ABSTRACT
OBJECTIVES: To analyze device designs, similarities and overlaps of custom-made fenestrated arch endografts intended for mid/distal arch thoracic endovascular aortic repair. MATERIALS AND METHODS: A multicenter cross-sectional study analyzing custom-made anonymized graft plans was performed. Graft plans were included from a cohort of mid/distal aortic arch repairs using custom-made fenestrated aortic endografts treated at 8 centers. Grafts targeting >2 arteries were excluded. No patient/clinical data were analyzed. A descriptive analysis was performed followed by an analysis of overlap of the designs to reach a common design in which the greatest number of grafts would overlap. RESULTS: One hundred thirty-one graft plans were included. All grafts were custom-made grafts from the COOK Medical Fenestrated arch platform. Ninety-four (71.8%) had a scallop-and-single-fenestration design, 33 (25.2%) had a single fenestration and 4 (4.3%) a single scallop. For analysis purposes, these latter 4 grafts were excluded. Two main graft plans (Plans 1 and 2) were proposed after analysis with similar configuration (1 scallop with 30 mm width, 20 mm height, 12:00 position; 1 preloaded fenestration with 8 mm diameter, 26 mm from the top of the graft and 12:00 position; tapered, with a 193 mm length and 32 mm distal diameter) but with 2 different proximal diameters of 38 mm (Plan 1) and 44 mm (Plan 2), reaching an overall feasibility of 85.8% (n=109), being 47.2% (n=60) and 38.6% (n=49) for each design, respectively. CONCLUSION: The degree of overlap between the studied fenestrated and/or scalloped thoracic endovascular aneurysm repair (TEVAR) graft designs was high. Future studies analyzing these designs in a real-world cohort of patients are needed to further address off-the-shelf feasibility. CLINICAL IMPACT: In a multicenter study analyzing 127 fenestrated aortic arch endograft plans from 9 aortic centers, we found that the degree of overlap between the studied fenestrated and/or scalloped arch graft designs was high and that 2 proposed graft designs would be theoretically applicable in 85.8% of cases. Future studies analyzing these designs in a real-world cohort of patients are needed to further address off-the-shelf feasibility.
ABSTRACT
OBJECTIVES: The aim of this study was to evaluate the diagnostic possibilities of accurately locating the entry site in acute retrograde Type A aortic dissection and the results of the corresponding endovascular treatments. METHODS: Among 100 patients who underwent surgery for the treatment of spontaneous acute Type A aortic dissection between 2012 and June 2017, all but 1 patient had preoperative computed tomographic angiography. A total of 8 retrograde extensions originated from the descending aorta, in which 6 of them were diagnosed correctly using radiological imaging. The surgical team was unable to properly diagnose the entry site using radiological imaging in only 1 patient, and no preoperative computed tomographic-angiographic scans were available for 1 other patient. In the latter case, the retrograde dissection was diagnosed intraoperatively and confirmed by postoperative computed tomographic angiography. RESULTS: In 5 patients, a tear-oriented endovascular repair was performed based on preoperative radiological findings. In the remaining 3 patients, conventional surgery of the proximal aorta was performed because of the clinical situation (e.g. aortic insufficiency, pericardial effusion) and/or diagnostic uncertainty. One patient subsequently underwent an endograft successfully. All patients survived surgery and were alive at the last follow-up; however, complete remodelling of the thoracic aorta was evident in only patients with endovascular repair. CONCLUSIONS: Tear-oriented endovascular repair of acute Type A aortic dissection originating from the descending aorta seems to be a valuable and durable therapeutic option. However, the determination of the entry site in the descending aorta is a prerequisite for this type of treatment. Therefore, the surgical team should consider a diagnostics based on modern, sophisticated radiological methods.
