Initial Results After Combined Repair of Aortic Arch Aneurysms by Sequential Transposition of the Supra-Aortic Branches and Consecutive Endovascular Stent-Graft Placement

Czerny, Martin; Zimpfer, Daniel; Fleck, Tatjana; Hofmann, Wolfgang; Schoder, Maria; Cejna, Manfred; Stampfl, Paul; Lämmer, Johannes; Wolner, Ernst; Grabenwöger, Martin

doi:10.1016/j.athoracsur.2004.03.063

Cited by 83 publications

(65 citation statements)

References 21 publications

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“…However, if acute or chronic occlusion of the subclavian, lumbar or hypogastric arteries is present, likelihood of symptomatic malperfusion dramatically increases. Supra-aortic transpositions are now an established procedure for extending the proximal landing zone to enable stent-graft placement [7][8][9]. In our setting, this method is used extensively as short-and mid-term results have shown excellent patency as well as no increase in procedural risk as compared with isolated descending stent-graft placement [10].…”

Section: Discussionmentioning

confidence: 97%

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Symptomatic spinal cord malperfusion after stent-graft coverage of the entire descending aorta☆

Gottardi

Dumfarth

Holfeld

et al. 2010

European Journal of Cardio-Thoracic Surgery

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Extensive stent-graft coverage of the entire thoracic aorta can be performed with a high rate of success. If collateral blood supply to the spinal cord is maintained, occlusion of the intercostal arteries does not cause symptomatic malperfusion. However, if acute or chronic occlusion of the subclavian, lumbar or hypogastric arteries is present, likelihood of symptomatic malperfusion dramatically increases.

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Section: Discussionmentioning

confidence: 97%

“…The original methods have been described in detail previously [7][8][9][10]. Re-routing procedures were performed metachronously.…”

Section: Re-routing Proceduresmentioning

confidence: 99%

Symptomatic spinal cord malperfusion after stent-graft coverage of the entire descending aorta☆

Gottardi

Dumfarth

Holfeld

et al. 2010

European Journal of Cardio-Thoracic Surgery

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“…This is mainly the case with Standford type B aortic dissections which can result in upper limb ischemia following covering of the left subclavian artery inlet with a stent graft (12). The authors of this paper, performing endovascular procedures, in 30 cases of subclavian artery inlet closure observed limb ischemia symptoms requiring surgical restoration of arterial blood supply in only 2 patients (6.7%).…”

Section: Discussionmentioning

confidence: 99%

Contemporary Indications and own Results of Surgical Treatment of occlusions of the initial section of the Left subclavian artery

Pukacki¹,

Zieliński²,

Oszkinis³

et al. 2010

Polish Journal of Surgery

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Symptomatic occlusion of the initial section of the subclavian artery, resistant to intravascular treatment, is an indication for a surgery as it exacerbates the verterbrobasilar insufficiency and creates the risk of peripheral embolism. Reconstructive surgery fixes the reversed blood flow in the vertebral artery, alleviates neurological and limb ischemia symptoms. the aim of the study was to retrospectively evaluate the results of surgical treatment of the occlusion of the initial section of the subclavian artery using transposition or subclavian-carotid by-pass with a PTFE. material and methods. Retrospective analysis covered 55 patients operated on between June 1996 and August 2008 for occlusion of the left subclavian artery. 39 patients underwent a subclavian artery transposition (SCT) and the remaining 16 had a subclavian-carotid by-pass (SCB) using a PTFE. Indications for surgery included ischeamic symptoms in the upper limb and impaired vertebrobasilar circulation. Clinical symptoms occurred in the following order: vertebrobasilar insufficiency and upper limb ischemia (62%), upper limb ischemia symptoms (22%), vertebrobasilar insufficiency (16%). Results. There were no early deaths (by day 30). Ischemia was lifted in 100% of the patients operated using transposition and in 93% of those with a by-pass. In the perioperative period, one patient had a bypass thrombosis, and 2 patients had a transitional brain ischemia. These incidents affected patients who underwent subclavian-carotid by-pass. In the late postoperative period, 12 patients (21.81%) died due to cardiological complications and 7 patients (12.72%) for other causes, and none of them was related to the primary surgery. All patients with transposition have maintained the primary patency, with average follow-up period of 73 months . In the group with a by-pass, occlusion occurred in 3 patients in the first follow-up month. These incidents had no effect on survival rates. For the remaining 14/16 patients from the SCB group the average primary patency was 63.4 (8-104) months. conclusions. Subclavian-carotid transposition is a safe and effective method of upper limb revascularization. It is technically more difficult than the by-pass but ensures a better short-term and long-term result.

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“…Hybrid arch procedures are generally performed without hypothermic circulatory arrest or extracorporal circulation and may expand the treatment group to older patients with severe comorbidities or redo surgery currently ineligible for open surgical intervention. To treat distal arch aneurysms involving both the left subclavian and the left common carotid artery, these vessels can be translocated upstream to the right common carotid artery approached via a cervical access [79,80]. For arch aneurysms extending to the innominate artery, the ascending aorta can be used, via sternotomy, as a donor site for debranching bypasses and serve as a proximal landing zone for the endograft [81,82].…”

Section: Hybrid Procedures For Aortic Arch Pathologiesmentioning

confidence: 99%

Tevar

Akın

Kische

et al. 2011

Herz

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Chronic as well as acute diseases of the thoracic aorta are attracting increasing attention, both in the light of an ageing Western and Oriental population and with the proliferation of modern diagnostic imaging modalities. While classic surgical strategies still dominate the treatment of pathology of the ascending aorta and the proximal arch region, new endovascular concepts are emerging and are likely to evolve as primary treatment strategies for descending and abdominal aortic pathology. Additionally, aortic arch pathologies are becoming the target of hybrid approaches combining surgical head-vessel debranching and interventional stent-graft implantation in an attempt to improve outcome by avoiding the high risk of open arch repair or complete replacement. Nonetheless, due to the complexity of the underlying vascular disease, each patient should be discussed in a team consisting of cardiologists, cardiac surgeons, and an imaging specialist in order to design an individualized therapeutic strategy carried out best in a center with experience in both endovascular and surgical procedures.

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Initial Results After Combined Repair of Aortic Arch Aneurysms by Sequential Transposition of the Supra-Aortic Branches and Consecutive Endovascular Stent-Graft Placement

Cited by 83 publications

References 21 publications

Symptomatic spinal cord malperfusion after stent-graft coverage of the entire descending aorta☆

Symptomatic spinal cord malperfusion after stent-graft coverage of the entire descending aorta☆

Contemporary Indications and own Results of Surgical Treatment of occlusions of the initial section of the Left subclavian artery

Tevar

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