Distal aortic remodelling after the standard and the elongated frozen elephant trunk procedure

Kozlov, B. N.; Panfilov, D. S.; Саушкин, В. В.; Nasrashvili, G. G.; Кузнецов, М. С.; Nenakhova, Aleksandra A; Шипулин, В. М.

doi:10.1093/icvts/ivz026

Cited by 25 publications

(16 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The authors suggested that the 100 mm endograft can sufficiently stabilize the dissection flap and that a large intimal tear is often located proximally near the left subclavian artery. Moreover, a recent study has shown that elongated grafts were associated with a 13% increase in freedom from negative remodeling ( 47 ). Nevertheless, the majority of evidence favors greater FET insertion lengths for improved remodeling.…”

Section: Fet Insertion Length Graft Size Aortic Remodeling and Dsine:...mentioning

confidence: 99%

Incidence of Distal Stent Graft Induced New Entry vs. Aortic Remodeling Associated With Frozen Elephant Trunk

Jubouri

Kayali

Saha

et al. 2022

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

BackgroundThe introduction of the frozen elephant trunk (FET) technique for total arch replacement (TAR) has revolutionized the field of aortivascular surgery by allowing hybrid repair of complex aortic pathologies in a single step through combining an open surgical approach with an endovascular one. FET has been associated with favorable aortic remodeling, however, its is also associated with development of distal stent graft induced new entry (dSINE) tears postoperatively. The rate of aortic remodeling and the incidence of dSINE have been linked together, in addition, there seems to be a relationship between these two variables and FET insetion length as well as graft size.AimsThe scope of this review is to highlight the rate of aortic remodeling as well the incidence of dSINE associated with different FET devices available commercially. This review also aimed to investigate the relationship between aortic remodeling, dSINE, FET insertion length and FET graft size.MethodsWe conducted a comprehensive literature search using multiple electronic databases including PubMed, Ovid, Scopus and Embase in order to collate all research evidence on the above mentioned variables.ResultsThoraflex™ Hybrid Plexus seems to yield optimum aortic remodeling by promoting maximum false thrombosis as well true lumen expansion. Thoraflex Hybrid™ is also associated with the lowest incidence of dSINE post-FET relative to the other FET devices on the market. Aortic remodeling and dSINE do influence each other and are both linked with FET graft length and size.ConclusionThe FET technique for TAR shows excellent aortic remodeling but is associated with a considerable risk of dSINE development. However, Thoraflex™ Hybrid has demonstrated itself to be the superior FET device on the aortic arch prostheses market. Since aortic remodeling, dSINE, FET insertion length and stent graft size are all interconnect, the choice of FET device length and size must be made with great care for optimum results.

show abstract

Section: Fet Insertion Length Graft Size Aortic Remodeling and Dsine:...mentioning

confidence: 99%

Incidence of Distal Stent Graft Induced New Entry vs. Aortic Remodeling Associated With Frozen Elephant Trunk

Jubouri

Kayali

Saha

et al. 2022

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

show abstract

“…Despite this being a matter of debate, Czerny et al 9 recently described how the FET stent resulted in distal stent-graft-induced new entry (dSINE) in 5.3% of patients in the acute setting and in 6.5% of patients in the chronic setting. Kozlov et al, 10 concluded in their comparative study of patients who underwent FET versus extended FET with additional TEVAR within 30 days of the index procedure, that more favorable remodeling was achieved downstream of the graft reaching as far as the abdominal aorta in the second group. Low-risk secondary procedures could prevent complications, such as the one described in this case report.…”

Section: Discussionmentioning

confidence: 99%

A Case Report: Is the Lack of Sufficient Radial Force Unfreezing the “Frozen Elephant Trunk”?

et al. 2021

View full text Add to dashboard Cite

The “frozen elephant trunk” is a hybrid technique to treat aortic arch and proximal descending aortic pathologies in a single step. Despite its encouraging early and long-term results, some stent-graft-related adverse events have been reported. Here, we describe a possible treatment option to “re-freeze” the FET in case of loss of landing zone. We report a patient who developed significant kinking of the FET over the course of the first 2 postoperative years. The 1-year follow-up computed tomography angiography (CTA) showed significant kinking and proximal migration of the endograft portion of the FET, resulting in new thrombus formation. Due to kinking and thrombus progression in subsequent CTA follow-ups (2 years and 2½ years) with risk for peripheral embolization, a secondary endovascular repair was indicated. Transfemoral relining of the stent component with a thoracic aortic endovascular repair (Zenith®TX2®30142) stent-graft was performed. In the context of postoperative aneurysm sac shrinkage, the low radial force and lack of longitudinal stiffness of the hybrid graft may lead to proximal migration, thus secondary kinking, emphasizing the importance of an adequate degree of oversizing of the primary graft and an appropriate follow-up. Selection of a suitable graft for a particular pathology concerning the radial force and longitudinal stiffness is furthermore important.

show abstract

“…The mechanisms behind the thrombosis of the false lumen in the case of aortic dissections are varied. The socalled "aortic remodelling" consequent to the endovascular exclusion of the false lumen has been seen as the most relevant factor triggering the occurrence and extension of postoperative thrombosis (22)(23)(24)(25). However, the extension of concomitant atherosclerotic lesions, the changes of local haemodynamics inside the aorta, as well as the activation of or blood coagulation and haemolysis can be seen as concurrent factors in activating the thrombotic reaction after the FET and endovascular treatment in general (26,27).…”

Section: Discussionmentioning

confidence: 99%

Post-implantation syndrome after frozen elephant trunk is associated with the volume of new-onset aortic thrombus

et al. 2021

View full text Add to dashboard Cite

Background: Post-implantation syndrome (PIS) is defined as non-infectious continuous fever and a concomitant rise in inflammatory markers shortly after endovascular aortic repair. PIS occurrence after hybrid procedures, such as the frozen elephant trunk (FET) technique, has not been adequately investigated. The current study aims to define the incidence of PIS after the FET and to identify possible risk factors associated with its occurrence. Methods: The clinical charts of 59 patients undergoing the FET between February 2015 and April 2020 were reviewed retrospectively. The occurrence of PIS was defined as the presence of fever (>38 ℃ lasting longer than one day during the hospitalisation) and leucocytosis (white blood cell count >12,000/µL).Patients with concomitant conditions possibly leading to fever and/or leucocytosis were excluded. Beside demographic and procedure-related data, serum/plasma inflammatory markers were evaluated before surgery and daily up to seven days postoperatively. Computed tomography scans (CT) were examined to calculate the volume of pre-existent and new-onset mural thrombus after the FET. Results: Thirty-eight patients met the inclusion criteria. The study cohort was divided into two groups based on the occurrence of PIS (17 cases; 44.7%). Patients with PIS were significantly younger than those without PIS (53.5±8.9 vs. 62.5±9.6 years; P=0.005). Female patients were less likely to develop PIS (5.2% vs. 26.3%, P=0.018). Patients with PIS had a higher volume of new-onset thrombus in the postoperative CT (P<0.001). Patients treated for post-dissection aneurysm had, postoperatively, significantly more thrombus material developed in a false lumen (P=0.02). Among the PIS markers, CRP (C-reactive protein) levels on the third postoperative day were independently associated with the volume of new-onset thrombus (P=0.011).After multivariate analysis, the volume of new-onset thrombus (P=0.028) and age (P=0.036) remained the variable associated with a statistically significant increased incidence of PIS.Conclusions: PIS can occur after the frozen elephant trunk procedure. The volume of new-onset thrombus seems to be associated with an increased incidence of PIS. These findings need to be confirmed in larger patient cohorts.

show abstract

Distal aortic remodelling after the standard and the elongated frozen elephant trunk procedure

Cited by 25 publications

References 12 publications

Incidence of Distal Stent Graft Induced New Entry vs. Aortic Remodeling Associated With Frozen Elephant Trunk

Incidence of Distal Stent Graft Induced New Entry vs. Aortic Remodeling Associated With Frozen Elephant Trunk

A Case Report: Is the Lack of Sufficient Radial Force Unfreezing the “Frozen Elephant Trunk”?

Post-implantation syndrome after frozen elephant trunk is associated with the volume of new-onset aortic thrombus

Contact Info

Product

Resources

About