Technical Strategies to Expand Stent-Graft Applicability in the Aortic Arch and Proximal Descending Thoracic Aorta

Criado, Frank J.; Barnatan, Marcos F.; Rizk, Youssef; Clark, Nancy S.; Wang, Cecilia F.

doi:10.1583/1545-1550-9.sp3.32

Cited by 94 publications

(110 citation statements)

References 10 publications

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“…This technique, firstly performed in 2002, was thought to be a ''bailout'' option to rescue inadvertently covered vessels, and the follow-up observation proved the good results of this alternative [14,16]. This technique was then used even in planned procedures for patients considered unsuitable for open repair [12,17].…”

Section: Discussionmentioning

confidence: 99%

Early Results of Chimney Technique for Type B Aortic Dissections Extending to the Aortic Arch

Huang

Tang

Qiao

et al. 2015

Cardiovasc Intervent Radiol

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Objective To summarize our early experience gained from the chimney technique for type B aortic dissection (TBAD) extending to the aortic arch and to evaluate the aortic remodeling in the follow-up period. Methods From September 2011 to July 2014, 27 consecutive TBAD patients without adequate proximal landing zones were retrograde analyzed. Chimney stent-grafts were deployed parallel to the main endografts to reserve flow to branch vessels while extending the landing zones. In the follow-up period, aortic remodeling was observed with computed tomography angiography. Results The technical success rate was 100 %, and endografts were deployed in zone 0 (n = 3, 11.1 %), zone 1 (n = 18, 66.7 %), and zone 2 (n = 6, 22.2 %). Immediately, proximal endoleaks were detected in 5 patients (18.5 %). During a mean follow-up period of 17.6 months, computed tomography angiography showed all the aortic stent-grafts and chimney grafts to be patent. Favorable remodeling was observed at the level of maximum descending aorta and left subclavian artery with expansion of true lumen (from 18.4 ± 4.8 to 25 ± 0.86 mm, p \ 0.001 and 27.1 ± 0.62 to 28.5 ± 0.37 mm, p \ 0.001) and depressurization of false lumen (from 23.7 ± 2.7 to 8.7 ± 3.8 mm, p \ 0.001, from 5.3 ± 1.2 to 2.1 ± 2.1 mm, p \ 0.001). While at the level of maximum abdominal aorta, suboptimal remodeling of the total aorta (from 24.1 ± 0.4 to 23.6 ± 1.5 mm, p = 0.06) and true lumen (from 13.8 ± 0.6 to 14.5 ± 0.4 mm, p = 0.08) was observed. Conclusion Based on our limited experience, the chimney technique with thoracic endovascular repair is demonstrated to be promising for TBAD extending to the arch with favorable aortic remodeling.

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Section: Discussionmentioning

confidence: 99%

Early Results of Chimney Technique for Type B Aortic Dissections Extending to the Aortic Arch

Huang

Tang

Qiao

et al. 2015

Cardiovasc Intervent Radiol

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“…Existing experience with endovascular stent-graft repair of isolated descending thoracic aortic aneurysms indicates that spinal cord ischemia remains a serious complication, with a reported frequency that ranges from 0% to 12.0% [2,[6][7][8][9][10][11][12][13][14][15][16][17] (Table 5).…”

Section: Discussionmentioning

confidence: 99%

Spinal cord ischemia after elective endovascular stent-graft repair of the thoracic aorta☆

Kawaharada

Morishita

Kurimoto

et al. 2007

European Journal of Cardio-Thoracic Surgery

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Background: We reviewed our experience to investigate the determinants of paraplegia/paraparesis after endovascular stent-graft repair of the thoracic aorta, to assess the influence of the artery of Adamkiewicz (ARM) detected by preoperative magnetic resonance angiography (MRA) and to identify patients at risk. Methods: Over a 5-year period (March 2001-June 2006, 149 patients underwent elective endovascular stentgraft repair of the descending thoracic aorta. Patient demographics and perioperative factors relating to the endovascular procedure were evaluated by using univariate statistical analyses. To assess the influence of the ARM in the thoracolumbar region, patients in whom ARM was detected by preoperative MRA were divided into two groups: patients who had occlusion of the intercostal artery for ARM due to stent-graft (group A, n = 33) and patients who had patency of the intercostal artery for ARM following stent-graft (group B, n = 38). Results: Five (3.6%) of the 144 patients had paraparesis/paraplegia. Two of these five patients had previously undergone operation for total arch replacement with elephant trunk and one had surgery for descending aortic repair. Univariate analyses identified only prior aortic surgery as a significant risk factor ( p = 0.04). Paraparesis/paraplegia rates were 10% (three patients) in group A and 0% in group B ( p = 0.09). Conclusion: Prior thoracic aortic replacement was found to be a significant predictor of spinal cord ischemia, and therefore vigilance is needed regarding occlusion of the intercostal artery for ARM detected prior to stent-graft repair. #

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“…In order to adequately describe and classify the various techniques and the extension of the endoluminal stenting, Criado and colleagues defined the proximal landing zone as: zone 0 (proximal to the innominate artery), zone 1 (between the innominate and left common carotid artery), zone 2 (between the left common carotid and subclavian arteries), and zone 3 (distal of the left subclavian artery) (51).…”

Section: The Techniquesmentioning

confidence: 99%

Open repair techniques in the aortic arch are still superior

Bachet¹

2018

Ann. Cardiothorac. Surg.

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Conventional arch replacement can be carried out in a great majority of patients. Hybrid procedures are often as invasive and technically difficult as conventional ones. Moreover, their immediate results are, in many reported experiences, not better and their long-term results less favourable than the ones observed with conventional methods. So, yes, the open conventional arch replacement is still "the gold standard".

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Technical Strategies to Expand Stent-Graft Applicability in the Aortic Arch and Proximal Descending Thoracic Aorta

Cited by 94 publications

References 10 publications

Early Results of Chimney Technique for Type B Aortic Dissections Extending to the Aortic Arch

Early Results of Chimney Technique for Type B Aortic Dissections Extending to the Aortic Arch

Spinal cord ischemia after elective endovascular stent-graft repair of the thoracic aorta☆

Open repair techniques in the aortic arch are still superior

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