Hybrid thoracic endovascular aortic repair: Pushing the envelope

Younes, Houssam K.; Davies, Mark G.; Bismuth, Jean; Naoum, Joseph J.; Peden, Eric K.; Reardon, Michael J.; Lumsden, Alan B.

doi:10.1016/j.jvs.2009.09.043

Cited by 52 publications

(42 citation statements)

References 33 publications

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“…However, as more experience was gained with this procedure, many authorities considered EVT as the procedure of choice for the management of aortic aneurysms in patients with suitable anatomy. 171,238,[271][272][273] EVT has a number of advantages over open surgical repair, including lower perioperative morbidity and mortality. EVT may be used for emergency management of rupture, may result in a shorter hospitalization, and may have outcome measures similar to those of traditional open procedures.…”

Section: Additional Factors In Management Of Aortic Mamentioning

confidence: 99%

Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

Wilson¹,

Bower²,

Creager³

et al. 2016

Circulation

373

307

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The use of synthetic material for reconstructive vascular surgery was first reported during the early 1950s. Infection involving vascular graft prostheses is an infrequent but devastating complication of reconstructive vascular graft surgery and is associated with a high morbidity and, in some situations, mortality. Improvements in surgical techniques and graft design, including the use of native venous or arterial tissue, have reduced the frequency of infection and severity of complications from vascular graft infection (VGI). However, these advances have also led to more frequent vascular graft procedures occurring in a patient population with multiple underlying comorbidities that would have previously disqualified them as candidates for vascular reconstructive surgery. Underlying comorbidities, such as diabetes mellitus or immune compromise, increase the risk of infection and serious infection-related complications. The major complications of VGI include sepsis, amputation, disruption of infected anastomotic suture line with rupture or pseudoaneurysm formation, embolization of infected thrombi, reinfection of reconstructed vascular grafts, enteric fistulae to the small or large bowel, bacteremic spread of infection to other sites, and death. VGIs can be categorized broadly into those that occur in an extracavitary location, primarily in the groin or lower extremities, or in an intracavitary location, primarily within the abdomen or less commonly within the thorax. frequencyThe frequency of VGI depends on the anatomic location of the graft. The infection rate is 1.5% to 2% for most extracavitary grafts and as high as 6% with vascular grafts in the groin. [1][2][3][4][5][6][7][8][9] For intracavitary grafts, the infection rate is ≈1% to 5%. 1-6 Graft infection is most common after emergency procedures and after reoperation. [1][2][3][4]10 Aortic graft erosion or fistulous communication into the duodenum or other areas of the bowel reportedly occurs in 1% to 2% of patients after aortic reconstruction. 11,12 MicrobiologyThe microbiological cause of VGI has evolved over the years. 1 In early published studies, Staphylococcus aureus was the predominant microorganism recovered. 1,13 Improvements in surgical technique, administration of prophylactic antistaphylococcal antimicrobial therapy, and other factors have resulted in a changing microbiological epidemiology. Vascular graft surgery performed on patients with multiple underlying comorbidities and the increased frequency of emergency procedures have contributed to the changing spectrum of infection. Other factors such as changes in hospital flora, surgery in patients with complicated vascular anatomy, and multiple revisions of previous vascular surgery have resulted in a more diverse microbio- clInIcal stateMents anD GuIDelInes logical spectrum of infection, which includes multidrugresistant strains, polymicrobial infection, and Candida species. Gram-positive cocci accounts for at least two thirds of VGIs. 1,13 Infections caused by coagulase-negative staphylococ...

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Section: Additional Factors In Management Of Aortic Mamentioning

confidence: 99%

Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

Wilson¹,

Bower²,

Creager³

et al. 2016

Circulation

373

307

View full text Add to dashboard Cite

show abstract

“…Thus, a proximal landing zone at least 2 cm long at the aortic arch level must take into account the presence of supra-aortic vessels and of anatomic and hemodynamic properties peculiar to the aortic arch, such as its curvature, the high blood-flow velocity usually present in this area, and the substantial movement of this portion of the aorta with each heartbeat in comparison to other aortic segments [68]. To create a suitable landing zone for endovascular repair, authors rerouted blood flow to the supra-aortic vessels prior to stent-graft deployment, by introducing different 'debranching' techniques, such as surgical extra-anatomic bypasses or transpositions [69][70][71][72][73][74][75][76][77][78][79][80][81][82][83][84] and branched or fenestrated stent grafts [85][86][87][88][89][90][91][92][93]. Stent-graft completion can then be performed immediately or deferred to arch debranching.…”

Section: Aortic Arch Debranching and Endovascular Exclusionmentioning

confidence: 99%

“…Although, in the majority of series, the cardiopulmonary bypass is thus avoided altogether, there are a few authors, who report brief periods of cardiopulmonary bypass to extend hybrid aortic arch repair to as many high-risk patients as possible, such as those with a compromised cardiac function, who would not tolerate the side clamping of the ascending aorta, those who should undergo concomitant cardiac procedures, and those who present a relatively short ascending aorta and where side clamping of the ascending aorta would involve also the sinotubular junction [75]. Other surgical approaches have been proposed by rerouting blood to the supra-aortic vessels from the femoral arteries or the descending aorta [82], but have been rarely employed. Recently, a new sutureless telescoping anastomosis technique has been introduced, called VORTEC (Viabahn Open Rebranching TEChnique, W.L.…”

Section: Aortic Arch Debranching and Endovascular Exclusionmentioning

confidence: 99%

Elephant trunk procedure 27 years after Borst: what remains and what is new?

Ius¹,

Hagl²,

Haverich³

et al. 2011

European Journal of Cardio-Thoracic Surgery

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The treatment of complex aortic pathology involving both the ascending and descending aortic segments at the same time represents a surgical challenge, with high postoperative morbidity and mortality rates reported. Over the past 27 years, different open surgical and endovascular techniques have been introduced and applied in various two-stage- or one-stage approaches to such cases. Thus, in 1983, Hans Borst significantly changed the traditional two-stage approach by introducing his elephant trunk technique. Leaving a segment of Dacron prosthesis reaching into the descending aorta during the first stage, the second-stage replacement of the residual dilated descending aorta was made far easier. The presence of interval mortality between the two stages, the unaffected need for two large operations to complete aortic repair, and the general failure of some patients to return for the second-stage repair set the scene for the development of one-stage procedures, both open surgical or hybrid surgical and endovascular, such as the frozen elephant trunk. However, the size of the operation, on the one hand, and the risk of spinal cord injury and need for surgical or endovascular completion during follow-up, on the other, have dampened enthusiasm. Recently, the introduction of supra-aortic debranching and endovascular aortic arch stent-graft repair has yet extended treatment to high-risk patients unsuitable to the more aggressive surgery, but mid- and long-term follow-up results are lacking. The lack of randomization and the presence of procedural and complication-related limitations for each technique do not allow for definitive conclusions about the ideal procedure to treat complex aortic pathology. However, the technical revolution experienced over the past 27 years, along with the improvement in perioperative management, has produced outstanding morbidity and mortality results even in this challenging patient population, but the decision regarding which pathology correlates with what operation remains highly debated and dependent also on regional competence.

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“…Although controversial, the artery of Adamkiewicz, normally located between T8 and L2, should be preserved if possible [100]. If essential branches of the aorta are to be covered by stent grafts, revascularization by either a bypass surgery, open debranching, or endovascular debranching with a chimney technique or a fenestrated stent graft is necessary [101][102][103][104][105]. Adjunctive procedures, such as open debridement and percutaneous drainage, could be performed, based on the clinical judgment [74].…”

Section: Endovascular Techniquementioning

confidence: 99%

Infected Aortic Aneurysms

Lin¹,

Kan²

2017

Aortic Aneurysm

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Infected aortic aneurysms are surgical urgencies, requiring prompt management to avoid the development of catastrophic complications. Although traditional open surgery composed of radical debridement and aortic reconstruction remains the gold-standard, many favorable results of the endovascular repair strategy have been reported. In this chapter, the etiology, bacteriology, clinical manifestation, and diagnostic criteria of infected aortic aneurysms will be discussed in detail at first, followed by a comprehensive review of both traditional open surgery and endovascular repair, based on current evidences and the authors' institutional experience. Along with long-term oral antibiotic suppression and aggressive adjunctive procedures, endovascular repair for uncomplicated infected aortic aneurysms could be a definite treatment alternative to traditional open surgery in the endovascular era.

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Hybrid thoracic endovascular aortic repair: Pushing the envelope

Cited by 52 publications

References 33 publications

Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

Elephant trunk procedure 27 years after Borst: what remains and what is new?

Infected Aortic Aneurysms

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