Endovascular Solutions for Aortic Arch Diseases: Total and Hybrid

2021 ◽  
Author(s):  
Luca Marco ◽  
Giacomo Murana ◽  
Luigi Lovato ◽  
Gregorio Gliozzi ◽  
Francesco Buia ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Stent Graft ◽  
Open Surgery ◽  
New Technologies ◽  
Therapeutic Option ◽  
Circulatory Arrest ◽  
Acute Type ◽  
Aortic Diseases ◽  
Increased Risk ◽  
Endovascular Approach

Although the endovascular approach is the therapeutic option of choice for thoracic and abdominal aortic diseases, open surgery is still the treatment of choice for aortic arch diseases. While open surgical repair remains the gold standard treatment for complete aortic arch replacement, it continues to be burdened by high mortality and neurologic complications, especially for patients who require redo surgery. Therefore, in the era of endovascular surgery, it is not surprising that hybrid operating rooms, new technologies, and new approaches are strongly challenging open surgery. Less-invasive endovascular procedures, when used to treat aortic arch diseases, when feasible and indicated, have clear advantages over open surgery, primarily because there is no need for cardiopulmonary bypass, hypothermic circulatory arrest, or cerebral protection. Moreover, patients who have already been treated for acute type A aortic dissection continue to have a considerable risk for future aortic reintervention, which is associated with increased risk for short- and long-term mortality. In light of these advantages, it is clear how selected high-risk patients with aortic arch disease could benefit from the endovascular approach. However, the hemodynamic and anatomic characteristics of the aortic arch make the endovascular approach in this region challenging. In fact, uncorrected stent-graft placement can have fatal consequences for the patient and increase the risk of endoleaks and stroke. To minimize these potential risks, precise and accurate preoperative planning to achieve optimal stent-graft dimensions and implantation is essential together with careful patient selection. Endovascular options for the treatment of aortic arch disease include both hybrid procedures and total endovascular solutions. This manuscript provides an overview of the current strategies for endovascular aortic arch treatment, including the most recent available series on this topic. In addition, a literature search offers insight into the current state of the art.

Acute Type A Aortic Dissection Treated Using a Tubular Stent-Graft in the Ascending Aorta and a Multibranched Stent-Graft in the Aortic Arch

2016 ◽  
Vol 24 (1) ◽  
pp. 75-80 ◽  
Author(s):  
Tilo Kölbel ◽  
Christian Detter ◽  
Sebastian W. Carpenter ◽  
Fiona Rohlffs ◽  
Yskert von Kodolitsch ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Stent Graft ◽  
Open Surgery ◽  
Type A ◽  
Ascending Aorta ◽  
Type I ◽  
Acute Type ◽  
Stent Grafts ◽  
Type A Aortic Dissection ◽  
Custom Made

Purpose: To describe the combined use of a tubular stent-graft for the ascending aorta and an inner-branched arch stent-graft for patients with acute type A aortic dissection. Technique: The technique to deploy these modular, custom-made stent-grafts is demonstrated in 2 patients with acute DeBakey type I aortic dissections and significant comorbidities precluding open surgery. Both emergent procedures were made possible by the availability of suitable devices manufactured for elective repair in other patients. After preliminary carotid-subclavian bypass, a long Lunderquist guidewire was introduced from the right femoral artery to the left ventricle for delivery of the Zenith Ascend and Zenith Branched Arch Endovascular Grafts under inflow occlusion. Bridging stent-grafts were delivered to the innominate and left common carotid arteries to connect to the 2 inner branches; the left subclavian artery was occluded. Both cases were technically successful and resulted in exclusion of the false lumen in the ascending aorta. The operating and fluoroscopy times did not exceed those of comparable elective procedures. The patients were rapidly extubated shortly after the procedure and without serious immediate complications. One patient survived 11 months with a satisfactory repair; the other succumbed to complications of recurrent pneumonia after 23 days. Conclusion: Endovascular treatment of patients with acute type A aortic dissection using a combination of tubular and branched stent-grafts in the ascending aorta is feasible and offers an alternative strategy to open surgery.

Intraoperative angiography for visceral arteries originating from false lumen

2021 ◽  
pp. 021849232110414
Author(s):  
Shintaro Takago ◽  
Satoru Nishida ◽  
Yukihiro Noda ◽  
Yu Nosaka ◽  
Ryo Yamamura ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Circulatory Arrest ◽  
False Lumen ◽  
External Iliac Artery ◽  
Acute Type ◽  
Elephant Trunk ◽  
Intraoperative Angiography ◽  
Visceral Arteries ◽  
Enhanced Computed Tomography

A 70-year-old man had an acute type B aortic dissection 9 years before his admission. The last enhanced computed tomography that was performed revealed an aneurysm that extended from the ascending aorta to the aortic arch, associated with a chronic aortic dissection, which extended from the aortic arch to the left external iliac artery. His visceral arteries originated from the false lumen. We performed a total arch replacement with a frozen elephant trunk in the hybrid operating room. Immediately after the circulatory arrest termination, using intraoperative angiography, we verified that the blood supply to the visceral arteries was patent.

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.

Endovascular Repair of a Tracheoinnominate Fistula with a Stent Graft

Vascular ◽  
2008 ◽  
Vol 16 (5) ◽  
pp. 287-290 ◽  
Author(s):  
Marcelo Guimaraes ◽  
Claudio Schönholz ◽  
Travis Phifer ◽  
Horacio D'Agostino
Keyword(s):  
Stent Graft ◽  
Endovascular Repair ◽  
Open Surgery ◽  
Surgical Repair ◽  
Bleeding Episode ◽  
Rare Complication ◽  
Massive Bleeding ◽  
Feasible Alternative ◽  
Endovascular Approach ◽  
A Minor

Massive bleeding from a tracheostomy developed in a 65-year-old woman with stroke after successful conservative management of a minor tracheostomy bleeding episode. Temporary hemostasis was achieved, and angiography showed a tracheoinnominate fistula (TIF), a rare complication of tracheostomy. Open surgery was contraindicated in this patient, so endovascular repair using a stent graft was performed. Permanent hemostasis was obtained, and there were no immediate complications from the procedure. The patient never recovered from her stroke and died 2 weeks later. The endovascular approach may be a feasible alternative to surgical repair of TIF, especially in patients unable to tolerate an open procedure.

scholarly journals Sedatives during circulatory arrest are not necessary for aortic arch repair in acute type A aortic dissection

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Alexander O. Makkinejad ◽  
Jeffrey Clemence ◽  
Elizabeth L. Norton ◽  
Linda Farhat ◽  
Xiao-Ting Wu ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Circulatory Arrest ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Aortic Arch Repair

scholarly journals Spontaneous splenic rupture, mesenteric ischemia and spinal infarction after aortic repair for acute type A dissection in a patient with sickle cell trait

2020 ◽  
Author(s):  
Makoto Toyoda ◽  
Tadashi Kitamura ◽  
Kouki Nakashima ◽  
Yoshikiyo Matsunaga ◽  
Masaki Nie ◽  
...  
Keyword(s):  
Sickle Cell ◽  
Mesenteric Ischemia ◽  
Sickle Cell Trait ◽  
Circulatory Arrest ◽  
Type A ◽  
Splenic Infarction ◽  
Acute Type ◽  
Nonocclusive Mesenteric Ischemia ◽  
Aortic Repair ◽  
Increased Risk

Abstract Sickle cell trait (SCT), a benign hematological condition affecting approximately 300 million individuals globally, is associated with an increased risk of vaso-occlusive disease. However, the risks related to surgery employing cardiopulmonary bypass in patients with SCT are not well established. Herein, we report the case of a 27-year-old African American man with SCT who underwent an emergency aortic repair for acute Stanford type A aortic dissection using hypothermic circulatory arrest. The patient developed a sickle cell crisis, which was followed by spontaneous splenic infarction and rupture, nonocclusive mesenteric ischemia, and spinal infarction.

Double Barreled Graft (Chimney) as a Strategy to Preserve Supraortic Branches in Contained Ruptured Thoracic Aneurysm Thoraco Endovascular Aortic Aneurysmal Repair- A Case Report

2021 ◽  
Author(s):  
Rohit Mody
Keyword(s):  
Case Report ◽  
Aortic Arch ◽  
Stent Graft ◽  
Open Surgery ◽  
Thoracic Aortic Aneurysm ◽  
Thoracic Aneurysm ◽  
Complete Coverage ◽  
Hybrid Repair ◽  
Adequate Coverage ◽  
Aortic Branch

Out of many strategies that are used to treat aortic arch disease, including open surgery, branched techniques, and hybrid repair with Thoracic Endovascular Aortic Aneurysmal Repair (TEVAR) and supra-aortic branch reconstruction and fenestration, Thoracic Endovascular Aortic Aneurysmal Repair (TEVAR) incorporating chimney is frequently used in unstable and morbid patients not suitable for other procedures. We describe here a case of contained rupture of a thoracic aortic aneurysm, which was treated with TEVAR incorporating a double chimney to the left common carotid and left subclavian arteries. There was an uncomplicated course of the procedure with complete coverage of aneurysm with stent-graft and open aortic arch vessels when followed up to 6 months. There were no complications noted as well. In this case we took the precaution to upsize the stent-graft by 20% to 30% also for adequate coverage of aneurysm we had to adopt to the chimney technique. To prevent complications like gutter and endoleaks, the kissing technique was used during deployment. In addition, there was adequate coverage of chimney-grafts with adequate proximal projection.

Complete Aortic Arch Remodeling After Stent Graft of Acute Type B Dissection and Kommerell's Diverticulum

2012 ◽  
Vol 93 (2) ◽  
pp. 673 ◽  
Author(s):  
Stefano Pirrelli ◽  
Antonio Bozzani ◽  
Vittorio Arici ◽  
Attilio Odero
Keyword(s):  
Aortic Arch ◽  
Stent Graft ◽  
Acute Type ◽  
Type B ◽  
Kommerell’S Diverticulum ◽  
Type B Dissection

Postpartum dissection in bovine aorta with anomalous brachiocephalic vessels

2018 ◽  
Vol 27 (5) ◽  
pp. 400-403 ◽  
Author(s):  
Andrea De Martino ◽  
Giosuè Falcetta ◽  
Giovanni Scioti ◽  
Angela Pucci ◽  
Uberto Bortolotti
Keyword(s):  
Computed Tomography ◽  
Aortic Dissection ◽  
Aortic Arch ◽  
Acute Aortic Dissection ◽  
Left Vertebral Artery ◽  
Aortic Diseases ◽  
Histological Changes ◽  
Uncomplicated Pregnancy ◽  
Increased Risk ◽  
Bovine Aortic Arch

A 42-year-old woman, with no evidence of connective tissue disease, presented with acute aortic dissection after an uneventful vaginal delivery following an uncomplicated pregnancy. Emergency computed tomography angiography showed a bovine aortic arch with a separate origin of the left vertebral artery. At surgery, a tricuspid aortic valve was found and the aortic arch was successfully repaired with reimplantation of a button incorporating the origin of the brachiocephalic vessels. Acute aortic dissection throughout pregnancy is uncommon and favoured by hemodynamic, hormonal, and histological changes. Anomalies of the aortic arch branches might represent an increased risk of thoracic aortic diseases.

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