Extra-Thoracic Supra-aortic Bypass Surgery Is Safe in Thoracic Endovascular Aortic Repair and Arterial Occlusive Disease Treatment

Gombert, Alexander; Issum, Lea van; Barbati, Mohammad E.; Grommes, Jochen; Keszei, András; Kotelis, Drosos; Jalaie, Houman; Greiner, Andreas; Jacobs, Michael J.; Kalder, Johannes

doi:10.1016/j.ejvs.2018.03.020

Cited by 9 publications

(4 citation statements)

References 22 publications

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“…13,26,32,33,45 Prophylactic use of closed-incision negativepressure therapy on surgical wound dehiscence has been demonstrated in a substantial number of studies, such as in abdominal, vascular, orthopedic, and plastic operations. 8,9,17,[41][42][43][46][47][48][49][50][51][52][53][54][55][56][57][58] Closed-incision negative-pressure therapy is a negative-pressure wound dressing that keeps the edges together, promotes perfusion, and maintains a closed wound environment. 59 However, it is still uncertain whether closed-incision negativepressure therapy reduces postoperative complications such as surgical wound dehiscence and surgical-site infection, because of the paucity of high-quality, prospective studies.…”

Section: Smentioning

confidence: 99%

“Closed Incision Negative Pressure Therapy (ciNPT) reduces abdominal donor site surgical wound dehiscence in Deep Internal Epigastric Perforator (DIEP) flap breast reconstructions: DEhiscence PREvention Study II (DEPRES II) - a Randomized Clinical Trial”

Muller-Sloof

Laat

Kenç

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Background: In breast reconstruction operations, surgical wound dehiscence is a serious complication that generates a significant burden on patients and health care systems. There are indications that postoperative treatment with closed-incision negative-pressure therapy has been associated with reduced wound dehiscence rates. This randomized clinical trial examines the effect of closed-incision negative-pressure application on abdominal donor-site surgical wound dehiscence in low- and high-risk patients undergoing breast reconstruction with a deep inferior epigastric perforator flap. Methods: Eighty eligible women, stratified as low- or high-risk patients, were included and were randomized for treatment with either closed-incision negative-pressure or adhesive strips by drawing sealed, opaque envelopes. All surgeons were kept blinded for allocation. Primary outcomes were surgical wound dehiscence and surgical-site infection at the abdominal donor site on follow-up after 12 weeks. Secondary outcomes were seroma and hematoma formation. Five patients were excluded from the study because of insufficient exposure to the study treatment (n = 4) or major protocol deviation (n = 1). Results: A total of 75 women, low-risk (n = 38) and high-risk (n = 37), received either closed-incision negative-pressure (n = 36) or adhesive strips (n = 39). Patients’ demographics did not differ significantly. Donor-site surgical wound dehiscence occurred in 23 patients; the absolute risk reduction was statistically significant (21.6 percent; 95 percent CI, 1.5 to 41.7 percent). No statistically significant differences were found in surgical-site infection or secondary outcomes. Conclusion: In this randomized clinical trial, postoperative treatment with closed-incision negative-pressure therapy decreased the incidence of surgical wound dehiscence at the abdominal donor site in low- and high-risk deep inferior epigastric perforator flap breast reconstruction patients. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.

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Section: Smentioning

confidence: 99%

“Closed Incision Negative Pressure Therapy (ciNPT) reduces abdominal donor site surgical wound dehiscence in Deep Internal Epigastric Perforator (DIEP) flap breast reconstructions: DEhiscence PREvention Study II (DEPRES II) - a Randomized Clinical Trial”

Muller-Sloof

Laat

Kenç

et al. 2022

Plastic &Amp; Reconstructive Surgery

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“…Patency rate for these surgical bypasses has been reported to be more than 95% at 3-year follow-up. 18 In this regard, the advantage of double-branch devices is related to the single surgical bypass required for the LSA. As far as timing is concerned, we believe that ASG after surgery for type A acute aortic dissection can be performed whenever there is an indication for surgery on the arch, with no particular restrictions.…”

Section: Discussionmentioning

confidence: 99%

Endovascular exclusion of the entire aortic arch with branched stent-grafts after surgery for acute type A aortic dissection

et al. 2020

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Background: The treatment of residual pathology of the aortic arch after surgical repair for type A acute dissection (AAD) represents a therapeutic challenge. Recently, new branched endovascular devices have expanded the possibility of aortic arch stent-grafting (ASG) with proximal landing in zone 0. The aim of this retrospective, single-center study was to evaluate outcomes of patients with a history of surgical repair for AAD undergoing ASG with branched devices. Methods:We analyzed patients undergoing ASG after treatment for type AAD with 2 different branched devices: Nexus (dual-module, single branch, off-the-shelf) and RelayBranch (single-module, dual branch, custom-made). Before ASG, surgical bypass of supra-aortic vessels was performed according to patient's anatomy and to the selected device. All patients underwent clinical and computed tomography scan evaluation before hospital discharge, at 6 months, and on a yearly basis thereafter.Results: From March 2017 to April 2019, 4 consecutive patients underwent ASG after surgery for AAD at our institution. Mean time from surgery for AAD to ASG was 20 months. Mean age at the time of ASG was 72 years. Nexus and Relay were implanted in 2 patients each. All patients survived and were successfully discharged. Mean intensive care unit stay and hospital stay were 3 and 19 days, respectively. We did not observe any major adverse events. At a mean follow-up of 28 months, all patients are alive and computed tomography scans showed good anatomic results with no endoleaks.Conclusions: This preliminary experience shows that ASG after surgery for AAD is feasible and provides encouraging clinical and anatomic early results. (JTCVS Techniques 2020;3:1-8) Residual dissection of the aortic arch after surgery for type A acute aortic dissection 4 patientsSee Commentaries on pages 9 and 11.

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“…While results have been promising in some series, experts have questioned the feasibility and durability of such types of extra-anatomic reconstruction based on the anatomic observation that the distance between the two target vessels is generally not enough to guarantee safe sealing. Points of concern include: the length of the intervention, which includes the carotid-subclavian bypass, the potential risk of stroke, and prosthetic graft infection [reported in less than 4% of cases (16)]. This type of reconstruction is feasible both for elective cases and in an emergency setting, when conventional open repair would not be tolerated by a fragile patient.…”

Section: Hybrid Options For Cerebral Revascularizationmentioning

confidence: 99%

“…On the left side, an "L-shape" incision is performed to allow easier access to the LSA. The prosthetic bypasses are generally tunneled anteriorly in the suprajugular fossa but a retropharyngeal route has also been described as feasible (16). Prosthetic graft bypasses have been described with a variety of technical variants, including the use of separated grafts to the left common carotid and LSA, or with the use of a preconstituted bifurcated graft, or with a direct bypass from the right common carotid artery to the LSA and an end-toside transposition of the left common carotid artery onto the prosthetic graft.…”

Section: Operation: Hybrid Procedures For Arch Repairmentioning

confidence: 99%

Art of operative techniques: treatment options in arch penetrating aortic ulcer

Lomazzi

Grassi

Domanin

et al. 2019

Ann. Cardiothorac. Surg.

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Penetrating aortic ulcer (PAU) of the arch has a focal extent which often represents an adequate anatomic target for thoracic endovascular aortic repair (TEVAR). However, the anatomic constraints represented by the supra-aortic vessels pose either clinical or technical challenges that increase when the PAU develops proximally in the arch. Currently, different types of endografts are commercially available and have been used to treat aortic arch lesions. These include branched/fenestrated endografts for a total endovascular approach, and standard devices that can be used in combination with open/hybrid surgical operations, with the aim to exploit the minimally invasive nature of TEVAR by extending the proximal landing zone when necessary. We describe several current techniques adopted in such settings.

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Extra-Thoracic Supra-aortic Bypass Surgery Is Safe in Thoracic Endovascular Aortic Repair and Arterial Occlusive Disease Treatment

Abstract: Extra-thoracic supra-aortic bypass surgery involves low complication rates and high mid-term bypass patency rates. It is a safe and feasible treatment option in the form of debranching in combination with endovascular aortic aneurysm repair and in AOD.

Cited by 9 publications

References 22 publications

“Closed Incision Negative Pressure Therapy (ciNPT) reduces abdominal donor site surgical wound dehiscence in Deep Internal Epigastric Perforator (DIEP) flap breast reconstructions: DEhiscence PREvention Study II (DEPRES II) - a Randomized Clinical Trial”

“Closed Incision Negative Pressure Therapy (ciNPT) reduces abdominal donor site surgical wound dehiscence in Deep Internal Epigastric Perforator (DIEP) flap breast reconstructions: DEhiscence PREvention Study II (DEPRES II) - a Randomized Clinical Trial”

Endovascular exclusion of the entire aortic arch with branched stent-grafts after surgery for acute type A aortic dissection

Art of operative techniques: treatment options in arch penetrating aortic ulcer

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