Multiple factors predict the risk of spinal cord injury after the frozen elephant trunk technique for extended thoracic aortic disease

Katayama, Kosuke; Uchida, Naoshige; Katayama, Akira; Takahashi, Shinya; Takasaki, Taiichi; Kurosaki, T.; Imai, Kyoichi; Sueda, Taijiro

doi:10.1093/ejcts/ezu243

Cited by 97 publications

(75 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Sizing of the endograft for the hybrid approach is crucial because the endograft needs to be large enough to open up the collapsed true lumen and avoid type I endoleak. But, in the meantime, oversizing would cause SINE (33). SINE can cause catastrophic complication after hybrid type A dissection repair (17,24).…”

Section: Sizing Techniquementioning

confidence: 99%

Descending endografts for type A dissections: con

Tanaka¹,

Sandhu²,

Estrera³

2016

Ann. Cardiothorac. Surg.

View full text Add to dashboard Cite

An important goal of surgical repair of type A aortic dissection is to resect the intimal tear. Studies on the fate of residual dissection after acute type A aortic dissection repair in the past decade have driven surgeons to seek procedures to avoid distal reoperation. Aggressive surgical approach with total arch replacement in acute type A dissection has demonstrated lower incidence of distal reoperation and slower aortic growth rate compared to less aggressive ascending/hemiarch repair. Recently, successful results of thoracic endovascular aortic repair (TEVAR) in type B aortic dissection have encouraged surgeons to further attack acute type A aortic dissection with hybrid approach: antegrade endografting in the descending thoracic true lumen as an adjunct to hemiarch or total arch repair. However, is the hybrid approach with simultaneous descending endografting justified in all the acute type A aortic dissection cases? The outcomes of the hybrid approach reported by the several groups have demonstrated 80-100% of false lumen thrombus formation in the proximal descending aorta (stented segment); however, the complete obliteration of the false lumen is only 17-50%. The incidence of distal reoperation/reintervention after hybrid approach is as high as 14% and an adjunctive procedure is often performed. Moreover, there are concerns about additional risks associated with the hybrid procedures, such as spinal cord injury (SCI), stent graft induced new entry and stroke. The data on this new approach are still very limited. Hence, further study is warranted to prove its safety and durability.

show abstract

Section: Sizing Techniquementioning

confidence: 99%

Descending endografts for type A dissections: con

Tanaka¹,

Sandhu²,

Estrera³

2016

Ann. Cardiothorac. Surg.

View full text Add to dashboard Cite

show abstract

“…Conversely, an overly deep implantation of a FET can lead to spinal cord injury. 2,3) The incidence of spinal cord injury following the FET technique ranges between 3.5% and 24%. [2][3][4] A distal landing zone over T7 has been reported as an independent risk factor for spinal cord injury.…”

Section: Discussionmentioning

confidence: 99%

“…2,3) The incidence of spinal cord injury following the FET technique ranges between 3.5% and 24%. [2][3][4] A distal landing zone over T7 has been reported as an independent risk factor for spinal cord injury. 3) The simplest method for the positioning of a FET is marking the preoperatively measured length on the stent graft.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Radiopaque Ruler-Guided Frozen Elephant Trunk Technique

Ikeda

Konishi

Matsuzaki

et al. 2016

Annals of Vascular Diseases

View full text Add to dashboard Cite

Frozen elephant trunk (FET) technique combines open surgery and endovascular repair for extensive thoracic aortic aneurysms. When a FET is inserted into the descending thoracic aorta, it is difficult to confirm its proper positioning. Here we report a radiopaque ruler-guided FET technique. On the basis of preoperative computed tomography, we create a roadmap which shows the relationship between the descending thoracic aorta and vertebrae. During surgery, a radiopaque ruler placed beneath the patient's back provides the accurate target position under fluoroscopy. Our technique is effective to prevent spinal cord injury because it avoids an overly deep implantation of a FET. Keywords: thoracic aortic aneurysm, open surgery, endovascular repair TechniqueA 73-year old male, who had a distal arch aneurysm with a maximal diameter of 55 mm, underwent a total arch replacement using the FET technique. Based on preoperative computed tomography (CT), we created a road map which showed the relationship between the thoracic aorta and vertebrae (Fig. 1). We decided the target position of a FET according to following criteria: i) the distal landing zone is >20 mm and ii) FET is never inserted over T7. If an implantation of a FET over T7 is needed to secure an adequate landing zone, we consider that the FET technique is contraindicated. In this patient, the target position was set at the lower border of T6.Before starting surgery, a radiopaque ruler (LeMaitre Stent Guide 270 mm, LeMaitre Vascular, Burlington, MA) was placed beneath the left side of the patient's back, and then we confirmed the graduation of the ruler which indicated the target position under fluoroscopy. Prophylactic cerebrospinal drainage was not routinely performed.After exposure of the left axillary artery using an infraclavicular approach, a median sternotomy was performed. The left pleural cavity was opened, and a hole was bored in the 2nd intercostal space. Thus, an extra-anatomical bypass route from the mediastinum to the left axillary artery was created. After systemic heparinization, cardiopulmonary bypass was established by cannulation of the ascending aorta and right atrium. While systemic cooling, an 8-mm Triplex vascular prosthesis (Terumo, Tokyo, Japan) was anastomosed to the left axillary artery.Circulatory arrest was induced at a rectal temperature of 25°C. After clamping the ascending aorta, cold crystalloid cardioplegia was administered through the aortic root cannula. Selective cerebral perfusion was initiated using balloon catheters cannulated into the brachiocephalic and left common carotid artery. The left subclavian artery was ligated and perfused using the 8-mm graft which was anastomosed to the left axillary artery. The aortic arch was transected between the brachiocephalic and left common carotid artery. The orifice of the left common carotid artery was stumped. A 33 × 90 mm J Graft Open Stent (Japan Lifeline, Tokyo, Japan) was inserted into the descending thoracic aorta and deployed at the target

show abstract

“…In-hospital mortality (10%) and stroke (4.8%) rates were extremely satisfactory while the risk of spinal cord injury (4.3%) appeared to be higher than that reported in more conservatively managed series. In this setting, lately, Katayama et al showed that in patients undergoing FET, postoperative spinal cord injury may be prevented or minimized by avoiding deep insertion of the stent graft, keeping blood pressure elevated after the operation and using cerebrospinal fluid drainage (40). Nevertheless, the spinal cord injury remains the main Achilles heel of FET procedure.…”

Section: Current Evidencementioning

confidence: 99%

Descending endograft for DeBakey type 1 aortic dissection: pro

Berretta¹,

Eusanio²

2016

Ann. Cardiothorac. Surg.

View full text Add to dashboard Cite

The surgical management of patients with DeBakey type 1 acute aortic dissection (DBT1-AAD) represents a major challenge for aortic surgeons. It has been demonstrated that the distal false lumen remains patent in about 70% to 80% of patients undergoing DBT1-AAD surgery and that a patent false lumen worsens the prognosis. In order to improve long term outcomes and reduce the frequency of late aneurysm formation and reoperation, a more aggressive primary operation involving total arch replacement (TAR) and concomitant antegrade stenting of the descending thoracic aorta (DTA) with a frozen elephant trunk (FET) has been introduced. Such extensive operations, however, remain controversial due to their increased technical complexity and perceived higher operative mortality and morbidity. This perspective article will overview the rationale behind, and the potential advantages and current evidence for, FET surgery in acute aortic dissection.

show abstract

Multiple factors predict the risk of spinal cord injury after the frozen elephant trunk technique for extended thoracic aortic disease

Abstract: There were multiple factors predicting the risk of SCI after the FET technique. Paraplegia may be prevented by avoiding deep insertion of the stent graft and by keeping blood pressure elevated after the operation.

Cited by 97 publications

References 19 publications

Descending endografts for type A dissections: con

Descending endografts for type A dissections: con

Radiopaque Ruler-Guided Frozen Elephant Trunk Technique

Descending endograft for DeBakey type 1 aortic dissection: pro

Contact Info

Product

Resources

About