Emergency Use of Branched Thoracic Endovascular Repair in the Treatment of Aortic Arch Pathologies
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Emergency Use of Branched Thoracic Endovascular Repair in the Treatment of Aortic Arch Pathologies. / Law, Yuk; Kölbel, Tilo; Detter, Christian; Rohlffs, Fiona; von Kodolitsch, Yskert; Makaloski, Vladimir; Debus, Eike Sebastian; Tsilimparis, Nikolaos.
in: ANN THORAC SURG, Jahrgang 107, Nr. 6, 06.2019, S. 1799-1806.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Emergency Use of Branched Thoracic Endovascular Repair in the Treatment of Aortic Arch Pathologies
AU - Law, Yuk
AU - Kölbel, Tilo
AU - Detter, Christian
AU - Rohlffs, Fiona
AU - von Kodolitsch, Yskert
AU - Makaloski, Vladimir
AU - Debus, Eike Sebastian
AU - Tsilimparis, Nikolaos
N1 - Copyright © 2019 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
PY - 2019/6
Y1 - 2019/6
N2 - BACKGROUND: Branched thoracic endovascular aortic repair (b-TEVAR) has revolutionized the treatment of aortic arch pathologies. However, b-TEVAR requires custom design and time for manufacturing, which limits its use in emergency situation.METHODS: We retrospectively studied a series of 11 patients, who underwent emergency b-TEVAR in our institution. Stent grafts were either already available for the patient or from another patient with similar anatomy. Study endpoints were technical success, 30-day mortality, perioperative complications, early reinterventions, and subsequent image follow-up.RESULTS: Between December 2012 and December 2017, 11 patients (5 male; age 67 ± 14 years) were treated emergently with b-TEVAR for type A dissection (n = 2), peripheral malperfusion despite ascending repair in type A dissection (n = 1), contained ruptured ascending aortic pseudoaneurysm (n = 2), symptomatic arch aneurysm (n = 4), and ruptured subclavian aneurysm (n = 2). Three patients received their personal custom-made endografts but were hospitalized and treated urgently because of new symptom onset; the remaining 8 patients were treated with endografts from other patients. Technical success was 100%. Thirty-day mortality was 9% (1 of 11). Perioperative complications included one major stroke (9%), one sepsis (9%), two respiratory failures (18%), one acute renal injury (9%), and one retroperitoneal hematoma (9%). There were five (45%) early reinterventions. With median 6 months (range, 1 to 28) of follow-up, 2 patients had persistent false lumen perfusion, whereas all supraaortic branches remained patent.CONCLUSIONS: Our experience provided an early insight to the feasibility and safety of b-TEVAR in an emergency situation, although the early reintervention rate was not negligible. The endograft was versatile, with potential off-the-shelf use in future.
AB - BACKGROUND: Branched thoracic endovascular aortic repair (b-TEVAR) has revolutionized the treatment of aortic arch pathologies. However, b-TEVAR requires custom design and time for manufacturing, which limits its use in emergency situation.METHODS: We retrospectively studied a series of 11 patients, who underwent emergency b-TEVAR in our institution. Stent grafts were either already available for the patient or from another patient with similar anatomy. Study endpoints were technical success, 30-day mortality, perioperative complications, early reinterventions, and subsequent image follow-up.RESULTS: Between December 2012 and December 2017, 11 patients (5 male; age 67 ± 14 years) were treated emergently with b-TEVAR for type A dissection (n = 2), peripheral malperfusion despite ascending repair in type A dissection (n = 1), contained ruptured ascending aortic pseudoaneurysm (n = 2), symptomatic arch aneurysm (n = 4), and ruptured subclavian aneurysm (n = 2). Three patients received their personal custom-made endografts but were hospitalized and treated urgently because of new symptom onset; the remaining 8 patients were treated with endografts from other patients. Technical success was 100%. Thirty-day mortality was 9% (1 of 11). Perioperative complications included one major stroke (9%), one sepsis (9%), two respiratory failures (18%), one acute renal injury (9%), and one retroperitoneal hematoma (9%). There were five (45%) early reinterventions. With median 6 months (range, 1 to 28) of follow-up, 2 patients had persistent false lumen perfusion, whereas all supraaortic branches remained patent.CONCLUSIONS: Our experience provided an early insight to the feasibility and safety of b-TEVAR in an emergency situation, although the early reintervention rate was not negligible. The endograft was versatile, with potential off-the-shelf use in future.
KW - Aged
KW - Aorta, Thoracic
KW - Aortic Diseases/surgery
KW - Emergency Treatment
KW - Endovascular Procedures/methods
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Retrospective Studies
U2 - 10.1016/j.athoracsur.2018.09.020
DO - 10.1016/j.athoracsur.2018.09.020
M3 - SCORING: Journal article
C2 - 30389447
VL - 107
SP - 1799
EP - 1806
JO - ANN THORAC SURG
JF - ANN THORAC SURG
SN - 0003-4975
IS - 6
ER -