Chimney stent graft for left subclavian artery preservation during thoracic endograft placement

Ramdon, Andre; Patel, Ramkrishna; Hnath, Jeffrey; Yeh, Chin-Chin; Darling, R. Clement

doi:10.1016/j.jvs.2019.05.049

Cited by 18 publications

(22 citation statements)

References 32 publications

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“…6) In fact, there are only four studies exclusively comparing carotid-subclavian bypasses or subclavian-carotid transposition to chimney or periscope-sandwich grafts for LSA debranching. 8,[15][16][17] Table 4 demonstrates their results along with studies that examined either open or parallel graft-based LSA debranching only. 2,4,6,9,18) A former study from the reporting institution also described results of periscope-sandwich grafts for LSA debranching, but as only some of the patients were included into the presented cohort, their results were not used for comparison.…”

Section: Discussionmentioning

confidence: 99%

“…As in our study, statistical differences were neither detected for strokes, mortality, or reintervention rate. 8,[15][16][17] Nevertheless, all comparative studies reported more aortic reinterventions after parallel grafts than after open procedures. 8,[15][16][17] Our rate of 33% for parallel grafts is in line with Johnson et al, but others have reported much lower rates of 0.6%-12.5%.…”

Section: Discussionmentioning

confidence: 99%

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Early and Mid-Term Outcomes of Open versus Endovascular Left Subclavian Artery Debranching for Thoracic Aortic Diseases

Dueppers

Meuli

Reutersberg

et al. 2022

ATCS

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Purpose: To compare open versus endovascular left subclavian artery debranching for thoracic endovascular aortic repair of thoracic aortic pathologies. Methods: This is a retrospective study of patients receiving left subclavian artery debranching in our institution from October 2009 to January 2020. The primary outcome was freedom from aortic reintervention. Secondary outcomes were type I endoleaks, left subclavian artery (LSA) debranching failure, stroke, technical or clinical success, procedure-related reintervention, as well as 30-day or overall all-cause and aorta-related mortality. Results: Forty-eight patients received parallel graft-based (n = 24, ENDO; median age 75 years [70-80 years]) or open (n = 24, OPEN; median age 71 years [59-75 years]) debranching for type B aortic dissection (n = 25), degenerative aneurysm (n = 12), type IA endoleak (n = 6), suture-associated (n = 3) or ostial LSA aneurysm (n = 1), or penetrating aortic ulcer (n = 1). The median follow-up was 36 months (13-61 months). After 16 months, aortic reintervention-free survival in groups OPEN and ENDO was 91% (95% confidence interval [CI]: 79 to 100%) and 86% (73 to 100%) (p = 0.71), respectively. After 36 months, all-cause survival in groups OPEN and ENDO was 74% (95% CI: 55 to 99%) and 79% (95% CI: 64 to 97%) (p = 0.74), respectively; freedom from aorta-related mortality was 81% (95% CI: 62 to 100%) and 91% (95% CI: 80 to 100%) (p = 0.78), respectively. Group OPEN presented less type I endoleaks (OPEN/ENDO = 3/19, p <0.001) and higher technical (OPEN/ENDO = 81/36%, p = 0.003) and clinical success rates (OPEN/ENDO = 67/36%, p = 0.047). No statistical differences were found for other outcomes. Conclusion: Both strategies achieved comparable reintervention and mortality rates, but open debranching should be preferred due to its higher technical and clinical success and less type I endoleaks.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Early and Mid-Term Outcomes of Open versus Endovascular Left Subclavian Artery Debranching for Thoracic Aortic Diseases

Dueppers

Meuli

Reutersberg

et al. 2022

ATCS

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“…Despite the increased arch manipulation and procedural complexity required for totally endovascular therapy of the LSA during zone 2 F-TEVAR, this may not translate into worse neurological outcomes. Besides, graft manipulation and the clamping of left common carotid could also increase rates of stroke in the CSB group [ 18 ]. Although unable to comment on the exact role of specific anatomic features in determining the prognosis of individual outcomes, the findings would suggest that, provided physician’s judgment of patients’ fitness for one technique (which is a complex decision based on the need to balance lowest possible perioperative morbidity in top of ensuring the longest durable outcomes possible), 30-day and midterm outcomes are equally satisfied with both CSB and F-TEVAR.…”

Section: Discussionmentioning

confidence: 99%

Left subclavian artery revascularization in thoracic endovascular aortic repair: single center’s clinical experiences from 171 patients

Xie

Xue

et al. 2021

J Cardiothorac Surg

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Background Left subclavian artery revascularization (LSA) is frequently performed in the setting of thoracic endovascular repair (TEVAR). The purpose of this study was to compare different techniques for LSA revascularization during TEVAR. Methods We performed a single center’s retrospective cohort study from 2016 to 2019. Patients were categorized by LSA revascularization methods, including direct coverage without revascularization (Unrevascularized), carotid-subclavian bypass (CSB), fenestrated TEVAR (F-TEVAR). Indications, demographics, operation details, and outcomes were analyzed using standard statistical analysis. Results 171 patients underwent TEVAR with LSA coverage, 16.4% (n = 28) were unrevascularized and the remaining patients underwent CSB (n = 100 [58.5%]) or F-TEVAR (n = 43 [25.1%]). Demographics were similar between the unrevascularized and revascularized groups, except for procedure urgent status (p = 0.005). The incidence of postoperative spinal cord ischemia was significantly higher between unrevascularized and revascularized group (10.7% vs. 1.4%; p = 0.032). There was no difference in 30-day and mid-term rates of mortality, stroke, and left upper extremity ischemia. CSB was more likely time-consuming than F-TEVAR [3.25 (2.83–4) vs. 2 (1.67–2.67) hours, p = 0], but there were no statistically significant differences in 30-day or midterm outcomes for CSB versus F-TEVAR. During a mean follow-up time of 24.8 months, estimates survival rates had no difference. Conclusions LSA revascularization in zone 2 TEVAR is necessary which is associated with a low 30-day rate of spinal cord ischemia. When LSA revascularization is required during TEVAR, CSB and F-TEVAR are all safe and effective methods, and F-TEVAR appears to offer equivalent clinical outcomes as a less time-consuming and minimally invasive alternative.

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“…In conditions when reconstruction of branch arteries of arotic arch is essential, TEVAR is combined with chimney technique, fenestrated stent-graft and branched stent-graft. [8][9][10] The overall success rate, mortality and morbidity of endovascular repair are encouraging with those emerging techniques.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcomes of Thoracic Endovascular Repair for Aortic Arch Dissection Using Customized Single-Branched Fenestrated Stent-Graft

Zhang

Song

et al. 2021

Vasc Endovascular Surg

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Objectives: To report outcomes of thoracic endovascular repair using customized single-branched fenestrated stent-grafts in treatment of aortic arch dissections. Materials and Methods: Between November 2009 and November 2011, 16 patients with aortic arch dissections underwent thoracic endovascular aortic repair utilizing customized unibody single-branched fenestrated stent-graft (UBFSG) in our institution. Results: All 16 patients were male with mean age of 54.50 ± 11.33. The technical success rate was 100%. 30-day mortality rate was 6.25% (n = 1). The median follow-up period was 98 months (range, 0-119). During follow-up, 4 nonaorta-related deaths were recorded. Two (2) cases of left subclavian artery occlusion were observed 12 and 14 months after the operation. Two (2) patients had another successful endovascular repair in time, including one case of type Ib endoleak occurred 100 months after the operation and one case of stent-graft induced new entry tear 38 months after the operation. No stroke and migration of stent-grafts were observed. Conclusions: The branched fenestrated stent-graft may be an effective alternative treatment for aortic arch dissections unfit for open surgery.

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Chimney stent graft for left subclavian artery preservation during thoracic endograft placement

Cited by 18 publications

References 32 publications

Early and Mid-Term Outcomes of Open versus Endovascular Left Subclavian Artery Debranching for Thoracic Aortic Diseases

Early and Mid-Term Outcomes of Open versus Endovascular Left Subclavian Artery Debranching for Thoracic Aortic Diseases

Left subclavian artery revascularization in thoracic endovascular aortic repair: single center’s clinical experiences from 171 patients

Long-Term Outcomes of Thoracic Endovascular Repair for Aortic Arch Dissection Using Customized Single-Branched Fenestrated Stent-Graft

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