Total Endovascular Debranching of the Aortic Arch

Yoshida, Ricardo de Alvarenga; Kolvenbach, Ralf; Yoshida, Winston Bonetti; Wassijew, S.; Schwierz, Elisabeth; Lin, Feng‐Yen

doi:10.1016/j.ejvs.2011.06.054

Cited by 41 publications

(24 citation statements)

References 15 publications

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“…This technique was then used even in planned procedures for patients considered unsuitable for open repair [12,17]. Its relatively easy procedure, familiar to most practicing surgeons, has shown its potential advantages and has been reported by increasingly more literature [3][4][5][6]. Nevertheless, scarce studies focus on safety and efficacy of chimney technique in TBAD.…”

Section: Discussionmentioning

confidence: 99%

“…Other modified techniques such as fenestrated grafts or branch grafts were limited by the evolution of the treatment modalities and the complex procedures. [3][4][5][6] Another option to perfuse supra-aortic vessels is the chimney technique, firstly described by Greenberg et al as a mean to rescue renal arteries [7]. Advantageously, this technique makes use of commercially available devices for planned surgeries or accidental coverage of the supra-aortic branches in emergent cases.…”

Section: Introductionmentioning

confidence: 99%

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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%

Section: Introductionmentioning

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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“…4,6,7,9 Whenever Viabahn is used in combination with Zenith stent grafts, there are reports of reinforcement of the parallel stent using additional baremetal stents relining the Viabahn and avoiding stent compression. 9,18,19 This technique could also allow better conformability and kink resistance in angulated configurations or as periscopes. However, there is no clear evidence on whether such a modification results in clinically improved outcomes.…”

Section: Silicon Aortic Model Endograftmentioning

confidence: 99%

The Best Conditions for Parallel Stenting During EVAR: An In Vitro Study

Mestres

Uribe

García-Madrid

et al. 2012

European Journal of Vascular and Endovascular Surgery

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“…Total-endovascular techniques are also being developed and may soon be a more widely utilized treatment option (8,9).…”

Section: Introductionmentioning

confidence: 99%

Long-term survival and related outcomes for hybrid versus traditional arch repair—a meta-analysis

Chakos¹,

Jbara²,

Yan³

et al. 2018

Ann. Cardiothorac. Surg.

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Background: Surgical interventions for aortic aneurysm and dissection remain associated with high risk of mortality and morbidity. Advances in operative techniques have led to a variety of options for the cardiac surgeon, including endovascular and hybrid approaches. Debate remains over which of these techniques provide optimal outcomes for the patient. The present systematic review and meta-analysis aims to evaluate long term patient survival and identify short-term outcomes for conventional (open) aortic arch repair and hybrid aortic arch repair (HAR).Methods: An electronic literature search was conducted according to predefined inclusion criteria for hybrid and conventional aortic arch repair surgery. Digitized survival data was extracted from identified studies' Kaplan-Meier curves and used to re-create individual patient data for aggregated survival analysis.Post-operative morbidity and mortality were analyzed using random-effects model meta-analysis.Results: Nine studies were included, containing 841 hybrid arch repair and 1,182 conventional arch repair patients. Pooled Kaplan-Meier analysis of all patients demonstrated higher survival in hybrid arch repair patients than conventional arch repair patients, however, this was noted to be sensitive to results from a particular study. Overall results showed for the hybrid repair cohort, survival at 1, 2, 3, 5 and 7 years was 87%, 85%, 83%, 78% and 75%, respectively. Survival in the conventional repair cohort at 1, 2, 3, 5 and 7 years was 84%, 82%, 80%, 75% and 71%, respectively. Statistically significant findings from meta-analysis showed hybrid arch repair was associated with lower risk of re-operation for bleeding, while conventional arch repair was associated with reduced risk of spinal cord injury.Conclusions: Pooled Kaplan-Meier analysis of all studies showed long-term survival outcomes for hybrid and conventional aortic arch repair patients are heterogeneous and sensitive to the results of particular studies. Superior results from particular centres and the low number of comparative studies mean that more data is required to make definitive findings with regards to the long-term survival outcomes of either procedure. Hybrid arch repair was associated with lower risk of re-operation for bleeding, while conventional arch repair was associated with lower risk of spinal cord injury. Surgeons should consider their own center's experience and patient suitability when deciding between hybrid or conventional aortic repair techniques.

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Total Endovascular Debranching of the Aortic Arch

Cited by 41 publications

References 15 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

The Best Conditions for Parallel Stenting During EVAR: An In Vitro Study

Long-term survival and related outcomes for hybrid versus traditional arch repair—a meta-analysis

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