Global experience with an inner branched arch endograft

Haulon, Stéphan; Greenberg, Roy K.; Spear, Rafaëlle; Eagleton, Matt; Abraham, Cherrie Z.; Lioupis, Christos; Verhoeven, Eric L.G.; Ivancev, Krassi; Kölbel, Tilo; Stanley, Brendan M.; Resch, Timothy; Desgranges, Pascal; Maurel, Blandine; Roeder, Blayne A.; Chuter, Timothy A.M.; Mastracci, Tara M.

doi:10.1016/j.jtcvs.2014.02.072

Cited by 267 publications

(234 citation statements)

References 26 publications

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“…Compared with extra-anatomical bypass and branched endografting, the incidence of neurological sequelae with the chimney technique is lower due to less manipulation of target vessels and the aortic arch. 6,9,10,28 In the current study, 32 (28.1%) of 114 LCCA chimneys were deployed via a percutaneous approach, and all the chimneys in the IA were inserted via a right brachial access. The only stroke was caused by migration and compression of the chimney grafts.…”

Section: Discussionmentioning

confidence: 95%

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: Discussionmentioning

confidence: 95%

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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“…In more complex endovascular procedures of aortic arch pathologies, stroke rates have been reported to be up to 16%. 7 The pathomechanism of stroke during TEVAR is not sufficiently recognized. Generally, it is thought to be embolization of thrombotic and atherosclerotic material from the vessel wall caused by wire manipulation and "violent" apposition of the stent-graft on the aortic wall during deployment or repositioning.…”

Section: Introductionmentioning

confidence: 99%

Carbon Dioxide Flushing Technique to Prevent Cerebral Arterial Air Embolism and Stroke During TEVAR

et al. 2016

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“…Placement of the device in the ascending aorta and arch violates the instructions for use 5 ; angulation of the device in the arch may have prevented full device expansion and adequate proximal fixation. Newer graft designs specifically for the ascending arch from Cook Corp and Bolton Corp may improve the graft limitations experienced in this case 6, 7…”

Section: Discussionmentioning

confidence: 99%

Challenges of “Reverse” Aortic Arch Debranching for Repair of the Ascending Aorta by Thoracic Endovascular Aortic Repair

Kansal

Hadziomerovic

Nagpal

2016

EJVES Short Reports

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IntroductionAscending aortic pathology presents a unique challenge for treatment by thoracic endovascular aortic repair (TEVAR), because of lack of adequate endograft landing zones. This report describes a unique “reverse” extra-anatomical aortic arch debranching procedure performed to enable TEVAR of the ascending aorta.ReportA 71-year-old male presented with a large ascending aortic pseudoaneurysm secondary to previous arch repair anastomosis. This pathology was treated by TEVAR of the ascending aorta. To create a sufficient landing zone for the endovascular stent graft, a “reverse” extra-anatomical aortic arch debranching procedure was performed. This involved a left subclavian artery to left carotid artery bypass, left to right carotid-to-carotid bypass, ligation of proximal left common carotid artery, and embolization of the innominate artery origin.DiscussionTEVAR of the ascending aorta can be made feasible through a novel debranching procedure that creates sufficient landing zones for the endograft. This surgical approach may prove useful in patients who present with aortic arch pathology and comorbidities that prevent open surgical repair.

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Global experience with an inner branched arch endograft

Abstract: Thoracic IDE NCT00583817, FDA IDE# 000101.

Cited by 267 publications

References 26 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

Carbon Dioxide Flushing Technique to Prevent Cerebral Arterial Air Embolism and Stroke During TEVAR

Challenges of “Reverse” Aortic Arch Debranching for Repair of the Ascending Aorta by Thoracic Endovascular Aortic Repair

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