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Scott R Mitchell - One of the best experts on this subject based on the ideXlab platform.

  • complicated acute type b aortic dissection midterm results of emergency Endovascular Stent grafting
    The Journal of Thoracic and Cardiovascular Surgery, 2008
    Co-Authors: Jean Phillipe Verhoye, Michael D Dake, Craig D Miller, Daniel Y Sze, Scott R Mitchell
    Abstract:

    Objective This study assessed midterm results of emergency Endovascular Stent–grafting for patients with life-threatening complications of acute type B aortic dissection. Methods Between November 1996 and June 2004, 16 patients with complicated acute type B aortic dissections (mean age 57 years, range 16–88 years) underwent Endovascular Stent–grafting within 48 hours of presentation. Complications included contained rupture, hemothorax, refractory chest pain, and severe visceral or lower limb ischemia. Stent–graft types included custom-made first-generation endografts and second-generation commercial Stent–grafts (Gore Excluder or TAG; W. L. Gore & Associates, Inc, Flagstaff, Ariz.). Follow-up was 100% complete, averaged 36 ± 36 months, and included postprocedural surveillance computed tomographic scans. Results Early mortality was 25% ± 11% (70% confidence limit), with no late deaths. No new neurologic complications occurred. According to the latest scan, 4 patients (25%) had complete thrombosis of the false lumen; the lumen was partially thrombosed in 6 patients (38%). Distal aortic diameter was increased in only 1 patient. Actuarial survival at 1 and 5 years was 73% ± 11%; freedom from treatment failure (including aortic rupture, device fault, reintervention, aortic death, or sudden, unexplained late death) was 67% ± 14% at 5 years. Conclusion With follow-up to 9 years, Endovascular Stent–grafting for patients with complicated acute type B aortic dissection conferred benefit. Consideration of emergency Stent–grafting may improve the dismal outlook for these patients; future refinements in Stent–graft design and technology and earlier diagnosis and intervention should be associated with improved results.

  • Endovascular Stent grafting versus open surgical repair of descending thoracic aortic aneurysms in low risk patients a multicenter comparative trial
    The Journal of Thoracic and Cardiovascular Surgery, 2007
    Co-Authors: Joseph E Bavaria, Jehangir J Appoo, Michel S Makaroun, Joel Verter, Zifan Yu, Scott R Mitchell
    Abstract:

    Objective Results are presented from the first completed multicenter trial directed at gaining approval from the US Food and Drug Administration of Endovascular versus open surgical repair of descending thoracic aortic aneurysms. Methods Between September 1999 and May 2001, 140 patients with descending thoracic aneurysms were enrolled at 17 sites and evaluated for a Gore TAG Thoracic Endograft. An open surgical control cohort of 94 patients was identified by enrolling historical and concurrent subjects. Patients were assessed before treatment, at treatment, and at hospital discharge and returned for follow-up visits at 1 month, 6 months, and annually thereafter. Results One hundred thirty-seven of 140 patients had successful implantation of the endograft. Perioperative mortality in the endograft versus open surgical control cohort was 2.1% (n = 3) versus 11.7% (n = 11, P Conclusions In this multicenter study early outcomes with descending aortic Endovascular Stent grafting were very encouraging when compared with those of a well-matched surgical cohort. However, at 2 years’ follow-up, there is an incidence of endoleaks and reinterventions associated with Endovascular versus open surgical repair. Continued vigilant surveillance of patients treated with an endograft is important.

  • thoracic aortic aneurysm repair with an Endovascular Stent graft the first generation
    The Annals of Thoracic Surgery, 1999
    Co-Authors: Scott R Mitchell, Charles P Semba, Craig D Miller, Michael D Dake, Kathleen A Moore, Toyohiko Sakai
    Abstract:

    Abstract Objective . The feasibility and efficacy trial of an Endovascular Stent-grafting system for the treatment of aneurysms of the descending thoracic aorta was investigated. Methods . After Institutional Review Board approval, 103 patients (mean age 69 years) underwent Stent graft repair of a descending thoracic aortic aneurysm between July 1992 and November 1997. The Stent graft was fabricated using self-expanding "Z" Stents covered by a woven Dacron tube graft. Follow-up, which averaged 22 months, was 100% complete. Simultaneous open abdominal aortic aneurysm repair was performed in 19 patients. Results . Complete aneurysm thrombosis was achieved in 86 patients (83%). Early mortality, defined as a death during the same hospitalization or in less than 30 days, was 9 ± 3%, and was significantly associated with preoperative cerebrovascular accident (CVA) or myocardial infarction. Major perioperative morbidity occurred in 31 patients, and included paraplegia in 3, CVA in 7, and respiratory insufficiency in 12 patients each. Actuarial survival was 81 ± 4% at 1 year, and 73 ± 5% at 2 years. Treatment failure (including all late, sudden, unexplained deaths) occurred in 38 patients, and only 53 ± 10% of patients were free of treatment failure at 3.7 years. Five patients required late operative therapy for endoleaks associated with aneurysm enlargement. Conclusions . Satisfactory results were achieved using this "first-generation" homemade Stent graft device. Mortality and morbidity occurred frequently, but may have been associated with the high-risk character of this patient population. Medium-term results were acceptable, but continued aortic enlargement, with the late development of endoleaks, is a significant concern. Second-generation devices with commercial development, coupled with this initial experience, should allow improved clinical results in the future. Longer term follow-up is still necessary to fully define the efficacy of this Endovascular approach.

  • Endovascular Stent graft placement for the treatment of acute aortic dissection
    The New England Journal of Medicine, 1999
    Co-Authors: Michael D Dake, Tadanori Hirano, Scott R Mitchell, Charles P Semba, Kan Takeda, Takatsugu Shimono, Isao Yada, Noriyuki Kato, Mahmood K Razavi, Craig D Miller
    Abstract:

    Background The standard treatment for acute aortic dissection is either surgical or medical therapy, depending on the morphologic features of the lesion and any associated complications. Irrespective of the form of treatment, the associated mortality and morbidity are considerable. Methods We studied the placement of Endovascular Stent–grafts across the primary entry tear for the management of acute aortic dissection originating in the descending thoracic aorta. We evaluated the feasibility, safety, and effectiveness of transluminal Stent–graft placement over the entry tear in 4 patients with acute type A aortic dissections (which involve the ascending aorta) and 15 patients with acute type B aortic dissections (which are confined to the descending aorta). Dissections involved aortic branches in 14 of the 19 patients (74 percent), and symptomatic compromise of multiple branch vessels was observed in 7 patients (37 percent). The Stent–grafts were made of self-expanding stainless-steel covered with woven po...

  • the first generation of Endovascular Stent grafts for patients with aneurysms of the descending thoracic aorta
    The Journal of Thoracic and Cardiovascular Surgery, 1998
    Co-Authors: Michael D Dake, Scott R Mitchell, Charles P Semba, Craig D Miller, Kathleen A Moore, Toyohiko Sakai
    Abstract:

    Abstract Objective: Our goal was to determine whether Endovascular Stent-grafting is feasible and effective for patients with aneurysms of the descending thoracic aorta. Methods: Starting in July 1992, we conducted a prospective, uncontrolled clinical trial in 103 patients (mean age 69 years [range 34-89 years]) who underwent Endovascular treatment of aneurysms of the descending thoracic aorta using a custom-fabricated, self-expanding Stent-graft device. Follow-up was 100% complete and averaged 22 months. Sixty-two patients (60%) were judged not to be reasonable candidates for a conventional "open" surgical procedure. Results: Complete thrombosis of the aneurysm was ultimately achieved in 86 (83%) patients. The early mortality rate was 9% ± 3% (±70% CL). Multivariable analysis revealed that myocardial infarction or stroke was linked with a higher likelihood of early death ( P = .001). Early serious complications included paraplegia in 3% ± 2% and stroke in 7% ± 3%. Actuarial survival estimates at 1 year and 2 years were 81% ± 4% and 73% ± 5% (±1 SE), respectively; being judged not to be a surgical candidate portended a higher probability of death ( P = .003). According to the intent-to-treat principle, "treatment failure" (including all late sudden unexplained deaths) occurred in 38 patients; 53% ± 10% of patients were free from treatment failure at 3.7 years. Stent-graft related complications occurred commonly and were linked with several anatomic, technical, and patient-related risk factors. Conclusions: This 5-year clinical trial involving use of a "first generation" device indicates that Endovascular Stent-grafting of descending thoracic aortic aneurysms is feasible with acceptable medium-term results. More refined, commercially developed devices available today offer less traumatic and more precise Stent-graft deployment; these major technical advantages, coupled with important lessons we have learned over time and better patient selection, should be associated with more salutary clinical results in the future. (J Thorac Cardiovasc Surg 1998;116:689-704)

Michael D Dake - One of the best experts on this subject based on the ideXlab platform.

  • complicated acute type b aortic dissection midterm results of emergency Endovascular Stent grafting
    The Journal of Thoracic and Cardiovascular Surgery, 2008
    Co-Authors: Jean Phillipe Verhoye, Michael D Dake, Craig D Miller, Daniel Y Sze, Scott R Mitchell
    Abstract:

    Objective This study assessed midterm results of emergency Endovascular Stent–grafting for patients with life-threatening complications of acute type B aortic dissection. Methods Between November 1996 and June 2004, 16 patients with complicated acute type B aortic dissections (mean age 57 years, range 16–88 years) underwent Endovascular Stent–grafting within 48 hours of presentation. Complications included contained rupture, hemothorax, refractory chest pain, and severe visceral or lower limb ischemia. Stent–graft types included custom-made first-generation endografts and second-generation commercial Stent–grafts (Gore Excluder or TAG; W. L. Gore & Associates, Inc, Flagstaff, Ariz.). Follow-up was 100% complete, averaged 36 ± 36 months, and included postprocedural surveillance computed tomographic scans. Results Early mortality was 25% ± 11% (70% confidence limit), with no late deaths. No new neurologic complications occurred. According to the latest scan, 4 patients (25%) had complete thrombosis of the false lumen; the lumen was partially thrombosed in 6 patients (38%). Distal aortic diameter was increased in only 1 patient. Actuarial survival at 1 and 5 years was 73% ± 11%; freedom from treatment failure (including aortic rupture, device fault, reintervention, aortic death, or sudden, unexplained late death) was 67% ± 14% at 5 years. Conclusion With follow-up to 9 years, Endovascular Stent–grafting for patients with complicated acute type B aortic dissection conferred benefit. Consideration of emergency Stent–grafting may improve the dismal outlook for these patients; future refinements in Stent–graft design and technology and earlier diagnosis and intervention should be associated with improved results.

  • Endovascular Stent graft management of thoracic aortic diseases
    European Journal of Radiology, 2001
    Co-Authors: Michael D Dake
    Abstract:

    The traditional standard therapy for descending thoracic aortic aneurysm (TAA) is open operative repair with graft replacement of the diseased aortic segment. Despite important advances in surgical techniques, anesthetic management, and post-operative care over the last 30 years, the mortality and morbidity of surgery remains considerable, especially in patients at high risk for thoracotomy because of coexisting severe cardiopulmonary abnormalities or other medical diseases. The advent of Endovascular Stent-graft technology provides an alternative to open surgery for selected patients with TAA. The initial experience suggests that Stent-graft therapy potentially may reduce the operative risk, hospital stay and procedural expenses of TAA repair. These potential benefits are especially attractive for patients at high risk for open TAA repair. Current results of Endovascular TAA therapy document operative mortalities of between 0 and 4%, aneurysm thrombosis in 90 and 100% of cases, and paraplegia as a complication in 0 and 1.6% of patients. The early success of Stent-graft repair of TAA has fostered the application of these devices for the management of a wide variety of thoracic aortic pathologies, including acute and chronic dissection, intramural hematoma, penetrating ulcer, traumatic injuries, and other diseases. The results of prospective controlled trials that compare the outcomes of Stent-graft therapy with those of surgical treatment in patients with specific types of aortic disease are anxiously awaited before recommendations regarding the general use of these new devices can be made with confidence.

  • thoracic aortic aneurysm repair with an Endovascular Stent graft the first generation
    The Annals of Thoracic Surgery, 1999
    Co-Authors: Scott R Mitchell, Charles P Semba, Craig D Miller, Michael D Dake, Kathleen A Moore, Toyohiko Sakai
    Abstract:

    Abstract Objective . The feasibility and efficacy trial of an Endovascular Stent-grafting system for the treatment of aneurysms of the descending thoracic aorta was investigated. Methods . After Institutional Review Board approval, 103 patients (mean age 69 years) underwent Stent graft repair of a descending thoracic aortic aneurysm between July 1992 and November 1997. The Stent graft was fabricated using self-expanding "Z" Stents covered by a woven Dacron tube graft. Follow-up, which averaged 22 months, was 100% complete. Simultaneous open abdominal aortic aneurysm repair was performed in 19 patients. Results . Complete aneurysm thrombosis was achieved in 86 patients (83%). Early mortality, defined as a death during the same hospitalization or in less than 30 days, was 9 ± 3%, and was significantly associated with preoperative cerebrovascular accident (CVA) or myocardial infarction. Major perioperative morbidity occurred in 31 patients, and included paraplegia in 3, CVA in 7, and respiratory insufficiency in 12 patients each. Actuarial survival was 81 ± 4% at 1 year, and 73 ± 5% at 2 years. Treatment failure (including all late, sudden, unexplained deaths) occurred in 38 patients, and only 53 ± 10% of patients were free of treatment failure at 3.7 years. Five patients required late operative therapy for endoleaks associated with aneurysm enlargement. Conclusions . Satisfactory results were achieved using this "first-generation" homemade Stent graft device. Mortality and morbidity occurred frequently, but may have been associated with the high-risk character of this patient population. Medium-term results were acceptable, but continued aortic enlargement, with the late development of endoleaks, is a significant concern. Second-generation devices with commercial development, coupled with this initial experience, should allow improved clinical results in the future. Longer term follow-up is still necessary to fully define the efficacy of this Endovascular approach.

  • Endovascular Stent graft placement for the treatment of acute aortic dissection
    The New England Journal of Medicine, 1999
    Co-Authors: Michael D Dake, Tadanori Hirano, Scott R Mitchell, Charles P Semba, Kan Takeda, Takatsugu Shimono, Isao Yada, Noriyuki Kato, Mahmood K Razavi, Craig D Miller
    Abstract:

    Background The standard treatment for acute aortic dissection is either surgical or medical therapy, depending on the morphologic features of the lesion and any associated complications. Irrespective of the form of treatment, the associated mortality and morbidity are considerable. Methods We studied the placement of Endovascular Stent–grafts across the primary entry tear for the management of acute aortic dissection originating in the descending thoracic aorta. We evaluated the feasibility, safety, and effectiveness of transluminal Stent–graft placement over the entry tear in 4 patients with acute type A aortic dissections (which involve the ascending aorta) and 15 patients with acute type B aortic dissections (which are confined to the descending aorta). Dissections involved aortic branches in 14 of the 19 patients (74 percent), and symptomatic compromise of multiple branch vessels was observed in 7 patients (37 percent). The Stent–grafts were made of self-expanding stainless-steel covered with woven po...

  • the first generation of Endovascular Stent grafts for patients with aneurysms of the descending thoracic aorta
    The Journal of Thoracic and Cardiovascular Surgery, 1998
    Co-Authors: Michael D Dake, Scott R Mitchell, Charles P Semba, Craig D Miller, Kathleen A Moore, Toyohiko Sakai
    Abstract:

    Abstract Objective: Our goal was to determine whether Endovascular Stent-grafting is feasible and effective for patients with aneurysms of the descending thoracic aorta. Methods: Starting in July 1992, we conducted a prospective, uncontrolled clinical trial in 103 patients (mean age 69 years [range 34-89 years]) who underwent Endovascular treatment of aneurysms of the descending thoracic aorta using a custom-fabricated, self-expanding Stent-graft device. Follow-up was 100% complete and averaged 22 months. Sixty-two patients (60%) were judged not to be reasonable candidates for a conventional "open" surgical procedure. Results: Complete thrombosis of the aneurysm was ultimately achieved in 86 (83%) patients. The early mortality rate was 9% ± 3% (±70% CL). Multivariable analysis revealed that myocardial infarction or stroke was linked with a higher likelihood of early death ( P = .001). Early serious complications included paraplegia in 3% ± 2% and stroke in 7% ± 3%. Actuarial survival estimates at 1 year and 2 years were 81% ± 4% and 73% ± 5% (±1 SE), respectively; being judged not to be a surgical candidate portended a higher probability of death ( P = .003). According to the intent-to-treat principle, "treatment failure" (including all late sudden unexplained deaths) occurred in 38 patients; 53% ± 10% of patients were free from treatment failure at 3.7 years. Stent-graft related complications occurred commonly and were linked with several anatomic, technical, and patient-related risk factors. Conclusions: This 5-year clinical trial involving use of a "first generation" device indicates that Endovascular Stent-grafting of descending thoracic aortic aneurysms is feasible with acceptable medium-term results. More refined, commercially developed devices available today offer less traumatic and more precise Stent-graft deployment; these major technical advantages, coupled with important lessons we have learned over time and better patient selection, should be associated with more salutary clinical results in the future. (J Thorac Cardiovasc Surg 1998;116:689-704)

Charles P Semba - One of the best experts on this subject based on the ideXlab platform.

  • thoracic aortic aneurysm repair with an Endovascular Stent graft the first generation
    The Annals of Thoracic Surgery, 1999
    Co-Authors: Scott R Mitchell, Charles P Semba, Craig D Miller, Michael D Dake, Kathleen A Moore, Toyohiko Sakai
    Abstract:

    Abstract Objective . The feasibility and efficacy trial of an Endovascular Stent-grafting system for the treatment of aneurysms of the descending thoracic aorta was investigated. Methods . After Institutional Review Board approval, 103 patients (mean age 69 years) underwent Stent graft repair of a descending thoracic aortic aneurysm between July 1992 and November 1997. The Stent graft was fabricated using self-expanding "Z" Stents covered by a woven Dacron tube graft. Follow-up, which averaged 22 months, was 100% complete. Simultaneous open abdominal aortic aneurysm repair was performed in 19 patients. Results . Complete aneurysm thrombosis was achieved in 86 patients (83%). Early mortality, defined as a death during the same hospitalization or in less than 30 days, was 9 ± 3%, and was significantly associated with preoperative cerebrovascular accident (CVA) or myocardial infarction. Major perioperative morbidity occurred in 31 patients, and included paraplegia in 3, CVA in 7, and respiratory insufficiency in 12 patients each. Actuarial survival was 81 ± 4% at 1 year, and 73 ± 5% at 2 years. Treatment failure (including all late, sudden, unexplained deaths) occurred in 38 patients, and only 53 ± 10% of patients were free of treatment failure at 3.7 years. Five patients required late operative therapy for endoleaks associated with aneurysm enlargement. Conclusions . Satisfactory results were achieved using this "first-generation" homemade Stent graft device. Mortality and morbidity occurred frequently, but may have been associated with the high-risk character of this patient population. Medium-term results were acceptable, but continued aortic enlargement, with the late development of endoleaks, is a significant concern. Second-generation devices with commercial development, coupled with this initial experience, should allow improved clinical results in the future. Longer term follow-up is still necessary to fully define the efficacy of this Endovascular approach.

  • Endovascular Stent graft placement for the treatment of acute aortic dissection
    The New England Journal of Medicine, 1999
    Co-Authors: Michael D Dake, Tadanori Hirano, Scott R Mitchell, Charles P Semba, Kan Takeda, Takatsugu Shimono, Isao Yada, Noriyuki Kato, Mahmood K Razavi, Craig D Miller
    Abstract:

    Background The standard treatment for acute aortic dissection is either surgical or medical therapy, depending on the morphologic features of the lesion and any associated complications. Irrespective of the form of treatment, the associated mortality and morbidity are considerable. Methods We studied the placement of Endovascular Stent–grafts across the primary entry tear for the management of acute aortic dissection originating in the descending thoracic aorta. We evaluated the feasibility, safety, and effectiveness of transluminal Stent–graft placement over the entry tear in 4 patients with acute type A aortic dissections (which involve the ascending aorta) and 15 patients with acute type B aortic dissections (which are confined to the descending aorta). Dissections involved aortic branches in 14 of the 19 patients (74 percent), and symptomatic compromise of multiple branch vessels was observed in 7 patients (37 percent). The Stent–grafts were made of self-expanding stainless-steel covered with woven po...

  • the first generation of Endovascular Stent grafts for patients with aneurysms of the descending thoracic aorta
    The Journal of Thoracic and Cardiovascular Surgery, 1998
    Co-Authors: Michael D Dake, Scott R Mitchell, Charles P Semba, Craig D Miller, Kathleen A Moore, Toyohiko Sakai
    Abstract:

    Abstract Objective: Our goal was to determine whether Endovascular Stent-grafting is feasible and effective for patients with aneurysms of the descending thoracic aorta. Methods: Starting in July 1992, we conducted a prospective, uncontrolled clinical trial in 103 patients (mean age 69 years [range 34-89 years]) who underwent Endovascular treatment of aneurysms of the descending thoracic aorta using a custom-fabricated, self-expanding Stent-graft device. Follow-up was 100% complete and averaged 22 months. Sixty-two patients (60%) were judged not to be reasonable candidates for a conventional "open" surgical procedure. Results: Complete thrombosis of the aneurysm was ultimately achieved in 86 (83%) patients. The early mortality rate was 9% ± 3% (±70% CL). Multivariable analysis revealed that myocardial infarction or stroke was linked with a higher likelihood of early death ( P = .001). Early serious complications included paraplegia in 3% ± 2% and stroke in 7% ± 3%. Actuarial survival estimates at 1 year and 2 years were 81% ± 4% and 73% ± 5% (±1 SE), respectively; being judged not to be a surgical candidate portended a higher probability of death ( P = .003). According to the intent-to-treat principle, "treatment failure" (including all late sudden unexplained deaths) occurred in 38 patients; 53% ± 10% of patients were free from treatment failure at 3.7 years. Stent-graft related complications occurred commonly and were linked with several anatomic, technical, and patient-related risk factors. Conclusions: This 5-year clinical trial involving use of a "first generation" device indicates that Endovascular Stent-grafting of descending thoracic aortic aneurysms is feasible with acceptable medium-term results. More refined, commercially developed devices available today offer less traumatic and more precise Stent-graft deployment; these major technical advantages, coupled with important lessons we have learned over time and better patient selection, should be associated with more salutary clinical results in the future. (J Thorac Cardiovasc Surg 1998;116:689-704)

  • superior vena cava syndrome treatment with catheter directed thrombolysis and Endovascular Stent placement
    Radiology, 1998
    Co-Authors: Lisa Kinoshita, Charles P Semba, Mahmood K Razavi, Ulf Nyman, Michael D Dake
    Abstract:

    PURPOSE: To evaluate use of catheter-directed thrombolysis and/or Endovascular Stent placement to treat superior vena cava (SVC) syndrome. MATERIALS AND METHODS: Fifty-nine consecutive patients with SVC syndrome were studied. The cause was underlying malignancy in 43 and benign disease in 16. All patients underwent bilateral upper-extremity venography. The SVC was occluded in 31 cases and stenosed in 28. Twenty-seven patients underwent catheter-directed thrombolysis; 51 underwent Endovascular Stent placement. Patency was defined in terms of absence of symptoms and signs of SVC syndrome. RESULTS: Technical success was achieved in 56 of 59 patients (95%). Among 42 patients with underlying malignancy (mean follow-up, 7.0 months; range, 1-34 months), primary clinical patency was achieved in 33 (79%) and secondary clinical patency was achieved in 39 (93%). Among 13 patients with benign disease (mean follow-up, 17.0 months; range, 1-27 months), primary clinical patency was achieved in 10 (77%) and secondary cli...

  • mycotic aneurysms of the thoracic aorta repair with use of Endovascular Stent grafts
    Journal of Vascular and Interventional Radiology, 1998
    Co-Authors: Charles P Semba, Scott R Mitchell, Mahmood K Razavi, Stephen T Kee, Gerald K Lee, Toyohiko Sakai, Suzanne M Slonim, Mark J Jorgensen, Robert C Hagberg, Craig D Miller
    Abstract:

    Purpose Standard therapy of mycotic aneurysms in the descending aorta consists of thoracotomy and in situ graft placement or extraanatomic bypass. The alternative use of Endovascular Stent-grafts was evaluated for management of infected aneurysms of the thoracic aorta. Materials and Methods In a retrospective analysis during a 5-year period, 112 patients underwent Stent-graft placement for thoracic aortic aneurysms. Three patients (mean age, 68.6; range, 64–70 years) had mycotic thoracic aneurysms. Stent-grafts were constructed from Z Stents covered with polyester fabric and were delivered remotely through a catheter under fluoroscopic guidance. Results Complete thrombosis of the mycotic aneurysms was achieved in all patients. One patient required a second separate Stent-graft placement procedure because of migration of the initial device; the second patient underwent surgical repair of a ruptured mycotic abdominal aortic aneurysm followed immediately by Stent-graft placement for a chronic mycotic thoracic aneurysm; a third patient underwent repair of two infected false aneurysms secondary to complete rupture of a surgical interposition graft. There were no complications of persiStent bacteremia despite placement of the Stent-graft device at the site of primary infection, reinfection, delayed rupture, paraplegia, distal emboli, or surgical conversion. One patient died of cardiac arrest at 25 months; there were no perioperative deaths (≤ 30 days). The remaining two patients were alive and well at median follow-up of 24 months (range, 4–25 months). Conclusion Endovascular Stent-grafts combined with antibiotic therapy may be an alternative to conventional thoracotomy in managing mycotic aneurysms of the descending thoracic aorta.

Craig D Miller - One of the best experts on this subject based on the ideXlab platform.

  • complicated acute type b aortic dissection midterm results of emergency Endovascular Stent grafting
    The Journal of Thoracic and Cardiovascular Surgery, 2008
    Co-Authors: Jean Phillipe Verhoye, Michael D Dake, Craig D Miller, Daniel Y Sze, Scott R Mitchell
    Abstract:

    Objective This study assessed midterm results of emergency Endovascular Stent–grafting for patients with life-threatening complications of acute type B aortic dissection. Methods Between November 1996 and June 2004, 16 patients with complicated acute type B aortic dissections (mean age 57 years, range 16–88 years) underwent Endovascular Stent–grafting within 48 hours of presentation. Complications included contained rupture, hemothorax, refractory chest pain, and severe visceral or lower limb ischemia. Stent–graft types included custom-made first-generation endografts and second-generation commercial Stent–grafts (Gore Excluder or TAG; W. L. Gore & Associates, Inc, Flagstaff, Ariz.). Follow-up was 100% complete, averaged 36 ± 36 months, and included postprocedural surveillance computed tomographic scans. Results Early mortality was 25% ± 11% (70% confidence limit), with no late deaths. No new neurologic complications occurred. According to the latest scan, 4 patients (25%) had complete thrombosis of the false lumen; the lumen was partially thrombosed in 6 patients (38%). Distal aortic diameter was increased in only 1 patient. Actuarial survival at 1 and 5 years was 73% ± 11%; freedom from treatment failure (including aortic rupture, device fault, reintervention, aortic death, or sudden, unexplained late death) was 67% ± 14% at 5 years. Conclusion With follow-up to 9 years, Endovascular Stent–grafting for patients with complicated acute type B aortic dissection conferred benefit. Consideration of emergency Stent–grafting may improve the dismal outlook for these patients; future refinements in Stent–graft design and technology and earlier diagnosis and intervention should be associated with improved results.

  • thoracic aortic aneurysm repair with an Endovascular Stent graft the first generation
    The Annals of Thoracic Surgery, 1999
    Co-Authors: Scott R Mitchell, Charles P Semba, Craig D Miller, Michael D Dake, Kathleen A Moore, Toyohiko Sakai
    Abstract:

    Abstract Objective . The feasibility and efficacy trial of an Endovascular Stent-grafting system for the treatment of aneurysms of the descending thoracic aorta was investigated. Methods . After Institutional Review Board approval, 103 patients (mean age 69 years) underwent Stent graft repair of a descending thoracic aortic aneurysm between July 1992 and November 1997. The Stent graft was fabricated using self-expanding "Z" Stents covered by a woven Dacron tube graft. Follow-up, which averaged 22 months, was 100% complete. Simultaneous open abdominal aortic aneurysm repair was performed in 19 patients. Results . Complete aneurysm thrombosis was achieved in 86 patients (83%). Early mortality, defined as a death during the same hospitalization or in less than 30 days, was 9 ± 3%, and was significantly associated with preoperative cerebrovascular accident (CVA) or myocardial infarction. Major perioperative morbidity occurred in 31 patients, and included paraplegia in 3, CVA in 7, and respiratory insufficiency in 12 patients each. Actuarial survival was 81 ± 4% at 1 year, and 73 ± 5% at 2 years. Treatment failure (including all late, sudden, unexplained deaths) occurred in 38 patients, and only 53 ± 10% of patients were free of treatment failure at 3.7 years. Five patients required late operative therapy for endoleaks associated with aneurysm enlargement. Conclusions . Satisfactory results were achieved using this "first-generation" homemade Stent graft device. Mortality and morbidity occurred frequently, but may have been associated with the high-risk character of this patient population. Medium-term results were acceptable, but continued aortic enlargement, with the late development of endoleaks, is a significant concern. Second-generation devices with commercial development, coupled with this initial experience, should allow improved clinical results in the future. Longer term follow-up is still necessary to fully define the efficacy of this Endovascular approach.

  • Endovascular Stent graft placement for the treatment of acute aortic dissection
    The New England Journal of Medicine, 1999
    Co-Authors: Michael D Dake, Tadanori Hirano, Scott R Mitchell, Charles P Semba, Kan Takeda, Takatsugu Shimono, Isao Yada, Noriyuki Kato, Mahmood K Razavi, Craig D Miller
    Abstract:

    Background The standard treatment for acute aortic dissection is either surgical or medical therapy, depending on the morphologic features of the lesion and any associated complications. Irrespective of the form of treatment, the associated mortality and morbidity are considerable. Methods We studied the placement of Endovascular Stent–grafts across the primary entry tear for the management of acute aortic dissection originating in the descending thoracic aorta. We evaluated the feasibility, safety, and effectiveness of transluminal Stent–graft placement over the entry tear in 4 patients with acute type A aortic dissections (which involve the ascending aorta) and 15 patients with acute type B aortic dissections (which are confined to the descending aorta). Dissections involved aortic branches in 14 of the 19 patients (74 percent), and symptomatic compromise of multiple branch vessels was observed in 7 patients (37 percent). The Stent–grafts were made of self-expanding stainless-steel covered with woven po...

  • the first generation of Endovascular Stent grafts for patients with aneurysms of the descending thoracic aorta
    The Journal of Thoracic and Cardiovascular Surgery, 1998
    Co-Authors: Michael D Dake, Scott R Mitchell, Charles P Semba, Craig D Miller, Kathleen A Moore, Toyohiko Sakai
    Abstract:

    Abstract Objective: Our goal was to determine whether Endovascular Stent-grafting is feasible and effective for patients with aneurysms of the descending thoracic aorta. Methods: Starting in July 1992, we conducted a prospective, uncontrolled clinical trial in 103 patients (mean age 69 years [range 34-89 years]) who underwent Endovascular treatment of aneurysms of the descending thoracic aorta using a custom-fabricated, self-expanding Stent-graft device. Follow-up was 100% complete and averaged 22 months. Sixty-two patients (60%) were judged not to be reasonable candidates for a conventional "open" surgical procedure. Results: Complete thrombosis of the aneurysm was ultimately achieved in 86 (83%) patients. The early mortality rate was 9% ± 3% (±70% CL). Multivariable analysis revealed that myocardial infarction or stroke was linked with a higher likelihood of early death ( P = .001). Early serious complications included paraplegia in 3% ± 2% and stroke in 7% ± 3%. Actuarial survival estimates at 1 year and 2 years were 81% ± 4% and 73% ± 5% (±1 SE), respectively; being judged not to be a surgical candidate portended a higher probability of death ( P = .003). According to the intent-to-treat principle, "treatment failure" (including all late sudden unexplained deaths) occurred in 38 patients; 53% ± 10% of patients were free from treatment failure at 3.7 years. Stent-graft related complications occurred commonly and were linked with several anatomic, technical, and patient-related risk factors. Conclusions: This 5-year clinical trial involving use of a "first generation" device indicates that Endovascular Stent-grafting of descending thoracic aortic aneurysms is feasible with acceptable medium-term results. More refined, commercially developed devices available today offer less traumatic and more precise Stent-graft deployment; these major technical advantages, coupled with important lessons we have learned over time and better patient selection, should be associated with more salutary clinical results in the future. (J Thorac Cardiovasc Surg 1998;116:689-704)

  • mycotic aneurysms of the thoracic aorta repair with use of Endovascular Stent grafts
    Journal of Vascular and Interventional Radiology, 1998
    Co-Authors: Charles P Semba, Scott R Mitchell, Mahmood K Razavi, Stephen T Kee, Gerald K Lee, Toyohiko Sakai, Suzanne M Slonim, Mark J Jorgensen, Robert C Hagberg, Craig D Miller
    Abstract:

    Purpose Standard therapy of mycotic aneurysms in the descending aorta consists of thoracotomy and in situ graft placement or extraanatomic bypass. The alternative use of Endovascular Stent-grafts was evaluated for management of infected aneurysms of the thoracic aorta. Materials and Methods In a retrospective analysis during a 5-year period, 112 patients underwent Stent-graft placement for thoracic aortic aneurysms. Three patients (mean age, 68.6; range, 64–70 years) had mycotic thoracic aneurysms. Stent-grafts were constructed from Z Stents covered with polyester fabric and were delivered remotely through a catheter under fluoroscopic guidance. Results Complete thrombosis of the mycotic aneurysms was achieved in all patients. One patient required a second separate Stent-graft placement procedure because of migration of the initial device; the second patient underwent surgical repair of a ruptured mycotic abdominal aortic aneurysm followed immediately by Stent-graft placement for a chronic mycotic thoracic aneurysm; a third patient underwent repair of two infected false aneurysms secondary to complete rupture of a surgical interposition graft. There were no complications of persiStent bacteremia despite placement of the Stent-graft device at the site of primary infection, reinfection, delayed rupture, paraplegia, distal emboli, or surgical conversion. One patient died of cardiac arrest at 25 months; there were no perioperative deaths (≤ 30 days). The remaining two patients were alive and well at median follow-up of 24 months (range, 4–25 months). Conclusion Endovascular Stent-grafts combined with antibiotic therapy may be an alternative to conventional thoracotomy in managing mycotic aneurysms of the descending thoracic aorta.

Johannes Lammer - One of the best experts on this subject based on the ideXlab platform.

  • Endovascular Stent graft placement of aneurysms involving the descending aorta originating from chronic type b dissections
    The Annals of Thoracic Surgery, 2007
    Co-Authors: Martin Czerny, Daniel Zimpfer, Suzanne Rodler, Roman Gottardi, Maria Schoder, Ernst Weigang, Martin Funovics, Marion Dorfmeister, Gabriel Marta, Johannes Lammer
    Abstract:

    Background The performance of Endovascular Stent-graft placement in patients suffering from aneurysms involving the descending aorta originating from chronic type B dissections is unclear. Methods Within a 2-year period, we treated 6 patients with this pathology. Four patients required extension of the proximal landing zone (autologous double transposition, n=2; subclavian-to-carotid artery transposition, n=2) before Stent-graft placement. Results Supra-aortic rerouting procedures and Endovascular Stent-graft placement were performed successfully in all patients. Closure of the primary entry tear, full expansion of the Stent-graft, and eventually, thrombosis of the false lumen was achieved in 5 patients. In 1 patient with a short proximal landing zone, a persisting type Ia endoleak was observed. In all patients with successful primary entry closure, a reduction in aneurysm diameter occurred. Mean follow-up is 16 months (range, 4 to 25). Conclusions Endovascular Stent-graft placement of aneurysms involving the descending aorta originating from chronic type B dissections may serve as a valuable treatment option in this complex pathology. The chronic dissection membrane can be successfully compressed against large areas of the native aortic wall. A sufficient proximal landing zone is mandatory for early and late success.

  • results after Endovascular Stent graft placement in atherosclerotic aneurysms involving the descending aorta
    The Annals of Thoracic Surgery, 2007
    Co-Authors: Martin Czerny, M Grimm, Johannes Lammer, Ernst Wolner, Daniel Zimpfer, Suzanne Rodler, Roman Gottardi, Doris Hutschala, Maria Schoder
    Abstract:

    Background The purpose of this study was to determine durability and need for reinterventions after Endovascular Stent graft placement in atherosclerotic aneurysms involving the descending aorta. Methods We performed a prospective follow-up analysis of a consecutive series of 79 patients undergoing Endovascular Stent graft placement due to atherosclerotic aneurysms involving the descending aorta between 1996 and 2006. Acute aortic syndromes were excluded from this analysis. Mean follow-up was 42 months (range, 1 to 108 months). Data were collected for in-hospital mortality, occurrence of early and late endoleaks, reintervention due to early and late endoleaks, and survival. Results In-hospital mortality was 6.3% (n = 5). Two of these patients underwent emergent treatment. Early type I and III endoleaks were observed in 29% of patients (n = 23). The assisted primary endoleak rate was 11%. Late type I or III endoleaks occurred in 21% (n = 17). At 1, 3, and 5 years, overall actuarial survival was 96%, 86%, and 69%, and event-free survival was 90%, 82%, and 65%, respectively. Cox proportional hazard analysis revealed that a short proximal landing zone and a high number of Stent grafts used were independent risk factors for early and late endoleak formation. Late endoleak formation was an independent predictor of survival. Conclusions Endovascular Stent graft placement in atherosclerotic aneurysms involving the descending aorta has satisfactory durability. An extensive landing zone is a prerequisite of early and late success. Further clinical investigations are warranted to evaluate long-term durability of this attractive treatment modality.

  • treatment of acute type a dissection by percutaneous Endovascular Stent graft placement
    The Annals of Thoracic Surgery, 2006
    Co-Authors: Daniel Zimpfer, Johannes Lammer, Ernst Wolner, Martin Czerny, Maria Schoder, Joachim Kettenbach, M Grimm
    Abstract:

    Acute type A dissections are a life threatening condition requiring immediate surgical intervention to avoid aortic rupture or pericardial tamponade. Success of surgical intervention is markedly limited in those patients with advanced age, neurological deficits, and multiple co-morbidities at the time of treatment. We report the successful Endovascular Stent-graft treatment in a patient suffering from an acute type A dissection. Due to the presence of multiple comorbidities the patient was considered too high risk for surgical treatment.

  • initial results after combined repair of aortic arch aneurysms by sequential transposition of the supra aortic branches and consecutive Endovascular Stent graft placement
    The Annals of Thoracic Surgery, 2004
    Co-Authors: Martin Czerny, Johannes Lammer, Ernst Wolner, Daniel Zimpfer, Maria Schoder, Tatjana Fleck, Wolfgang Hofmann, Manfred Cejna, Paul Stampfl, Martin Grabenwoger
    Abstract:

    BACKGROUND: To evaluate safety and efficacy of a combined repair of aortic arch aneurysms by sequential transposition of the supra-aortic branches and Endovascular Stent-graft placement. METHODS: Between October 2002 and September 2003, 5 patients (mean age, 79.5 years) presented with aortic arch aneurysms involving the origin of the left carotid artery. Treatment was made by sequential transposition of the left carotid artery into the brachiocephalic trunk and transposition of the left subclavian artery into the already transposed left common carotid artery with consecutive Endovascular Stent-graft placement into the aortic arch. RESULTS: All patients survived both procedures. At completion angiography, a small type 1a endoleak was observed in 1 patient. After 1 week, the patient was readmitted for completion three-dimensional computed tomographic scan. The leak had already occluded spontaneously. Mean follow-up was 10 months (range, 4 to 16 months). At follow-up, all patients had normal computed tomographic scans with regular perfusion of the supra-aortic branches without any signs of endoleaks. CONCLUSIONS: Combined repair of aortic arch aneurysms by sequential transposition of the supra-aortic branches with consecutive Endovascular Stent-graft placement is feasible. Extended application of this technique will enable safe and effective treatment of a highly selected subgroup of patients with aortic aneurysms by avoiding conventional arch aneurysm repair in deep hypothermia and circulatory arrest.

  • secondary surgical interventions after Endovascular Stent grafting of the thoracic aorta
    European Journal of Cardio-Thoracic Surgery, 2004
    Co-Authors: Martin Grabenwoger, Marek Ehrlich, Johannes Lammer, Martin Czerny, Doris Hutschala, Maria Schoder, Tatjana Fleck, Ernst Wolner
    Abstract:

    Objective: The objective of the study was to evaluate mid-term durability and need for reinterventions after Endovascular Stent-grafting (ESG) in descending aortic aneurysms and dissections. Patients and Methods: Between November 1996 and February 2003 a total of 80 patients underwent ESG for the following indications: atherosclerotic aneurysms (50/80; 63%), type B dissections (20/80; 25%), penetrating ulcers (6/80; 8%), traumatic aneurysms (4/80; 5%). Two types of commercially available ESG (Talent, Medtronic, Santa Rosa, CA and Excluder, WL GORE, Flagstaff, AZ) were inserted via the femoral artery in 53 patients, via the iliac artery in 21 patients and via the abdominal aorta in 6 patients. Results: In-hospital mortality was 3.8% ðn ¼ 3Þ: Type I endoleak formation requiring Endovascular reintervention was observed in 3.8% ðn ¼ 3Þ: Surgical reintervention became necessary in 4 patients (4/80; 5%). One patient experienced a retrograde type A dissection, detected in the 3 month control after ESG of an acute type B dissection, consecutively undergoing frozen elephant trunc repair. Three patients with late type I endoleak formation (mean interval: 62 months) after ESG (two atherosclerotic aneurysms, one penetrating ulcer) underwent open thoraco-abdominal repair in deep hypothermia or left heart bypass technique. All patients had an uneventful postoperative course. Conclusions: Occurrence of late endoleak formation requiring surgical reintervention after ESG is acceptably low. In atherosclerotic aneurysms the development of endoleaks is assumed to be causative related to progression of the underlying aortic disease. A close follow-up of patients after ESG is crucial. q 2004 Elsevier B.V. All rights reserved.