STENT GRAFT APPLICATIONS AND RESULTS IN PATIENTS WITH THORACIC AORTIC PATHOLOGIES

Yıl 2020, Cilt: 83 Sayı: 2, 132 - 137, 23.03.2020

Yılmaz Önal Cesur Samancı Bülent Acunaş Murat Uğurlucan Ufuk Alpagut

Öz

Objective: The aim of this study was to evaluate the long-term results of patients who underwent thoracic stent grafting. Material and Method: We retrospectively evaluated 25 patients with a mean age of 67.1 (20-82) with thoracic aortic pathology treated with a stent graft or the hybrid method (endovascular intervention after surgery) in our clinic. Results: 23 patients were treated electively and 2 of them were treated urgently. Type 1A endoleak was observed in 5 patients in control imaging. Additional intervention was performed in 3 of these patients. In one patient, the endoleak spontaneously regressed during follow-up. One patient died on the 6th postoperative day due to MI. A total of 7 patients underwent hybrid procedures. One of the debranching patients developed major complications during endovascular procedure. In the type B dissection patients, neurological complications were observed during post-procedure controls in 1 of the 7 patients who underwent hybrid intervention. Conclusion: Endovascular thoracic stent grafting is performed with high technical success and survival rates in thoracic aortic pathologies. Hybrid intervention is preferred in patients with non-suitable anatomy for TEVAR alone.

Anahtar Kelimeler

Thoracic Aortic Aneurysm, Stent Graft, Hybrid Intervention

TORASİK AORT PATOLOJİLİ HASTALARDA STENT GREFT UYGULAMALARI VE SONUÇLARI

Öz

Amaç: Bu çalışmada, torasik stent greft uygulanmış hastaların uzun dönem sonuçlarının değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Kliniğimizde sadece stent greft ile ya da hibrid yöntem (cerrahi sonrası endovasküler girişim) ile tedavi edilmiş torasik aort patolojili, yaş ortalaması 67,1 (20-82) olan 25 hastayı retrospektif olarak değerlendirdik. Bulgular: Hastalardan 23’ü elektif olarak tedavi edilirken, 2’si acil olarak işleme alınmıştır. Kontrol görüntülemelerde 5 hastada tip 1A endoleak izlenmiştir. Bu hastalardan 3’üne ek girişim uygulanmıştır. Hastalardan birisinde endoleak takip sırasında kendiliğinden regrese olmuştur. 1 hastada ise post-op 6. günde MI nedeniyle ex olmuştur. Toplam 7 hastada hibrid işlem uygulanmıştır. Debranching uygulanan hastalardan bir tanesinde endovasküler işlem sırasında majör komplikasyon gelişmiştir. Hibrid girişim uygulanan 7 hastadan 1’i olan tip B diseksiyon hastasında işlem sonrası kontroller sırasında nörolojik komplikasyon izlenmiştir. Sonuç: Endovasküler torakal stent greft işlemi torakal aort patolojilerinde yüksek teknik başarı ve sağ kalım oranları ile uygulanmaktadır. Tek başına TEVAR’a uygun olmayan anatomiye sahip hastalarda hibrid girişim tercih edilmektedir.

Anahtar Kelimeler

Torasik Aort Anevrizması, Stent Greft, Hibrid Girişim

Kaynakça

• 1. Ranney DN, Cox ML, Yerokun BA, Benrashid E, McCann RL, Hughes GC. Long-term results of endovascular repair for descending thoracic aortic aneurysms. J Vasc Surg 2018;67(2):363-8.
• 2. Nienaber CA, Kische S, Rousseau H, Eggebrecht H, Rehders TC, Kundt G, Zipfel B. Endovascular repair of type B aortic dissection: long-term results of the randomized investigation of stent grafts in aortic dissection trial. Circ Cardiovasc Interv 2013;6(4);407-16.
• 3. Kiguchi M, Chaer RA. Endovascular repair of thoracic aortic pathology. Expert review of medical devices 2011;8:515-25.
• 4. Şırlak M, Çakıcı M, İnan MB, Eryılmaz S, Yazıcıoğlu L, Akar R, Aral A, Kaya B, Özyurda Ü. Torakal Ve Abdominal Aort Anevrizmalı Hastalarda Endovasküler Stent ile Onarım Uygulamalarımız. Damar Cer Derg 2009;18:1-9.
• 5. Zhou W, Reardon M, Peden EK, Lin PH, Lumsden AB. Hybrid approach to complex thoracic aortic aneurysms in high-risk patients: surgical challenges and clinical outcomes. J of Vasc Surg 2006;44(4),688-93.
• 6. Ugurlucan M, Alpagut U. Treatment solution by the readers: endovascular treatment of aortic arch aneurysms following aortic debranching. Interact Cardiovasc Thorac Surg 2015:20(5):688.
• 7. Czermak BV, Waldenberger P, Fraedrich G, Dessl AH, Roberts KE, Bale RJ, Perkmann R, Jaschke WR. Treatment of Stanford type B aortic dissection with stent-grafts: preliminary results. Radiology 2000;217(2):544-50.
• 8. Dake MD, Miller DC, Semba CP, Mitchell RS, Walker PJ, Liddell RP. Transluminal placement of endovascular stentgrafts for the treatment of descending thoracic aortic aneurysms. N Engl J Med 1994;331:1729-34.
• 9. Isselbacher EM. Thoracic and abdominal aortic aneurysms. Circulation 2005;111:816-28.
• 10. Gowda RM, Misra D, Tranbaugh RF, Ohki T, Khan IA. Endovascular stent grafting of descending thoracic aortic aneurysms. Chest 2003;124:714-9.
• 11. Davies RR, Goldstein LJ, Coady MA, Tittle SL, Rizzo JA, Kopf GS, Elefteriades JA. Yearly rupture or dissection rates for thoracic aortic aneurysms: simple prediction based on size. Ann Thorac Surg 2002;73(1):17-28.
• 12. Brown KE, Eskandari MK, Matsumura JS, Rodriguez H, Morasch MD. Short and midterm results with minimally invasive endovascular repair of acute and chronic thoracic aortic pathology. J Vasc Surg 2008;47:714-22.
• 13. Beregi JP, Midulla M. Stent-grafting of the thoracic aorta. In Handbook of Angioplasty and Stenting Procedures. Springer, London. 2010;207-23.
• 14. Cheung AT, Pochettino A, McGarvey ML, Appoo JJ, Fairman RM, Carpenter JP, Bavaria JE. Strategies to manage paraplegia risk after endovascular stent repair of descending thoracic aortic aneurysms. Ann Thorac Surg 2005;80(4):1280-9.
• 15. Banga PV, Oderich GS, Reis de Souza L, Hofer J, Cazares Gonzalez ML, Pulido JN, Gloviczki P. Neuromonitoring, cerebrospinal fluid drainage, and selective use of iliofemoral conduits to minimize risk of spinal cord injury during complex endovascular aortic repair. J Endovasc Ther 2016;23(1):139-49.
• 16. Hnath JC, Mehta M, Taggert JB, Sternbach Y, Roddy SP, Kreienberg PB, Ozsvath KJ, Chang BB, Shah DM, Darling RC. Strategies to improve spinal cord ischemia in endovascular thoracic aortic repair: Outcomes of a prospective cerebrospinal fluid drainage protocol. J Vasc Surg 2008;48(4):836-40.
• 17. Cheung AT, Pochettino A, McGarvey ML, Appoo JJ, Fairman RM, Carpenter JP, Bavaria JE. Strategies to manage paraplegia risk after endovascular stent repair of descending thoracic aortic aneurysms. Ann Thorac Surg 2005;80(4):1280-9.
• 18. Matsuda H, Ogino H, Fukuda T, Iritani O, Sato S, Iba Y, Yagihara T. Multidisciplinary approach to prevent spinal cord ischemia after thoracic endovascular aneurysm repair for distal descending aorta. Ann Thorac Surg 2010;90(2):5615.
• 19. Martin G, Riga C, Gibbs R, Jenkins M, Hamady M, Bicknell C. Short-and long-term results of hybrid arch and proximal descending thoracic aortic repair: a benchmark for new technologies. J Endovasc Ther 2016;23(5):783-90.
• 20. Weigang E, Parker JA, Czerny M, Lonn L, Bonser RS, Carrel TP, Vahl CF. Should intentional endovascular stent-graft coverage of the left subclavian artery be preceded by prophylactic revascularisation? Eur J Cardiothorac Surg 2011;40(4):858-68.
• 21. Kotelis D, Geisbüsch P, Hinz U, Hyhlik-Dürr A, von TenggKobligk H, Allenberg JR, Böckler D. Short and midterm results after left subclavian artery coverage during endovascular repair of the thoracic aorta. J Vasc Surg 2009;50(6):1285-92.
• 22. Caronno R, Piffaretti G, Tozzi M, Lomazzi C, Rivolta N, Castelli P. Intentional coverage of the left subclavian artery during endovascular stent graft repair for thoracic aortic disease Surg Endosc 2006;20(6):915-8.
• 23. Torsello GB, Torsello GF, Osada N, Teebken OE, Ratusinski CM, Nienaber CA. Midterm results from the TRAVIATA registry: treatment of thoracic aortic disease with the valiant stent graft. J Endovasc Ther 2010;17:137-50.
• 24. Väärämäki S, Suominen V, Pimenoff G, Saarinen J, Uurto I, Salenius J. Hybrid repair of thoracoabdominal aortic aneurysms is a durable option for high-risk patients in the endovascular era. Vasc Endovascular Surg 2016;50(7):491-6.