Feasibility of the Inoue single-branched stent-graft implantation for thoracic aortic aneurysm or dissection involving the left subclavian artery: Short- to medium-term results in 17 patients

Saito, Naritatsu; Kimura, Takeshi; Odashiro, Keita; Toma, Masanao; Nobuyoshi, Masakiyo; Ueno, Katsuya; Kita, Toru; Inoue, Kanji

doi:10.1016/j.jvs.2004.11.030

Cited by 72 publications

(45 citation statements)

References 17 publications

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“…Some studies have reported favorable results using fenestrated/branched techniques in aortic arch pathologies. [3][4][5][6][7] However, this approach is limited by the morphological diversity of the aortic arch, necessitating patient-specific and tailor-made devices. Moreover, the procedures are complex and time-consuming, often inapplicable in emergency situations, and place a considerable financial burden on the patient, limiting their clinical usefulness.…”

Section: Introductionmentioning

confidence: 99%

Thoracic Endovascular Aortic Repair With Single/Double Chimney Technique for Aortic Arch Pathologies

Wang

Shu

et al. 2017

J Endovasc Ther

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Purpose: To summarize a single-center experience using the single/double chimney technique in association with thoracic endovascular aortic repairs (TEVAR) for aortic arch pathologies. Methods: From November 2007 to March 2016, 122 patients (mean age 50.4±12.7 years, range 29-80; 92 men) with aortic arch pathologies underwent TEVAR combined with single (n=101) or double (n=21) chimney grafts to reconstruct the supra-aortic branches: 21 innominate arteries, 114 left common carotid arteries, and 8 left subclavian arteries (LSA). Pathologies included type B aortic dissection (n=47), aortic arch dissection (n=49), retrograde type A aortic dissection (n=8), thoracic aortic aneurysm (n=7), penetrating aortic arch ulcer (n=9), and post-TEVAR type I endoleak (n=2). Follow-up examinations included computed tomography at 0.5, 3, 6, and 12 months and yearly thereafter. Results: The aortic stent-grafts were deployed in zone 0 (n=21), zone 1 (n=93), and zone 2 (n=8). One (0.8%) of the 122 patients died at 4 days due to a perforated peptic ulcer. Type Ia endoleaks were found intraoperatively in 13 (10.7%) patients, including 3 with the double chimney technique. Type II endoleaks occurred in 6 (4.9%) patients; 3 were treated with duct occluders in the LSA. Postoperative chimney graft migration occurred in 1 (0.8%) patient with double chimneys; additional stent-grafts were deployed in both chimneys. Median follow-up was 32.3 months, during which 1 (0.8%) patient died after a stroke at 3 months. Chimney stent-graft patency was observed in the remaining 120 patients. Two (1.7%) secondary TEVARs were performed for distal aortic dissection. Nine asymptomatic type Ia endoleaks and 1 type II endoleak persisted in follow-up; a type II endoleak in 1 patient with Marfan syndrome sealed in 52 months. Conclusion: TEVAR with the chimney technique provides a safe, minimally invasive alternative with good chimney graft patency and low postoperative mortality during midterm follow-up. The double chimney technique should be used judiciously owing to its potential complications.

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Section: Introductionmentioning

confidence: 99%

Thoracic Endovascular Aortic Repair With Single/Double Chimney Technique for Aortic Arch Pathologies

Wang

Shu

et al. 2017

J Endovasc Ther

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“…Saito et al recently reported improved results without any stroke complication using a single-branched stent graft for distal aortic arch aneurysm. 16 If limited to an indication for stent-grafting only from zone 2, a branched-stent graft seems to be an acceptable procedure. However, as we report, more than one-third of cases of distal aortic arch disease need a more proximal landing from zone 1 at least.…”

Section: Discussionmentioning

confidence: 99%

Management of Left Subclavian Artery in Endovascular Stent-Grafting for Distal Aortic Arch Disease

Kurimoto

Ito

Harada

et al. 2008

Circ J

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linically, intentional occlusion of the left subclavian artery (LSA) has been done to exclude a distal aortic arch aneurysm during endovascular stentgrafting. [1][2][3][4][5] However, the LSA is crucial for patients with critically stenosed carotid or vertebral arteries or a functionally compromised circle of Willis, and also for those who have undergone coronary artery bypass grafting using the left internal thoracic artery (LITA). We have attempted to save the LSA by using hand-made fenestrated stent grafts, which facilitate stent-graft placement in the aortic arch without necessitating bypass-grafting to the LSA; however, because of the complex configurations of aortic disease, the LSA cannot always be saved by this technique. In our institution, a LSA occlusion test is used and when the results indicate no adverse effects from loss of the LSA, intentional LSA occlusion can be an option. We report our strategy for dealing with the LSA during endovascular stent-grafting for distal aortic arch diseases. hand-made stents. From among these, 40 cases (28.6%) in which the stent grafts were placed proximal to the LSA (zone 0-2) 6 became the subject of this study (Table 1). The patients, aged 17-92 years (mean 71.6), consisted of 36 males and 4 females. Emergency stent-grafting was performed in 9 cases (22.5%). MethodsSurgery was performed in an operating room with mobile digital subtracted angiography (DSA) available. Patients were placed on a radiolucent operating table under general intubated anesthesia. The stent graft is custom-made 7 and reconstructed by suturing graft material (Ube Corp, Ube, Japan) to an endoskeleton of Gianturco Z stents (Cook Inc, Bloomington, IN, USA). Z-stents are attached to each other using stainless steel wires with solder, leaving spaces of 8- For all 31 elective cases, the LSA occlusion test using a balloon catheter was preoperatively performed to predict critical complications secondary to LSA coverage by a stent graft and this revealed 2 cases in which the LSA was crucial for brain circulation (6.5%). The LSA was saved by using a hand-made fenestrated stent graft without bypass-grafting to the LSA in 22 cases. Bypass-grafting to LSA was performed in 5 cases. The LSA was simply occluded in 13 cases. Hospital mortality rates for the elective and emergency cases were 3.2% and 30.0%, respectively. One elective patient had a cerebral infarction (2.5%). LSA patency was successfully maintained in all 22 cases using a fenestrated stent graft. Conclusion The LSA plays an important role in brain circulation in some patients and so a preoperative LSA occlusion test is helpful when aortic stent-grafting is proposed. Fenestrated stent graft saved the LSA in more than 50% of the present cases. (Circ J 2008; 72: 449 -453)

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“…Reports on handmade SGs are limited, and the results in these cases are unknown. [15][16][17][18][19][20][21][22][23] In Japan, EVR devices have not been approved as medical devices thus far. Therefore some medical institutions produce their own handmade SGs, and compared with other countries, only a small number of patients undergo this procedure in Japan.…”

Section: Discussionmentioning

confidence: 99%

“…Hence, both the materials used to prepare the SGs and the procedure followed for EVR vary, and the clinical results are influenced by the institutional indications and techniques. 1,[16][17][18][19][20] Our department has been producing and using SGs that comprise stainless steel Z stents and are covered with an ultrathin-wall woven polyester fabric. The initial and midterm results for repair using these handmade SGs for thoracic and abdominal aortic diseases in high-risk patients are considered to be satisfactory.…”

Section: Discussionmentioning

confidence: 99%

“…Alteration of the SGs yielded good results in the later surgeries. Saito et al 20 reported the feasibility of EVR for thoracic aortic diseases using an Inoue single-branched SG. They used a specialized computer system for designing custom-made SGs for individual patients, and similar systems will be required to modify the commercially available SGs.…”

Section: Discussionmentioning

confidence: 99%

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Initial and Midterm Results for Repair of Aortic Diseases With Handmade Stent Grafts

Onitsuka

Tanaka

Akashi

et al. 2006

Circ J

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Feasibility of the Inoue single-branched stent-graft implantation for thoracic aortic aneurysm or dissection involving the left subclavian artery: Short- to medium-term results in 17 patients

Abstract: The results demonstrate the feasibility of the Inoue single-branched stent graft for thoracic aortic aneurysms or dissections involving the left subclavian artery.

Cited by 72 publications

References 17 publications

Thoracic Endovascular Aortic Repair With Single/Double Chimney Technique for Aortic Arch Pathologies

Thoracic Endovascular Aortic Repair With Single/Double Chimney Technique for Aortic Arch Pathologies

Management of Left Subclavian Artery in Endovascular Stent-Grafting for Distal Aortic Arch Disease

Initial and Midterm Results for Repair of Aortic Diseases With Handmade Stent Grafts

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