The Experts below are selected from a list of 294 Experts worldwide ranked by ideXlab platform
Blair A Keagy - One of the best experts on this subject based on the ideXlab platform.
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coverage of the left Subclavian Artery during thoracic endovascular aortic repair
Journal of Vascular Surgery, 2008Co-Authors: Paul J Riesenman, Mark A Farber, Robert Mendes, William A Marston, Joseph J Fulton, Blair A KeagyAbstract:Background Thoracic aortic stent grafts require proximal and distal landing zones of adequate length to effectively exclude thoracic aortic lesions. The origins of the left Subclavian Artery and other aortic arch branch vessels often impose limitations on the proximal landing zone, thereby disallowing endovascular repair of more proximal thoracic lesions. Methods Between October 2000 and November 2005, 112 patients received stent grafts to treat lesions involving the thoracic aorta. The proximal aspect of the stent graft partially or totally occluded the origin of at least one great vessel in 28 patients (25%). The proximal attachment site was in zone 0 in one patient (3.6%), zone 1 in three patients (10.7%), and zone 2 in 24 patients (85.7%). Patients with proximal implantation in zones 0 or 1 underwent debranching procedures of the supra-aortic vessels before stent graft repair. In one patient who underwent zone 1 deployment, the left Subclavian Artery was revascularized before stent graft deployment. Among patients who underwent zone 2 deployment with partial or complete occlusion of the left Subclavian Artery, none underwent prior revascularization. Patients were assessed postoperatively and at follow-up for development of neurologic symptoms as well as symptoms of left upper extremity claudication or ischemia. Results Mean follow-up was 7.3 months. Among the 24 patients with zone 2 implantation, 10 (42%) had partial left Subclavian Artery coverage at the time of their primary procedure. A total of 19 patients experienced complete cessation of antegrade flow through the origin of the left Subclavian Artery without revascularization at the time of the initial endograft repair as a result of a secondary procedure or as a consequence of left Subclavian Artery thrombosis. Left upper extremity symptoms developed in three (15.8%) patients that did not warrant intervention, and rest pain developed in one (5.3%), which was treated with the deployment of a left Subclavian Artery stent. Two primary (type IA and type III) endoleaks (7.1%) and one secondary endoleak (type IA) (3.6%) were observed in patients who underwent zone 2 deployment. Three cerebrovascular accidents were observed. Thoracic aortic lesions were successfully excluded in all patients who underwent supra-aortic debranching procedures. Conclusion Intentional coverage of the origin of the left Subclavian Artery to obtain an adequate proximal landing zone during endovascular repair of thoracic aortic lesions is well tolerated and may be managed expectantly, with some exceptions.
Junjiro Kobayashi - One of the best experts on this subject based on the ideXlab platform.
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balloon protection of the left Subclavian Artery in debranching thoracic endovascular aortic repair
The Journal of Thoracic and Cardiovascular Surgery, 2019Co-Authors: Yoshimasa Seike, Hitoshi Matsuda, Yosuke Inoue, Atsushi Omura, Kyokun Uehara, Tetsuya Fukuda, Junjiro KobayashiAbstract:Abstract Objectives Since 2012, we have routinely applied balloon protection of the proximal left Subclavian Artery to prevent embolic events through the left vertebral Artery during debranching thoracic endovascular aortic repair. This study aimed to study the effectiveness of balloon protection of the proximal left Subclavian Artery. Methods We reviewed the medical records of 157 patients who underwent debranching thoracic endovascular aortic repair between 2007 and 2017. Of these, 71 patients for whom balloon protection of the proximal left Subclavian Artery was used were assigned to the balloon protection of the proximal left Subclavian Artery group (58 men; age: 78 ± 6.7 years), and 86 patients were assigned to the control group (66 men; age: 78 ± 8.9 years). A total of 51 patients from each group were matched by their propensity scores to adjust for differences in the patients' characteristics. Results Perioperative stroke was significantly lower in the balloon protection of the proximal left Subclavian Artery group than in the control group (0%: 0/71 vs 7.9%: 7/86, P = .014). Freedom from all causes of mortality at 2 and 4 years was significantly higher in the balloon protection of the proximal left Subclavian Artery group compared with the control group (93%/76% vs 77%/59%, P = .015). Freedom from aortic death at 2 and 4 years was similar in both groups (97%/97% vs 91%/86%, P = .094). Propensity score matching yielded similar results of better freedom from all causes of mortality in the balloon protection of the proximal left Subclavian Artery group (93%/93% vs 81%/63%, P = .017) and equivalent aortic death in both groups (95%/95% vs 92%/88%, P = .30). Conclusions Debranching thoracic endovascular aortic repair using balloon protection of the proximal left Subclavian Artery demonstrated more appropriate early and late outcomes. Evaluation using propensity score matching enhanced the efficacy of balloon protection of the proximal left Subclavian Artery.
Paul J Riesenman - One of the best experts on this subject based on the ideXlab platform.
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coverage of the left Subclavian Artery during thoracic endovascular aortic repair
Journal of Vascular Surgery, 2008Co-Authors: Paul J Riesenman, Mark A Farber, Robert Mendes, William A Marston, Joseph J Fulton, Blair A KeagyAbstract:Background Thoracic aortic stent grafts require proximal and distal landing zones of adequate length to effectively exclude thoracic aortic lesions. The origins of the left Subclavian Artery and other aortic arch branch vessels often impose limitations on the proximal landing zone, thereby disallowing endovascular repair of more proximal thoracic lesions. Methods Between October 2000 and November 2005, 112 patients received stent grafts to treat lesions involving the thoracic aorta. The proximal aspect of the stent graft partially or totally occluded the origin of at least one great vessel in 28 patients (25%). The proximal attachment site was in zone 0 in one patient (3.6%), zone 1 in three patients (10.7%), and zone 2 in 24 patients (85.7%). Patients with proximal implantation in zones 0 or 1 underwent debranching procedures of the supra-aortic vessels before stent graft repair. In one patient who underwent zone 1 deployment, the left Subclavian Artery was revascularized before stent graft deployment. Among patients who underwent zone 2 deployment with partial or complete occlusion of the left Subclavian Artery, none underwent prior revascularization. Patients were assessed postoperatively and at follow-up for development of neurologic symptoms as well as symptoms of left upper extremity claudication or ischemia. Results Mean follow-up was 7.3 months. Among the 24 patients with zone 2 implantation, 10 (42%) had partial left Subclavian Artery coverage at the time of their primary procedure. A total of 19 patients experienced complete cessation of antegrade flow through the origin of the left Subclavian Artery without revascularization at the time of the initial endograft repair as a result of a secondary procedure or as a consequence of left Subclavian Artery thrombosis. Left upper extremity symptoms developed in three (15.8%) patients that did not warrant intervention, and rest pain developed in one (5.3%), which was treated with the deployment of a left Subclavian Artery stent. Two primary (type IA and type III) endoleaks (7.1%) and one secondary endoleak (type IA) (3.6%) were observed in patients who underwent zone 2 deployment. Three cerebrovascular accidents were observed. Thoracic aortic lesions were successfully excluded in all patients who underwent supra-aortic debranching procedures. Conclusion Intentional coverage of the origin of the left Subclavian Artery to obtain an adequate proximal landing zone during endovascular repair of thoracic aortic lesions is well tolerated and may be managed expectantly, with some exceptions.
Yoshimasa Seike - One of the best experts on this subject based on the ideXlab platform.
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balloon protection of the left Subclavian Artery in debranching thoracic endovascular aortic repair
The Journal of Thoracic and Cardiovascular Surgery, 2019Co-Authors: Yoshimasa Seike, Hitoshi Matsuda, Yosuke Inoue, Atsushi Omura, Kyokun Uehara, Tetsuya Fukuda, Junjiro KobayashiAbstract:Abstract Objectives Since 2012, we have routinely applied balloon protection of the proximal left Subclavian Artery to prevent embolic events through the left vertebral Artery during debranching thoracic endovascular aortic repair. This study aimed to study the effectiveness of balloon protection of the proximal left Subclavian Artery. Methods We reviewed the medical records of 157 patients who underwent debranching thoracic endovascular aortic repair between 2007 and 2017. Of these, 71 patients for whom balloon protection of the proximal left Subclavian Artery was used were assigned to the balloon protection of the proximal left Subclavian Artery group (58 men; age: 78 ± 6.7 years), and 86 patients were assigned to the control group (66 men; age: 78 ± 8.9 years). A total of 51 patients from each group were matched by their propensity scores to adjust for differences in the patients' characteristics. Results Perioperative stroke was significantly lower in the balloon protection of the proximal left Subclavian Artery group than in the control group (0%: 0/71 vs 7.9%: 7/86, P = .014). Freedom from all causes of mortality at 2 and 4 years was significantly higher in the balloon protection of the proximal left Subclavian Artery group compared with the control group (93%/76% vs 77%/59%, P = .015). Freedom from aortic death at 2 and 4 years was similar in both groups (97%/97% vs 91%/86%, P = .094). Propensity score matching yielded similar results of better freedom from all causes of mortality in the balloon protection of the proximal left Subclavian Artery group (93%/93% vs 81%/63%, P = .017) and equivalent aortic death in both groups (95%/95% vs 92%/88%, P = .30). Conclusions Debranching thoracic endovascular aortic repair using balloon protection of the proximal left Subclavian Artery demonstrated more appropriate early and late outcomes. Evaluation using propensity score matching enhanced the efficacy of balloon protection of the proximal left Subclavian Artery.
Philippe Noirhomme - One of the best experts on this subject based on the ideXlab platform.
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endovascular treatment of an aneurysmal aberrant right Subclavian Artery
Journal of Endovascular Therapy, 2003Co-Authors: Valerie Lacroix, Parla Astarci, Devaux Philippe, Pierre Goffette, Frank Hammer, Robert Verhelst, Philippe NoirhommeAbstract:PURPOSE: To describe combined endovascular and surgical management of a complex aneurysmal aberrant right Subclavian Artery (RSA). CASE REPORT: A 75-year-old obese man with severe chronic obstructive pulmonary disease was referred for treatment of a 6.8-cm aneurysm of an aberrant right Subclavian Artery. A stent-graft was deployed in the proximal part of the descending aorta to cover the origin of the dilated aberrant RSA, and then a venous carotid-Subclavian bypass was made to restore blood flow in the right arm. In a second stage, the prevertebral segment of the aberrant RSA was embolized to avoid retrograde perfusion of the aneurysm. CONCLUSIONS: Combined endovascular and surgical treatment of an aneurysmal aberrant Subclavian Artery is feasible, safe, and effective. This less invasive approach could be the treatment of choice in high-risk patients.
