Thoracic endovascular aortic repair with branched Inoue Stent Graft for arch aortic aneurysms Junichi Tazaki, MD, Kanji Inoue, MD, Hirooki Higami, MD,

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Presentation transcript:

Thoracic endovascular aortic repair with branched Inoue Stent Graft for arch aortic aneurysms Junichi Tazaki, MD, Kanji Inoue, MD, Hirooki Higami, MD, Nobuya Higashitani, MD, Masanao Toma, MD, Naritatsu Saito, MD, Masahide Kawatou, MD, Takeshi Kimura, MD Journal of Vascular Surgery Volume 66, Issue 5, Pages 1340-1348.e5 (November 2017) DOI: 10.1016/j.jvs.2017.03.432 Copyright © 2017 The Authors Terms and Conditions

Fig 1 Study flow chart. DAA, Dissecting aneurysm of aorta; PDA, patent ductus arteriosus; TEVAR, thoracic endovascular aortic repair. Journal of Vascular Surgery 2017 66, 1340-1348.e5DOI: (10.1016/j.jvs.2017.03.432) Copyright © 2017 The Authors Terms and Conditions

Fig 2 Branched Inoue Stent Graft (ISG). A, Single branch. B, Double branch. C, Triple branch. Journal of Vascular Surgery 2017 66, 1340-1348.e5DOI: (10.1016/j.jvs.2017.03.432) Copyright © 2017 The Authors Terms and Conditions

Fig 3 Volume-rendered computed tomography (CT) images (left) before and (right) after implantation of the (A) single-branch, (B) double-branch, and (C) triple-branch Inoue Stent Graft (ISG). Journal of Vascular Surgery 2017 66, 1340-1348.e5DOI: (10.1016/j.jvs.2017.03.432) Copyright © 2017 The Authors Terms and Conditions

Fig 4 Kaplan-Meier curves for aneurysm-related death and all-cause death. The estimated event-free survival of aneurysm-related death and standard error was 93% ± 2.7% at 1 year, 93% ± 2.7% at 2 years, 93% ± 2.7% at 3 years, 93% ± 2.7% at 4 years, and 93% ± 2.7% at 5 years. The estimated event-free survival of all-cause death and standard error was 85% ± 3.8% at 1 year, 77% ± 4.5% at 2 years, 70% ± 5.0% at 3 years, 62% ± 5.4% at 4 years, and 59% ± 5.6% at 5 years. Journal of Vascular Surgery 2017 66, 1340-1348.e5DOI: (10.1016/j.jvs.2017.03.432) Copyright © 2017 The Authors Terms and Conditions

Fig 5 A, Kaplan-Meier curve for major adverse event (MAE), defined as aortic disease-related death, surgical conversion, aneurysm rupture, persistent type I or III endoleak, infection of stent graft, stent graft occlusion, and migration or >5 mm expansion of maximum diameter. The estimated event-free survival of MAE and standard error was 85% ± 3.8% at 1 year, 85% ± 3.8% at 2 years, 85% ± 3.8% at 3 years, 79% ± 4.4% at 4 years, and 76% ± 5.5% at 5 years. B, Kaplan-Meier curve for incidence of additional endovascular repair. The estimated event-free survival of additional endovascular repair and standard error was 95% ± 2.4% at 1 year, 94% ± 2.7% at 2 years, 92% ± 3.3% at 3 years, 92% ± 3.3% at 4 years, and 92% ± 3.3% at 5 years. Journal of Vascular Surgery 2017 66, 1340-1348.e5DOI: (10.1016/j.jvs.2017.03.432) Copyright © 2017 The Authors Terms and Conditions

Supplementary Fig 1 (online only) Angiographic images of implanted branch Inoue Stent Graft (ISG). A, Single branch. B, Double branch. C, Triple branch. Journal of Vascular Surgery 2017 66, 1340-1348.e5DOI: (10.1016/j.jvs.2017.03.432) Copyright © 2017 The Authors Terms and Conditions

Supplementary Fig 2 (online only) Details of deployment procedure of single-branch Inoue Stent Graft (ISG). A, Single-branch ISG system in the folded form was introduced into the sheath, released from the sheath at the descending thoracic aorta, and advanced to the aortic arch. B, The free end of a traction wire attached to the tip of the branch section was caught by a gooseneck snare as introduced through the 7F guiding catheter from left brachial artery. C, The traction wire of the branch section was pulled into the left subclavian artery (LSCA) to fix the single branch ISG system at the planned position. D, Singe-branch ISG was expanded after the deployment wire was removed with rapid right ventricular pacing support. After deployment of the ISG, touch-up balloon was performed with rapid right ventricular pacing support. Journal of Vascular Surgery 2017 66, 1340-1348.e5DOI: (10.1016/j.jvs.2017.03.432) Copyright © 2017 The Authors Terms and Conditions

Supplementary Fig 3 (online only) Details of deployment procedure of the triple-branch Inoue Stent Graft (ISG). A, Triple-branch ISG system in the folded form was advanced to the aortic arch. The free end of a traction wire attached to the innominate artery branch section was caught by a gooseneck snare as introduced through the 7F guiding catheter from right brachial artery. B, The free end of a traction wire attached to the left common carotid artery (LCCA) branch section was caught by a gooseneck snare as introduced through the 5F sheath from left carotid artery with percutaneous access. C, The free end of a traction wire attached to the left subclavian artery (LSCA) branch section was caught by a gooseneck snare as introduced through the 7F guiding catheter from the left brachial artery. D, After the fixation of ISG position, the triple-branched ISG was expanded with rapid right ventricular pacing support. After deployment of the ISG, touch-up balloon was performed with rapid right ventricular pacing support. Journal of Vascular Surgery 2017 66, 1340-1348.e5DOI: (10.1016/j.jvs.2017.03.432) Copyright © 2017 The Authors Terms and Conditions

Supplementary Fig 4 (online only) Computed tomography (CT) images of a patient with shaggy aorta treated with triple-branch Inoue Stent Graft (ISG). Journal of Vascular Surgery 2017 66, 1340-1348.e5DOI: (10.1016/j.jvs.2017.03.432) Copyright © 2017 The Authors Terms and Conditions