Aortic Arch and Descending Thoracic Aortic Aneurysms: Experience with Stent Grafting for Second-Stage “Elephant Trunk” Repair

Vascular ◽  
2005 ◽  
Vol 13 (1) ◽  
pp. 5-10 ◽  
Author(s):  
Alfio Carroccio ◽  
David Spielvogel ◽  
Sharif H. Ellozy ◽  
Robert A. Lookstein ◽  
Iris Y. Chin ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Stent Graft ◽  
Clinical Success ◽  
Perioperative Complications ◽  
Aortic Aneurysms ◽  
Elephant Trunk ◽  
Stent Grafting ◽  
Thoracic Aortic Aneurysms ◽  
Second Stage ◽  
Antegrade Approach

Reconstruction of aortic arch and descending thoracic aortic aneurysms (TAAs) is technically challenging and associated with significant morbidity and mortality. We report our experience with extensive TAAs using a two-stage “elephant trunk” repair, with the second stage completed using an endovascular stent graft (ESG). Over 6 years, 111 patients underwent ESG treatment of TAAs at Mount Sinai Medical Center. Twelve of these patients were referred for ESG placement for the second stage of elephant trunk reconstruction because comorbidities placed them at high risk of open surgical repair. Our database was analyzed for technical and clinical success and perioperative complications. The mean follow-up was 11.8 months (range 1–64 months). Twelve patients (five women and seven men) with a mean age of 69 ± 10 years underwent repair of their distal aortic arch and descending TAAs. These aneurysms included nine atherosclerotic aneurysms, one pseudoaneurysm, and two penetrating atherosclerotic ulcers. Three patients were symptomatic. Stent graft repair was technically successful in 91.7% or 11 of 12 patients. Excessive aortic arch tortuosity resulted in failure to deploy a stent graft in one patient. An antegrade approach through the open elephant trunk was used in two patients with severe iliac occlusive disease. Endoleaks (type 2) were identified in two patients with no aneurysm expansion; however, a 14 mm expansion over 1 year occurred in a patient with no identifiable endoleak. One early mortality occurred in a patient with a ruptured 6 cm infrarenal AAA after successful exclusion of the 8 cm TAA. Second-stage elephant trunk reconstruction of an extensive TAA using an ESG is effective in the short term. Its long-term durability remains to be determined.

Aortic Arch and Descending Thoracic Aortic Aneurysms: Experience with Stent Grafting for Second-Stage “Elephant Trunk” Repair

Vascular ◽  
2005 ◽  
Vol 13 (01) ◽  
pp. 5 ◽  
Author(s):  
Alfio Carroccio ◽  
David Spielvogel ◽  
Sharif H. Ellozy ◽  
Robert A. Lookstein ◽  
Iris Y. Chin ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Aortic Aneurysms ◽  
Elephant Trunk ◽  
Stent Grafting ◽  
Thoracic Aortic Aneurysms ◽  
Second Stage

Aortic Arch Reconstruction by Transluminally Placed Endovascular Branched Stent Graft

Circulation ◽  
1999 ◽  
Vol 100 (suppl_2) ◽  
Author(s):  
Kanji Inoue ◽  
Hiroaki Hosokawa ◽  
Tomoyuki Iwase ◽  
Mitsuru Sato ◽  
Yuki Yoshida ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Stent Graft ◽  
Aortic Aneurysms ◽  
Therapeutic Modality ◽  
Stent Grafts ◽  
Stent Grafting ◽  
Thoracic Aortic Aneurysms ◽  
Stent Graft Repair ◽  
Aortic Dissections

Background —Recently, thoracic aortic stent grafting has emerged as an alternative therapeutic modality for patients with thoracic aortic aneurysms and aortic dissections. However, its application has been limited to descending thoracic aortic aneurysms distal to the aortic arch. We report our initial clinical experience of endovascular branched stent graft repair for aortic arch aneurysms. Methods and Results —Endovascular grafting with Inoue branched stent grafts was attempted for 15 patients with thoracic aortic aneurysms and aortic dissections under local anesthesia (n=14) or general anesthesia (n=1). Single-branched stent grafts were used in 14 patients, and a triple-branched stent graft in one. The branched stent grafts were delivered through a 22F or a 24F sheath under fluoroscopic guidance and implanted across the aneurysmal aortic arch. In 2 patients, the single-branched stent graft did not pass through the 22F sheath used. Complete thrombosis of the aneurysm was ultimately achieved in 11 patients (73%). Of 4 persistent leaks, 1 minor leak spontaneously thrombosed and 1 major leak was successfully treated by additional straight stent graft placement. In 1 patient, the right external iliac artery ruptured during the withdrawal of the sheath and was successfully repaired by the implantation of a straight stent graft. One patient with severe stenosis of the aortic graft section was successfully managed by additional stent deployment. Peripheral microembolization to a toe occurred in 1 patient, and cerebral infarction occurred in 1 other patient. Two patients who had failed to receive endovascular stent grafts died during an average follow-up of 12.6 months, 1 of pneumonia and the other of rupture of a concomitant abdominal aortic aneurysm. Conclusions —This report demonstrates the technical feasibility of endovascular branched stent graft repair for aneurysms located at the aortic arch. Careful, longer follow-up and further extensive clinical trials are awaited toward establishing this technique as a recommendable alternative to surgical treatment of thoracic aortic aneurysms.

Clinical Application of an Original Flexible MK Stent-Graft for Nonruptured Thoracic Aortic Aneurysms: Early Experience

2006 ◽  
Vol 1 (3) ◽  
pp. 119-122 ◽  
Author(s):  
Hiroshi Ohtake ◽  
Keiichi Kimura ◽  
Go Watanabe ◽  
Junichiro Sanada ◽  
Osamu Matsui
Keyword(s):  
Stent Graft ◽  
Bypass Surgery ◽  
Thrombus Formation ◽  
Perioperative Complications ◽  
Artery Bypass ◽  
Polyester Fabric ◽  
Aortic Aneurysms ◽  
Stent Grafts ◽  
Stent Grafting ◽  
Thoracic Aortic Aneurysms

Objective To obtain early MK stent-grafting results for nonruptured thoracic aortic aneurysms and thoracoabdominal aortic aneurysms. Methods The authors analyzed 47 patients who underwent treatment using MK stent-grafting. All patients (40 men and 7 women; mean age, 70.8 years) underwent elective procedures. Straight, curved, or tapered MK stents were constructed from a nitinol wire and covered with seamless, cylindrical woven polyester fabric grafts. The mean stent-graft diameter was 24 to 48 mm. In cases where the aneurysm had a short proximal neck (under 15 mm), supraaortic arch artery bypass surgery was planned to lengthen the neck. Results Simple stent-grafting without bypass was performed in 26 patients, whereas stent-grafting with supraaortic arch artery bypass was performed in 21 patients. An 18 or 20 F sheath was used as the delivery system in 46 patients (96%). In all 47 patients, the stent-grafts were successfully deployed. Two patients died while in hospital, and another 2 patients suffered a stroke. No other perioperative complications were observed. Postoperative computed tomography after 3 months showed complete thrombus formation in 42 patients (93.3%; 42/45 patients). Conclusions Forty-seven patients with thoracic aortic aneurysm were treated with our original flexible MK stent-graft system. Using a small sheath system, straight or curved M-K stent-grafts could be deployed to adequately fit to the aorta as planned. Furthermore, simultaneous bypass surgery widened the application of stent-grafting. However, careful long-term observation is necessary, and further studies are needed to assess such stent-grafting with bypass surgery.

Clinical Application of a Curved Nitinol Stent-Graft for Thoracic Aortic Aneurysms

2003 ◽  
Vol 10 (1) ◽  
pp. 20-28 ◽  
Author(s):  
Junichiro Sanada ◽  
Osamu Matsui ◽  
Noboru Terayama ◽  
Satoshi Kobayashi ◽  
Tetsuya Minami ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Stent Graft ◽  
Neurological Complications ◽  
Polyester Fabric ◽  
Aortic Aneurysms ◽  
The Other ◽  
Neck Length ◽  
Nitinol Stent ◽  
Proximal Neck ◽  
Thoracic Aortic Aneurysms

Purpose: To evaluate the clinical efficacy of a curved nitinol stent-graft for repair of thoracic aortic aneurysms. Methods: The Matsui-Kitamura stent-graft (MKSG), composed of a self-expanding nitinol stent and polyester fabric, was shaped to match the aortic curvature of 11 patients (6 men; mean age 72.6 years, range 33–90) with 6 true and 5 false aneurysms of the distal arch or proximal descending aorta. The delivery system was an 18 or 20-F J-shaped sheath combined with a preloader-type introducer. The original mean proximal neck length was 16.4 mm, but 4 patients received an axilloaxillary bypass to lengthen the neck. Although the mean corrected proximal neck length was 21.9 mm (overall), 5 cases still had proximal necks <15 mm long. Results: All curved MKSGs were successfully deployed in the correct position and fitted to the curvature of the aortic arch, achieving complete aneurysm exclusion in 8 (73%) cases. The other 3 repairs displayed early endoleaks; 1 received an additional MKSG, but the other 2 are being observed. Thirty-day mortality was 0%. One patient developed transient renal failure requiring hemodialysis; no neurological complications were observed. Conclusions: Endovascular repair of thoracic aortic aneurysms using curved MKSGs appears to be feasible and clinically effective. A tighter fit of the device to the curvature of the aortic arch may exclude distal arch aneurysms despite a short proximal neck.

Type III Endoleak from a Thoracic Aortic Stent-Graft

2002 ◽  
Vol 9 (4) ◽  
pp. 535-538 ◽  
Author(s):  
Conrad Lange ◽  
Asbjørn Ødegård ◽  
Jan Lundbom ◽  
Staal Hatlinghus ◽  
Hans O. Myhre
Keyword(s):  
Stent Graft ◽  
Late Complication ◽  
Thoracoabdominal Aortic Aneurysm ◽  
Aortic Aneurysms ◽  
Stent Grafts ◽  
Stent Grafting ◽  
Thoracic Aortic Aneurysms ◽  
Type Iii ◽  
Aortic Stent Graft ◽  
Type V

Purpose: To present an as yet unreported late complication of an Excluder thoracic endograft. Case Report: A 78-year-old man underwent surgery for a ruptured type V thoracoabdominal aortic aneurysm in 1996. Four years later, an aneurysm was detected in the proximal thoracic aorta and repaired with 2 Excluder endoprostheses. At 12 months, computed tomography showed an increase in the aneurysm sac diameter and a type III endoleak, which was traced to a hole in the stent-graft fabric on arteriography. No fracture of the metal components was detected in the stent-grafts. Another Excluder device was implanted within the distal endograft. Satisfactory exclusion of the leak has been maintained for 6 months. Conclusions: The risk of type III leaks must be minimized before stent-grafting can be regarded as a routine procedure in the treatment of thoracic aortic aneurysms.

scholarly journals Early results of a low-profile stent-graft for thoracic endovascular aortic repair

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0240560
Author(s):  
Hazem El Beyrouti ◽  
Mario Lescan ◽  
Marco Doemland ◽  
Migdat Mustafi ◽  
Florian Jungmann ◽  
...  
Keyword(s):  
Stent Graft ◽  
Aortic Rupture ◽  
Clinical Success ◽  
Intramural Hematoma ◽  
Aortic Aneurysms ◽  
Elephant Trunk ◽  
Landing Zone ◽  
Early Results ◽  
Low Profile

Purpose To assess outcomes of a low-profile thoracic stent-graft in the treatment of thoracic aortic pathologies. Methods A retrospective analysis of all consecutive patients with aortic thoracic pathologies treated with the RelayPro device in two university hospitals between October 2018 and July 2019. Results 23 patients (65% men; mean age 63.4 ± 15 years) were treated. Pathologies included aortic dissections (n = 10), 5 residual type A (22%) and 5 type B (22%), 6 degenerative aortic aneurysms (26%), 4 penetrating aortic ulcers (17%), and aortic erosion, intramural hematoma and aortic rupture (n = 1 and 4% in each case). Two cases (9%) were emergent and two urgent. Proximal landing was achieved in zones 0 (4%), 1 (4%), 2 (43%), and 3 (26%). Five grafts were frozen elephant trunk extensions. Technical success was 100% with accurate device deployment in the intended landing zone of the aortic arch in all 23 patients and with no Ia/III endoleaks and three (13%) type II endoleaks. Apposition was adequate in 96%. Two patients had post-implantation syndromes (one fever, one leukocytosis). Mean follow-up was 11.6 ± 3.7 months (range, 2–16) with no other complications, secondary interventions or conversions to open surgery. There was no 30-day mortality and no aortic-related mortality; all-cause mortality was 4% during follow-up. Conclusion A 3–4 French reduced profile in the current generation of stent-grafts facilitates TEVAR particularly in patients with smaller vessels access. Early safety and effectiveness outcomes are favorable, even in endpoints such as deployment accuracy and apposition which may be surrogates for longer-term clinical success and durability.

Endovascular Repair of Thoracic Aortic Aneurysms: Stent-graft Fixation across the Aortic Arch Vessels

2002 ◽  
Vol 16 (1) ◽  
pp. 24-28 ◽  
Author(s):  
James A. Burks ◽  
Peter L. Faries ◽  
Edwin C. Gravereaux ◽  
Larry H. Hollier ◽  
Michael L. Marin
Keyword(s):  
Aortic Arch ◽  
Stent Graft ◽  
Endovascular Repair ◽  
Aortic Aneurysms ◽  
Graft Fixation ◽  
Thoracic Aortic Aneurysms

scholarly journals Hybrid Approach in Acute and Chronic Aortic Disease

Medicina ◽  
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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