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LSA coverage

Arnoud V Kamman, Jonathan L Eliason, David M Williams, Bo Yang, Frans L Moll, Santi Trimarchi, Kim A Eagle, Himanshu J Patel
OBJECTIVES: The impact of left subclavian artery (LSA) revascularization prior to thoracic endovascular aortic repair (TEVAR) on cerebrovascular flow is not well described. We studied bilateral vertebral and carotid artery flow characteristics before and after TEVAR, to evaluate the hemodynamic effects of LSA revascularization. METHODS: Seventy-four patients with mixed etiologies (mean age 70.9±10.5 years) underwent LSA revascularization and TEVAR (2006-2016) and had available pre- and post-operative carotid Duplex study available...
June 21, 2017: Annals of Vascular Surgery
Jian Zhu, Er-Ping Xi, Shui-Bo Zhu, Gui-Lin Yin, Rong-Ping Wang, Yu Zhang
BACKGROUND: The application of thoracic endovascular aortic repair (TEVAR), a minimally invasive operation, in the aortic arch has been a challenge of cardiovascular surgery in recent years. This study aimed to investigate management of the vertebral artery with coverage of the left subclavian artery (LSA) during TEVAR. METHODS: From January 2007 to September 2014 in the Department of Cardiothoracic Surgery at Wuhan General Hospital of Guangzhou Military Region, 160 patients underwent LSA closure or partial coverage during TEVAR of an aortic lesion near the LSA...
May 2017: Journal of Thoracic Disease
Cornelis P van der Zee, Tryfon Vainas, Freek A van Brussel, Ignace F Tielliu, Clark J Zeebregts, Maarten J van der Laan
BACKGROUND: To provide an overview of the experience of endovascular treatment for traumatic thoracic aortic lesions (TTAL). Thoracic aortic injury secondary to high-energy chest trauma constitutes an emergency situation with potentially devastating outcome. In the present time, the majority of patients are treated with thoracic endovascular aortic repair. The aim of this study was to provide a systematic overview of endovascular aortic repair in patients with TTAL with special attention to perioperative mortality, paraplegia, stroke, influence of left subclavian artery (LSA) coverage herein, and long term stent related complications...
May 3, 2017: Journal of Cardiovascular Surgery
Sergio Quilici Belczak, Erasmo Simão Silva, Rafael Klajner, Pedro Puech-Leão, Nelson De Luccia
BACKGROUND: The status of the left arm, the need of revascularization, and the occurrence of type II endoleakes from de left subclavian artery (LSA) after intention LSA coverage for thoracic aortic aneurysm endovascular repair need to be better understood. This systematic review was developed for contributing with such issue. METHODS: Systematic literature review of studies published from January 2000 through December 2015 identified 7 studies comprising 201 patients submitted to elective endovascular repair for thoracic aortic aneurysms requiring intentional LSA coverage...
May 2017: Annals of Vascular Surgery
Rhiannon J Bradshaw, S Sadie Ahanchi, Obie Powell, Sebastian Larion, Colin Brandt, Michael C Soult, Jean M Panneton
BACKGROUND: The best management strategy for the left subclavian artery (LSA) in pathologic processes of the aorta requiring zone 2 thoracic endovascular aortic repair (TEVAR) remains controversial. We compared LSA coverage with or without revascularization as well as the different means of LSA revascularization. METHODS: A retrospective chart review was conducted of patients with any aortic diseases who underwent zone 2 TEVAR deployment from 2007 to 2014. Primary end points included 30-day stroke and 30-day spinal cord injury (SCI)...
May 2017: Journal of Vascular Surgery
Tze-Woei Tan, Amy H Coulter, Wayne W Zhang
Left subclavian artery (LSA) revascularization is recommended during elective thoracic endovascular aortic aneurysm repair (TEVAR) when coverage is required for adequate proximal seal. Reported method for LSA revascularization includes open bypass, covered stent placement using chimney technique, and in situ laser fenestration. We reported a novel technique using percutaneous Outback reentry device for LSA revascularization in a 68-year-old male patient who underwent TEVAR for a 9-cm thoracic aortic aneurysm...
December 2016: International Journal of Angiology: Official Publication of the International College of Angiology, Inc
R S von Allmen, B Gahl, J T Powell
OBJECTIVE: Stroke is an increasingly recognised complication following thoracic endovascular aortic repair (TEVAR). The aim of this study was to systematically synthesise the published data on perioperative stroke incidence during TEVAR for patients with descending thoracic aneurysmal disease and to assess the impact of left subclavian artery (LSA) coverage on stroke incidence. METHODS: A systematic review of English and German articles on perioperative (in-hospital or 30 day) stroke incidence following TEVAR for descending aortic aneurysm was performed, including studies with ≥50 cases, using MEDLINE and EMBASE (2005-2015)...
December 16, 2016: European Journal of Vascular and Endovascular Surgery
Alexander Gombert, Drosos Kotelis, Ulrike M Griepenkerl, Gustav Fraedrich, Josef Klocker, Bernhard Glodny, Michael J Jacobs, Andreas Greiner, Jochen Grommes
BACKGROUND: Patients suffering blunt thoracic aortic injury (BTAI) can be treated by use of thoracic endovascular aortic repair (TEVAR). In this setting, the coverage of the left subclavian artery (LSA) is frequently necessary. Nevertheless, the functionality of the upper left extremity after TEVAR had been rarely analyzed. Thus, this study intends to underline the safety of TEVAR as well as to determine the functionality of the left arm after coverage of the LSA. METHODS: All patients suffering from BTAI treated by endovascular means in 3 centers (Aachen [Germany], Maastricht [Netherlands], and Innsbruck [Austria]) between 1996 and 2009 were retrospectively analyzed...
November 27, 2016: Annals of Vascular Surgery
Yuji Kanaoka, Takao Ohki, Koji Maeda, Takeshi Baba
PURPOSE: To evaluate risk factors for early (<30 days) type I endoleak following thoracic endovascular aortic repair (TEVAR). METHODS: A retrospective study was conducted of 439 consecutive patients (mean age 74.0±10.0 years; 333 men) who underwent TEVAR at a single center between June 2006 and June 2013. Pathologies included 237 aortic arch aneurysms and 202 descending thoracic aortic aneurysms (dTAA). Maximum TAA diameter was 63.6±13.7 mm. Among the distal aortic arch aneurysms, 124 required coverage of the left subclavian artery (LSA), while the remaining 113 arch aneurysms had debranching (n=40), the chimney technique (n=52), and a branched stent-graft (n=13)...
February 2017: Journal of Endovascular Therapy
Ludovic Canaud, Vincent Ziza, Baris Ata Ozdemir, Jean-Philippe Berthet, Charles-Henri Marty-Ané, Pierre Alric
BACKGROUND: The aim of this study was to evaluate outcomes of left subclavian artery (LSA) revascularization for hybrid aortic arch debranching. METHODS: Between 1998 and 2015, 68 patients (41 men; mean age, 67 ± 16 years) underwent thoracic endovascular aortic repair (TEVAR) with LSA coverage, 19.2% (n = 13) were never revascularized, and the remaining patients underwent LSA revascularization (n = 55; 80.8%). Revascularization was achieved by LSA-carotid transposition via a medial approach in 81...
September 23, 2016: Annals of Vascular Surgery
Shahin Hajibandeh, Shahab Hajibandeh, Stavros A Antoniou, Francesco Torella, George A Antoniou
PURPOSE: To examine the role of left subclavian artery (LSA) revascularization in thoracic endovascular aortic repair (TEVAR) with LSA coverage. METHODS: A systematic search was conducted to identify all studies providing comparative outcomes with or without LSA revascularization for LSA occlusion during TEVAR. The search included MEDLINE, EMBASE, CINAHL, the Cochrane Central Register of Controlled Trials, the World Health Organization International Clinical Trials Registry, ClinicalTrials...
August 2016: Journal of Endovascular Therapy
Shahin Hajibandeh, Shahab Hajibandeh, Stavros A Antoniou, Francesco Torella, George A Antoniou
BACKGROUND: Controversy exists as to whether revascularisation of the left subclavian artery (LSA) confers improved outcomes in patients undergoing thoracic endovascular aortic repair (TEVAR). Even though preemptive revascularisation of the LSA has theoretical advantages, including a reduced risk of ischaemic damage to vital organs, such as the brain and the spinal cord, it is not without risks. Current practice guidelines recommend routine revascularisation of the LSA in patients undergoing elective TEVAR where achievement of a proximal seal necessitates coverage of the LSA, and in patients who have an anatomy that compromises perfusion to critical organs...
April 27, 2016: Cochrane Database of Systematic Reviews
Takeshi Baba, Takao Ohki, Yuji Kanaoka, Koji Maeda
BACKGROUND: This single-center study assessed left subclavian artery (LSA) revascularization management and morbidity and mortality of LSA coverage outcomes during elective thoracic endovascular aortic repair (TEVAR) for distal arch aneurysms. METHODS: Between July 2006 and June 2014, 178 patients underwent TEVAR (zone 2 + 3) for distal arch aneurysms. TEVAR with LSA coverage (zone 2) was performed in 121 patients (68.0 %). Multivariate analysis was performed to determine factors associated with perioperative cerebral infarction (CI) and postoperative endoleak (EL)...
November 2015: World Journal of Surgery
Kimberly C Zamor, Mark K Eskandari, Heron E Rodriguez, Karen J Ho, Mark D Morasch, Andrew W Hoel
BACKGROUND: Practice guidelines for management of the left subclavian artery (LSA) during thoracic endovascular aortic repair (TEVAR) are based on low-quality evidence, and there is limited literature that addresses optimal revascularization techniques. The purpose of this study was to compare outcomes of LSA coverage during TEVAR and revascularization techniques. STUDY DESIGN: We performed a single-center retrospective cohort study from 2001 to 2013. Patients were categorized by LSA revascularization and by revascularization technique, carotid-subclavian bypass (CSB), or subclavian-carotid transposition (SCT)...
July 2015: Journal of the American College of Surgeons
Drosos Kotelis, Carolin Brenke, Stefan Wörz, Fabian Rengier, Karl Rohr, Hans-Ulrich Kauczor, Dittmar Böckler, Hendrik von Tengg-Kobligk
PURPOSE: The purpose of this study was to identify morphologic factors affecting type I endoleak formation and bird-beak configuration after thoracic endovascular aortic repair (TEVAR). METHODS: Computed tomography (CT) data of 57 patients (40 males; median age, 66 years) undergoing TEVAR for thoracic aortic aneurysm (34 TAA, 19 TAAA) or penetrating aortic ulcer (n = 4) between 2001 and 2010 were retrospectively reviewed. In 28 patients, the Gore TAG® stent-graft was used, followed by the Medtronic Valiant® in 16 cases, the Medtronic Talent® in 8, and the Cook Zenith® in 5 cases...
May 2015: Langenbeck's Archives of Surgery
Abdullah S Amoudi, Anas A Merdad, Ahmed Q Makhdoom, Reda A Jamjoom
Endovascular repair of blunt aortic injury is now a first-line approach in management. This can warrant coverage of the left subclavian artery (LSA), which could lead to posterior strokes. In this case report, we present a severe complication of endovascular repair of a traumatic aortic aneurysm. A 53-year-old man presented with blunt aortic injury, endovascular repair was carried out where the left subclavian artery was covered. The intervention had a 100% technical success. Twelve hours later, he was discovered to have quadriplegia, a CT scan showed a large left cerebellar infarction extending to the medulla oblongata and proximal spinal cord...
January 2015: Neurosciences: the Official Journal of the Pan Arab Union of Neurological Sciences
Benjamin O Patterson, Peter J Holt, Christoph Nienaber, Ronald M Fairman, Robin H Heijmen, Matt M Thompson
OBJECTIVE: Thoracic endovascular aortic repair (TEVAR) of various pathologies has been associated with peri-interventional neurologic complication rates of up to 15%. The objective of this study was to determine the influence of the management of the left subclavian artery (LSA) on neurologic complications and to define subgroups that might benefit from LSA revascularization. METHODS: The Medtronic Thoracic Endovascular Registry (MOTHER; Medtronic, Santa Rosa, Calif), consists of data from five sponsored trials and one institutional series incorporating 1010 patients undergoing TEVAR from 2002 to 2010...
December 2014: Journal of Vascular Surgery
Holta Kasemi, Mario Marino, Costantino Luca Di Angelo, Gian Franco Fadda, Francesco Speziale
We report the case of a 76-year-old man presented with three saccular aneurysms at the aortic arch and descending thoracic aorta. A two-staged hybrid approach was performed. A left common carotid-to-left subclavian artery bypass and a custom-made fenestrated endograft were used for the two proximal aneurysms. The endograft deployment was complicated by the unadverted coverage of the left common carotid artery ostium, promptly corrected with the chimney technique. The endovascular treatment was completed with the third endovascular aneurysm exclusion 5 months after the first procedure to reduce the risk of spinal cord ischemia...
January 2015: Annals of Vascular Surgery
Yoshiyuki Yamashita, Takashi Matsumoto, Sho Matsuyama, Fumio Fukumura, Hiromi Ando, Jiro Tanaka, Takayuki Uchida
OBJECTIVES: We present our experience of endovascular surgery for traumatic aortic injury and the results of our procedures. MATERIALS AND METHODS: From January 2009 to December 2013, we performed endovascular repairs of traumatic thoracic aortic injury on 5 male patients 16-75 years old (mean, 50.8), two of whom were young. Three of the patients had multiple organ injuries. The mean interval time to the operation is 22.0 hours (range, 10-36). All patients underwent endovascular repair with heparinization...
2014: Annals of Vascular Diseases
Xinyu Zhang, Jiguo Cao, Raymond J Carroll
We consider model selection and estimation in a context where there are competing ordinary differential equation (ODE) models, and all the models are special cases of a "full" model. We propose a computationally inexpensive approach that employs statistical estimation of the full model, followed by a combination of a least squares approximation (LSA) and the adaptive Lasso. We show the resulting method, here called the LSA method, to be an (asymptotically) oracle model selection method. The finite sample performance of the proposed LSA method is investigated with Monte Carlo simulations, in which we examine the percentage of selecting true ODE models, the efficiency of the parameter estimation compared to simply using the full and true models, and coverage probabilities of the estimated confidence intervals for ODE parameters, all of which have satisfactory performances...
March 2015: Biometrics
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