Document Detail


Endovascular repair of aortic arch lesions in high-risk patients or after previous aortic surgery: midterm results.
MedLine Citation:
PMID:  19919865     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The aim of this study was to assess the short- and midterm results after endovascular repair of the aortic arch in high-risk patients or after previous aortic surgery. METHODS: From November 1998 to November 2008, 57 thoracic stent grafts were implanted in 44 patients (sex ratio, 4.5; mean age, 66.5 +/- 16.5 years) for aortic arch repair (zone 0 to 2 according to the arch map proposed by Ishimaru) of 19 degenerative aneurysms, 12 traumatic transections of the aorta, 8 complicated aortic dissections, 4 postcoarctectomy aortic pseudoaneurysms, and 1 penetrating atheromatous ulcer. All patients were considered to be at high surgical risk owing to serious comorbidities (American Society of Anesthesiologists score > or = III [79.5%]) or previous aortic surgery. Endovascular repair was performed in an emergency setting in 27.3% (n = 12) of the patients. Thirty-four underwent a hybrid technique with supra-aortic debranching and simultaneous or staged endovascular stent grafting. Debranching was performed to provide an adequate proximal aortic landing zone, in 28 patients by a cervical approach and in 6 patients by a sternotomy approach. RESULTS: The technical success rates for aortic zone 0 patients (n = 6), zone 1 patients (n = 4), and zone 2 patients (n = 34) were, respectively, 100%, 100%, and 97%. The 30-day mortality rate was 20.4%. The actuarial survival was 70% over a mean follow-up of 29.9 months. The rate of stroke was 6.8%. Two (4.5%) cases of paraplegia were observed, 1 of which was reversible after cerebrospinal fluid drainage. The rate of endoleak was 15.9% (n = 7): 3 type I, 3 type II, and 1 type III. There were no cases of device migration, but 1 stent-graft collapse occurred 20 days after exclusion of an aortic traumatic transection. CONCLUSION: Hybrid endovascular aortic arch reconstructions, although some of these adjunctive procedures remain major operations, provide attractive alternatives for treating aortic arch lesions in high-risk patients who would otherwise be unsuitable for open repair, with acceptable primary results and encouraging midterm efficacy to prevent rupture.
Authors:
Ludovic Canaud; Kheira Hireche; Jean-Philippe Berthet; Pascal Branchereau; Charles Marty-Ané; Pierre Alric
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  140     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-07-12     Completed Date:  2010-08-12     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  52-8     Citation Subset:  AIM; IM    
Copyright Information:
2010 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
Affiliation:
Department of Vascular and Thoracic Surgery Arnaud de Villeneuve Hospital, Montpellier, France.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Aorta, Thoracic / surgery*
Aortic Diseases / complications,  mortality,  surgery*
Aortic Rupture / etiology,  mortality,  prevention & control*
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation* / adverse effects,  instrumentation,  mortality
Female
Humans
Kaplan-Meiers Estimate
Male
Middle Aged
Paraplegia / etiology
Patient Selection
Prosthesis Failure
Reoperation
Risk Assessment
Risk Factors
Stents
Stroke / etiology
Time Factors
Treatment Outcome
Young Adult

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