Direct Videoscopic Approach to the Thoracic Aorta for Aortic Endograft Delivery: Evaluation in a Human Cadaver Circulation Model

Jongkind, Vincent; Yeung, Kak K.; Linsen, Matteus A. M.; Heidsieck, David S. P.; Coveliers, H.M.E.; Hoksbergen, Arjan W.J.; Wisselink, Willem

doi:10.1583/09-2877.1

Cited by 14 publications

(9 citation statements)

References 12 publications

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“…using coaxial sheaths, transapical access, transapical-femoro “body floss” wire. 21–25 Adopting these alternative strategies for proximal advancement of the endograft into the aortic arch is, however, associated with several concerns about the safety of these approaches. 26 Early or late complications, such as an apex or ascending aortic bleeding, coronary artery lesions and pseudoaneurysms can occur.…”

Section: Discussionmentioning

confidence: 99%

Single-center mid-term experience with chimney-graft technique for the preservation of flow to the supra-aortic branches

et al. 2017

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Objectives To investigate the feasibility and the mid-term outcomes of the chimney-graft technique for the revascularization of supra-aortic branches in patients with thoracic aortic pathologies involving the aortic arch. Methods A retrospective analysis of a prospectively maintained database between January 2010 and July 2016 was performed. Primary endpoints were 30-day and overall mortality. Secondary endpoints were technical success, target vessel patency, stroke/transitory ischemic attack and type I/III endoleak rate. Results A total of 30 patients (80% male, median age 70.0 years) were treated using the chimney-graft technique for the supra-aortic branches. The indication was a degenerative aneurysm in nine patients (32%) and a type B Stanford aortic dissection and a penetrating aortic ulcer in the descending aorta in seven patients (23%), respectively. In six patients (20.0%), the indication was an type Ia endoleak after previous endovascular thoracic repair, whereas a pseudoaneurysm after previous open repair of the descending aorta was the indication in one patient (3%). Twenty-three patients (77%) were treated electively, five (17%) emergently and two (7%) urgently because of free rupture. Technical success was achieved in 90% of patients. The 30-day/in-hospital mortality was 17% (5/30). A retrograde dissection was presented in five patients. Four patients experienced a cerebrovascular event. Eight patients had type Ia endoleak and 10 had type II. During the median follow-up of 16 months (range: 0-56), four further patients died: one in respiratory insufficiency, one due to a ruptured abdominal aortic aneurysm, one in meningitis and the last one for unknown reason. The chimney-graft patency was 100%. According to the Kaplan-Meier curve, the estimated survival at one year was 66 ± 9%. Conclusions The chimney-graft technique, despite a technically demanding strategy, is a useful tool as bailout procedure in our armamentarium for high-risk patients, unsuitable for open or hybrid repair.

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Section: Discussionmentioning

confidence: 99%

Single-center mid-term experience with chimney-graft technique for the preservation of flow to the supra-aortic branches

et al. 2017

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“…For the former, chimney grafts have shown promising midterm results in the preservation of supra-aortic branches during aortic arch TEVAR. 9 For introduction and deployment of the stent-graft, there are several maneuvers to overcome access issues raised by aortic tortuosity, 7,8,10 which is usually severe in large thoracic aneurysms. 6 Among the maneuvers attempted in our case, coaxial sheaths allowed cannulation of the aortic arch, but accurate insertion of the endograft was not feasible.…”

Section: Discussionmentioning

confidence: 99%

“…Several methods have been suggested to overcome access and stability issues when dealing with tortuous aortic anatomy, including the use of stiff “buddy wires” from the contralateral femoral artery, coaxial sheaths, and open or videoscopic assistance to straighten the tortuous thoracic aorta, as well as the through-and through guidewire manuever. 7,8…”

Section: Introductionmentioning

confidence: 99%

The Ascending Aorta as an Exit Site for a Through-and-Through Wire in TEVAR

et al. 2015

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“…Alternative access techniques have been described, including conduits to the iliac arteries and infrarenal aorta, as well as to the descending thoracic aorta. 2,3 MacDonald et al first described TEVAR through the apex of the left ventricle in a single report in 2009, using a Gore TAG (W L Gore and Associates, Flagstaff, AZ, USA) thoracic endoprosthesis in a patient with a ruptured pseudoaneurysm of the aortic arch and Szeto et al reported transapical TEVAR in a patient with a large pseudoaneurysm of the ascending aorta using a Zenith TX2 endograft (Cook Europe, Bjaeverskov, Denmark). 4,5 This new technique may be indicated in patients with life-threatening thoracic aortic pathologies, that can neither receive open nor endovascular repair from a downstream access site.…”

Section: Introductionmentioning

confidence: 99%

“…Alternative access techniques have been described, including conduits to the iliac arteries and infrarenal aorta, as well as to the descending thoracic aorta. 2,3…”

Section: Introductionmentioning

confidence: 99%

Transapical access for thoracic endograft delivery

Kölbel¹,

Treede

Carpenter³

et al. 2011

Vascular

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The purpose of this paper is to describe the technique of transapical deployment of a thoracic endograft and to discuss the specifics of this access. The technique of endograft deployment through a transapical access is demonstrated in a patient with a symptomatic 14-cm aortic arch aneurysm. The 73-year-old patient, with concomitant chronic obstructive airway disease and cardiovascular disease, had been denied open surgery. Femoral artery access was deemed contraindicated because of a more distal concomitant type III thoracoabdominal aneurysm, borderline renal failure and heavily calcified iliac arteries. Bilateral iliac-subclavian debranching and thoracic endografting via a combined transapical and left subclavian access successfully excluded the thoracic aortic aneurysm. The patient died within 24 hours postoperatively due to a massive myocardial infarction. In conclusion, transapical access for thoracic endograft delivery is feasible. Combined with complex debranching procedures in a challenging aneurysmal anatomy, it carries a high risk for periprocedural complications.

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Direct Videoscopic Approach to the Thoracic Aorta for Aortic Endograft Delivery: Evaluation in a Human Cadaver Circulation Model

Abstract: A direct videoscopic approach to the descending thoracic aorta proved a feasible technique for branched endograft delivery to the aortic arch and abdominal aorta in a human cadaver model.

Cited by 14 publications

References 12 publications

Single-center mid-term experience with chimney-graft technique for the preservation of flow to the supra-aortic branches

Single-center mid-term experience with chimney-graft technique for the preservation of flow to the supra-aortic branches

The Ascending Aorta as an Exit Site for a Through-and-Through Wire in TEVAR

Transapical access for thoracic endograft delivery

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