Document Detail


Hybrid repair of thoracic aortic lesions for zone 0 and 1 in high-risk patients.
MedLine Citation:
PMID:  22047829     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: Some patients with aortic arch or descending thoracic aorta pathologies are not suited for open repair because of comorbidities that may increase their risk of procedural complications or death. Endovascular approaches may also be difficult when there are inadequate proximal landing zones in the aortic arch. We report our experience using rerouting techniques with bypass, stenting of the branches, or a combination of both to create a landing area in zones 0 and 1 of the aortic arch.
METHODS: Since November 2002, thoracic aortic endoluminal grafts were placed in 38 patients in whom the endograft was deployed in zone 0 (n = 27) or zone 1 (n = 11). A retrospective review is included.
RESULTS: There were 11 women and 27 men with a mean age of 65.4 years (range 38-88). Aortic pathology included 12 Stanford type A dissections, 10 aortic arch aneurysms, 8 Stanford type B dissections, 3 descending thoracic aortic aneurysms, 2 aortobronchial fistulas, 1 innominate artery aneurysm and 2 aortic arch pseudoaneurysms. In zone 0, 21 had thoracic debranching with an ascending bypass, three patients had a remote-inflow and three patients had a chimney-stent with carotid-carotid bypass. In zone 1, five patients had a carotid-carotid bypass, one patient had an aortic to left common carotid artery (LCCA) bypass and five patients had chimney-stent on the LCCA. Fifty-eight percent of the patients were symptomatic and 26% emergent. Three patients required hemodialysis postoperatively (7.9%), 18 patients (47.4%) required prolonged mechanical ventilation for respiratory insufficiency. Paraplegia occurred in one patient (2.7%), and five patients suffered a cerebrovascular accident (13.1%). There were four early type I and two type II endoleaks. Overall 30-day mortality was 23.7%.
CONCLUSIONS: The hybrid approach for repair of the aortic arch pathologies is feasible in patients unfit for open repair. We present the results of performing different techniques to treat the aortic arch with hybrid repair with antegrade or retrograde inflow, stenting of the branches or a combination of both. Long-term results are unknown, and larger series results and comparative studies are needed to determine safety and efficacy.
Authors:
Nadia Vallejo; Julio A Rodriguez-Lopez; Paniz Heidari; Grayson Wheatley; David Caparrelli; Venkatesh Ramaiah; Edward B Diethrich
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Publication Detail:
Type:  Journal Article     Date:  2011-11-01
Journal Detail:
Title:  Journal of vascular surgery     Volume:  55     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-01-23     Completed Date:  2012-03-12     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  318-25     Citation Subset:  IM    
Copyright Information:
Published by Mosby, Inc.
Affiliation:
Department of Cardiovascular and Endovascular Surgery, Arizona Heart Institute & Hospital, Phoenix, AZ 85006, USA. jrodriguez@azheart.com
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Aorta, Thoracic / radiography,  surgery*
Aortic Diseases / mortality,  radiography,  surgery*
Aortography / methods
Arizona
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation* / adverse effects,  instrumentation,  mortality
Endovascular Procedures* / adverse effects,  instrumentation,  mortality
Feasibility Studies
Female
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Postoperative Complications / etiology
Retrospective Studies
Risk Assessment
Risk Factors
Stents
Time Factors
Tomography, X-Ray Computed
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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