Fenestrated endovascular repair for diseases involving the aortic arch

Nikolaos Tsilimparis; Yuk Law; Fiona Rohlffs; Konstantinos Spanos; Eike Sebastian Debus; Tilo Kölbel

doi:10.1016/j.jvs.2019.06.205

Fenestrated endovascular repair for diseases involving the aortic arch

Standard

Fenestrated endovascular repair for diseases involving the aortic arch. / Tsilimparis, Nikolaos; Law, Yuk; Rohlffs, Fiona; Spanos, Konstantinos; Debus, Eike Sebastian ; Kölbel, Tilo.

In: J VASC SURG, Vol. 71, No. 5, 05.2020, p. 1464-1471.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Tsilimparis, N, Law, Y, Rohlffs, F, Spanos, K, Debus, ES & Kölbel, T 2020, 'Fenestrated endovascular repair for diseases involving the aortic arch', J VASC SURG, vol. 71, no. 5, pp. 1464-1471. https://doi.org/10.1016/j.jvs.2019.06.205

APA

Tsilimparis, N., Law, Y., Rohlffs, F., Spanos, K., Debus, E. S., & Kölbel, T. (2020). Fenestrated endovascular repair for diseases involving the aortic arch. J VASC SURG, 71(5), 1464-1471. https://doi.org/10.1016/j.jvs.2019.06.205

Vancouver

Tsilimparis N, Law Y, Rohlffs F, Spanos K, Debus ES , Kölbel T. Fenestrated endovascular repair for diseases involving the aortic arch. J VASC SURG. 2020 May;71(5):1464-1471. https://doi.org/10.1016/j.jvs.2019.06.205

Bibtex

@article{e91453fd17a54fa8a84635be5fc990e6,

title = "Fenestrated endovascular repair for diseases involving the aortic arch",

abstract = "OBJECTIVE: Extension of aortic disease to the aortic arch is common, frequently requiring cervical debranching procedures to maintain patency of supra-aortic branches. Endovascular aortic arch repair is an attractive alternative in the treatment of aortic arch disease for high-risk patients with thoracoabdominal diseases encroaching on the arch. The aim of our study was to report our experience of fenestrated endovascular repair in the aortic arch.METHODS: A retrospective review of prospectively collected data involving consecutive patients in a single tertiary center treated with custom-made fenestrated endografts for the aortic arch (Cook Medical, Bloomington, Ind) was undertaken. End points included technical success, perioperative mortality and morbidity, reintervention, and late survival.RESULTS: Between 2011 and 2017, there were 44 patients with a mean age of 67 ± 9 years (27 male [61%]) who were treated with fenestrated endografts for arch aneurysm (n = 11 [25%]), arch penetrating aortic ulcer (n = 6 [14%]), thoracoabdominal aneurysm with arch involvement (n = 11 [25%]), postdissection false lumen aneurysm (n = 13 [29%]), or lusorian artery aneurysm (n = 3 [7%]). The proximal landing zone was at Ishimaru zone 0 in 12 cases (27%), zone 1 in 27 cases (62%), and zone 2 in 5 cases (11%). Nine patients (20%) underwent a unilateral carotid-subclavian bypass, two (5%) a bilateral carotid-subclavian bypass, and four (9%) a subclavian transposition. In total, of the 73 target supra-aortic vessels (average of 1.7 target vessels per patient), 37 were treated with fenestrations and 36 with scallops. The mean operation time, fluoroscopy time, and contrast material volume were 215 ± 152 minutes, 33 ± 23 minutes, and 114 ± 45 mL, respectively. Technical success was 95% (42/44). The median intensive care unit and hospital stays were 3 ± 1 days and 7 ± 6 days, respectively. The 30-day mortality was 9% (4/44; one graft displacement and stroke, one retrograde type A dissection, one access complication and stroke, and one death of unknown cause). Major stroke occurred in three (7%), minor stroke in one (2%), temporary spinal cord ischemia in three (7%), and renal injury in three (7%) patients, whereas three (7%) patients required early reintervention. With mean follow-up of 18 ± 17 months, 10 more patients required secondary interventions, most of which (90%) were planned distal intervention to complete the repair of thoracoabdominal diseases. Overall survival rates were 78% ± 7% and 72% ± 8% at postoperative years 1 and 2, respectively.CONCLUSIONS: Fenestrated endograft repair of aortic arch disease is a feasible technique with a high technical success rate and acceptable rates of stroke and paraplegia. A high number of secondary interventions were needed to complete the treatment of underlying diseases.",

keywords = "Aged, Aneurysm, Dissecting/diagnostic imaging, Aorta, Thoracic/diagnostic imaging, Aortic Aneurysm, Thoracic/diagnostic imaging, Blood Vessel Prosthesis, Blood Vessel Prosthesis Implantation/adverse effects, Databases, Factual, Endovascular Procedures/adverse effects, Female, Humans, Male, Middle Aged, Postoperative Complications/mortality, Retrospective Studies, Risk Factors, Stents, Time Factors, Treatment Outcome, Ulcer/diagnostic imaging",

author = "Nikolaos Tsilimparis and Yuk Law and Fiona Rohlffs and Konstantinos Spanos and Debus, {Eike Sebastian} and Tilo K{\"o}lbel",

year = "2020",

month = may,

doi = "10.1016/j.jvs.2019.06.205",

language = "English",

volume = "71",

pages = "1464--1471",

journal = "J VASC SURG",

issn = "0741-5214",

publisher = "Mosby Inc.",

number = "5",

}

RIS

TY - JOUR

T1 - Fenestrated endovascular repair for diseases involving the aortic arch

AU - Tsilimparis, Nikolaos

AU - Law, Yuk

AU - Rohlffs, Fiona

AU - Spanos, Konstantinos

AU - Debus, Eike Sebastian

AU - Kölbel, Tilo

PY - 2020/5

Y1 - 2020/5

N2 - OBJECTIVE: Extension of aortic disease to the aortic arch is common, frequently requiring cervical debranching procedures to maintain patency of supra-aortic branches. Endovascular aortic arch repair is an attractive alternative in the treatment of aortic arch disease for high-risk patients with thoracoabdominal diseases encroaching on the arch. The aim of our study was to report our experience of fenestrated endovascular repair in the aortic arch.METHODS: A retrospective review of prospectively collected data involving consecutive patients in a single tertiary center treated with custom-made fenestrated endografts for the aortic arch (Cook Medical, Bloomington, Ind) was undertaken. End points included technical success, perioperative mortality and morbidity, reintervention, and late survival.RESULTS: Between 2011 and 2017, there were 44 patients with a mean age of 67 ± 9 years (27 male [61%]) who were treated with fenestrated endografts for arch aneurysm (n = 11 [25%]), arch penetrating aortic ulcer (n = 6 [14%]), thoracoabdominal aneurysm with arch involvement (n = 11 [25%]), postdissection false lumen aneurysm (n = 13 [29%]), or lusorian artery aneurysm (n = 3 [7%]). The proximal landing zone was at Ishimaru zone 0 in 12 cases (27%), zone 1 in 27 cases (62%), and zone 2 in 5 cases (11%). Nine patients (20%) underwent a unilateral carotid-subclavian bypass, two (5%) a bilateral carotid-subclavian bypass, and four (9%) a subclavian transposition. In total, of the 73 target supra-aortic vessels (average of 1.7 target vessels per patient), 37 were treated with fenestrations and 36 with scallops. The mean operation time, fluoroscopy time, and contrast material volume were 215 ± 152 minutes, 33 ± 23 minutes, and 114 ± 45 mL, respectively. Technical success was 95% (42/44). The median intensive care unit and hospital stays were 3 ± 1 days and 7 ± 6 days, respectively. The 30-day mortality was 9% (4/44; one graft displacement and stroke, one retrograde type A dissection, one access complication and stroke, and one death of unknown cause). Major stroke occurred in three (7%), minor stroke in one (2%), temporary spinal cord ischemia in three (7%), and renal injury in three (7%) patients, whereas three (7%) patients required early reintervention. With mean follow-up of 18 ± 17 months, 10 more patients required secondary interventions, most of which (90%) were planned distal intervention to complete the repair of thoracoabdominal diseases. Overall survival rates were 78% ± 7% and 72% ± 8% at postoperative years 1 and 2, respectively.CONCLUSIONS: Fenestrated endograft repair of aortic arch disease is a feasible technique with a high technical success rate and acceptable rates of stroke and paraplegia. A high number of secondary interventions were needed to complete the treatment of underlying diseases.

AB - OBJECTIVE: Extension of aortic disease to the aortic arch is common, frequently requiring cervical debranching procedures to maintain patency of supra-aortic branches. Endovascular aortic arch repair is an attractive alternative in the treatment of aortic arch disease for high-risk patients with thoracoabdominal diseases encroaching on the arch. The aim of our study was to report our experience of fenestrated endovascular repair in the aortic arch.METHODS: A retrospective review of prospectively collected data involving consecutive patients in a single tertiary center treated with custom-made fenestrated endografts for the aortic arch (Cook Medical, Bloomington, Ind) was undertaken. End points included technical success, perioperative mortality and morbidity, reintervention, and late survival.RESULTS: Between 2011 and 2017, there were 44 patients with a mean age of 67 ± 9 years (27 male [61%]) who were treated with fenestrated endografts for arch aneurysm (n = 11 [25%]), arch penetrating aortic ulcer (n = 6 [14%]), thoracoabdominal aneurysm with arch involvement (n = 11 [25%]), postdissection false lumen aneurysm (n = 13 [29%]), or lusorian artery aneurysm (n = 3 [7%]). The proximal landing zone was at Ishimaru zone 0 in 12 cases (27%), zone 1 in 27 cases (62%), and zone 2 in 5 cases (11%). Nine patients (20%) underwent a unilateral carotid-subclavian bypass, two (5%) a bilateral carotid-subclavian bypass, and four (9%) a subclavian transposition. In total, of the 73 target supra-aortic vessels (average of 1.7 target vessels per patient), 37 were treated with fenestrations and 36 with scallops. The mean operation time, fluoroscopy time, and contrast material volume were 215 ± 152 minutes, 33 ± 23 minutes, and 114 ± 45 mL, respectively. Technical success was 95% (42/44). The median intensive care unit and hospital stays were 3 ± 1 days and 7 ± 6 days, respectively. The 30-day mortality was 9% (4/44; one graft displacement and stroke, one retrograde type A dissection, one access complication and stroke, and one death of unknown cause). Major stroke occurred in three (7%), minor stroke in one (2%), temporary spinal cord ischemia in three (7%), and renal injury in three (7%) patients, whereas three (7%) patients required early reintervention. With mean follow-up of 18 ± 17 months, 10 more patients required secondary interventions, most of which (90%) were planned distal intervention to complete the repair of thoracoabdominal diseases. Overall survival rates were 78% ± 7% and 72% ± 8% at postoperative years 1 and 2, respectively.CONCLUSIONS: Fenestrated endograft repair of aortic arch disease is a feasible technique with a high technical success rate and acceptable rates of stroke and paraplegia. A high number of secondary interventions were needed to complete the treatment of underlying diseases.

KW - Aged

KW - Aneurysm, Dissecting/diagnostic imaging

KW - Aorta, Thoracic/diagnostic imaging

KW - Aortic Aneurysm, Thoracic/diagnostic imaging

KW - Blood Vessel Prosthesis

KW - Blood Vessel Prosthesis Implantation/adverse effects

KW - Databases, Factual

KW - Endovascular Procedures/adverse effects

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Postoperative Complications/mortality

KW - Retrospective Studies

KW - Risk Factors

KW - Stents

KW - Time Factors

KW - Treatment Outcome

KW - Ulcer/diagnostic imaging

U2 - 10.1016/j.jvs.2019.06.205

DO - 10.1016/j.jvs.2019.06.205

M3 - SCORING: Journal article

C2 - 32063444

VL - 71

SP - 1464

EP - 1471

JO - J VASC SURG

JF - J VASC SURG

SN - 0741-5214

IS - 5

ER -