 0.001, P &lt; 0.001, respectively). There were more type III arch patients in the aTBAD group than the controls (67.9 vs. 22.6%). The true lumen angulation was sharper than that in the false lumen (P &lt; 0.01). The true lumen tortuosity was significantly lower than that in the false lumen (P &lt; 0.001). The multivariable models identified that aortic arch angulation, tortuosity, and type III arch were independent and specific geometric factors associated with aTBAD occurrence. The AUC of the multivariable models 1, 2, 3 were 0.945, 0.953, and 0.96, respectively.Conclusions: The sharper angulation and higher tortuosity of aortic arch and type III arch were the geometric factors associated with aTBAD in addition to the ascending aorta elongation and aortic arch dilation. The angulation and tortuosity of the true and false lumens may carry significant clinical implications for the treatment and prognosis of aTBAD.

Endoanchor stenting for the repair of a Type I endoleak in the aortic arch following the endovascular repair of a Kommerrell's diverticulum

2016 ◽  
Vol 31 (8) ◽  
pp. 541-543 ◽  
Author(s):  
Rohan S. Menon ◽  
Corbin Muetterties ◽  
George William Moser ◽  
Grayson H. Wheatley
Keyword(s):  
Aortic Arch ◽  
Endovascular Repair ◽  
Type I ◽  
Type I Endoleak

Ascending aorta and aortic arch replacement after previous treatment of DeBakey type I acute aortic dissection

2015 ◽  
Vol 8 (6) ◽  
pp. 87
Author(s):  
K. O. Barbukhatti ◽  
S. Yu. Boldyrev ◽  
G. I. Kim ◽  
O. N. Ponkina ◽  
S. S. Babeshko ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Acute Aortic Dissection ◽  
Previous Treatment ◽  
Ascending Aorta ◽  
Type I ◽  
Aortic Arch Replacement

Homemade Fenestrated Stent-Grafts for Complete Endovascular Repair of Aortic Arch Dissections

2019 ◽  
Vol 26 (5) ◽  
pp. 645-651 ◽  
Author(s):  
Ludovic Canaud ◽  
Baris Ata Ozdemir ◽  
Lucien Chassin-Trubert ◽  
Julien Sfeir ◽  
Pierre Alric ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Stent Graft ◽  
Endovascular Repair ◽  
Covered Stent ◽  
Type I ◽  
Type Ii ◽  
Stent Grafts ◽  
Fenestrated Stent Graft ◽  
Type I Endoleak

Purpose: To evaluate outcomes of homemade fenestrated stent-grafts for complete endovascular aortic repair of aortic arch dissections. Materials and Methods: From July 2014 through September 2018, 35 patients (mean age 66±11 years; 25 men) underwent homemade fenestrated stent-graft repair of acute (n=16) or chronic (n=10) complicated type B aortic dissections (n=16) and dissecting aortic arch aneurysms subsequent to surgical treatment of acute type A dissections (n=9). Nineteen (54%) procedures were emergent. Results: Zone 2 single-fenestrated stent-grafts were used in 25 cases; the remaining 10 were double-fenestrated stent-grafts deployed in zone 0. Median time for stent-graft modification was 18 minutes (range 16–20). Technical success was achieved in all cases. An immediate distal type I endoleak was treated intraoperatively. Among the double-fenestrated stent-graft cases, the left subclavian artery fenestration could not be cannulated in 2 patients and revascularization was required. Partial coverage of the left common carotid artery necessitated placement of a covered stent in 3 cases. One (3%) patient had a stroke without permanent sequelae. Two type II endoleaks required additional covered stent placement at 5 and 7 days postoperatively, respectively. The 30-day mortality was 6% (2 patients with ruptured aortic arch aneurysm). During a mean follow-up of 17.6±13 months, there was no aortic rupture or retrograde dissection. One late type I endoleak was treated with additional proximal fenestrated stent-graft placement. One type II endoleak is currently under observation. One additional patient died (unrelated to the aorta); overall mortality was 9%. All supra-aortic trunks were patent. Conclusion: The use of homemade fenestrated stent-grafts for endovascular repair of aortic arch dissections is feasible and effective for total endovascular aortic arch repair. Durability concerns will need to be assessed in additional studies with long-term follow-up.

scholarly journals Chimney Graft Technique Combined With Embolization for Treating Ruptured Aortic Arch Lesions

2021 ◽  
Vol 8 ◽  
Author(s):  
Xianhao Bao ◽  
Yuxi Zhao ◽  
Tao Li ◽  
Mingwei Wu ◽  
Zhaoxiang Zeng ◽  
...  
Keyword(s):  
Aortic Arch ◽  
False Lumen ◽  
Endovascular Embolization ◽  
Type I ◽  
Technical Success ◽  
Early Term ◽  
Primary Operation ◽  
Type I Endoleak ◽  
Chimney Graft

Background: This study aimed to share the experience in applying the chimney graft technique combined with embolization for treating aortic arch rupture under emergency conditions and evaluating early-term results in these patients.Methods: This study retrospectively included patients with ruptured aortic arch lesions who received the chimney graft technique combined with embolization between March 2016 and March 2021. The primary endpoint was a technical success, deemed as successful stent graft deployment to the planned location, patency of the target branch vessel, and absence of significant type I endoleak. The secondary endpoint was clinical success defined with the size of false lumen in follow-up remaining unchanged or decreasing over time, 30-day mortality, complication, and primary patency of chimney graft.Results: This study included 12 patients (age, 61 ± 12 years; male, 83%). Five patients (42%) received single chimney, one patient (8%) received double chimney, and six patients (50%) received triple chimney. Intraoperative type I endoleak occurred in six patients (50%) who underwent endovascular embolization in the primary operation. Post-operative type I endoleak, evaluated by computed tomography angiography examination following the primary operation, occurred in seven patients (58%), including one patient who received endovascular embolization two times. All patients with post-operative type I endoleak were successfully re-treated using coil and Onyx glue within 1 week, and the median length of stay was 22 ± 11 days (range: 7–44 days). Overall technical success was 100%. Eleven patients had completed their follow-up (median, 12 months, range: 1–34 months), and one patient was out of contact. The 30-day mortality was 9% (1/11, post-operative death of a patient with cerebral hemorrhage). No major complications and no chimney compression, migration, occlusion, or stenosis were recorded during follow-up. Seven patients (58%) have ≥6 months of clinical follow-up time with appropriate imaging. In four (57%) of these patients, diameter stabilization was detected, whereas three (43%) experienced significant reduction (≥5 mm).Conclusion: The patients in this study had satisfactory early-term outcomes. The chimney graft technique combined with coil and Onyx glue embolization may be a safe and effective treatment for ruptured aortic arch lesions under emergency conditions.

Repair of acute type A dissection with distal malperfusion using a novel hybrid arch device

2020 ◽  
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Circulatory Arrest ◽  
Spinal Cord Ischemia ◽  
False Lumen ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Acute Type A Dissection ◽  
Feasible Option

Acute type A aortic dissection remains a high-risk surgical condition, and mortality among those presenting with malperfusion is up to 3-fold higher. Despite the added technical challenge of distal aortic arch interventions in the acute setting, it may be necessary to resolve distal malperfusion in patients with this disorder. The ideal arch intervention to address acute type A aortic dissection complicated by malperfusion should address the following objectives: (1) to relieve distal malperfusion by expanding the distal true lumen and depressurizing the false lumen; (2) to avoid compromising arch branches without requiring additional arch branch interventions; (3) to minimize the risk of spinal cord ischemia; and (4) to minimize the operative duration and circulatory arrest time. The use of an uncovered aortic arch stent that is delivered in an antegrade manner during circulatory arrest, concomitantly with hemiarch replacement, therefore represents an attractive solution in the management of acute type A aortic dissection complicated by malperfusion. This strategy does not require complex arch reconstruction and may thus be a feasible option among cardiac and vascular surgeons in lower volume aortic centers. Here we present a step-by-step approach to acute type A aortic dissection repair with hemiarch repair and delivery of an uncovered arch stent for a patient presenting with malperfusion.

Amplatzer Vascular Plug for Complicated Residual DeBakey Type 1 Aortic Dissection in the Aortic Arch

2021 ◽  
pp. 155698452098379
Author(s):  
Shinichiro Ikeda ◽  
Michael Shih ◽  
Robert Y. Rhee ◽  
Benjamin A. Youdelman
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
False Lumen ◽  
Type I ◽  
Descending Aorta ◽  
Complete Thrombosis ◽  
One Year ◽  
Hemiarch Replacement

Surgical treatment of acute DeBakey type I aortic dissection does not address the entire aorta, which can leave anatomically complex residual aortic dissection in the aortic arch and descending aorta. Open repair has been the standard treatment for this pathology. When the lesions are located in the aortic arch, re-do total arch replacement needs to be performed. Plug placement to close small entry tears in the aortic arch has been reported. This article reports about a 79-year-old man who underwent hemiarch replacement for acute DeBakey type I aortic dissection. One year later, his proximal descending aorta dilated to 6.3 cm. The patient was treated with Amplatzer plug in the false lumen, and a stent graft was placed in the true lumen. Follow-up computed tomography scan confirmed complete thrombosis of the false lumen in the descending aorta which had decreased from 6.3 to 4.0 cm. Plug placement in the false lumen in the aortic arch is a potential treatment strategy for anatomically complex residual aortic dissection to induce thrombosis of the false lumen and encourage remodeling.

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