scholarly journals Surgeon-modified fenestrated stent graft deployment in type B aortic dissection

2021 ◽  
Vol 29 (2) ◽  
pp. 285-289
Author(s):  
Hakkı Zafer İşcan ◽  
Ertekin Utku Ünal
Keyword(s):  
Aortic Dissection ◽  
Stent Graft ◽  
Subclavian Artery ◽  
Left Subclavian Artery ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Landing Zone ◽  
Ischemic Complications ◽  
Fenestrated Stent Graft ◽  
Aortic Dissections

The treatment of aortic dissections and aneurysms may be challenging for vascular surgeons. Currently, thoracic endovascular aortic repair is usually the first treatment option for descending aortic pathologies. Left subclavian artery coverage during this procedure is often required to achieve a sufficient proximal landing zone. Most surgeons agree that the left subclavian artery can be selectively covered, but revascularization is preferred to reduce the risk of neurological or ischemic complications. The chimney method, hybrid operations with extra-anatomic bypass, back table or in situ fenestrations are assistive techniques in this procedure. Herein, we present a surgeon-modified fenestrated stent graft for a type B aortic dissection patient.

Complications after Endovascular Repair of Type B Aortic Dissection

2002 ◽  
Vol 9 (6) ◽  
pp. 822-828 ◽  
Author(s):  
Reinhard S. Pamler ◽  
Thomas Kotsis ◽  
Johannes Görich ◽  
Xaver Kapfer ◽  
Karl-Heinz Orend ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Stent Graft ◽  
Subclavian Artery ◽  
Left Subclavian Artery ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Stent Grafting ◽  
Stent Graft Implantation ◽  
Graft Implantation

Purpose: To outline the complications encountered after endoluminal treatment in patients with type B aortic dissection. Methods: Between 1999 and 2001, 14 patients (12 men; mean age 60.3 years, range 39–79) with isolated type B aortic dissection (13 chronic, 1 acute) underwent aortic stent-grafting. Three patients with chronic dissection presented an acute clinical picture and were managed emergently. The left subclavian artery was intentionally covered by the prosthesis in 9 patients. Follow-up studies were performed at 6-month intervals. Results: Stent-graft implantation was technically successful in all patients, but incomplete sealing (endoleak) of the entry site required additional proximal stent-graft implantation in 4. The left subclavian artery remained patent in 5 patients. Secondary conversion was required in 3 patients: 2 for acute type A dissection resulting from injury to the aortic arch by Talent endografts and a sustained hemorrhage (left hemothorax). In another patient, a secondary intramural hematoma subsided spontaneously. Anterior spinal artery syndrome in 1 patient persisted at 1 month. No bypass was necessary for the 9 patients with the covered left subclavian arteries. Mean follow-up was 14 months (range 1–23). Conclusions: Stent-grafting is feasible in patients with type B aortic dissection, although it is associated with a considerable rate of complications. Frank reporting of these sequelae for a variety of stent-grafts is of paramount importance to clarifying the limitations of the method.

scholarly journals Treatment with Aortic Stent Graft Placement for Stanford B-Type Aortic Dissection in a Patient with an Aberrant Right Subclavian Artery

2015 ◽  
Vol 2015 ◽  
pp. 1-5
Author(s):  
Yohei Kawatani ◽  
Yujiro Hayashi ◽  
Yujiro Ito ◽  
Hirotsugu Kurobe ◽  
Yoshitsugu Nakamura ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Stent Graft ◽  
Subclavian Artery ◽  
Distal Portion ◽  
Aberrant Right Subclavian Artery ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Aortic Stent Graft ◽  
The Right ◽  
Stanford Type B

A 71-year-old man visited our hospital with the chief complaint of back pain and was diagnosed with acute aortic dissection (Debakey type III, Stanford type B). He was found to have a variant branching pattern in which the right subclavian artery was the fourth branch of the aorta. We performed conservative management for uncomplicated Stanford type B aortic dissection, and the patient was discharged. An ulcer-like projection (ULP) was discovered during outpatient follow-up. Complicated type B aortic dissection was suspected, and we performed thoracic endovascular aortic repair (TEVAR). The aim of operative treatment was ULP closure; thus we placed two stent grafts in the descending aorta from the distal portion of the right subclavian artery. The patient was released without complications on postoperative day 5. Deliberate sizing and examination of placement location were necessary when placing the stent graft, but operative techniques allowed the procedure to be safely completed.

Comparison of supra-arch in situ fenestration and chimney techniques for aortic dissection involving the left subclavian artery

Vascular ◽  
2018 ◽  
Vol 27 (2) ◽  
pp. 153-160 ◽  
Author(s):  
Ma XiaoHui ◽  
Wei Li ◽  
Guo Wei ◽  
Liu XiaoPing ◽  
Jia Xin ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Subclavian Artery ◽  
Left Subclavian Artery ◽  
Small Sample ◽  
Covered Stents ◽  
Type I ◽  
Type B ◽  
Aortic Dissections

Introduction Endovascular intervention involving the aortic arch, particularly in thoracic aortic dissection, remains challenging and controversial at current time when there is no commercially suitable grafts on most of the international markets. This study compared two endovascular treatments that maintain left subclavian artery perfusion using two modified techniques for type-B aortic dissection patients. Methods Consecutive cases utilizing chimney or in situ fenestration techniques to preserve left subclavian artery in type B AD from 2006 to 2015 in our single institution were retrospectively reviewed. Statistical analyses were performed with Student t-test, Wilcoxon rank sum, and Fisher exact tests when appropriate. Significant statistical differences were determined with p < 0.05. Results A total of 85 cases, including 67 (79.8%) with chimney and 18 (21.2%) with in situ fenestration techniques were identified in this retrospective study. In chimney group, there were 18 (26.9%) acute, 29 (43.3%) sub-acute, and 20 (29.9%) chronic aortic dissections. We implanted 24 Zenith and 43 Talent aortic endografts along with 55 balloon-expandable bare stents and 12 self-expanding covered stents in chimney group. Whereas in in situ fenestration group, there were four (22.2%) acute, six (33.3%) subacute, and eight (44.5%) chronic aortic dissections, all of which received Zenith endografts with 11 balloon-expandable covered and seven self-expanding covered stents, respectively. Demographic variables were similarly distributed with 100% intraoperative technical overall success in both groups. Comparing to in situ fenestration group, chimney group has shorter procedural and fluoroscopy time, less blood loss, and contrast volume used. All patients were followed-up to 52 months (median 38, range 24–52). Overall group mortality is 3.6% (3/84). All deaths were from chimney group. There was no procedure-related stroke observed within the study series. Primary patency was maintained while aortic remodeling with complete false lumen was achieved in all patients except that there were three (4.55%) Type-I endoleak cases in early post-operative period and one (1.5%) stent compression at 3-months follow-up in chimney group. There were no stent-related complications observed in in situ fenestration group. Conclusion Although there were previous studies describing the similar techniques, this study appears to be the first study to compare in situ fenestration and chimney techniques for aortic dissection involving the left subclavian artery according to the MEDLINE search. Although we are unable to establish the superiority between two approaches due to small sample size and relative short period of follow-up, in situ fenestration may represent a more favorable option, especially among aortic dissections with short proximal landing zones in the study.

Endovascular Aortic Repair With Castor Single-Branched Stent-Graft in Treatment of Acute Type B Aortic Syndrome and Aberrant Right Subclavian Artery

2021 ◽  
pp. 153857442110056
Author(s):  
Xinyan Pang ◽  
Shi Qiu ◽  
Chen Wang ◽  
Kai Liu ◽  
Xin Zhao ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Stent Graft ◽  
Subclavian Artery ◽  
False Lumen ◽  
Endovascular Aortic Repair ◽  
Aberrant Right Subclavian Artery ◽  
Acute Type ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Aortic Repair

Objective: In this retrospective study, we presented the results of Castor single-branched stent-graft in a small series of patients with acute type B aortic syndrome and aberrant right subclavian artery (ARSA). Methods: Between January 2019 and November 2019, 5 patients were diagnosed with acute type B aortic syndrome and ARSA (4 patients with intramural hematoma and ARSA, 1 patient with type B aortic dissection and ARSA). All the patients underwent thoracic endovascular aortic repair (TEVAR) using Castor single-branched stent-graft. In-hospital and 3-month outcomes were collected. Results: The mean operative time was 116 ± 20.43 minutes (range 90-145). All the TEVAR procedures were successfully performed without conversion to open surgery (100% success rate). All the ARSAs of the 5 patients were revascularized in situ by Castor single-branched stent-grafts. No deaths and complications were observed in the 3-month follow-up. The maximal diameters of diseased aortas in the 4 patients with IMH decreased 3 months after TEVAR. The false lumen in the graft-covered segment was completely thrombosed in the patient with type B aortic dissection. Conclusions: Castor single-branched stent-graft may be a good choice in treatment of acute type B aortic syndrome and aberrant right subclavian artery.

Homemade Candy Plug Using a Zenith Alpha Thoracic Stent-Graft for False Lumen Distal Occlusion in Acute-on-Chronic Type B Aortic Dissection

2019 ◽  
Vol 26 (5) ◽  
pp. 732-735 ◽  
Author(s):  
Kok Hooi Yap ◽  
Yi Chuan Tham ◽  
Kiang Hiong Tay ◽  
Chong Tze Tec ◽  
Farah Gillan Irani ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Stent Graft ◽  
Subclavian Artery ◽  
Artery Bypass ◽  
False Lumen ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Chronic Type ◽  
Male Smoker ◽  
Type Ia

Purpose: To report a candy-plug technique using a Zenith Alpha stent-graft to occlude the distal false lumen in a patient with a complicated chronic type B aortic dissection. Case Report: A 50-year-old male smoker presented with chest pain due to rapidly growing complicated chronic type B aortic dissection. Computed tomography angiography (CTA) showed the dissection extending from distal to the origin of the left subclavian artery (LSA) down to the left femoral artery. There was fusiform aneurysmal dilatation of the proximal descending aorta measuring up to 5.8 cm in diameter. He underwent left carotid–subclavian artery bypass, thoracic endovascular aortic repair with a Zenith Alpha stent-graft, a left common carotid artery chimney, and embolization of the proximal LSA. Serial CTA showed persistent false lumen flow. A decision was made to occlude the distal large false lumen using the candy-plug technique. A 44×125-mm Zenith Alpha stent-graft was used to prepare the candy plug. A gutter leak and a type Ia endoleak were embolized via a left brachial artery approach. At 2.5 years, imaging showed the candy plug in position, no endoleak, and the thrombosed false lumen in the thoracic aorta reduced in size. Conclusion: The candy-plug technique is useful in facilitating complete occlusion of the false lumen in chronic aortic dissection, which avoids an open procedure and the risk of higher morbidity.

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