Thoracic aortic aneurysm repair with an endovascular stent graft: the “first generation”

Mitchell, R. Scott; Miller, D. Craig; Dake, Michael D.; Semba, Charles P.; Moore, Kathleen A.; Sakai, Toyohiko

doi:10.1016/s0003-4975(99)00436-1

Cited by 223 publications

(155 citation statements)

References 17 publications

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“…[1][2][3][4][5][6][7] We reported previously the efficacy of a treatment using endovascular stent grafts (S/Gs) for aortic dissections, especially for acute onset. 6 -8 In successful cases, the thrombi inside the excluded aneurysmal cavity gradually become organized, followed by shrinkage of the aneurysm.…”

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confidence: 99%

Development of a New Method for Endovascular Aortic Repair

Kajimoto

Shimono²,

Hirano³

et al. 2006

Circulation

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Background-Endovascular aortic repair by stent grafts (S/Gs) has been developed as a less invasive treatment for aortic aneurysms. However, some aneurysmal cavities can remain without organization, causing re-expansion. We demonstrated previously that transplantation of a cell combination (myoblasts and fibroblasts) promoted thrombus organization in a rat model. We also developed basic fibroblast growth factor (bFGF) slow-delivery S/Gs coated with elastin and impregnated with bFGF. Here, we evaluated the effects of cell transplantation combined with bFGF slow release on canine thoracic aortic aneurysmal sacs after S/Gs repair. Methods and Results-Thoracic aortic aneurysms were surgically created with jugular vein patches in 15 beagles.Myoblasts and fibroblasts of autologous skeletal muscle were isolated and cultured for cell transplantation. The S/Gs had 6 holes and produced endoleaks in the excluded cavities. Collagen gel (gel group, nϭ5) or a mixture of skeletal myoblasts and fibroblasts with collagen gel (cell group, nϭ5) were injected into the aneurysmal sacs excluded by the S/Gs. We also studied the effects of combined therapy of bFGF slow-release S/Gs and cell transplantation (hybrid group, nϭ5). After 14 days, histological analyses revealed that the excluded aneurysmal cavities of the gel group were filled with fresh thrombus, whereas the excluded cavities in the cell-transplanted groups were occupied by organized tissue. The percentages of the organized areas relative to the excluded cavities, evaluated by Masson's trichrome staining, were 18.1Ϯ4.0%, 52.6Ϯ4.0%, and 77.1Ϯ6.9% in the gel, cell, and hybrid groups, respectively. Collagen fibers had already appeared, and increased numbers of ␣-smooth muscle actin-positive cells were observed in the hybrid group. Conclusions-Cell

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confidence: 99%

Development of a New Method for Endovascular Aortic Repair

Kajimoto

Shimono²,

Hirano³

et al. 2006

Circulation

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“…Despite borderline statistical significance, the operative mortality was halved in the stent graft group compared with the open group (7.6% versus 15.1%; Pϭ0.09). 64 Although a 7.6% mortality lies in the lower end of reported rates for thoracic endografts, which have been up to 20%, 73,74 it is substantially higher than that of our updated experience with 873 infrarenal abdominal aortic aneurysm endovascular repairs (1.8%) 75 or the PIVITOL trial 59 and may be related to the fact that 30% of the endograft patients were not considered open surgical candidates. 64 The SCI rate was 6.7% in our stent graft population, with 2 patients experiencing transient paraparesis that had resolved by discharge.…”

Section: Single-center Experience With Tevarmentioning

confidence: 85%

“…Similarly, several reviews have noted that 8% to 43% of landing sites in descending aortic aneurysms will not allow an appropriate 2-cm length for secure proximal fixation. 73,74,76,77 Indeed, in 20% of our patients, the left subclavian artery was intentionally covered (11.5% underwent preprocedural subclavian artery bypass). The 4-year survival after endovascular repair was 54%, and the freedom from reintervention rate was 81%.…”

Section: Single-center Experience With Tevarmentioning

confidence: 95%

Contemporary Management of Descending Thoracic and Thoracoabdominal Aortic Aneurysms: Endovascular Versus Open

Conrad

Cambria

2008

Circulation

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“…Reports on handmade SGs are limited, and the results in these cases are unknown. [15][16][17][18][19][20][21][22][23] In Japan, EVR devices have not been approved as medical devices thus far. Therefore some medical institutions produce their own handmade SGs, and compared with other countries, only a small number of patients undergo this procedure in Japan.…”

Section: Discussionmentioning

confidence: 99%