Cardiovascular Remodeling after Endovascular Treatment for Thoracic Aortic Injury

Vallerio, Paola; Maloberti, Alessandro; D’Alessio, Ilenia; Lista, Alfredo; Varrenti, Marisa; Castelnuovo, S.; Marone, M.; Piccinelli, Enrico; Palmieri, Bruno; Giannattasio, Cristina

doi:10.1016/j.avsg.2019.04.015

“…Therefore, zone 2 TEVAR is a good option for most patients with PAU. However, despite the good early outcomes for TAI, there are concerns regarding the long-term aorta-related outcome [11]. Secondary aortic interventions rates were high (22%) in a previous study of the e cacy of zone 2 TEVAR for TAI [12].…”

Section: Discussionmentioning

confidence: 97%

Zone 2 Hybrid Thoracic Endovascular Aortic Repair: Is It a Good Option for All Types of Thoracic Aortic Disease?

Sohn¹,

Lee²,

Jung³

et al. 2021

Preprint

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Background Zone 2 thoracic endovascular aortic repair (TEVAR) is performed for the treatment of various thoracic aortic diseases involving the left subclavian artery. This study aimed to analyze the late clinical outcomes of zone 2 hybrid TEVAR according to the various indications. Methods A total of 48 patients who underwent zone 2 TEVAR at our institution between December, 2010 and July, 2020 were enrolled. The indications were aortic aneurysm (AA, n = 15), acute type B aortic dissection (AD, n = 14), penetrating aortic ulcer (PAU, n = 8), traumatic aortic injury (TAI, n = 8), and others (n = 3). The clinical outcomes including early complications and mid-term aortic measurements were retrospectively reviewed. Results The technical success rate was 100% and in-hospital mortality occurred in one patient. The early postoperative complications included stroke (n = 1), transient spinal cord ischemia (n = 1), neck wound hematoma (n = 1), and left phrenic or vagus nerve injury (n = 9). In patients with AD, positive remodeling was observed in ten patients (76.9%) (false lumen regression in the entire or thoracic aorta [n = 9], false lumen thrombosis in the thoracic aorta [n = 1]). However, in patients with AA, increased aneurysm was found in six patients (40%). Persistent aneurysmal growth was found in patients with a maximal aortic diameter of > 60 mm on initial imaging (4/6, 50%). No aortic expansion was observed in those with TAI or PAU. Endoleak was noted in five patients (10.4%), and among them, aortic reintervention was required only in patients with large AAs. Conclusions Zone 2 hybrid TEVAR was associated with an acceptable early complication rate and provided acceptable mid-term aortic results for patients with AD, PAU, and TAI. However, patients with large AAs were at increased risk of aortic reintervention. In cases of large AA, clinicians should carefully consider whether zone 2 hybrid TEVAR or open surgical repair will be more effective for the patient.

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“…Therefore, zone 2 TEVAR is a good option for most patients with PAU. However, despite the good early outcomes for TAI, there are concerns regarding the long-term aorta-related outcome [ 11 ]. Secondary aortic interventions rates were high (22%) in a previous study of the efficacy of zone 2 TEVAR for TAI [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Zone 2 hybrid thoracic endovascular aortic repair: Is it a good option for all types of thoracic aortic disease?

Sohn

¹

,

Lee

²

,

Jung

³

et al. 2022

J Cardiothorac Surg

View full text Add to dashboard Cite

Background Zone 2 thoracic endovascular aortic repair (TEVAR) is performed for the treatment of various thoracic aortic diseases involving the left subclavian artery. This study aimed to analyze the late clinical outcomes of zone 2 hybrid TEVAR according to the various indications. Methods A total of 48 patients who underwent zone 2 TEVAR at our institution between December, 2010 and July, 2020 were enrolled. The indications were aortic aneurysm (AA, n = 15), acute type B aortic dissection (AD, n = 14), penetrating aortic ulcer (PAU, n = 8), traumatic aortic injury (TAI, n = 8), and others (n = 3). The clinical outcomes including early complications and mid-term aortic measurements were retrospectively reviewed. Results The technical success rate was 100% and in-hospital mortality occurred in one patient. The early postoperative complications included stroke (n = 1), transient spinal cord ischemia (n = 1), neck wound hematoma (n = 1), and left phrenic or vagus nerve injury (n = 9). In patients with AD, positive remodeling was observed in ten patients (76.9%) (false lumen regression in the entire or thoracic aorta [n = 9], false lumen thrombosis in the thoracic aorta [n = 1]). However, in patients with AA, increased aneurysm was found in six patients (40%). Persistent aneurysmal growth was found in patients with a maximal aortic diameter of > 60 mm on initial imaging (4/6, 50%). No aortic expansion was observed in those with TAI or PAU. Endoleak was noted in five patients (10.4%), and among them, aortic reintervention was required only in patients with large AAs. Conclusions Zone 2 hybrid TEVAR was associated with an acceptable early complication rate and provided acceptable mid-term aortic results for patients with AD, PAU, and TAI. However, patients with large AAs were at increased risk of aortic reintervention. In cases of large AA, clinicians should carefully consider whether zone 2 hybrid TEVAR or open surgical repair will be more effective for the patient.

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“…The same study showed changes in diametric strain from 5.0 % to 6.3 % for the ascending aorta from pre- to post-TEVAR, which are also well within the range of our findings. The increased deformation in the ascending aorta post-TEVAR may be related to the clinical findings of increased rate of ascending aortic enlargement and left ventricular remodeling observed during post-TEVAR follow-up [ 24 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

Multiaxial pulsatile dynamics of the thoracic aorta and impact of thoracic endovascular repair

Suh

¹

,

Bondesson

²

,

Zhu

³

et al. 2021

European Journal of Radiology Open

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Cardiovascular Remodeling after Endovascular Treatment for Thoracic Aortic Injury

Cited by 17 publications

References 34 publications

Zone 2 Hybrid Thoracic Endovascular Aortic Repair: Is It a Good Option for All Types of Thoracic Aortic Disease?

Zone 2 Hybrid Thoracic Endovascular Aortic Repair: Is It a Good Option for All Types of Thoracic Aortic Disease?

Zone 2 hybrid thoracic endovascular aortic repair: Is it a good option for all types of thoracic aortic disease?

Multiaxial pulsatile dynamics of the thoracic aorta and impact of thoracic endovascular repair

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