Usefulness of fenestrated stent grafts for thoracic aortic aneurysms

Yasuda, Kôichi; Yokoi, Yoshiaki; Yamaguchi, Atsushi; Hori, Daijiro; Adachi, Koichi; Adachi, Hideo

doi:10.1093/ejcts/ezt127

Cited by 18 publications

(14 citation statements)

References 21 publications

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“…The site of the entry tear and the extent of dissection were determined on 0.5-to 1-mm preoperative CT slices, including arterial-and venous-phase images. Three types of nonfenestrated thoracic stent-graft, including the Relay (Bolton Medical SL, Barcelona, Spain), GORE TAG (WL Gore & Associates, Inc, Flagstaff, Ariz), and Zenith Tx2 (Cook Medical Inc, Bloomington, Ind), and 1 fenestrated thoracic stent-graft (Najuta, Kawasumi Laboratory, Tokyo, Japan) 17,18 were used. Covered length was determined intraoperatively according to the aortic pathology.…”

Section: Endovascular Treatment Between March 2009 and May 2013 123mentioning

confidence: 99%

Reoperation for enlargement of the distal aorta after initial surgery for acute type A aortic dissection

Kimura

Itoh

Yasuda

et al. 2015

The Journal of Thoracic and Cardiovascular Surgery

115

101

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Section: Endovascular Treatment Between March 2009 and May 2013 123mentioning

confidence: 99%

Reoperation for enlargement of the distal aorta after initial surgery for acute type A aortic dissection

Kimura

Itoh

Yasuda

et al. 2015

The Journal of Thoracic and Cardiovascular Surgery

115

101

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“…In most series, it has been reported that the need for many unplanned adjunctive intraoperative procedures to achieve an optimal outcome is common but also access related complications. The technique has also expanded to thoracic cases (Mc Williams et al 2004, Yuri et al 2013. Small series of using this technique in thoracic aorta allows preserving aortic branch flow to vital side branches.…”

mentioning

confidence: 99%

Impact of Renal Chimney Grafts on Anatomical Suitability for Endovascular Repair in Ruptured Abdominal Aortic Aneurysm

et al. 2015

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Introduction: Open repair of the aorta carries a high risk for morbidity and mortality especially in the elderly population and in patients unfit for major surgery. Endovascular aortic repair is safe, durable and effective when there is adequate proximal and distal sealing zone for the aortic stent graft. Fenestrated and branched stent grafts have made the repair possible for complex but elective cases that do not have an adequate sealing zone. Urgent complex cases and patients with midaortic occlusive diseases do not have any therapeutic alternative if they are not fit for open repair. Chimney graft technique fills this gap and allows the sealing zones for aortic stent graft to be extended as required. The aim of the present thesis is to study the applicability, safety and durability of CG technique in urgent cases with complex lesions in the thoracic and abdominal aorta including the midaortic occlusive diseases. Patients and Methods: All patients who received CG were treated urgently or semi-urgently. The majority of the treated aortic lesions were aneurysms, dissections, pseudoaneurysms, infection, and accidental overstented vital aortic side branches. The median age of all patients was 75 years (IQR, 69-78), of them 32% were female except for the first study where all ten patients were female with midaortic occlusive diseases. The second study evaluated the mid to long-term efficacy and durability of the CG technique in 29 patients with urgent and complex lesions of the thoracic aorta. The third study examined the long-term results of CG in preserving the visceral flow of 51 patients with urgent complex aortic lesions. The fourth study evaluated the CTA images of 206 patients with ruptured abdominal aortic aneurysm. The study measured the applicability of CG in patients for whom standard EVAR was contraindicated because of a short aneurysmal neck. Results:The results showed that CG is applicable and safe for midaortic occlusive diseases with high technical success and patency rate without major adverse effect. The treated patients with thoracic aortic lesions had 14% 30-day mortality, 21% type I endoleak, 7% CG-related mortality, 98% secondary patency and 68% of the aortic lesions shrank significantly. Visceral CG had a 10% 30-day mortality, 6% CG-related mortality, 12% type I endoleak, 93% secondary patency and 63% of the aortic lesions shrank significantly. Twenty-two patients had one renal arteriy sacrificed, 57% of these required permanent renal dialysis. The fourth study proved that CG technique increased the overall suitability for endovascular repair from 34% to 40-46%. Conclusions: Chimney graft seems effective and safe for treating midaortic occlusive diseases in patients unfit for open surgery. The early and mid to long-term results of the CG technique for urgent and complex lesions of the thoracic and abdominal aorta in high-risk patients are promising with a low early mortality, acceptable rate of type I endoleaks and long durability of the CGs, which may justify a broader applicability of this ...

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“…20 Excellent results with custom-made fenestrated devices have been reported. [21][22][23] The Japanese Najuta fenestrated thoracic stent graft (Kawasumi Laboratories, Tokyo, Japan) uses a combination of preformed stainless steel stents, externally attached PTFE, and curved delivery sheaths for total endovascular aortic arch reconstruction. In a study of the first-generation thoracic stent graft in more than 380 patients, technical success was achieved in 95.8% of patients, with a perioperative mortality rate of 1.6%, paraplegia rate of 0.8%, and CVA rate of 1.8%.…”

Section: Total Endovascular Arch Reconstructionmentioning

confidence: 99%

“…In a study of the first-generation thoracic stent graft in more than 380 patients, technical success was achieved in 95.8% of patients, with a perioperative mortality rate of 1.6%, paraplegia rate of 0.8%, and CVA rate of 1.8%. 22 In a more recent experience, the authors successfully deployed the fenestrated arch device in more than 99% of the 393 patients, with a perioperative mortality rate of 1.5%, stroke rate of 1.7%, and paraplegia rate below 1%. 24 These studies confirm the excellent early results with fenestrated grafts.…”

Section: Total Endovascular Arch Reconstructionmentioning

confidence: 99%

Minimally Invasive Techniques for Total Aortic Arch Reconstruction

Faulds

Sandhu

Estrera

et al. 2016

Methodist DeBakey Cardiovascular Journal

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The cumulative experience with endovascular aortic repair in the descending thoracic and infrarenal aorta has led to increased interest in endovascular aortic arch reconstruction. Open total arch replacement is a robust operation that can be performed with excellent results. However, it requires cardiopulmonary bypass and circulatory arrest and, therefore, may not be tolerated by all patients. Minimally invasive techniques have been considered as an alternative and include hybrid arch debranching, parallel stent graft deployment in the chimney and snorkel configurations, and complete endovascular branched reconstruction with multi-branched devices. This review discusses the evolving use of endovascular techniques in the management of aortic arch pathology and considers their relevance in an era of safe and durable open aortic arch reconstruction.

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Usefulness of fenestrated stent grafts for thoracic aortic aneurysms

Abstract: Treatment with fenestrated SGs does not require surgical transposition of the arch branches. The procedure is widely applicable and less invasive and outcomes are excellent.

Cited by 18 publications

References 21 publications

Reoperation for enlargement of the distal aorta after initial surgery for acute type A aortic dissection

Reoperation for enlargement of the distal aorta after initial surgery for acute type A aortic dissection

Impact of Renal Chimney Grafts on Anatomical Suitability for Endovascular Repair in Ruptured Abdominal Aortic Aneurysm

Minimally Invasive Techniques for Total Aortic Arch Reconstruction

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