1. Applicability of a standardized thoracic endograft with a single branch for the left subclavian artery to treat aortic disease involving the distal arch
- Author
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Dominique Fabre, Jarin Kratzberg, Jonathan Sobocinski, Stéphan Haulon, and Justine Mougin
- Subjects
Aortic arch ,medicine.medical_specialty ,Computed Tomography Angiography ,Subclavian Artery ,Aorta, Thoracic ,Dissection (medical) ,030204 cardiovascular system & hematology ,Blood Vessel Prosthesis Implantation ,03 medical and health sciences ,Imaging, Three-Dimensional ,0302 clinical medicine ,Aneurysm ,medicine.artery ,medicine ,Humans ,Multicenter Studies as Topic ,Prospective Studies ,030212 general & internal medicine ,Common carotid artery ,Arch ,Retrospective Studies ,Computed tomography angiography ,Aortic Aneurysm, Thoracic ,medicine.diagnostic_test ,business.industry ,Endovascular Procedures ,medicine.disease ,Aortic Dissection ,Observational Studies as Topic ,Treatment Outcome ,Preoperative Period ,Cohort ,Left subclavian artery ,Feasibility Studies ,Stents ,Surgery ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Coverage of the left subclavian artery (LSA) origin during thoracic endovascular aortic repair (TEVAR) is associated with increased neurologic complications. Our group is involved in the development of an off-the-shelf (OTS) thoracic endograft incorporating a left common carotid artery (LCCA) scallop and a retrograde inner branch for LSA perfusion. This study aimed to evaluate the arch morphology of patients treated by TEVAR and requiring LSA coverage to determine the applicability of this OTS device.The preoperative anatomy of consecutive patients from three separate cohorts treated with TEVAR with LSA coverage was studied. High-quality preoperative computed tomography angiography images were analyzed on an imaging workstation. Location of the origin of the supra-aortic trunks and their anatomic relationship were depicted in all patients; the LCCA origin was set as reference point. We determined the proportion of arch morphology in our cohort of patients eligible for this OTS device configuration.There were 196 patients included in this study, 132 in the dissection cohort and 64 in the aneurysm cohort. The median length from the lower margin of the LCCA to the proximal aspect of the pathologic process was 25.0 mm (18.2-35.2 mm), with 68.4% (n = 134) of our cohort presenting with a proximal sealing zone length20 mm. The median LCCA-LSA distance was 20.8 mm (16.6-25.4 mm). The median clock position of the LSA from the LCCA was -10 minutes (-30 to 0 minutes). In total, 127 patients (64.8%) could have been treated with the current OTS branched TEVAR configuration; 59 were excluded for proximal neck length distal to the LCCA 20 mm and 10 because of the clock position of the LCCA, and 9 first required a vertebral artery transposition.The low variability of LSA and LCCA locations in patients with distal aortic arch disease offers wide applicability of a new standardized thoracic branched endograft.
- Published
- 2020