Project description:An 80-year-old man with a chronic penetrating atherosclerotic ulcer was not a candidate for open surgical repair owing to the presence of diffuse vascular atherosclerosis and a deep ulcerative lesion originating at the level of the aortic arch concavity. No appropriate endovascular landing zone was present in arch zones 1 or 2. However, a totally endovascular branched arch repair involving transapical delivery of the three branches was successful.
Project description:Endovascular repair has been introduced to decrease the morbidity and mortality associated with open surgical repair of aortic arch pathology. We illustrate total percutaneous transfemoral approach with a 3-vessel inner branch stent-graft to treat aortic arch aneurysm. (Level of Difficulty: Advanced.) Graphical abstract
Project description:BackgroundThe modular inner branched stent-graft (MIBSG) (WeFlow-Arch™) is an emerging device for challenging aortic arch pathologies. Hemodynamic numerical simulation is conducive to predicting long-term outcomes as well as optimizing the stent-graft design.ObjectiveThis study aims to analyze the hemodynamic characteristics of the MIBSG devices based on numerical simulation analyses.MethodsFrom June 2019 to June 2021, MIBSGs were utilized in eight cases. Numerical simulation analyses of branch perfusion and indicators including the time-averaged wall shear stress, oscillatory shear index, and relative residence time were performed.ResultsLesions involved Zone 1 (n = 2), Zone 2 (n = 4), and Zone 3 (n = 2). Branched stent-grafts were deployed in the innominate artery and left common carotid artery (n = 5) or in the innominate artery and left subclavian artery (n = 3). The hemodynamic change in common was increased perfusion in the descending aorta and left common carotid artery. Half of the patients had increased cerebral perfusion of 8.7% at most, and the other half of the patients showed a reduction of 5.3% or less. Case 3 was considered to have acquired the greatest improvement in hemodynamic features.ConclusionThe MIBSG showed improved hemodynamic features in most cases. The design of the MIBSG could be partly modified to acquire better hemodynamic performance.
Project description:PurposeIn this study, we compared the early results between the extensive arch repair with a novel two-branched stent graft (TSG) and the traditional technique.MethodsBetween 2013 July and 2015 March, 63 acute type A aortic dissection (ATAAD) patients from four cardiac centers with indications for extensive arch repair were included in this study. Finally, 28 patients were involved in the traditional procedure (TP) group (23 males with the age of 49.75 ± 9.26 years) and 35 patients were involved in the TSG group (29 males with the age of 53.82 ± 8.17 years).ResultsThe operation was successful in all patients. The selective cerebral perfusion time, total operation time, and chest drainage within 24 hours after the operation in the TSG group were significantly less than those in the TP group (P ≤0.05). The mean follow-up time was 11.17 ± 1.74 months in the TP group and 11.94 ± 4.29 months in the TSG group. No statistical differences were found in aortic diameter, false lumen diameter, and true lumen diameter at the diaphragmatic level during the follow-up.ConclusionOur technique with a novel TSG simplified the extensive arch repair procedure and was an effective way for the treatment of ATAAD.
Project description:Which graft material is the optimal graft material for the treatment of aortic graft infections is still a matter of controversy. We used a branched xenopericardial roll graft to replace an infected aortic arch graft as a "rescue" operation. The patient is alive and well 37 months postoperatively without recurrence of the infection and any surgical complication. This procedure may have the possibility to serve as an option for the treatment of aortic arch graft infection.
Project description:Treatment of multiple penetrating aortic ulcers becomes troublesome if they involve the aortic arch. We report a percutaneous aortic repair using a unibody design endoprosthesis with a precannulated side component for the left subclavian artery to manage a large aortic arch ulcer and preserve the patency of previous coronary artery bypass graft. (Level of Difficulty: Advanced.).
Project description:ObjectivesThe primary objective of this research was to evaluate the safety and feasibility of an innovative double-branched stent graft system employing four-stage deployment technology for aortic arch repair in porcine models.MethodsThe double-branched stent graft system consisted of a proximal polyester artificial blood vessel, the main and double-branched stent grafts and a delivery system. We utilized 12 healthy pigs as experimental animals (6 per group). Postimplantation, samples were collected at 90 and 180 days after the operations. Preoperative and postoperative imaging and intraoperative arterial blood gas analyses were performed. After the pigs were euthanized, the implanted product, surrounding tissue and major organs were collected for pathological analysis.ResultsThe technical success rate of the stent graft implants was 100% (12/12). All animals survived to the experimental end point. Perioperative assessments showed intact stent grafts, and imaging features at the end of the follow-up period revealed neither endoleak nor device migration. No major adverse cardiovascular events were observed during the postoperative follow-up period. Pathological examinations confirmed the satisfactory biocompatibility of the stent graft.ConclusionsThis innovative double-branched stent graft system with four-stage deployment technology was affirmed as a safe and feasible option for aortic arch repair in accordance with our preclinical evaluation with porcine models.