First International Summit on Thoracic Aortic Endografting: Roundtable on Thoracic Aortic Dissection as an Indication for Endografting

Background-In this study, we report the late outcomes of a large, decade-long single-center thoracic endovascular aortic repair experience. Methods and Results-A prospectively maintained registry and the electronic medical records of 400 consecutive thoracic endovascular aortic repair performed at a tertiary care center were reviewed. The distribution of pathologies treated included aneurysms (198, 49%), dissections (100, 25%), penetrating ulcers (54, 14%), traumatic transections (25, 6%), and other pathologies (23, 6%). Spinal drains were placed prophylactically in 127 cases (32%) of planned extended aortic coverage. There were no acute surgical conversions. Adjunctive surgical procedures were performed on 94 patients (24%). Subclavian revascularizations were performed selectively in only 15% of zone 0 to 2 deployments. The median length of stay was 5 days (limits, 1 and 79 days). Overall 30-day mortality was 6.5% (elective, 2.6%; urgent, 9.5%; and emergent, 20%). Permanent spinal cord ischemia occurred in 4.5% and stroke in 3%. Kaplan-Meier estimates of survival were 82%, 76%, 68%, and 60% and freedom from secondary intervention was 90%, 86%, 81%, and 78% at 6, 12, 24, and 36 months, respectively. Risk factors for mortality included stroke, urgent/emergent repair, age Ն80 years, general anesthesia, and dissection pathology. Conclusions-Thoracic endovascular aortic repair may be used to treat a variety of thoracic aortic pathologies with a very low risk of intraoperative conversion. Overall rates of mortality and neurological complications were relatively low but significantly increased in emergent repairs. There appeared to be a substantial number of late deaths, which may represent a combination of poor patient selection and treatment failures. (Circulation. 2011;123:2938-2945.)

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“…The distribution of proximal landing zones is shown in Figure 1. 12 There were no intraoperative surgical conversions.…”

Section: Resultsmentioning

confidence: 96%

Late Outcomes of a Single-Center Experience of 400 Consecutive Thoracic Endovascular Aortic Repairs

et al. 2011

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“…2), Zone 1 (18 patients, Fig. 3), and Zone 0 (three patients) according to Ishimaru classification [13]. Distal restrictive bare stents were used in 18 cases with an estimated mismatch rate greater than 120 %.…”

Section: Resultsmentioning

confidence: 99%

“…However, in aortic dissections, this technique might be substantially different from that in aneurysm repairs owing to anatomical and pathophysiologic differences. Regarding the application of chimney grafts in aortic dissection, reports have been limited to small series with relatively short follow-up [12][13][14][15], and no study has focused specially on aortic remodeling with this technique. In this study, we summarize our initial experience with the chimney technique and evaluate the follow-up aortic remodeling for TBAD extending to the aortic arch.…”

Section: Introductionmentioning

confidence: 99%

Early Results of Chimney Technique for Type B Aortic Dissections Extending to the Aortic Arch

Huang

Tang

Qiao

et al. 2015

Cardiovasc Intervent Radiol

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Objective To summarize our early experience gained from the chimney technique for type B aortic dissection (TBAD) extending to the aortic arch and to evaluate the aortic remodeling in the follow-up period. Methods From September 2011 to July 2014, 27 consecutive TBAD patients without adequate proximal landing zones were retrograde analyzed. Chimney stent-grafts were deployed parallel to the main endografts to reserve flow to branch vessels while extending the landing zones. In the follow-up period, aortic remodeling was observed with computed tomography angiography. Results The technical success rate was 100 %, and endografts were deployed in zone 0 (n = 3, 11.1 %), zone 1 (n = 18, 66.7 %), and zone 2 (n = 6, 22.2 %). Immediately, proximal endoleaks were detected in 5 patients (18.5 %). During a mean follow-up period of 17.6 months, computed tomography angiography showed all the aortic stent-grafts and chimney grafts to be patent. Favorable remodeling was observed at the level of maximum descending aorta and left subclavian artery with expansion of true lumen (from 18.4 ± 4.8 to 25 ± 0.86 mm, p \ 0.001 and 27.1 ± 0.62 to 28.5 ± 0.37 mm, p \ 0.001) and depressurization of false lumen (from 23.7 ± 2.7 to 8.7 ± 3.8 mm, p \ 0.001, from 5.3 ± 1.2 to 2.1 ± 2.1 mm, p \ 0.001). While at the level of maximum abdominal aorta, suboptimal remodeling of the total aorta (from 24.1 ± 0.4 to 23.6 ± 1.5 mm, p = 0.06) and true lumen (from 13.8 ± 0.6 to 14.5 ± 0.4 mm, p = 0.08) was observed. Conclusion Based on our limited experience, the chimney technique with thoracic endovascular repair is demonstrated to be promising for TBAD extending to the arch with favorable aortic remodeling.

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“…The anchorage sites for the thoracic aortic endoprosthetic fixation were distributed, based on the classification of Ishimaru, 10 in six cases (23%) in zone 2, 14 cases (53.8%) in zone 3, and six cases (23%), in zone 4. All of the patients with anchorage in zone 2 underwent subclavian artery bypass surgery before the procedure.…”

Section: Resultsmentioning

confidence: 99%

Tratamento endovascular da dissecção crônica de aorta tipo B complicada

Metzger¹,

Fontes²,

Novero³

et al. 2012

Rev. Bras. Cardiol. Invasiva

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Background: Endovascular repair of aortic diseases is a well-established therapeutic alternative for patients with the appropriate anatomy and/or high surgical risk, as it provides lower morbidity and mortality rates. This study aimed to analyse the outcomes of asymptomatic patients undergoing endovascular treatment of thoracic aortic dissections with an aortic diameter > 5.5 cm or endoleaks. Technical success, therapeutic success, morbidity, mortality, and perioperative complication and reintervention rates were assessed. Methods: The present retrospective study, which was performed at a reference centre from January, 2010 to July, 2011, analysed consecutive patients undergoing endovascular repair of chronic complicated type B aortic dissections based on the Stanford classification. Results: Twenty-six patients were treated. The mean age was 56.4 ± 7 years, and 61.5% were males. Technical and therapeutic success rates were 100% and 74%, respectively. The perioperative mortality was 7.6%, and the mortality rate in the first year of follow-up was 19.3%. The reintervention rate was 15.3%. Conclusions: In the present study, endovascular treatment of chronic type B aortic dissections proved to be a feasible method associated with acceptable perioperative complication rates. The therapeutic success and reintervention rates indicated the

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First International Summit on Thoracic Aortic Endografting: Roundtable on Thoracic Aortic Dissection as an Indication for Endografting

Cited by 268 publications

References 1 publication

Late Outcomes of a Single-Center Experience of 400 Consecutive Thoracic Endovascular Aortic Repairs

Late Outcomes of a Single-Center Experience of 400 Consecutive Thoracic Endovascular Aortic Repairs

Early Results of Chimney Technique for Type B Aortic Dissections Extending to the Aortic Arch

Tratamento endovascular da dissecção crônica de aorta tipo B complicada

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