<b>Intentional Occlusion of the Left Subclavian Artery During Stent-Graft Implantation in the Thoracic Aorta:</b>Risk and Relevance

Rehders, Tim C.; Petzsch, Michael; İnce, Hüseyin; Kische, Stephan; Körber, Thomas; Koschyk, Dietmar; Chatterjee, Tushar; Weber, Frank; Nienaber, Christoph

doi:10.1583/04-1311r.1

Cited by 146 publications

(99 citation statements)

References 16 publications

(31 reference statements)

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“…The close vicinity of the left subclavian artery origin to the primary tear in Type B dissections presents a unique anatomical problem, often requiring a radical solution. A complete closure of the left subclavian artery (LSA) ostium may be necessary at times to ensure the proper placement and debranching of the stent graft, else use of extra-anatomical bypasses would have to be considered [23]. Observational evidence dictates that prophylactic surgical maneuvers are not always required but could be performed electively after the endovascular intervention in the event of developing ischemia.…”

Section: Technique Of Endovascular Stent-graft Placementmentioning

confidence: 99%

Role of Interventional Treatment of Thoracic Aorta

Akın¹,

Ansari²,

Nienaber³

2017

Aortic Aneurysm

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An aging western and oriental population coupled with breakthrough advances in modern diagnostic imaging modalities has evoked renewed interest in the hitherto underdiagnosed acute and chronic diseases of the aorta, which also include aortic aneurysm and aortic dissection. Although classical surgical strategies still dominate the clinical management of acute and chronic pathologies of the ascending aorta and the proximal arch region, the emergence of novel endovascular concepts has ofered an interesting therapy alternative for the treatment of descending aortic pathology in suitable patients and is highly likely to evolve as the primary treatment strategy in majority of the cases. Moreover, the use of hybrid approaches combining surgical head-vessel debranching and interventional stent-graft implantation in an atempt to improve clinical outcome in aortic arch pathologies has helped avoid the high risk of open arch repair or complete replacement. Notwithstanding these recent advancements, the complex nature of the underlying vascular disease still dictates that the proposed management of every diagnosed patient is discussed in a team constituting cardiologists, cardiac surgeons, anesthesiologists, and radiologists, with the conceptualization of individualized therapeutic strategies and conducted in a center with signiicant surgical and endovascular experience.

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Section: Technique Of Endovascular Stent-graft Placementmentioning

confidence: 99%

Role of Interventional Treatment of Thoracic Aorta

Akın¹,

Ansari²,

Nienaber³

2017

Aortic Aneurysm

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“…1,2,[12][13][14] Although endovascular strategies are therapeutic options for complicated aortic dissection as rescue maneuvers, 5,6,[15][16][17][18] there is ongoing controversy about clinically stable type B aortic dissection, with current consensus in support of surveillance and tight control of hypertension. 19,20 Conversely, with a death rate up to 30% at 2 years 11 and a survival rate Ͻ50% in the long term, 21 attention has shifted to TEVAR as a viable alternative.…”

Section: Editorial See P 2513 Clinical Perspective On P 2528mentioning

confidence: 99%

Randomized Comparison of Strategies for Type B Aortic Dissection

et al. 2009

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Background-Thoracic endovascular aortic repair (TEVAR) represents a novel concept for type B aortic dissection.Although life-saving in acute emergencies, outcomes and survival of TEVAR in stable dissection are unknown. Methods and Results-One hundred forty patients in stable clinical condition at least 2 weeks after index dissection were randomly subjected to elective stent-graft placement in addition to optimal medical therapy (nϭ72) or to optimal medical therapy alone (nϭ68) with surveillance (arterial pressure according to World Health Organization guidelines Յ120/ 80 mm Hg). The primary end point was all-cause death at 2 years, whereas aorta-related death, progression (with need for conversion or additional endovascular or open surgery), and aortic remodeling were secondary end points. There was no difference in all-cause deaths, with a 2-year cumulative survival rate of 95.6Ϯ2.5% with optimal medical therapy versus 88.9Ϯ3.7% with TEVAR (Pϭ0.15); the trial, however, turned out to be underpowered. Moreover, the aorta-related death rate was not different (Pϭ0.44), and the risk for the combined end point of aorta-related death (rupture) and progression (including conversion or additional endovascular or open surgery) was similar (Pϭ0.65). Three neurological adverse events occurred in the TEVAR group (1 paraplegia, 1 stroke, and 1 transient paraparesis), versus 1 case of paraparesis with medical treatment. Finally, aortic remodeling (with true-lumen recovery and thoracic false-lumen thrombosis) occurred in 91.3% of patients with TEVAR versus 19.4% of those who received medical treatment (PϽ0.001), which suggests ongoing aortic remodeling. Conclusions-In the first randomized study on elective stent-graft placement in survivors of uncomplicated type B aortic dissection, TEVAR failed to improve 2-year survival and adverse event rates despite favorable aortic remodeling. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00525356.

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“…Invasive options include carotid-subclavia bypass (CSB), carotid-subclavia transposition (CST), and axillo-axillary bypass. [23][24][25][26] With this presentation we would like to describe the realization of complex radiological interventional therapeutic procedures of treating subclavia steal syndrome and stenosis of the left common iliac artery, at the institute of Radiology KCUS under the supervision of a Bosnian expert Dr. Suad Jaganjac working at the Hamburg Klinik Eilbek in Germany.…”

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confidence: 99%