Outcomes for supra-aortic branch vessel stenting in the treatment of thoracic aortic disease

O’Callaghan, Adrian; Mastracci, Tara M.; Greenberg, Roy K.; Eagleton, Matthew J.; Bena, James; Kuramochi, Yuki

doi:10.1016/j.jvs.2013.12.053

Cited by 38 publications

(32 citation statements)

References 18 publications

(18 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Like others 38 , despite the high technical success and acceptable short-term outcomes, we remain concerned about the durability of AAC due to endoleak and/or arch vessel patency. Concerns about ‘gutter leaks’ were initially raised by Suguira et al 39 when they reported midterm outcomes after 11 AAC procedures and 2(18%) patients developed type 1a endoleak.…”

Section: Discussionmentioning

confidence: 98%

Outcomes of thoracic endovascular aortic repair using aortic arch chimney stents in high-risk patients

Voskresensky

Scali

Feezor

et al. 2017

Journal of Vascular Surgery

View full text Add to dashboard Cite

Introduction Aortic arch disease is a challenging clinical problem, especially in high-risk patients where open repair can have morbidity and mortality rates of 30–40% and 2–20%, respectively. Aortic arch “chimney”(AAC) stents used during thoracic endovascular aortic repair(TEVAR) are a less invasive treatment strategy than open repair, but the current literature is inconclusive about the role of this technology. The focus of this analysis is to describe our experience with TEVAR and AAC stent(s). Methods All TEVAR procedures performed from 2002–15 were reviewed to identify those with AAC stents. Primary end-points were technical success, as well as 30-day and 1-year mortality. Secondary end-points included complications, reintervention, and endoleak. Technical success was defined as a patient surviving the index operation with deployment of the AAC stent(s) at the intended treatment zone with no evidence of type 1 or 3 endoleak on initial postoperative imaging. The Kaplan-Meier method was used to estimate survival. Results Twenty-seven patients(age:69±12 years[male 70%]) were identified, and all were described as prohibitive risk for open repair by the treating team. Relevant comorbidity rates were: coronary artery disease/myocardial infarction(59%), O2-dependent emphysema(30%), preoperative creatinine>1.8mg/dL(19%), and congestive heart failure(15%). Presentations included: elective-67%(n=18), symptomatic-26%(n=7), and ruptured-7%(n= 2). Eleven(41%) had prior endovascular and/or open arch/descending thoracic repair. Indications were: degenerative aneurysm(49%), chronic residual type A dissection with aneurysm(15%), type 1a endoleak after TEVAR(11%), post-surgical pseudoaneurysm(11%), penetrating ulcer(7%), and acute type B dissection(7%). 32 BC vessels were treated: innominate, n=7; left common carotid artery(LCCA), n=24; left subclavian artery(LSA), n=1. Five patients(19%) had simultaneous innominate-LCCA chimneys. BCC stents were planned in 75%(n=24) with the remainder placed for either LCCA or innominate artery encroachment(n=8). Overall technical success was 89%(1-intraoperative death, 2-persistent type 1a endoleaks in follow-up). 30-day mortality was 4%(n=1; intraoperative in a patient with a ruptured arch aneurysm) and median LOS was 6[IQR 4, 9] days. Seven(26%) patients experienced a major complication(stroke-3[all with unplanned BCC], respiratory failure-3, and death-1). Nine(33%) patients underwent aorta-related reintervention, and no chimney occlusion events occurred during follow-up(median follow-up:9[IQR 1,23] months). One and 3-year survival is estimated to be 88±6% and 69±9%, respectively. Conclusions TEVAR with AAC can be performed with high technical success and acceptable morbidity and mortality in high-risk patients. Unplanned AAC placement during TEVAR results in an elevated stroke risk, which may be related to the branch vessel coverage necessitating AAC placement. Acceptable mid-term survival can be anticipated, but aorta-related reintervention is not uncommon, and diligent follow-u...

show abstract

Section: Discussionmentioning

confidence: 98%

Outcomes of thoracic endovascular aortic repair using aortic arch chimney stents in high-risk patients

Voskresensky

Scali

Feezor

et al. 2017

Journal of Vascular Surgery

View full text Add to dashboard Cite

show abstract

“…Small published series representing early experience have reported mortality up to 20% and stroke rate up to 14%. 192,202 The Relay scalloped endograft (Terumo Aortic) does not include fenestrations, preloaded catheters or the use of covered stents for the target-vessels and is mainly used for zones 2 and 3. In a single reported small series, the mortality rate was 5% and the stroke rate 14%.…”

Section: Classmentioning

confidence: 99%

Editor's Choice – Current Options and Recommendations for the Treatment of Thoracic Aortic Pathologies Involving the Aortic Arch: An Expert Consensus Document of the European Association for Cardio-Thoracic Surgery (EACTS) & the European Society for Vascular Surgery (ESVS)

Czerny¹,

Schmidli²,

Adler³

et al. 2019

European Journal of Vascular and Endovascular Surgery

237

122

View full text Add to dashboard Cite

“…This paradigm can present difficulties, particularly in emergency clinical situations such as the presence of ruptured aneurysms, aortic transection, or acute type B dissection with malperfusion. Endovascular solutions in these settings include chimney or snorkel techniques or in situ fenestration [9][10][11][12]. Reports for these options describe mortality rates of up to 16.5% and stroke rates of up to 18%.…”

Section: Commentmentioning

confidence: 99%

“…Reports for these options describe mortality rates of up to 16.5% and stroke rates of up to 18%. Just as important, the reliability of exclusion of pathologic features is variable, particularly with the chimney technique [12].…”

Section: Commentmentioning

confidence: 99%

Branched Endovascular Therapy of the Distal Aortic Arch: Preliminary Results of the Feasibility Multicenter Trial of the Gore Thoracic Branch Endoprosthesis

Patel

Dake

Bavaria

et al. 2016

The Annals of Thoracic Surgery

124

View full text Add to dashboard Cite

show abstract

Outcomes for supra-aortic branch vessel stenting in the treatment of thoracic aortic disease

Cited by 38 publications

References 18 publications

Outcomes of thoracic endovascular aortic repair using aortic arch chimney stents in high-risk patients

Outcomes of thoracic endovascular aortic repair using aortic arch chimney stents in high-risk patients

Editor's Choice – Current Options and Recommendations for the Treatment of Thoracic Aortic Pathologies Involving the Aortic Arch: An Expert Consensus Document of the European Association for Cardio-Thoracic Surgery (EACTS) & the European Society for Vascular Surgery (ESVS)

Branched Endovascular Therapy of the Distal Aortic Arch: Preliminary Results of the Feasibility Multicenter Trial of the Gore Thoracic Branch Endoprosthesis

Contact Info

Product

Resources

About