“Hybrid” Repair of Aneurysms of the Transverse Aortic Arch: Midterm Results

Hughes, G. Chad; Daneshmand, Mani A.; Balsara, Keki R.; Achneck, Hardean A.; Sileshi, Bantayehu; Lee, Sean M.; McCann, Richard L.

doi:10.1016/j.athoracsur.2009.07.027

Cited by 67 publications

(71 citation statements)

References 23 publications

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“…However, extreme banding has been reported to lead to aortic wall necrosis [95]. Other authors have proposed a more aggressive and invasive approach by replacing the ascending aorta with or without the hemiarch using a trifurcated graft and subsequently deploying the stent antegradely through the third branch of the ascending aorta graft or retrogradely through the femoral artery [75,80,83].…”

Section: Aortic Arch Debranching and Endovascular Exclusionmentioning

confidence: 98%

“…Thus, a proximal landing zone at least 2 cm long at the aortic arch level must take into account the presence of supra-aortic vessels and of anatomic and hemodynamic properties peculiar to the aortic arch, such as its curvature, the high blood-flow velocity usually present in this area, and the substantial movement of this portion of the aorta with each heartbeat in comparison to other aortic segments [68]. To create a suitable landing zone for endovascular repair, authors rerouted blood flow to the supra-aortic vessels prior to stent-graft deployment, by introducing different 'debranching' techniques, such as surgical extra-anatomic bypasses or transpositions [69][70][71][72][73][74][75][76][77][78][79][80][81][82][83][84] and branched or fenestrated stent grafts [85][86][87][88][89][90][91][92][93]. Stent-graft completion can then be performed immediately or deferred to arch debranching.…”

Section: Aortic Arch Debranching and Endovascular Exclusionmentioning

confidence: 99%

“…It has even been proposed that radial forces exerted by the stent may aggravate this process, leading to subsequent type I proximal endoleaks and migration [80].…”

Section: Aortic Arch Debranching and Endovascular Exclusionmentioning

confidence: 99%

See 2 more Smart Citations

Elephant trunk procedure 27 years after Borst: what remains and what is new?

Ius¹,

Hagl²,

Haverich³

et al. 2011

European Journal of Cardio-Thoracic Surgery

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The treatment of complex aortic pathology involving both the ascending and descending aortic segments at the same time represents a surgical challenge, with high postoperative morbidity and mortality rates reported. Over the past 27 years, different open surgical and endovascular techniques have been introduced and applied in various two-stage- or one-stage approaches to such cases. Thus, in 1983, Hans Borst significantly changed the traditional two-stage approach by introducing his elephant trunk technique. Leaving a segment of Dacron prosthesis reaching into the descending aorta during the first stage, the second-stage replacement of the residual dilated descending aorta was made far easier. The presence of interval mortality between the two stages, the unaffected need for two large operations to complete aortic repair, and the general failure of some patients to return for the second-stage repair set the scene for the development of one-stage procedures, both open surgical or hybrid surgical and endovascular, such as the frozen elephant trunk. However, the size of the operation, on the one hand, and the risk of spinal cord injury and need for surgical or endovascular completion during follow-up, on the other, have dampened enthusiasm. Recently, the introduction of supra-aortic debranching and endovascular aortic arch stent-graft repair has yet extended treatment to high-risk patients unsuitable to the more aggressive surgery, but mid- and long-term follow-up results are lacking. The lack of randomization and the presence of procedural and complication-related limitations for each technique do not allow for definitive conclusions about the ideal procedure to treat complex aortic pathology. However, the technical revolution experienced over the past 27 years, along with the improvement in perioperative management, has produced outstanding morbidity and mortality results even in this challenging patient population, but the decision regarding which pathology correlates with what operation remains highly debated and dependent also on regional competence.

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Section: Aortic Arch Debranching and Endovascular Exclusionmentioning

confidence: 98%

Section: Aortic Arch Debranching and Endovascular Exclusionmentioning

confidence: 99%

See 1 more Smart Citation

Elephant trunk procedure 27 years after Borst: what remains and what is new?

Ius¹,

Hagl²,

Haverich³

et al. 2011

European Journal of Cardio-Thoracic Surgery

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“…Hughes et al 9 ont fait des pontages carotido-carotidiens ant erieurs mais ont mentionn e qu'ils avaient eu la chance qu'aucune trach eotomie n'ait et e n ecessaire. Depuis le d ebut des ann ees 90, Criado et al 10,11 ont fait des pontages r etro-pharyngiens, initialement pour traiter des l esions occlusives des troncs supraaortiques, avec des r esultats favorables, puis principalement pour des d ebranchements des branches de la crosse aortique chez des patients ayant TEVAR et le besoin d'une reconstruction de l'ASCG.…”

Section: R Esultatsunclassified

Réparation endovasculaire de l'aorte thoracique et revascularisation de la crosse

Iida

Kawaguchi

Koizumi

et al. 2011

Annales de Chirurgie Vasculaire

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“…After right axillary cannulation and median sternotomy, total arch replacement was performed using a modified Mt Sinai technique as previously described. 1 The innominate and left common carotid arteries were individually anastomosed to the limbs of a multibranch Dacron graft; the left subclavian artery was ligated at its origin from the arch to treat the subclavian aneurysm in conjunction with the carotid-axillary bypass. The arch was replaced using a 28-mm Vascutek Dacron Siena graft with radiologic markers ("Dumbo graft") to facilitate second stage endovascular repair (Vascutek Terumo, Ann Arbor, Mich).…”

mentioning

confidence: 99%

Pan-aortic hybrid treatment of mega-aorta syndrome

Shah

Bhattacharya

McCann

et al. 2011

Journal of Vascular Surgery

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Hybrid procedures combining traditional open and newer endovascular techniques are increasingly used to treat complex aortic disease. We present a novel approach for total aortic replacement, including hybrid repair of the arch and thoracoabdominal aorta, in a patient with "mega-aorta syndrome." A two-stage approach using a valve-sparing aortic root replacement, total arch replacement (stage I elephant trunk), and left carotid-axillary bypass was used to treat the root, proximal-mid arch, and left subclavian aneurysmal pathology. This was followed by a hybrid distal arch/Extent II thoracoabdominal aneurysm repair 3 months later. After 15 months follow-up, the patient remains asymptomatic with an intact repair, no endoleak, and normal ventricular and aortic valve function. This case demonstrates a novel "pan-aortic" hybrid approach for repair of extensive thoracic aortic disease.

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“Hybrid” Repair of Aneurysms of the Transverse Aortic Arch: Midterm Results

Cited by 67 publications

References 23 publications

Elephant trunk procedure 27 years after Borst: what remains and what is new?

Elephant trunk procedure 27 years after Borst: what remains and what is new?

Réparation endovasculaire de l'aorte thoracique et revascularisation de la crosse

Pan-aortic hybrid treatment of mega-aorta syndrome

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