Aortic Dissection: Accurate Subintimal Flap Fenestration by Using a Reentry Catheter with Fluoroscopic Guidance—Initial Single-Institution Experience

Wolfschmidt, Franziska; Hassold, Nicole; Goltz, Jan Peter; Leyh, Rainer; Bley, Thorsten Alexander; Kickuth, Ralph

doi:10.1148/radiol.2015140520

Cited by 15 publications

(10 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In situ fenestrations were employed for the arch arteries and were reported in both experimental and clinical works . Different fenestration techniques were reported: radiofrequency probes, the use of needles or sharp guide wire, in situ retrograde fenestration, and laser . All the techniques demonstrated advantages and disadvantages.…”

Section: Discussionmentioning

confidence: 99%

In Situ Laser Fenestration Is a Feasible Method for Revascularization of Aortic Arch During Thoracic Endovascular Aortic Repair

Qin

Zhao

Wang

et al. 2017

JAHA

View full text Add to dashboard Cite

BackgroundReconstruction of the aortic major branches during thoracic endovascular aortic repair is complicated because of the complex anatomic configuration and variation of the aortic arch. In situ laser fenestration has shown great potential for the revascularization of aortic branches. This study aims to evaluate the feasibility, effectiveness, and safety of in situ laser fenestration on the three branches of the aortic arch during thoracic endovascular aortic repair.Methods and ResultsBefore clinical application, the polytetrafluoroethylene and Dacron grafts were fenestrated by an 810‐nm laser system ex vivo, which did not damage the bare metal portion of the endografts and created a clean fenestration while maintaining the integrity of the endografts. In vivo, 6 anesthetized female swine survived after this operation, including stent‐graft implantation in the aortic arches, laser fenestration, and conduit implantation through the innominate arteries and the left carotid arteries. Based on the animal experiments, in situ laser fenestration during thoracic endovascular aortic repair was successively performed on 24 patients (aged 33–86 years) with aortic artery diseases (dissection type A: n=4, type B: n=7, aneurysm: n=2, mural thrombus: n=7). Fenestration of 3 aortic branches was performed in 2 (8.3%) patients. Both the left carotid artery and the left subclavian artery were fenestrated in 6 (25%) patients. Only left subclavian artery fenestration surgery was done in 16 (66.7%) patients. Among these patients, 1 fenestration was abandoned secondary to an acute takeoff of the innominate artery in a type III aortic arch. The average operative time was 137±15 minutes. The technical success rate was 95.8% (n=23). No fenestration‐related complications or neurological morbidity occurred after this operation. During a mean postoperative 10‐month follow‐up (range: 2–17 months), 1 patient died of severe pneumonia, and all the left subclavian artery and carotid artery stents were patent with no fenestration‐related endoleaks upon computed tomography angiography images.ConclusionsIn situ laser fenestration is a feasible, effective, rapid, repeatable, and safe option for the reconstruction of aortic arch during thoracic endovascular aortic repair, which might be available to revascularize the 3 branches. However, follow‐up periods should be extended to evaluate the robustness of this technique.

show abstract

Section: Discussionmentioning

confidence: 99%

In Situ Laser Fenestration Is a Feasible Method for Revascularization of Aortic Arch During Thoracic Endovascular Aortic Repair

Qin

Zhao

Wang

et al. 2017

JAHA

View full text Add to dashboard Cite

show abstract

“…The key difference from the known application of reentry systems for neofenestrations in acute aortic dissections [6][7][8] is that, in chronic dissections, the short needles of these devices are usually ineffective in perforating a thickened, stable lamella because it is deflected by the needle. This is the rationale for the combination of a reentry device with a balloon; indeed, by inflating a balloon in the opposite lumen, the lamella is not only pushed closer to the needle and fixed in position, but it is also under greater tension, thus becoming easier to perforate.…”

Section: Discussionmentioning

confidence: 99%

“…2,6 While reentry devices have been used to create neofenestrations in acute aortic dissections, their effectiveness for chronic dissections has been only postulated. 7,8 The technique proposed here is based on the delivery of a needle-based reentry device [with or without intravascular ultrasound (IVUS) guidance] in one lumen while a balloon is simultaneously inflated in the opposite lumen to stabilize the mobile dissecting lamella.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Reentry Devices for Lamella Neofenestration During Endovascular Aortic Repair of Chronic Type B Aortic Dissection

et al. 2018

View full text Add to dashboard Cite

The balloon-supported lamella neofenestration technique involving off-label application of two currently available reentry devices can be applied to endovascular treatment chronic aortic dissections. While the technique will definitely not become a standard of practice, it provides a safe, effective, and readily available option for endovascular management of those patients with complex chronic aortic dissections requiring bailout maneuvers or elective treatment.

show abstract

“…Although treatments strongly depend on the type of AAD, the presence of MPS can have a substantial clinical impact, because it typically requires additional aggressive therapies. Endovascular methods for managing MPS, such as bare-metal stents, stentgraft placement, and/or intimal fenestration, provided a benefit by reducing the mortality rate (28)(29)(30). Recently, Augoustides et al (31)(32)(33) introduced the Penn classification, which integrated localized and generalized ischemia into the traditional Stanford classification, but that classification was allocated solely to type A AAD.…”

Section: Figure 4 |mentioning

confidence: 99%

A New Clinically Driven Classification for Acute Aortic Dissection

Qanadli

Malekzadeh²,

Villard³

et al. 2020

Front. Surg.

View full text Add to dashboard Cite

Objectives: To report a new classification scheme for acute aortic dissection (AAD) that considers the aortic arch as a separate entity and integrates patterns of malperfusion syndrome (MPS). The proposed classification was evaluated retrospectively in a large population. Materials and Methods: We retrospectively reviewed pre-therapy CT angiograms of 226 consecutive patients (mean ± SD age: 64 ± 12 years) with AAD. AADs were reclassified with a new classification scheme that included three aortic dissection types (A, involving at least the ascending aorta; B, involving exclusively the descending aorta; and C, involving the aortic arch with/without the descending aorta) and four malperfusion grades (0: no MPS; 1: dynamic MPS; 2: static MPS; 3: static and dynamic MPS). AAD features were assessed and correlated to patient outcomes. Results: According to the new classification, we identified 152 type A dissections (92 A0, 11 A1, 38 A2, 11 A3); 50 type B (38 B0, 5 B1, 6 B2, 1 B3); and 24 type C (17 C0, 6 C2, 1 C3). Type C represented 11% of all AADs. MPS occurred in 39, 24, and 29% in type A, B, and C, respectively. Type C was treated with significantly more endovascular or hybrid interventions (37%) than in types A (3%) and B (20%) (p < 0.001). Conclusion: The new AAD classification was feasible, and type C was easily identified ("non-A, non-B"). Preliminary findings supported the usefulness of this classification for the decision-making process and subsequent treatments.

show abstract

Aortic Dissection: Accurate Subintimal Flap Fenestration by Using a Reentry Catheter with Fluoroscopic Guidance—Initial Single-Institution Experience

Abstract: The applied commercially available reentry catheter seems to be a reliable and safe tool that may be useful for gaining target lumen reentry with reasonably good clinical outcomes.

Cited by 15 publications

References 35 publications

In Situ Laser Fenestration Is a Feasible Method for Revascularization of Aortic Arch During Thoracic Endovascular Aortic Repair

In Situ Laser Fenestration Is a Feasible Method for Revascularization of Aortic Arch During Thoracic Endovascular Aortic Repair

Reentry Devices for Lamella Neofenestration During Endovascular Aortic Repair of Chronic Type B Aortic Dissection

A New Clinically Driven Classification for Acute Aortic Dissection

Contact Info

Product

Resources

About