Physician modified stent-graft for blunt thoracic aortic injuries: do the benefits worth the trouble? - CNRS - Centre national de la recherche scientifique Accéder directement au contenu
Article Dans Une Revue Annals of Vascular Surgery Année : 2022

Physician modified stent-graft for blunt thoracic aortic injuries: do the benefits worth the trouble?

Résumé

Background: Obtaining a suitable proximal landing zone in blunt thoracic aortic injuries (BTAI) often necessitates coverage of the left subclavian artery (LSA). This study aimed to evaluate the outcomes of physician-modified endovascular grafts (PMEGs) in this indication. Methods: We performed a retrospective analysis of a prospective registry including all patients who had undergone a thoracic endovascular aortic repair (TEVAR) for BTAI from October 2008 to October 2020. Starting in 2015, patients requiring coverage of the LSA were either treated using a physician-modified proximal scalloped or single-fenestrated stent graft. After an early postoperative computed tomography scan, follow-up was performed at 3 months, 6-months, and yearly. Results: Among 58 patients treated with TEVAR for BTAI, 23 (39.6%) patients required a zone 2 landing zone of which 10 (17.2%) patients were treated with PMEGs. The median age was 48 [31–64.5] years, and 78.2% (n = 18) patients were male. The median Injury Severity Score was 38 [27–55.5]. Coverage of the LSA was performed in 25.8% (n = 15) of the total population in which 5 patients had an LSA transposition. The median modification time was 18 [14–27] minutes. Technical success of PMEGs was 90.0% overall and 100% for fenestrated stent grafts. No stroke, paraplegia, or retrograde dissection was observed. The primary patency of the LSA in the PMEGs group was 90 % at 1 year and 28.8 % in the LSA coverage group (P < 0.01). Conclusions: The use of PMEGs is feasible and effective in the management of BTAI with a short proximal landing zone. Further evaluation of long-term outcomes and durability are awaited.
Fichier principal
Vignette du fichier
2022 Lounes et al., Physician.pdf (730.78 Ko) Télécharger le fichier
Origine : Fichiers produits par l'(les) auteur(s)

Dates et versions

hal-03825247 , version 1 (06-07-2023)

Identifiants

Citer

Youcef Lounes, Amin Belarbi, Kheira Hireche, Lucien Chassin-Trubert, Baris Ata Ozdemir, et al.. Physician modified stent-graft for blunt thoracic aortic injuries: do the benefits worth the trouble?. Annals of Vascular Surgery, 2022, 90, pp.100-108. ⟨10.1016/j.avsg.2022.09.054⟩. ⟨hal-03825247⟩
38 Consultations
26 Téléchargements

Altmetric

Partager

Gmail Facebook X LinkedIn More