Aortic dissection: Perspectives in the era of stent-graft repair

Slides:

Advertisements

Similar presentations

Stent graft repair of descending aortic dissection in patients with Marfan syndrome: An effective alternative to open reoperation? Luca Botta, MD, Vincenzo.

Advertisements

Penetrating atherosclerotic ulcers of the thoracic aorta

Restrictive bare stent for prevention of stent graft-induced distal redissection after thoracic endovascular aortic repair for type B aortic dissection

James H. Black, MD, Richard P. Cambria, MD Journal of Vascular Surgery

Thoracic Aortic Frontier: Review of Current Applications and Directions of Thoracic Endovascular Aortic Repair (TEVAR) Jehangir J. Appoo, MDCM, FRCSC,

Hemodynamic evaluation using four-dimensional flow magnetic resonance imaging for a patient with multichanneled aortic dissection Baolei Guo, MD, PhD,

Vascular complications associated with spontaneous aortic dissection

Jacques Kpodonu, MD, Venkatesh G. Ramaiah, MD, Edward B. Diethrich, MD

Endovascular management of acute aortic dissections

Combined proximal stent grafting plus distal bare metal stenting for management of aortic dissection: Superior to standard endovascular repair? Sophie.

Aortoduodenal fistula 5 years after endovascular abdominal aortic aneurysm repair with the Ancure stent graft Blaine J. Ruby, MD, Thomas H. Cogbill,

Stent graft repair of descending aortic dissection in patients with Marfan syndrome: An effective alternative to open reoperation? Luca Botta, MD, Vincenzo.

Combined surgical and endovascular treatment of aortic arch aneurysms

Prospective multicenter clinical trial (STABLE) on the endovascular treatment of complicated type B aortic dissection using a composite device design

Simplified total arch repair with a stented graft for acute DeBakey type I dissection Enyi Shi, MD, PhD, Tianxiang Gu, MD, PhD, Yang Yu, MD, Chun Wang,

Leon M. Ptaszek, MD, PhD, Kibeom Kim, BA, Amy E. Spooner, MD, Thomas E

Volume changes in aortic true and false lumen after the “PETTICOAT” procedure for type B aortic dissection Germano Melissano, MD, Luca Bertoglio, MD,

A single-center experience treating renal malperfusion after aortic dissection with central aortic fenestration and renal artery stenting Dawn M. Barnes,

Surgery for acute type A aortic dissection

Stent graft–induced new entry tear (SINE): Intentional and NOT

Endovascular repair of complicated chronic distal aortic dissections: Intermediate outcomes and complications Woong Chol Kang, MD, PhD, Roy K. Greenberg,

Joseph S. Coselli, MD, Peter Oberwalder, MD

Shane S. Parmer, MD, Jeffrey P. Carpenter, MD

Acute retrograde aortic dissection during endovascular repair of a thoracic aortic aneurysm Noëlla Bethuyne, MD, Thierry Bove, MD, Pierre Van den Brande,

Gary R. Seabrook, MD Journal of Vascular Surgery

Christopher L. Stout, MD, Eric C. Scott, MD, Gordon K

George Matalanis, BSc, MB, MS, FRACS, Shoane Ip, MBBS, BMedSc, FRACS

Volume 38, Pages (January 2018)

Mark F. Conrad, MD, Robert S. Crawford, MD, Christopher J

Risk factors of incomplete thrombosis in the false lumen after endovascular treatment of extensive acute type B aortic dissection Yong-Lin Qin, MD, Gang.

Restrictive bare stent for prevention of stent graft-induced distal redissection after thoracic endovascular aortic repair for type B aortic dissection

Successful surgical treatment of multilevel aortic aneurysms combined with renal transplantation Ivan Matia, MD, PhD, Jan Pirk, MD, PhD, Květoslav Lipar,

Timothy A.M. Chuter, DM Journal of Vascular Surgery

Staged hybrid approach using proximal thoracic endovascular aneurysm repair and distal open repair for the treatment of extensive thoracoabdominal aortic.

Efficacy and durability of the chimney graft technique in urgent and complex thoracic endovascular aortic repair Adel Bin Jabr, MD, Bengt Lindblad, MD,

Management of acute type B aortic dissection

Endovascular treatment of acute type B dissection complicating graft-bypass repair for aortic coarctation Serkan Ertugay, Hakan Posacıoglu, Mustafa Parildar,

A Complex Thoracoabdominal Aneurysm in a Loeys-Dietz Patient: An Open, Hybrid, Anatomic Repair Eugenio Neri, MD, Giulio Tommasino, MD, Enrico Tucci,

Late complications of thoracic endografts

Penetrating atherosclerotic ulcers of the thoracic aorta

Extended aortic replacement for acute type a dissection with the tear in the descending aorta Terushisa Kazui, MD, Yukihiko Tamiya, MD, Toshiaki Tanaka,

Stent graft-induced new entry after endovascular repair for Stanford type B aortic dissection Zhihui Dong, MD, Weiguo Fu, MD, Yuqi Wang, MD, Chunsheng.

Acute iatrogenic type A aortic dissection following thoracic aortic endografting Gabriele Piffaretti, MD, Giovanni Mariscalco, MD, PhD, Matteo Tozzi,

Placement of a branched stent graft into the false lumen of a chronic type B aortic dissection Dominic Simring, FRACS (Vasc), Jowad Raja, MRCS, FRCR,

Combined endovascular and surgical approach (CESA) to thoracoabdominal aortic pathology: A 10-year experience William Quinones-Baldrich, MD, Juan Carlos.

Staged hybrid repair of extensive thoracoabdominal aortic aneurysms secondary to chronic aortic dissection Amit Jain, MD, Tanya F. Flohr, MD, William.

Double-chimney technology for treating secondary type I endoleak after endovascular repair for complicated thoracic aortic dissection Rui Feng, MD, PhD,

The use of an aortoiliac side-arm conduit to maintain distal perfusion during thoracoabdominal aortic aneurysm repair Kenneth Ouriel, MD Journal of.

Coil embolization of persistent false lumen after stent graft repair of type B aortic dissection Enrique María San Norberto, MD, Vicente Manuel Gutiérrez,

Fenestrated and branched endovascular aortic repair for chronic type B aortic dissection with thoracoabdominal aneurysms Atsushi Kitagawa, MD, Roy K.

Thomas J. Takach, MD, Jeko M. Madjarov, MD, Jeremiah H

The first endovascular repair of an acute type A dissection using an endograft designed for the ascending aorta Matthew J. Metcalfe, MD, MRCS, Alan Karthikesalingam,

Aortic type B dissection with acute expansion of iliac artery aneurysm in previous endovascular repair with iliac branched graft Raffaele Pulli, MD,

James H. Black, MD Journal of Vascular Surgery

Primary aortoesophageal fistula from aortic aneurysm: Successful surgical treatment by use of omental pedicle graft Joseph S. Coselli, MD, E.Stanley.

Emergent endovascular stent-graft placement to treat ruptured Stanford type B acute aortic dissection Saori Kawamura, MD, Hiroshi Nishimaki, MD, PhD,

Pregnancy-Associated Type B Aortic Dissection Treated With Thoracic Endovascular Aneurysm Repair Chang Shu, MD, PhD, Kun Fang, MD, Alan Dardik, MD, PhD,

Balloon expandable stents facilitate right renal artery reconstruction during complex open aortic aneurysm repair Rajendra Patel, MD, Mark F. Conrad,

G. Chad Hughes, MD, Asvin M. Ganapathi, MD, Jeffrey E

Shane S. Parmer, MD, Jeffrey P. Carpenter, MD

Type B aortic dissection after endovascular abdominal aortic aneurysm repair causing endograft collapse and severe malperfusion Vikram Iyer, MD, Mark.

Assessment of abdominal branch vessel patency after bare-metal stenting of the thoracoabdominal aorta in a human ex vivo model of acute type B aortic.

Sukgu M. Han, MD, Warren J. Gasper, MD, Timothy A.M. Chuter, MD

John L. Anderson, Donald J. Adam, MD, Michael Berce, David E. Hartley

Hybrid Repair of an Aortic Arch Aneurysm Using Double Parallel Grafts Perfused by Retrograde Flow in Endovascular Repair Combined With Left Subclavian.

A novel percutaneous double-lumen stent graft technique for treatment of chronic type B aortic dissection under local anesthesia Sophie Wang, BS, Mahmoud.

Endovascular longitudinal fenestration and stent graft placement for treatment of aneurysms developing after chronic type B aortic dissection Neal R.

A staged replacement of the entire aorta from the ascending arch to the hypogastric arteries using a hybrid approach Juan Carlos Jimenez, MD, Wesley.

Mesenteric vascular insufficiency and claudication following acute dissecting thoracic aortic aneurysm Thomas H. Cogbill, M.D., A.Erik Gundersen, M.D.,

Retrograde ascending Stanford B aortic dissection complicating a routine infrarenal endovascular aortic reconstruction Apostolos T. Mamopoulos, MD, Thomas.

Presentation transcript:

Aortic dissection: Perspectives in the era of stent-graft repair Marvin D. Atkins, MD, James H. Black, MD, Richard P. Cambria, MD Journal of Vascular Surgery Volume 43, Issue 2, Pages A30-A43 (February 2006) DOI: 10.1016/j.jvs.2005.10.052 Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 1 DeBakey and Stanford classification schemes for acute aortic dissection. The principle distinction between proximal and distal dissections is the involvement of the ascending aorta. Journal of Vascular Surgery 2006 43, A30-A43DOI: (10.1016/j.jvs.2005.10.052) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 2 Demographic and clinical features of 512 patients with acute aortic dissection classified by the DeBakey system. The distribution of dissection extent, demographic features, and incidence of peripheral vascular complications were similar over the 35-year period (1965 to 1999) in which these patients were treated. Patients with type III dissections tend to be older and almost universally hypertensive. As anticipated, vascular complications tend to cluster among the more extensive type I and IIIb dissections. HBP, High blood pressure; VC, vascular complications. (Adapted from Lauterbach SR, Cambria RP, Brewster DC, et al: Contemporary management of aortic branch compromise resulting from acute aortic dissection. J Vasc Surg 2001;33:1185-92 and Cambria RP, Brewster DC, Gertler J, et al: Vascular complications associated with spontaneous aortic dissection. J Vasc Surg 1988;7:199-209.) Journal of Vascular Surgery 2006 43, A30-A43DOI: (10.1016/j.jvs.2005.10.052) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 3 Stent-graft treatment (white arrow) of a mid descending thoracic aorta penetrating atheromatous ulcer (black arrows). Journal of Vascular Surgery 2006 43, A30-A43DOI: (10.1016/j.jvs.2005.10.052) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 4 Distribution of peripheral vascular complications in 512 patients over a 35-year period (1965 to 1999) treated at the Massachusetts General Hospital. Peripheral vascular complications are classified by aortic branch site. Differences between site occlusions and clinical events represent asymptomatic occlusions. HBP, high blood pressure. Journal of Vascular Surgery 2006 43, A30-A43DOI: (10.1016/j.jvs.2005.10.052) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 5 Mechanisms of aortic branch obstruction in acute dissection. A, In dynamic obstruction, the septum may prolapse into the vessel ostium during the cardiac cycle, and the compressed true lumen flow is inadequate to perfuse branch vessel ostia, which remain anatomically intact. B, Near complete circumferential dissection with static obstruction. The cleavage plane of the dissection extends into the ostium and compromises inflow. Thrombosis beyond the compromised ostia may further worsen perfusion. C, Spontaneous perfusion of aortic branches perfused from the false lumen occurs if the dissecting process tears the ostia away from the true lumen. Such spontaneous “fenestrations” often account for persistent false lumen flow. F, false lumen; T, true lumen. Journal of Vascular Surgery 2006 43, A30-A43DOI: (10.1016/j.jvs.2005.10.052) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 6 Sagittal computed tomography view of aortic dissection. Journal of Vascular Surgery 2006 43, A30-A43DOI: (10.1016/j.jvs.2005.10.052) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 7 Surgical fenestration of the infrarenal aorta. The septum is excised up to the clamp (dashed line), and proximal anastomosis to a short tube graft is carried out with interrupted pledgetted fine sutures (because part of the anastomosis circumference is carried out to the adventitial layer alone). The distal aortic suture line (inset) is carried out to an aorta-felt composite after aortic layers have been approximated. Journal of Vascular Surgery 2006 43, A30-A43DOI: (10.1016/j.jvs.2005.10.052) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 8 Stent-graft deployment to cover the proximal entry tear in the hopes of inducing false lumen thrombosis and true lumen re-expansion. The latter should also alleviate “downstream” branch compromise caused by dynamic obstruction mechanisms. False lumen thrombosis in the thoracic aorta should, in theory, minimize subsequent aneurysmal expansion of the outer wall of the false lumen. Journal of Vascular Surgery 2006 43, A30-A43DOI: (10.1016/j.jvs.2005.10.052) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 9 Thoracic aortic stent-graft designed specifically for treatment of dissection. This particular polyester-over-Z-stent construct has bare metal proximal fixation stents (desirable to minimize risk of retrograde dissection) but is augmented with multiple uncovered distal stents to insure true lumen expansion. Journal of Vascular Surgery 2006 43, A30-A43DOI: (10.1016/j.jvs.2005.10.052) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 10 Anatomic requirements for stent-graft repair of acute aortic dissection. Journal of Vascular Surgery 2006 43, A30-A43DOI: (10.1016/j.jvs.2005.10.052) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 11 Endovascular balloon fenestration from the true to the false lumen. This causes decompression of the false lumen and allows perfusion of side branches originating from the true lumen and compromised by dynamic obstruction (see text). In this particular example, note also static obstruction of the left renal artery, which will require stenting from the true lumen. Journal of Vascular Surgery 2006 43, A30-A43DOI: (10.1016/j.jvs.2005.10.052) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 12 Thoracoabdominal aneurysm of chronic dissection etiology 22 years after short graft repair of type B dissection entry tear (large arrow). Note large aneurysmal dilatation of the outer wall false lumen and narrowed compressed true lumen (3 arrows), from which multiple patent intercostals vessels emanate. Open surgical thoracoabdominal resection was curative. Journal of Vascular Surgery 2006 43, A30-A43DOI: (10.1016/j.jvs.2005.10.052) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions