Emergency Use of Branched Thoracic Endovascular Repair in the Treatment of Aortic Arch Pathologies. 2019

Yuk Law, and Tilo Kölbel, and Christian Detter, and Fiona Rohlffs, and Yskert von Kodolitsch, and Vladimir Makaloski, and Eike Sebastian Debus, and Nikolaos Tsilimparis
Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center of Hamburg, Hamburg, Germany; Division of Vascular Surgery, Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong.

Branched thoracic endovascular aortic repair (b-TEVAR) has revolutionized the treatment of aortic arch pathologies. However, b-TEVAR requires custom design and time for manufacturing, which limits its use in emergency situation. We retrospectively studied a series of 11 patients, who underwent emergency b-TEVAR in our institution. Stent grafts were either already available for the patient or from another patient with similar anatomy. Study endpoints were technical success, 30-day mortality, perioperative complications, early reinterventions, and subsequent image follow-up. Between December 2012 and December 2017, 11 patients (5 male; age 67 ± 14 years) were treated emergently with b-TEVAR for type A dissection (n = 2), peripheral malperfusion despite ascending repair in type A dissection (n = 1), contained ruptured ascending aortic pseudoaneurysm (n = 2), symptomatic arch aneurysm (n = 4), and ruptured subclavian aneurysm (n = 2). Three patients received their personal custom-made endografts but were hospitalized and treated urgently because of new symptom onset; the remaining 8 patients were treated with endografts from other patients. Technical success was 100%. Thirty-day mortality was 9% (1 of 11). Perioperative complications included one major stroke (9%), one sepsis (9%), two respiratory failures (18%), one acute renal injury (9%), and one retroperitoneal hematoma (9%). There were five (45%) early reinterventions. With median 6 months (range, 1 to 28) of follow-up, 2 patients had persistent false lumen perfusion, whereas all supraaortic branches remained patent. Our experience provided an early insight to the feasibility and safety of b-TEVAR in an emergency situation, although the early reintervention rate was not negligible. The endograft was versatile, with potential off-the-shelf use in future.

UI MeSH Term Description Entries
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D004638 Emergency Treatment First aid or other immediate intervention for accidents or medical conditions requiring immediate care and treatment before definitive medical and surgical management can be procured. Emergency Therapy,Therapy, Emergency,Emergency Therapies,Emergency Treatments,Therapies, Emergency,Treatment, Emergency,Treatments, Emergency
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000368 Aged A person 65 years of age or older. For a person older than 79 years, AGED, 80 AND OVER is available. Elderly
D001013 Aorta, Thoracic The portion of the descending aorta proceeding from the arch of the aorta and extending to the DIAPHRAGM, eventually connecting to the ABDOMINAL AORTA. Aorta, Ascending,Aorta, Descending,Aortic Arch,Aortic Root,Arch of the Aorta,Descending Aorta,Sinotubular Junction,Ascending Aorta,Thoracic Aorta,Aortic Roots,Arch, Aortic,Ascending Aortas,Junction, Sinotubular,Root, Aortic,Sinotubular Junctions
D001018 Aortic Diseases Pathological processes involving any part of the AORTA. Aortic Disease,Disease, Aortic,Diseases, Aortic
D012189 Retrospective Studies Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons. Retrospective Study,Studies, Retrospective,Study, Retrospective
D057510 Endovascular Procedures Minimally invasive procedures, diagnostic or therapeutic, performed within the BLOOD VESSELS. They may be perfomed via ANGIOSCOPY; INTERVENTIONAL MAGNETIC RESONANCE IMAGING; INTERVENTIONAL RADIOGRAPHY; or INTERVENTIONAL ULTRASONOGRAPHY. Endovascular Techniques,Intravascular Procedures,Intravascular Techniques,Endovascular Procedure,Endovascular Technique,Intravascular Procedure,Intravascular Technique,Procedure, Endovascular,Procedure, Intravascular,Procedures, Endovascular,Procedures, Intravascular,Technique, Endovascular,Technique, Intravascular,Techniques, Endovascular,Techniques, Intravascular

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