Type II Endoleaks, Left-Arm Complications, and Need of Revascularization after Left Subclavian Artery Coverage for Thoracic Aortic Aneurysms Endovascular Repair: A Systematic Review

Belczak, Sérgio Quilici; Silva, Erasmo Simão da; Klajner, Rafael Kogan; Puech-Leão, Pedro; Luccia, Nélson De

doi:10.1016/j.avsg.2016.08.049

Cited by 11 publications

(4 citation statements)

References 28 publications

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“…Although not primarily regarded as treatment failure, there is evidence that EL-II in TEVAR is associated with RI, particularly in cases involving the LSA. 15,23,30 In this study, seven EL-II–LSA occurred, six of them in oIFU patients, often leading to RI. Although the severity of EL-II in contrast to EL-I/III should not be overrated, the LSA orifice is involved in PLZ length in up to 40% in TEVAR collectives in terms of LZ creation, 15 especially in TEVAR cohorts comprising high rates of type 2/3 arches (76.8% in the presented cohort).…”

Section: Discussionmentioning

confidence: 51%

Outcomes of thoracic endovascular aortic repair in thoracic aortic aneurysm and penetrating aortic ulcer using the Conformable Gore TAG within and outside the instructions for use

et al. 2020

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Objective To describe the outcome of thoracic endovascular aortic repair (TEVAR) in thoracic aortic aneurysm and penetrating aortic ulcer with respect to instructions for use status. Methods Between October 2009 and September 2017, a total of 532 patients underwent TEVAR; of which 195 have been treated using the Conformable GORE® TAG® thoracic endoprosthesis (CTAG). Fifty-six patients of this cohort underwent TEVAR for thoracic aortic aneurysm/penetrating aortic ulcer using the CTAG. Depending on the preoperative computed tomography angiography findings, patients were classified as inside or outside the device’s instructions for use. All inside instruction for use patients underwent postoperative reclassification regarding the instructions for use status. Study endpoints included TEVAR-related reintervention, exclusion of the pathology (endoleak type I/III), TEVAR-related mortality, and graft-related serious adverse events. The median duration of follow-up was 29.7 months (range: 0–109.4 months). Results Of the 56 patients, 17 were primarily classified as outside instruction for use, and in additional 13 patients, TEVAR was performed outside instruction for use, leading to 30 outside instruction for use patients (53.6%). Twenty-six patients (46.4%) were treated inside instruction for use. Reintervention-free survival was lower in outside instruction for use patients ( P = 0.016) with a hazard ratio of 9.74 (confidence interval 1.2–80.2; P = 0.034) for TEVAR-related reintervention. With respect to endoleak type I/III, relevant difference was detected between inside/outside instruction for use status ( P = 0.012). The serious adverse event rate was 30.4%, mainly in outside instruction for use patients ( P = 0.004). Logistic regression analysis indicated an association between graft-related serious adverse event/instructions for use status (odds ratio 6.11; confidence interval 1.6–30.06; P = 0.012). In-hospital death was seen more frequently in outside instruction for use patients ( P = 0.12) as was procedure-related death (log-rank test: P = 0.21). Conclusion TEVAR for thoracic aortic aneurysm/penetrating aortic ulcer is frequently performed outside instruction for use despite preoperative inside instruction for use eligibility, leading to important consequences for technical/clinical outcome. Instructions for use adherence in TEVAR should be of interest for further large-scale studies.

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Section: Discussionmentioning

confidence: 51%

Outcomes of thoracic endovascular aortic repair in thoracic aortic aneurysm and penetrating aortic ulcer using the Conformable Gore TAG within and outside the instructions for use

et al. 2020

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“…When compared with the literature, following EVAR type 2 endoleaks occurred at frequencies 22% 25 and 24.5%. 26 Following TEVAR, type 2 endoleaks occurred at frequencies between 1% 27,28 and 7%, 13 and type 1 endoleaks occurred at frequencies between 2% 27 and 8%. 13 Therefore, the low frequencies of type 2 endoleaks as detected with the sCTA approach might not reflect real-world situations.…”

Section: Discussionmentioning

confidence: 97%

Detection of Endoleaks Following Thoracic and Abdominal Aortic Endovascular Aortic Repair—: A Comparison of Standard and Dynamic 4D-Computed Tomography Angiography

et al. 2022

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Purpose: Endoleaks are a common complication after endovascular aortic repair (EVAR) and thoracic endovascular aortic repair (TEVAR). The detection and correct classification of endoleaks is essential for the further treatment of affected patients. However, standard computed tomography angiography (CTA) provides no hemodynamic information on endoleaks, which can result in misclassification in complex cases. The aim of this study was to compare standard CTA (sCTA) with dynamic, dual-energy CTA (dCTA) for detection and classification of endoleaks following EVAR or TEVAR. Materials and Methods: This retrospective evaluation compared 69 sCTA diagnostic examinations performed on 50 different patients with 89 dCTA diagnostic examinations performed on 69 different patients. Results: In total, 15.9% of sCTA examinations and 49.4% of dCTA examinations led to the detection of endoleaks. With sCTA, 20.0% of patients were diagnosed with endoleaks, while with dCTA, 37.7% of patients were diagnosed with endoleaks. With sCTA, mainly Type 1 endoleaks were detected, whereas, with dCTA, the types of detected endoleaks were more evenly distributed. In comparison with the literature, the frequencies of endoleak types detected with dCTA better reflect the natural distribution than the frequencies detected with standard CTA. Conclusion: Based on the retrospective comparative evaluation, dCTA could pose a valuable supplementary diagnostic tool resulting in a more accurate and realistic detection and classification of suspected endoleaks.

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“…14 Moreover, Belczak et al had also reported a very low incidence of arm ischemia after LSA coverage without revascularization. 15 However, for patients with the dominant vertebral artery on the left and the collateral circulation of the left internal mammary artery and coronary artery, LSA should be revascularized. The Society for Vascular Surgery Guidelines recommends revascularizing the LSA to prevent spinal cord ischemia and cerebrovascular accidents.…”

Section: Discussionmentioning

confidence: 99%

Mid-term Outcomes of Endovascular and Hybrid Procedures to Treat Complex Aortic Arch Pathologies

Niu

et al. 2022

J Endovasc Ther

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Purpose: To compare the mid-term outcomes of endovascular and hybrid procedures in treating aortic arch pathologies with an unfavorable proximal landing zone, and analyze the different indications of the 2 methods. Methods: We collected the clinical data from 59 patients with complex aortic arch pathologies who underwent endovascular or hybrid surgery from March 2018 to April 2020 at a single center. Among the patients, 45 were treated by branched or fenestrated surgery and 14 by hybrid surgery. The clinical data of preoperative, perioperative, and postoperative results were retrospectively analyzed and compared. The main study indexes were the branch patency rate and endoleakage rate during the follow-up period. The secondary study indexes included the operation success rate, operative time, hospital expenses, complication incidence, freedom from reintervention rate, mortality, etc. Results: The operation success rate of all the groups was 100%. The hospital expenses of the hybrid group were lower than those of the endovascular group (p<0.05). The operative time of the hybrid group was longer than that of the endovascular group (p<0.05). The incidence of anatomic variants in the hybrid group was 28.6%, which was significantly higher than that in the endovascular group (2.2%, p=0.011). However, there were no significant differences in operative bleeding, ventilator use duration, and treatment time in intensive care units between the 2 groups (p>0.05). Follow-up was conducted for a period of 12 to 34 months. Four patients of the hybrid group experienced numbness of the upper limb (28.57%); the proportion was higher than the endovascular group (0%, p=0.002). There were no significant differences in the occurrence of endoleaks, retrograde aortic dissection, target lesion, secondary operation, branch patency rate, paraplegia, cerebral apoplexy, renal failure, or other complications in either group (p>0.05). The mortality of the endovascular group was 6.67% (3/45). Overall cumulative survival at 1 year was 100% in the hybrid group and 93.3% in the endovascular group. There was no statistical difference in the increase of the true lumen between the 2 groups for vascular remodeling (p>0.05). Conclusion: The hybrid surgery costs less and proves more suitable for treating variants of the aortic arch. The endovascular treatment still has limitations due to anatomical conditions.

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Type II Endoleaks, Left-Arm Complications, and Need of Revascularization after Left Subclavian Artery Coverage for Thoracic Aortic Aneurysms Endovascular Repair: A Systematic Review

Cited by 11 publications

References 28 publications

Outcomes of thoracic endovascular aortic repair in thoracic aortic aneurysm and penetrating aortic ulcer using the Conformable Gore TAG within and outside the instructions for use

Outcomes of thoracic endovascular aortic repair in thoracic aortic aneurysm and penetrating aortic ulcer using the Conformable Gore TAG within and outside the instructions for use

Detection of Endoleaks Following Thoracic and Abdominal Aortic Endovascular Aortic Repair—: A Comparison of Standard and Dynamic 4D-Computed Tomography Angiography

Mid-term Outcomes of Endovascular and Hybrid Procedures to Treat Complex Aortic Arch Pathologies

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