Document Detail


Strategies for managing the insufficiency of the proximal landing zone during endovascular thoracic aortic repair.
MedLine Citation:
PMID:  16098257     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The insufficiency of the proximal landing zone (PLZ) is a frequent factor challenging the applicability and efficacy of endovascular repair (EVR) for thoracic aortic disorders. This study discusses two strategies for conquering this challenge. METHODS: Ten patients underwent EVR for thoracic aortic diseases during a one-year period ending June 30, 2004. Nine patients had DeBakey type III dissecting aortic aneurysm (DAA), and one had descending thoracic aortic aneurysm (DTAA). The PLZ, defined as the distance from the origin of the left subclavian artery (LSA) to the primary entry tear of the dissection or to the proximal aspect of DTAA, was less than 15 mm in all instances. EVR with intentional coverage of the LSA without any supportive bypass was employed in 6 patients with DAA, and the preliminary right-left carotid and left carotid-subclavian bypass combined with EVR in the DTAA and other 3 DAA cases. RESULTS: Technical success was achieved in all the patients. The patient with DTAA died from hemispheric cerebral infarction and subsequent multiple system organ failure following an uneventful recovery from the cervical reconstruction performed 1 week previously. In cases receiving the EVR with intentional coverage of the LSA, in two patients dizziness occurred, which noticeably resolved after intravenous administration of mannitol for 4 to 5 days, and a drop in blood pressure of the left arm was noted in all the cases, but remained clinically silent. No neurological deficits or limb ischaemia developed perioperatively or during the followup, ranging from 3 to 12 months, and complete thrombosis of the thoracic aortic false lumen was revealed on CT at 3 months in the 9 patients with DAA. CONCLUSIONS: Both the intentional bypass absent coverage of the LSA and the adjunctive surgical bypass appear to be feasible and effective in managing the insufficiency of the PLZ during the endovascular thoracic aortic repair.
Authors:
Wei-guo Fu; Zhi-hui Dong; Yu-qi Wang; Da-qiao Guo; Xin Xu; Bin Chen; Jun-hao Jiang; Jue Yang; Zheng-yu Shi
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Chinese medical journal     Volume:  118     ISSN:  0366-6999     ISO Abbreviation:  Chin. Med. J.     Publication Date:  2005 Jul 
Date Detail:
Created Date:  2005-08-15     Completed Date:  2005-09-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7513795     Medline TA:  Chin Med J (Engl)     Country:  China    
Other Details:
Languages:  eng     Pagination:  1066-71     Citation Subset:  IM    
Affiliation:
Division of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aorta, Thoracic / surgery*
Aortic Aneurysm, Thoracic / surgery*
Humans
Male
Middle Aged
Vascular Surgical Procedures

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