Cerebrospinal dysfunction after endovascular stent-grafting via a median sternotomy:the frozen elephant trunk procedure

Usui, Akihiko; Fujimoto, Kazuro; Ishiguchi, Tsuneo; Yoshikawa, Masahide; Akita, Toshiaki; Ueda, Yuichi

doi:10.1016/s0003-4975(02)04131-0

Cited by 84 publications

(62 citation statements)

References 5 publications

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“…Even though this result is in line with those of endovascular stent grafting of descending aortic aneurysms it is still intriguing in view of the significant paraplegia rates reported with open surgical approaches similar to ours [11][12][13][14]. One aspect that could have reduced the risk of spinal cord injury in our series was keeping exclusion criteria with regard to the extent of descending aortic aneurysm to be treated together with a stent graft fabrication, that was adjusted specifically to the patients' individual pathology.…”

Section: Discussionsupporting

confidence: 79%

The frozen elephant trunk technique for the treatment of extensive thoracic aortic aneurysms: operative results and follow-up☆

Kretzler

Chavan

Khaladj

et al. 2005

European Journal of Cardio-Thoracic Surgery

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Objective: The 'frozen' elephant trunk technique allows for single-stage repair of combined aortic arch and descending aortic aneurysms using a 'hybridprosthesis' with a stented and a non-stented end. This report summarizes the operative-and follow-up data (mean follow-up 14 months) with this new treatment. Methods: Between 09/01 and 4/04, 22 patients (62G9 years; 9 female) with different aortic pathologies (15 aortic dissections, 7 aneurysms) were operated on after approval from the local institutional review board. The stented end of the hybridprosthesis was deployed in the descending aorta through the opened aortic arch during hypothermic circulatory arrest and selective antegrade cerebral perfusion. Results: All patients survived the procedure but one patient died of acute hemorrhage due to rupture of the false lumen in the descending aorta on the second postoperative day. Two patients required reexploration of the chest for bleeding complications. In 2 of 4 patients who developed neurological dysfunction, symptoms resolved completely. In one of them, the descending aorta was perforated intraoperatively due to misplacement of the stented end of the hybridprosthesis. In all follow-up CT-scans thrombus formation in the descending aortic aneurysm excluded by the stented end of the hybridprosthesis has been observed. Conclusions: This procedure is performed through median sternotomy and combines the concepts of the elephant trunk operation and endovascular stenting of descending aortic aneurysms. Favourable intraoperative and postoperative results during follow-up with regard to thrombus formation around the stented descending aortic segment encourage us to evaluate all patients with thoracic aneurysms extending to proximal and distal of the left subclavian artery for this treatment.Q 2005 Published by Elsevier B.V.

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Section: Discussionsupporting

confidence: 79%

The frozen elephant trunk technique for the treatment of extensive thoracic aortic aneurysms: operative results and follow-up☆

Kretzler

Chavan

Khaladj

et al. 2005

European Journal of Cardio-Thoracic Surgery

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“…4,19 Overall, the elephant trunk graft dimensions were consistent with other published series, 1,9 whereas the length of the distal repair was based on the distal extent of aortic disease. Both Usui et al 20 and Mizuno et al 21 reported paraplegia (2 cases) and stroke (1 case) after similar types of repairs. The lack of paraplegia or stroke in the present series provides us with some optimism, yet the 3 cases of paraparesis caused us concern, particularly in the setting of extensive aortic coverage (none occurred in patients without mesenteric bypass or prior aortic repair).…”

Section: Discussionmentioning

confidence: 85%

Hybrid Approaches to Thoracic Aortic Aneurysms

et al. 2005

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Background-Thoracic aortic aneurysm affecting the arch and proximal descending thoracic aorta requires 2-stage repairs that include proximal elephant trunk graft placement and completion of thoracic or thoracoabdominal repair. The application of endovascular grafting to complete the proximal procedure avoids a thoracotomy and may improve the morbidity and mortality of the patient population at risk. Methods and Results-A retrospective review of 399 thoracic endovascular grafts at our institution between 2000 and 2004 identified 22 patients who required elephant trunk and endovascular completion. Three patients underwent mesenteric bypass in addition to their proximal repairs. Mean follow-up was 10 months (range 1 to 42 months); there were no ruptures, and all patients returned for follow-up. Technical success was achieved in all patients. The 1-, 12-, and 24-month mortality rates (by Kaplan-Meier analysis) were 4.5%, 15.8%, and 15.8%, respectively. Caudal migration of the endograft occurred in 1 patient, and all but 2 aneurysms decreased or remained stable in size. The 2 patients with growth included a type III endoleak (which resolved after treatment) and pressurization through an expanded PTFE stentgraft. Three cases of transient paraparesis occurred (all in patients requiring mesenteric bypass or abdominal aortic aneurysm repair), and there were no paraplegias or strokes. Conclusions-Endovascular completion of elephant trunks is feasible and can be accomplished with minimal mortality.Meticulous imaging follow-up is required to detect persistent aneurysm pressurization and to verify the integrity of the repair. Improvements in implant design and delivery systems will further simplify the second-stage portion of these complex aneurysm repairs.

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“…This operation is reported to be associated with an unexpectedly high incidence of ischemic spinal cord injury. 7 The fate of the excluded aneurysm is a major concern. In our patient, aneurysm enlargement necessitated the second operation, although back-pressure from the only Fig.…”

Section: Discussionmentioning

confidence: 99%

Proximal Aortic Replacement with Ascending–Descending Bypass for a Diffuse Aneurysm: Report of a Case

et al. 2006

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We performed successful ascending-arch aortic replacement and concomitant ascending-to-descending aorta bypass with exclusion of a descending thoracic aneurysm, via median sternotomy, for a ruptured aortic aneurysm involving the entire thoracic aorta. The patient was an 80-year-old man with cardiopulmonary dysfunction and a history of lung tuberculosis. This operation, which has been used for complex descending thoracic aortic lesions such as recoarctation, is a feasible option for a diffuse thoracic aortic aneurysm when single-stage repair is mandatory.

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Cerebrospinal dysfunction after endovascular stent-grafting via a median sternotomy:the frozen elephant trunk procedure

Cited by 84 publications

References 5 publications

The frozen elephant trunk technique for the treatment of extensive thoracic aortic aneurysms: operative results and follow-up☆

The frozen elephant trunk technique for the treatment of extensive thoracic aortic aneurysms: operative results and follow-up☆

Hybrid Approaches to Thoracic Aortic Aneurysms

Proximal Aortic Replacement with Ascending–Descending Bypass for a Diffuse Aneurysm: Report of a Case

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