The 2019 Charing Cross Symposium (London, UK) featured an Aortic Techniques & Technologies edited live cases session, which aimed to give delegates the opportunity to explore the application of different technologies in complex situations, which are perhaps not suitable for broadcast in a live case.
This year, the session began with the Best of Aortic Live, based in Hamburg, Germany, and the Paris Endovascular Aortic Course of Paris, France, and was chaired by Tilo Kölbel (Hamburg, Germany) and moderated by Heinz Jakob of Essen, Germany.
Stéphan Haulon (Le Plessis-Robinson, France) began proceedings by describing a total endovascular repair in a chronic aortic arch dissection. The procedure he described was carried out at the Centre de l’Aorte, Hôpital Marie Lannelongue, Université Paris Sud, France, as part of the Paris Endovascular Course. Haulon began with an overview of an inner branched arch endograft following ascending open repair with Cook’s A-branch device before showing an edited video of the case. He mentioned that he chose to focus on a case performed in chronic dissection as these patients are the “perfect match” for this new technology because they present an ideal landing zone.
Haulon went on to discuss a recent paper in which he and his colleagues describe findings from 70 patients, all of whom had previously undergone acute type A open repair. The in-hospital combined mortality and stroke rate was 4% (n=3), which included one minor stroke, one major stroke causing death, and one death following multi-organ failure. The technical success rate was 97%. After a mean follow-up of 301 days, 20 patients (29%) underwent secondary interventions, including nine for endoleak correction, and 110 had a distal extension to the thoracic or thoracoabdominal aorta.
He concluded: “Patient selection is key, and those patients with a prior open ascending repair are probably a niche of patients that will highly benefit from this technology.” In addition, he noted: “You have to inform patients that you are going to perform two/three procedures in order to completely exclude the false lumen.” Indeed, “this is not a one-stage procedure”, he said. “These patients had the acute type A open repair and then had an evolution of their false lumen at arch level.”
Later in the session, Tilo Kölbel presented an edited live fenestrated arch repair in a type B aortic dissection case from 2018. He noted that the procedure was carried out in a 73-year-old female who had undergone a lobectomy for lung cancer in 2017, and a transverse colectomy in 1998. She had previously had a type II thoracoabdominal aortic aneurysm (53mm) and her treatment plan was fenestrated endovascular aneurysm repair (fEVAR) followed by three-vessel branched EVAR (bEVAR) for the superior mesenteric artery and the renal arteries. He described that access was through both common femoral artery (Proglide, Abbott) and the left brachial artery, and there was no cerebrospinal fluid drainage. The first step taken was the main body insertion, followed by the snaring of the preloaded wire for the left subclavian artery (LSA), the complete deployment of the main body, bridging stents in the LSA and finally distal endograft.