Arminder Jassar1, Maximilian Kreibich2, Julia Morlock2, Stoyan Kondov2, Johannes Scheumann2, Fabian A Kari2, Bartosz Rylski2, Matthias Siepe2, Alexander Jonaszik3, Cornelius Keyl4, Frank Humburger5, Friedhelm Beyersdorf2, Martin Czerny6. 1. Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany; Department of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Albert Ludwigs University Freiburg, Faculty of Medicine, Freiburg, Germany. 2. Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany; Albert Ludwigs University Freiburg, Faculty of Medicine, Freiburg, Germany. 3. Department of Radiology, University Hospital Freiburg, Freiburg, Germany; Albert Ludwigs University Freiburg, Faculty of Medicine, Freiburg, Germany. 4. Department of Anesthesiology, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany; Albert Ludwigs University Freiburg, Faculty of Medicine, Freiburg, Germany. 5. Department of Anesthesiology, University Hospital Freiburg, Freiburg, Germany; Albert Ludwigs University Freiburg, Faculty of Medicine, Freiburg, Germany. 6. Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany; Albert Ludwigs University Freiburg, Faculty of Medicine, Freiburg, Germany. Electronic address: martin.czerny@universitaets-herzzentrum.de.
Abstract
BACKGROUND: To report a new technique for diameter correction in patients after thoracic endovascular aortic repair (TEVAR) with large stent-grafts using the Vascutek Siena 4-branch collared prosthesis (Vascutek Terumo, Inchinnan, Scotland, UK) in patients undergoing thoracoabdominal (TA) aortic replacement. METHODS: Within a 24-month period, 39 patients underwent TA replacement at our center. Of these, 6 patients had undergone previous TEVAR with large stent-grafts (42 to 48 mm diameter). Indications for TEVAR were aneurysm formation in 3 patients and residual type B aortic dissection (status post repair of type A dissection) in 3 patients. In these patients, the Vascutek Siena 4-branch prosthesis was used in a reversed fashion, removing the elephant trunk portion and using the sewing collar for diameter correction at the anastomotic site. RESULTS: No 30-day mortality and no stroke or symptomatic spinal cord ischemia was observed. Median diameter of the TEVAR graft at the anastomotic site was 44 mm. Median size of the Siena graft used was 26 mm. Diameter correction was successfully achieved in all patients by tailoring the sewing collar of the Siena 4-branch prosthesis to the individual need according to the diameter of the distal end of the stent-graft. CONCLUSIONS: Using the sewing collar of the Vascutek Siena 4-branch prosthesis for diameter correction in patients undergoing TA replacement after previous TEVAR with large stent-grafts adds a useful adjunct to the armamentarium of options in a growing patient population.
BACKGROUND: To report a new technique for diameter correction in patients after thoracic endovascular aortic repair (TEVAR) with large stent-grafts using the Vascutek Siena 4-branch collared prosthesis (Vascutek Terumo, Inchinnan, Scotland, UK) in patients undergoing thoracoabdominal (TA) aortic replacement. METHODS: Within a 24-month period, 39 patients underwent TA replacement at our center. Of these, 6 patients had undergone previous TEVAR with large stent-grafts (42 to 48 mm diameter). Indications for TEVAR were aneurysm formation in 3 patients and residual type B aortic dissection (status post repair of type A dissection) in 3 patients. In these patients, the Vascutek Siena 4-branch prosthesis was used in a reversed fashion, removing the elephant trunk portion and using the sewing collar for diameter correction at the anastomotic site. RESULTS: No 30-day mortality and no stroke or symptomatic spinal cord ischemia was observed. Median diameter of the TEVAR graft at the anastomotic site was 44 mm. Median size of the Siena graft used was 26 mm. Diameter correction was successfully achieved in all patients by tailoring the sewing collar of the Siena 4-branch prosthesis to the individual need according to the diameter of the distal end of the stent-graft. CONCLUSIONS: Using the sewing collar of the Vascutek Siena 4-branch prosthesis for diameter correction in patients undergoing TA replacement after previous TEVAR with large stent-grafts adds a useful adjunct to the armamentarium of options in a growing patient population.
Authors: Martin Czerny; Maximilian Kreibich; Julia Morlock; Stoyan Kondov; Johannes Scheumann; Holger Schröfel; Fabian A Kari; Tim Berger; Matthias Siepe; Friedhelm Beyersdorf; Bartosz Rylski Journal: J Vis Surg Date: 2018-01-17
Authors: Stoyan Kondov; Leon Frankenberger; Matthias Siepe; Cornelius Keyl; Klaus Staier; Frank Humburger; Bartosz Rylski; Maximilian Kreibich; Tim Berger; Friedhelm Beyersdorf; Martin Czerny Journal: Interact Cardiovasc Thorac Surg Date: 2022-08-03