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Jimmy Wei Hwa Tan, Surg, MD Director, Department of Surgery
Chief , Department of Cardiovascular Surgery
Tainan An-Nan Municipal Hospital , China Medical University, Taiwan
Disclosure
I have the following potential
conflicts of interest to report:
No Conflict of Interest
Total endovascular
treatment of
Complex aortic arch?
Issues for Good outcome
• Good Landing Zone Critical for Good Outcome
• 40% Have Landing Zone Involving Neck Vessels
• Seal and Fixation
Seal and Fixation
• Proximal bare spring – Allows coverage of branches – Provides alignment of the proximal sealing stent
• Hybrid repair Branch devices Chimney /Periscope Technique
In Situ Fenestration
Why Chimney/Periscopes TEVAR
• Off the-Shelf device for emergencies
• Device adaptability
• Low profile device in hostile iliac access compared to F-EVAR
• Lower cost
• Shorter procedure time
Limitation of CPG TEVAR
• Off-label
• > 2 chimneys might increase risk of type Ia endoleak
• Risk of stroke if severe aortic arch calcification
• Long term results to be answered?
1.Case sharing
2.Our data
1.Case sharing
2.Our data
Case 1: Single Chimney
Postop Follow-up at 12M
Case 2: Double Chimney
Postop CTA after 9M
Case 3: Triple Chimney
60 y/o man Residual Type B DAA with rapid progression of arch aneurysm
1.Case sharing
2.Our data
2014.1- 2016.12
Total 76 cases
–Standard: 53 ( Zone 3 )
–Complex: 23 (Zone 0,1,2 )
–Elective: 61
–Emergent: 15
Standard 53 Complex 23
TAA 7 5
PAU 20 6
Acute TBD 5 2
Chronic TBD 14 3
Residual TBD 7 7
TAA 13% 22% PAU 38% 26%
Acute TBD 9% 9% Chronic TBD 26% 13% Residual TBD 13% 30%
Mortality Elective n=61 Emergent n=15
<30days 1 3
1Year (Aneurysm related) 1 0
1Year (non-related) 6 0
<30days 2% 20% 1Year (Aneurysm related)
2% 0%
1Year (Non-related)
10% 0%
Mean Hospitalization days Mean Follow-up
Stand procedure =53 9.85 482.8
Complex procedure=23 13.4 329.3
Morbidity and Mortality
• 3/23( 13%) in CPG TEVAR , 0% in Standrad TEVAR
• 1 Temporary paraparesis , recovered in 6M
• 1 Aspiration pneumonia , expired at POD 7
• 1 Respiratory failure, refused tracheostomy acute ICH at POD 31 ,refused surgery and exp at POD 33
• 1 OHCA at POD 17 , cardiac-related
Elective n=61 Emergent n=15
30day exp 1 3
1Year (Aneurysm related) 1 0
1Year (non-related) 6 0
30day exp 2% 20%
1Year (Aneurysm related) 2% 0%
1Year (non-related) 10% 0%
Mean Hospitalization days Mean Follow-up days
Stand procedure =53 9.85 482.8
Complex procedure=23 13.4 329.3
Endoleaks and Outcome
Endoleaks Standard Complex
Type Ia 1 3
Delay Ia 1 1
Delay Ib 1 0
3/9(30%) Zone 0 CPG TEVAR with 1 patient
received surgical repair at postop 2 yr
Comparing other series
Conclusions
• Chimney and Periscope grafts have promising mid-term results for total endovascular treatment of complex aortic arch disease in our series.
• Long term results still need to be followed.
Jimmy Wei Hwa Tan, Surg, MD Director, Department of Surgery
Chief , Department of Cardiovascular Surgery
Tainan An-Nan Municipal Hospital , China Medical University, Taiwan
