126 results on '"Sukgu M. Han"'
Search Results
2. In situ laser fenestration of aortic septum to bridge false and true lumen during endovascular repair of aortic dissection
- Author
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Alexander D. DiBartolomeo, MD, Elizabeth Miranda, MD, Sukgu M. Han, MD, MS, and Gregory A. Magee, MD, MSc
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Aortic dissection ,Endovascular aortic repair ,Laser in situ fenestration ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Fenestration of the septum between the true and false lumen might be necessary after aortic dissection. We report the technical aspects of in situ laser fenestration of the aortic dissection septum. Two illustrative cases are provided: a 56-year-old man with false lumen deployment of a frozen elephant trunk graft, and a 67-year-old man who underwent fenestrated endovascular aortic repair with a target branch vessel off the false lumen. In both cases, the septum was crossed using in situ laser fenestration. This technique is a precise option to enable passage between true and false lumens during endovascular repair of an aortic dissection.
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- 2024
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3. Aortic rupture during STABILISE (stent-assisted balloon-induced intimal disruption and relamination in aortic dissection repair) technique
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Ashley C. Hsu, MD, Alexander D. DiBartolomeo, MD, Sukgu M. Han, MD, MS, Fernando Fleischman, MD, and Gregory A. Magee, MD, MSc
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Aortic ballooning ,Aortic dissection ,Aortic rupture ,Endovascular repair ,STABILISE technique ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
The STABILISE (stent-assisted balloon-induced intimal disruption and relamination in aortic dissection repair) technique has shown promising results for treating type B aortic dissections, but the potential exists for fatal adverse effects. We present a case of infrarenal aortic rupture while using a compliant balloon to balloon mold the true lumen inside previously placed bare metal stents during the STABILISE technique. Caution is advised for providers who wish to perform the STABILISE technique, and we recommend using a semi-compliant balloon sized to the smallest total aortic diameter to mitigate the risk of rupture.
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- 2023
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4. Incorporation of internal iliac arteries as target vessels during physician-modified fenestrated branched endovascular repair of pararenal abdominal aortic aneurysm with concomitant bilateral short common iliac artery aneurysms
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Michelle Manesh, MD, Herbert I. James, III, MD, Alyssa Pyun, MD, Young Hong, BS, Jacquelyn Paige, DNP, and Sukgu M. Han, MD, MS
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Abdominal aortic aneurysm ,Fenestrated branched endovascular repair ,Iliac artery aneurysm ,Iliac branch device ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
This report describes an alternative endovascular approach to iliac branch devices for treatment of an abdominal aortic aneurysm with concomitant bilateral short common iliac aneurysms. The short distance between the renal arteries and internal iliac artery origins made the addition of distal iliac branch devices to the proximal fenestrated stent graft challenging. We elected to perform physician-modified fenestrated branched endovascular repair, using four fenestrations for the visceral and renal arteries and an additional two directional branches for the bilateral internal iliac arteries. The patient recovered uneventfully, and the 24-month follow-up imaging shows successful aneurysm exclusion with patent internal iliac artery branches.
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- 2023
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5. Sandwich thoracic branch endoprosthesis technique for endovascular repair of thoracic aortic aneurysm with aberrant right subclavian artery
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Yasmeen Dhindsa, MD, Alexander DiBartolomeo, MD, Gregory A. Magee, MD, MSc, Fernando Fleischman, MD, and Sukgu M. Han, MD, MS
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Ruptured thoracic aortic aneurysm ,Thoracic branch endograft ,Thoracic endovascular aortic repair ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Subclavian artery coverage is frequently required to achieve an adequate proximal seal during thoracic endovascular aortic repair. The thoracic branch endoprosthesis (TBE; W.L. Gore & Associates) is the first U.S. Food and Drug Administration–approved branched device for thoracic endovascular aortic repair, designed for left subclavian artery incorporation. However, anatomic suitability of the TBE has been shown to be limited. In the present report, we describe a novel technique using the TBE in a sandwich periscope configuration to allow for emergent repair of a ruptured thoracic aortic aneurysm with a highly angulated proximal seal zone and aberrant right subclavian artery.
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- 2023
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6. Techniques of antegrade in situ laser fenestration for endovascular aortic repair of complex abdominal and thoracoabdominal aortic aneurysms
- Author
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Alexander D. DiBartolomeo, MD and Sukgu M. Han, MD, MS
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Endovascular aneurysm repair ,In situ laser fenestration ,Ruptured aortic aneurysm ,Technique ,Thoracoabdominal aortic aneurysm ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Antegrade in situ laser fenestration allows for incorporation of visceral and renal arteries during endovascular repair of complex abdominal and thoracoabdominal aortic aneurysms. This technique can be particularly useful for urgent and emergent cases and for centers without access to manufactured fenestrated-branched endovascular aneurysm repair devices. In the present report, we have described two techniques of antegrade in situ fenestration, the common pitfalls, and the anatomic considerations for each technique.
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- 2022
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7. Physician-modified fenestrated endograft for postdissection thoracoabdominal aortic aneurysm following provisional extension to induce complete attachment and renal artery stenting
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Anand V. Ganapathy, MD, MEng, Jonathan C. Cash, MD, Gregory A. Magee, MD, MSc, Kenneth R. Ziegler, MD, and Sukgu M. Han, MD, MS
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Aneurysmal degeneration ,Aortic dissection ,Aortic remodeling ,Fenestrated endovascular aortic repair ,Malperfusion ,PETTICOAT ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
We have described a patient with a history of type A-11 dissection repair, who subsequently underwent thoracic endovascular aortic repair with distal bare metal dissection stents (provisional extension to induce complete attachment) and renal artery stenting for malperfusion. During the next 3 years, the thoracoabdominal aorta had continued to enlarge to 6.9 cm, despite false lumen embolization and thoracic endovascular aortic repair extension. Given the continued aortic enlargement, physician-modified fenestrated endovascular aortic repair was performed within the prior aortic and renal stents with successful aneurysm sealing. The results from the present case have illustrated that continued aneurysmal degeneration can occur after provisional extension to induce complete attachment and that subsequent physician-modified fenestrated endovascular aortic repair is feasible.
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- 2022
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8. Use of retrograde left subclavian branch portal of Gore TAG thoracic branch endoprosthesis for physician-modified fenestrated branched endovascular repair of thoracoabdominal aortic aneurysm
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Alexander D. DiBartolomeo, MD, Elizabeth Miranda, MD, MPH, Alyssa J. Pyun, MD, Fernando Fleischman, MD, Gregory A. Magee, MD, MSc, and Sukgu M. Han, MD, MS
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Case report ,Fenestrated-branched endovascular repair ,Gore thoracic branch endoprosthesis ,Thoracoabdominal aortic aneurysm ,Thoracic endovascular aortic repair ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
A 75-year-old man who had undergone zone 2 thoracic endovascular repair of a symptomatic penetrating aortic ulcer using a Gore TAG thoracic branch endoprosthesis (TBE) device (W.L. Gore & Associates) 5 years before had presented with an enlarging extent I thoracoabdominal aortic aneurysm. A physician-modified five-vessel fenestrated-branched endograft repair was performed using preloaded wires. The visceral renal vessels were sequentially catheterized from the left brachial access via the TBE portal, and the endograft was deployed in staggered fashion. At 1 year of follow-up, imaging studies demonstrated a stable aneurysm sac, patent visceral renal branches, and no endoleak. The retrograde portal of Gore TAG TBE can facilitate fenestrated-branched endovascular repair of thoracoabdominal aortic aneurysms.
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- 2023
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9. Near-wall hemodynamic changes in subclavian artery perfusion induced by retrograde inner branched thoracic endograft implantation
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William J. Yoon, MD, Kevin Mani, MD, PhD, Sukgu M. Han, MD, MS, Cheong J. Lee, MD, Jae S. Cho, MD, and Anders Wanhainen, MD, PhD
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Branched endografts ,Computational fluid dynamics ,Left subclavian artery revascularization ,Wall shear stress ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Objective: Left subclavian artery (LSA)-branched endografts with retrograde inner branch configuration (thoracic branch endoprosthesis [TBE]) offer a complete endovascular solution when LSA preservation is required during zone 2 thoracic endovascular aortic repair. However, the hemodynamic consequences of the TBE have not been well-investigated. We compared near-wall hemodynamic parameters before and after the TBE implantation using computational fluid dynamic simulations. Methods: Eleven patients who had undergone TBE implantation were included. Three-dimensional aortic arch geometries were constructed from the pre- and post-TBE implantation computed tomography images. The resulting 22 three-dimensional aortic arch geometries were then discretized into finite element meshes for computational fluid dynamic simulations. Inflow boundary conditions were prescribed using normal physiological pulsatile circulation. Outlet boundary conditions consisted of Windkessel models with previously published values. Blood flow, modeled as Newtonian fluid, simulations were performed with rigid wall assumptions using SimVascular's incompressible Navier-Stokes solver. We compared well-established hemodynamic descriptors: pressure, flow rate, time-averaged wall shear stress (TAWSS), the oscillatory shear index (OSI), and percent area with an OSI of >0.2. Data were presented on the stented portion of the LSA. Results: TBE implantation was associated with a small decrease in peak LSA pressure (153 mm Hg; interquartile range [IQR], 151-154 mm Hg vs 159 mm Hg; IQR, 158-160 mm Hg; P = .005). No difference was observed in peak LSA flow rates before and after implantation: 40.4 cm3/ (IQR, 39.5-41.6 cm3/s) vs 41.3 cm3/s (IQR, 37.2-44.8 cm3/s; P = .59). There was a significant postimplantation increase in TAWSS (15.2 dynes/cm2 [IQR, 12.2-17.7 dynes/cm2] vs 6.2 dynes/cm2 [IQR, 5.7-10.3 dynes/cm2]; P = .003), leading to decreases in both the OSI (0.088 [IQR, 0.063 to –0.099] vs 0.1 [IQR, 0.096-0.16]; P = .03) and percentage of area with an OSI of >0.2 (10.4 [IQR, 5.8-15.8] vs 15.7 [IQR, 10.7-31.9]; P = .13). Neither LSA side branch angulation (median, 81°, IQR, 77°-109°) nor moderate compression (16%-58%) seemed to have an impact on the pressure, flow rate, TAWSS, or percentage of area with an OSI of >0.2 in the stented LSA. Conclusions: The implantation of TBE produces modest hemodynamic disturbances that are unlikely to result in clinically relevant changes. : Clinical Relevance: The Gore thoracic branch endoprosthesis represents the only commercially available stent graft in the United States for the treatment of aortic arch pathologies involving the left subclavian artery. The implantation of endografts cause alterations in flow patterns that, in turn, can have a significant impact on long-term device durability and the prognosis of the patient. The results of this computational modelling study provide important data regarding the hemodynamic performance of the thoracic branch endoprosthesis relevant to the associated clinical outcomes and subsequent implications on device durability.
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- 2023
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10. Caudally directed in situ fenestrated endografting for emergent thoracoabdominal aortic aneurysm repair
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Miguel Manzur, MD, Gregory A. Magee, MD, Kenneth R. Ziegler, MD, Fred A. Weaver, MD, Vincent L. Rowe, MD, and Sukgu M. Han, MD, MS
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Ruptured thoracoabdominal aortic aneurysm ,In situ fenestrated ,Branched endovascular aortic repair ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
We previously described a transfemoral antegrade in situ laser fenestration technique (in situ fenestrated endovascular abdominal aortic aneurysm repair) for ruptured thoracoabdominal aortic aneurysms. In the present report, we have described an alternative technique of caudally directed in situ fenestrated endografts using upper extremity access for branch vessel incorporation. This technique involves partial deployment of the aortic stent graft in the thoracic aorta to achieve proximal control, followed by sequential branch incorporation using a laser probe through a steerable sheath, from the upper extremity access. The advantages of the technique include rapid proximal aortic control before branch incorporation without target vessel prestenting and separation of in situ fenestration from the target branch vessel origin, facilitating cannulation of angulated branch vessels.
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- 2021
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11. Physician-Modified Fenestrated Endovascular Repair for Iatrogenic Innominate Vein Injury
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Kyung Bae Lee, Alyssa J. Pyun, Jonathan Praeger, Kenneth R. Ziegler, and Sukgu M. Han
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endovascular procedures ,iatrogenic disease ,brachiocephalic vein ,jugular veins ,Diseases of the blood and blood-forming organs ,RC633-647.5 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Iatrogenic innominate vein injuries are rare complications associated with internal jugular venous catheters. These complications are accompanied by high morbidity and mortality rates in patients with severe underlying medical conditions. Without proper treatment, emergency surgery may be needed due to acute cardiac tamponade or hemothorax. Endovascular repair can be advantageous for patients with significant medical comorbidities. Herein, we report the case of a 62-year-old female with an iatrogenic injury to the innominate vein at the subclavian vein and internal jugular confluence due to a malpositioned left internal jugular catheter. A customized fenestrated endograft was positioned with fenestration oriented to the internal jugular vein and a new tunneled catheter was inserted across the fenestration into the superior vena cava upon removal of the malpositioned catheter. In addition, a brachio-basilic arteriovenous fistula was created. At one month follow-up, the patient had a palpable thrill over the arteriovenous fistula and a functioning tunneled catheter.
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- 2022
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12. Antegrade in situ fenestrated endovascular repair of a ruptured thoracoabdominal aortic aneurysm
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Louis L. Zhang, MD, Fred A. Weaver, MD, Vincent L. Rowe, MD, Kenneth R. Ziegler, MD, Gregory A. Magee, MD, and Sukgu M. Han, MD
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In situ laser fenestration ,Thoracoabdominal aortic aneurysm ,Fenestrated endovascular aortic repair ,Thoracic endovascular aortic repair ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
We describe a technique for antegrade in situ laser fenestration that has several advantages in the setting of ruptured thoracoabdominal aortic aneurysms. This technique involves rapid aneurysm sealing by deployment of aortic stent graft, followed by sequential incorporation of branch vessels using a laser probe through steerable sheath. The advantages of this technique include (1) rapid seal of the ruptured aneurysm, (2) preservation of the visceral and renal branch perfusion, (3) use of an off-the-shelf device, and (4) the ability to be performed without general anesthesia.
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- 2020
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13. Endovascular septal fenestration using a radiofrequency wire to salvage inadvertent false lumen deployment of a frozen elephant trunk stent graft
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Anastasia Plotkin, MD, Sue E. Hanks, MD, Sukgu M. Han, MD, MS, Fernando Fleischman, MD, Fred A. Weaver, MD, MMM, and Gregory A. Magee, MD, MSc
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Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
ABSTRACT: We report a case of a frozen elephant trunk arch repair, where the stent graft was unintentionally placed into the false lumen. Postoperative imaging demonstrated an enlarged false lumen with no thoracic aorta fenestrations that could be traversed to place another thoracic endovascular aortic repair endograft into the true lumen. An atraumatic radiofrequency wire (PowerWire, Baylis Medical, Montreal, Quebec, Canada) was used to create a new septal fenestration, enabling thoracic endovascular aortic repair endograft extension into the thoracic true lumen. This novel use of a radiofrequency wire can enable safe and controlled endovascular septal fenestration even in chronic dissections to redirect flow into the true lumen. Keywords: Aortic dissection, Fenestration, TEVAR, Radiofrequency wire, Septum, False lumen, Elephant trunk
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- 2019
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14. Transbrachial branch cannulation during Zenith fenestrated endovascular aortic aneurysm repair using a robotically guided body-floss technique
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Sukgu M. Han, MD, Anuj Mahajan, MD, Sung W. Ham, MD, William Lee, MD, Vincent L. Rowe, MD, and Fred A. Weaver, MD
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Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Caudal angulation and stenosis of the renal arteries pose significant challenges in branch cannulation during the standard fenestrated endovascular aortic aneurysm repair (FEVAR). We describe an alternative technique of branch cannulation during FEVAR in a patient with a 6.5-cm juxtarenal abdominal aortic aneurysm, renal artery stenosis, and bilateral caudally oriented renal arteries. A brachiofemoral or “body-floss” access was established by traversing the top scallop. The brachial sheath was deflected toward the target fenestration using a steerable robotic femoral sheath, enabling transbrachial cannulation of the downgoing target renal artery. Postoperatively, the patient was discharged without complications. Steerable sheath-guided body-floss technique may facilitate cannulation of severely downgoing branch vessels during FEVAR.
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- 2016
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15. Readmission after early thoracic endovascular aortic repair versus medical management of acute type B aortic dissection
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Jeniann A. Yi, Ryan Gupta, Quy Tat, Helen A. Potter, Sukgu M. Han, Fernando Fleischman, Donald Jacobs, Mark Nehler, and Gregory A. Magee
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Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2023
16. Impact of Using Endografts From Multiple Manufacturers on the Mid-term Outcomes of Physician-Modified Fenestrated-Branched Endovascular Aneurysm Repair
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Alexander D. DiBartolomeo, Jesse Han, Alyssa Pyun, Gregory A. Magee, Miguel F. Manzur, Fred Weaver, Jacquelyn K. Paige, and Sukgu M. Han
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Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2023
17. A Novel Bypass Technique to Prevent Vexing Spinal Cord Ischemia in Endovascular Thoracoabdominal Aortic Intervention
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Nadia A. Atai, Aidin Abedi, Joseph Carey, Sukgu M. Han, and Jonathan J. Russin
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Surgery ,Neurology (clinical) - Published
- 2022
18. Transposition of anomalous left vertebral to carotid artery during the management of thoracic aortic dissections and aneurysms
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Helen A. Potter, Kenneth R. Ziegler, Fred A. Weaver, Sukgu M. Han, and Gregory A. Magee
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Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2022
19. Comparative early results of in situ fenestrated endovascular aortic repair and other emergent complex endovascular aortic repair techniques for ruptured suprarenal and thoracoabdominal aortic aneurysms at a regional aortic center
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Alyssa J, Pyun, Helen A, Potter, Gregory A, Magee, Miguel F, Manzur, Fred A, Weaver, Kenneth R, Ziegler, Jacquelyn K, Paige, and Sukgu M, Han
- Subjects
Time Factors ,Aortic Aneurysm, Thoracic ,Aortic Rupture ,Endovascular Procedures ,Prosthesis Design ,Blood Vessel Prosthesis ,Blood Vessel Prosthesis Implantation ,Postoperative Complications ,Treatment Outcome ,Risk Factors ,Humans ,Kidney Diseases ,Surgery ,Hypotension ,Cardiology and Cardiovascular Medicine - Abstract
Emergent endovascular repair of suprarenal (SRAAAs) and thoracoabdominal aortic aneurysms (TAAAs) poses a significant challenge due to the need for branch vessel incorporation, time constraints, and lack of dedicated devices. Techniques to incorporate branch vessels have included parallel grafting, physician-modified endografts, double-barrel/reversed iliac branch device, and in situ fenestration (ISF). This study describes a single-center experience and the associated outcomes when using these techniques for ruptured SRAAAs and TAAAs.A retrospective review of patients who underwent endovascular repair of ruptured SRAAAs and TAAAs from July 2014 to March 2021 with branch vessel incorporation was performed. Clinical presentation, intraoperative details, and postoperative outcomes of those who underwent ISF were compared with those who underwent repair using non-ISF techniques. The primary outcome of interest was in-hospital mortality. Secondary outcomes were major adverse events including myocardial infarction, respiratory failure, renal dysfunction, new onset dialysis, bowel ischemia, stroke, and spinal cord ischemia.Forty-two patients underwent endovascular repair for ruptured SRAAAs and TAAAs, 18 of whom underwent ISF repair. Seventy-two percent of ISF patients were hypotensive before surgery, compared with 46% of the patients who underwent repair using non-ISF techniques (physician-modified endografts, parallel grafting, or double-barrel/reversed iliac branch device). The total procedural and fluoroscopy times were similar between the two groups despite a greater mean number of branch vessels incorporated with the ISF technique (3.1 vs 2.2 per patient, P = .015). In-hospital mortality was 19% for all ruptures and 25% for ruptures with hypotension. Compared with the non-ISF group, in-hospital mortality trended lower in the ISF group (11% vs 25%, P = .233), reaching statistical significance when comparing patients who presented with hypotension (8% vs 45%, P = .048). The rate of major adverse events was 57% across all techniques and did not significantly differ between the ISF and non-ISF groups, with postoperative renal dysfunction being the most frequent complication (48%). Overall, ISF became the most commonly used technique later in the study period.Although emergent endovascular repair of ruptured SRAAAs/TAAAs remains a challenge, a number of techniques are available for expeditious treatment. In this series, ISF was associated improve survival, including a fivefold reduction in mortality in patients presenting with hypotension, and has now become the dominant technique at our center. Despite these advantages, postoperative complications and reinterventions are common. Further experience and longer-term follow-up are needed to validate these initial results and assess durability.
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- 2022
20. Contemporary indications, techniques, and outcomes of physician-modified endografts for the treatment of complex abdominal and thoracoabdominal aortic aneurysms
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Alyssa J. Pyun and Sukgu M. Han
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Blood Vessel Prosthesis Implantation ,Postoperative Complications ,Time Factors ,Treatment Outcome ,Aortic Aneurysm, Thoracic ,Physicians ,Endovascular Procedures ,Humans ,Surgery ,Prosthesis Design ,Cardiology and Cardiovascular Medicine ,Aortic Aneurysm, Abdominal ,Blood Vessel Prosthesis - Abstract
The article describes contemporary indications, techniques, and outcomes of physician-modified endografts (PMEGs) for the treatment of complex aortic aneurysms. Physician-modified endografting has been performed with high technical success rates and lower complication rates compared with traditional open surgery for complex aortic aneurysms. Various techniques have been reported for the design, modification, and implantation of PMEGs, using different off-the-shelf devices. Although PMEGs are used more commonly for urgent and emergent repair of symptomatic or ruptured complex abdominal and thoracoabdominal aortic aneurysms in patients who do not have access to manufactured devices, some centers have reported utilization of PMEGs in elective cases under the aegis of the US Food and Drug Administration-approved Investigational Device Exemption protocols. Although the initial outcomes of PMEGs are promising, continued surveillance remains a crucial component to determine long-term durability. All treatment options for complex abdominal and thoracoabdominal aortic aneurysms should be considered carefully, with PMEGs reserved for those cases unsuitable for other repair alternatives, and at centers with the volume and expertise to execute the procedure with high technical success and low morbidity and mortality rates. With the continued evolution of endovascular technology, the role and indications for PMEGs are expected to change.
- Published
- 2022
21. Comparative Outcomes of Physician-Modified Fenestrated-Branched Endovascular Repair of Post-Dissection and Degenerative Complex Abdominal or Thoracoabdominal Aortic Aneurysms
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Alexander D. DiBartolomeo, Alyssa J. Pyun, Li Ding, Kathleen O’Donnell, Jacquelyn K. Paige, Gregory A. Magee, Fred A. Weaver, and Sukgu M. Han
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Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2023
22. Impact of Perioperative Blood Transfusion in Anemic Patients Undergoing Infra Inguinal Bypass
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Gregory A. Magee, Sukgu M. Han, Fred A. Weaver, Vincent L. Rowe, Alberto J Ortega, Cali E. Johnson, Miguel F. Manzur, Li Ding, Kenneth R. Ziegler, and Helen A. Potter
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Male ,Time Factors ,Blood transfusion ,Anemia ,medicine.medical_treatment ,Risk Assessment ,Perioperative Care ,Hemoglobins ,Peripheral Arterial Disease ,Ischemia ,Risk Factors ,hemic and lymphatic diseases ,medicine ,Humans ,Myocardial infarction ,Stroke ,Aged ,Retrospective Studies ,Aged, 80 and over ,Univariate analysis ,business.industry ,General Medicine ,Perioperative ,Length of Stay ,Middle Aged ,medicine.disease ,Treatment Outcome ,Cardiovascular Diseases ,Anesthesia ,Heart failure ,Female ,Vascular Grafting ,Surgery ,Erythrocyte Transfusion ,Cardiology and Cardiovascular Medicine ,business ,Biomarkers ,Mace - Abstract
Objective Patients who present with lower extremity ischemia are frequently anemic and the optimal transfusion threshold for this cohort remains controversial. We sought to evaluate the impact of blood transfusion on postoperative major adverse cardiac events (MACE), including myocardial infarction, dysrhythmia, stroke, congestive heart failure, and 30-day mortality for these patients. Methods All consecutive patients who underwent infra-inguinal bypass at our institution from 2011 to 2020 were included. Perioperative red blood cell transfusion was the primary exposure, and the primary outcome was MACE. Univariate and multivariable analyses were performed to assess the impact of patient and procedural variables, including red blood cell transfusion, stratified by hemoglobin (Hgb) nadir: 8 g/dL. Results Of the 287 patients reviewed for analysis, 146 (50.9%) had a perioperative transfusion (mean: 1.6 ± 3 units). Patients who received a transfusion had a mean nadir Hgb of 8.3 ± 1.0 g/dL, compared to 10.1 ± 1.7 g/dL without a transfusion. The overall incidence of MACE was 15.7% (45 of 287 patients). Univariate analysis demonstrated that MACE was associated with blood transfusion (P = 0.009), lower Hgb nadir (P = 0.02), and higher blood loss (P = 0.003). On multivariate analysis, transfusion was independently associated with MACE for patients with a Hgb nadir >8 g/dL (OR: 3.09; P = 0.006), but not for patients with Hgb nadir 7–8 g/dL (OR: 0.818; P = 0.77). Additionally, patients with MACE had significantly longer length of hospital stay than for patients without (13 vs. 7.7 days, P = 0.001). Conclusions For patients undergoing infra-inguinal bypass, receiving a red blood cell transfusion with a Hgb nadir >8 g/dL was associated with a 3-fold increase in MACE, with nearly twice the length of stay. For patients with a Hgb 7–8 g/dL, transfusion did not increase or reduce the incidence of MACE. These findings suggest no benefit of blood transfusion for patients with Hgb nadir >7 g/dL and harm for Hgb >8 g/dL, however causation cannot be proven due to the retrospective nature of the study and randomized studies are needed to confirm or refute these findings.
- Published
- 2022
23. Feasibility of Direct Intercostal and Lumbar Artery Revascularization to Prevent Spinal Cord Ischemia Associated with Endovascular Thoracoabdominal Aortic Repair
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Anand V. Ganapathy, Alexander D. DiBartolomeo, William J. Mack, Gregory A. Magee, Anastasia Plotkin, Joseph N. Carey, Jonathan J. Russin, and Sukgu M. Han
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Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2023
24. Aortoiliac Artery Aneurysms and Peripheral Artery Aneurysms
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Emaad Farooqui and Sukgu M. Han
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- 2023
25. Risk Of Stroke With Thoracic Endovascular Aortic Repair In The Aortic Arch
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Alexander D. DiBartolomeo, Li Ding, Fred A. Weaver, Sukgu M. Han, and Gregory A. Magee
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Surgery ,General Medicine ,Cardiology and Cardiovascular Medicine - Published
- 2023
26. Management strategy for lower extremity malperfusion due to acute aortic dissection
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Anastasia Plotkin, Vincent L. Rowe, Sukgu M. Han, Diana Vares-Lum, Gregory A. Magee, and Fernando Fleischman
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,Databases, Factual ,medicine.medical_treatment ,Ischemia ,030204 cardiovascular system & hematology ,Revascularization ,Risk Assessment ,Amputation, Surgical ,Time-to-Treatment ,Blood Vessel Prosthesis Implantation ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,medicine ,Clinical endpoint ,Humans ,Hospital Mortality ,030212 general & internal medicine ,Myocardial infarction ,Stroke ,Dialysis ,Aged ,Retrospective Studies ,Aortic dissection ,business.industry ,Endovascular Procedures ,Middle Aged ,Limb Salvage ,medicine.disease ,Aortic Aneurysm ,Surgery ,Aortic Dissection ,Treatment Outcome ,Lower Extremity ,Amputation ,Regional Blood Flow ,Acute Disease ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objective Aortic dissection can result in devastating cerebral, visceral, renal, spinal, and extremity ischemia. We describe the management and outcomes of patients presenting with aortic dissection and lower extremity malperfusion (LEM). Methods A single-center institutional aortic database was queried for patients with aortic dissection and LEM from 2011 to 2019. The primary end point was resolution of LEM after aortic repair. Secondary end points were amputation, in-hospital mortality, time to intervention, and postoperative complications. Results Of 769 patients with aortic dissection, 42 (5.5%) presented acutely with LEM: 16 with Stanford type A and 26 Stanford type B aortic dissection (age 55 ± 13 years; 90% men). Most presented as Rutherford IIB symptoms, but patients with type A had Rutherford III more often, compared with those with type B. Aortic repair was performed before limb interventions in 36 patients (86%; 19 TEVAR, 16 open arch and ascending repair, and 1 open descending aortic repair with fenestration). Seven (19%) had immediate failure with persistent malperfusion recognized in the operating room and underwent additional limb intervention, including extra-anatomic revascularization (n = 4), iliac stenting (n = 2), and femoral patch with septal fenestration or tacking (n = 2). Three patients (8%) had early delayed failure requiring extra-anatomic bypass in two and amputation in one. In contrast, six patients had limb-first intervention with extra-anatomic revascularization. None had immediate failure, but one-half had early delayed failure requiring proximal aortic intervention: two TEVAR and one open aortic fenestration. Limb-first patients were more likely to have early delayed failure compared with aortic dissection treated first patients (50% vs 8%; P = .029). The amputation rate was 2%, occurring in one type A patient. The overall in-hospital mortality was 7% (n = 3), with no difference between type A and type B aortic dissection. There was no difference in surgical site infection, postoperative dialysis need, stroke, and myocardial infarction. Conclusions In patients presenting with acute aortic dissection with limb ischemia, resolution of the malperfusion occurs in the majority of cases after primary aortic dissection intervention, emphasizing the usefulness of urgent TEVAR for complicated type B and open repair of type A before lower extremity intervention. Limb-first interventions have a higher early delayed failure rate and thus require more frequent reoperation. However, the overall amputation rate in LEM owing to aortic dissection remains low.
- Published
- 2021
27. Use of Inner Branches During Physician-Modified Endografting for Complex Abdominal and Thoracoabdominal Aortic Aneurysms
- Author
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Sukgu M. Han, Gregory A. Magee, Kenneth R. Ziegler, Raquel Caldera, Louis L. Zhang, Fred A. Weaver, Vincent L. Rowe, and Alyssa J. Pyun
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Prosthesis Design ,Thoracoabdominal Aortic Aneurysms ,Risk Assessment ,030218 nuclear medicine & medical imaging ,Blood Vessel Prosthesis Implantation ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Risk Factors ,medicine.artery ,Occlusion ,medicine ,Humans ,Myocardial infarction ,Renal artery ,Vascular Patency ,Aged ,Retrospective Studies ,Aged, 80 and over ,Aortic Aneurysm, Thoracic ,business.industry ,Endovascular Procedures ,Stent ,General Medicine ,Perioperative ,medicine.disease ,Blood Vessel Prosthesis ,Surgery ,Treatment Outcome ,cardiovascular system ,Female ,Stents ,Hemodialysis ,Cardiology and Cardiovascular Medicine ,business ,Lumbar arteries ,Aortic Aneurysm, Abdominal - Abstract
Objectives Endovascular repair of complex abdominal and thoracoabdominal aortic aneurysms have been performed widely in an increasing number of centers, utilizing custom-manufactured or physician-modified stent grafts containing fenestrations and side-arm branches for visceral and renal artery incorporation. Alternatively, inner branch configurations may be useful in complex anatomy, where application of fenestrations or side-arm branches can be challenging. Our study aims to evaluate the incidence of target vessel instability when incorporated with inner branch configurations, and report clinical outcomes of patients who underwent fenestrated/branched endovascular aortic repairs (F-BEVAR) containing one or more inner branches. Methods We reviewed patients who underwent F-BEVAR with at least one inner branch configuration for complex abdominal or thoracoabdominal aortic aneurysms at Keck Hospital of University of Southern California from 2014 to 2020. Endpoints were mortality, major adverse events (MAE), technical success, and target vessel instability. Target vessel instability was assessed using follow-up computed tomography (CT) and duplex imaging. Results Out of the 175 patients who underwent F-BEVAR for complex abdominal and TAAA during the study period, 17 patients had at least one inner branch configuration. All were deemed high-risk for open repair with multiple cardiovascular and/or pulmonary comorbidities. Eight (47%) patients had extent I, II, III thoracoabdominal aortic aneurysms, and 10 (59%) had prior aortic repairs. A total of 68 target vessels were incorporated (mean = 4 vessels/patient, range=1~6), of which 40% were inner branch configurations, most commonly for renal arteries. Technical success was 94.1%. There was one perioperative mortality due to massive myocardial infarction, as well as one patient who needed temporary hemodialysis. No device-related mortalities were observed. At 30 days, primary inner branch patency was 100% with no target vessel instability or reintervention. At mean follow-up of 5.8 months, the overall survival was 94% with one patient who expired from unknown cause. Overall primary inner branch patency was 96.3%, due to occlusion of a long lumbar artery branch with no clinical sequelae. Conclusion Inner branch configurations can provide a safe alternative technique of branch incorporation during complex endovascular aortic repair.
- Published
- 2021
28. Caudally directed in situ fenestrated endografting for emergent thoracoabdominal aortic aneurysm repair
- Author
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Sukgu M. Han, Fred A. Weaver, Vincent L. Rowe, Kenneth R. Ziegler, Miguel F. Manzur, and Gregory A. Magee
- Subjects
medicine.medical_specialty ,Innovative technique ,RD1-811 ,Target vessel ,Branch vessel ,030204 cardiovascular system & hematology ,Aortic stent ,Thoracoabdominal Aortic Aneurysms ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,medicine.artery ,medicine ,Thoracic aorta ,Diseases of the circulatory (Cardiovascular) system ,Ruptured thoracoabdominal aortic aneurysm ,Aortic aneurysm repair ,business.industry ,medicine.disease ,Abdominal aortic aneurysm ,Surgery ,In situ fenestrated ,RC666-701 ,cardiovascular system ,Cardiology and Cardiovascular Medicine ,Fenestration ,business ,Branched endovascular aortic repair - Abstract
We previously described a transfemoral antegrade in situ laser fenestration technique (in situ fenestrated endovascular abdominal aortic aneurysm repair) for ruptured thoracoabdominal aortic aneurysms. In the present report, we have described an alternative technique of caudally directed in situ fenestrated endografts using upper extremity access for branch vessel incorporation. This technique involves partial deployment of the aortic stent graft in the thoracic aorta to achieve proximal control, followed by sequential branch incorporation using a laser probe through a steerable sheath, from the upper extremity access. The advantages of the technique include rapid proximal aortic control before branch incorporation without target vessel prestenting and separation of in situ fenestration from the target branch vessel origin, facilitating cannulation of angulated branch vessels.
- Published
- 2021
29. Functional performance status and risk of cardiovascular events and mortality following endovascular repair of thoracic and abdominal aortic pathology
- Author
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Anastasia Plotkin, Li Ding, Nandita Singh, Gregory A. Magee, Pradeep Nadeswaran, Sukgu M. Han, and Parveen K. Garg
- Subjects
medicine.medical_specialty ,Performance status ,business.industry ,Endovascular Procedures ,General Medicine ,Physical Functional Performance ,030204 cardiovascular system & hematology ,Risk Assessment ,Blood Vessel Prosthesis Implantation ,03 medical and health sciences ,Postoperative Complications ,Treatment Outcome ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Surgery ,Functional status ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business ,Aortic Aneurysm, Abdominal ,Retrospective Studies - Abstract
Objective To characterize the association of preoperative functional performance status based on Eastern Cooperative Oncology Group (ECOG) scoring with the risk of adverse cardiovascular events, vascular events, and mortality in patients undergoing EVAR and TEVAR. Methods Retrospective review of the Society for Vascular Surgery Vascular Quality Initiative, a large, multi-center, registry database was performed. All individuals undergoing EVAR ( n = 18,730) and TEVAR ( n = 6595) for non-ruptured aortic pathologies between 2014 and 2018 were eligible for analysis. Multivariable logistic regression was used to determine the association of pre-procedure ECOG functional performance status on risk of in-hospital adverse cardiovascular events, vascular events, and mortality. Results The number of operations complicated by adverse cardiovascular and vascular events was 480 (2.6%) and 190 (1.0%) for EVAR and 733 (11.1%) and 219 (3.3%) for TEVAR, respectively. There were 118 (0.6%) and 240 (3.6%) in-hospital deaths following EVAR and TEVAR, respectively. Patients with ECOG grades 3 or 4 undergoing EVAR were at increased risk of cardiovascular events (OR = 1.62; 95% CI = 1.09, 2.41) and one-year mortality (HR = 2.62; 95% CI = 1.92, 3.57) compared to those with ECOG grade 0. Patients undergoing TEVAR with ECOG grade 3 or 4 were at increased risk for both inpatient death (OR = 2.77; 95% CI = 1.56, 4.9) and one-year mortality (HR = 3.27, 95% CI = 2.06, 5.21). ECOG status was not associated with an increased risk of adverse vascular events following either EVAR or TEVAR. Conclusions Poor preoperative functional status as assessed by ECOG score is associated with an increased risk of adverse postoperative cardiovascular events following EVAR and a higher mortality risk following both EVAR and TEVAR. Functional status assessment may be useful for risk stratification and determining procedural candidacy prior to EVAR and TEVAR.
- Published
- 2021
30. Risk Factors For Cerebral Hyperperfusion Syndrome Following Carotid Revascularization
- Author
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Ashley C. Hsu, Brian Williams, Li Ding, Fred A. Weaver, Sukgu M. Han, Kenneth R. Ziegler, and Gregory A. Magee
- Subjects
Surgery ,General Medicine ,Cardiology and Cardiovascular Medicine - Published
- 2023
31. Intercostal artery incorporation to prevent spinal cord ischemia during total endovascular thoracoabdominal aortic repair
- Author
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Miguel F. Manzur, Gregory A. Magee, Mark J. Cunningham, Fernando Fleischman, Sukgu M. Han, and Anastasia Plotkin
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,medicine.disease ,Aortic repair ,Left Common Iliac Artery ,Thrombosis ,Surgery ,Pseudoaneurysm ,Aortic aneurysm ,Lumbar ,Aneurysm ,Adult: Aorta: Evolving Technology: Surgical Technique ,medicine.artery ,cardiovascular system ,medicine ,cardiovascular diseases ,business ,Intercostal arteries - Abstract
A 71-year-old man with prior total arch repair and open repair of Crawford extent II thoracoabdominal aortic aneurysm (TAAA) presented with hemoptysis in the setting of two large pseudoaneurysms of his intercostal and visceral artery Carrel patches and left common iliac artery aneurysm. Despite a presumed aortobronchial fistula, endovascular repair was planned due to his advanced age, and prior extensive open aortic repairs. A thoracic endograft modified with a single caudally directed side branch was used to repair the intercostal patch pseudoaneurysm, while preserving flow to the intercostal artery. Subsequently, he underwent a 4-vessel fenestrated endovascular aortic repair with left iliac branched endograft. Completion CTA demonstrated thrombosis of both pseudoaneurysms, preservation of flow into all branches, and no endoleak. Due to preservation of the intercostal artery, the endovascular repairs were completed without lumbar drain placement.
- Published
- 2021
32. Physician-modified fenestrated endovascular repair of type 1A endoleaks from polymer-based low-profile endografts
- Author
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Kenneth R. Ziegler, Gregory A. Magee, Fred A. Weaver, Sukgu M. Han, and Louis L. Zhang
- Subjects
medicine.medical_specialty ,Aortic aneurysm repair ,business.industry ,General Medicine ,030204 cardiovascular system & hematology ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine ,business ,030217 neurology & neurosurgery - Abstract
Purpose There have been increasing number of endovascular aortic aneurysm repair performed in hostile necks using newer generation technology including polymer-based proximal sealing devices such as the Ovation system. Unique design features of the device can pose challenges during endovascular salvage of type 1A endoleak. We describe two cases of successful application of physician-modified fenestrated endografting, in order to repair type 1A endoleaks following endovascular aortic aneurysm repair with ovation system. Technique In both cases, multi-fenestrated endografts were custom-modified using preloaded wire technique on Cook Zenith Alpha thoracic stent grafts at the back table. Under general anesthesia, left brachial cut down and a single percutaneous femoral access were performed. Staggered deployment of fenestrated endograft, accompanied by sequential catheterization of target vessels, facilitated correct alignment of fenestrated endograft. Infolding of fenestrated endograft inside the Ovation main body resulted in leg claudication, and repaired with balloon expandable covered tent. Prophylactic deployment of balloon expandable covered stent was performed in the second case. Both cases showed resolution of type 1A endoleak. Conclusion Fenestrated endovascular repair is feasible for proximal failure of Ovation endografts. Careful planning and advanced skill set in complex endovascular aortic repair are required, as well as detailed knowledge of the failed endografts.
- Published
- 2020
33. Association of upper extremity and neck access with stroke in endovascular aortic repair
- Author
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Anastasia Plotkin, Sukgu M. Han, Li Ding, Gustavo S. Oderich, Mahmoud B. Malas, Gregory A. Magee, Benjamin W. Starnes, Jason T. Lee, and Fred A. Weaver
- Subjects
Male ,Aortic arch ,Stroke rate ,medicine.medical_specialty ,Operative Time ,Blood Loss, Surgical ,030204 cardiovascular system & hematology ,Aortic repair ,Iliac Artery ,Risk Assessment ,Upper Extremity ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Risk Factors ,medicine.artery ,Odds Ratio ,medicine ,Humans ,Hospital Mortality ,Registries ,030212 general & internal medicine ,Stroke ,Survival analysis ,Aged ,Retrospective Studies ,Perioperative stroke ,Aged, 80 and over ,business.industry ,Endovascular Procedures ,Perioperative ,Middle Aged ,medicine.disease ,Aortic Aneurysm ,Surgery ,Femoral Artery ,Survival Rate ,Treatment Outcome ,Landing zone ,Female ,Cardiology and Cardiovascular Medicine ,business ,Neck - Abstract
Upper extremity and neck access is commonly used for complex endovascular aortic repairs. We sought to compare perioperative stroke and other complications of (1) arm/neck (AN) and femoral or iliac access versus femoral/iliac (FI) access alone, (2) right- versus left-sided AN, and (3) specific arm versus neck access sites.Patients entered in the thoracic endovascular aortic repair/complex endovascular aortic repair registry in the Vascular Quality Initiative from 2009 to 2018 were analyzed. Patients with a missing access variable and aortic arch proximal landing zone were excluded. The primary outcome was perioperative in-hospital stroke. Secondary outcomes were other postoperative complications and 1-year survival. Kaplan-Meier curves and log-rank test were used for survival analysis.Of 11,621 patients with 11,774 recorded operations, 6691 operations in 6602 patients met criteria for analysis (1418 AN, 5273 FI). AN patients had a higher rate of smoking history (83.6% vs 76.1%; P .0001), and prior stroke (12.6% vs 10.1%; P = .01). Operative time (280 ± 124 minutes vs 157 ± 102 minutes; P .0001), contrast load (141 ± 82 mL vs 103 ± 67 mL; P .0001), and estimated blood loss (300 mL vs 100 mL; P .0001) were larger in the AN group, indicative of greater complexity cases. Overall, AN had a higher rate of stroke (3.1% vs 1.8%; P = .003) compared with FI and on multivariable analysis AN access was found to be an independent risk factor for stroke (odds ratio, 1.97; P = .0003). There was no difference in stroke when comparing right- and left-sided AN access (2.8% vs 3.2%; P = .71). Stroke rates were similar between arm, axillary, and multiple access sites, but were significantly higher in patients with carotid access (2.6% vs 3.5% vs 13% vs 3.7%; P = .04). AN also had higher rates of puncture site hematoma, access site occlusion, arm ischemia, and in-hospital mortality (7.1% vs 4.2%; P .0001). At 1 year, AN had a lower survival rate (85.1% vs 88.1%; P = .03).Upper extremity and neck access for complex aortic repairs has a higher risk of stroke compared with femoral and iliac access alone. Right-sided access does not have a higher stroke rate than left-sided access. Carotid access has a higher stroke rate than axillary, arm, and multiple arm/neck access sites.
- Published
- 2020
34. Association of aberrant subclavian arteries with aortic pathology and proposed classification system
- Author
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Sukgu M. Han, Fred A. Weaver, Anastasia Plotkin, Gregory A. Magee, Sung W. Ham, Brian Ng, Alison Wilcox, and Michael E. Bowdish
- Subjects
Adult ,Male ,Aortic arch ,Pathology ,medicine.medical_specialty ,Vertebral artery ,Cardiovascular Abnormalities ,Subclavian Artery ,Aorta, Thoracic ,Disease ,030204 cardiovascular system & hematology ,Patient Care Planning ,Aberrant subclavian artery ,03 medical and health sciences ,0302 clinical medicine ,Aneurysm ,medicine.artery ,Humans ,Medicine ,030212 general & internal medicine ,Aged ,Retrospective Studies ,Aortic dissection ,Anatomy, Cross-Sectional ,Aortic Aneurysm, Thoracic ,business.industry ,Endovascular Procedures ,Anatomic Variation ,Middle Aged ,medicine.disease ,Dysphagia ,Aortic Dissection ,Dissection ,Female ,Surgery ,medicine.symptom ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business - Abstract
Aberrant subclavian artery (aSCA) is a rare anatomic variant whose association with other aortic branch variations and aortic pathology has yet to be established. Knowledge of such an association could be relevant to recommendations for screening and awareness as associated variations are important for operative planning. We describe the incidence of aSCA variations, its association with aortic pathology, and a proposed classification system.The thoracic cross-sectional imaging database at Keck Hospital of the University of Southern California from 2006 to 2018 was queried for presence of aSCA. Studies were evaluated for aSCA laterality, variant anatomy, and aortic and branch vessel disease. Medical records were reviewed for associated symptoms and diagnoses. The primary outcome was association of aSCA with aortic pathology (aneurysm or dissection). Secondary outcomes were comparison of right and left aSCA, comparison between the sexes, and creation of a proposed classification system.Of 98,580 axial imaging studies, 810 studies (0.82%) were identified with aSCA in 312 unique patients. Right aSCA made up the majority of cases (90.1%). All aSCAs had a retroesophageal course. Kommerell's diverticulum (KD) was present in 184 (59%) with an average diameter of 1.67 cm (range, 1.2-3.3 cm). KD was more frequent (84% vs 56%; P = .0003) and larger (2.05 cm vs 1.61 cm; P .0001) in left aSCA patients. When present, KD was more often symptomatic in left aSCA compared with right aSCA (77.4% vs 49.1%; P = .005). Dysphagia, chest pain, reflux, and asthma were all more common in left aSCA patients. KD was also more common in men (73.3% vs 50%; P .0001) and larger in men (1.81 cm vs 1.54 cm; P .0001) but with no difference in symptoms between sexes. Our proposed classification system based on aortic arch branching is as follows: type 1, left arch with right aSCA (59.9%); type 2, left arch with common carotid trunk and right aSCA (30.1%); type 3, right arch with left aSCA (9.6%); and type 4, right arch with common carotid trunk and left aSCA (0.3%). Subtypes describe the right vertebral artery (RVA) and left vertebral artery (LVA) origin: subclavian (s, RVA 90.1%, LVA 96.8%), carotid (c, RVA 9.6%, LVA 0.3%), or arch (a, RVA 0.3%, LVA 2.9%). Overall, 9.9% (31/312) had associated aortic pathology, although the study was underpowered to detect a difference between right aSCA and left aSCA (9.3% vs 16.1%; P = .213). Type 3 and type 4 arches more often have associated aortic pathology, KD, and symptoms.aSCAs are frequently symptomatic and commonly associated with aortic dissection and aneurysm. Our proposed classification scheme depicts all four aSCA arch variants and accounts for vertebral artery origin variation. These variants are common, and vertebral anatomy can differ greatly. Knowledge of these anatomic variations is critical to planning for endovascular and open repair of aortic arch pathology.
- Published
- 2020
35. Antegrade in situ fenestrated endovascular repair of a ruptured thoracoabdominal aortic aneurysm
- Author
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Kenneth R. Ziegler, Fred A. Weaver, Gregory A. Magee, Vincent L. Rowe, Sukgu M. Han, and Louis L. Zhang
- Subjects
Innovative technique ,medicine.medical_specialty ,In situ laser fenestration ,lcsh:Diseases of the circulatory (Cardiovascular) system ,Fenestrated endovascular aortic repair ,lcsh:Surgery ,Thoracic endovascular aortic repair ,030204 cardiovascular system & hematology ,Aortic stent ,Thoracoabdominal Aortic Aneurysms ,Seal (mechanical) ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Aortic aneurysm ,0302 clinical medicine ,Aneurysm ,medicine ,cardiovascular diseases ,business.industry ,Laser probe ,lcsh:RD1-811 ,medicine.disease ,Surgery ,lcsh:RC666-701 ,cardiovascular system ,Cardiology and Cardiovascular Medicine ,business ,Fenestration ,Perfusion ,Thoracoabdominal aortic aneurysm - Abstract
We describe a technique for antegrade in situ laser fenestration that has several advantages in the setting of ruptured thoracoabdominal aortic aneurysms. This technique involves rapid aneurysm sealing by deployment of aortic stent graft, followed by sequential incorporation of branch vessels using a laser probe through steerable sheath. The advantages of this technique include (1) rapid seal of the ruptured aneurysm, (2) preservation of the visceral and renal branch perfusion, (3) use of an off-the-shelf device, and (4) the ability to be performed without general anesthesia.
- Published
- 2020
36. Outcomes of endovascular repair of aortic aneurysms with the GORE thoracic branch endoprosthesis for left subclavian artery preservation
- Author
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Michael D, Dake, William T, Brinkman, Sukgu M, Han, Jon S, Matsumura, Matthew P, Sweet, Himanshu J, Patel, Bradley S, Taylor, and Gustavo S, Oderich
- Subjects
Male ,Aged, 80 and over ,Aortic Aneurysm, Thoracic ,Aortic Rupture ,Endovascular Procedures ,Subclavian Artery ,Aorta, Thoracic ,Middle Aged ,Blood Vessel Prosthesis ,Blood Vessel Prosthesis Implantation ,Treatment Outcome ,Humans ,Female ,Surgery ,Prospective Studies ,Cardiology and Cardiovascular Medicine ,Aged ,Retrospective Studies - Abstract
Thoracic endovascular aortic repair has emerged as the dominant paradigm for treatment of patients with descending thoracic aortic aneurysms. For aneurysms involving the aortic arch in the region of the left subclavian artery (LSA), branch vessel preservation to maintain blood flow to the LSA is recommended. Branched aortic endografts are an alternative to surgical revascularization of the LSA.Across 34 investigative sites, 84 patients with zone 2 aneurysms were enrolled in a nonrandomized, prospective study of a single branched aortic endograft. The thoracic branch endoprosthesis device allows for graft placement proximal to the LSA and incorporates a single side branch for left subclavian perfusion.More than one-half of the patients were male (63%). Their average age was 70 ± 11 years. The aneurysm morphology was fusiform in 43 and saccular in 41 patients. The mean aneurysm diameter at screening was 56.2 mm. The mean follow-up was 30 months (range, 2.6-50.7 months). Reported here are the patient outcomes at 1 and 12 months. Predefined technical success with implantation of the device in landing zone 2 was achieved in 92% of patients (n = 77). There were no cases of aortic rupture, lesion-related mortality, or new-onset renal failure. There was no perioperative (30-day) mortality. A single case each of permanent paraplegia and paraparesis occurred. Three patients experienced a procedure-related stroke. Through 12 months, four patients died; none of the deaths were adjudicated as related to the device or procedure. One aortic reintervention was required. A single case of aortic enlargement (core laboratory) was reported at 6 months. Type I (n = 3) and III (n = 5) endoleaks occurred in 9.8% of patients, of which one (type III) required reintervention.Results from this device study in patients with zone 2 aneurysms demonstrate that early safety and efficacy outcomes are maintained up to 12 months after the endovascular procedure with low mortality and reintervention rates and an acceptable frequency of procedural complications, including neurologic complications.
- Published
- 2022
37. Expanding the applicability of the off-the-shelf multibranched thoracoabdominal aortic device beyond the anatomic boundaries
- Author
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Sukgu M. Han
- Subjects
Aortic Aneurysm, Thoracic ,Humans ,Surgery ,Cardiology and Cardiovascular Medicine ,Blood Vessel Prosthesis - Published
- 2021
38. Aortic visceral segment instability is evident following thoracic endovascular aortic repair for acute and subacute type B aortic dissection
- Author
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Juliet Blakeslee-Carter, Hellen A. Potter, Charles A. Banks, Marc Passman, Benjamin Pearce, Graeme McFarland, Sukgu M. Han, Salvatore Scali, Gregory A. Magee, Emily Spangler, and Adam W. Beck
- Subjects
Aortic Dissection ,Blood Vessel Prosthesis Implantation ,Time Factors ,Treatment Outcome ,Aortic Aneurysm, Thoracic ,Risk Factors ,Endovascular Procedures ,Humans ,Aorta, Thoracic ,Surgery ,Cardiology and Cardiovascular Medicine ,Blood Vessel Prosthesis ,Retrospective Studies - Abstract
Anatomic remodeling within the thoracic aorta following thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD) has been well documented. However, less is known about the response of the untreated visceral aorta. In the present study, we investigated the visceral aortic behavior after TEVAR for acute or subacute TBAD to identify any associations with the clinical outcomes.A multicenter retrospective review was performed of all imaging studies for all patients who had undergone TEVAR for acute (0-14 days) and subacute (14-90 days) nontraumatic TBAD from 2006 to 2020. The cohort was inclusive of those with uncomplicated, high-risk, and complicated (defined in accordance with the Society for Vascular Surgery reporting guidelines) dissections. Centerline aortic measurements of the true and false lumen and total aortic diameter (TAD) were taken at standardized locations relative to the aortic anatomy within each aortic zone (the zones were defined by the Society for Vascular Surgery reporting guidelines). Diameter changes over time were evaluated using repeated measures mixed effects linear growth modeling. Visceral segment instability (VSI) was defined as any growth in the TAD of ≥5 mm within aortic zones 5 through 9.A total of 82 patients were identified. The median length of imaging follow-up was 2.1 years (interquartile range, 0.75-4.5 years), with 15% of the cohort having follow-up5 years. VSI was present in 55% of the cohort, with an average maximal increase in the TAD of 10.4 ± 6.3 mm during a median follow-up of 2.1 years (interquartile range, 0.75-4.5 years). Approximately one third of the cohort had experienced rapid VSI (growth ≥5 mm in the first year), and 4.8% of the cohort had developed a large paravisceral aortic aneurysm (TAD ≥5 cm) secondary to VSI. Linear growth modeling identified significant predictable growth in the TAD across all visceral zones. Zone 7 had the highest rate of TAD dilation, with a fixed effect estimated rate of 1.3 mm/y (95% confidence interval [CI], 0.23-2.1; P = .022). The preoperative factor most strongly associated with VSI was a cumulative number of zones dissected of six or more (odds ratio, 6.4; 95% CI, 1.07-8.6; P = .041). The odds for aortic reintervention were significantly increased for cases in which VSI led to the development of a paravisceral aortic aneurysm of ≥5 cm (odds ratio, 3.7; 95% CI, 1.1-13; P = .038).VSI was identified in most patients who had undergone TEVAR for management of acute and subacute TBAD. The preoperative anatomic features such as the dissection extent, rather than the procedural details of graft coverage, might play a more significant role in VSI occurrence. Significant TAD growth had occurred in all visceral segments. These results highlight the importance of lifelong surveillance following TEVAR and identified a subset of patients who might have an increased risk of reintervention.
- Published
- 2022
39. Modern Management of Type B Aortic Dissections
- Author
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Sukgu M. Han and Alyssa J. Pyun
- Subjects
Aortic dissection ,medicine.medical_specialty ,Potential impact ,business.industry ,General surgery ,First line ,Vascular surgery ,medicine.disease ,Natural history ,Management strategy ,cardiovascular system ,medicine ,Surgery ,Registry data ,In patient ,business - Abstract
The following describes the recent advancement in the diagnosis, imaging, and treatment of type B aortic dissections. We will review the recent updates of aortic dissection classifications, and potential impact on clinical management. Type B aortic dissections can be classified anatomically and temporally using the recent Society for Vascular Surgery and Society of Thoracic Surgeons reporting standards. A number of high-risk features have been correlated with poor prognoses with medical management alone, leading to the expansion of indications for thoracic endovascular aortic repair (TEVAR). Emerging data suggest that timing of intervention may play a role in patient outcomes. Special attention to endovascular technique regarding landing zones and device selection can also significantly impact patient outcomes. Anti-impulse therapy should promptly be initiated for all dissections. Type A dissections continue to depend largely on emergent open surgical intervention, whereas TEVAR remains first line for complicated type b aortic dissections. Uncomplicated type b aortic dissections are historically managed conservatively; however, data continue to emerge suggesting benefits of early endovascular intervention to prevent risk of late aortic degeneration or rupture. These approaches continue to be challenged as growing registry data and progressive endovascular technology develop. Regardless of initial management strategy, continued surveillance is crucial. Widespread utilization of standardized classification systems can aid in understanding the natural history and outcomes of aortic dissections.
- Published
- 2021
40. Early Results and Technical Tips of Combining Iliac Branch Endoprostheses with Fenestrated Aortic Stent Grafts during Endovascular Repair of Complex Abdominal and Thoracoabdominal Aortic Aneurysms
- Author
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Louis L. Zhang, Alyssa Pyun, Gregory A. Magee, Kenneth R. Ziegler, Fred A. Weaver, Kathleen O'Donnell, Jacquelyn Paige, and Sukgu M. Han
- Subjects
Time Factors ,Aortic Aneurysm, Thoracic ,Endoleak ,Spinal Cord Ischemia ,Endovascular Procedures ,General Medicine ,Prosthesis Design ,Blood Vessel Prosthesis ,Blood Vessel Prosthesis Implantation ,Treatment Outcome ,Humans ,Surgery ,Stents ,Cardiology and Cardiovascular Medicine ,Aortic Aneurysm, Abdominal - Abstract
Concomitant iliac artery aneurysms can pose challenges during repair of complex abdominal and thoracoabdominal aortic aneurysms. In fenestrated aortic aneurysm repairs (FEVAR), preservation of internal iliac perfusion is important to minimize risk of spinal cord ischemia. Currently, most commonly used fenestrated stent grafts and the only approved iliac branch devices are manufactured by different companies in the United States. We report our experience with combining Iliac Branch Endoprosthesis (IBE) (W.L. Gore and Associates, Flagstaff, AZ) and fenestrated stent grafts, using the Zenith platform (Cook Medical, Bloomington, IN).Retrospective review of consecutive patients who underwent FEVAR at a single institution from September, 2015 to June, 2020 was performed. Patients were deemed high-risk for open repair. Fenestrated aortic components implanted were either physician-modified or custom manufactured. Cases in which IBEs were deployed during FEVAR were specifically reviewed. Anatomic details were obtained from preoperative CT scans. Postoperative outcomes such as mortality, technical success, major adverse events, limb patency, limb-related endoleaks and re-intervention rates were assessed.During the study period, 171 patients underwent FEVAR at our institution. Among those, 15 patients had unilateral IBE implantation during FEVAR, while one received bilateral IBE implantation. Fourteen cases involved physician-modified fenestrated endograft, and Zenith Fenestrated (Cook Medical, Bloomington, IN) in combination with Excluder bifurcated main body and IBE (W.L. Gore and Associates, Flagstaff, AZ). Mean operative, and fluoroscopy times were 340.2 minutes, and 65.4 minutes respectively. A total of 67 viscerorenal target vessels (mean = 3.9, range =_3-5) and 15 internal iliac arteries were incorporated, with a mean of 160 cc contrast used. Completion angiograms were free of type 1 and type 3 endoleaks. Technical success was 100%. There was no perioperative mortality. One patient developed spinal cord ischemia post-operative day two with neurological recovery. At mean follow-up of 430 days, overall survival was 100% with no aneurysm-related mortalities. Limb patency remained 100%. There were no type 3 endoleaks while one patient had a type 1B endoleak that is currently being monitored. There was one re-intervention for type 1C renal branch graft endoleak.Combining IBE with FEVAR allows internal iliac preservation during endovascular repair of complex abdominal aortic aneurysms, with encouraging early results.
- Published
- 2021
41. Early Thoracic Endovascular Aortic Repair is Superior to Medical Therapy in Acute Uncomplicated Type B Aortic Dissection
- Author
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Jeniann A. Yi, Ryan Gupta, Quy Tat, Helen A. Potter, Sukgu M. Han, Fernando Fleischman, Donald Jacobs, Mark Nehler, and Gregory A. Magee
- Subjects
Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2021
42. Role of In Situ Fenestration as the Technique of Choice for Endovascular Repair of Ruptured Thoracoabdominal and Suprarenal Aortic Aneurysms at a Regional Aortic Center
- Author
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Kenneth R. Ziegler, Helen A. Potter, Gregory A. Magee, Fred A. Weaver, Sukgu M. Han, Alyssa J. Pyun, Miguel F. Manzur, and Jacquelyn K. Paige
- Subjects
medicine.medical_specialty ,business.industry ,Medicine ,Surgery ,Center (algebra and category theory) ,Cardiology and Cardiovascular Medicine ,business ,Fenestration - Published
- 2021
43. Reintervention and Spinal Cord Ischemia After Thoracic Endovascular Aortic Repair for Acute Type B Aortic Dissection With a Zone 3 Entry Tear
- Author
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Helen A. Potter, Li Ding, Fernando Fleischman, Fred A. Weaver, Gregory A. Magee, Mahmoud B. Malas, and Sukgu M. Han
- Subjects
Aortic dissection ,medicine.medical_specialty ,business.industry ,Acute type ,Medicine ,Spinal cord ischemia ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,medicine.disease ,Aortic repair - Published
- 2021
44. Evolution of Branch Vessel Incorporation During Emergent Endovascular Repair of Ruptured or Symptomatic Suprarenal and Thoracoabdominal Aortic Aneurysms
- Author
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Jacquelyn K. Paige, Sukgu M. Han, Gregory A. Magee, Helen A. Potter, Fred A. Weaver, Kenneth R. Ziegler, Alyssa J. Pyun, and Miguel F. Manzur
- Subjects
medicine.medical_specialty ,business.industry ,medicine ,Surgery ,Branch vessel ,Cardiology and Cardiovascular Medicine ,Thoracoabdominal Aortic Aneurysms ,business - Published
- 2021
45. Performance of Viabahn VBX and iCast as Bridging Stents Across Physician-created Fenestrations During Endovascular Repair of Complex Abdominal and Thoracoabdominal Aortic Aneurysms
- Author
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Alyssa J. Pyun, Fred A. Weaver, Vincent L. Rowe, Louis L. Zhang, Kenneth R. Ziegler, Sukgu M. Han, Kathleen O'Donnell, and Gregory A. Magee
- Subjects
medicine.medical_specialty ,Bridging (networking) ,business.industry ,medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Thoracoabdominal Aortic Aneurysms - Published
- 2021
46. Incidence of Type III Endoleaks and Major Adverse Events When Using Multiple Aortic Endografts from Single Versus Multiple Manufacturers During Endovascular Aortic Repair
- Author
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Li Ding, Sukgu M. Han, Helen A. Potter, Alyssa J. Pyun, Fred A. Weaver, Vincent L. Rowe, Kenneth R. Ziegler, and Gregory A. Magee
- Subjects
medicine.medical_specialty ,business.industry ,Incidence (epidemiology) ,medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,Aortic repair ,Adverse effect ,business - Published
- 2021
47. Effect of infrainguinal bypass tunneling technique on patency and amputation in patients with limb ischemia
- Author
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Nallely Saldana-Ruiz, Kenneth R. Ziegler, Sung W. Ham, Gregory A. Magee, Sukgu M. Han, Josefina Dominguez, Fred A. Weaver, and Vincent L. Rowe
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,Databases, Factual ,Infrainguinal bypass ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Risk Assessment ,Amputation, Surgical ,03 medical and health sciences ,Peripheral Arterial Disease ,0302 clinical medicine ,Ischemia ,Risk Factors ,medicine.artery ,medicine ,Humans ,In patient ,Saphenous Vein ,030212 general & internal medicine ,Registries ,Vascular Patency ,Aged ,Retrospective Studies ,business.industry ,Great saphenous vein ,Middle Aged ,medicine.disease ,Limb Salvage ,Limb ischemia ,Popliteal artery ,Progression-Free Survival ,Surgery ,medicine.anatomical_structure ,Amputation ,Heart failure ,Female ,Vascular Grafting ,Cardiology and Cardiovascular Medicine ,business ,Artery - Abstract
We investigated the association of tunneling technique on patency and amputation in patients undergoing lower extremity bypass for limb ischemia.The National Vascular Quality Initiative database infrainguinal bypass module from 2008 to 2017 was queried for analysis. We excluded cases with non-great saphenous vein grafts, grafts using multiple segments, aneurysmal disease indications, bypass locations outside the femoral to below the knee popliteal artery or tibial arteries, and missing data on tunneling type and limb ischemia. The main exposure variable was the tunneling type, subcutaneously vs subfascially. Our primary outcomes were primary patency and amputation. The secondary outcomes included primary-assisted patency and secondary patency. Univariate and multivariate logistic regression models were used.A total of 5497 bypass patients (2835 subcutaneous and 2662 subfascial) were included. Age, race, graft orientation (reversed vs not reversed), bypass donor and recipient vessels, harvest type, end-stage renal disease, smoking, coronary artery bypass graft, congestive heart failure, P2Y12 inhibitor at discharge, surgical site infection at discharge, and indication (rest pain vs tissue loss vs acute ischemia) were analyzed for an association with the tunneling technique (P .05). Multivariate analyses demonstrated that the tunneling type was not associated with primary patency, primary-assisted patency, secondary patency, or major amputation (P.05).Compared with subfascial tunneling, the superficial tunneling technique was not associated with primary patency or major amputation in limb ischemia patients undergoing infrainguinal bypass with a single-segment great saphenous vein.
- Published
- 2020
48. Complications associated with lumbar drain placement for endovascular aortic repair
- Author
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Fred A. Weaver, Vincent L. Rowe, Anastasia Plotkin, Kenneth R. Ziegler, Gregory A. Magee, Fernando Fleischman, Joseph A. Hendrix, William J. Mack, and Sukgu M. Han
- Subjects
Male ,medicine.medical_specialty ,Databases, Factual ,Aortic Diseases ,Aorta, Thoracic ,030204 cardiovascular system & hematology ,Risk Assessment ,Body Mass Index ,03 medical and health sciences ,Blood Vessel Prosthesis Implantation ,0302 clinical medicine ,Aneurysm ,Epidural hematoma ,Lumbar ,Postoperative Complications ,Risk Factors ,medicine ,Humans ,030212 general & internal medicine ,Obesity ,Aged ,Retrospective Studies ,Lumbar Vertebrae ,business.industry ,Endovascular Procedures ,Perioperative ,Middle Aged ,medicine.disease ,Surgery ,Dissection ,Catheter ,Treatment Outcome ,Drainage ,Female ,Arachnoiditis ,Cardiology and Cardiovascular Medicine ,business ,Paraplegia - Abstract
Objective We reviewed the complications associated with perioperative lumbar drain (LD) placement for endovascular aortic repair. Methods Patients who had undergone perioperative LD placement for endovascular repair of thoracic and thoracoabdominal aortic pathologies from 2010 to 2019 were reviewed. The primary endpoints were major and minor LD-associated complications. Complications that had resulted in neurological sequelae or had required an intervention or a delay in operation were defined as major. These included intracranial hemorrhage, symptomatic spinal hematoma, cerebrospinal fluid (CSF) leak requiring intervention, meningitis, retained catheter tip, arachnoiditis, and traumatic (or bloody) tap resulting in delayed operation. Minor complications were defined as a bloody tap without a delay in surgery, asymptomatic epidural hematoma, and CSF leak with no intervention required. Isolated headaches were recorded separately owing to the minimal clinical impact. Results A total of 309 LDs had been placed in 268 consecutive patients for 222 thoracic endovascular aortic repairs, 85 complex endovascular aortic repairs (EVARs; fenestrated branched EVAR/parallel grafting), and 2 EVARs (age, 65 ± 13 years; 71% male) for aortic pathology, including aneurysm (47%), dissection (49%), penetrating aortic ulcer (3%), and traumatic injury (0.6%). A dedicated neurosurgical team performed all LD procedures; most were performed by the same individual, with a technical success rate of 98%. Radiologic guidance was required in 3%. The reasons for unsuccessful placement were body habitus (n = 2) and severe spinal disease (n = 3). Most were placed prophylactically (96%). The overall complication rate was 8.1% (4.2% major and 3.9% minor). Major complications included spinal hematoma with paraplegia in 1 patient, intracranial hemorrhage in 2, meningitis in 2, arachnoiditis in 3, CSF leak requiring a blood patch in 3, bloody tap delaying the operation in 1, and a retained catheter tip in 1 patient. Patients who had undergone previous LD placement had experienced significantly more major LD-related complications (12.2% vs 3%; P = .019). The rate of total LD-associated complications did not differ between prophylactic and emergent therapeutic placements (8.1% vs 7.7%; P = 1.00) nor between major or minor complications. On multivariate analysis, previous LD placement and an overweight body mass index were the only independent predictors of major LD-related complications. Conclusions The complications associated with LD placement can be severe even when performed by a dedicated team. Previous LD placement and overweight body mass index were associated with a significantly greater risk of complications; however, emergent therapeutic placement was not. Although these risks are justified for therapeutic LD placement, the benefit of prophylactic LD placement to prevent paraplegia should be weighed against these serious complications.
- Published
- 2020
49. Branch Vessel Patency after Thoracic Endovascular Aortic Repair for Type B Aortic Dissection
- Author
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Li Ding, Benjamin W. Starnes, Sukgu M. Han, Gregory A. Magee, Anastasia Plotkin, Michael D. Dake, and Fred A. Weaver
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,Databases, Factual ,Aorta, Thoracic ,030204 cardiovascular system & hematology ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Aortic aneurysm ,Blood Vessel Prosthesis Implantation ,0302 clinical medicine ,Aneurysm ,medicine.artery ,medicine ,Vascular Patency ,Humans ,Superior mesenteric artery ,Aged ,Retrospective Studies ,Aortic dissection ,Aorta ,Aortic Aneurysm, Thoracic ,business.industry ,Endovascular Procedures ,General Medicine ,Middle Aged ,medicine.disease ,Thrombosis ,Surgery ,Aortic Dissection ,Treatment Outcome ,Cardiothoracic surgery ,cardiovascular system ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Thoracic endovascular aortic repair (TEVAR) for type B aortic dissections is used to promote false lumen (FL) thrombosis and favorable aortic remodeling, but its impact on occlusion of FL origin branch vessels has not been widely described. We compare FL versus true lumen (TL) branch vessel patency after TEVAR.Patients treated by TEVAR for type B aortic dissection in zones 2-5 in the Vascular Quality Initiative from 2009 to 2018 were evaluated. The primary outcome was postoperative branch patency. Secondary outcomes were need for branch vessel intervention, preoperative origin, and postoperative patency of individual branch vessels (celiac, superior mesenteric artery, renal arteries, and iliac arteries). A subset analysis was performed comparing acute and chronic dissections.Of 11,774 patients, 1,484 met criteria for analysis. The left renal was the most common to have FL origin (21.6%), whereas right and left common iliac arteries were the most likely to originate off both lumens (BLs; 22% and 24%). Branch vessels that originated from the TL, FL, BLs, or were obstructed had postoperative patency rates of 99%, 99%, 99%, and 87% (P 0.0001). Branch vessel treatment was performed in 5% of patients. The right (2.5%) and left (2.8%) renal arteries were the most frequently obstructed branches postoperatively. On multivariate analysis, preoperatively obstructed branches (odds ratio 0.03, P 0.0001) were negatively associated with postoperative branch patency and branch vessel treatment (odds ratio 3.8, P = 0.004) was positively associated with postoperative patency. FL or BL origin, number of zones covered by TEVAR, urgency, dissection chronicity (acute versus chronic), and demographics were not independently associated with patency. These findings remained unchanged in the subset analysis of only acute dissections.Branch vessel patency rates after TEVAR for a type B aortic dissection are high and are not significantly different for FL or BL origin vessels compared with TL vessels. Branches that are patent before TEVAR almost always remain patent after TEVAR, but branch vessel stenting may be required in less than 5%.
- Published
- 2020
50. Impact of High-Risk Features and Timing of Repair for Acute Type B Aortic Dissections
- Author
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Sukgu M. Han, Helen A. Potter, Fred A. Weaver, Li Ding, and Gregory A. Magee
- Subjects
medicine.medical_specialty ,business.industry ,Acute type ,Medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Published
- 2021
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