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Article: Theoretical Feasibility of Using Arch Branched Endograft Devices for Repair of Post Type A Aortic Dissection in Patients With Prior Ascending Aortic Replacement

TitleTheoretical Feasibility of Using Arch Branched Endograft Devices for Repair of Post Type A Aortic Dissection in Patients With Prior Ascending Aortic Replacement
Authors
Keywordsacute type A aortic dissection
arch branched endografts
ascending aortic replacement
endovascular procedures
hemiarch replacement
Issue Date1-Aug-2023
PublisherSAGE Publications
Citation
Journal of Endovascular Therapy, 2023, v. 30, n. 4, p. 561-570 How to Cite?
Abstract

Purpose:

Ascending aortic replacement is a common emergency procedure for treating acute type A aortic dissection. Secondary open or endovascular interventions for residual arch pathologies is difficult because of adhesions, short prosthetic grafts, and distorted anatomies. Aortic arch branched stent grafts have emerged as a potential solution for these patients if they have suitable anatomical conditions. This study aimed to evaluate the theoretical anatomical and technical feasibility of 2 currently used aortic arch branch endografts in patients who had prior replacement of the ascending aorta.

Materials and Methods:

All patients who had a prosthetic ascending aortic or hemiarch replacement for acute type A dissection in a single institution between January 2013 and December 2018 were included. Contrast computed tomography images on the most recent follow-up were analyzed on a 3-dimensional workstation. Morphological parameters were measured individually for the ascending aorta, aortic arch, supra-aortic branches, and access iliac arteries. The computed tomography scan of each patient was individually evaluated for anatomical suitability for the arch branched and double-branch devices according to set selection criteria.

Results:

Computed tomography images of 56 patients (median age of 57 years, 45 males) were reviewed. Based on our evaluation, 26 patients (46.4%) were good candidates for an endovascular arch branched device. It would be feasible for 13 patients (23.2%), but prudent preoperative planning was required due to complicated anatomy. The other 17 patients (30.4%) were unsuitable because they met at least 1 exclusion criterion. Short prosthetic grafts, extreme graft angulations, and extensive dissections in the supra-aortic branches were the main reasons for exclusion.

Conclusion:

Endovascular repair using arch branched endografts is feasible in patients with prior ascending aortic arch or hemiarch replacement for acute type A aortic dissection. The most common anatomical conditions that may influence the feasibility of the arch branched endograft procedure include insufficient proximal seal length, severe angulation of the graft, and extensive aortic dissection within the supra-aortic vessels.


Persistent Identifierhttp://hdl.handle.net/10722/331630
ISSN
2023 Impact Factor: 1.7
2023 SCImago Journal Rankings: 1.006
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorNi, L-
dc.contributor.authorWong, ACC-
dc.contributor.authorHui, V-
dc.contributor.authorChan, YC-
dc.contributor.authorCheng, SWK-
dc.date.accessioned2023-09-21T06:57:30Z-
dc.date.available2023-09-21T06:57:30Z-
dc.date.issued2023-08-01-
dc.identifier.citationJournal of Endovascular Therapy, 2023, v. 30, n. 4, p. 561-570-
dc.identifier.issn1526-6028-
dc.identifier.urihttp://hdl.handle.net/10722/331630-
dc.description.abstract<h3>Purpose:</h3><p>Ascending aortic replacement is a common emergency procedure for treating acute type A aortic dissection. Secondary open or endovascular interventions for residual arch pathologies is difficult because of adhesions, short prosthetic grafts, and distorted anatomies. Aortic arch branched stent grafts have emerged as a potential solution for these patients if they have suitable anatomical conditions. This study aimed to evaluate the theoretical anatomical and technical feasibility of 2 currently used aortic arch branch endografts in patients who had prior replacement of the ascending aorta.</p><h3>Materials and Methods:</h3><p>All patients who had a prosthetic ascending aortic or hemiarch replacement for acute type A dissection in a single institution between January 2013 and December 2018 were included. Contrast computed tomography images on the most recent follow-up were analyzed on a 3-dimensional workstation. Morphological parameters were measured individually for the ascending aorta, aortic arch, supra-aortic branches, and access iliac arteries. The computed tomography scan of each patient was individually evaluated for anatomical suitability for the arch branched and double-branch devices according to set selection criteria.</p><h3>Results:</h3><p>Computed tomography images of 56 patients (median age of 57 years, 45 males) were reviewed. Based on our evaluation, 26 patients (46.4%) were good candidates for an endovascular arch branched device. It would be feasible for 13 patients (23.2%), but prudent preoperative planning was required due to complicated anatomy. The other 17 patients (30.4%) were unsuitable because they met at least 1 exclusion criterion. Short prosthetic grafts, extreme graft angulations, and extensive dissections in the supra-aortic branches were the main reasons for exclusion.</p><h3>Conclusion:</h3><p>Endovascular repair using arch branched endografts is feasible in patients with prior ascending aortic arch or hemiarch replacement for acute type A aortic dissection. The most common anatomical conditions that may influence the feasibility of the arch branched endograft procedure include insufficient proximal seal length, severe angulation of the graft, and extensive aortic dissection within the supra-aortic vessels.</p>-
dc.languageeng-
dc.publisherSAGE Publications-
dc.relation.ispartofJournal of Endovascular Therapy-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.subjectacute type A aortic dissection-
dc.subjectarch branched endografts-
dc.subjectascending aortic replacement-
dc.subjectendovascular procedures-
dc.subjecthemiarch replacement-
dc.titleTheoretical Feasibility of Using Arch Branched Endograft Devices for Repair of Post Type A Aortic Dissection in Patients With Prior Ascending Aortic Replacement-
dc.typeArticle-
dc.identifier.doi10.1177/15266028221090476-
dc.identifier.scopuseid_2-s2.0-85130007336-
dc.identifier.volume30-
dc.identifier.issue4-
dc.identifier.spage561-
dc.identifier.epage570-
dc.identifier.eissn1545-1550-
dc.identifier.isiWOS:000788042800001-
dc.identifier.issnl1526-6028-

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