Arch and visceral/renal debranching combined with endovascular repair for thoracic and thoracoabdominal aortic aneurysms

Ham, Sung W.; Chong, Terry J.; Moos, John; Rowe, Vincent L.; Cohen, Robbin G.; Cunningham, Mark J.; Wilcox, Alison; Weaver, Fred A.

doi:10.1016/j.jvs.2010.12.033

Cited by 36 publications

(24 citation statements)

References 43 publications

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“…[32][33][34] In studies in which patients are more likely to undergo a staged procedure, some authors have demonstrated that mortality and neurologic deficits approach those of TEVAR alone. 35 Conflicting data are found when TEVAR with aortic debranching is compared to open surgical repair. Some evidence suggests that the two populations have equivalent mortality and neurologic deficit rates, with the hybrid operation cohort having a significantly increased reintervention rate.…”

Section: Discussionmentioning

confidence: 99%

Impact of operative indication and surgical complexity on outcomes after thoracic endovascular aortic repair at National Surgical Quality Improvement Program Centers

Ehlert

Durham

Parker

et al. 2011

Journal of Vascular Surgery

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The operative indication for a TEVAR procedure was not found to be a predictor of poor patient outcome. Surgical complexity, specifically the need for brachiocephalic aortic debranching and aortoiliac conduit, was shown to influence the occurrence of SAEs in a multivariate model. Comparative data, such as these, illustrate real-world outcomes of patients undergoing TEVAR outside of the original FDA-approved indications. This information is of paramount importance to various stakeholders, including third-party payers, the device industry, regulatory agencies, surgeons, and their patients.

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Section: Discussionmentioning

confidence: 99%

Impact of operative indication and surgical complexity on outcomes after thoracic endovascular aortic repair at National Surgical Quality Improvement Program Centers

Ehlert

Durham

Parker

et al. 2011

Journal of Vascular Surgery

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“…Although open repair is an effective and durable option for patients with JAA, particularly in centers of excellence for patients at low physiologic risk, 7,8 fenestrated and branched EVAR (FBE) in other parts of the world have emerged as effective, potentially less invasive alternatives. [9][10][11] In the United States, however, lack of widespread availability of FBE has allowed other techniques to emerge, namely open debranching, [12][13][14] homemade fenestrations, 15 and the "snorkel" or "chimney" configuration.…”

mentioning

confidence: 99%

Early experience with the snorkel technique for juxtarenal aneurysms

Lee

Greenberg

Dalman

2012

Journal of Vascular Surgery

152

156

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Objective: The lack of readily available branched and fenestrated endovascular aneurysm repair (EVAR) options has created an opportunity for creative deployment of endograft components to treat juxtarenal aneurysms. We present our early experience with "snorkel" or "chimney" techniques in the endovascular management of complex aortic aneurysms. Methods: We retrospectively reviewed planned snorkel procedures for juxtarenal aneurysms performed from September 2009 to August 2011. Our standardized technique included axillary or brachial cutdown for delivery of covered snorkel stents and mostly percutaneous femoral access for the main body endograft. Results: Fifty-six snorkel grafts were successfully placed in 28 consecutive patients (mean age, 75 years) with juxtarenal aneurysms. Mean aneurysm size was 64.8 mm (range, 53-87 mm). The snorkel configuration extended the proximal seal zone from an unsuitable infrarenal neck for standard EVAR (median diameter, 33.5 mm; length, 0.0 mm) to a median neck diameter of 24.5 mm and length of 18.0 mm. Five patients had unilateral renal snorkels, 17 had bilateral renal snorkels, and six had celiac/superior mesenteric artery/renal combinations. Technical success of snorkel placements was 98.2%, with loss of wire access leading to one renal stent deployment failure. Thirty-day mortality was 7.1%: one patient was readmitted 1 week postoperatively with pneumonia and died of sepsis; one patient died at 1 week of a right hemispheric stroke. Other major complications included perinephric hematomas, 7.1%; permanent hemodialysis, 3.6%; iliac artery injury requiring endoconduit placement, 3.6%; and brachial plexus nerve injury, 3.6%. Cardiac complications included self-limited arrhythmias (14.3%) and one non-Q-wave myocardial infarction (3.6%), with all recovering without coronary intervention. Mean follow-up was 10.7 months (range, 3-25 months). One patient died of nonaneurysmalrelated causes at 3 months (89.3% survival). Postoperative imaging revealed one renal snorkel graft occlusion occurring at 3 months (98.2% overall primary patency). Seven (25%) early endoleaks were noted on the first follow-up computed tomography angiography: two type I, three type II, and two type III (25%), leading to one secondary intervention (3.6%) with bridging cuff placement (type III). The small type Ia endoleaks and other type III endoleak resolved at the 6-month scan. Mean sac regression at the latest follow-up was 7.3 mm. No aneurysm has enlarged on postoperative imaging. Conclusions: Early success with the snorkel technique for juxtarenal aneurysms has made it our procedure of choice for complex short-neck to no-neck EVAR. Although long-term follow-up is needed, the flexibility of the snorkel technique and lack of requirement for custom-built devices may make this approach more attractive than branched or fenestrated stent grafts. ( J Vasc Surg 2012;55:935-46.)

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“…Mortality rates are higher when 3 or more vessels are reconstructed 10 . However, visceral graft patency range from 85% to 97% in more than a year follow-up in large series [10][11][12] . This minimally invasive surgical approach offers a possible alternative treatment option for patients who are un t for the open repair or who have unfavourable anatomy for total endovascular repair 13 .…”

Section: Discussionmentioning

confidence: 99%

Visceral hybrid reconstruction of thoracoabdominal aortic aneurysm after open repair of type a aortic dissection by the Bentall procedure with the elephant trunk technique: A case report

et al. 2014

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Arch and visceral/renal debranching combined with endovascular repair for thoracic and thoracoabdominal aortic aneurysms

Cited by 36 publications

References 43 publications

Impact of operative indication and surgical complexity on outcomes after thoracic endovascular aortic repair at National Surgical Quality Improvement Program Centers

Impact of operative indication and surgical complexity on outcomes after thoracic endovascular aortic repair at National Surgical Quality Improvement Program Centers

Early experience with the snorkel technique for juxtarenal aneurysms

Visceral hybrid reconstruction of thoracoabdominal aortic aneurysm after open repair of type a aortic dissection by the Bentall procedure with the elephant trunk technique: A case report

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