The Results of the Use of the Technique of Switching the Vessels of the Aortic Arch in the Formation of the Avascular Zone of Stent-Graft Fixation in the Hybrid Treatment of Thoracic Aortic Aneurysms

DOI: https://doi.org/10.30702/ujcvs/22.30(01)/PK002-3236
Keywords: TEVAR, thoracic endovascular aortic repair, covering of the left subclavian artery, “landing zone”, type B aortic dissection, endoleak, steal syndrome

Abstract

Thoracic and aortic aneurysms, including Stanford type B and neither A nor B aneurysms, are a complex problem for cardiac surgery. For a long time, the treatment of this pathology was carried out through the open method, which was associated with high hospital mortality. Hybrid and endovascular treatment have significantly reduced the number of complications and improved in-hospital mortality, although such methods are associated with specific difficulties, the study and elimination of which is an urgent issue at the present stage of cardiac surgery.

The aim. To analyze the immediate and first long-term results of treatment of type B and non-A non-B aortic dissection through the hybrid method with the formation of avascular zone of proximal fixation of the stent-graft in the aortic arch, i.e. “landing zone”.

Materials and methods. For the period from January 1, 2016 to December 31, 2019 at the National Amosov Institute of Cardiovascular Surgery of the NAMS of Ukraine 122 patients underwent surgical treatment for type B and non-A nonB aortic dissection, of whom 57 (46.7%) patients underwent hybrid intervention involving the formation of a “landing zone”, i.e. an avascular section of the aortic arch to fix the stent-graft. Stent-graft was implanted in Z0 in 5 (8.8%) cases, in Z1 in 24 (42.1%) cases, and in Z2 in 28 (49.1%) cases. The stent-grafts used were Lifetech Ankura (41 cases), Relay (12 cases), and Medtronic Valiant (4 cases). The main causes of pathology were type B acute aortic aneurysm (11 [19%]), type B subacute aortic aneurysm (4 [7%]), type B chronic aortic aneurysm (30 [53%]), penetrating aortic ulcer (1 [2%]), primary parietal thrombosis of the aortic lumen (1 [2%]), postcoarctation aortic aneurysm (8 [14%]), thoracic aortic aneurysm (3 [5%]).

Results. The total number of complications was 11 (19% of cases). Among the types of operations, the number of complications was evenly distributed, 5/28 (18%) were observed in partial debranching, 5/27 (19%) in subtotal debranching and 1/2 (50%) in total debranching. Hospital mortality was 3/122 (5.3%).

Conclusions. The described methods of treatment of aneurysms of the arch and descending aorta have real prospects for development due to minimal invasiveness, reduction of the duration of surgery and time spent in the clinic, and significantly lower in-hospital mortality compared to traditional “open” surgery.

References

  1. Patel AY, Eagle KA, Vaishnava P. Acute type B aortic dissection: insights from the International Registry of Acute Aortic Dissection. Ann Cardiothorac Surg. 2014;3(4):368-74. https://doi.org/10.3978/j.issn.2225-319X.2014.07.06
  2. Fang C, Wang C, Liu K, Pang X. Early Outcomes of Left Subclavian Artery Revascularization Using Castor Single-Branched Stent-Graft in the Treatment of Type B Aortic Dissection or Intramural Hematoma. Ann Thorac Cardiovasc Surg. 2021;27(4):251-9. https://doi.org/10.5761/atcs.oa.20-00166
  3. Belczak SQ, Silva ES, Klajner R, Puech-Leão P, De Luccia N. Type II Endoleaks, Left-Arm Complications, and Need of Revascularization after Left Subclavian Artery Coverage for Thoracic Aortic Aneurysms Endovascular Repair: A Systematic Review. Ann Vasc Surg. 2017;41:294-9. https://doi.org/10.1016/j.avsg.2016.08.049
  4. Okita Y, Ando M, Minatoya K, Kitamura S, Takamoto S, Nakajima N. Predictive factors for mortality and cerebral complications in arteriosclerotic aneurysm of the aortic arch. Ann Thorac Surg. 1999;67(1):72-8. https://doi.org/10.1016/s0003-4975(98)01043-1
  5. Jacobs MJ, de Mol BA, Veldman DJ. Aortic arch and proximal supraaortic arterial repair under continuous antegrade cerebral perfusion and moderate hypothermia. Cardiovasc Surg. 2001;9(4):396-402. https://doi.org/10.1016/s0967-2109(01)00009-6
  6. Bellamkonda KS, Yousef S, Nassiri N, Dardik A, Guzman RJ, Geirsson A, Ochoa Chaar CI. Trends and outcomes of thoracic endovascular aortic repair with open concomitant cervical debranching. J Vasc Surg. 2021;73(4):1205-12.e3. https://doi.org/10.1016/j.jvs.2020.07.103
  7. Konstantinou N, Debus ES, Vermeulen CFW, Wipper S, Diener H, Larena-Avellaneda A, Kölbel T, Tsilimparis N. Cervical Debranching in the Endovascular Era: A Single Centre Experience. Eur J Vasc Endovasc Surg. 2019;58(1):34-40. https://doi.org/10.1016/j.ejvs.2018.12.010
  8. Madenci AL, Ozaki CK, Belkin M, McPhee JT. Carotid-subclavian bypass and subclavian-carotid transposition in the thoracic endovascular aortic repair era. J Vasc Surg. 2013;57(5):1275-82.e2. https://doi.org/10.1016/j.jvs.2012.11.044
  9. Zamor KC, Eskandari MK, Rodriguez HE, Ho KJ, Morasch MD, Hoel AW. Outcomes of Thoracic Endovascular Aortic Repair and Subclavian Revascularization Techniques. J Am Coll Surg. 2015;221(1):93-100. https://doi.org/10.1016/j.jamcollsurg.2015.02.028
  10. Buth J, Harris PL, Hobo R, van Eps R, Cuypers P, Duijm L, Tielbeek X. Neurologic complications associated with endovascular repair of thoracic aortic pathology: Incidence and risk factors. a study from the European Collaborators on Stent/Graft Techniques for Aortic Aneurysm Repair (EU-ROSTAR) registry. J Vasc Surg. 2007;46(6):1103-10; discus-sion 1110-1. https://doi.org/10.1016/j.jvs.2007.08.020
  11. Rizvi AZ, Murad MH, Fairman RM, Erwin PJ, Montori VM. The effect of left subclavian artery coverage on morbidity and mortality in patients undergoing endovascular thoracic aortic interventions: a systematic review and meta-analysis. J Vasc Surg. 2009;50(5):1159-69. https://doi.org/10.1016/j.jvs.2009.09.002
  12. Teixeira PG, Woo K, Beck AW, Scali ST, Weaver FA; Society for Vascular Surgery, Vascular Quality Initiative (VQI)®. Association of left subclavian artery coverage without revascularization and spinal cord ischemia in patients undergoing thoracic endovascular aortic repair: A Vascular Quality Initiative® analysis. Vascular. 2017;25(6):587-97. https://doi.org/10.1177/1708538116681910
  13. Bradshaw RJ, Ahanchi SS, Powell O, Larion S, Brandt C, Soult MC, Panneton JM. Left subclavian artery revascularization in zone 2 thoracic endovascular aortic repair is associated with lower stroke risk across all aortic diseases. J Vasc Surg. 2017;65(5):1270-9. https://doi.org/10.1016/j.jvs.2016.10.111
  14. Hajibandeh S, Hajibandeh S, Antoniou SA, Torella F, Antoniou GA. Meta-analysis of Left Subclavian Artery Coverage With and Without Revascularization in Thoracic En-dovascular Aortic Repair. J Endovasc Ther. 2016;23(4):634-41. https://doi.org/10.1177/1526602816651417
  15. Bavaria JE, McCarthy FH. TEVAR Versus Open Surgery in Medicare Patients With Descending Thoracic Aneurysms: And the Winner Is? J Am Coll Cardiol. 2019;73(6):652-3. https://doi.org/10.1016/j.jacc.2018.11.037
  16. Conrad MF, Ergul EA, Patel VI, Paruchuri V, Kwolek CJ, Cambria RP. Management of diseases of the descending thoracic aorta in the endovascular era: a Medicare population study. Ann Surg. 2010;252(4):603-10. https://doi.org/10.1097/SLA.0b013e3181f4eaef
  17. Fukushima S, Ohki T, Toya N, Shukuzawa K, Ito E, Murakami Y, Akiba T. Initial results of thoracic endovascular repair for uncomplicated type B aortic dissection involving the arch vessels using a semicustom-made thoracic fenestrated stent graft. J Vasc Surg. 2019;69(6):1694-703. https://doi.org/10.1016/j.jvs.2018.09.028
  18. Konstantinou N, Kölbel T, Debus ES, Rohlffs F, Tsilimparis N. Fenestrated versus debranching thoracic endovascular aortic repair for endovascular treatment of distal aortic arch and descending aortic lesions. J Vasc Surg. 2021;73(6):1915-24. https://doi.org/10.1016/j.jvs.2020.10.078
Published
2022-03-23
How to Cite
1.
Kravchenko VI, Perepeliuk AI, Zhekov II, Cherpak BV, Sarhosh OI. The Results of the Use of the Technique of Switching the Vessels of the Aortic Arch in the Formation of the Avascular Zone of Stent-Graft Fixation in the Hybrid Treatment of Thoracic Aortic Aneurysms. ujcvs [Internet]. 2022Mar.23 [cited 2024Dec.22];30(1):32-6. Available from: http://cvs.org.ua/index.php/ujcvs/article/view/465
Issue
Ukrainian Journal of Cardiovascular Surgery Vol 30 No 1 2022
Section
PATHOLOGY OF AORTA

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