scholarly journals Krónikus aortadissectio talaján kialakult thoracoabdominalis aneurysma endovascularis kezelése fenesztrált sztentgrafttal

2021 ◽  
Vol 162 (31) ◽  
pp. 1260-1264
Author(s):  
Csaba Csobay-Novák ◽  
László Entz ◽  
Péter Banga ◽  
Miklós Pólos ◽  
Zoltán Szabolcs ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Open Repair ◽  
Aortic Aneurysms ◽  
Endovascular Aortic Repair ◽  
Advanced Technology ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Aorta Ascendens ◽  
Mortality And Morbidity ◽  
Aortic Repair

Összefoglaló. Az aortadissectio krónikus stádiumában kialakuló thoracoabdominalis tágulatok megoldása multidiszciplináris megközelítést, nagy felkészültséget és fejlett technológiát igényel. A jellemzően többlépcsős műtétsorozat mortalitása és morbiditása az endovascularis technológia fejlődésével csökkent, de még mindig jelentős. A fenesztrált endovascularis aortaműtét a thoracoabdominalis nyitott műtét alternatívája, mely kisebb mortalitással és morbiditással, rövidebb kórházi tartózkodással jár. Aortadissectio esetén történő alkalmazása az aorta lumenében lévő membrán miatt kihívást jelent. Esetbemutatásunkban egy 56 éves nőbeteget demonstrálunk, aki tíz évvel korábban A-típusú dissectio miatt aorta ascendens rekonstrukción esett át. A követés során csaknem a teljes aorta tágulata alakult ki, melynek megoldása három lépésben történt. Az első lépésben a disszekált aortaív nyitott műtétjét végeztük ’frozen elephant trunk’ technikával, majd az aorta descendens tágulatának endovascularis kezelése történt sztentgraft-implantációval. A műtétsorozat záró lépése egy fenesztrált endovascularis aortaműtét volt, mely egyben ezen technikának az aortadissectio esetében történt első hazai alkalmazását jelenti. Orv Hetil. 2021; 162(31): 1260–1264. Summary. Thoracoabdominal aortic aneurysms developing in the chronic phase of an aortic dissection require multidisciplinary approach, experienced operators and advanced technology. The mortality and morbidity rate of these multistage operations were reduced with the latest technical achievements in endovascular repair, but they are still significant. Fenestrated endovascular aortic repair, an alternative of thoracoabdominal open repair, is associated with less mortality and morbidity, shorter hospital stay. Using fenestrated devices in aortic dissection is usually technically demanding due to the dissection membrane. We report the case of a 56-year-old woman, who underwent ascending aortic repair due to type A aortic dissection. During the follow-up, a large thoracoabdominal aneurysm developed involving also the arch. We performed a three-stage operation starting with the open repair of the aortic arch using a ‘frozen elephant trunk’ device followed by a thoracic endovascular aortic repair of the descending aorta. The final stage was a fenestrated endovascular aortic repair, which is the first use of this technique in aortic dissection in Hungary. Orv Hetil. 2021; 162(31): 1260–1264.

The frozen elephant trunk technique for aortic dissection is safe after previous aortic repair

2020 ◽  
Vol 59 (1) ◽  
pp. 130-136
Author(s):  
Tim Berger ◽  
Maximilian Kreibich ◽  
Felix Mueller ◽  
Bartosz Rylski ◽  
Stoyan Kondov ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Aortic Surgery ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Aortic Arch Replacement ◽  
Mortality And Morbidity ◽  
Aortic Repair ◽  
Aortic Replacement ◽  
Aortic Interventions

Abstract OBJECTIVES The goal of this study was to evaluate outcomes of aortic arch replacement using the frozen elephant trunk (FET) technique after previous proximal and/or distal open or endovascular thoracic aortic repair. METHODS Sixty-three patients [median age: 63 (55–74) years; 65% men] were operated on for acute or chronic aortic dissection after previous proximal and/or distal open or endovascular thoracic aortic repair. Intraoperative details, clinical outcome and follow-up results were evaluated. RESULTS The median time between the index and the FET procedure was 81 (40–113) months. Fifty-eight (92%) patients had already undergone proximal aortic surgery; supracoronary ascending aortic replacement was the most frequent index procedure [n = 25 (40%)]. Distal aortic interventions had been done in 8 (13%) patients including endovascular thoracic aortic repair in 6 patients (10%). In-hospital mortality was 3% (n = 2). Postoperative strokes occurred in 5 patients (8%); of those, 1 stroke was dissection-related (2%). Subsequent aortic reinterventions after the FET procedure had to be done in 33% (n = 21). CONCLUSIONS Outcomes of aortic arch replacement using the FET technique after previous proximal and/or distal open or endovascular thoracic aortic repair are associated with low mortality and morbidity. Still, postoperative stroke remains an issue. After the successful accomplishments, the approach serves as an ideal platform for the secondary surgical or endovascular downstream aortic procedures, which are frequently needed.

Retrograde Ascending Dissection After Thoracic Endovascular Aortic Repair Combined With the Chimney Technique and Successful Open Repair Using the Frozen Elephant Trunk Technique

2017 ◽  
Vol 52 (1) ◽  
pp. 80-85 ◽  
Author(s):  
Koji Hirano ◽  
Toshiya Tokui ◽  
Bun Nakamura ◽  
Ryosai Inoue ◽  
Masahiro Inagaki ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Surgical Repair ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Chimney Technique ◽  
Aortic Repair ◽  
Elephant Trunk Technique ◽  
Frozen Elephant Trunk Technique

The chimney technique can be combined with thoracic endovascular aortic repair (TEVAR) to both obtain an appropriate landing zone and maintain blood flow of the arch vessels. However, surgical repair becomes more complicated if retrograde type A aortic dissection occurs after TEVAR with the chimney technique. We herein report a case involving a 73-year-old woman who developed a retrograde ascending dissection 3 months after TEVAR for acute type B aortic dissection. To ensure an adequate proximal sealing distance, the proximal edge of the stent graft was located at the zone 2 level and an additional bare stent was placed at the left subclavian artery (the chimney technique) at the time of TEVAR. Enhanced computed tomography revealed an aortic dissection involving the ascending aorta and aortic arch. Surgical aortic repair using the frozen elephant trunk technique was urgently performed. The patient survived without stroke, paraplegia, renal failure, or other major complications. Retrograde ascending dissection can occur after TEVAR combined with the chimney technique. The frozen elephant trunk technique is useful for surgical repair in such complicated cases.

scholarly journals Improved outcomes from endovascular aortic repair in younger patients: Towards improved risk stratification

Vascular ◽  
2019 ◽  
Vol 27 (6) ◽  
pp. 573-581 ◽  
Author(s):  
Wan Chin Hsieh ◽  
Chung Dann Kan ◽  
Chong Chao Hsieh ◽  
Mohamed Omara ◽  
Brandon Michael Henry ◽  
...  
Keyword(s):  
Open Repair ◽  
Abdominal Aortic Aneurysms ◽  
Aortic Aneurysms ◽  
Endovascular Aortic Repair ◽  
Younger Patients ◽  
Aortic Repair ◽  
Abdominal Aortic ◽  
Short And Long Term ◽  
Long Term Mortality

Objectives Abdominal aortic aneurysms are conventionally treated by open repair surgery. While endovascular aortic repair improves survival in high-risk patients, younger patients (40–65 years) potentially at lower risk with asymptomatic abdominal aortic aneurysms undergoing endovascular aortic repair usually have poorer post-operative outcomes and require longer term follow-up. In this study, clinical data on younger patients were analyzed to investigate whether endovascular aortic repair leads to poorer short- and long-term outcomes. Methods This was a systematic review and meta-analysis of articles comparing clinical outcomes in patients aged 40–65 years undergoing open repair or endovascular aortic repair and published between 2000 and 2017. In-hospital mortality, long-term mortality, and post-operative complication data were retrieved from eligible studies and clinical outcomes were compared. Twenty-one retrospective cohort analyses were included, accounting for 250,837 patients (149,051 endovascular aortic repair; 101,786 open repair). Risk ratios were pooled using the DerSimonian and Laird random effects model. All statistical analyses were performed in Review Manager 5.3. Results Younger patients with asymptomatic abdominal aortic aneurysms undergoing endovascular aortic repair had a significantly reduced 30-day mortality (odds ratio (OR) = 0.40, 95% confidence intervals (CI) 0.28–0.57; p < 0.00001), long-term mortality (OR = 0.37, 95% CI 0.17–0.82; p = 0.01), incidence of reintervention (OR = 0.47, 95% CI 0.34–0.66; p < 0.0001), and incidence of renal failure (OR = 1.58, 95% CI 1.37–1.82; p < 0.00001). Conclusions Endovascular aortic repair may improve short- and long-term survival and reduce post-operative complications in younger patients with asymptomatic abdominal aortic aneurysms.

scholarly journals Bail-out thoracic endovascular aortic repair for incorrect deployment of frozen elephant trunk into the false lumen

2020 ◽  
Vol 30 (6) ◽  
pp. 947-949
Author(s):  
Motoharu Kawashima ◽  
Yoshikatsu Nomura ◽  
Masamichi Matsumori ◽  
Hirohisa Murakami
Keyword(s):  
Computed Tomography ◽  
False Lumen ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Descending Aorta ◽  
Aortic Repair ◽  
Enhanced Computed Tomography ◽  
Bail Out

Abstract We report a rare case of bail-out thoracic endovascular aortic repair after incorrect deployment of a frozen elephant trunk into the false lumen. A 54-year-old man presented to our department complaining of chest pain. Enhanced computed tomography revealed Stanford type A acute aortic dissection, which had a large entry site at the mid-descending aorta. Emergency total aortic arch replacement with a frozen elephant trunk was performed. Progressive intraoperative acidosis was observed. Immediate postoperative enhanced computed tomography showed that the distal end of the frozen elephant trunk was deployed into the false lumen through the initial tear at the proximal descending aorta. We performed emergency thoracic endovascular aortic repair through a fenestration made into the intimal flap using an Outback LTD re-entry device. The patient was discharged home on postoperative day 67 after a complete recovery.

Abstract 19354: Management and Outcomes of Acute Type B Dissection in IRAD Treated with Open Surgery, Endovascular Flap Fenestration or TEVAR

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Nathaniel I Costin ◽  
Peter Levanovich ◽  
Eduardo Bossone ◽  
Mark D Peterson ◽  
Truls Myrmel ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Open Surgery ◽  
Acute Aortic Dissection ◽  
Open Repair ◽  
Surgical Intervention ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Acute Type ◽  
Type B ◽  
Aortic Repair

Background: The debate for the optimal treatment of complicated Type B Acute Aortic Dissection (TBAAD) is primarily focused upon open surgical intervention versus thoracic endovascular aortic repair (TEVAR). The technique of fenestration with stenting has been proposed to resolve malperfusion. This study evaluated post-procedural outcomes of all three approaches for TBAAD. Methods: TBAAD patients enrolled in the International Registry of Acute Aortic Dissection were stratified by management type: TEVAR, fenestration and stenting, and surgery. Results: Of the 552 patients with TBAAD, 231 (41.8%) underwent TEVAR, 214 (38.8%) standard open surgery, and 107 (19.4%) fenestration and stenting. TEVAR or fenestration and stenting were more likely to be performed in classic double barrel aortic dissection when compared to open surgery (73.2%, 76.6%, 52.8% respectively; p<0.001). Patients treated with open repair were less likely to have distal extension into the abdominal aorta than those with TEVAR or fenestration and stenting (47.7%, 62.7%, 86.4%, respectively; p<0.001). In-hospital mortality was similar between groups (11.7% TEVAR, 14.0% fenestration and stenting, 15.9% surgery). At five years, Kaplan-Meier post-discharge all-cause survival estimates were highest for TEVAR, followed by endovascular fenestration and finally open surgical intervention (85.2%, 78.3%, 67.2%, respectively; p=0.039). Conclusion: Patients treated by endovascular approaches, whether with flap fenestration or thoracic endovascular aortic repair, had lower five year mortality when compared to patients who required open repair in the setting of TBAAD. Either endovascular approach may be helpful in the treatment of TBAAD. Further research is needed to determine how much of the observed difference represents patient selection versus differential effects of treatment.

scholarly journals The frozen elephant trunk technique in acute DeBakey type I aortic dissection

2020 ◽  
Vol 28 (3) ◽  
pp. 411-418
Author(s):  
Davut Çekmecelioğlu
Keyword(s):  
Aortic Dissection ◽  
Thoracic Aorta ◽  
Median Sternotomy ◽  
Type I ◽  
Frozen Elephant Trunk ◽  
Descending Thoracic Aorta ◽  
Elephant Trunk ◽  
Mortality And Morbidity ◽  
Elephant Trunk Technique ◽  
Frozen Elephant Trunk Technique

Although advances in the field of cardiovascular surgery have improved outcomes for patients with acute DeBakey type I aortic dissection, postoperative in-hospital mortality and morbidity remain substantial. The frozen elephant trunk technique has become a treatment option for this disease and was developed primarily to extend repair into the proximal descending thoracic aorta during aortic arch repair (because the descending thoracic aorta is largely inaccessible via median sternotomy), thus avoiding, delaying, or facilitating subsequent repair of residual native aorta. In this review, we discuss the evidence for and future development of frozen elephant trunk reconstruction for acute DeBakey type I aortic dissection.

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