Debranching aortic surgery

Pérez, Manuel Alonso; Coto, José Manuel Llaneza; Castro-Madrazo, J.A. del; Prendes, Carlota Fernández; Al-Sibbai, Ahmad Amer Zanabili

doi:10.21037/jtd.2017.03.87

Cited by 20 publications

(13 citation statements)

References 74 publications

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“…The de-branching technique 7,8 increases the risk of retrograde dissection due to clamping of the ascending aorta and anastomosis suture. 9 The gap between two parallel stents in the chimney technique increases the risk of type I endoleak. 10,11 In one study on a case of TEVAR, the incidence of type I endoleak was 57.14% (4/7) when the triple-branch chimney technique with C-TAG and Viabahn was used to treat arch lesions.…”

Section: Discussionmentioning

confidence: 99%

“…6,17 Prior research has shown that the incidence of RTAD can be reduced if the proximal landing zone is extended to the straight segment of the ascending aorta. 9,14,18 Therefore, triple pre-fenestration with branch vessel stent-graft recannulation was utilized in the present study, and the proximal landing zone was extended to the straight ascending aorta.…”

Section: Discussionmentioning

confidence: 99%

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Pre-fenestration endovascular repair of aortic diseases in patients with zone 2 segment: A single-center experience

et al. 2020

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Objective The present study aims to analyze the outcomes of three cases of pre-fenestration and branch stent-graft endovascular repair of aortic disease with zone 2 aortic lesions. Methods From August 2017 to June 2018, three patients with zone 2 aortic lesions underwent thoracic endovascular repair with innominate artery, left common carotid artery, and left subclavian artery recannulation using pre-fenestration and branched stent-grafts to preserve the patency of the aortic arch branches. Results The technical success rate was 100%. One patient had a proximal type I endoleak with no need for additional treatment. The overall mortality was 0%. All branches were patent. The follow-up period lasted for 2–15 months, with one patient lost to follow-up. There were no conversions to open surgical repair, aortic rupture, paraplegia, or retrograde type A aortic dissection. Conclusion The use of a pre-fenestration and branch stent-graft for the thoracic endovascular repair of zone 2 aortic lesions is a feasible and effective method for aortic arch branch revascularization. The risk of this surgical procedure is high, requiring significant expertise. The procedure should be conducted only in experienced centers. Durability concerns should be assessed in future studies with long-term follow-up.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pre-fenestration endovascular repair of aortic diseases in patients with zone 2 segment: A single-center experience

et al. 2020

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“…Conventional open surgery of the aortic arch and thoracoabdominal aneurysms is the gold standard therapy, however, it still carries serious mortality and morbidity risks [ 1 ] . Consequences of this surgery include mortality as well as visceral organ dysfunction, paraplegia, and complications of cardiopulmonary bypass [ 2 ] .…”

Section: Introductionmentioning

confidence: 99%

“…Consequences of this surgery include mortality as well as visceral organ dysfunction, paraplegia, and complications of cardiopulmonary bypass [ 2 ] . Complication rates range between 5-19%, including spinal cord ischemia (2.7-13.2%) and renal failure (4.6-5.6%) [ 1 ] .…”

Section: Introductionmentioning

confidence: 99%

Follow-up Results of Endovascular Aneurysm Repair Following Abdominal Visceral Debranching

Öztaş¹,

ÖZTAŞ²,

Sayın³

et al. 2022

Braz J Cardiovasc Surg

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Introduction The aim of this study is to present a series of six cases with thoracoabdominal aneurysm treated with hybrid technique in our center. Methods Between May 2015 and December 2018, the data of six patients with thoracoabdominal aneurysms and various comorbidities who underwent visceral debranching followed by endovascular aortic aneurysm repair were reviewed retrospectively. Results Patients’ mean age was 65.3±19.6 years. All of them were male. Comorbidities were old age, congestive heart failure, coronary artery disease, chronic obstructive pulmonary disease, previous surgical interventions, and/or esophageal hemangioma. Except for one patient who underwent coronary artery bypass grafting (inflow was taken from ascending aorta), debranching was performed from the right iliac artery. Debranching of four visceral arteries (superior mesenteric artery, celiac trunk, and bilateral renal right arteries) was performed in three patients, of three visceral arteries (superior mesenteric artery, celiac trunk, right renal artery) was performed in one, and of two visceral arteries (superior mesenteric artery, celiac trunk) was performed in two patients. Great saphenous vein and 6-mm polytetrafluoroethylene grafts were used in one and five patients, respectively, for debranching. Endovascular aneurysm repair was performed following debranching procedures as soon as the patients were stabilized. In total, three patients died at the early, mid, and long-term follow-up due to multiorgan failure, pneumonia, and unknown reasons. Conclusion Hybrid repair of thoracoabdominal aneurysms may be an alternative to fenestrated or branched endovascular stent grafts in patients with increased risk factors for open surgical thoracoabdominal aneurysm repair; however, the procedure requires experience and care.

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“…Upon release of the cross-clamp, the blood flow is restored, triggering an ischemia/reperfusion (I/R) injury, leading to tissue inflammation, humoral changes, and lactate acidosis that increases the risk of multi-organ failure (MOF) and therefore affects postoperative outcome [ 1 ]. The most vulnerable organs are the kidney (renal failure, incidence 4.6–5.6%) and the spinal cord (ischemia, incidence 2.7–13.2%) [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

Intravenous hydrogen sulfide does not induce neuroprotection after aortic balloon occlusion-induced spinal cord ischemia/reperfusion injury in a human-like porcine model of ubiquitous arteriosclerosis

Bredthauer

Lehle

Scheuerle

et al. 2018

ICMx

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ObjectiveIn rodents, intravenous sulfide protected against spinal cord ischemia/reperfusion (I/R) injury during aortic balloon occlusion. We investigated the effect of intravenous sulfide on aortic occlusion-induced porcine spinal cord I/R injury.MethodsAnesthetized and mechanically ventilated “familial hypercholesterolemia Bretoncelles Meishan” (FBM) pigs with high-fat-diet-induced hypercholesterolemia and atherosclerosis were randomized to receive either intravenous sodium sulfide 2 h (initial bolus, 0.2 mg kg body weight (bw)−1; infusion, 2 mg kg bw−1 h−1; n = 4) or vehicle (sodium chloride, n = 4) prior to 45 min of thoracic aortic balloon occlusion and for 8 h during reperfusion (infusion, 1 mg kg bw−1 h−1). During reperfusion, noradrenaline was titrated to maintain blood pressure at above 80% of the baseline level. Spinal cord function was assessed by motor evoked potentials (MEPs) and lower limb reflexes using a modified Tarlov score. Spinal cord tissue damage was evaluated in tissue collected at the end of experiment using hematoxylin and eosin and Nissl staining.ResultsA balloon occlusion time of 45 min resulted in marked ischemic neuron damage (mean of 16% damaged motoneurons in the anterior horn of all thoracic motor neurons) in the spinal cord. In the vehicle group, only one animal recovered partial neuronal function with regain of MEPs and link motions at each time point after deflating. All other animals completely lost neuronal functions. The intravenous application of sodium sulfide did not prevent neuronal cell injury and did not confer to functional recovery.ConclusionIn a porcine model of I/R injury of the spinal cord, treatment with intravenous sodium sulfide had no protective effect in animals with a pre-existing arteriosclerosis.

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Debranching aortic surgery

Cited by 20 publications

References 74 publications

Pre-fenestration endovascular repair of aortic diseases in patients with zone 2 segment: A single-center experience

Pre-fenestration endovascular repair of aortic diseases in patients with zone 2 segment: A single-center experience

Follow-up Results of Endovascular Aneurysm Repair Following Abdominal Visceral Debranching

Intravenous hydrogen sulfide does not induce neuroprotection after aortic balloon occlusion-induced spinal cord ischemia/reperfusion injury in a human-like porcine model of ubiquitous arteriosclerosis

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