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.

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

Vascular ◽  
2014 ◽  
Vol 23 (1) ◽  
pp. 9-16 ◽  
Author(s):  
Sebastian Zerwes ◽  
Giesbert Leissner ◽  
Yvonne Gosslau ◽  
Rudolf Jakob ◽  
Hans-Kees Bruijnen ◽  
...  
Keyword(s):  
Success Rate ◽  
Aortic Arch ◽  
Circulatory Arrest ◽  
Aortic Disease ◽  
Aortic Aneurysms ◽  
Type I ◽  
Technical Success ◽  
Aortic Diseases ◽  
Promising Alternative ◽  
Technical Success Rate

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.

scholarly journals Reversed Frozen Elephant Trunk Technique to Treat a Type II Thoracoabdominal Aortic Aneurysm

2016 ◽  
Vol 24 (2) ◽  
pp. 277-280 ◽  
Author(s):  
E. Sebastian Debus ◽  
Tilo Kölbel ◽  
Sabine Wipper ◽  
Holger Diener ◽  
Beate Reiter ◽  
...  
Keyword(s):  
Stent Graft ◽  
Spinal Cord Ischemia ◽  
False Lumen ◽  
Thoracoabdominal Aortic Aneurysm ◽  
Aortic Aneurysms ◽  
Hybrid Technique ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Elephant Trunk Technique ◽  
Frozen Elephant Trunk Technique

Purpose: To describe a hybrid technique of reversed frozen elephant trunk to treat thoracoabdominal aortic aneurysms (TAAA) through an abdominal only approach. Technique: The technique is demonstrated in a 29-year-old Marfan patient with a chronic type B aortic dissection previously treated with a thoracic stent-graft who presented with a thoracoabdominal false lumen aneurysm. Through an open distal retroperitoneal approach to the abdominal aorta, a frozen elephant trunk graft was implanted over a super-stiff wire upside down with the stent-graft component in the thoracic aorta. Following deployment of the stent-graft proximally and preservation of renovisceral perfusion in a retrograde manner, the renovisceral vessels were sequentially anastomosed to the elephant trunk graft branches, thus reducing the ischemia time of the end organs. The aortic sac was then opened, and the distal part of the hybrid graft was anastomosed with a further bifurcated graft to the iliac vessels. Conclusion: The reversed frozen elephant trunk technique is feasible for hybrid treatment of TAAAs via an abdominal approach only. This has the benefit of substantially reducing the trauma of thoracic exposure, thus preserving major benefits of open thoracoabdominal surgery, such as the presence of short bypasses to the renovisceral vessels and reimplantation of lumbar arteries to reduce spinal cord ischemia.

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.

scholarly journals Complex thoracic aortic disease: Single-stage procedure with the frozen elephant trunk technique

2010 ◽  
Vol 140 (6) ◽  
pp. S81-S85 ◽  
Author(s):  
Roberto Di Bartolomeo ◽  
Davide Pacini ◽  
Carlo Savini ◽  
Emanuele Pilato ◽  
Sofia Martin-Suarez ◽  
...  
Keyword(s):  
Aortic Disease ◽  
Single Stage ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Thoracic Aortic Disease ◽  
Elephant Trunk Technique ◽  
Frozen Elephant Trunk Technique

A simplified delivery frozen elephant trunk technique to reduce circulatory arrest time in hybrid aortic arch surgery

2021 ◽  
Author(s):  
Thomas Sénage ◽  
Nicolas Bonnet ◽  
Guillaume Guimbretière ◽  
Charles‐Henri David ◽  
Jean‐Christian Roussel ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Circulatory Arrest ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Aortic Arch Surgery ◽  
Elephant Trunk Technique ◽  
Frozen Elephant Trunk Technique

scholarly journals “ELEPHANT TRUNK” AND ENDOVASCULAR STENTGRAFTING – A HYBRID APPROACH TO THE TREATMENT OF EXTENSIVE THORACIC AORTIC ANEURYSM

2013 ◽  
Vol 56 (2) ◽  
pp. 80-82 ◽  
Author(s):  
Tomáš Holubec ◽  
Jan Raupach ◽  
Jan Dominik ◽  
Jan Vojáček
Keyword(s):  
Thoracic Aorta ◽  
Thoracic Aortic Aneurysm ◽  
Hybrid Approach ◽  
Giant Aneurysm ◽  
Aortic Aneurysms ◽  
Elephant Trunk ◽  
Mortality And Morbidity ◽  
Thoracic Aortic Aneurysms ◽  
Ventricular Septum Defect ◽  
Elephant Trunk Technique

A hybrid approach to elephant trunk technique for treatment of thoracic aortic aneurysms combines a conventional surgical and endovascular therapy. Compared to surgery alone, there is a presumption that mortality and morbidity is reduced. We present a case report of a 42-year-old man with a giant aneurysm of the entire thoracic aorta, significant aortic and tricuspid regurgitation and ventricular septum defect. The patient underwent multiple consecutive operations and interventions having, among others, finally replaced the entire thoracic aorta with the use of the hybrid elephant trunk technique.

scholarly journals Single-Stage Treatment of Aneurysm of the Distal Aortic Arch and Proximal Descending Aorta Using the Frozen Elephant Trunk Procedure. Case Report

PRILOZI ◽  
2020 ◽  
Vol 41 (3) ◽  
pp. 65-70
Author(s):  
Sasko Jovev ◽  
Vasil Papestiev ◽  
Marjan Shokarovski ◽  
Stefanija Hadzievska ◽  
Nadica Mehmedovic ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Median Sternotomy ◽  
Aortic Aneurysms ◽  
Single Stage ◽  
Frozen Elephant Trunk ◽  
Organ Protection ◽  
Elephant Trunk ◽  
Descending Aorta ◽  
Systemic Hypothermia ◽  
Elephant Trunk Procedure

AbstractAneurysms of the thoracic aorta involving the distal arch and the proximal descending aorta have traditionally been treated with two open procedures. During the first stage, the aortic arch pathology has been addressed through a median sternotomy. Several weeks or months later, a second stage followed and included completing the repair of the descending aorta through a lateral thoracotomy.We, herein, report a single stage repair of an aneurysm involving the distal aortic arch and the proximal descending aorta using the frozen elephant trunk operative technique. Vascular hybrid stent graft prosthesis, specifically designed for treatment of extensive aortic aneurysms, has been used to replace the arch component and exclude the descending aorta component of the aneurysm through a median sternotomy, using bilateral antegrade cerebral perfusion and mild systemic hypothermia for intraoperative organ protection.

scholarly journals Early Results of a Novel Single-Stage Hybrid Aortic Arch Replacement Technique to Reduce Bypass and Circulatory Arrest Duration

2020 ◽  
Vol 23 (2) ◽  
pp. E107-E113
Author(s):  
Castigliano Murthy Bhamidipati ◽  
Jay D Pal
Keyword(s):  
Cardiopulmonary Bypass ◽  
Aortic Dissection ◽  
Aortic Arch ◽  
Stent Graft ◽  
Circulatory Arrest ◽  
True Lumen ◽  
Elephant Trunk ◽  
Aortic Arch Replacement ◽  
Descending Aorta ◽  
The Mean

ABSTRACT Objective: Hybrid repair procedures of the aortic arch have been utilized to reduce surgical risks and apply this therapy to patients who would not traditionally be candidates for open surgical repair.  We present a variation on the frozen elephant trunk technique to further reduce cardiopulmonary bypass and circulatory arrest duration. Methods: After initiation of cardiopulmonary bypass and during systemic cooling, a wire is advanced from the femoral artery into the aortic arch.  In the case of aortic dissection, intravascular ultrasound is used to confirm true lumen placement.  Under circulatory arrest, the proximal aortic arch is resected and the wire externalized.  Antegrade deployment of a stent graft is performed into the aortic arch and proximal descending aorta.  The ascending aortic graft is sewn to the cut end of the aorta, incorporating the stent graft.  The graft is cannulated and cardiopulmonary bypass reinitiated.  The remainder of the arch replacement is performed during re-warming. Results: Twenty two patients underwent this novel hybrid arch replacement procedure for aortic pseudoaneurysm, aortic dissection, or aneurysm.  In comparison to the frozen elephant trunk procedure, where a dacron graft is inserted into the descending aorta, and later fixed with an endograft, this technique allows for immediate distal fixation.  In the case of aortic dissection, there is immediate expansion of the true lumen with distal seal, potentially obviating the need for additional procedures.  Mean duration of follow up is 12 months (range 1 – 14 months).  The mean duration of cardiopulmonary bypass was 109.32 ±3.14 minutes.  The mean duration of circulatory arrest was 18.00 ±1.33 minutes at a mean temperature of 23.64 ±0.58 degrees Celsius.  There were no mortalities, no permanent disabling strokes, and no renal failure (requiring dialysis). Conclusions: This novel hybrid technique for aortic arch replacement is safe, significantly reduces cardiopulmonary bypass and circulatory arrest times, and is performed readily without need for fluoroscopy.  In patients with thoracoabdominal aneurysms, the stent graft can be used as an elephant trunk for further thoracoabdominal aneurysm repair or branched thoracic endovascular aortic repair procedures.  

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