Efficacy of Endovascular Repair Using Single Left Common Carotid Artery Stent Combined with Castor Single-Branched Stent-Graft in the Treatment of Regional Diseases of Zone 2 of the Aorta

Abstract

Purpose:

To observe the short-term efficacy of thoracic endovascular aortic repair (TEVAR) using a single left common carotid artery chimney stent combined with a Castor single-branched stent-graft (SC-TEVAR) in the treatment of zone 2 (Z2) aortic diseases.

Materials and Methods:

To conduct a retrospective analysis of 20 patients with Z2 aortic diseases who were treated in our department from June 2021 to April 2022. The lesions included true aortic degenerative aneurysms with diameter ≥5.0 cm and penetrating aortic ulcers with depth >1.0 cm or basal width >2.0 cm. All 20 patients accepted the SC-TEVAR treatment, which was a new hybrid method to assure the flow of the left common carotid artery (LCCA) and left subclavian artery (LSA). This method was defined as a concomitant chimney stent for LCCA and a Castor single-branched stent graft for the aorta and LSA. The baseline data and intraoperative data were collected to evaluate the safety and efficacy of this method. The patency of the target blood vessel and any associated complications were evaluated at 1 and 6 months postoperatively, to analyze the safety and efficacy of this new method.

Results:

After discharge from the hospital, all patients were followed up by a specific follow-up team. At 6 monthly follow-up period, there were no cardiac events, stroke, hemiplegia, type I endoleak, type II endoleak, proximal stent graft-induced new entries, distal stent graft-induced new entries, wound infection, or bleeding. Only 1 patient developed an inguinal wound hematoma and got conservative treatment. Importantly, no patients developed stenosis or occlusion of the LCCA or LSA. The patency of branched arteries was 100%. The technical success rate was 90%.

Conclusion:

SC-TEVAR appears to be a new and relatively simple, safe, and effective treatment for Z2 aortic diseases.

Clinical Impact

This was a single-center retrospective cohort study. A total of 20 patients with zone 2 aortic diseases accepted a new hybrid surgical method named SC-TEVAR. This method was not complicated and could be finished with only 3 peripheral artery exposure. The result showed no mortality, 100% patency of the branch artery, and 90% of technical success in 6 months of follow-up time. SC-TEVAR showed a satisfactory result in this retrospective study and could be promoted as an easy method to treat zone 2 aortic diseases.

Keywords

branched endovascular aneurysm repair hybrid arch repair thoracic endovascular aortic repair parallel stenting technique penetrating aortic ulcer

Get full access to this article

View all access options for this article.

References

Upchurch

Jr Escobar

Azizzadeh

, et al. Society for vascular surgery clinical practice guidelines of thoracic endovascular aortic repair for descending thoracic aortic aneurysms. J Vasc Surg. 2021;73(1S):55S–83S. doi:10.1016/j.jvs.2020.05.076.

Czerny

Schmidli

Adler

, et al. Editor’s choice—current options and recommendations for the treatment of thoracic aortic pathologies involving the aortic arch: an expert consensus document of the European Association for Cardio-Thoracic Surgery (EACTS) & the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2019;57(2):165–198. doi:10.1016/j.ejvs.2018.09.016.

Zeng

Xiang

, et al. Experimental analysis of the quality of needle-assisted fenestration in aortic stent-grafts and the differences between gradual and rapid balloon dilation. J Endovasc Ther. 2021;28(1):44–52. doi:10.1177/1526602820947095.

Jing

Feng

, et al. Endovascular repair of aortic dissection involving the left subclavian artery by castor stent graft: a multicentre prospective trial. Eur J Vasc Endovasc Surg. 2020;60(6):854–861. doi:10.1016/j.ejvs.2020.08.022.

Mesar

Alie-Cusson

Rathore

, et al. A more proximal landing zone is preferred for thoracic endovascular repair of acute type B aortic dissections. J Vasc Surg. 2022;75(1):38–46. doi:10.1016/j.jvs.2021.06.036.

Choudhury

Basharat

Zahra

, et al. “Proximalization is advancement”—zone 3 frozen elephant trunk vs zone 2 frozen elephant trunk: a literature review. Vasc Endovascular Surg. 2021;55(6):612–618. doi:10.1177/15385744211002493.

Liebrich

Charitos

Schlereth

, et al. The zone 2 concept and distal stent graft positioning in TH 2–3 are associated with high rates of secondary aortic interventions in frozen elephant trunk surgery. Eur J Cardiothorac Surg. 2021;60(2):343–351. doi:10.1093/ejcts/ezab132.

Appoo

Gregory

Fichadiya

, et al. Zone 2 arch replacement and staged thoracic endovascular aortic repair for acute type a aortic dissection. Ann Thorac Surg. 2017;104(3):e299–e301. doi:10.1016/j.athoracsur.2017.05.039.

Desai

Hoedt

Wang

, et al. Simplifying aortic arch surgery: open zone 2 arch with single branched thoracic endovascular aortic repair completion. Ann Cardiothorac Surg. 2018;7(3):351–356. doi:10.21037/acs.2018.05.08.

10.

Chassin-Trubert

Mandelli

Ozdemir

, et al. Midterm follow-up of fenestrated and scalloped physician-modified endovascular grafts for zone 2 TEVAR. J Endovasc Ther. 2019;27(3):377–384. doi:10.1177/1526602819881128.

11.

Zhang

Bai

Wang

, et al. Pre-fenestration endovascular repair of aortic diseases in patients with zone 2 segment: a single-center experience. Vascular. 2020;29(5):637–643. doi:10.1177/1708538120979874.

12.

Niu

, et al. Midterm outcomes of fenestrated TEVAR using physician-modified endovascular grafts for zone 2. Vascular. 2021;30(3):432–440. doi:10.1177/17085381211019611.

13.

Johnson

Zhang

Magee

, et al. Periscope sandwich stenting as an alternative to open cervical revascularization of left subclavian artery during zone 2 thoracic endovascular aortic repair. J Vasc Surg. 2021;73(2):466–475. doi:10.1016/j.jvs.2020.05.063.

14.

Bradshaw

Ahanchi

Powell

, et al. Left subclavian artery revascularization in zone 2 thoracic endovascular aortic repair is associated with lower stroke risk across all aortic diseases. J Vasc Surg. 2017;65(5):1270–1279. doi:10.1016/j.jvs.2016.10.111.

15.

Piffaretti

Pratesi

Gelpi

, et al. Comparison of two different techniques for isolated left subclavian artery revascularization during thoracic endovascular aortic repair in zone 2. J Vasc Surg. 2019;25(2):620–621. doi:10.1016/j.jvs.2018.10.080.

16.

Bianco

Sultan

Kilic

, et al. Concomitant left subclavian artery revascularization with carotid-subclavian transposition during zone 2 thoracic endovascular aortic repair. J Thorac Cardiovasc Surg. 2020;159(4):1222–1227. doi:10.1016/j.jtcvs.2019.03.060.

17.

D’Oria

Kärkkäinen

Tenorio

, et al. Perioperative outcomes of carotid–subclavian bypass or transposition versus endovascular techniques for left subclavian artery revascularization during nontraumatic zone 2 thoracic endovascular aortic repair in the vascular quality initiative. Ann Vasc Surg. 2020;69:17–26. doi:10.1016/j.avsg.2020.05.062.

18.

Choi

SHJ

Yang

Baxter

, et al. Evaluation of aortic zone 2 proximal landing accuracy during thoracic endovascular aortic repair following carotid-subclavian revascularization. Vasc Endovascular Surg. 2021;55(4):355–360. doi:10.1177/1538574421989851.

19.

Seguchi

Kiuchi

Horikawa

, et al. Novel brain protection method for zone 0 endovascular aortic repair with selective cerebral perfusion. Ann Vasc Dis. 2021;14(2):153–158. doi:10.3400/avd.oa.21-00025.

20.

Brusa

Lutz

Schoenhoff

, et al. One-year outcome of postoperative stroke and nerve injury after supraclavicular revascularization of the left subclavian artery for proximal landing zone extension in thoracic endovascular aortic repair. Ann Vasc Surg. 2022;83:265–274. doi:10.1016/j.avsg.2021.12.009.

21.

Kudo

Kuratani

Shimamura

, et al. Type 1a endoleak following zone 1 and zone 2 thoracic endovascular aortic repair: effect of bird-beak configuration†. Eur J Cardiothorac Surg. 2017;52(4):718–724. doi:10.1093/ejcts/ezx254.

22.

De León Ayala

Cheng

Chen

, et al. Outcomes of type Ia endoleaks after endovascular repair of the proximal aorta. J Thorac Cardiovasc Surg. 2022;163(6):2012–2021. doi:10.1016/j.jtcvs.2020.06.026.

23.

Kudo

Kuratani

Shimamura

, et al. Determining the optimal proximal landing zone for TEVAR in the aortic arch: comparing the occurrence of the bird-beak phenomenon in zone 0 vs zones 1 and 2. J Endovasc Ther. 2020;27(3):368–376. doi:10.1177/1526602820914269.