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Thorac Cardiovasc Surg 2022; 70(04): 314-322
DOI: 10.1055/s-0040-1722732
Original Cardiovascular

TEVAR Following FET: Current Outcomes of Rendezvous Procedures in Clinical Practice

Katrin Meisenbacher‡   *
1   Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Heidelberg, Baden-Württemberg, Germany
,
Anja Osswald‡   *
2   Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Baden-Württemberg, Germany
,
Moritz Sebastian Bischoff
1   Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Heidelberg, Baden-Württemberg, Germany
,
Dittmar Böckler
1   Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Heidelberg, Baden-Württemberg, Germany
,
Matthias Karck
2   Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Baden-Württemberg, Germany
,
Arjang Ruhparwar
2   Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Baden-Württemberg, Germany
,
Philipp Geisbüsch
1   Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Heidelberg, Baden-Württemberg, Germany
› Author Affiliations Funding Philipp Geisbüsch has received speaker honoraria and travel grants from WL Gore & Associates, Medtronic, and Abbott. Dittmar Böckler is a consultant for WL Gore & Associates, Siemens AG, and Medtronic and has received educational and research grants, speaker honoraria from WL Gore & Associates, Medtronic, and Siemens. Moritz S. Bischoff has received speaker honoraria from W.L. Gore & Associates. All other authors state that there is no conflict of interest to declare. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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Abstract

Background The treatment of extensive thoracic/thoracoabdominal aortic pathologies with arch involvement remains a challenging task in aortic surgery. The introduction of the frozen elephant trunk (FET) technique offered a link between open surgery and thoracic endovascular aortic repair (TEVAR). Despite a decade of experience, data on the complementary use of these techniques are scant. The aim of this study was to evaluate TEVAR following FET in clinical reality.

Methods Between November 2006 and June 2018, 20 patients (9 females; median age of 69 years) underwent endovascular second-stage completion after FET. The clinical outcomes, technical feasibility, and morphological findings were analyzed retrospectively.

Results Eleven of the 20 interventions were intended “rendezvous procedures” in a multistage approach; 4 were elective reinterventions, and 5 were emergency complication repairs. The median interval between FET and TEVAR was 231 days (11 days–7.4 years). The technical success rate was 100%. During a median follow-up (FU) period of 58.3 months, the overall survival rate was 95%, with one in-hospital death. Neurological complications occurred in three cases (spinal cord injury: n = 1; stroke: n = 2). Computed tomography angiography showed overall regression in the median diameter of the proximal descending aorta (from 57 to 48.5 mm).

Conclusion TEVAR as a second-stage intervention after FET is a feasible option, with satisfactory results at medium-term FU. In extensive thoracoabdominal aortic disease without proximal landing zones, the complementary use of both techniques in a multistage approach should be considered.

Keywords

thoracic endovascular aortic repair - frozen elephant trunk - TEVAR - FET - thoracoabdominal aortic disease - reintervention - outcome

* Both authors contributed equally to this work.




Publication History

Received: 08 August 2020

Accepted: 07 December 2020

Article published online:
12 February 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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