Arch and access vessel complications in penetrating aortic ulcer managed with thoracic endovascular aortic repair

Piffaretti, Gabriele; Fontana, Federico; Tadiello, Marco; Guttadauro, Chiara; Piacentino, Filippo; Bush, Ruth L.; Socrate, Anna Maria; Tozzi, Matteo

doi:10.21037/acs.2019.06.07

Cited by 9 publications

(4 citation statements)

References 39 publications

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“…The main difference here is that PAU is an obliterative aortic disease that makes these patients prone to multisite arterial disease such as coronary artery disease, carotid artery disease or peripheral arterial disease. Consequently, procedural risk, in particular for access vessel challenges, and most importantly for stroke, is higher [10]. It remains of utmost importance to anticipate risk during screening and to link findings of preoperative imaging to the potential complications caused by wire manipulation early and to rethink the treatment strategy.…”

Section: Discussionmentioning

confidence: 99%

Results of endovascular aortic arch repair using the Relay Branch system

Czerny

Berger

Kondov

et al. 2021

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES Our goal was to evaluate results of endovascular aortic arch repair using the Relay Branch system. METHODS Forty-three patients with thoracic aortic pathology involving the aortic arch have been treated with the Relay Branch system (Terumo Aortic, Sunrise, FL, USA) in 10 centres. We assessed in-hospital mortality, neurological injury, treatment success according to current reporting standards and the need for secondary interventions. In addition, outcome was analysed according to the underlying pathology: non-dissective disease versus residual aortic dissection (RAD) (defined as remaining dissection after previous type A repair, chronic type B aortic dissections). RESULTS In-hospital mortality was 9% (0% in patients with RAD). Disabling stroke occurred in 7% (0% in patients with RAD); non-disabling stroke occurred in 19% (7% in patients with RAD). Early type IA and B endoleak formation occurred in 4%. Median follow-up was 16 ± 18 months. During the follow-up period, 23% of the patients died. Aortic-related deaths were low (3% in patients with RAD). CONCLUSIONS The results of endovascular aortic arch repair using the Relay Branch system in a selected patient population with regard to technical success are good. In-hospital mortality is acceptable, the number of disabling strokes is low and technical success is high. Non-disabling stroke is a major concern, and every effort has to be taken to reduce this to a minimum. The best outcome is seen in patients with underlying RAD. Finally, more data are needed.

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Section: Discussionmentioning

confidence: 99%

Results of endovascular aortic arch repair using the Relay Branch system

Czerny

Berger

Kondov

et al. 2021

European Journal of Cardio-Thoracic Surgery

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“…16 In a recent study published by Piffaretti et al, a cohort of 48 patients with PAUs were reported, 37 of them treated with TEVAR. 17 In this study, a proximal sealing zone of a minimum of 15 mm was required. Adjunctive procedures within the arch (carotid subclavian bypasses, LSA chimney, and supra-aortic trunk debranching) were performed in 7 cases.…”

Section: Discussionmentioning

confidence: 99%

The Jailed Coiling Technique for the Treatment of Penetrating Ulcers and Saccular Aneurysms of the Aortic Arch

Silverberg

Bar-Dayan

Rimon

et al. 2020

Vasc Endovascular Surg

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Objective: To evaluate the technical success and short-term outcome of patients with penetrating aortic ulcers (PAUs) and saccular aneurysms (SAs) of the aortic arch treated with the jailed coiling technique. Methods: A retrospective review of 9 patients (mean age 70 years, 9 males) treated for PAUs and SAs of the aortic arch between 2018 and 2019 at our institution. Treatment included thoracic endovascular aneurysm repair (TEVAR) with a short (1cm) proximal landing zone, followed by coiling of aneurysm through a jailed extraluminal catheter. Results: All 9 patients underwent TEVAR followed by jailed coiling of the lumen of the aneurysms. Debranching of supra-aortic vessels was performed in 4 patients in order to create a proximal landing zone of at least 10 mm. Technical success was achieved in all cases. Coils were placed accurately within the aneurysm lumen in all patients. No distal embolization occurred. One patient expired in the perioperative period from a cardiac event. No patient developed spinal cord ischemia or stroke in the perioperative period. Mean follow-up was 10 months (range 3-18). On follow-up imaging, complete thrombosis of the aneurysm lumen was seen in all patients. None experienced enlargement of ulcer dimensions and none required reintervention. Conclusion: PAUs and SAs of the aortic arch with a very short landing zone can be treated successfully by jailed coiling of the aneurysm and TEVAR. The procedure is technically feasible and can be performed with minimal morbidity. Long-term durability of the repair needs to be determined.

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“…Complications related to the femoral artery access sites are also common 25 . The femoral arteries are cuff down to deploy the stent graft in most of the patients in our center.…”

Section: Discussionmentioning

confidence: 99%

Analysis of clinical outcomes of one‐staged hybrid procedure without thoracotomy for aorta lesion involving distal aortic arch

et al. 2021

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Background This study aimed to evaluate the clinical outcomes of one‐staged hybrid procedure for aortic lesions involving the distal aortic arch. Methods We retrospectively studied 99 consecutive patients who underwent the hybrid procedure (thoracic endovascular aortic repair combined with supra‐arch branch vessel bypass) in our center between April 2009 and January 2020 for lesions involving the distal aortic arch. Results Median age was 64.0 (57.0–69.0) years, and 83 (83.8%) patients were male. There were five deaths in the perioperative period (three due to cerebral infarction and two due to intimal rupture). During the median follow‐up of 41.0 months, 20 patients died, three had endoleak, one had a newly formed intimal tear, and two had femoral artery pseudoaneurysm. The 5‐ and 10‐year survival rates of the total population were 72.2% and 48.8%, respectively. Additionally, there was no difference in the 5‐year survival rate among the four groups according to different pathologies (Type B aortic dissection, aortic ulcer, aortic aneurysm, aortic pseudoaneurysm: 74.7%, 78.2%, 61.1%, and 75.5%, respectively, p = .58). Furthermore, there was no difference in the 5‐ and 10‐year survival rates between the two groups according to the different bypass methods (right axillary artery [RAA]‐left axillary artery [LAA] vs. RAA‐LAA‐left common carotid artery: 74.1% vs. 68.9%, p = .38). Conclusions Although one‐staged hybrid procedure has fewer complications in high‐risk patients with lesions involving the distal aortic arch, the long‐term survival rate is not optimistic.

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Arch and access vessel complications in penetrating aortic ulcer managed with thoracic endovascular aortic repair

Cited by 9 publications

References 39 publications

Results of endovascular aortic arch repair using the Relay Branch system

Results of endovascular aortic arch repair using the Relay Branch system

The Jailed Coiling Technique for the Treatment of Penetrating Ulcers and Saccular Aneurysms of the Aortic Arch

Analysis of clinical outcomes of one‐staged hybrid procedure without thoracotomy for aorta lesion involving distal aortic arch

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