Periscope endograft technique to revascularize the left subclavian artery during thoracic endovascular aortic repair.

Felice Pecoraro, Felice Pecoraro, Frank J. Veith, Mario Lachat, Thomas Larzon, Zoran Rancic, Frank J. Criado, Thomas Pfammatter, Dieter Mayer

Risultato della ricerca: Articlepeer review

25 Citazioni (Scopus)

Abstract

Purpose: To present early and midterm results of the periscope endograft (PG) techniqueto maintain left subclavian artery (LSA) blood flow in thoracic endovascular aortic repairs(TEVAR) involving zone 3.Methods: From April 2010 to January 2013, 14 consecutive high-risk patients (11 men; meanage 7068 years, range 56–87) underwent TEVAR with the PG technique for 10 thoracic aorticaneurysms (TAA), 2 traumatic aortic ruptures, and 2 aortic dissections without a suitablelanding zone (.2 cm distal to the LSA). Five procedures were performed emergently forrupture (3 TAAs and the 2 trauma cases). Two patients had a periscope deployed in anaberrant right subclavian artery. The periscope endografts were sized 1 to 2 mm larger thanthe branch artery at the intended landing zone. The caudal end was extended distal to theintended distal landing site of the thoracic stent-graft, which was usually deployed after thePG. Both the PG and thoracic stent-grafts were generally molded using the kissing balloontechnique. Outcomes analyzed were immediate technical success, perioperative mortalityand morbidity, aneurysm diameter change, and periscope endograft patency.Results: Immediate technical success was 100%, with all procedures completed as planned.Perioperatively, one periscope occluded and one of the ruptured TAA patients died. Onepercutaneous access site hematoma required only conservative management. At a meanfollow-up of 2669 months (range 9–37), there was no additional PG occlusion. The Kaplan-Meier estimate of PG patency was 93% at 2 years.Conclusion: The periscope endograft is a simple technique to maintain perfusion to theLSA in cases where the aortic stent-graft crosses its ostium. The PG technique can beperformed transfemorally and even percutaneously, and it can be applied to all supraaorticbranches. Early and midterm results are encouraging, but more experience andlong-term results are mandatory before this technique can be widely recommended
Lingua originaleEnglish
pagine (da-a)728-734
Numero di pagine7
RivistaJournal of Endovascular Therapy
Volume20
Stato di pubblicazionePublished - 2013

All Science Journal Classification (ASJC) codes

  • Surgery
  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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