Early and midterm results of thoracic endovascular aortic repair using a branched endograft for aortic arch pathologies: A retrospective single-center studyCentral MessagePerspective
Background: Zone 0 landing hybrid thoracic endovascular aortic repair (TEVAR) includes a few moderately invasive surgical procedures. To reduce invasiveness, TEVAR with a branched aortic arch stent-graft can be considered. This study aimed to elucidate the effectiveness of performing TEVAR using a B...
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Elsevier
2020-12-01
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| Series: | JTCVS Techniques |
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| author | Tomoaki Kudo, MD, PhD Toru Kuratani, MD, PhD Kazuo Shimamura, MD, PhD Yoshiki Sawa, MD, PhD |
| author_facet | Tomoaki Kudo, MD, PhD Toru Kuratani, MD, PhD Kazuo Shimamura, MD, PhD Yoshiki Sawa, MD, PhD |
| author_sort | Tomoaki Kudo, MD, PhD |
| collection | DOAJ |
| description | Background: Zone 0 landing hybrid thoracic endovascular aortic repair (TEVAR) includes a few moderately invasive surgical procedures. To reduce invasiveness, TEVAR with a branched aortic arch stent-graft can be considered. This study aimed to elucidate the effectiveness of performing TEVAR using a Bolton (Bolton Medical, Inc, Sunrise, Fla) branched endograft by analyzing early and midterm results. Methods: We enrolled 28 patients (mean age, 78.4 years) who underwent TEVAR with the Bolton branched endograft in Osaka University Hospital between October 2012 and June 2018 with a mean follow-up period of 4.0 years. Double-side and single-side branched devices were used in 24 (85.7%) and 4 (14.3%) patients, respectively. Results: All procedures were successful; no cases of endoleak or conversion to open repair were noted during the 30-day postoperative period. The perioperative stroke rate was 14.3% (4 out of 28); midterm stroke was not detected. All patients with perioperative stroke had atheroma grade ≥2 in the brachiocephalic artery. No type 1a endoleak was reported during the early or midterm results. The cumulative survival rate, aorta-related death-free rate, and aortic event-free survival rate at 5 years were 80.8%, 95.8%, and 81.6%, respectively. Conclusions: We achieved satisfactory early and midterm results by using a Bolton branched endograft for high-risk patients with arch pathologies except for high postoperative stroke. Although this treatment method is associated with postoperative stroke, performing strict evaluation of atheroma may prevent such complication. By preventing intraoperative stroke, TEVAR with this custom-made Bolton branched endograft may be considered a less-invasive treatment. |
| format | Article |
| id | doaj-art-4214d71cd7094ce6bf7c4ee406f65c74 |
| institution | DOAJ |
| issn | 2666-2507 |
| language | English |
| publishDate | 2020-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Techniques |
| spelling | doaj-art-4214d71cd7094ce6bf7c4ee406f65c742025-08-20T03:04:46ZengElsevierJTCVS Techniques2666-25072020-12-014172510.1016/j.xjtc.2020.09.023Early and midterm results of thoracic endovascular aortic repair using a branched endograft for aortic arch pathologies: A retrospective single-center studyCentral MessagePerspectiveTomoaki Kudo, MD, PhD0Toru Kuratani, MD, PhD1Kazuo Shimamura, MD, PhD2Yoshiki Sawa, MD, PhD3Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan; Address for reprints: Tomoaki Kudo, MD, PhD, and Yoshiki Sawa, MD, PhD, Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871 Japan.Department of Minimally Invasive Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, JapanDepartment of Minimally Invasive Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, JapanDepartment of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan; Address for reprints: Tomoaki Kudo, MD, PhD, and Yoshiki Sawa, MD, PhD, Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871 Japan.Background: Zone 0 landing hybrid thoracic endovascular aortic repair (TEVAR) includes a few moderately invasive surgical procedures. To reduce invasiveness, TEVAR with a branched aortic arch stent-graft can be considered. This study aimed to elucidate the effectiveness of performing TEVAR using a Bolton (Bolton Medical, Inc, Sunrise, Fla) branched endograft by analyzing early and midterm results. Methods: We enrolled 28 patients (mean age, 78.4 years) who underwent TEVAR with the Bolton branched endograft in Osaka University Hospital between October 2012 and June 2018 with a mean follow-up period of 4.0 years. Double-side and single-side branched devices were used in 24 (85.7%) and 4 (14.3%) patients, respectively. Results: All procedures were successful; no cases of endoleak or conversion to open repair were noted during the 30-day postoperative period. The perioperative stroke rate was 14.3% (4 out of 28); midterm stroke was not detected. All patients with perioperative stroke had atheroma grade ≥2 in the brachiocephalic artery. No type 1a endoleak was reported during the early or midterm results. The cumulative survival rate, aorta-related death-free rate, and aortic event-free survival rate at 5 years were 80.8%, 95.8%, and 81.6%, respectively. Conclusions: We achieved satisfactory early and midterm results by using a Bolton branched endograft for high-risk patients with arch pathologies except for high postoperative stroke. Although this treatment method is associated with postoperative stroke, performing strict evaluation of atheroma may prevent such complication. By preventing intraoperative stroke, TEVAR with this custom-made Bolton branched endograft may be considered a less-invasive treatment.http://www.sciencedirect.com/science/article/pii/S2666250720305423endovascular graftendovascular procedureaortic arch aneurysmstroke |
| spellingShingle | Tomoaki Kudo, MD, PhD Toru Kuratani, MD, PhD Kazuo Shimamura, MD, PhD Yoshiki Sawa, MD, PhD Early and midterm results of thoracic endovascular aortic repair using a branched endograft for aortic arch pathologies: A retrospective single-center studyCentral MessagePerspective JTCVS Techniques endovascular graft endovascular procedure aortic arch aneurysm stroke |
| title | Early and midterm results of thoracic endovascular aortic repair using a branched endograft for aortic arch pathologies: A retrospective single-center studyCentral MessagePerspective |
| title_full | Early and midterm results of thoracic endovascular aortic repair using a branched endograft for aortic arch pathologies: A retrospective single-center studyCentral MessagePerspective |
| title_fullStr | Early and midterm results of thoracic endovascular aortic repair using a branched endograft for aortic arch pathologies: A retrospective single-center studyCentral MessagePerspective |
| title_full_unstemmed | Early and midterm results of thoracic endovascular aortic repair using a branched endograft for aortic arch pathologies: A retrospective single-center studyCentral MessagePerspective |
| title_short | Early and midterm results of thoracic endovascular aortic repair using a branched endograft for aortic arch pathologies: A retrospective single-center studyCentral MessagePerspective |
| title_sort | early and midterm results of thoracic endovascular aortic repair using a branched endograft for aortic arch pathologies a retrospective single center studycentral messageperspective |
| topic | endovascular graft endovascular procedure aortic arch aneurysm stroke |
| url | http://www.sciencedirect.com/science/article/pii/S2666250720305423 |
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