Fenestrated Thoracic Endovascular Aortic Repair Using Physician Modified Stent Grafts for Acute Type B Aortic Dissection with Unfavourable Landing Zone

Zhu, Jiechang; Zhao, Lujing; Dai, Xiangchen; Luo, Yudong; Fan, Hailun; zhang, Feng; Zhang, Yiwei; Hu, Fanguo

doi:10.1016/j.ejvs.2017.11.012

Cited by 43 publications

(29 citation statements)

References 18 publications

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“…However, regarding of the obvious limitations of the soft delivery sheath in supporting, it could be manifested that the Relay thoracic stent graft is normally considered unsuitable for implementation in certain settings. [21] Furthermore, in consideration of needle technique, it is important to highlight the fact that the Ankura graft, thanks to its thinner fabric intima than Medtronic graft, turned to be more feasible for in situ fenestration. Also, it is by now generally accepted that the Ankura thoracic stent graft was widely chosen in China when facing with economic issues.…”

Section: Discussionmentioning

confidence: 99%

Thoracic endovascular aortic repair in penetrating aortic ulcer combined with isolated left vertebral artery

Fan

Li²,

Zheng³

et al. 2019

Medicine

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Rationale:Penetrating aorta ulcer (PAU) with isolated left vertebral artery (ILVA) is a rare condition, accounting for no more than 1% of all kinds of aorta diseases. And traditional treatment was open surgery with total arch replacement by elephant trunk. Here, we report a case of PAU combined with ILVA managed by thoracic endovascular aortic repair (TEVAR) technique.Patient concerns:A 65-year-old male with chronic hypertension and Nicotine abuse underwent intermittent back pain for 2 years and aggravated a bit for 1 week.Diagnoses:Preoperative computed tomography angiogram (CTA) indicated PAU combined with ILVA.Interventions:TEVAR was performed for PAU following with retrograde in situ fenestration and chimney technique for revascularization of ILVA and left subclavian artery (LSA), respectively.Outcomes:The operation was successfully and the patient was discharged from hospital after 1 week of treatment. Postoperatively, the images of CTA illustrated the patency of aorta, ILVA, and LSA without obvious endoleak. Besides, no ischemia attack or other relative syndromes were detected at 6-months follow-up.Lessons:This case demonstrates that TEVAR is an alternative to elephant trunk especially for PAU with ILVA. And it also showed the precise exposure of ILVA and necessity to reconstruct ILVA during TEVAR operation in order to reduce the occurrence of ischemia attack.

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Section: Discussionmentioning

confidence: 99%

Thoracic endovascular aortic repair in penetrating aortic ulcer combined with isolated left vertebral artery

Fan

Li²,

Zheng³

et al. 2019

Medicine

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“…10 There have been reports on the use of aortic-coated stent for extracorporeal pre-fenestration. 11 The extracorporeal pre-fenestration technique allows timely treatment of more patients with high-risk complex abdominal aortic aneurysms that are near rupture. Pre-fenestration extends the anchoring zone to completely close the rupture of dissection while ensuring the patency of the branch arteries.…”

Section: Discussionmentioning

confidence: 99%

Hybrid versus in vitro fenestration for preserving the left subclavian artery in patients undergoing thoracic endovascular aortic repair with unfavorable proximal landing zone

et al. 2019

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Purpose To compare hybrid and in vitro fenestration procedures for preserving the left subclavian artery in thoracic endovascular aortic repair (TEVAR) with unfavorable proximal landing zone. Methods Retrospective comparison of data from 49 consecutive patients who underwent left subclavian artery revascularization during TEVAR by either hybrid or fenestration approaches from January 2015 to March 2018. Procedural duration, and 30-day rates of procedural success, mortality and complications (endoleaks, cerebral infarction, spinal cord ischemia, left arm ischemic symptoms, and delirium) were compared. Results For hybrid procedure ( n = 32) vs. fenestration ( n = 17) groups, which were age and gender matched: procedural success rate was 100%, with significantly longer procedural duration (248.4 ± 40.9 vs. 60.6 ± 16.8 min; t = –22.653, P = 0.000) and similar 30-day complication rate (18.8% vs. 11.8%; χ2 = 0.397, P = 0.529). At 12.7 ± 9.3 months’ follow-up, there were no cases of death, spinal cord ischemia, or other complications in either group. Conclusions In this retrospective, single-center comparison, both hybrid and in vitro fenestration approaches for reconstructing the left subclavian artery in TEVAR with unfavorable proximal landing zone appeared safe and effective, with shorter procedural duration for fenestration. Larger studies with longer term follow-up are warranted.

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“… 5 Fenestrated stent graft technology is accurate and it is a viable alternative for patients without healthy proximal landing zones. 6 However, it requires preoperative measurements to ensure precise matching between branchial and aortic covered stent grafts and it is technically much more challenging than parallel stent grafting. According to a review, 7 parallel stent graft technology appears to be suitable for patients at high risk for open repair or contained rupture aneurysms, while fenestrated stent graft technology is more appropriate for more than two aortic branches with a lower risk of rupture.…”

Section: Discussionmentioning

confidence: 99%

Treatment for thoracoabdominal aortic aneurysm by fenestrated endovascular aortic repair with physician-modified stent graft

et al. 2018

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Despite being widely used for several years, the endovascular aortic repair (EVAR) of a thoracoabdominal aneurysm (TAAA) remains challenging, particularly the revascularization of the abdominal aortic visceral branches. A 66-year-old male was admitted to hospital with abdominal bloating and pain. Computed tomographic angiography (CTA) confirmed a Crawford type III TAAA from the distal descending aorta to the suprarenal abdominal aorta that involved the celiac axis, accompanied with an occlusion of the left subclavian artery. Fenestrated-EVAR was performed successfully and 1 week later CTA showed a type III endoleak, which had resolved 3 months later, without stent migration or visceral artery occlusion. In this present case, the surgeons preferred to perform the procedure in three surgical stages, postponing the deployment of a covered stent in the CA fenestration to provide additional time for the development of collateral circulation to the spinal cord as a possible means of preventing postoperative paraplegia.

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Fenestrated Thoracic Endovascular Aortic Repair Using Physician Modified Stent Grafts for Acute Type B Aortic Dissection with Unfavourable Landing Zone

Abstract: fTEVAR using PMSGs may be a viable alternative for patients who present with ABAD without healthy proximal landing zones and who are unable to wait for a custom made fenestrated device.

Cited by 43 publications

References 18 publications

Thoracic endovascular aortic repair in penetrating aortic ulcer combined with isolated left vertebral artery

Thoracic endovascular aortic repair in penetrating aortic ulcer combined with isolated left vertebral artery

Hybrid versus in vitro fenestration for preserving the left subclavian artery in patients undergoing thoracic endovascular aortic repair with unfavorable proximal landing zone

Treatment for thoracoabdominal aortic aneurysm by fenestrated endovascular aortic repair with physician-modified stent graft

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