Sandwich Technique for Endovascular Repair of Acute Type A Aortic Dissection

Abstract

Overview: To describe a new endovascular procedure for acute type A aortic dissection (TAAD) repair. Methods: Between 2013 and 2016, 12 patients (average age 54±9.6 years; 10 men) with acute TAAD (mean EURO score 11.4%±3.2%, range 5–17) and unfit for surgery underwent thoracic endovascular aortic repair (TEVAR) with 2 periscope grafts to preserve blood supply to supra-aortic branches plus bypass grafting as needed. If the ascending aorta was dilated to >40 mm, sternotomy was performed to wrap the ascending aorta and reduce its diameter to accommodate the aortic stent-grafts. Results: All patients were successfully treated. Seven patients required bypass grafting, and most of the patients had periscope grafts to the innominate/right common carotid artery and left common carotid artery; only 3 patients had the left subclavian artery preserved. All patients exhibited good hemodynamics and normal pressures after the procedure. The mean procedure time and blood loss were 4.5±1.0 hours and 217±111.5 mL, respectively. Two patients treated emergently died shortly after surgery from multiorgan failure. The average follow-up duration was 17±14.5 months (range 2–42) in the 10 survivors. The remaining patients recovered and none experienced stent-graft thrombosis, stroke, or peripheral artery embolism during follow-up. Conclusion: A procedure that combines sandwich/periscope grafting with TEVAR, wrapping of the aorta, and supra-arch bypass grafting can be used to treat patients with acute TAAD.

Keywords

acute dissection aortic wrapping common carotid artery hybrid procedure left subclavian artery periscope technique supra-aortic branches thoracic endovascular aortic repair type A aortic dissection

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References

Berretta

Patel

Gleason

et al

IRAD experience on surgical type A acute dissection patients: results and predictors of mortality. Ann Cardiothorac Surg. 2016;5:346–351.

Pape

Awais

Woznicki

et al

Presentation, diagnosis, and outcomes of acute aortic dissection: 17-year trends from the International Registry of Acute Aortic Dissection. J Am Coll Cardiol. 2015;66:350–358.

Ramadan

Azmoun

Al-Attar

et al

Wrapping of the ascending aorta in acute type A retrograde aortic dissection. Ann Thorac Surg. 2011;92:e49–e50.

Kölbel

Detter

Carpenter

et al

Acute type A aortic dissection treated using a tubular stent-graft in the ascending aorta and a multibranched stent-graft in the aortic arch. J Endovasc Ther. 2017;24:75–80.

Rohlffs

Tsilimparis

Detter

et al

New advances in endovascular therapy: endovascular repair of a chronic DeBakey type II aortic dissection with a scalloped stent-graft designed for the ascending aorta. J Endovasc Ther. 2016;23:182–185.

Kurimoto

Maruyama

Ujihira

et al

Thoracic endovascular aortic repair for challenging aortic arch diseases using fenestrated stent grafts from zone 0. Ann Thorac Surg. 2015;100:24–32.

Rancic

Pfammatter

Lachat

et al

Periscope graft to extend distal landing zone in ruptured thoracoabdominal aneurysms with short distal necks. J Vasc Surg. 2010;51:1293–1296.

Schlösser

Hogendoorn

Muhs

BE.

Commentary: Midterm results of thoracic endovascular aortic repair with periscope graft revascularization of the left subclavian artery. J Endovasc Ther. 2013;20:735–737.

Lachat

Mayer

Pfammatter

et al

Periscope endograft technique to revascularize the left subclavian artery during thoracic endovascular aortic repair. J Endovasc Ther. 2013;20:728–734.

10.

Lachat

Veith

Pfammatter

et al

Chimney and periscope grafts observed over 2 years after their use to revascularize 169 renovisceral branches in 77 patients with complex aortic aneurysms. J Endovasc Ther. 2013;20:597–605.

11.

Hashizume

Shimizu

Koizumi

et al

Endovascular aneurysm repair using the periscope graft technique for thoracic aortic anastomotic pseudoaneurysm. Interact Cardiovasc Thorac Surg. 2013;16:553–555.

12.

Feng

Qian

Jun

et al

Hybrid repair of an aortic arch aneurysm using double parallel grafts perfused by retrograde flow in endovascular repair combined with left subclavian artery surgical bypass. Ann Thorac Surg. 2015;100:1888–1891.

13.

Krankenberg

Bader

Sixt

et al

Endovascular repair of ascending aortic aneurysm by transapical approach and periscope technique. J Endovasc Ther. 2013;20:13–17.

14.

Liu

Zhang

et al

Impact of oversizing on the risk of retrograde dissection after TEVAR for acute and chronic type B dissection. J Endovasc Ther. 2016;24:620–625.

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