The University of Osaka · Medicine
Professor Tomoaki Kudo's research lab specializes in endovascular and hybrid surgical interventions for aortic arch pathologies, with a primary focus on optimizing thoracic endovascular aortic repair (TEVAR) outcomes. The lab investigates proximal landing zone selection to prevent complications such as type 1a endoleak and bird-beak deformity, emphasizing precise preoperative imaging and patient-specific stent graft design. A key research direction involves minimizing postoperative stroke through rigorous atheroma evaluation and innovative techniques like hypoxic preconditioning of peripheral blood mononuclear cells to enhance therapeutic angiogenesis in limb ischemia. The lab also explores the feasibility and long-term safety of total endovascular aortic arch repair using custom-made branched endografts in high-risk surgical candidates.
Figures are computed from collected data and may differ slightly.
Appropriate stent grafts need to be chosen carefully to prevent Type 1a endoleak and bird-beak configuration after landing Zone 1 and 2 TEVAR. Patients with bird-beak configuration on early postoperative multidetector computed tomography require closer follow-up to screen for Type 1a endoleak.
We achieved satisfactory early and midterm results by using a Bolton branched endograft for high-risk patients with arch pathologies except for high postoperative stroke. Although this treatment method is associated with postoperative stroke, performing strict evaluation of atheroma may prevent such complication. By preventing intraoperative stroke, TEVAR with this custom-made Bolton branched endograft may be considered a less-invasive treatment.
<b>Purpose:</b> To identify the optimal proximal landing zone for thoracic aortic endovascular repair (TEVAR) of aortic arch pathologies so as to avoid the bird-beak phenomenon that leads to type Ia endoleak. <b>Materials and Methods:</b> A retrospective single-center review was conducted of 164 patients (mean age 70.3±10.8 years, range 29-93; 127 men) who underwent repairs of the aortic arch using hybrid TEVAR from April 2008 to March 2017. The patients were divided into 2 groups according to t
Satisfactory early and long-term results of a hybrid TEVAR with a zone 0 landing were achieved using our treatment strategy. When performing hybrid TEVAR in zone 0, postoperative aortic events may be reduced by accurate preoperative assessment of the ascending aorta.
Total endovascular aortic arch repair using bTEVAR and cTEVAR is feasible for the treatment of aortic arch diseases in high-risk patients who are unsuitable for open surgery. However, as the rate of stroke is high, strict preoperative evaluation to prevent stroke is needed. No rupture of the aneurysm was observed in cTEVAR, but patients should be selected carefully because of the high incidence of type 1a endoleak.
Transplantation of peripheral blood mononuclear cells (PBMNCs) is a promising therapeutic approach for the treatment of hindlimb ischemia. However, insufficient angiogenesis in ischemic hindlimb after cell transplantation reduces the importance and practicality of this approach. Previously, we demonstrated using mouse models that hypoxic preconditioning augmented the cellular functions of rodent PBMNCs, such as increased cell adhesion capacity and accelerated neovascularization in ischemic hindl
This study aimed to clarify the effectiveness and expand the possibilities of zones 1 and 2 landing TEVAR for type B aortic dissection (TBAD) using our treatment strategy. Satisfactory early and long-term results in the TBAD and thoracic arch aneurysm (TAA) groups were obtained with zones 1 and 2 landing TEVAR. The TBAD cases had the same good results as the TAA cases. Using our strategy, we especially might reduce complications and be an effective treatment for acute complicated TBAD.
It is essential to prevent type 1a endoleak, the most severe complication of hybrid TEVAR. The risk factor for type 1a endoleak in this study was a sharper angle of the aortic arch (≤95°). For patients at high risk of type 1a endoleak, it is necessary to consider alternative procedures depending on a patient's surgical risk.
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