Late Endograft Migration After Thoracic Endovascular Aortic Repair: A Systematic Review and Meta-analysis

Skrypnik, Denis; Калмыков, Е.Л.; Bischoff, Moritz S.; Meisenbacher, Katrin; Klotz, Rosa; Hagedorn, Matthias; Kalkum, Eva; Probst, Pascal; Dammrau, Rolf; Böckler, Dittmar

doi:10.1177/15266028221109455

Cited by 3 publications

(1 citation statement)

References 35 publications

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“…Forces acting on proximally deployed endograft are complex and could have various effect, more often a distal migration of the endograft. 4 However, it seems necessary to us a better comprehension of possible interactions between endograft and native aortic arch. 5 More advanced total endovascular strategies are spreading quickly but long-term data are still lacking on this specific argument.…”

Section: Discussionmentioning

confidence: 99%

When even luck matters: a compendium of all possible complications during hybrid repair of a dissecting TAAA occurred in a single patient

Pascucci,

Mastrangelo,

Palazzo

2023

HJVES

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Purpose. A 73-year-old woman, already submitted to repair of the ascending aorta and subsequently to aortic valve substitution in redo sternotomy, presented to our attention with a dissecting TAAA with a distal aortic arch diameter of 6 cm. Our goal was to offer this extremely fragile patient the least invasive surgical treatment as possible. Technique. We treated this patient in two stages. In the first stage we performed a carotid-carotid-subclavian bypass. In the second stage we performed a TEVAR in zone 1, extending from the brachiocephalic artery to the celiac trunk. Left subclavian artery was previously occluded with a plug. CSFD was not adopted by default. Conclusion. This patient reported some extremely rare and unexpected complications that brought us to report this case. Hybrid techniques represent an extremely appealing opportunity to treat fragile patients affected by complex aortic diseases with relatively little invasive strategies, however, serious complications can occur.

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Section: Discussionmentioning

confidence: 99%

When even luck matters: a compendium of all possible complications during hybrid repair of a dissecting TAAA occurred in a single patient

Pascucci,

Mastrangelo,

Palazzo

2023

HJVES

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Anatomical Feasibility of the “Canaud Technique” for Physician-Modified Thoracic Endovascular Grafts for the Treatment of Aortic Arch Disease

Santoro,

Favia,

Valente

et al. 2024

J Endovasc Ther

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Purpose: Thoracic endovascular aortic repair (TEVAR), originally conceived for deployment distal to the left subclavian artery (LSA), has been recently extended to more proximal landing zones. Among total endovascular solutions, the “Canaud technique” for Physician-Modified Thoracic Endovascular Grafts (C-PMEGs) has gained acceptance with good early results. The aim of this study is to report the proportion of patients with zone 0, 1, and 2 aortic arch lesions that could theoretically be treated with a C-PMEG. Materials and Methods: Computed tomography angiography (CTA) of all consecutive patient candidates to open, hybrid, or endovascular arch repair from January 2009 to July 2023 at our Institution were analyzed. The assessment of feasibility of C-PEMG was conducted following previously extensively described anatomical criteria. Results: During the study period, 209 consecutive patients were candidates for an open, hybrid, or endovascular aortic arch repair. Of them, 164 patients had a preoperative CTA scan eligible for analysis. One hundred twenty-six patients were male (76.8 %), with a mean age of 67 ± 10.8 years. Ninety-four patients (57.3%) were affected by atherosclerotic aneurysms, 48 post-dissecting aneurysms (29.3%) and 22 penetrating aortic ulcers (PAUs) (13.4%). Twenty patients (12.2%) were suitable for double-fenestrated C-PMEG, and 34 patients (20.7%) for single-fenestrated C-PMEG, totaling 32.9% of the entire cohort. The combination of supra-aortic trunks (SAT) bypass or the use of covered stent in IA or left common carotid artery (LCCA) as adjunctive maneuvers, would extend the C-PMEGs feasibility to 69 patients (42.1%). The use of an iliac graft conduit in 3 (1.8%) patients with inadequate ileo-femoral accesses would increase the C-PMEG suitability to 72 patients (43.9%). The main reason for exclusion was excessive ascending aortic diameter in 78 patients (47.6%). Conclusions: The use of C-PMEG was shown to be theoretically feasible in a percentage of patients ranging from 32.9 to 43.9% affected by aortic arch aneurysms, dissections, and PAU. The main reason for exclusion was the dimension of the ascending aorta. The C-PMEG technique is a viable option in aortic arch lesions endovascular treatment. An off-the-shelf device with similar characteristics could also be used in emergency, avoiding the limitations of physician modifications (such as time for back-table procedure, sterility, off-label use). Clinical Impact Thoracic endovascular aortic repair (TEVAR) has been extended to more proximal landing zones for the treatment of aortic arch aneurysm, dissections, penetrating aortic ulcers. Among total endovascular solutions, the “Canaud technique” for Physician-Modified Thoracic Endovascular Grafts (C-PMEGs) has gained acceptance with good early results. The anatomical feasibility in 164 consecutive patients was 69 patients (42.1%), with the combination of supra-aortic trunks (SAT) bypass or the use of covered stent in IA or left common carotid artery (LCCA) as adjunctive maneuvers, showing that the C-PMEG technique is a viable option in aortic arch lesions endovascular treatment.

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Dynamic Morphology of the Ascending Aorta and Its Implications for Proximal Landing in Thoracic Endovascular Aortic Repair

Skrypnik

Ante

Meisenbacher

et al. 2022

JCM

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In this study, we assessed the dynamic segmental anatomy of the entire ascending aorta (AA), enabling the determination of a favorable proximal landing zone and appropriate aortic sizing for the most proximal thoracic endovascular aortic repair (TEVAR). Methods: Patients with a non-operated AA (diameter < 40 mm) underwent electrocardiogram-gated computed tomography angiography (ECG-CTA) of the entire AA in the systolic and diastolic phases. For each plane of each segment, the maximum and minimum diameters in the systole and diastole phases were recorded. The Wilcoxon signed-rank test was used to compare aortic size values. Results: A total of 100 patients were enrolled (53% male; median age 82.1 years; age range 76.8–85.1). Analysis of the dynamic plane dimensions of the AA during the cardiac cycle showed significantly higher systolic values than diastolic values (p < 0.001). Analysis of the proximal AA segment showed greater distal plane values than proximal plane values (p < 0.001), showing a reversed funnel form. At the mid-ascending segment, the dynamic values did not notably differ between the distal plane and the proximal segmental plane, demonstrating a cylindrical form. At the distal segment of the AA, the proximal plane values were larger than the distal segmental plane values (p < 0.001), thus generating a funnel form. Conclusions: The entire AA showed greater systolic than diastolic aortic dimensions throughout the cardiac cycle. The mid-ascending and distal-ascending segments showed favorable forms for TEVAR using a regular cylindrical endograft design. The most proximal segment of the AA showed a pronounced conical form; therefore, a specific endograft design should be considered.

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Late Endograft Migration After Thoracic Endovascular Aortic Repair: A Systematic Review and Meta-analysis

Cited by 3 publications

References 35 publications

When even luck matters: a compendium of all possible complications during hybrid repair of a dissecting TAAA occurred in a single patient

When even luck matters: a compendium of all possible complications during hybrid repair of a dissecting TAAA occurred in a single patient

Anatomical Feasibility of the “Canaud Technique” for Physician-Modified Thoracic Endovascular Grafts for the Treatment of Aortic Arch Disease

Dynamic Morphology of the Ascending Aorta and Its Implications for Proximal Landing in Thoracic Endovascular Aortic Repair

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