Early Intraluminal Frozen Elephant Trunk Stent Graft Thrombosis After Aortic Arch Surgery

Misfeld, Martín; Marín-Cuartas, Mateo; Ramírez, Paulina Pérez; Wehrmann, Katharina; Renatus, Katharina; Deo, Salil V.; Gohman, Robin; Haunschild, Josephina; Leontyev, Sergey; Borger, Michael A.; Etz, Christian D.

doi:10.1016/j.athoracsur.2022.12.030

Cited by 10 publications

(18 citation statements)

References 12 publications

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“…Furthermore, the Freiburg group around Misfeld et al . observed a higher volumetric size of the descending aorta in patients who developed ILT ( 23 ). Both, Martens et al .…”

Section: Risk Factorsmentioning

confidence: 93%

“…As usual in the analysis of aortic pathologies, all measurements should be made in multiplanar reconstruction and strictly perpendicular to the aortic axis ( 21 ). Although not explicitly stated in practice guidelines, many centers perform standard pre-discharge CT-angiography especially with a focus on early ILT formation ( 21 – 23 ). If CT-angiography is inconclusive, Martens et al .…”

Section: Definition and Diagnostics Of Iltmentioning

confidence: 99%

“…In the currently available studies focusing specifically on ILT formation, reported incidence of postoperative ILT after the frozen elephant trunk procedure ranges from 6% to 16.8% of cases ( 21 , 23 ) ( Table 1 ). Contrary to that, this phenomenon has not been reported in the initial pioneering experience reports of the frozen elephant trunk technique ( 26 , 27 ).…”

Section: Incidence and Characteristics Of Postoperative Iltmentioning

confidence: 99%

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Risk factors, prevention, and therapy of intraluminal stent thrombosis in frozen elephant trunk prostheses—what we know so far

Helms,

Schmack,

Weymann

et al. 2024

Front. Cardiovasc. Med.

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Intraluminal thrombus formation (ILT) is a recently discovered and highly clinically relevant complication after frozen elephant trunk implantation in cardiovascular surgery. In this phenomenon, a thrombus forms within the lumen of the stent graft component of the frozen elephant trunk prosthesis and puts the patient at risk for downstream embolization with visceral or lower limb ischemia. Incidence of ILT reported in the currently available studies ranges from 6% to 17% of patients after frozen elephant trunk implantation. Adverse thromboembolic events include acute occlusion of the celiac and superior mesenteric arteries, both renal arteries as well as acute lower limb ischemia due to iliac or femoral artery embolization that not infrequently require interventional or open embolectomy. Therefore, the presence of ILT is associated with increased short-term mortality and morbidity. Currently proposed strategies to avoid ILT formation include a more aggressive anticoagulation management, minimization of postoperative coagulation factor application, and even technical optimizations of the stent graft portion itself. If ILT is manifested, the therapeutic strategies tested to date are long-term escalation of anticoagulation and early endovascular extension of the FET stent graft with overstenting of the intraluminal thrombus. The long-term efficiency of these prophylactic and therapeutic measures has yet to be proven. Nonetheless, all surgeons performing the frozen elephant trunk procedure must be aware of the risk of ILT formation to facilitate a timely diagnosis and therapy.

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“…Furthermore, the Freiburg group around Misfeld et al . observed a higher volumetric size of the descending aorta in patients who developed ILT ( 23 ). Both, Martens et al .…”

Section: Risk Factorsmentioning

confidence: 93%

Section: Definition and Diagnostics Of Iltmentioning

confidence: 99%

Section: Incidence and Characteristics Of Postoperative Iltmentioning

confidence: 99%

See 1 more Smart Citation

Risk factors, prevention, and therapy of intraluminal stent thrombosis in frozen elephant trunk prostheses—what we know so far

Helms,

Schmack,

Weymann

et al. 2024

Front. Cardiovasc. Med.

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“…These concerns can be mitigated somewhat by early transthoracic endovascular aortic repair (TEVAR) completion, slight FET oversizing, and early reintervention for major bleeding. 31 Prior to the approval of industry-made hybrid devices in the United States, the innovative Buffalo Trunk technique allows for immediate single-stage FET repair at the time of circulatory arrest without compromising patient outcomes compared to hybrid devices. 32…”

Section: Cardiac Valve and Thoracic Aortic Endograft Advancementsmentioning

confidence: 99%

“…completion, slight FET oversizing, and early reintervention for major bleeding. 31 Prior to the approval of industrymade hybrid devices in the United States, the innovative Buffalo Trunk technique allows for immediate single-stage FET repair at the time of circulatory arrest without compromising patient outcomes compared to hybrid devices. 32 In cases of aortic arch pathologies, traditional TEVAR requires covering the aortic arch branch vessels with subsequent anatomic bypass.…”

Section: Thoracic Aortic Endograftsmentioning

confidence: 99%

Cardiac Surgeons Highlight the Need for Innovation Stewardship: Noteworthy in 2022

Netsanet

Cotton

Suarez‐Pierre

et al. 2023

Semin Cardiothorac Vasc Anesth

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Modern cardiac surgery has rapidly evolved to treat complex cardiovascular disease. This past year boasted noteworthy advances in xenotransplantation, prosthetic cardiac valves, and endovascular thoracic aortic repair. Newer devices often offer incremental design changes while demanding significant cost increases that leave surgeons to decide if the benefit to patients justifies the increased cost. As innovations are introduced, surgeons must continuously aim to harmonize short- and long-term benefits with financial costs). We must also ensure quality patient outcomes while embracing innovations that will advance equitable cardiovascular care.

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Shaggy Aorta: How Much Thrombus Is Too Much?

Watkins¹

2023

The Annals of Thoracic Surgery

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Early Intraluminal Frozen Elephant Trunk Stent Graft Thrombosis After Aortic Arch Surgery

Cited by 10 publications

References 12 publications

Risk factors, prevention, and therapy of intraluminal stent thrombosis in frozen elephant trunk prostheses—what we know so far

Risk factors, prevention, and therapy of intraluminal stent thrombosis in frozen elephant trunk prostheses—what we know so far

Cardiac Surgeons Highlight the Need for Innovation Stewardship: Noteworthy in 2022

Shaggy Aorta: How Much Thrombus Is Too Much?

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