Home-made frozen stented elephant trunk for acute arch dissection: an hybrid off-the-shelf treatment in an emergency setting
Autor(a) principal: | |
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Data de Publicação: | 2021 |
Outros Autores: | , , , , , , , , |
Tipo de documento: | Relatório |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-706X2021000300264 |
Resumo: | Abstract Introduction: Involvement of the ascending/aortic arch in the thoracic aorta pathology can preclude thoracic endovascular aortic repair (TEVAR) due to the absence of an adequate proximal landing zone. Hybrid interventions combining ascending/aortic arch replacement with TEVAR of the descending thoracic aorta (DTA) are associated with good outcomes. Despite the existence of dedicated devices (E-vita®, Thoraflex®), they may not be available in good time in emergent cases that might require inventive solutions, like the one we present. Case Report: A 53-year-old hypertensive, active smoker male was admitted due to a non-A-non-B acute aortic dissection, complicated with a contained rupture at the aortic isthmus and a left haemothorax. Considering the absence of a secure proximal landing zone we decided on an aortic arch replacement and frozen stented elephant trunk using off-the-shelf devices. Debranching of the innominate and left common carotid arteries was performed with a 16×8mm bifurcated graft. The aortic arch replacement was performed with a 28 mm Dacron, under hypothermic circulatory arrest. A 30×30×157mm stent graft was anterogradely advanced to the DTA, under direct vision, with its proximal part parked at the level of the Dacron anastomosis. The proximal arch anastomosis was completed at the level of the sinotubular junction. Completion angiography revealed appropriately reconstructed aortic arch, successful exclusion of the entry tear and rupture site, as well as adequate renal and visceral perfusion. The patient had an uneventful postoperative course, being discharged on postoperative day 23. Control CTA demonstrated successful arch reconstruction, true lumen expansion and no signs of complications. Conclusion: This hybrid approach with off-the-shelf devices was successful and avoided the cumulative morbidity of an additional left thoracotomy as the technical difficulty of a full open surgery in this setting. In the absence of readily available dedicated devices, hybrid techniques will undoubtedly play a role in the treatment of acute aortic syndromes. The existence of an “Aortic Team” available to evaluate, decide and combine the expertise of cardiothoracic and vascular surgery was essential in this case. |
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Home-made frozen stented elephant trunk for acute arch dissection: an hybrid off-the-shelf treatment in an emergency settingNon-A non-B acute aortic dissectionAortic ruptureFrozen-Stented Elephant TrunkAbstract Introduction: Involvement of the ascending/aortic arch in the thoracic aorta pathology can preclude thoracic endovascular aortic repair (TEVAR) due to the absence of an adequate proximal landing zone. Hybrid interventions combining ascending/aortic arch replacement with TEVAR of the descending thoracic aorta (DTA) are associated with good outcomes. Despite the existence of dedicated devices (E-vita®, Thoraflex®), they may not be available in good time in emergent cases that might require inventive solutions, like the one we present. Case Report: A 53-year-old hypertensive, active smoker male was admitted due to a non-A-non-B acute aortic dissection, complicated with a contained rupture at the aortic isthmus and a left haemothorax. Considering the absence of a secure proximal landing zone we decided on an aortic arch replacement and frozen stented elephant trunk using off-the-shelf devices. Debranching of the innominate and left common carotid arteries was performed with a 16×8mm bifurcated graft. The aortic arch replacement was performed with a 28 mm Dacron, under hypothermic circulatory arrest. A 30×30×157mm stent graft was anterogradely advanced to the DTA, under direct vision, with its proximal part parked at the level of the Dacron anastomosis. The proximal arch anastomosis was completed at the level of the sinotubular junction. Completion angiography revealed appropriately reconstructed aortic arch, successful exclusion of the entry tear and rupture site, as well as adequate renal and visceral perfusion. The patient had an uneventful postoperative course, being discharged on postoperative day 23. Control CTA demonstrated successful arch reconstruction, true lumen expansion and no signs of complications. Conclusion: This hybrid approach with off-the-shelf devices was successful and avoided the cumulative morbidity of an additional left thoracotomy as the technical difficulty of a full open surgery in this setting. In the absence of readily available dedicated devices, hybrid techniques will undoubtedly play a role in the treatment of acute aortic syndromes. The existence of an “Aortic Team” available to evaluate, decide and combine the expertise of cardiothoracic and vascular surgery was essential in this case.Sociedade Portuguesa de Angiologia e Cirurgia Vascular2021-09-01info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/reporttext/htmlhttp://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-706X2021000300264Angiologia e Cirurgia Vascular v.17 n.3 2021reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPenghttp://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-706X2021000300264Coelho,Nuno HenriquesSilveira,DiogoMartins,VictorMartins,DanielPaulo,NelsonSemião,CarolinaPeixoto,JoãoFernandes,LuísMachado,MartaCanedo,Alexandrainfo:eu-repo/semantics/openAccess2024-02-06T17:23:03Zoai:scielo:S1646-706X2021000300264Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-20T02:29:29.716315Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Home-made frozen stented elephant trunk for acute arch dissection: an hybrid off-the-shelf treatment in an emergency setting |
title |
Home-made frozen stented elephant trunk for acute arch dissection: an hybrid off-the-shelf treatment in an emergency setting |
spellingShingle |
Home-made frozen stented elephant trunk for acute arch dissection: an hybrid off-the-shelf treatment in an emergency setting Coelho,Nuno Henriques Non-A non-B acute aortic dissection Aortic rupture Frozen-Stented Elephant Trunk |
title_short |
Home-made frozen stented elephant trunk for acute arch dissection: an hybrid off-the-shelf treatment in an emergency setting |
title_full |
Home-made frozen stented elephant trunk for acute arch dissection: an hybrid off-the-shelf treatment in an emergency setting |
title_fullStr |
Home-made frozen stented elephant trunk for acute arch dissection: an hybrid off-the-shelf treatment in an emergency setting |
title_full_unstemmed |
Home-made frozen stented elephant trunk for acute arch dissection: an hybrid off-the-shelf treatment in an emergency setting |
title_sort |
Home-made frozen stented elephant trunk for acute arch dissection: an hybrid off-the-shelf treatment in an emergency setting |
author |
Coelho,Nuno Henriques |
author_facet |
Coelho,Nuno Henriques Silveira,Diogo Martins,Victor Martins,Daniel Paulo,Nelson Semião,Carolina Peixoto,João Fernandes,Luís Machado,Marta Canedo,Alexandra |
author_role |
author |
author2 |
Silveira,Diogo Martins,Victor Martins,Daniel Paulo,Nelson Semião,Carolina Peixoto,João Fernandes,Luís Machado,Marta Canedo,Alexandra |
author2_role |
author author author author author author author author author |
dc.contributor.author.fl_str_mv |
Coelho,Nuno Henriques Silveira,Diogo Martins,Victor Martins,Daniel Paulo,Nelson Semião,Carolina Peixoto,João Fernandes,Luís Machado,Marta Canedo,Alexandra |
dc.subject.por.fl_str_mv |
Non-A non-B acute aortic dissection Aortic rupture Frozen-Stented Elephant Trunk |
topic |
Non-A non-B acute aortic dissection Aortic rupture Frozen-Stented Elephant Trunk |
description |
Abstract Introduction: Involvement of the ascending/aortic arch in the thoracic aorta pathology can preclude thoracic endovascular aortic repair (TEVAR) due to the absence of an adequate proximal landing zone. Hybrid interventions combining ascending/aortic arch replacement with TEVAR of the descending thoracic aorta (DTA) are associated with good outcomes. Despite the existence of dedicated devices (E-vita®, Thoraflex®), they may not be available in good time in emergent cases that might require inventive solutions, like the one we present. Case Report: A 53-year-old hypertensive, active smoker male was admitted due to a non-A-non-B acute aortic dissection, complicated with a contained rupture at the aortic isthmus and a left haemothorax. Considering the absence of a secure proximal landing zone we decided on an aortic arch replacement and frozen stented elephant trunk using off-the-shelf devices. Debranching of the innominate and left common carotid arteries was performed with a 16×8mm bifurcated graft. The aortic arch replacement was performed with a 28 mm Dacron, under hypothermic circulatory arrest. A 30×30×157mm stent graft was anterogradely advanced to the DTA, under direct vision, with its proximal part parked at the level of the Dacron anastomosis. The proximal arch anastomosis was completed at the level of the sinotubular junction. Completion angiography revealed appropriately reconstructed aortic arch, successful exclusion of the entry tear and rupture site, as well as adequate renal and visceral perfusion. The patient had an uneventful postoperative course, being discharged on postoperative day 23. Control CTA demonstrated successful arch reconstruction, true lumen expansion and no signs of complications. Conclusion: This hybrid approach with off-the-shelf devices was successful and avoided the cumulative morbidity of an additional left thoracotomy as the technical difficulty of a full open surgery in this setting. In the absence of readily available dedicated devices, hybrid techniques will undoubtedly play a role in the treatment of acute aortic syndromes. The existence of an “Aortic Team” available to evaluate, decide and combine the expertise of cardiothoracic and vascular surgery was essential in this case. |
publishDate |
2021 |
dc.date.none.fl_str_mv |
2021-09-01 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/report |
format |
report |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-706X2021000300264 |
url |
http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-706X2021000300264 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
http://scielo.pt/scielo.php?script=sci_arttext&pid=S1646-706X2021000300264 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
text/html |
dc.publisher.none.fl_str_mv |
Sociedade Portuguesa de Angiologia e Cirurgia Vascular |
publisher.none.fl_str_mv |
Sociedade Portuguesa de Angiologia e Cirurgia Vascular |
dc.source.none.fl_str_mv |
Angiologia e Cirurgia Vascular v.17 n.3 2021 reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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RCAAP |
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RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
collection |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
repository.name.fl_str_mv |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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1799137362259738624 |