Branched Endovascular Therapy of the Distal Aortic Arch: Preliminary Results of the Feasibility Multicenter Trial of the Gore Thoracic Branch Endoprosthesis

Patel, Himanshu J.; Dake, Michael D.; Bavaria, Joseph E.; Singh, Michael J.; Filinger, Mark; Fischbein, Michael P.; Williams, David M.; Matsumura, Jon S.; Oderich, Gustavo S.

doi:10.1016/j.athoracsur.2016.03.091

Cited by 124 publications

(116 citation statements)

References 14 publications

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“…During the development of this type of stent graft, Dake and Patel reported on their work on a branched stent graft which has a similar delivery system [13]. The result of the initial clinical trials are encouraging with 100% procedural success and patency of the side branch.…”

Section: Discussionmentioning

confidence: 99%

Two Wire System and Modified Olive Tip to Facilitate Implantation of Fenestrated TEVAR in Patient with Proximal Descending Aortic Pathology: First Two Cases

Adiarto

Kang

Sunu

et al. 2019

Cardiovasc Intervent Radiol

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IntroductionAlthough Fenestrated TEVAR (F-TEVAR) has been considered to be a more physiologic approach to treat proximal descending aortic pathology, its application is still limited due to availability, cost and technical difficulties. We introduce a new design of fenestrated stent graft with a new delivery system and successfully performed first in human implantation in two patients, one with an aortic aneurysm and one with an acute aortic dissection.Materials and MethodsThe design of these two wires fenestrated stent graft include creation of an additional lumen at the side of the olive tip during manufacture, from which an additional wire can be introduced for a side branch passing into the fenestration, running inside the stent graft and exit the delivery sheath through additional hub. The two wires will facilitate delivery and deployment of the stent graft. One patient with descending aortic aneurysm and another with Stanford B aortic dissection is included in this first in human study.ResultsThe aneurysm and dissection were completely excluded immediately after the TEVAR. Six month follow up CT showed good position of the stent graft and patent LSA in both patients. In the patient with aortic dissection, expansion of the true lumen and partial thrombosis of the false lumen was seen.ConclusionsThis is a report of a two wire system in 2 patients with distal aortic arch pathology demonstrating a good technical and clinical success using pre-cannulated fenestrations through a modified nose cone olive.Level of EvidenceLevel 4, report of two cases.

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Section: Discussionmentioning

confidence: 99%

Two Wire System and Modified Olive Tip to Facilitate Implantation of Fenestrated TEVAR in Patient with Proximal Descending Aortic Pathology: First Two Cases

Adiarto

Kang

Sunu

et al. 2019

Cardiovasc Intervent Radiol

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“…Moulakakis et al published a meta-analysis of 136 patients with chimney grafts in the aortic arch, reporting an endoleak rate of 11% and 8% for type Ia and type II endoleak, respectively (33). A stroke rate of 4% was observed (31). Similarly, another meta-analysis of 94 patients with 101 chimney grafts in the aortic arch reported a perioperative mortality rate of 3%, stroke rate of 5% and endoleak rate of 18% (of those most frequently type Ia with 6%) (34).…”

Section: Chimney Graftsmentioning

confidence: 91%

“…There have been no reports of death, rupture, paraplegia, conversion or secondary endovascular procedure during follow-up (30). Similarly, Gore Thoracic Branch Endoprosthesis (WL Gore, Flagstaff, AZ, USA) based on the cTAG platform with a caudally-oriented internal branch, was used in 22 patients with distal arch aneurysms (31). Technical success rates of 100%, without 30-day death, stroke or permanent paraplegia were reported (31).…”

Section: Alternative Investigational Stent-graft Systemsmentioning

confidence: 99%

“…Similarly, Gore Thoracic Branch Endoprosthesis (WL Gore, Flagstaff, AZ, USA) based on the cTAG platform with a caudally-oriented internal branch, was used in 22 patients with distal arch aneurysms (31). Technical success rates of 100%, without 30-day death, stroke or permanent paraplegia were reported (31). These novel single-branched arch stentgrafts can be successfully used for total endovascular repair of distal zone 2 aortic arch aneurysms.…”

Section: Alternative Investigational Stent-graft Systemsmentioning

confidence: 99%

See 1 more Smart Citation

Endovascular total arch replacement techniques and early results

Makaloski

Tsilimparis

Rohlffs

et al. 2018

Ann. Cardiothorac. Surg.

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During the last 20 years, a clear shift has been observed towards thoracic endovascular aortic repair for different aortic pathologies. However, total endovascular repair of the aortic arch remains technically demanding. Simultaneous perfusion of all supra-aortic arteries without longer cerebral ischemia time, whilst trying to avoid cerebral embolization, labels endovascular aortic arch repair with highest level of technical difficulty and surgical expertise. The aim of this article is to present an overview of the current technical options for endovascular aortic arch repair and their early results. Currently, early results are reported from four endovascular arch replacement techniques: hybrid repair, total endovascular approach, chimney grafts and in-situ fenestration. The early results of these different arch replacement techniques are promising, especially the total arch replacement with custom-made fenestrated or branched stent-grafts. Long-term results are unknown, and larger series results and comparative studies are needed to determine safety and efficacy.

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“…These devices may supplant hybrid aortic arch repairs, at least for zone 1 and 2 repairs. The feasibility results of a novel branched device designed for zone 2 repairs have been reported (29). There were a total 22 patients who underwent total endovascular repair of distal arch aneurysms, with a single side branch designed to facilitate aortic coverage proximal to the left subclavian artery.…”

Section: Future Directionsmentioning

confidence: 99%

Hybrid repair of aortic arch aneurysms: a comprehensive review

et al. 2017

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Open total arch replacement (TAR) has become safer with refinements in cerebral protection techniques. The frequent extension of aortic arch aneurysms into the descending thoracic aorta customarily requires a two-staged conventional elephant trunk procedure, carrying relatively high mortality and morbidity risks and high rates of rupture in the interval between the two open surgeries. The technical demands and invasive nature of TAR has therefore precluded many high-risk patients from being surgical candidates for aneurysm repair. As a result, hybrid techniques and approaches to the aortic arch have become common since the adoption of thoracic endovascular aortic repair (TEVAR) and advancement in the commercial grafts that are available. The results of hybrid aortic arch repairs have been encouraging, though with higher rates of re-interventions than TAR and variable reported rates of stroke and spinal cord ischemia.The aim of this publication is to review the current literature on hybrid repair of aortic arch aneurysms.

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Branched Endovascular Therapy of the Distal Aortic Arch: Preliminary Results of the Feasibility Multicenter Trial of the Gore Thoracic Branch Endoprosthesis

Abstract: Total endovascular repair of distal zone 2 arch aortic aneurysms can be achieved with a novel branched arch endograft. Future studies will evaluate the feasibility of this approach for aneurysms encompassing the brachiocephalic trunk and left carotid artery.

Cited by 124 publications

References 14 publications

Two Wire System and Modified Olive Tip to Facilitate Implantation of Fenestrated TEVAR in Patient with Proximal Descending Aortic Pathology: First Two Cases

Two Wire System and Modified Olive Tip to Facilitate Implantation of Fenestrated TEVAR in Patient with Proximal Descending Aortic Pathology: First Two Cases

Endovascular total arch replacement techniques and early results

Hybrid repair of aortic arch aneurysms: a comprehensive review

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