Surgery for Type B Dissection Using a Short-Stented Elephant Trunk Procedure

2012 ◽  
Vol 15 (2) ◽  
pp. 79
Author(s):  
LiangXin Tian ◽  
RuiDong Qi ◽  
Qian Chang ◽  
CunTao Yu ◽  
JunMing Zhu ◽  
...  
Keyword(s):  
Thoracic Aorta ◽  
False Lumen ◽  
Type B ◽  
Descending Thoracic Aorta ◽  
True Lumen ◽  
Elephant Trunk ◽  
Suitable Alternative ◽  
Stent Grafting ◽  
Type B Dissection

<p><b>Background:</b> Stent grafting is a very important treatment for type B dissection. Some patients are unsuitable for endograft repair because of inadequate proximal and/or distal fixation zones. We reviewed our experience of proximal descending thoracic replacement combined with short-stented elephant trunk implantation for type B dissection for patients without adequate fixation zones for endografts.</p><p><b>Methods:</b> Twenty-one patients with type B dissection (10 acute, 11 chronic) underwent this procedure between August 2003 and December 2007. After replacement of the proximal descending thoracic aorta, a short-stented elephant trunk was implanted into the residual descending thoracic aorta. The residual false lumen was evaluated post-operatively using computed tomography (CT) scans.</p><p><b>Results:</b> There were no in-hospital deaths. One death was observed during a mean follow-up of 69 � 15 months. One patient with preoperative shock suffered paraparesis but recovered postoperatively. One patient had paraplegia and was lost to follow-up. Cerebral hemorrhage was observed in 1 patient, but he recovered. Thrombus obliteration of the false lumen around the stented elephant trunk was observed in 19 patients (95%) and at the diaphragmatic level in 17 patients (85%) during follow-up.</p><p><b>Conclusion:</b> Replacement of the proximal descending thoracic aorta combined with short-stented elephant trunk implantation was a suitable alternative for type B dissection for patients without adequate fixation zones for endografts (particularly for young subjects). This procedure allowed enlargement of the true lumen, re-establishment of the true lumen, induction of thrombosis of the false lumen, and shrinkage of the aorta. Injury to the spinal cord, however, was an intractable problem.</p>

scholarly journals Thoraflex hybrid as frozen elephant trunk in chronic, residual type A and chronic type B aortic dissection

2020 ◽  
Author(s):  
Mariafrancesca Fiorentino ◽  
Hector W L de Beaufort ◽  
Uday Sonker ◽  
Robin H Heijmen
Keyword(s):  
Thoracic Aorta ◽  
False Lumen ◽  
Frozen Elephant Trunk ◽  
True Lumen ◽  
Elephant Trunk ◽  
Stroke Incidence ◽  
The Status ◽  
Elephant Trunk Technique ◽  
Complete Thrombosis ◽  
Aortic Dissections

Abstract OBJECTIVES The frozen elephant trunk technique is an increasingly common treatment for extensive disease of the thoracic aorta. The objective of the study was to evaluate the outcomes of frozen elephant trunk specifically in chronic (residual) aortic dissections, focusing on downstream aortic remodelling. METHODS Between 2013 and 2019, a total of 28 patients were treated using the Vascutek Thoraflex hybrid graft at our institution for chronic dissections/post-dissection aneurysms. Immediate and follow-up outcomes were studied, as well as the changes in total aortic diameter, true lumen and false lumen diameter and the status of the false lumen at 3 different levels of the thoraco-abdominal aorta. RESULTS No in-hospital or 30-day mortality was observed, temporary paraparesis rate was 7% and disabling stroke incidence was 14.3%. Freedom from all-cause mortality at 2 years was 91.6 ± 5.7%, while freedom from reintervention on the downstream aorta at 2 years was 59.1 ± 10.8%. Positive aortic remodelling was achieved in 50.0%, with an enlargement in the true lumen and a reduction of the false lumen not only at the level of the proximal descending aorta with 73.1% of complete thrombosis but also at the level of the distal descending thoracic aorta, with 41.7% of complete thrombosis. CONCLUSIONS The frozen elephant trunk is a good solution in chronic (residual) downstream aortic dissections inducing positive aortic remodelling and preventing from II stage operations or allowing an endovascular approach.

scholarly journals Complete Shrinkage of the Obliterated False Lumen After Open and Endovascular Chronic Aortic Dissection Stanford Type A Repair

Aorta ◽  
2017 ◽  
Vol 05 (02) ◽  
pp. 61-63
Author(s):  
George Samanidis ◽  
Meletios Kanakis ◽  
Constantinos Ieromonachos ◽  
George Stavridis
Keyword(s):  
Aortic Dissection ◽  
Circulatory Arrest ◽  
False Lumen ◽  
Type A ◽  
Frozen Elephant Trunk ◽  
Descending Thoracic Aorta ◽  
Elephant Trunk ◽  
Chronic Aortic Dissection ◽  
Antegrade Cerebral Perfusion

AbstractA 48-year-old man was admitted to our hospital with chronic aortic dissection Stanford Type A. His diagnosis was confirmed by chest multi-detector computed tomography (CT). The patient underwent combined (i.e., hybrid) open and endovascular repair (frozen elephant trunk) in a one-stage operation with moderate hypothermic circulatory arrest and antegrade cerebral perfusion. His postoperative course was uneventful, and he was discharged home on postoperative day 9. At 2-year follow-up, chest CT angiography revealed complete shrinkage of the obliterated false lumen in the distal aortic arch and descending thoracic aorta.

Management of a Compromised Frozen Elephant Trunk Due to Acute Type B Aortic Dissection

2020 ◽  
Vol 54 (8) ◽  
pp. 756-759
Author(s):  
Amer Harky ◽  
Robert K. Fisher ◽  
Mark L. Field
Keyword(s):  
Aortic Valve ◽  
Aortic Dissection ◽  
False Lumen ◽  
Acute Type ◽  
Type B ◽  
Frozen Elephant Trunk ◽  
Type B Aortic Dissection ◽  
Elephant Trunk ◽  
Thoracoabdominal Aorta

Purpose: To report a case who required a thoracic endovascular stenting (TEVAR) following the deployment of frozen elephant trunk due to false lumen expansion Case Report: A 47 years old male patient undergone emergency repair of acute type A aortic dissection in 2011 with bioprosthetic aortic root conduit. Seven years later he presented with moderate aortic valve disease and expanding chronic dissection of the aortic arch, therefore a redo operation with replacement of the prosthetic aortic valve, ascending aorta, total arch and deployment of frozen elephant trunk and he was discharged in good health. Several days post discharge he presented with new onset of chest pain and a new dissection involved the thoracoabdominal aorta was noted pressing on the true lumen and the frozen elephant trunk. Following a multi-disciplinary team meeting, TEVAR was deemed as a most appropriate approach and this was achieved successfully, and patient was discharged. At 1 year of follow up, he remains well and asymptomatic. Conclusion: Close imaging follow-up following deployment of a FET is mandatory. A new acute Type B aortic dissection distal to the FET, that causes false lumen propagation parallel to the stented portion, is a surgical emergency and further intervention mandated.

scholarly journals Hybrid two-stage repair of Stanford A dissection with visceral or peripheral malperfusion

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Zanxin Wang ◽  
Xianmian Zhuang ◽  
Bailang Chen ◽  
Junmin Wen ◽  
Minxin Wei
Keyword(s):  
False Lumen ◽  
Case Series ◽  
Celiac Artery ◽  
True Lumen ◽  
Elephant Trunk ◽  
Two Stage ◽  
Aortic Repair ◽  
Initial Surgery ◽  
Cord Injury

Abstract Background The present study aimed to evaluate the effect of two-stage hybrid aortic repair at the distal aorta of Stanford A dissection with malperfusion. Methods This retrospective case series included 20 patients with Stanford A dissection administered two-stage thoracic endovascular aortic repair (TEVAR) about 1 month after central repair because of visceral or limb malperfusion. The patients were examined by computed tomography (CT) angiography at 3, 6, 12 and 24 months after operation. Recovery of malperfusion and true lumen index were evaluated during follow-up. Results Twenty patients underwent two-stage hybrid aortic repair, including 11 males and 9 females. The follow-up time was 24 ± 7 months. No intervention-related complications were observed, including stent graft-induced new re-entry tears, death, stroke and spinal cord injury. Malperfusion in all cases was corrected. The true lumen was not enlarged enough 1 month after the first surgery. Thrombosis of the false lumen was observed around the elephant trunk at the carina level and the celiac artery. Three months after second stage TEVAR, the false lumen thrombosis was resorbed; in addition, the trunk was fully expanded at the carina level, and the true lumen was enlarged at the celiac artery. Conclusions Two-stage hybrid aortic repair for residual true lumen in the distal aorta 1 month after initial surgery is helpful for descending aorta remodeling and effective in treating malperfusion. This procedure may be a good option for patients suffering from Stanford A dissection with small true lumen in the distal aorta and malperfusion.

Satisfactory Long-term Outcomes of Thoracic Endovascular Aortic Repair With a Bare Stent for Acute Complicated Type B Aortic Dissections

2020 ◽  
pp. 152660282096699
Author(s):  
Yaowang Lin ◽  
Shaohong Dong ◽  
Jianfan Luo ◽  
Weijie Bei ◽  
Qiyun Liu ◽  
...  
Keyword(s):  
Stent Graft ◽  
False Lumen ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Type B ◽  
Stent Group ◽  
True Lumen ◽  
Aortic Remodeling

Purpose To compare the clinical outcomes after thoracic endovascular aortic repair (TEVAR) with a bare stent to those after TEVAR alone in patients with complicated acute type B aortic dissection (cATBAD). Materials and Methods A prospective, randomized trial was conducted at 2 medical centers in China between 2010 and 2013. Patients with cATBAD were randomly assigned to receive TEVAR with a bare stent (n=42) or TEVAR only (n=42). Patients were scheduled to undergo computed tomography angiography at 3, 6, and 12 months and then annually to 5 years. The primary endpoint was all-cause mortality at 5 years; secondary outcomes were a composite of complications (endoleak, stent-graft–induced new entry, aortic rupture, and secondary intervention) and aortic remodeling at 1 and 5 years. Results All-cause death occurred in 1 (2.4%) patient in the TEVAR with bare stent group (lung cancer) and 5 patients (11.9%) in the TEVAR group (4 aorta-related) during the 5-year follow-up (log-rank p=0.025). The 1- and 5-year rates of complications and secondary interventions did not differ between the groups. Patients in the TEVAR with bare stent group had higher increases in the thoracic true lumen diameter (19.7±3.6 vs 17.0±6.2 mm, p=0.018) and abdominal true lumen diameter (13.7±4.8 vs 7.2±6.1 mm, p<0.001) and a higher incidence of complete false lumen thrombosis (80.9% vs 47.6%, p=0.005) at the 1-year follow-up. However, no between-group differences in the changes of aortic remodeling parameters were observed between the 1- and 5-year follow-up periods. Conclusion The addition of a distal bare stent to a thoracic stent-graft during TEVAR was associated with significantly improved long-term survival in cATBAD patients vs TEVAR only, likely due to the prevention of true lumen collapse and improvement of complete false lumen thrombosis of the dissected aorta.

Tortuosity of the Descending Thoracic Aorta in Patients with Aneurysm and Type B Dissection

2019 ◽  
Vol 44 (4) ◽  
pp. 1323-1330
Author(s):  
Viony M. Belvroy ◽  
Hector W. L. de Beaufort ◽  
Joost A. van Herwaarden ◽  
Jean Bismuth ◽  
Gabriele Piffaretti ◽  
...  
Keyword(s):  
Thoracic Aorta ◽  
Type B ◽  
Descending Thoracic Aorta ◽  
Type B Dissection

scholarly journals Description of a new technique for repairing chronic type B dissections that involve visceral branches being fed by both true and false lumen by using both lumens as conduits

Vascular ◽  
2015 ◽  
Vol 24 (1) ◽  
pp. 103-105 ◽  
Author(s):  
Joe Anderson ◽  
Tyler Remund ◽  
Katie Pohlson ◽  
Patrick Kelly
Keyword(s):  
False Lumen ◽  
Aortic Aneurysms ◽  
Type B ◽  
Stent Grafts ◽  
True Lumen ◽  
Chronic Type ◽  
Novel Technique ◽  
A New Technique

Here we present three cases performed using a novel technique where aortic flow is compartmentalized proximal to the target vessels through a physician-modified endograft. The visceral segment is then further compartmentalized by the use of another physician modified endograft. By compartmentalizing the flow proximal to the visceral segment, both the true lumen and false lumen can be used as conduits for coextensive bridging stent grafts. Overall, patients have tolerated this procedure extremely well, and while further study and follow-up must be conducted, this procedure could offer a reasonable long-term solution to thoracoabdominal aortic aneurysms complicated by dissection.

scholarly journals Reversed Elephant Trunk Technique for the Repair of Type B Aortic Dissection: A Case Report

2019 ◽  
Author(s):  
Anjith Prakash Rajakumar ◽  
Mithun Sundararaaja Ravikumar ◽  
Karthik Raman ◽  
Arun Singh ◽  
Ejaz Ahmed Sheriff ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Regurgitation ◽  
Thoracic Aorta ◽  
Left Ventricular ◽  
Type B ◽  
Descending Thoracic Aorta ◽  
Type B Aortic Dissection ◽  
Elephant Trunk ◽  
Severe Aortic Regurgitation ◽  
Elephant Trunk Technique

We report a case of a type B aortic dissection with an aneurysm treated by the replacement of the proximal descending thoracic aorta via the reversed elephant trunk technique. A 48-year-old asymptomatic man was diagnosed with a type B aortic dissection, moderate aortic regurgitation, and a good biventricular function in March 2012. Four years later (April 2016), a contrast-enhanced computed tomography examination revealed an aneurysmal dilatation in the patient’s descending thoracic aorta with a thrombosis in the proximal part of the false lumen, which warranted surgical repair. He underwent type B aortic dissection repair through the left posterolateral thoracotomy. Three months after the surgery, the patient developed a type A aortic dissection with severe aortic regurgitation, which was successfully managed via a Bentall procedure with arch replacement facilitated by the reversed elephant trunk technique performed during the initial surgery through thoracotomy. At 2 years follow-up, the patient was doing well with a normal left ventricular function.

Abstract 102: Number of Reentry Tears Influences Flap Motion and Flow Reversal in an in vitro Model of Type B Aortic Dissection

2016 ◽  
Vol 36 (suppl_1) ◽  
Author(s):  
Joav Birjiniuk ◽  
Mark Young ◽  
Lucas H Timmins ◽  
Bradley G Leshnower ◽  
John N Oshinski ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
False Lumen ◽  
Flow Reversal ◽  
Patient Specific ◽  
Type B ◽  
True Lumen ◽  
Flow Rates ◽  
Custom Made ◽  
Type B Dissection

Objectives: Aortic remodeling after dissection is poorly understood. Thus, optimal patient-specific recommendations for treatment are lacking. An in vitro aortic model of Type B dissection was used to interrogate local aortic hemodynamic parameters implicated in thrombosis and aneurysm formation. We hypothesize that dissections with multiple reentry tears will exhibit decreased flap motion, and, as a result, reduce flow reversal. Methods: Anatomic models of aortic dissection with fidelity to patient CT images were fabricated out of silicone. Models with primary entry and single fenestration (Figure 1A), two fenestrations (Figure 1B), and three fenestrations (Figure 1C) were installed in a flow loop. Physiologic flow was established at a cardiac index of 4 L/min. Flow velocities were acquired using phase contrast magnetic resonance (PCMR) imaging. Flow rates and flap motion were quantified using custom made software. Results: Relative true lumen area (RTLA) varied along the dissection (entry: 55% +/- 3, middle: 34% +/-7, exit: 91%+/-3, p<0.00001 pair-wise for 2-tear model). At mid-dissection, RTLA was lower in dissections with fewer tears (p<0.01). Total flow was nearly identical in all cases, while true and false lumen flow rates differed significantly across tear configurations and along the dissection (p<0.01). Secondary tears allowed for flow communication within the dissected portion of the aortic model. Flow reversal was seen in the false lumen at the mid-dissection plane in the absence of secondary tears (Figure 1D). However, as secondary tears were added, the flow reversal in the false lumen decreased, with concomitant flow reversal in the true lumen (Figure 1E,F). Conclusions: Anatomic characteristics of dissection, such as number of tears, affect blood flow and motion of the dissection flap, as shown quantitatively. This compliant aorta model illustrates alterations in flow reversal in both true and false lumina that may lead to aneurysmal degeneration.

Sign in / Sign up

Export Citation Format

Share Document