Long-Term Outcomes after Thoracic Endovascular Aortic Repair Using Chimney Grafts for Aortic Arch Pathologies: 10 Years of Single-Center Experience

Ahmad, Wael; Liakopoulos, Oliver J.; Mylonas, Spyridon N.; Wegner, Moritz; Brunkwall, Jan; Dorweiler, Bernhard

doi:10.1016/j.avsg.2020.08.129

Cited by 9 publications

(26 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The average incidence ranged from 7.4% (2 out of 27), as reported by Voskresensky [ 8 ] et al, to 40% (22 out of 55), as reported by Kanaoka et al [ 6 ]. Other incidences described were 14.8% (8 patients out of 54 reported by Ahmad et al [ 3 ]), Bosiers et al [ 4 ] 10.5% (10 out of 95), Huang et al [ 5 ] 16.3% (37 out of 226), Mangialardi et al [ 7 ] 23% (6 out of 26), Wang et al [ 9 , 10 ] 13 (3 out of 23) and 10.6% (13 out of 122), Zhao et al [ 11 ] 32% (75 out of 234), and Zou [ 12 ] et al 14.2% (5 out of 35). Most of them were described as intraoperative endoleaks.…”

Section: Resultsmentioning

confidence: 92%

“…Out of the 48 studies selected: 10 [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 ] described outcomes in chimney procedures, 13 [ 1 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ] with the use of fenestrated devices, 9 [ 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ] focused on in situ fenestration outcomes, 14 [ 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 ] on branched devices, one study compared fenestrated and branched devices [ 48 ], and one compared in situ fenestration and the chimney technique [ 49 ].…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Type 1A Endoleak after TEVAR in the Aortic Arch: A Review of the Literature

Scurto

Peluso

Pascucci

et al. 2022

JPM

View full text Add to dashboard Cite

Aortic arch repair is a challenging intervention. Open surgical repair is still considered the gold standard, but in high-risk patients, it is not always a reasonable option, making endovascular approaches an enticing, when not the only available, alternative for treatment. The strategies more commonly adopted are surgical supra-aortic trunk (SAT) rerouting followed by deployment of a standard thoracic endoprosthesis, chimney techniques, custom-made scalloped, fenestrated, and branched devices, and in situ or physician-modified fenestrations. If we excluded techniques involving SAT rerouting where the arch anatomy is surgically modified in order to make deployment in the aortic arch of a standard thoracic endoprosthesis possible, in the other techniques, one or more SATs are incorporated in the thoracic endoprosthesis. In these cases, no matter what solution is adopted, because of the morphology of the aorta at this level, achieving an ideal sealing is extremely difficult, and endovascular treatments of the arch are burdened by an increased risk of type IA endoleaks. PubMed, EMBASE, and Cochrane Library were searched. We identified 1277 records. After reading titles, abstracts, and full texts, we excluded 1231 records. Exclusion criteria were low-quality evidence, abstracts, case reports, conference presentations, reviews, editorials, and expert opinions. A total of 48 studies were included, for a total of 3114 patients. A type IA endoleak occurred in 248 patients (7.7%) with a mean incidence of 18.8% in chimney procedures, 4.8% and 3%, respectively, in fenestrated and branched devices, and 2.2% in in situ fenestration. We excluded from our analysis scalloped technology that is used when the target vessel originates from a healthy landing zone and represents a different anatomical setting. Type IA endoleaks are a concern with all types of endovascular aortic arch repair, and they can compromise the outcomes of the procedure. The rate of type IA endoleaks appears to be significantly higher in chimney procedures. In order to maximize sealing, whenever possible, endovascular repair of the arch should be achieved with custom-made fenestrated devices. However, chimney configurations are still a valuable solution particularly in the emergency setting, although in such a procedure, to guarantee accurate postoperative management and follow-up, an imaging protocol could be useful.

show abstract

Section: Resultsmentioning

confidence: 92%

Section: Resultsmentioning

confidence: 99%

Type 1A Endoleak after TEVAR in the Aortic Arch: A Review of the Literature

Scurto

Peluso

Pascucci

et al. 2022

JPM

View full text Add to dashboard Cite

show abstract

“…Compared to open surgery or hybrid operation, the endovascular treatment is with fewer perioperative complications ( 3 ). In treating these aortic arch lesions, physicians prefer to use several assisted techniques including chimney stents ( 4 , 5 ), in situ ( 6 , 7 ) or in vitro fenestration ( 8 , 9 ), branched stent-graft ( 10 ) according to individual experience and patients' anatomy characteristics. Theoretically, the branched stent graft is the most ideal prosthesis for arch reconstruction purposes, but the shortage of this pattern is that it needs customizing according to a different configuration of the arch.…”

Section: Commentmentioning

confidence: 99%

First-in-Human Implantation of Gutter-Free Design Stent-Graft in in situ Fenestration TEVAR for Aortic Arch Pathology

Shu

Wang

et al. 2022

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

PurposeTo report the technology and preliminary result of gutter-free design stent-grafted in in situ fenestration thoracic endovascular aortic repair (TEVAR).DescriptionThe gutter-free stent-graft has a nickel-titanium self-expanding skeleton, double polytetrafluoroethylene coating, and an outer-skirt fabric structure (named C-skirt endograft). The outer skirt fabric prevents endoleak from the gutter around the stent graft fenestration. Further, the skirt structure right under the fenestration in the aortic stent graft can function as a fixation of the side-branch artery endograft. These designs have the following advantages, such as: 1) prevention of endoleak; and 2) fixation tightly between the branch and aorta endograft pieces.EvaluationA patient who was diagnosed with an aortic arch aneurysm, combined with localized dissection, has successfully implanted the aortic stent graft and C-skirt endograft for the left subclavian artery. The 6-month follow-up result of the C-skirt in situ fenestration TEVAR is satisfactory without obvious endoleak.ConclusionsThe new gutter-free C-skirt stent graft is being safely and effectively used for aortic arch TEVAR. Long-term evaluation of safety, effectivity, and durability needs to be proven by future multi-center studies.

show abstract

“…Given these encouraging results, endovascular treatment strategies for patients suffering pathologies involving the aortic arch, such as degenerative aneurysms or non-A-non-B aortic dissections, which are considered unfit for OR due to age, frailty, severe comorbidities, or prior cardiac or aortic surgery requiring sternotomy, have been developed [8][9][10][11][12]. Over the past decade, in order to reduce invasiveness, morbidity, and mortality in this specific subset of patients, endovascular approaches treating pathologies in the aortic arch have been investigated with promising results [13].…”

Section: Introductionmentioning

confidence: 99%

Feasibility of Total Endovascular Repair of the Aorta in Patients with Acute Type A Aortic Dissection: Morphological Analysis of 119 Patients

Ahmad,

Liebezeit-Sievert,

Wegner

et al. 2023

JCM

Self Cite

View full text Add to dashboard Cite

(1) Background: This study aimed to morphologically analyze acute type A aortic dissection (aTAAD) patients for potential endovascular treatment candidates. The objective was to specify requirements for aTAAD endovascular devices. (2) Methods: A single-center retrospective analysis included aTAAD patients who underwent open surgical repair between November 2005 and December 2020. Preoperative CTA scans were used for morphological analysis, assessing endovascular repair eligibility. Statistical tests were performed. (3) Results: A total of 129 patients with aTAAD were studied, with 119 included. Entry tear (ET) locations were identified, mainly in the aortic root, 20 mm above the sinotubular junction (STJ) and within the ascending aorta (20 mm above STJ to −20 mm before the brachiocephalic trunk). Endovascular treatment was deemed feasible for 36 patients, with suggested solutions for the aortic arch and descending aorta. Significant differences were observed between eligible and noneligible groups for aortic diameter, false lumen diameter, distance between STJ and entry tear, and more. Dissection extension showed no significant difference. (4) Conclusions: Morphological analysis identified potential aTAAD candidates for endovascular treatment, highlighting differences between eligible and noneligible morphologies. This study offers insights for implementing endovascular approaches in aTAAD treatment and emphasizes the need for research and standardized protocols.

show abstract

Long-Term Outcomes after Thoracic Endovascular Aortic Repair Using Chimney Grafts for Aortic Arch Pathologies: 10 Years of Single-Center Experience

Cited by 9 publications

References 38 publications

Type 1A Endoleak after TEVAR in the Aortic Arch: A Review of the Literature

Type 1A Endoleak after TEVAR in the Aortic Arch: A Review of the Literature

First-in-Human Implantation of Gutter-Free Design Stent-Graft in in situ Fenestration TEVAR for Aortic Arch Pathology

Feasibility of Total Endovascular Repair of the Aorta in Patients with Acute Type A Aortic Dissection: Morphological Analysis of 119 Patients

Contact Info

Product

Resources

About