Outcomes of type Ia endoleaks after endovascular repair of the proximal aorta

Ayala, Ivan; Cheng, Yu‐Ting; Chen, Shaowei; Chu, Sung‐Yu; Nan, Yu-Yun; Liu, Kuo‐Sheng

doi:10.1016/j.jtcvs.2020.06.026

Cited by 8 publications

(4 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Meanwhile, the LSA branch stent protruding into the aortic arch can avoid endograft migration ( 21 ). Defined as displacement of the endograft by more than 5–10 mm from its original position, endograft migration has been reported to occur following 1.0–2.8% of TEVAR operations and 1–10% of endovascular repair procedures for the abdominal aorta at 1-year postintervention ( 22 , 23 ). Thus, the patients in our center who underwent ISF-TEVAR did not experience stent displacement.…”

Section: Discussionmentioning

confidence: 99%

Clinical Validation of the Impact of Branch Stent Extension on Hemodynamics in ISF-TEVAR Involving LSA Reconstruction

Qiu

et al. 2022

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

BackgroundThe study of hemodynamics regarding thoracic endovascular aortic repair (TEVAR) is helpful to improve the surgical efficacy.ObjectiveCorrelations between hemodynamic changes and branch stent extension length and interference factors for branch stent extension length of in situ fenestration TEVAR (ISF-TEVAR) involving the left subclavian artery (LSA) were evaluated.Materials and MethodsThis study retrospectively analyzed 196 patients with Stanford type B aortic dissection who received in situ laser fenestrated thoracic endovascular aortic repair with LSA fenestration from April 2014 to March 2021. Branch stent extension to the main stent graft was evaluated by the computed tomographic angiography (CTA). Hemodynamic change of LSA was defined as a 20 mmHg interbrachial systolic pressure difference. The factors affecting the extension of the branch stent were also evaluated.ResultsAll patients underwent ISF-TEVAR with LSA fenestration, and there was no recurrence during the follow-up. The mean length of the branch stent extension was 10.37 ± 0.34 mm, which was used to divide the patients into long and short groups. Asymptomatic hemodynamic changes (defined as a 20 mmHg interbrachial systolic pressure difference) in LSA were observed in 61 patients undergoing ISF-TEVAR involving LSA fenestration. The Spearman correlation analysis showed extension length of a branch stent >1.5 cm elevated the risk of hemodynamic changes.ConclusionOverall, we conclude that branch stent extension length >1.5 cm induced LSA hemodynamic changes. Appropriate shortening of the stent extension length can improve the curative effect of ISF-TEVAR, especially when faced with a type II/III aortic arch and stent angles of <30 degrees.

show abstract

Section: Discussionmentioning

confidence: 99%

Clinical Validation of the Impact of Branch Stent Extension on Hemodynamics in ISF-TEVAR Involving LSA Reconstruction

Qiu

et al. 2022

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

show abstract

“…Other possible causes suggested by the authors included aneurysmal evolution of aorta, unfavorable stent placement, gutter leakage between the main stent graft and chimney stent, short distance between the ostium of innominate artery and the aneurysm, lack of comfortability of Najuta stent prototype, and short proximal neck length (10, 20, 31, 37, 55). Based on available data, 17 of the 36 patients who presented with type Ia endoleak were treated conservatively, while in 5 patients type Ia endoleak lead to aneurysm enlargement, which ruptured and caused death in 1 patient (6,10,15,20,28,30,42). Tables 8,9 show the causes and outcomes of SCI and RTAD in 11 and 9 studies, respectively.…”

Section: Perioperative Mortality and Post-operative Complicationsmentioning

confidence: 99%

A systematic review and meta-analysis of thoracic endovascular aortic repair with the proximal landing zone 0

Zhu

Li²,

Lu³

2023

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

BackgroundThoracic endovascular aortic repair, initially intended for thoracic aortic disease treatment, has extended its application to the proximal zone of the aorta. However, the safety and surgical outcomes of extending the proximal landing zone into the ascending aorta (zone 0) in selected cases remain unknown. Thus, we performed a systematic review and meta-analysis of zone 0 thoracic endovascular aortic repair (TEVAR) to obtain a deeper understanding of its safety, outcomes, and trends over time.MethodsA literature search was performed using PubMed, EMBASE, and Web of Science databases in accordance with the preferred reporting items for systematic reviews and meta-analyses guidelines, from January, 1997 to January, 2022. Only studies involving zone 0 TEVAR were included. The retrieved data from the eligible studies included basic study characteristics, 30-day/in-hospital mortality rate, indications, comorbidities, stent grafts, techniques, and complications. Summary effect measures of the primary outcomes were obtained by logarithmically pooling the data with an inverse variance-weighted fixed-effects model.ResultsFifty-three studies with 1,013 patients were eligible for analysis. The pooled 30-day/in-hospital mortality rate of zone 0 TEVAR was 7.49%. The rates of post-operative stroke, type Ia endoleak, retrograde type A aortic dissection, and spinal cord ischemia were 8.95, 9.01, 5.72, and 4.12%, respectively.ConclusionsAlthough many novel stent grafts and techniques targeting zone 0 TEVAR are being investigated, a consensus on technique and device selection in zone 0 TEVAR is yet to be established in current practice. Furthermore, the post-operative stroke rate is relatively high, while other complication rates and perioperative death rate are comparable to those of TEVAR for other aortic zones.

show abstract

“…4 Endoleaks type Ia have been reported in up to 21% of cases, if the landing zone is approaching into the arch (zones 1 and 2). 5 A recent literature review found that endoleak type Ia varied depending on the type of endovascular procedure. In situ fenestration had the lowest endoleak rate with a mean incidence of 2.8%, whereas the procedure with the highest endoleak rate was chimney TEVAR with a mean rate of 20.1%.…”

Section: Introductionmentioning

confidence: 99%

Expert opinion: How to treat type IA endoleakage

Peterß

Stana

Rantner

et al. 2023

Asian Cardiovasc Thorac Ann

View full text Add to dashboard Cite

Type Ia endoleaks due to failed sealing or loss of landing zone and the adequate management thereof remain crucial for long-term therapeutic success following TEVAR. This expert opinion summarizes our institutional experience with endovascular, open surgical, and hybrid techniques in the context of recent scientific publications. The rapid turnover of technical innovations, but most importantly outcome data demonstrate the requirement for increasingly patient-tailored treatment strategies and the need for specialized aortic centers. The latter should offer a complete range of treatment options, an adequate perioperative management, and the highest level of multidisciplinary expertise.

show abstract

Outcomes of type Ia endoleaks after endovascular repair of the proximal aorta

Cited by 8 publications

References 24 publications

Clinical Validation of the Impact of Branch Stent Extension on Hemodynamics in ISF-TEVAR Involving LSA Reconstruction

Clinical Validation of the Impact of Branch Stent Extension on Hemodynamics in ISF-TEVAR Involving LSA Reconstruction

A systematic review and meta-analysis of thoracic endovascular aortic repair with the proximal landing zone 0

Expert opinion: How to treat type IA endoleakage

Contact Info

Product

Resources

About