Arch replacement with collared elephant trunks: The Siena approachCentral MessagePerspective
Objective: To illustrate our experience and results in patients with diffuse aneurysmal disease treated with arch replacement using the Siena collared graft, a device designed in 2002 to improve the elephant trunk technique. Results of the first step surgical implant and the subsequent treatment str...
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Elsevier
2021-04-01
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| Series: | JTCVS Techniques |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666250720307021 |
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| author | Eugenio Neri, MD Luigi Muzzi, MD Enrico Tucci, MD Marco Cini, MD Lucio Barabesi, DrPh Giulio Tommasino, MD Carmelo Ricci, MD |
| author_facet | Eugenio Neri, MD Luigi Muzzi, MD Enrico Tucci, MD Marco Cini, MD Lucio Barabesi, DrPh Giulio Tommasino, MD Carmelo Ricci, MD |
| author_sort | Eugenio Neri, MD |
| collection | DOAJ |
| description | Objective: To illustrate our experience and results in patients with diffuse aneurysmal disease treated with arch replacement using the Siena collared graft, a device designed in 2002 to improve the elephant trunk technique. Results of the first step surgical implant and the subsequent treatment strategies, with extensive use of endovascular techniques, are reported. Methods: All aortic arch–replacement procedures using the Siena graft between February 2002 and January 2020 were retrospectively analyzed for early and late clinical outcomes. Results: Of 146 patients (54 women, 36.9%) with a median age of 69.1 years (interquartile range 58.4-75.0 years), 55 (37.6%) had acute/chronic dissection with false lumen aneurysmal dilatation, 91 (62.3%) had degenerative aneurysms, 45 (30.8%) were redo operations, and 14 (9.5%) had connective tissue disease. First-stage outcomes: 10.9% 30-day mortality (n = 16); 5.4% stroke (n = 8, 6 disabling, 2 nondisabling; 3 fatal); and 0.6% paraplegia. Outcomes for 113 second-stage procedures (77.3%, n = 97 endovascular [66.4%], n = 16 surgical [10.9%]) were 5.3% and 8.8% 30-day and 180-day mortality; no stroke; 10.6% paraplegia. Median follow-up was 5.7 years (range: 0-18.02 years) median survival was 16.65 years (95% lower confidence limit, 10.06 years) with no significant difference between aneurysm and dissection patients. Freedom from further treatment was 87.0% (95% confidence interval, 79.9%-94.7%) at 5 years and 71.4% (95% confidence interval, 71.4%-84.7%) at 10 years; median time to reintervention was 2.59 years (interquartile range, 0.52-5.20 years) with no difference (P = .22) between dissection and aneurysm groups. Conclusions: Siena collared graft represents a reliable platform for the treatment of diffuse aneurysmal disease. This device offers the flexibility required in the treatment of extended aortic lesions and guarantees the choice of the most appropriate approach for treatment completion. In this context, the availability of hybrid grafts has not modified the role of this device in arch surgery. |
| format | Article |
| id | doaj-art-84a6b905e58d4a039342a5a86e7bdcac |
| institution | Kabale University |
| issn | 2666-2507 |
| language | English |
| publishDate | 2021-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Techniques |
| spelling | doaj-art-84a6b905e58d4a039342a5a86e7bdcac2025-08-20T03:36:41ZengElsevierJTCVS Techniques2666-25072021-04-016132710.1016/j.xjtc.2020.11.017Arch replacement with collared elephant trunks: The Siena approachCentral MessagePerspectiveEugenio Neri, MD0Luigi Muzzi, MD1Enrico Tucci, MD2Marco Cini, MD3Lucio Barabesi, DrPh4Giulio Tommasino, MD5Carmelo Ricci, MD6Aortic Surgery Unit, Siena University Hospital, Siena, Italy; Address for reprints: Eugenio Neri, MD, Azienda Ospedaliera Universitaria Senese, Policlinico “Santa Maria alle Scotte,” Viale M. Bracci, 53100 Siena, Italy.Aortic Surgery Unit, Siena University Hospital, Siena, ItalyAortic Surgery Unit, Siena University Hospital, Siena, ItalyInterventional Radiology Unit, Siena University Hospital, Siena, ItalyDepartment of Statistics, Università degli Studi di Siena, Siena, ItalyAortic Surgery Unit, Siena University Hospital, Siena, ItalyInterventional Radiology Unit, Siena University Hospital, Siena, ItalyObjective: To illustrate our experience and results in patients with diffuse aneurysmal disease treated with arch replacement using the Siena collared graft, a device designed in 2002 to improve the elephant trunk technique. Results of the first step surgical implant and the subsequent treatment strategies, with extensive use of endovascular techniques, are reported. Methods: All aortic arch–replacement procedures using the Siena graft between February 2002 and January 2020 were retrospectively analyzed for early and late clinical outcomes. Results: Of 146 patients (54 women, 36.9%) with a median age of 69.1 years (interquartile range 58.4-75.0 years), 55 (37.6%) had acute/chronic dissection with false lumen aneurysmal dilatation, 91 (62.3%) had degenerative aneurysms, 45 (30.8%) were redo operations, and 14 (9.5%) had connective tissue disease. First-stage outcomes: 10.9% 30-day mortality (n = 16); 5.4% stroke (n = 8, 6 disabling, 2 nondisabling; 3 fatal); and 0.6% paraplegia. Outcomes for 113 second-stage procedures (77.3%, n = 97 endovascular [66.4%], n = 16 surgical [10.9%]) were 5.3% and 8.8% 30-day and 180-day mortality; no stroke; 10.6% paraplegia. Median follow-up was 5.7 years (range: 0-18.02 years) median survival was 16.65 years (95% lower confidence limit, 10.06 years) with no significant difference between aneurysm and dissection patients. Freedom from further treatment was 87.0% (95% confidence interval, 79.9%-94.7%) at 5 years and 71.4% (95% confidence interval, 71.4%-84.7%) at 10 years; median time to reintervention was 2.59 years (interquartile range, 0.52-5.20 years) with no difference (P = .22) between dissection and aneurysm groups. Conclusions: Siena collared graft represents a reliable platform for the treatment of diffuse aneurysmal disease. This device offers the flexibility required in the treatment of extended aortic lesions and guarantees the choice of the most appropriate approach for treatment completion. In this context, the availability of hybrid grafts has not modified the role of this device in arch surgery.http://www.sciencedirect.com/science/article/pii/S2666250720307021aortaaortic arch surgeryelephant trunk techniquethoracic endovascular repair |
| spellingShingle | Eugenio Neri, MD Luigi Muzzi, MD Enrico Tucci, MD Marco Cini, MD Lucio Barabesi, DrPh Giulio Tommasino, MD Carmelo Ricci, MD Arch replacement with collared elephant trunks: The Siena approachCentral MessagePerspective JTCVS Techniques aorta aortic arch surgery elephant trunk technique thoracic endovascular repair |
| title | Arch replacement with collared elephant trunks: The Siena approachCentral MessagePerspective |
| title_full | Arch replacement with collared elephant trunks: The Siena approachCentral MessagePerspective |
| title_fullStr | Arch replacement with collared elephant trunks: The Siena approachCentral MessagePerspective |
| title_full_unstemmed | Arch replacement with collared elephant trunks: The Siena approachCentral MessagePerspective |
| title_short | Arch replacement with collared elephant trunks: The Siena approachCentral MessagePerspective |
| title_sort | arch replacement with collared elephant trunks the siena approachcentral messageperspective |
| topic | aorta aortic arch surgery elephant trunk technique thoracic endovascular repair |
| url | http://www.sciencedirect.com/science/article/pii/S2666250720307021 |
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