International experience with endovascular therapy of the ascending aorta with a dedicated endograft

TY - JOUR

T1 - International experience with endovascular therapy of the ascending aorta with a dedicated endograft

AU - Tsilimparis, Nikolaos

AU - Debus, E Sebastian

AU - Oderich, Gustavo S

AU - Haulon, Stephan

AU - Terp, Kim Allan

AU - Roeder, Blayne

AU - Detter, Christian

AU - Kölbel, Tilo

N1 - Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

PY - 2016/6

Y1 - 2016/6

N2 - OBJECTIVE: The objective of this study was to evaluate the safety and feasibility of a novel stent graft specifically designed for treatment of the ascending aorta.METHODS: This was a multicenter, retrospective analysis of all consecutive patients treated with the dedicated Zenith Ascend TAA Endovascular Graft (William Cook Europe, Bjaeverskov, Denmark) for pathologic processes requiring stent grafting of the ascending aorta. The graft is short (6.5 cm), with a delivery system designed for transfemoral placement in the ascending aorta.RESULTS: In 10 patients (five men; age, 67 years; range, 26-90 years), the Zenith Ascend graft was implanted for the following indications: dissection (n = 5) and aneurysm (n = 4) of the ascending aorta and fixation of an intraprocedural dislocated aortic valve (n = 1). All patients were judged to be at high risk for open surgery (nine patients were classified as American Society of Anesthesiologists class 3 or class 4). A transfemoral approach was selected in eight cases and a transapical approach in two. All endografts were successfully deployed without intraoperative adverse events at the targeted landing zone. Clinical success in coverage of the lesions was achieved in all cases with the exception of an attempted treatment of an intraprocedural aortic valve implantation dissection that resulted in early mortality. The 30-day survival was 90%. Early neurologic events included one patient with stroke and paraplegia and one patient with a transient ischemic attack. One patient underwent early evacuation of a hemopericardium. There were two late reinterventions for persisting endoleaks. At a mean follow-up of 10 months (range, 1-36 months), three late deaths occurred, with one treatment related, as a result of graft infection.CONCLUSIONS: Despite the fact that in this first published series the graft was frequently used as a "rescue tool" outside its intended indication, treatment with the Zenith Ascend graft in this early experience appears to be safe and feasible for repair of ascending aorta pathologic processes in high-risk patients unsuitable for open repair.

AB - OBJECTIVE: The objective of this study was to evaluate the safety and feasibility of a novel stent graft specifically designed for treatment of the ascending aorta.METHODS: This was a multicenter, retrospective analysis of all consecutive patients treated with the dedicated Zenith Ascend TAA Endovascular Graft (William Cook Europe, Bjaeverskov, Denmark) for pathologic processes requiring stent grafting of the ascending aorta. The graft is short (6.5 cm), with a delivery system designed for transfemoral placement in the ascending aorta.RESULTS: In 10 patients (five men; age, 67 years; range, 26-90 years), the Zenith Ascend graft was implanted for the following indications: dissection (n = 5) and aneurysm (n = 4) of the ascending aorta and fixation of an intraprocedural dislocated aortic valve (n = 1). All patients were judged to be at high risk for open surgery (nine patients were classified as American Society of Anesthesiologists class 3 or class 4). A transfemoral approach was selected in eight cases and a transapical approach in two. All endografts were successfully deployed without intraoperative adverse events at the targeted landing zone. Clinical success in coverage of the lesions was achieved in all cases with the exception of an attempted treatment of an intraprocedural aortic valve implantation dissection that resulted in early mortality. The 30-day survival was 90%. Early neurologic events included one patient with stroke and paraplegia and one patient with a transient ischemic attack. One patient underwent early evacuation of a hemopericardium. There were two late reinterventions for persisting endoleaks. At a mean follow-up of 10 months (range, 1-36 months), three late deaths occurred, with one treatment related, as a result of graft infection.CONCLUSIONS: Despite the fact that in this first published series the graft was frequently used as a "rescue tool" outside its intended indication, treatment with the Zenith Ascend graft in this early experience appears to be safe and feasible for repair of ascending aorta pathologic processes in high-risk patients unsuitable for open repair.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Aorta/diagnostic imaging

KW - Aortic Diseases/diagnostic imaging

KW - Aortography/methods

KW - Blood Vessel Prosthesis

KW - Blood Vessel Prosthesis Implantation/adverse effects

KW - Computed Tomography Angiography

KW - Endovascular Procedures/adverse effects

KW - Feasibility Studies

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Postoperative Complications/etiology

KW - Prosthesis Design

KW - Retreatment

KW - Retrospective Studies

KW - Risk Factors

KW - Stents

KW - Time Factors

KW - Treatment Outcome

U2 - 10.1016/j.jvs.2015.12.027

DO - 10.1016/j.jvs.2015.12.027

M3 - SCORING: Journal article

C2 - 26926935

VL - 63

SP - 1476

EP - 1482

JO - J VASC SURG

JF - J VASC SURG

SN - 0741-5214

IS - 6

ER -