Total Endovascular Repair of the Aortic Arch: Initial Experience in the Netherlands

Weijde, Emma van der; Heijmen, Robin H.; Schaik, P.M. van; Hazenberg, Constantijn E.V.B.; Herwaarden, Joost A. van

doi:10.1016/j.athoracsur.2019.09.009

Cited by 42 publications

(15 citation statements)

References 17 publications

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“…The combination of the novel ascending aortic endograft technique with branched aortic arch endograft could be a possible solution. Currently, all branched aortic arch endograft techniques are investigational, including the Dacron Inoue branch stent-graft ( 16 ), Zenith Arch endograft ( 17 ), Valiant MonaLSA Thoracic Stent Graft System ( 18 ), Dual Branch Relay endoprosthesis ( 19 ), and thoracic branch endoprosthesis (TBE) ( 20 ). Fenestrated aortic arch endograft could be another viable option.…”

Section: Discussionmentioning

confidence: 99%

Anatomical Feasibility Study on Novel Ascending Aortic Endograft With More Proximal Landing Zone for Treatment of Type A Aortic Dissection

Zhu

Zhang

et al. 2022

Front. Cardiovasc. Med.

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ObjectiveType A aortic dissection (TAAD) is associated with high morbidity and mortality, and open surgery is the best treatment option. Development of endovascular repair devices for TAAD will benefit patients deemed unfit for open surgery. In this study, we performed a thorough investigation of anatomical features in Asian patients with TAAD to learn about the patient eligibility of a novel ascending aortic endograft technique.MethodsComputed tomography angiography (CTA) images of TAAD cases in our institution from January 2015 to November 2021 were reviewed, and three-dimensional reconstructions were performed with the Endosize software (Therenva, Rennes, France). Anatomic structures including length measured along centerline and greater/lesser curvature, ascending aorta/aortic root dimensions, as well as location of entry tear and extent of dissection were analyzed.ResultsA total of 158 patients were included [median age 58 years, interquartile range (IQR), 30–76 years; 115 males, 72.8%]. In 99 (62.7%) of the cases, entry tear was distal to the sinotubular junction (STJ). In 106 (67.1%) of the cases, the pathology proximally extended into the aortic root, which was intramural hematoma in 37 (23.4%) of the cases, and the aortic root was free from the pathology in 52 (32.9%) of the cases. The median distance from the STJ to the proximal edge of the ostium of the innominate artery (IA) measured along the centerline was 65 mm (IQR 58–74 mm). The median distance from the distal edge of the higher coronary ostium to the STJ was 7.95 mm (IQR 5.625–10.9 mm). The bare metal stent part was set between the edge of the higher coronary ostium and the STJ. In our series, 63 (39.9%) of the cases had this distance >10 mm. The relative difference was <20% between the STJ and the proximal edge of the ostium of the IA in 92 (58.2%) of the cases. Ascending aorta radius of curvature was 52.2 mm (IQR 43.7–63.7 mm).ConclusionsOur study demonstrates that 56.3% of the TAAD cases would be amenable to endovascular repair by the novel ascending aortic endograft, with sufficient landing zone free of the dissected aorta.

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Section: Discussionmentioning

confidence: 99%

Anatomical Feasibility Study on Novel Ascending Aortic Endograft With More Proximal Landing Zone for Treatment of Type A Aortic Dissection

Zhu

Zhang

et al. 2022

Front. Cardiovasc. Med.

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“…Available branched devices include the Dacron Inoue branch stentgraft manufactured by PTMC Institute, 18,26 the double branch Zenith Arch Endograft by Cook Medical, 20 the single branch Valiant Mona LSA Thoracic Stent Graft System by Medtronic, 23 the Single thoracic branch endoprosthesis (TBE) by Gore, 24 the Triple Arch Branch Endovascular Graft by Cook Medical, 25 and the Dual Branch Relay endoprosthesis by Terumo Aortic. 27,29 Among available fenestrated endoprostheses, Kawasumi Laboratories, Inc. manufactures the Najuta fenestrated endograft 19,21 and Cook Medical has a customizable fenestrated endograft. 30 Interestingly, MicroPort Medical Co., Ltd. is producing a stent-graft that can be custom-made with both fenestrations and branches, which is a versatile option that can be utilized for a variety of situations.…”

Section: Available Devices and Techniquesmentioning

confidence: 99%

Endovascular repair of the aortic arch: State of the art

Brown

Arnaoutakis

Szeto

et al. 2021

Journal of Cardiac Surgery

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Background Open total arch replacement remains the gold standard treatment for aneurysms and dissections involving the aortic arch. However, high‐risk surgical candidates may benefit from endovascular techniques to reduce the risk of perioperative mortality and morbidity, especially neurologic complications. Numerous endografts are available for investigational use in the aortic arch as part of investigational device exemption (IDE) programs. Some devices are fenestrated or scalloped, while others are branched, ranging from single branch to triple branch stent‐grafts. Furthermore, chimney techniques and in situ fenestration may be utilized in bailout or emergent situations. Results Initial results describing outcomes of complete endovascular repair of the aortic arch are encouraging, with current data estimating that technical success ranges from 84.2% to 100%. Moreover, operative mortality may be as high as 13.2%, while neurologic complications also remain common, with stroke rates being as high as 20% and spinal cord ischemia being as high as 3.1%. However, more data are necessary to determine the comparative treatment effect of endovascular stent‐grafting of the aortic arch, compared with conventional open and hybrid repairs. Longitudinal follow‐up is also lacking, which will determine the long‐term durability of endografts in the aortic arch. Nevertheless, endovascular repair represents an important opportunity for improving outcomes in patients with complex and potentially devastating pathologies of the aortic arch.

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“…Successful use of the similar custom-made Relay (Bolton) system with 2 internal branches has also been reported. 41 There is a pre-curved self-orienting mechanism to the delivery system that allows for better positioning of the internal branches along the outer curve of the aorta. The branches are cannulated in a retrograde fashion and branch grafts deployed.…”

Section: Endovascular Arch Graftsmentioning

confidence: 99%