Branched versus fenestrated endografts for endovascular repair of aortic arch lesions

Tsilimparis, Nikolaos; Debus, Eike Sebastian; Kodolitsch, Yskert Von; Wipper, Sabine; Rohlffs, Fiona; Detter, Christian; Roeder, Blayne A.; Kölbel, Tilo

doi:10.1016/j.jvs.2016.03.410

Cited by 140 publications

(114 citation statements)

References 20 publications

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“…Compared with extra-anatomical bypass and branched endografting, the incidence of neurological sequelae with the chimney technique is lower due to less manipulation of target vessels and the aortic arch. 6,9,10,28 In the current study, 32 (28.1%) of 114 LCCA chimneys were deployed via a percutaneous approach, and all the chimneys in the IA were inserted via a right brachial access. The only stroke was caused by migration and compression of the chimney grafts.…”

Section: Discussionmentioning

confidence: 94%

“…Some studies have reported favorable results using fenestrated/branched techniques in aortic arch pathologies. [3][4][5][6][7] However, this approach is limited by the morphological diversity of the aortic arch, necessitating patient-specific and tailor-made devices. Moreover, the procedures are complex and time-consuming, often inapplicable in emergency situations, and place a considerable financial burden on the patient, limiting their clinical usefulness.…”

Section: Introductionmentioning

confidence: 99%

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Thoracic Endovascular Aortic Repair With Single/Double Chimney Technique for Aortic Arch Pathologies

Wang

Shu

et al. 2017

J Endovasc Ther

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Purpose: To summarize a single-center experience using the single/double chimney technique in association with thoracic endovascular aortic repairs (TEVAR) for aortic arch pathologies. Methods: From November 2007 to March 2016, 122 patients (mean age 50.4±12.7 years, range 29-80; 92 men) with aortic arch pathologies underwent TEVAR combined with single (n=101) or double (n=21) chimney grafts to reconstruct the supra-aortic branches: 21 innominate arteries, 114 left common carotid arteries, and 8 left subclavian arteries (LSA). Pathologies included type B aortic dissection (n=47), aortic arch dissection (n=49), retrograde type A aortic dissection (n=8), thoracic aortic aneurysm (n=7), penetrating aortic arch ulcer (n=9), and post-TEVAR type I endoleak (n=2). Follow-up examinations included computed tomography at 0.5, 3, 6, and 12 months and yearly thereafter. Results: The aortic stent-grafts were deployed in zone 0 (n=21), zone 1 (n=93), and zone 2 (n=8). One (0.8%) of the 122 patients died at 4 days due to a perforated peptic ulcer. Type Ia endoleaks were found intraoperatively in 13 (10.7%) patients, including 3 with the double chimney technique. Type II endoleaks occurred in 6 (4.9%) patients; 3 were treated with duct occluders in the LSA. Postoperative chimney graft migration occurred in 1 (0.8%) patient with double chimneys; additional stent-grafts were deployed in both chimneys. Median follow-up was 32.3 months, during which 1 (0.8%) patient died after a stroke at 3 months. Chimney stent-graft patency was observed in the remaining 120 patients. Two (1.7%) secondary TEVARs were performed for distal aortic dissection. Nine asymptomatic type Ia endoleaks and 1 type II endoleak persisted in follow-up; a type II endoleak in 1 patient with Marfan syndrome sealed in 52 months. Conclusion: TEVAR with the chimney technique provides a safe, minimally invasive alternative with good chimney graft patency and low postoperative mortality during midterm follow-up. The double chimney technique should be used judiciously owing to its potential complications.

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Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Thoracic Endovascular Aortic Repair With Single/Double Chimney Technique for Aortic Arch Pathologies

Wang

Shu

et al. 2017

J Endovasc Ther

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“…It is therefore difficult to judge how easily these outcomes can be translated to other centres. Other series presented in the literature 5,6,10,20 also reflect the experience of highly experienced centres.…”

Section: Discussionmentioning

confidence: 92%

“…The data presented are comparable with those from Tsilimparis and colleagues 6 in Hamburg, who performed branched thoracic endovascular aortic repair in 14 patients with an operative mortality rate of 0 per cent, stroke 7 per cent (1 patient) and no cases of spinal cord ischaemia or renal failure. These results were favourable when compared with the use of fenestrated devices in the aortic arch in 15 patients, which was associated with an operative mortality rate of 20 per cent (3 patients) and stroke rate of 14 per cent (2 patients) 6 .…”

Section: Discussionmentioning

confidence: 97%

Case series of aortic arch disease treated with branched stent-grafts

Clough

Spear

Calster

et al. 2018

British Journal of Surgery

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“…Finally these fenestrated stent-graft are ‘off the shelf’ so they can be used for emergency procedures. They avoid the potential risks of guttering with Chimney stent-grafts and the financial costs of T branch devices, which require much more stock [15]. …”

Section: Discussionmentioning

confidence: 99%

Two Wire System and Modified Olive Tip to Facilitate Implantation of Fenestrated TEVAR in Patient with Proximal Descending Aortic Pathology: First Two Cases

Adiarto

Kang

Sunu

et al. 2019

Cardiovasc Intervent Radiol

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IntroductionAlthough Fenestrated TEVAR (F-TEVAR) has been considered to be a more physiologic approach to treat proximal descending aortic pathology, its application is still limited due to availability, cost and technical difficulties. We introduce a new design of fenestrated stent graft with a new delivery system and successfully performed first in human implantation in two patients, one with an aortic aneurysm and one with an acute aortic dissection.Materials and MethodsThe design of these two wires fenestrated stent graft include creation of an additional lumen at the side of the olive tip during manufacture, from which an additional wire can be introduced for a side branch passing into the fenestration, running inside the stent graft and exit the delivery sheath through additional hub. The two wires will facilitate delivery and deployment of the stent graft. One patient with descending aortic aneurysm and another with Stanford B aortic dissection is included in this first in human study.ResultsThe aneurysm and dissection were completely excluded immediately after the TEVAR. Six month follow up CT showed good position of the stent graft and patent LSA in both patients. In the patient with aortic dissection, expansion of the true lumen and partial thrombosis of the false lumen was seen.ConclusionsThis is a report of a two wire system in 2 patients with distal aortic arch pathology demonstrating a good technical and clinical success using pre-cannulated fenestrations through a modified nose cone olive.Level of EvidenceLevel 4, report of two cases.

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Branched versus fenestrated endografts for endovascular repair of aortic arch lesions

Abstract: Both fTEVAR and bTEVAR are feasible for the treatment of aortic arch diseases in high-risk patients. Results are promising, although fTEVAR was associated with higher mortality in this early experience. bTEVAR was more commonly used in Ishimaru zone 0.

Cited by 140 publications

References 20 publications

Thoracic Endovascular Aortic Repair With Single/Double Chimney Technique for Aortic Arch Pathologies

Thoracic Endovascular Aortic Repair With Single/Double Chimney Technique for Aortic Arch Pathologies

Case series of aortic arch disease treated with branched stent-grafts

Two Wire System and Modified Olive Tip to Facilitate Implantation of Fenestrated TEVAR in Patient with Proximal Descending Aortic Pathology: First Two Cases

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