Frozen elephant trunk repair of aortic aneurysms: How to reduce the incidence of endoleak and reinterventionCentral MessagePerspective
Background: Frozen elephant trunk (FET) enables treatment of arch and proximal descending thoracic aorta aneurysms. In treating patients with single-stage FET, the relationship of distal stent size to endoleak and reintervention has remained unexamined. Methods: In this retrospective analysis of 63...
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Elsevier
2020-09-01
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| Series: | JTCVS Techniques |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666250720302935 |
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| author | Sandhir Kandola, FRCS (Vasc), PhD Ahmed Abdulsalam, FRCS (C-Th), MSc Mark Field, FRCS, DPhil Robert K. Fisher, FRCS, MD |
| author_facet | Sandhir Kandola, FRCS (Vasc), PhD Ahmed Abdulsalam, FRCS (C-Th), MSc Mark Field, FRCS, DPhil Robert K. Fisher, FRCS, MD |
| author_sort | Sandhir Kandola, FRCS (Vasc), PhD |
| collection | DOAJ |
| description | Background: Frozen elephant trunk (FET) enables treatment of arch and proximal descending thoracic aorta aneurysms. In treating patients with single-stage FET, the relationship of distal stent size to endoleak and reintervention has remained unexamined. Methods: In this retrospective analysis of 63 cases in which FET was used to repair aneurysms between 2008 and 2019, 36 were intended as single-stage procedures. Effective sizing and sealing of distal stents were analyzed by preoperative and postoperative computed tomography angiography (CTA). Results: During a mean of 25.8 ± 5.7 months of CTA follow-up, 10 of 36 (28%) experienced endoleak, and 3 of 36 (8%) had sac expansion. Ultimately, 5 of 13 (38%) underwent thoracic endovascular aneurysm repair. Patients without endoleak or sac expansion were more likely to have stents with >10% oversize and a >30-mm seal in healthy aorta compared with those experiencing these complications (11 of 23 vs 0 of 13; P = .0031). Conversely, 11 of 36 patients (31%) with adequately oversized and sealed stents developed fewer endoleaks compared with those without (0 of 11 vs 10 of 14; P < .0004). Patients with endoleak or sac expansion had smaller mean distal stent oversize and shorter mean sealing length compared with those without endoleak or sac expansion (2.3 ± 3.9% vs 18 ± 2.9% [P = .0023] and 1 ± 0.7 mm vs 34 ± 6 mm [P = .0005], respectively). Conclusions: We recommend >10% distal stent oversize and >30-mm sealing length to minimize endoleak and reintervention. Increasing multidisciplinary collaboration with endovascular surgeons will improve distal stent planning. |
| format | Article |
| id | doaj-art-ee083c74a2944d96814a55c4747c59c5 |
| institution | Kabale University |
| issn | 2666-2507 |
| language | English |
| publishDate | 2020-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Techniques |
| spelling | doaj-art-ee083c74a2944d96814a55c4747c59c52025-08-20T03:36:37ZengElsevierJTCVS Techniques2666-25072020-09-013132010.1016/j.xjtc.2020.06.015Frozen elephant trunk repair of aortic aneurysms: How to reduce the incidence of endoleak and reinterventionCentral MessagePerspectiveSandhir Kandola, FRCS (Vasc), PhD0Ahmed Abdulsalam, FRCS (C-Th), MSc1Mark Field, FRCS, DPhil2Robert K. Fisher, FRCS, MD3Liverpool Vascular and Endovascular Service, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom; Address for reprints: Sandhir Kandola, FRCS (Vasc), PhD, Liverpool Vascular and Endovascular Service, Liverpool University Hospitals NHS Foundation Trust, Prescot Street, Liverpool UK L7 8XP, United Kingdom.Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United KingdomDepartment of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United KingdomLiverpool Vascular and Endovascular Service, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United KingdomBackground: Frozen elephant trunk (FET) enables treatment of arch and proximal descending thoracic aorta aneurysms. In treating patients with single-stage FET, the relationship of distal stent size to endoleak and reintervention has remained unexamined. Methods: In this retrospective analysis of 63 cases in which FET was used to repair aneurysms between 2008 and 2019, 36 were intended as single-stage procedures. Effective sizing and sealing of distal stents were analyzed by preoperative and postoperative computed tomography angiography (CTA). Results: During a mean of 25.8 ± 5.7 months of CTA follow-up, 10 of 36 (28%) experienced endoleak, and 3 of 36 (8%) had sac expansion. Ultimately, 5 of 13 (38%) underwent thoracic endovascular aneurysm repair. Patients without endoleak or sac expansion were more likely to have stents with >10% oversize and a >30-mm seal in healthy aorta compared with those experiencing these complications (11 of 23 vs 0 of 13; P = .0031). Conversely, 11 of 36 patients (31%) with adequately oversized and sealed stents developed fewer endoleaks compared with those without (0 of 11 vs 10 of 14; P < .0004). Patients with endoleak or sac expansion had smaller mean distal stent oversize and shorter mean sealing length compared with those without endoleak or sac expansion (2.3 ± 3.9% vs 18 ± 2.9% [P = .0023] and 1 ± 0.7 mm vs 34 ± 6 mm [P = .0005], respectively). Conclusions: We recommend >10% distal stent oversize and >30-mm sealing length to minimize endoleak and reintervention. Increasing multidisciplinary collaboration with endovascular surgeons will improve distal stent planning.http://www.sciencedirect.com/science/article/pii/S2666250720302935computed tomography angiographydescending thoracic aortafrozen elephant trunkmultidisciplinary teamthoracic endovascular aneurysm repair |
| spellingShingle | Sandhir Kandola, FRCS (Vasc), PhD Ahmed Abdulsalam, FRCS (C-Th), MSc Mark Field, FRCS, DPhil Robert K. Fisher, FRCS, MD Frozen elephant trunk repair of aortic aneurysms: How to reduce the incidence of endoleak and reinterventionCentral MessagePerspective JTCVS Techniques computed tomography angiography descending thoracic aorta frozen elephant trunk multidisciplinary team thoracic endovascular aneurysm repair |
| title | Frozen elephant trunk repair of aortic aneurysms: How to reduce the incidence of endoleak and reinterventionCentral MessagePerspective |
| title_full | Frozen elephant trunk repair of aortic aneurysms: How to reduce the incidence of endoleak and reinterventionCentral MessagePerspective |
| title_fullStr | Frozen elephant trunk repair of aortic aneurysms: How to reduce the incidence of endoleak and reinterventionCentral MessagePerspective |
| title_full_unstemmed | Frozen elephant trunk repair of aortic aneurysms: How to reduce the incidence of endoleak and reinterventionCentral MessagePerspective |
| title_short | Frozen elephant trunk repair of aortic aneurysms: How to reduce the incidence of endoleak and reinterventionCentral MessagePerspective |
| title_sort | frozen elephant trunk repair of aortic aneurysms how to reduce the incidence of endoleak and reinterventioncentral messageperspective |
| topic | computed tomography angiography descending thoracic aorta frozen elephant trunk multidisciplinary team thoracic endovascular aneurysm repair |
| url | http://www.sciencedirect.com/science/article/pii/S2666250720302935 |
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