Supra-aortic hybrid endovascular procedures for complex thoracic aortic disease: Single center early to midterm results

Chan, Yiu Che; Cheng, Stephen W.K.; Ting, Acw; Ho, Pei

doi:10.1016/j.jvs.2008.04.047

Cited by 62 publications

(38 citation statements)

References 29 publications

(22 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For instance, no patient presenting with acute aortic dissection has been treated with this new technique, and this indication alone increases operative risks and postoperative morbidity rates in open surgery case series. Furthermore, authors sustaining the validity and feasibility of this new technique compare its postoperative morbidity and mortality rates to quite old open surgical repair case series results [73,76,77,83].…”

Section: Discussionmentioning

confidence: 97%

“…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%

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

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 97%

Section: Aortic Arch Debranching and Endovascular Exclusionmentioning

confidence: 99%

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

View full text Add to dashboard Cite

show abstract

“…[1,2,7,9,10,14,34]. Radiologists usually apply various types of angiography, MSCT, catheterisation, and trans-catheter coil occlusion, either for examination and identification of the aberrant arteries or for the treatment of their pathology [24,27].…”

Section: Discussionmentioning

confidence: 99%

Anatomy and radiology of the variations of aortic arch branches in 1,266 patients

et al. 2013

View full text Add to dashboard Cite

“…The reported mortality rates after aortic arch hybrid procedures vary between 0% and 15.4% and are thus below our mortality rate. [12][13][14][15][16][17] A possible explanation could be significant differences in patient selection. At present, all series limit patient selection for hybrid procedures to highrisk patients "unfit" or "not suitable" for open aortic arch repair but definition of "high-risk" and comparable selection criteria of these patients (eg, Risc scores) are frequently missing.…”

Section: Discussionmentioning

confidence: 99%