Repair of type Ⅰa endoleak after thoracic endovascular aortic repair_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Chengnan ,  ZHU Junming , QI Ruidong , YANG Yi , YU Hai , XING Xiaoyan , LIU Yongmin , HUANG Lianjun , SUN Lizhong

Anzhen Beijing Aortic Disease Center, Beijing Institute of Heart, Lung and Blood Vessel Diseases & Beijing Hospital, Capital Medical University, Beijing, 100029, P.R.China;

Corresponding author：

ZHU Junming, Email: anzhenzjm@163.com

Keywords：

Type Ⅰa endoleak; thoracic endovascular aortic repair; hybrid aortic arch repair; Sun's procedure; stented elephant trunk procedure; cuff extension

DOI：

10.7507/1007-4848.201804020

Video：

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Objective To retrospectively review our experience of correction of type Ⅰa endoleak after thoracic endovascular aortic repair(TEVAR). Methods From August 2009 to May 2016, 29 patients with type Ⅰa endoleak after TEVAR (25 males, 4 females at mean age of 56±10 years (range, 41–86 years) underwent treatment: open surgery in 15 patients (an open surgery group), hybrid aortic arch repair in 6 patients (a hybrid group) and cuff extension in 8 patients(a cuff group). A history of hypertension was noted in 25 patients, diabetes mellitus in 3 patients, coronary artery disease in 3 patients, lung infection in one patient, aortic root aneurysm in one patient and aberrant right subclavian artery in one patient. Results In the open surgery group, no death was observed. Continuous renal replacement therapy and re-intubation was done in one patient and drainage of pericardial effusion in one patient. No death was noted in the hybrid group and persistent type Ⅰa endoleak in one patient. In the cuff group, thrombosis of the left common artery was noted in one patient and bypass of the left axillary artery to the left axillary artery and the left common carotid artery was done. Unfortunately, he died of cerebral infarction and total in-hospital death rate was 3.4% (1/29). Bypass of the left axillary artery to the left axillary artery was done in one patient with left upper limb ischemia. There were 4 (14.2%) deaths during follow-up: 3 deaths in the open surgical group and one death in the cuff group. Endoleak was observed in one patient in the hybrid group and one in the cuff group. Conclusion The corresponding procedure, including open surgery, hybrid aortic arch repair or cuff extension, is scheduled to be done according to the characteristics of type Ⅰa endoleak. Satisfactory outcomes are achieved in patients with typeⅠa endoleak.

Citation： LI Chengnan, ZHU Junming, QI Ruidong, YANG Yi, YU Hai, XING Xiaoyan, LIU Yongmin, HUANG Lianjun, SUN Lizhong. Repair of type Ⅰa endoleak after thoracic endovascular aortic repair. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(10): 870-874. doi: 10.7507/1007-4848.201804020 Copy

1.	Dake MD, Miller DC, Semba CP, et al. Transluminal placement of endovascular stent-grafts for the treatment of descending thoracic aortic aneurysms. N Engl J Med, 1994, 331(26): 1729-1734.
2.	李庆, 黄连军, 许尚栋, 等. Stanford B主动脉夹层患者腔内修复术的疗效观察. 中华医学杂志, 2013, 93(19): 1469-1471.
3.	Lee WA. Failure modes of thoracic endografts: Prevention and management. J Vasc Surg, 2009, 49(3): 792-799.
4.	Ricotta JJ 2nd. Endoleak management and postoperative surveillance following endovascular repair of thoracic aortic aneurysms. J Vasc Surg, 2010, 52(4 Suppl): 91S-99S.
5.	Zhu J, Cheng L, Liu Y, et al. One-stage repair for Stanford type B aortic dissection concomitant with cardiac diseases: open stented elephant trunk technique combined with cardiac operation. Thorac Cardiovasc Surg, 2012, 60(1): 11-16.
6.	Zhu JM, Qi RD, Chen L, et al. Stented elephant trunk procedure with left subclavian artery transposition for acute type B dissection with distal arch involvement. J Thorac Cardiovasc Surg, 2015, 150(5): 1160-1165.
7.	Liu ZG, Sun LZ, Chang Q, et al. Should the "elephant trunk" be skeletonized? Total arch replacement combined with stented elephant trunk implantation for Stanford type A aortic dissection. J Thorac Cardiovasc Surg, 2006, 131(1): 107-113.
8.	Patel HJ, Williams DM, Drews JD, et al. A 20-year experience with thoracic endovascular aortic repair. Ann Surg, 2014, 260(4): 691-696.
9.	Preventza O, Wheatley GH 3rd, Ramaiah VG, et al. Management of endoleaks associated with endovascular treatment of descending thoracic aortic diseases. J Vasc Surg, 2008, 48(1): 69-73.
10.	Ruan ZB, Zhu L, Yin YG, et al. Risk factors of early and late mortality after thoracic endovascular aortic repair for complicated stanford B acute aortic dissection. J Card Surg, 2014, 29(4): 501-506.
11.	Lipsitz E, Michler RE, Neragi-Miandoab S. Hybrid arch debranching and proximal endograft extension to repair a type I endoleak after endovascular thoracic aneurysm repair. Ann Vasc Surg, 2014, 28(3): 740.
12.	Kefeng Z, Xudong P, Yongmin L, et al. Hybrid operation for type B aortic dissection involving distal aortic arch. J Card Surg, 2014, 29(3): 359-363.
13.	De Rango P, Cao P, Ferrer C, et al. Aortic arch debranching and thoracic endovascular repair. J Vasc Surg, 2014, 59(1): 107-114.
14.	Faure EM, Canaud L, Marty-Ané C, et al. Hybrid aortic arch repair for dissecting aneurysm. J Thorac Cardiovasc Surg, 2016, 152(1): 162-168.
15.	Bünger CM, Kische S, Liebold A, et al. Hybrid aortic arch repair for complicated type B aortic dissection. J Vasc Surg, 2013, 58(6): 1490-1496.
16.	Cochennec F, Tresson P, Cross J, et al. Hybrid repair of aortic arch dissections. J Vasc Surg, 2013, 57(6): 1560-1567.
17.	李滨, 孙立忠, 常谦, 等. 全弓替换加支架象鼻技术治疗复杂Standford B型主动脉夹层的临床观察. 中华医学杂志, 2010, 90(5): 323-326.
18.	齐瑞东, 朱俊明, 陈雷, 等. 孙氏手术治疗慢性Stanford B型主动脉夹层累及主动脉弓的观察. 中华医学杂志, 2017, 97(24): 1867-1870.
19.	Sun L, Qi R, Zhu J, et al. Total arch replacement combined with stented elephant trunk implantation: a new " standard” therapy for type a dissection involving repair of the aortic arch? Circulation, 2011, 123(9): 971-978.
20.	Zhu JM, Qi RD, Liu YM, et al. Repair of distal aortic arch aneurysms by left subclavian artery transposition with stented elephant trunk implantation. Ann Vasc Surg, 2016, 32: 98-103.
21.	Qi RD, Zhu JM, Liu YM, et al. The repair of a type Ia endoleak following thoracic endovascular aortic repair using a stented elephant trunk procedure. J Thorac Cardiovasc Surg, 2018, 155(4): 1391-1396.
22.	Landau JH, Dubois LA, Chu MWA. Hybrid arch frozen elephant trunk for persistent endoleak after thoracic endovascular aortic repair. Ann Thorac Surg, 2017, 104(3): e227-e229.

1. Dake MD, Miller DC, Semba CP, et al. Transluminal placement of endovascular stent-grafts for the treatment of descending thoracic aortic aneurysms. N Engl J Med, 1994, 331(26): 1729-1734.
2. 李庆, 黄连军, 许尚栋, 等. Stanford B主动脉夹层患者腔内修复术的疗效观察. 中华医学杂志, 2013, 93(19): 1469-1471.
3. Lee WA. Failure modes of thoracic endografts: Prevention and management. J Vasc Surg, 2009, 49(3): 792-799.
4. Ricotta JJ 2nd. Endoleak management and postoperative surveillance following endovascular repair of thoracic aortic aneurysms. J Vasc Surg, 2010, 52(4 Suppl): 91S-99S.
5. Zhu J, Cheng L, Liu Y, et al. One-stage repair for Stanford type B aortic dissection concomitant with cardiac diseases: open stented elephant trunk technique combined with cardiac operation. Thorac Cardiovasc Surg, 2012, 60(1): 11-16.
6. Zhu JM, Qi RD, Chen L, et al. Stented elephant trunk procedure with left subclavian artery transposition for acute type B dissection with distal arch involvement. J Thorac Cardiovasc Surg, 2015, 150(5): 1160-1165.
7. Liu ZG, Sun LZ, Chang Q, et al. Should the "elephant trunk" be skeletonized? Total arch replacement combined with stented elephant trunk implantation for Stanford type A aortic dissection. J Thorac Cardiovasc Surg, 2006, 131(1): 107-113.
8. Patel HJ, Williams DM, Drews JD, et al. A 20-year experience with thoracic endovascular aortic repair. Ann Surg, 2014, 260(4): 691-696.
9. Preventza O, Wheatley GH 3rd, Ramaiah VG, et al. Management of endoleaks associated with endovascular treatment of descending thoracic aortic diseases. J Vasc Surg, 2008, 48(1): 69-73.
10. Ruan ZB, Zhu L, Yin YG, et al. Risk factors of early and late mortality after thoracic endovascular aortic repair for complicated stanford B acute aortic dissection. J Card Surg, 2014, 29(4): 501-506.
11. Lipsitz E, Michler RE, Neragi-Miandoab S. Hybrid arch debranching and proximal endograft extension to repair a type I endoleak after endovascular thoracic aneurysm repair. Ann Vasc Surg, 2014, 28(3): 740.
12. Kefeng Z, Xudong P, Yongmin L, et al. Hybrid operation for type B aortic dissection involving distal aortic arch. J Card Surg, 2014, 29(3): 359-363.
13. De Rango P, Cao P, Ferrer C, et al. Aortic arch debranching and thoracic endovascular repair. J Vasc Surg, 2014, 59(1): 107-114.
14. Faure EM, Canaud L, Marty-Ané C, et al. Hybrid aortic arch repair for dissecting aneurysm. J Thorac Cardiovasc Surg, 2016, 152(1): 162-168.
15. Bünger CM, Kische S, Liebold A, et al. Hybrid aortic arch repair for complicated type B aortic dissection. J Vasc Surg, 2013, 58(6): 1490-1496.
16. Cochennec F, Tresson P, Cross J, et al. Hybrid repair of aortic arch dissections. J Vasc Surg, 2013, 57(6): 1560-1567.
17. 李滨, 孙立忠, 常谦, 等. 全弓替换加支架象鼻技术治疗复杂Standford B型主动脉夹层的临床观察. 中华医学杂志, 2010, 90(5): 323-326.
18. 齐瑞东, 朱俊明, 陈雷, 等. 孙氏手术治疗慢性Stanford B型主动脉夹层累及主动脉弓的观察. 中华医学杂志, 2017, 97(24): 1867-1870.
19. Sun L, Qi R, Zhu J, et al. Total arch replacement combined with stented elephant trunk implantation: a new " standard” therapy for type a dissection involving repair of the aortic arch? Circulation, 2011, 123(9): 971-978.
20. Zhu JM, Qi RD, Liu YM, et al. Repair of distal aortic arch aneurysms by left subclavian artery transposition with stented elephant trunk implantation. Ann Vasc Surg, 2016, 32: 98-103.
21. Qi RD, Zhu JM, Liu YM, et al. The repair of a type Ia endoleak following thoracic endovascular aortic repair using a stented elephant trunk procedure. J Thorac Cardiovasc Surg, 2018, 155(4): 1391-1396.
22. Landau JH, Dubois LA, Chu MWA. Hybrid arch frozen elephant trunk for persistent endoleak after thoracic endovascular aortic repair. Ann Thorac Surg, 2017, 104(3): e227-e229.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Repair of type Ⅰa endoleak after thoracic endovascular aortic repair

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