Skip to main content

Advertisement

Log in

Partial debranching hybrid stent graft for distal aortic arch aneurysms

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the early outcomes of treating distal aortic arch aneurysms (DAAAs) with a partial debranching hybrid stent graft, and to analyze the morphology of distances among the supra-aortic branches.

Methods

We used this stent graft to treat DAAA in 12 patients, by debranching the left common carotid artery (LCCA) and the left subclavian artery (LSA). With computed tomography (CT) data on the collective total 28 thoracic aortic aneurysms, the distances from the LSA to the LCCA and those from the LSA to the brachiocephalic artery (BA) were measured using multiplanar reconstruction (MPR) and centerline of flow (CLF) methods.

Results

All procedures were done in two stages and all stent grafts were deployed in zone-1. The devices used were the TALENT in seven patients and the TAG in five patients. There were no operative deaths, paraplegia, or type-1 or -3 endoleaks. One patient suffered minor cerebral infarction. The distance from the LSA to the BA was longer than that from the LSA to the LCCA by10 mm in the CLF method and by 13 mm in the MPR method.

Conclusions

It was possible to achieve a longer proximal landing zone by debranching two supra-aortic branches, the LCCA and the LSA. The partial debranching hybrid stent graft was less invasive and more effective for DAAAs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Sakata R, Fujii Y, Kuwano H. Thoracic and cardiovascular surgery in Japan during 2008: annual report by The Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg. 2010;58:356–83.

    Article  PubMed  Google Scholar 

  2. Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg. 1991;5:491–9.

    Article  PubMed  CAS  Google Scholar 

  3. Dake MD, Miller DC, Semba CP, Mitchell RS, Walker PJ, Liddell RP. Transluminal placement of endovascular stent-grafts for the treatment of descending thoracic aortic aneurysms. N Eng J Med. 1994;331:1729–34.

    Article  CAS  Google Scholar 

  4. Mitchell RS, Ishimaru S, Ehrlich MP, Iwase T, Lauterjung L, Shimono T, et al. First international summit on thoracic aortic endografting: roundtable on thoracic aortic dissection as an indication for endografting. J Endovasc Ther. 2002;9 (Suppl 2):II98–105.

    Google Scholar 

  5. Tadakoshi M, Ishibashi H, Ishiguchi T, Sugimoto I, Iwata H, Yamada T, et al. Stent strut penetration during thoracic endovascular aortic repair: report of a case. Surg Today. 2011. doi:10.1007/s00595-011-0050-3.

  6. Chaikof EL, Blankensteijn JD, Harris PL, White GH, Zarins CK, Bernhard VM, et al. Reporting standards for endovascular aortic aneurysm repair. J Vasc Surg. 2002;35:1048–60.

    Article  PubMed  Google Scholar 

  7. Ishibashi H, Ishiguchi T, Ohta T, Sugimoto I, Kawanishi J, Yamada T, et al. Endovascular repair for a descending thoracic aortic aneurysm with a stent-graft covering the celiac artery: report of two cases. Surg Today. 2009;39:518–22.

    Article  PubMed  Google Scholar 

  8. Ishibashi H, Ishiguchi T, Ohta T, Sugimoto I, Iwata H, Yamada T, et al. Mid-term results of endovascular abdominal aortic aneurysm repair: is it possible to predict sac shrinkage? Surg Today. 2011;41:1605–9.

    Article  PubMed  Google Scholar 

  9. Obitsu Y, Koizumi N, Takahashi S, Iida Y, Saiki N, Watanabe Y, et al. Hybrid procedures combining conventional and thoracic endovascular aortic repair for thoracic aortic aneurysms. Surg Today. 2011;41:922–7.

    Article  PubMed  Google Scholar 

  10. Matsuda H, Fukuda T, Iritani O, Nakazawa T, Tanaka H, Sasaki H, et al. Spinal cord injury is not negligible after TEVAR for lower descending aorta. Eur J Vasc Endovasc Surg. 2010;39:179–86.

    Article  PubMed  CAS  Google Scholar 

  11. Buth J, Harris PL, Hobo R, van Eps R, Cuypers P, Duijm L, et al. Neurologic complications associated with endovascular repair of thoracic aortic pathology: incidence and risk factors. A study from the European collaborators on stent/graft techniques for aortic aneurysm repair (EUROSTAR) registry. J Vasc Surg. 2007;46:1103–11.

    Article  PubMed  Google Scholar 

  12. Malkawi AM, Hinchliffe RJ, Yates M, Holt PJ, Loftus IM, Thompson MM. Morphology of aortic arch pathology: implications for endovascular repair. J Endovasc Ther. 2010;17:474–9.

    Article  PubMed  Google Scholar 

  13. Natsis KI, Tsitouridis IA, Didagelos MV, Fillipidis AA, Vlasis KG, Tsikaras PD. Anatomical variations in the branches of the human aortic arch in 633 angiographies: clinical significance and literature review. Surg Radiol Anat. 2009;31:319–23.

    Article  PubMed  Google Scholar 

  14. Chiesa R, Melissano G, Tshomba Y, Civilini E, Marone EM, Bertoglio L, et al. Ten years of endovascular aortic arch repair. J Endovasc Ther. 2010;17:1–11.

    Article  PubMed  Google Scholar 

  15. Gottardi R, Funovics M, Eggers N, Hirner A, Dorfmeister M, Holfeld J, et al. Supra-aortic transposition for combined vascular and endovascular repair of aortic arch pathology. Ann Thorac Surg. 2008;86:1534–9.

    Article  Google Scholar 

  16. Geisbüsch P, Kotelis D, Müller-Eschner M, Hyhlik-Dürr A, Böckler D. Complications after aortic arch hybrid repair. J Vasc Surg. 2011;53:935–41.

    Article  PubMed  Google Scholar 

  17. Czerny M, Gottardi R, Zimpfer D, Schoder M, Grabenwoger M, Lammer J, et al. Transposition of the supraaortic branches for extended endovascular arch repair. Eur J Cardiothorac Surg. 2006;29:709–13.

    Article  PubMed  Google Scholar 

  18. Criado FJ, McKendrick C, Criado FR. Technical solutions for common problems in TEVAR: managing access and aortic branches. J Endovasc Ther. 2009;16((Suppl I)):163–79.

    Google Scholar 

  19. Hiramoto JS. Multiple chimney grafts for total endovascular revascularization of the visceral arteries in the setting of ruptured TAAA: inventive but let’s wait for the smoke to clear on this one. J Endovasc Ther. 2010;17:222–3.

    Article  PubMed  Google Scholar 

  20. Lee WA. Failure modes of thoracic endografts: prevention and management. J Vasc Surg. 2009;49:792–9.

    Article  PubMed  Google Scholar 

  21. Kasirajan K, Kwolek CJ, Gupta N, Fairman RM. Incidence of and outcomes after misaligned deployment of the TALENT thoracic stent graft system. J Vasc Surg. 2010;51:1096–102.

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

We declare no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Hiroyuki Ishibashi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ishibashi, H., Ishiguchi, T., Ohta, T. et al. Partial debranching hybrid stent graft for distal aortic arch aneurysms. Surg Today 42, 765–769 (2012). https://doi.org/10.1007/s00595-012-0139-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-012-0139-3

Keywords

Navigation