Combined Surgical and Endovascular Repair of Complex Aortic Pathologies With a New Hybrid Prosthesis (original) (raw)

Postoperative Outcomes of Complex Aortic Aneurysm Repair Using Hybrid Open-Endovascular Techniques

Journal of Vascular and Endovascular Surgery, 2018

Aortic disease becomes more prevalent with age and can result in acute aortic conditions including aneurysm, dissection, intramural hematoma and penetrating ulcers. Repair techniques for these conditions remain controversial due to the varying outcomes of studies. This retrospective study collected and analyzed data from twenty-three (23) patients with complex aortic aneurysms repaired using hybrid open-endovascular techniques. A high percentage of patients (82.6%) suffered from multiple comorbidities, including hypertension, hyperlipidemia, renal disease, coronary artery disease, congestive heart failure and prior aortic procedures. All patients presented with ASA scores 3 or 4. Eleven patients (47.8%) presented with aneurysms of the ascending, transverse and descending arch, and seven patients (30.4%) with thoracoabdominal aneurysm. 78.3% of patients underwent thoracic vessel debranching, while the remainder underwent visceral vessel debranching (13.0%) or thoracic and visceral debranching (8.7%). No patients suffered visceral ischemia, spinal cord injury, extremity amputation or reoperation for bleeding post-operatively. Two patients suffered minor stroke (8.7%) and one patient (4.3%) had major stroke. Three patients (13.0%) suffered temporary kidney injury and one patient (4.3%) developed renal failure requiring dialysis. Four patients (17.4%) developed Type II stent graft endoleaks. All patients had patent grafts. Reintervention occurred in two patients (8.7%). Thirty-day mortality occurred in three patients (13.0%). These results are within the range reported in other studies involving hybrid repair of aortic conditions, and show that hybrid open-endovascular repair is a feasible alternative in high-risk patients.

Endovascular treatment of complex diseases of the thoracic aorta—10 years single centre experience

Journal of Thoracic Disease

Background: Introduction of invasive endovascular techniques constituted a real a breakthrough in the treatment of aortic aneurysm dissection and rupture. We assessed the effectiveness and safety of thoracic endovascular aortic repair (TEVAR) in patients with thoracic aortic pathologies. Methods: Between 2007 and 2017, 118 patients with thoracic aortic pathology underwent TEVAR. Among them, 20 (16.9%) patients required hybrid procedures. Stent grafts indication were thoracic aortic aneurysm in 46 (39.0%) patients, type B dissection in 68 (57.6%) patients and other indications in 4 (3.3%). Procedural success rate, in-hospital and late mortality and morbidity were evaluated. Results: The patients were followed-up for a mean of 55 months (range, 6-118 months). The technical success rate was 96%. Five patients died during the first 30 days after procedure (mortality 4.2%), four due to ischemic stroke followed by multi-organ failure and another one hemodynamically significant type I endoleak. Most of them were noted in the first years of our study. Five others died during post-discharged period. Four patients developed neurological complications, including stroke (n=2; 1.7%) and paraparesis (n=2; 1.7%). There were 6 (5.1%) primary (5 type I and 1 type II) and 3 (2.5%) secondary endoleaks (1 type I and 2 type III). Secondary interventions were required in 8 subjects. There was one case of stent collapse and two retrograde aortic dissection. Conclusions: Treatment of descending aortic diseases by using stent graft implantation has become the method of choice, decreasing the risk of open surgery, especially in patients with severe clinical state and comorbidities. However, effectiveness and safety may be achieved by experience team.

Endovascular treatment for aortic disease: Is a surgical environment necessary?

Journal of Vascular Surgery, 2005

Objective: Interventional radiologists, cardiologists, and vascular surgeons are capable of performing endovascular procedures successfully in their respective environments. Suboptimal anatomy or intraoperative technical problems can be encountered, and endovascular management alone is not always suitable. The objectives of this study were to define the incidence of adjunctive surgical techniques, to discuss the rationale for endovascular reconstruction in a well-developed surgical environment, and to assess the effect of experience on the incidence of adjunctive repair. Methods: All primary aortic and aortoiliac elective, urgent, and emergent endovascular procedures performed at the Peter Lougheed Center and entered into a prospective database from May 25, 1999 to June 01, 2005, were reviewed. All adjunctive surgical techniques to enable stent deployment, enhance attachment site, or solve intraoperative difficulties were captured. The study period was divided into two time periods based on learning curve data to assess the effect of experience on the rate of adjunctive repairs. Results: Four hundred thirty-eight patients underwent elective (80%), urgent (15%), or emergent (5%) endovascular procedures during the study period. These consisted of 101 thoracic and 337 abdominal operations, including the use of 13 fenestrated stents. One hundred thirty-nine patients (31.7%) required 180 open surgical procedures. Complete data were available for the entire patient cohort. The mean follow-up was 793.2 days (SD, 519.1 days). Procedures were necessary for vascular access, arterial dissection/rupture, limb ischemia, and enhancement/elongation of the stent attachment site. The persistent endoleak rate was 5.3%, the late rupture rate was 0.7%, the conversion rate was 1.6%, the 30-day surgical mortality rate was 3.2%, all-cause mortality to date is 7.3%, and the reintervention rate was 4.6%. There was no statistically significant effect of the learning curve on the incidence of surgical adjunctive procedures in either the thoracic group 11/26 [42.3%] for phase 1 vs 17/75 [22.6%] for phase 2) or the abdominal group (14/50 [28.0%] for phase 1 vs 97/287 [33.8%] for phase 2). Overall, 31.5% of patients required adjunctive surgical repair. Conclusions: Successful endografting requires endovascular expertise in addition to a well-developed surgical environment to increase applicability and decrease patient risk. Despite advances in endovascular technology, hybrid techniques will continue to be required to achieve good overall success rates. ( J Vasc Surg 2005;42:645-9.)

Endovascular aortic repair: First twenty years

Srpski arhiv za celokupno lekarstvo, 2012

Endovascular aortic/aneurysm repair (EVAR) was introduced into clinical practice at the beginning of the nineties. Its fast development had a great influence on clinicians, vascular surgeons and interventional radiologists, educational curriculums, patients, industry and medical insurance. The aim of this paper is to present the contribution of clinicians and industry to the development and advancement of endovascular aortic repair over the last 20 years. This review article presents the development of EVAR by focusing on the contribution of physicians, surgeons and interventional radiologists in the creation of the new field of vascular surgery termed hybrid vascular surgery, and also the contribution of technological advancement by a significant help of industrial representatives ? engineers and their counselors. This article also analyzes studies conducted in order to compare the successfulness of EVAR with up-to-now applied open surgical repair of aortic aneurysms, and some trea...

Endovascular treatment of arch and proximal thoracic aortic lesions

Journal of Vascular Surgery, 2008

Objective: To analyze at one institution the endovascular treatment for aortic arch and proximal thoracic aortic lesions, categorize open arch reconstruction, and make preliminary recommendations based on pathology (dissection vs aneurysm), and anatomical extent of disease. Methods: A retrospective review of aortic arch and descending thoracic aortic lesions managed with endovascular treatment between June 2002 and June 2007.

Endovascular surgery for failed open aortic aneurysm repair*1

European Journal of Cardio-Thoracic Surgery, 2004

Objective: Determine the usefulness of endovascular surgery for repair of aortic lesions late after open surgical repair. Patients and methods: A retrospective analysis of our databank (Patient Analysis and Tracking System, Dendrite, UK) for 2000-2002 showed 286 descending thoracic and/or abdominal aortic aneurysms: 60/286 (21%) descending thoracic, and 255/286 abdominal (89%). Endovascular surgery was planned in 98 patients (17/60 (28%) for thoracic lesions, and 81/255 (32%) for abdominal lesions). 13/98 patients (13%) underwent endovascular surgery late after failed open aortic repair: 4/13 at the level of distal aortic arch (3/4 for false aneurysms postcoarctation repair), 4/13 at the level of the descending thoracic aorta (3/4 for false aneurysms proximal to the previous graft), and 5/13 at the level of the infrarenal abdominal aorta (4/5 for false aneurysms proximal to the previous graft). Endovascular surgery included per procedural target site identification (previous graft) with intravascular ultrasound (IVUS) under fluoroscopic control (no angiographies), controlled hypotension (partial inflow occlusion with a right atrial balloon introduced through a femoral vein) for unloading of covered endoprostheses in the thoracic aorta, as well as in situ introducer sheath dilatation in case of complex access to the aorta. Results: There were no hospital deaths and no parapareses or paraplegias in this small series of patients who underwent endovascular surgery for aneurismal lesions occurring late after open repair. An endoleak type I was documented in 2/13 patients (15%) requiring a proximal extension in 1 patient. For the second patient with a minor endoleak, a control examination is planned at 6 months of follow-up. Conclusion: Endovascular surgery is an elegant approach for repair of recurring aortic lesions late after open aortic surgery. IVUS is a precious instrument for per procedural identification of the previous implants. However, long-term follow-up is mandatory after endovascular surgery. q

Endovascular Options in the Management of Complex Aortic Problems

Perspectives in Vascular Surgery, 2001

The eligibility for endovascular stent-graft repair in patients with aortic pathologies is dictated by the presence of favorable vascular anatomy. The two main anatomic features predicting successful repair are the presence of adequate attachment sites for the device anchoring and the availability of the relatively normal access vessels for safe device navigation. This chapter describes some of the complex vascular anatomies, which can initially impede aortic endovascular repair, and the maneuvers to circumvent these initial obstacles, increasing the overall pool of patients eligible for endovascular repair of complex aortic diseases.