Endovascular Repair of Ascending Aortic Aneurysm by Transapical Approach and Periscope Technique

Krankenberg, Hans; Bader, Ralf; Sixt, Sebastian; Tübler, Thilo; Schwencke, Carsten; Kivelitz, Dietmar; Rad, Azin Khodabakhshi; Caspary, Michael; Zeller, Thomas

doi:10.1583/12-4082.1

Cited by 17 publications

(11 citation statements)

References 19 publications

(27 reference statements)

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“…1,2 in 1986 and by Parodi and colleagues in 1991. 3 Since that time, EVAR has become widely accepted as a safe technique for the treatment of abdominal aortic aneurysm (AAA).…”

Section: Introductionmentioning

confidence: 97%

Endovascular treatment of abdominal aortic aneurysms

et al. 2013

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Patients with abdominal aortic aneurysms (AAAs) are usually treated with endovascular aneurysm repair (EVAR), which has become the standard of care in many hospitals for patients with suitable anatomy. Clinical evidence indicates that EVAR is associated with superior perioperative outcomes and similar long-term survival compared with open repair. Since the randomized, controlled trials that provided this evidence were conducted, however, the stent graft technology for infrarenal AAA has been further developed. Improvements include profile downsizing, optimization of sealing and fixation, and the use of low porosity fabrics. In addition, imaging techniques have improved, enabling better preoperative planning, stent graft placement, and postoperative surveillance. Also in the past few years, fenestrated and branched stent grafts have increasingly been used to manage anatomically challenging aneurysms, and experiments with off-label use of stent grafts have been performed to treat patients deemed unfit or unsuitable for other treatment strategies. Overall, the indications for endovascular management of AAA are expanding to include increasingly complex and anatomically challenging aneurysms. Ongoing studies and optimization of imaging, in addition to technological refinement of stent grafts, will hopefully continue to broaden the utilization of EVAR.

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“…1,2 in 1986 and by Parodi and colleagues in 1991. 3 Since that time, EVAR has become widely accepted as a safe technique for the treatment of abdominal aortic aneurysm (AAA).…”

Section: Introductionmentioning

confidence: 97%

Endovascular treatment of abdominal aortic aneurysms

et al. 2013

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“…Thus, the high-speed aortic flow could lead to a type I endoleak. In contrast, in the periscope technique, [7][8][9][10][11][12][13] the reconstruction of the supra-arch branches is located in the aortic stent-graft, with the periscope grafts perfused in a retrograde manner, thus avoiding the rush of blood toward the gutters. Therefore, blood in either the stent-grafts or the gutters is driven only by the pressure difference, and the blood in the gutters could easily form clots when the blood remains static at a balanced pressure between the true and false lumens.…”

Section: Discussionmentioning

confidence: 99%

Sandwich Technique for Endovascular Repair of Acute Type A Aortic Dissection

et al. 2017

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Overview: To describe a new endovascular procedure for acute type A aortic dissection (TAAD) repair. Methods: Between 2013 and 2016, 12 patients (average age 54±9.6 years; 10 men) with acute TAAD (mean EURO score 11.4%±3.2%, range 5-17) and unfit for surgery underwent thoracic endovascular aortic repair (TEVAR) with 2 periscope grafts to preserve blood supply to supra-aortic branches plus bypass grafting as needed. If the ascending aorta was dilated to >40 mm, sternotomy was performed to wrap the ascending aorta and reduce its diameter to accommodate the aortic stentgrafts. Results: All patients were successfully treated. Seven patients required bypass grafting, and most of the patients had periscope grafts to the innominate/right common carotid artery and left common carotid artery; only 3 patients had the left subclavian artery preserved. All patients exhibited good hemodynamics and normal pressures after the procedure. The mean procedure time and blood loss were 4.5±1.0 hours and 217±111.5 mL, respectively. Two patients treated emergently died shortly after surgery from multiorgan failure. The average follow-up duration was 17±14.5 months (range 2-42) in the 10 survivors. The remaining patients recovered and none experienced stent-graft thrombosis, stroke, or peripheral artery embolism during follow-up. Conclusion: A procedure that combines sandwich/periscope grafting with TEVAR, wrapping of the aorta, and supra-arch bypass grafting can be used to treat patients with acute TAAD.

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“…Recently, a few other groups have reported their early experience with this technique, 7e11 even to treat (acute) ascending aorta disease. 12,13 Several aspects of the procedure are worth emphasizing such as the importance of ''throughand-through'' stiff wire to guide the stent graft through the arch to its intended location. Although others prefer the use of a flexible wire as it is less traumatic to the aortic wall, we feel that by using a stiff wire better control is achieved when advancing the stent graft.…”

Section: Methodsmentioning

confidence: 99%