Thoracic Endovascular Aortic Repair on Zone 2 Landing for Type B Aortic Dissection

Miura, Shuhei; Kurimoto, Yoshihiko; Maruyama, Ryushi; Wada, Takuya; Konno, Mitsuhiko; Iba, Yutaka; Hatta, Eiichiro; Yamada, Akira

doi:10.1016/j.avsg.2019.02.017

Cited by 16 publications

(11 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In cases of acute type B AD, the rate of positive aortic remodeling (true lumen re-expansion and thoracic false lumen thrombosis) was as high as 77%. This was slightly lower than the rate of 80–90% reported in previous studies investigating remodeling rates of general TEVAR for AD [ 7 ]. However, we exclusively reported the outcomes of zone 2 hybrid TEVAR for acute type B AD with a low number of procedure-related complications and sustainable mid-term aortic remodeling rates.…”

Section: Discussioncontrasting

confidence: 65%

Zone 2 hybrid thoracic endovascular aortic repair: Is it a good option for all types of thoracic aortic disease?

Sohn

Lee

Jung

et al. 2022

J Cardiothorac Surg

View full text Add to dashboard Cite

Background Zone 2 thoracic endovascular aortic repair (TEVAR) is performed for the treatment of various thoracic aortic diseases involving the left subclavian artery. This study aimed to analyze the late clinical outcomes of zone 2 hybrid TEVAR according to the various indications. Methods A total of 48 patients who underwent zone 2 TEVAR at our institution between December, 2010 and July, 2020 were enrolled. The indications were aortic aneurysm (AA, n = 15), acute type B aortic dissection (AD, n = 14), penetrating aortic ulcer (PAU, n = 8), traumatic aortic injury (TAI, n = 8), and others (n = 3). The clinical outcomes including early complications and mid-term aortic measurements were retrospectively reviewed. Results The technical success rate was 100% and in-hospital mortality occurred in one patient. The early postoperative complications included stroke (n = 1), transient spinal cord ischemia (n = 1), neck wound hematoma (n = 1), and left phrenic or vagus nerve injury (n = 9). In patients with AD, positive remodeling was observed in ten patients (76.9%) (false lumen regression in the entire or thoracic aorta [n = 9], false lumen thrombosis in the thoracic aorta [n = 1]). However, in patients with AA, increased aneurysm was found in six patients (40%). Persistent aneurysmal growth was found in patients with a maximal aortic diameter of > 60 mm on initial imaging (4/6, 50%). No aortic expansion was observed in those with TAI or PAU. Endoleak was noted in five patients (10.4%), and among them, aortic reintervention was required only in patients with large AAs. Conclusions Zone 2 hybrid TEVAR was associated with an acceptable early complication rate and provided acceptable mid-term aortic results for patients with AD, PAU, and TAI. However, patients with large AAs were at increased risk of aortic reintervention. In cases of large AA, clinicians should carefully consider whether zone 2 hybrid TEVAR or open surgical repair will be more effective for the patient.

show abstract

Section: Discussioncontrasting

confidence: 65%

Zone 2 hybrid thoracic endovascular aortic repair: Is it a good option for all types of thoracic aortic disease?

Sohn

Lee

Jung

et al. 2022

J Cardiothorac Surg

View full text Add to dashboard Cite

show abstract

“…Compared to the high incidence of dSINE reported in other literature, [18][19][20] the 5.9% incidence seems acceptable in our study. Complete avoidance of dSINE is probably impossible because the distal landing zone usually is unhealthy aorta, 21 and the stentgraft size selected based on the proximal landing zone may be relatively too large for the distal landing zone in most patients, especially in aortic dissection with compressed distal true lumen and more fragile intimal membrane. With the remodeling of the aorta (false lumen reduction and true lumen expansion), the mismatch between the distal of the stent-grafts and the distal landing zone will become more obvious and fatal, and the interaction between the two during arterial pulsation may damage the aortic intima.…”

Section: Discussionmentioning

confidence: 99%

Midterm outcomes of fenestrated TEVAR using physician-modified endovascular grafts for zone 2

Niu

et al. 2021

Vascular

View full text Add to dashboard Cite

Objectives To summarize the experience and midterm outcomes of physician-modified endovascular grafts for zone 2 thoracic endovascular aortic repair. Methods A retrospective analysis was conducted of 51 consecutive patients (mean age 57.6 ± 12.5 years, 39 males) treated with thoracic endovascular aortic repair using physician-modified endovascular grafts for reconstructing the left subclavian artery from November 2015 to December 2019. The primary endpoints during follow-up were the overall mortality, aorta-related mortality, and major complications. The secondary endpoints were reintervention and the patency of the target branches, the demographics and technical details were also described and analyzed. Results Sixty-three thoracic stent-grafts were deployed in 51 patients and emergency surgery was performed in 10 patients (19.6%). Technical success was 94.1% (48/51). The incidence of perioperative complications was 15.7%, and the 30-day mortality was 0%. At a mean follow-up of 42.0 ± 14.4 months (range, 14–63 months), all the left subclavian arteries remained patent. All-cause mortality was 3.9% (2/51) and not aorta-related deaths. Estimated survival at one and three years was 98.0 ± 1.9% and 96.0 ± 2.8%, respectively. Conclusions The physician-modified endovascular grafts is feasible and effective to preserve left subclavian artery in thoracic endovascular aortic repair for aortic arch pathologies with unhealthy proximal landing zone.

show abstract

“…Zone 2 is usually regarded a preferred PLZ in TEVAR for TBAD with a low complication risk due to its relative stable structure at the level of the ostia of the supra-aortic arteries. [16][17][18] In patients with GAS, TEVAR is less common, and proximal landing in a native aortic segment is generally not recommended. This paradigm is changing, and in urgent cases as well as in high-risk patients, TEVAR is performed in increasing numbers also in GAS patients.…”

Section: Discussionmentioning

confidence: 99%

“…Proximal landing zone 2 is recognized as a safer landing zone in TBAD compared with PLZ 3 which carries a higher rate of complications. [16][17][18] The aim of this study is to report safety and effectiveness of TEVAR in native PLZ 2 for chronic TBAD patients with GAS.…”

Section: Introductionmentioning

confidence: 99%

Safety and Effectiveness of TEVAR in Native Proximal Landing Zone 2 for Chronic Type B Aortic Dissection in Patients With Genetic Aortic Syndrome

Eleshra¹,

Panuccio²,

Σπανός³

et al. 2021

J Endovasc Ther

View full text Add to dashboard Cite

Objectives The aim of this study is to report the safety and effectiveness of thoracic endovascular aortic repair (TEVAR) in a native proximal landing zone (PLZ) 2 for chronic type B aortic dissection (TBAD) patients with genetic aortic syndrome (GAS). Methods A retrospective review of a single center database to identify patients with GAS treated with TEVAR in native PLZ 2 for chronic TBAD and thoracic false lumen aneurysm between February 2012 and February 2018 was undertaken. Results In total, 31 patients with GAS (24 Marfan syndrome [MFS], 5 Loeys-Dietz syndrome [LDS], and 2 vascular Ehlers-Danlos syndrome [vEDS]) were treated by endovascular repair. Nineteen patients were treated by TEVAR as index procedures with 8 patients (5 females, mean age = 55, range = 36–79 years old) receiving TEVAR in native PLZ 2. Left subclavian artery (LSA) perfusion was preserved in all 8 patients: by left common carotid artery-LSA bypass in 6 patients, chimney stenting of the LSA in 1 patient, and partial coverage of LSA ostium in 1 patient. Technical success was achieved in all patients (100%). There was no 30 day mortality (0%). The 30 day morbidity (0%) was free from major complications. The median follow-up was 40 months (range = 7–79). One patient died due to non-aortic-related cause. Native PLZ 2 was free from complications in MFS patients (5/8). Two patients with LDS developed type Ia endoleak with aneurysmal progression. One patient was treated by proximal extension with a double inner branched arch stent-graft landing in the replaced ascending aorta. The other one was treated with frozen elephant trunk. Conclusion Thoracic endovascular aortic repair in native PLZ 2 was safe and effective with no early or midterm PLZ complications in patients with MFS with chronic TBAD in this limited series. Native PLZ 2 is not safe in patients with LDS and should only be used in emergencies as a bridging to open repair.

show abstract

Thoracic Endovascular Aortic Repair on Zone 2 Landing for Type B Aortic Dissection

Cited by 16 publications

References 22 publications

Zone 2 hybrid thoracic endovascular aortic repair: Is it a good option for all types of thoracic aortic disease?

Zone 2 hybrid thoracic endovascular aortic repair: Is it a good option for all types of thoracic aortic disease?

Midterm outcomes of fenestrated TEVAR using physician-modified endovascular grafts for zone 2

Safety and Effectiveness of TEVAR in Native Proximal Landing Zone 2 for Chronic Type B Aortic Dissection in Patients With Genetic Aortic Syndrome

Contact Info

Product

Resources

About