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Staged total arch replacement, followed by fenestrated-branched endovascular aortic repair, for patients with mega aortic syndrome.
Kawajiri, Hidetake; Tenorio, Emanuel R; Khasawneh, Mohammad A; Pochettino, Alberto; Mendes, Bernardo C; Marcondes, Giulianna B; Lima, Guilherme B B; Oderich, Gustavo S.
Affiliation
  • Kawajiri H; Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn; Department of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn.
  • Tenorio ER; Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Tex.
  • Khasawneh MA; Department of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn.
  • Pochettino A; Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
  • Mendes BC; Department of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn.
  • Marcondes GB; Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Tex.
  • Lima GBB; Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Tex.
  • Oderich GS; Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Tex. Electronic address: gustavo.oderich@uth.tmc.edu.
J Vasc Surg ; 73(5): 1488-1497.e1, 2021 05.
Article in En | MEDLINE | ID: mdl-33189762
OBJECTIVE: The aim of the present study was to review the clinical outcomes of a staged approach using total arch replacement (TAR) with an elephant trunk or a frozen elephant trunk, followed by fenestrated-branched endovascular aortic repair (F-BEVAR) for patients with mega aortic syndrome. METHODS: We reviewed the clinical data and outcomes of 11 consecutive patients (8 men; mean age, 71 ± 7 years) treated by staged TAR and F-BEVAR from January 2014 to December 2018. The F-BEVAR procedures were performed under a prospective, nonrandomized, physician-sponsored investigational device exemption protocol. All patients had had mega aortic syndrome, defined by an ascending aorta, arch, and extent I-II thoracoabdominal aortic aneurysm. The endpoints were 30-day mortality, major adverse events (MAE), patient survival, freedom from reintervention, and freedom from target vessel instability. RESULTS: Of the 11 patients, 6 had developed chronic postdissection aneurysms after previous Stanford A (three A11, two A10, one A9) dissection repair and 5 had had degenerative aneurysms with no suitable landing zone in the aortic arch. The thoracoabdominal aortic aneurysms were classified as extent I in four patients and extent II in seven. One patient had died within 30 days after TAR (9.0%). However, none of the remaining 10 patients who had undergone F-BEVAR had died. First-stage TAR resulted in MAE in three patients (27%), including one spinal cord injury. The mean length of stay was 12 ± 6 days. The mean interval between TAR and F-BEVAR was 245 ± 138 days with no aneurysm rupture during the interval. Second-stage F-BEVAR was associated with MAE in two patients (20%), including spinal cord injury in one patient from spinal hematoma due to placement of a cerebrospinal fluid drain. The mean follow-up period was 14 ± 10 months. At 2 years postoperatively, patient survival, primary patency, secondary patency, and freedom from renal-mesenteric target vessel instability was 80% ± 9%, 94% ± 6%, 100%, and 86% ± 8%, respectively. No aortic-related deaths occurred during the follow-up period. Four patients had required reintervention, all performed using an endovascular approach. CONCLUSIONS: A staged approach to treatment of mega aortic syndrome using TAR and F-BEVAR is a feasible alternative for selected high-risk patients. Larger clinical experience and longer follow-up are needed.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Aorta, Thoracic / Aortic Aneurysm, Thoracic / Blood Vessel Prosthesis Implantation / Endovascular Procedures / Aortic Dissection Type of study: Guideline / Observational_studies / Risk_factors_studies Limits: Aged / Female / Humans / Male / Middle aged Language: En Journal: J Vasc Surg Journal subject: ANGIOLOGIA Year: 2021 Document type: Article Country of publication: United States

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Aorta, Thoracic / Aortic Aneurysm, Thoracic / Blood Vessel Prosthesis Implantation / Endovascular Procedures / Aortic Dissection Type of study: Guideline / Observational_studies / Risk_factors_studies Limits: Aged / Female / Humans / Male / Middle aged Language: En Journal: J Vasc Surg Journal subject: ANGIOLOGIA Year: 2021 Document type: Article Country of publication: United States