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Published on: December 11, 2017
Aortic Replacement After TEVAR-Diameter Correction With Modified Use of the Siena Prosthesis
Arminder Jassar1, Maximilian Kreibich2, Julia Morlock2
1Department 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.
A novel technique using the Vascutek Siena 4-branch prosthesis collar successfully corrected large stent-graft diameters in patients undergoing thoracoabdominal aortic replacement after prior thoracic endovascular aortic repair (TEVAR). This method offers a safe and effective solution for a growing patient group.
Area of Science:
- Vascular Surgery
- Endovascular Repair
- Aortic Aneurysm and Dissection
Background:
- Thoracic endovascular aortic repair (TEVAR) can result in large stent-graft diameters.
- Diameter discrepancies pose challenges during subsequent thoracoabdominal (TA) aortic replacement.
- A new technique is needed to address these diameter challenges.
Purpose of the Study:
- To describe a novel technique for diameter correction in patients undergoing TA replacement after TEVAR with large stent-grafts.
- To evaluate the efficacy and safety of using the Vascutek Siena 4-branch prosthesis for diameter adjustment.
Main Methods:
- A retrospective review of 6 patients who underwent TA replacement after TEVAR with large stent-grafts (42-48 mm diameter).
- The Vascutek Siena 4-branch prosthesis was utilized in a reversed fashion, employing its sewing collar for diameter correction at the anastomotic site.
- Indications for prior TEVAR included aneurysm formation (3 patients) and residual type B aortic dissection (3 patients).
Main Results:
- Diameter correction was successfully achieved in all 6 patients.
- The median diameter of the prior TEVAR graft was 44 mm, with a median Siena graft size of 26 mm used for correction.
- No 30-day mortality, stroke, or symptomatic spinal cord ischemia was observed.
Conclusions:
- The sewing collar of the Vascutek Siena 4-branch prosthesis provides a valuable method for diameter correction in TA replacement following TEVAR with large stent-grafts.
- This technique expands the options for managing complex aortic pathologies in a growing patient population.
