Complete zone 0-10 aortic endovascular reconstruction
To the best of our knowledge, the present report is the first on the safety and efficacy of complete endovascular aortic reconstruction from zone 0 to 10 using a standardized approach and parallel stent graft configurations in high-risk patients considered unfit for surgery. During a 7-year period,...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-06-01
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| Series: | Journal of Vascular Surgery Cases and Innovative Techniques |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2468428723000205 |
| _version_ | 1797797208987271168 |
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| author | Mehdi Teymouri, MD Manish Mehta, MD, MPH Philip Paty, MD Lalithapriya Jayakumar, MD Zachary W. Kostun, MD |
| author_facet | Mehdi Teymouri, MD Manish Mehta, MD, MPH Philip Paty, MD Lalithapriya Jayakumar, MD Zachary W. Kostun, MD |
| author_sort | Mehdi Teymouri, MD |
| collection | DOAJ |
| description | To the best of our knowledge, the present report is the first on the safety and efficacy of complete endovascular aortic reconstruction from zone 0 to 10 using a standardized approach and parallel stent graft configurations in high-risk patients considered unfit for surgery. During a 7-year period, five patients with complex thoracoabdominal aortic aneurysms and dissections involving zone 0-10 presented with rupture (n = 1; 20%), were symptomatic (n = 2; 40%), or had an aortic pseudoaneurysm (n = 2; 40%) and underwent complete endovascular zone 0-10 reconstruction using off-the-shelf stent grafts in parallel configurations that included chimneys, periscopes, and endovascular docking stations. The zone 0-5 complete arch chimney thoracic endovascular repair included chimneys that extended from the ascending thoracic aorta to the innominate, left common carotid, and left subclavian arteries and a thoracic stent graft extending from zone 0 to 5. The zone 5-10 aortic reconstructions were staged. Stage 1 included either thoracic stent graft and antegrade four visceral chimney placement or abdominal aortic stent graft and retrograde four visceral chimney placement. Stage II included completion of the remainder of the aortic reconstruction with cerebrospinal fluid drainage. A total of 15 aortic procedures included 34 chimneys (14 aortic arch and 20 visceral). Two patients (40%) underwent zone 0-5 aortic reconstruction first, and three patients (60%) underwent zone 5-10 aortic reconstruction first. The incidence of 30-day mortality, spinal cord ischemia, myocardial infarction, stroke, and visceral ischemia was 0%. At a mean follow-up of 4.5 ± 3.1 years, the aortic reconstruction-related mortality was 0%. All-cause mortality was 20%; one patient had died of pneumonia at 3 years postoperatively. Two endoleaks each occurred in zone 0-5 and zone 5-10 (40% for both groups). All endoleaks were treated with coil embolization. Complete endovascular zone 0-10 aortic reconstruction using parallel stent grafts with a docking station is a feasible and relatively safe technique that offers the ability to customize off-the-shelf devices for the treatment of high-risk patients with limited morbidity and mortality. |
| first_indexed | 2024-03-13T03:44:45Z |
| format | Article |
| id | doaj.art-8e9251ec2d17465c9079faef4d631c13 |
| institution | Directory Open Access Journal |
| issn | 2468-4287 |
| language | English |
| last_indexed | 2024-03-13T03:44:45Z |
| publishDate | 2023-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Vascular Surgery Cases and Innovative Techniques |
| spelling | doaj.art-8e9251ec2d17465c9079faef4d631c132023-06-23T04:43:33ZengElsevierJournal of Vascular Surgery Cases and Innovative Techniques2468-42872023-06-0192101111Complete zone 0-10 aortic endovascular reconstructionMehdi Teymouri, MD0Manish Mehta, MD, MPH1Philip Paty, MD2Lalithapriya Jayakumar, MD3Zachary W. Kostun, MD4Vascular Health Partners, Latham, NYCorrespondence: Manish Mehta, MD, MPH, Center for Vascular Awareness, Vascular Health Partners, 713 Troy-Schenectady Rd, Ste 125, Latham, NY 12110; Vascular Health Partners, Latham, NYVascular Health Partners, Latham, NYVascular Health Partners, Latham, NYVascular Health Partners, Latham, NYTo the best of our knowledge, the present report is the first on the safety and efficacy of complete endovascular aortic reconstruction from zone 0 to 10 using a standardized approach and parallel stent graft configurations in high-risk patients considered unfit for surgery. During a 7-year period, five patients with complex thoracoabdominal aortic aneurysms and dissections involving zone 0-10 presented with rupture (n = 1; 20%), were symptomatic (n = 2; 40%), or had an aortic pseudoaneurysm (n = 2; 40%) and underwent complete endovascular zone 0-10 reconstruction using off-the-shelf stent grafts in parallel configurations that included chimneys, periscopes, and endovascular docking stations. The zone 0-5 complete arch chimney thoracic endovascular repair included chimneys that extended from the ascending thoracic aorta to the innominate, left common carotid, and left subclavian arteries and a thoracic stent graft extending from zone 0 to 5. The zone 5-10 aortic reconstructions were staged. Stage 1 included either thoracic stent graft and antegrade four visceral chimney placement or abdominal aortic stent graft and retrograde four visceral chimney placement. Stage II included completion of the remainder of the aortic reconstruction with cerebrospinal fluid drainage. A total of 15 aortic procedures included 34 chimneys (14 aortic arch and 20 visceral). Two patients (40%) underwent zone 0-5 aortic reconstruction first, and three patients (60%) underwent zone 5-10 aortic reconstruction first. The incidence of 30-day mortality, spinal cord ischemia, myocardial infarction, stroke, and visceral ischemia was 0%. At a mean follow-up of 4.5 ± 3.1 years, the aortic reconstruction-related mortality was 0%. All-cause mortality was 20%; one patient had died of pneumonia at 3 years postoperatively. Two endoleaks each occurred in zone 0-5 and zone 5-10 (40% for both groups). All endoleaks were treated with coil embolization. Complete endovascular zone 0-10 aortic reconstruction using parallel stent grafts with a docking station is a feasible and relatively safe technique that offers the ability to customize off-the-shelf devices for the treatment of high-risk patients with limited morbidity and mortality.http://www.sciencedirect.com/science/article/pii/S2468428723000205DockingEVARStationTEVARZone 0-10 |
| spellingShingle | Mehdi Teymouri, MD Manish Mehta, MD, MPH Philip Paty, MD Lalithapriya Jayakumar, MD Zachary W. Kostun, MD Complete zone 0-10 aortic endovascular reconstruction Journal of Vascular Surgery Cases and Innovative Techniques Docking EVAR Station TEVAR Zone 0-10 |
| title | Complete zone 0-10 aortic endovascular reconstruction |
| title_full | Complete zone 0-10 aortic endovascular reconstruction |
| title_fullStr | Complete zone 0-10 aortic endovascular reconstruction |
| title_full_unstemmed | Complete zone 0-10 aortic endovascular reconstruction |
| title_short | Complete zone 0-10 aortic endovascular reconstruction |
| title_sort | complete zone 0 10 aortic endovascular reconstruction |
| topic | Docking EVAR Station TEVAR Zone 0-10 |
| url | http://www.sciencedirect.com/science/article/pii/S2468428723000205 |
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