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Zhang Z, Feng H, Chen X, Li W. Ortner's syndrome secondary to thoracic aortic aneurysm: a case series. J Cardiothorac Surg 2022; 17:270. [PMID: 36266693 PMCID: PMC9583463 DOI: 10.1186/s13019-022-02023-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 10/14/2022] [Indexed: 11/23/2022] Open
Abstract
Background Ortner’s syndrome refers to vocal cord paralysis resulting from compression of the left recurrent laryngeal nerve by abnormal mediastinal vascular structures. This retrospective case series details our experience with Ortner’s syndrome due to thoracic aortic aneurysm. Methods This study was a retrospective analysis of a case series. A total of 4 patients (mean age, 65.5 years) with Ortner’s syndrome due to thoracic aortic aneurysm underwent thoracic endovascular aortic repair from July 2014 to May 2020. The patients’ demographics, comorbidities, initial symptoms, time from hoarseness to treatment, aneurysm shape and size, surgical procedures and outcome are summarized. Results A total of 4 patients with Ortner’s syndrome due to thoracic aortic aneurysm were analyzed. All the patients underwent thoracic endovascular aortic repair with no complications during the hospitalization period. At a mean follow-up of 26.8 (8–77) months, hoarseness in 3 patients had completely resolved or improved, and the symptoms in 1 patient had not progressed. Conclusions Hoarseness due to left recurrent laryngeal nerve palsy can be the presenting symptom of thoracic aortic aneurysm. Early diagnosis leads to timely treatment of these patients which may be helpful in the functional recovery of symptoms.
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Daimon M, Shimada R, Motohashi Y, Uchida H, Ozawa H, Katsumata T. Distal aortic replacement followed by endovascular repair for the management of severe intra-pleural adhesions accidentally detected during open surgery for chronic type B aortic dissection: a report of two cases. J Cardiothorac Surg 2022; 17:262. [PMID: 36209105 PMCID: PMC9547374 DOI: 10.1186/s13019-022-02002-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Open repair is the most promising curative treatment option for patients with chronic type B aortic dissection. However, based on our experience, following the accidental detection of intra-pleural adhesions during open surgery for chronic type B aortic dissection, complete replacement of the diseased aorta cannot be accomplished. To overcome this problem, we switched the procedure to create a distal landing zone for subsequent endovascular repair by replacing the distal aorta with a vascular graft. CASE PRESENTATION We report two cases in which open repair was attempted; however, the proximal descending thoracic aorta could not be exposed due to the presence of severe adhesion in the pleural cavity. In these patients, we accessed the lower descending thoracic aorta or thoracoabdominal aorta and created a distal landing zone for subsequent endovascular repair by replacing the aorta with a vascular graft. Thereafter, endovascular repair was performed with good outcomes. CONCLUSIONS Replacement of the distal aorta, which is typically easy to access despite the presence of intra-pleural adhesions, with a vascular graft serves as a reliable distal landing zone for subsequent endovascular repair. This method may be a viable option for the management of severe adhesions accidentally detected in the pleural cavity during open repair for chronic type B aortic dissection.
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Howard C, Acharya M, Surkhi AO, Mariscalco G. From The RELAY® Family - A Story of Single Branched International Outcomes. Ann Vasc Surg 2022:S0890-5096(22)00575-1. [PMID: 36179943 DOI: 10.1016/j.avsg.2022.09.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Advances in surgery over the last few decades has led to the development and widespread utilisation of thoracic endovascular aortic repair (TEVAR). TEVAR, due to its minimally invasive nature and potential superior outcomes, is now becoming a key focus of interest in treating pathologies of the aortic arch, which has traditionally been treated with open surgical repair (OSR). We present our findings of our international multi-centre dataset documenting the efficacy of the single-branched RELAY™ endograft in terms of technical success, post-operative outcomes, and reintervention rates. METHODS Prospective data was collected and retrospectively analysed with descriptive and distributive analysis between January 2019 and January 2022 from 17 patients treated with RELAY™ single-branched endoprostheses from centres across Europe. Follow up data from 30 days and 6-, 12-, and 24 months postoperatively was included. Patient follow up was evaluated in terms of post-operative outcomes, target vessel patency and reintervention rates. RESULTS Technical success was achieved in all 17 patients (100%) and there were no postoperative disabling or non-disabling strokes in our single-branched RELAY™ cohort. The target vessel patency remained 100% during the first 30 days post-operatively, however, by the end of the follow-up period (24 months), target vessel patency was achieved in 93.7% of the patients. There were no reinterventions or deaths during the full study duration using the single-branched RELAY™ stent-graft. CONCLUSION These results with the single branched RELAY™ stent graft demonstrate favourable outcomes in comparison to the literature and demonstrate the feasibility of treatment of aortic pathology with this single-branched graft in the future. Further studies with larger patient cohorts will help us to accumulate evidence for the feasibility of the single branched RELAY™ stent graft for aortic arch surgery in the future.
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Seike Y, Fukuda T, Yokawa K, Koizumi S, Masada K, Inoue Y, Matsuda H. Aggressive use of prophylactic cerebrospinal fluid drainage to prevent spinal cord ischemia during thoracic endovascular aortic repair is not supportive. Eur J Cardiothorac Surg 2022; 62:6692307. [PMID: 36063039 DOI: 10.1093/ejcts/ezac441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/18/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE We investigated whether prophylactic preoperative cerebrospinal fluid drainage was effective in preventing spinal cord ischaemia during thoracic endovascular aortic repair for degenerative descending thoracic aortic aneurysm, excluding dissecting aneurysms. METHODS We retrospectively reviewed medical records of the patients who underwent thoracic endovascular aortic repair with proximal landing zones 3 and 4 for between 2009 and 2020. RESULTS Eighty-nine patients with preemptive cerebrospinal fluid drainage (68 men; median [range] age, 76.0 [71.0-81.0] years) and 115 patients without cerebrospinal fluid drainage (89 men; median [range] age, 77.0 [74.0-81.5] years) were included in this study. Among them, 59 from each group were matched based on propensity scores to regulate for differences in backgrounds. The incidence rate of spinal cord ischaemia was similar: 8/89 (9.0%) in the cerebrospinal fluid drainage group and 6/115 (5.2%) in the non-cerebrospinal fluid drainage group (p = 0.403). Shaggy aorta (odds ratio, 5.13; p = 0.004) and iliac artery access (odds ratio, 5.04; p = 0.005) were identified as positive predictors of spinal cord ischaemia. Other clinically important confounders included Adamkiewicz artery coverage (odds ratio, 2.53; p = 0.108) and extensive stent graft coverage (>8 vertebrae) (odds ratio, 1.41; p = 0.541) were not statistically significant. Propensity scores matching yielded similar incidence of spinal cord ischaemia: 4/59 (6.8%) in the cerebrospinal fluid drainage group and 3/59 (5.1%) in the non-cerebrospinal fluid drainage group (p = 0.697). CONCLUSIONS Aggressive use of prophylactic cerebrospinal fluid drainage was not supportive in patients without complex risks of spinal cord ischaemia.
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Kyuchukov D, Simeonov P, Nachev G, Alexieva M, Yankov G. A rare case of posttraumatic aortic rupture, treated with an endovascular stent graft implantation and complicated with esophageal rupture. J Cardiothorac Surg 2022; 17:199. [PMID: 35999551 PMCID: PMC9400209 DOI: 10.1186/s13019-022-01955-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 08/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Esophageal necrosis and perforation after thoracic endovascular aortic repair (TEVAR) for ruptured traumatic aortic aneurysm is extremely rare. It is difficult to manage, and patients rarely survive without treatment. Although, there is no certain consensus in relation with the optimal treatment we present a subsequent successful management of both life-threatening conditions. CASE PRESENTATION A 52-year-old man experienced a blunt chest trauma after motor vehicle collision with mild symptoms of pain and fractured ribs. On the 12th day he had severe chest pain and computed tomography (CT) revealed a ruptured traumatic thoracic aortic aneurysm with massive mediastinal hematoma. An emergency thoracic endovascular aortic repair (TEVAR) was performed. Several days later the patient developed a fever. CT suspected a pneumomediastinum, a sign of esophageal rupture, but no confirmation from esophagography and esophagoscopy was achieved. Because of deteriorated septic condition, patient was referred for exploratory thoracotomy. The rupture was found and esophagectomy was performed, with an esophagostomy and gastrostomy to enable enteral nutrition. Almost one year after the esophagectomy, gastric conduit reconstruction through the retrosternal route was performed. The patient was still alive and symptom-free more than 1 year after the reconstruction and no infection of the stent graft was observed. CONCLUSION We successfully managed a rare case of esophageal necrosis after TEVAR for ruptured traumatic thoracic aortic aneurysm. It is essential to diagnose the esophageal necrosis at an early stage and provide appropriate treatment to increase survival.
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Liu H, Liu Y, Lai J. Management of disseminated intravascular coagulation after thoracic endovascular aortic repair of type B aortic dissection: a case report. BMC Cardiovasc Disord 2022; 22:323. [PMID: 35850643 PMCID: PMC9295365 DOI: 10.1186/s12872-022-02768-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 07/14/2022] [Indexed: 12/03/2022] Open
Abstract
Background Disseminated intravascular coagulation (DIC) is a critical and rare complication after thoracic endovascular aortic repair (TEVAR) of type B aortic dissection. The optimal treatment of aortic dissection-related DIC remains controversial. Case presentation We herein describe the successful management of a 65-year-old man who presented with gingival bleeding and multiple subcutaneous petechiae and was proven to have DIC after TEVAR of aortic dissection. The patient had initially been discharged with improved laboratory tests after anticoagulation treatment followed by oral rivaroxaban for maintenance. However, he was readmitted with recurrent gingival bleeding 17 days later. The DIC was successfully controlled with a combination of anticoagulation and antifibrinolytics. After the patient was discharged, his treatment was switched to oral tranexamic acid and warfarin for maintenance. During a 15-month follow-up, the patient had no recurrence of hemorrhage symptoms and maintained stable coagulative and fibrinolytic parameters. Conclusions Aortic dissection-related DIC requires long-term management under conservative treatment. The combination of warfarin and tranexamic acid may be a feasible method for long-term maintenance therapy.
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高 永, 姜 伟, 杨 燕, 张 振, 金 凤, 董 跃, 王 大, 魏 玉. [Risk Factor Analysis of Abdominal Aortic Enlargement after Thoracic Endovascular Aortic Repair Using Two-Stent Graft Implantation for Stanford Type B Aortic Dissection]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2022; 53:682-687. [PMID: 35871741 PMCID: PMC10409447 DOI: 10.12182/20220760201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Indexed: 06/15/2023]
Abstract
Objective To explore the risk factors of abdominal aortic enlargement (AAE) after thoracic endovascular aortic repair using two-stent graft implantation (TEVAR-TSI) for Stanford type B aortic dissection. Methods The clinical and imaging data of patients who underwent TEVAR-TSI for Stanford type B aortic dissection in the First Affiliated Hospital of Hebei North University from January 2013 through September 2020 were retrospectively collected and analyzed. CT angiography (CTA) scans were performed before the procedure. Follow-up CTA scans were scheduled and performed in 1, 3, 6, and 12 months after the procedure and annually thereafter. The primary outcome was AAE. The risk factors of AAE after TEVAR-TSI were selected and survival analysis and multivariate logistic regression were conducted accordingly. Results A total of 146 patients were regularly followed up at our hospital, with the median followup time of the entire cohort being 48 months (ranging from 12 to 84 months). During the followup period after TEVAR-TSI, the incidence of AAE was 19.9% (29/146). A total of 29 patients developed AAE (the AAE group), while 117 patients did not develop AAE (the non-AAE group). There were a total of 27 deaths, including 13 in the non-AAE group versus 14 in the AAE group. Distal aortic reoperation was performed on 10 patients, including 4 in the non-AAE group versus 6 in the AAE group. The cumulative long-term survival and freedom from distal aortic reoperation of the non-AAE group were both significantly better those of the AAE group ( P<0.05). Logistic multivariate regression analysis showed that independent risk factors of AAE after TEVAR-TSI included the following, partial thrombosis of the false lumen (odds ratio [ OR]=4.090, 95% confidence interval [ CI]: 1.539-10.867, P=0.005), the longer cumulative diameter of residual intimal tear above the level of the lowest renal arteries ( OR=1.290, 95% CI: 1.164-1.429, P=0.000), and shorter cumulative diameter of residual intimal tear below the level of the lowest renal arteries ( OR=0.487, 95% CI: 0.270-0.878, P=0.017). Conclusion The prognosis of patients who developed AAE after TEVAR-TSI was not good. During followup visits, as precautions against the development of AAE, close attention should be paid to partial thrombosis of the false lumen, cumulative diameter of residual intimal tear above the level of the lowest renal arteries, and cumulative diameter of residual intimal tear below the level of the lowest renal arteries.
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Burbelko M, Wagner HJ, Mahnken AH. [Chronic type B aortic dissection-what to do?]. RADIOLOGIE (HEIDELBERG, GERMANY) 2022; 62:556-562. [PMID: 35737001 DOI: 10.1007/s00117-022-01022-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/24/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Chronic type B aortic dissection requires optimal medical therapy. However, secondary complications like organ or extremity malperfusion or development of aneurysmal dilatation require interventional therapy. OBJECTIVES Presentation of different endovascular treatment options for complications of chronic type B aortic dissection. MATERIALS AND METHODS Analysis of current literature with regard to indications, techniques, results, and differential indications of interventional techniques for the treatment of chronic type B aortic dissection complications. RESULTS Endovascular implantation of an aortic stent graft is interventional standard therapy for treatment of aneurysmal dilatation of the aorta following type B dissection. Technical problems are the proximal and distal landing zones and the treatment of persistent flow in the false lumen. CONCLUSION Endovascular treatment of chronic complicated type B aortic dissection is increasingly used compared to open surgical treatment because not only are more complex stent grafts (fenestrated and branched devices) available but also because of newly developed techniques for effective occlusion of flow in the false lumen (e.g., candy plug).
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Aortic remodeling after endovascular aortic repair and tailored distal entry tears exclusion in Crawford type III or IV dissection aneurysm. J Formos Med Assoc 2022; 121:2520-2526. [PMID: 35717417 DOI: 10.1016/j.jfma.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 05/23/2022] [Accepted: 06/01/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Thoracic endovascular aortic repair (TEVAR) can only promote 55-80% false lumen (FL) thrombosis when only the proximal primary tear is covered during the repair of type B aortic dissection (TBAD). This study evaluated the effectiveness and clinical outcome of tailored exclusion of the primary entry tear with TEVAR and distal fenestrations with ancillary devices in patients with subacute or chronic Crawford type III and IV aortic dissection aneurysm. METHODS All patients underwent either TEVAR for primary entry tear; subsequently, various ancillary devices were applied on each distal fenestration. These techniques included covered stent occlusion of detached visceral artery entry tears, TL stenting and FL occlusion with vascular plugs in the common iliac artery dissection, or TEVAR coverage for multiple fenestrations from segmental arteries. This case series included nine patients (seven men and two women; mean age: 63.4 years) during January 2013 to May 2019. Outcome analysis included the rates of technical success and procedure-related complications, completeness of FL occlusion, aortic remodeling, and midterm mortality at 2 years. RESULTS The mean follow-up duration was 37.7 months without in-hospital mortality. One patient was lost to follow-up at the second month, the rest of patients were all alive during the follow-up period. All patients achieved complete FL thrombosis, and six patients exhibited aneurysm diameter shrinkage. CONCLUSION Tailored exclusion of visceral and iliac distal fenestrations with proximal primary tear coverage can promote FL thrombosis and aortic remodeling in the visceral aortic segment in patients with Crawford type III or IV aortic dissection aneurysm.
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Benk J, Siepe M, Berger T, Beyersdorf F, Kondov S, Rylski B, Czerny M, Kreibich M. Early and mid-term outcomes of thoracic endovascular aortic repair to treat aortic rupture in patients with aneurysms, dissections and trauma. Interact Cardiovasc Thorac Surg 2022; 35:ivac042. [PMID: 35167665 PMCID: PMC9714596 DOI: 10.1093/icvts/ivac042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/27/2022] [Accepted: 01/31/2022] [Indexed: 09/10/2023] Open
Abstract
OBJECTIVES The aim of this study was to analyse outcomes of thoracic endovascular aortic repair to treat aortic rupture. METHODS Patient and outcome characteristics of all emergent endovascular treatments for thoracic aortic rupture between January 2009 and December 2019 were analysed. RESULTS Thoracic aortic rupture occurred in patients with aortic aneurysms (n = 42, 49%), aortic dissection (n = 13, 16%) or after trauma (n = 30, 35%). Preoperative cerebrospinal fluid drainage was placed in 9 patients (11%) and 18 patients (21%) underwent perioperative supra-aortic transposition. The proximal landing zones were: zone 1 (n = 1, 1%), zone 2 (n = 23, 27%), zone 3 (n = 52, 61%) and zone 4 (n = 9, 11%). Temporary spinal cord injury occurred in 1 patient (1%), permanent spinal cord injury in 7 patients (8%). Two patients (2%) experienced a postoperative stroke. Seventeen patients (20%) expired in-hospital. Aortic dissection (odds ratio: 16.246, p = 0.001), aneurysm (odds ratio: 9.090, P = 0.003) and preoperative shock (odds ratio: 4.646, P < 0.001) were predictive for mortality. Eighteen patients (21%) required a stent-graft-related aortic reintervention for symptomatic supra-aortic malperfusion (n = 3, 4%), endoleaks (n = 6, 7%), a second aortic rupture (n = 4, 5%), retrograde type A aortic dissection (n = 2, 2%), aortic-oesophageal fistulation (n = 2, 2%) and stent-graft kinking (n = 1, 1%). CONCLUSIONS Thoracic endovascular aortic repair in patients with aortic rupture has become a valuable treatment modality to stabilize patients. However, a significant risk of postoperative morbidity and mortality remains, particularly in patients with aortic dissections, aneurysms or shock. Patients require thorough follow-up ideally in an aortic clinic with a staff having the entire spectrum of cardiovascular and thoracic surgical expertise.
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Zhong XQ, Li GX. Successful management of life-threatening aortoesophageal fistula: A case report and review of the literature. World J Clin Cases 2022; 10:3814-3821. [PMID: 35647167 PMCID: PMC9100730 DOI: 10.12998/wjcc.v10.i12.3814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/30/2021] [Accepted: 03/06/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Aortoesophageal fistula (AEF) is a rare but life-threatening cause of upper gastrointestinal bleeding. Only a handful of cases of successful management of AEF caused by esophageal cancer have been reported. The purpose of this study is to report a case of AEF managed by endovascular aortic repair and review the relevant literature.
CASE SUMMARY A 66-year-old man with upper gastroenterology bleeding presented at the Emergency Department of our hospital complaining of chest pain, fever and hematemesis for 6 h. He had vomited 400 mL of bright-red blood and experienced severe chest pain 6 h prior. He had a past medical history of advanced esophageal cancer. He received chemoradiotherapy but stopped 8 mo prior because of intolerance. A chest contrast computed tomographic scan revealed communication between the esophagus and the descending aorta as well as a descending aortic pseudoaneurysm. According to the symptoms and imaging findings, AEF was our primary consideration. The patient underwent aortic angiography, which indicated AEF and descending aortic pseudoaneurysm. Emergency percutaneous thoracic endovascular aortic repair (TEVAR) of the descending aorta was performed, and bleeding was controlled after TEVAR. He received antibiotics and was discharged after treatment. However, he died 2 mo after the TEVAR due to cancer progression.
CONCLUSION Although AEF is a lethal condition, timely diagnosis and TEVAR may successfully control bleeding.
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Nomura Y, Koide Y, Kawasaki R, Murakami H. Endovascular Repair for Ascending Aortic Graft Side Branch Pseudoaneurysm: A Report of Two Cases. EJVES Vasc Forum 2022; 55:48-51. [PMID: 35515008 PMCID: PMC9062449 DOI: 10.1016/j.ejvsvf.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 03/13/2022] [Accepted: 03/28/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction A pseudoaneurysm arising from the side branch of the prosthesis, following ascending aortic replacement, is extremely rare. Re-intervention usually involves open surgery, replacement of the ascending aorta, or ligation of the side branch. Redo surgery with an additional sternotomy carries the risk of cardiac and vascular injuries, and endovascular treatment can reduce such adverse events. Report This study describes the successful thoracic endovascular aortic repair (TEVAR) of two cases of pseudoaneurysms arising from the side branch after ascending aortic replacement. Case 1 involved a 79 year old man who underwent ascending aortic replacement and omentopexy for a ruptured tuberculous aortic aneurysm 13 years ago. The pseudoaneurysm was mushroom shaped with a 30 mm protrusion. Case 2 involved an 83 year old man who underwent ascending aortic replacement for Stanford type A acute aortic dissection 11 years ago. The pseudoaneurysm was rod shaped with a 27 mm protrusion. In both cases, the pseudoaneurysm arising from the side branch was not noted on computed tomography (CT) until one year earlier and was first identified at a routine follow up examination. The pseudoaneurysms required surgical repair because of the risk of rupture; however, TEVAR was selected considering the risks of redo surgery and the patients' ages. It was performed via a femoral artery approach without adverse events using a commercially available thoracic aortic device. Post-operative CT scan showed complete exclusion of the pseudoaneurysm. Discussion Although TEVAR is usually not indicated for ascending aortic pathologies, if there is an anatomical indication and a compatible stent graft, TEVAR for the ascending aorta should be the first choice in patients who are inoperable, at high risk and undergoing redo surgery.
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Morimura F, Hamamoto K, Edo H, Ishida O, Tsustsumi K, Tamada S, Kuwamura H, Enjoji Y, Suyama Y, Sugiura H, Watanabe S, Ozaki I, Shinmoto H. Treatment of massive hemoptysis after thoracic aortic aneurysm repair. CVIR Endovasc 2022; 5:17. [PMID: 35290529 PMCID: PMC8924344 DOI: 10.1186/s42155-022-00293-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background Massive hemoptysis after thoracic aortic aneurysm (TAA) repair is a rare but potentially lethal condition. Endovascular management is a challenging treatment option due to the complexity of culprit vessel access. Case presentation An 81-year-old woman was referred to our hospital with massive hemoptysis. She had a history of graft replacement and thoracic endovascular aortic repair (TEVAR) for dissecting TAA. Computed tomography (CT) showed massive atelectasis with hematoma in the left lower lung lobe adjacent to the descending aortic aneurysm treated with TEVAR. Contrast-enhanced CT revealed a pseudoaneurysm and proliferation of abnormal vessels at the peripheral side of the left pulmonary ligament artery (PLA) in the atelectasis. The PLA continued to the right subscapular artery via a complex collateral pathway. Diagnostic angiography of the right subcapsular artery revealed a pseudoaneurysm and abnormal vessels at the peripheral side of the left PLA with a systemic-pulmonary artery shunt. Transcatheter arterial embolization (TAE) for the left PLA via the collateral pathway with N-butyl cyanoacrylate achieved complete embolization. The patient’s hemoptysis was controlled and she was discharged. Conclusions Here we presented a case of massive hemoptysis due to PLA disruption that occurred after TAA repair. TAE via a complex collateral pathway is a feasible and effective treatment for hemoptysis, even in patients who have undergone surgical or endovascular TAA repair.
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Al-Thani H, Hakim S, Asim M, Basharat K, El-Menyar A. Patterns, management options and outcome of blunt thoracic aortic injuries: a 20-year experience from a Tertiary Care Hospital. Eur J Trauma Emerg Surg 2022; 48:4079-4091. [PMID: 35286404 PMCID: PMC9532277 DOI: 10.1007/s00068-022-01930-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/20/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Blunt Thoracic aortic injury (BTAI) is the second leading cause of mortality after head injuries in blunt trauma patients. There is a paucity of information on the presentation, management and outcome of BTAIs from the Middle Eastern region. We explored the patterns, management options and outcomes of BTAIs in a level I trauma center. METHODS We conducted a retrospective observational study on all adult patients who were admitted with BTAIs between 2000 and 2020. Patients were compared for the management option (conservative vs endovascular aortic repair (TEVAR) vs open surgery) and outcomes. Comparison between the respective groups was performed using one-way analysis of variance for continuous variables, and Pearson chi-square test for categorical variables. Kaplan-Meier curve and Cox regression analysis were performed for the outcome. RESULTS Eighty-seven patients had BTAI (82% male) with mean age 37.3 ± 14.5 years. The mean injury severity score was 30 ± 10 and the aortic injury grade was III (I-IV). Grade III (41.4%) and Grade IV (33.3%) injuries were more common followed by Grade II (13.8%) and Grade I (11.5%). Forty percent of cases were treated conservatively whereas aortic interventions were performed in 60% of cases (n = 52). The TEVAR was performed in 33 patients (63.5%), and 19 (36.5%) were treated with open surgery (14 with graft interposition and 5 with clamp and direct repair). The aortic injury grade was significantly higher in the intervention groups as compared to the conservative group (p = 0.001). Patients with Grade IV injuries were more likely to be treated by open repair whereas a higher frequency of patients with grade III was managed by TEVAR (p = 0.001). All the patients with Grade I-II were treated conservatively. The overall in-hospital mortality rate was 25.3% and it was significantly higher in the conservative group (40.0%) in comparison to the open repair (31.6%) and TEVAR (6.1%) group (P = 0.004). More of the non-survivors sustained head injuries (P = 0.004), had higher ISS (P = 0.001) and greater aortic injury grades (P = 0.002), and were treated non-operatively (P = 0.001). CONCLUSIONS BTAI seems not common in trauma, however, one quarter of cases died in a level 1 trauma center, prehospital deaths were not analyzed, and postmortem examination was lacking. The associated head injury and aortic injury grade have an impact on the management option and hospital outcome. The conservative and TEVAR options were performed almost equally in 78% of cases. TEVAR and open surgery were performed only for aortic injury grade III or IV whereas the conservative treatment was offered for selected cases among the 4 injury grades. However, the mortality was higher in the conservative followed by the open surgery group and mostly due to the associated severe head injury. TEVAR should be considered for patients requiring intervention unless contraindicated due to technical difficulties. Appropriately selected patients with low-grade injuries may be managed conservatively. Long-term follow-up is needed in young adults for concerns of aortic remodeling and complications.
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Wang ZW, Qiao ZT, Li MX, Bai HL, Liu YF, Bai T. Antegrade in situ laser fenestration of aortic stent graft during endovascular aortic repair: A case report. World J Clin Cases 2022; 10:1401-1409. [PMID: 35211576 PMCID: PMC8855181 DOI: 10.12998/wjcc.v10.i4.1401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/06/2021] [Accepted: 12/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The endovascular repair of juxtarenal abdominal aortic aneurysms (JAAA) usually requires combination treatment with various stent graft modifications to preserve side branch patency. As a feasible technique, according to the situation, antegrade in situ laser fenestration still needs to be improved.
CASE SUMMARY This report describes a case that was successfully treated with endovascular repair facilitated by antegrade in situ laser fenestration while maintaining renal arterial flow. Laser fenestration was performed using a steerable sheath positioned in the stent graft lumen in front of the renal artery ostium. With the bare stent region unreleased, renal artery perfusion could be maintained and accurate positioning could be achieved by angiography in real time.
CONCLUSION This study suggests the feasibility and short-term safety of this novel antegrade in situ laser fenestration technique for select JAAA patients.
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Lu H, Lin Z, Chen Y, Lin F, Dai X, Chen L. Aortic remodeling after false lumen occlusion using an atrial septal occluder in chronic DeBakey IIIb aortic dissection. J Vasc Surg 2022; 75:1864-1871.e3. [PMID: 34995720 DOI: 10.1016/j.jvs.2021.12.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/06/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Retrograde false lumen flow through distal entry tears poses a challenge in the treatment of chronic DeBakey IIIb aneurysms. In the present report, we have described the feasibility and outcomes of false lumen occlusion using an atrial septal occluder (ASO) in chronic DeBakey IIIb dissection associated with a descending aneurysm. METHODS All the patients who had undergone thoracic endovascular aortic repair for chronic DeBakey IIIb aortic dissection at our institution from January 2014 to November 2020 were retrospectively reviewed. The primary endpoints were technical success and in-hospital postoperative results. The secondary endpoints included the midterm survival status and aortic remodeling outcomes. RESULTS A total of 37 patients (age, 56.24 ± 10.47 years) with persistent retrograde false lumen perfusion and aneurysm formation at the thoracic segment were treated using an ASO for false lumen occlusion. We achieved 100% technical success. No spinal cord ischemia or in-hospital death was observed. The median follow-up time was 36 months (interquartile range, 24-51 months). After the procedure, three patients (8.1%) had had an endoleak (type Ia in two patients and type II in one patients), and five patients had required late reintervention. The overall 5-year survival rate was 71%. One aortic-related death (2.7% of the total cohort) occurred during follow-up at 9 months. Complete thrombosis of the false lumen along the treated aortic segment was recorded postoperatively in 34 patients (91.9%) at the final follow-up using computed tomography angiography. In a mixed-effects model, a diameter analysis revealed that the thoracic true lumen diameter had increased and the thoracic false lumen diameter had decreased significantly (0.256 mm/mo, P < .001; and -0.512 mm/mo, P < .001, respectively). CONCLUSIONS The combination of standard thoracic endovascular aortic repair and false lumen occlusion using the ASO to promote false lumen thrombosis and remodeling in the treated segments is a technically feasible and effective alternative treatment of chronic DeBakey IIIb dissection with an associated descending aneurysm. This approach yielded satisfactory midterm survival outcomes and a low incidence of aortic-related death in our patients. However, further studies with more subjects and a prospective design should verify our findings before routine clinical implementation of this technique.
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Qiao Y, Mao L, Wang Y, Luan J, Chen Y, Zhu T, Luo K, Fan J. Hemodynamic effects of stent-graft introducer sheath during thoracic endovascular aortic repair. Biomech Model Mechanobiol 2022; 21:419-431. [PMID: 34994871 DOI: 10.1007/s10237-021-01542-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/26/2021] [Indexed: 12/19/2022]
Abstract
Thoracic endovascular aortic repair (TEVAR) has become the standard treatment of a variety of aortic pathologies. The objective of this study is to evaluate the hemodynamic effects of stent-graft introducer sheath during TEVAR. Three idealized representative diseased aortas were designed: aortic aneurysm, coarctation of the aorta, and aortic dissection. Computational fluid dynamics studies were performed in the above idealized aortic geometries. An introducer sheath routinely used in the clinic was virtually placed into diseased aortas. Comparative analysis was carried out to evaluate the hemodynamic effects of the introducer sheath. Results show that the blood flow to the supra-aortic branches would increase above 9% due to the obstruction of the introducer sheath. The region exposed to high endothelial cell activation potential (ECAP) expands in the scenarios of coarctation of the aorta and aortic dissection, which indicates that the probability of thrombus formation may increase during TEVAR. The pressure magnitude in peak systole shows an obvious rise, and a similar phenomenon is not observed in early diastole. The blood viscosity in the aortic arch and descending aorta is remarkably altered by the introducer sheath. The uneven viscosity distribution confirms the necessity of using non-Newtonian models, and high-viscosity region with high ECAP further promotes thrombosis. Our results highlight the hemodynamic effects of stent-graft introducer sheath during TEVAR, which may associate with perioperative complications.
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Kreibich M, Siepe M, Berger T, Kondov S, Morlock J, Pingpoh C, Beyersdorf F, Rylski B, Czerny M. Downstream thoracic endovascular aortic repair following zone 2, 100-mm stent graft frozen elephant trunk implantation. Interact Cardiovasc Thorac Surg 2021; 34:1141-1146. [PMID: 34849947 PMCID: PMC9159434 DOI: 10.1093/icvts/ivab338] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/21/2021] [Accepted: 10/29/2021] [Indexed: 12/03/2022] Open
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Nishioka N, Kurimoto Y, Abe M, Kato H. Thoracic stent-graft herniation through the aortic wall in a case of lung cancer. Interact Cardiovasc Thorac Surg 2021; 34:714-716. [PMID: 34791243 PMCID: PMC8972222 DOI: 10.1093/icvts/ivab277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/10/2021] [Accepted: 09/15/2021] [Indexed: 11/15/2022] Open
Abstract
A 67-year-old man had left upper lung cancer with invasion into the descending aorta. He underwent pre-emptive thoracic endovascular aortic repair using a Valiant Navion followed by left lung upper lobectomy with resection of the aortic wall. Because of continuous bleeding, he underwent re-thoracotomy. Since the surgically resected aortic wall was largely cleaved, bleeding around the stent-graft that herniated into the left pleural cavity was observed. Re-thoracic endovascular aortic repair using a GORE TAG was immediately performed to prevent further stent-graft herniation and impending lethal haemorrhage. It may be necessary to consider reinforcement of the resected aortic wall to prevent thoracic endovascular aortic repair-related complications.
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Burdess A, D'Oria M, Mani K, Tegler G, Lindström D, Mogensen J, Kölbel T, Wanhainen A. Early experience with a novel dissection-specific stent-graft to prevent distal stent-graft-induced new entry tears after thoracic endovascular repair of chronic type B aortic dissections. Ann Vasc Surg 2021; 81:36-47. [PMID: 34785340 DOI: 10.1016/j.avsg.2021.10.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/10/2021] [Accepted: 10/14/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE The aim was to report short and mid-term outcomes of a novel, investigational, dissection-specific stent-graft (DSSG), specifically designed to address the features of chronic type B aortic dissection (CTBAD) and reduce the risk of distal stent-graft-induced new entry tears (dSINE). MATERIALS AND METHODS A retrospective single center cohort study of all patients undergoing TEVAR with the DSSG for CTBAD from January 1, 2017 to January 31, 2020. The DSSG, which is a modified stent-graft based on the Cook Zenith Alpha Thoracic platform, has no proximal barbs and a customized longer body length with substantial taper. The second and third distal Z-stents are sited internally to avoid any contact of the metal skeleton with the dissection membrane and have reduced radial force, while the most distal stent was removed creating a distal 30 mm unsupported Dacron graft. RESULTS Sixteen patients (13 males, 3 females) with a median age of 66 years (range 31-79 years) underwent elective TEVAR of CTBAD using the DSSG. Six patients (38%) had an underlying connective tissue disorder. The median tapering was 10mm (range 4mm-21mm) and median length 270mm (range 210-380 mm). Technical success was achieved in all but one case (96%). One patient died within 30 days, due to retrograde type A dissection with cardiac tamponade. The 30-day rate of stroke, spinal cord ischemia and re-interventions was 0%. After median imaging follow-up time of 17 months (range 1 - 31 months), one patient developed a dSINE four months after the index procedure. After median survival follow-up of 23 months (range 2 - 35 months), one late death occurred due to traumatic brain injury, while no aortic-related death occurred during follow-up. Complete false lumen (FL) thrombosis was achieved in nine patients while the remaining six showed partial FL thrombosis. No instances of diameter increase at the level of treated aortic segment were noted with serial measurements showing either stable (n=7) or decreased (n=8) maximal transverse diameter. CONCLUSIONS Use of a novel DSSG with low radial force for TEVAR in the setting of CTBAD is safe and feasible. This early real-world experience shows promising mid-term effectiveness with low rates of dSINE or unplanned re-interventions and satisfactory aortic remodelling during follow-up. Longer follow-up is needed, however, before any firm conclusions can be drawn.
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Descending thoracic aorta to bilateral femoral artery bypass and thoracic endovascular aortic repair in the management of atypical aortoiliac occlusive disease. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2021; 7:718-724. [PMID: 34754996 PMCID: PMC8560835 DOI: 10.1016/j.jvscit.2021.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/27/2021] [Indexed: 11/21/2022]
Abstract
Despite recent advancements in endovascular technology and the proven durability of open surgery, extensive thoracoabdominal aortoiliac occlusive disease (AIOD) remains challenging to treat. In the present report, we have described the case of a 58-year-old woman with AIOD and multiple medical comorbidities. She successfully underwent a novel intraoperative transesophageal echocardiography-guided combined treatment with concurrent descending thoracic aorta to bilateral femoral artery bypass and thoracic endovascular aortic repair. We have shown that this approach, which combines descending thoracic aorta to bilateral femoral artery bypass with thoracic endovascular aortic repair, is an effective treatment alternative for future cases of complex AIOD.
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Kim AH, King AH, Schmaier AH, Cho JS. Persistent disseminated intravascular coagulation despite correction of endoleaks after thoracoabdominal endovascular aneurysm repair. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2021; 7:730-733. [PMID: 34754997 PMCID: PMC8564492 DOI: 10.1016/j.jvscit.2021.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/25/2021] [Indexed: 12/02/2022]
Abstract
Disseminated intravascular coagulation (DIC) is a rare complication of endovascular aortic repair, commonly associated with type I or type III endoleaks. DIC is also known as consumption coagulopathy because excessive thrombin formation and secondary fibrinolysis leads to consumption of coagulation factors with hyperfibrinolysis and activation of platelets, which can lead to excessive bleeding. We present the case of an 80-year-old woman who had undergone thoracic endovascular aortic repair for a type B aortic dissection that was complicated by a series of recurrent endoleak-induced DICs requiring multiple thoracic endovascular aortic repair extensions to cover the entire thoracoabdominal aorta. The DIC persisted despite the resolution of the endoleaks.
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Monzio-Compagnoni N, Romani F, Mondino MG, Rampoldi AG, Trimarchi S, Tolva VS. Oxygen Partial Pressure in Cerebrospinal Fluid as a Potential Parameter to Identify Spinal Cord Ischaemia. Eur J Vasc Endovasc Surg 2021; 63:352-353. [PMID: 34774374 DOI: 10.1016/j.ejvs.2021.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 09/01/2021] [Accepted: 09/18/2021] [Indexed: 11/25/2022]
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Shu X, Xu H, Wang E, Wang L, Guo D, Chen B, Fu W. Midterm Outcomes of an Adjustable Puncture Device for In Situ Fenestration During Thoracic Endovascular Aortic Repair. Eur J Vasc Endovasc Surg 2021; 63:43-51. [PMID: 34750032 DOI: 10.1016/j.ejvs.2021.09.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 09/03/2021] [Accepted: 09/19/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the midterm outcomes of in situ fenestration (ISF) with an adjustable puncture device for aortic arch branch preservation during thoracic endovascular aortic repair (TEVAR). METHODS From October 2016 to April 2019, patients with complicated type B aortic dissection, thoracic aortic aneurysm > 5.5 cm in diameter, or aortic penetrating ulcer with a base > 20 mm or depth > 15 mm, who received TEVAR requiring a proximal sealing beyond zone 3 and underwent ISF using an adjustable puncture device, were included. After the procedure, patients were monitored at one, three, six, and 12 months, and annually thereafter. Peri-operative and follow up data were collected and analysed. RESULTS Fifty of 51 patients (98%) received successful ISFs. One, two, or three aortic arch branches were preserved in 44, six, and one patient, respectively. Intra-operatively, eight type Ia endoleaks and one type II endoleak were found on angiography. One patient died of cerebral hernia three days post-procedure from a severe stroke; one patient suffered from transient paraplegia but recovered in two weeks; one patient had a non-disabling stroke. The median follow up was 31 months (22.5 - 36.5 months). At six month follow up, all nine unmanaged endoleaks had disappeared. One new type Ia endoleak was identified in a patient at the one month follow up which resolved spontaneously one year later. All revascularised arteries were patent at the last follow up. No fractures, migrations, or bridging stent kinks were found. CONCLUSION In this largest mechanical based ISF study to date, an adjustable puncture device was shown to facilitate the procedure of ISF during endovascular repair of aortic diseases involving the aortic arch, with high success. The midterm outcome demonstrates the efficacy and safety of the device in assisting with preservation of aortic arch branches.
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Prior Infrarenal Aortic Surgery is Not Associated with Increased Risk of Spinal Cord Ischemia Following Thoracic Endovascular Aortic Repair and Complex Endovascular Aortic Repair. J Vasc Surg 2021; 75:1152-1162.e6. [PMID: 34742886 DOI: 10.1016/j.jvs.2021.10.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 10/10/2021] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Patients with prior infrarenal aortic intervention represent an increasing demographic of patients undergoing thoracic endovascular aortic repair (TEVAR) and/or complex EVAR. Studies have suggested that prior abdominal aortic surgery is a risk factor for spinal cord ischemia (SCI). However, these results are largely based on single-center experiences with limited multi-institutional and national data assessing clinical outcomes in these patients. The objective of this study was to evaluate the effect of prior infrarenal aortic surgery on SCI. METHODS The Society for Vascular Surgery Vascular Quality Initiative database was retrospectively reviewed to identify all patients ≥18 years old undergoing TEVAR/complex EVAR from January 2012 to June 2020. Patients with previous thoracic or suprarenal aortic repairs were excluded. Baseline and procedural characteristics and postoperative outcomes were compared by group: TEVAR/complex EVAR with or without previous infrarenal aortic repair. The primary outcome was postoperative SCI. Secondary outcomes included postoperative hospital length of stay (LOS), bowel ischemia, renal ischemia, and 30-day mortality. Multivariate regression was used to determine independent predictors of postoperative SCI. Additional analysis was performed for patients undergoing isolated TEVAR. RESULTS A total of 9506 patients met the inclusion criteria: 8691 (91.4%) had no history of infrarenal aortic repair and 815 (8.6%) had previous infrarenal aortic repair. Patients with previous infrarenal repair were older with an increased prevalence of chronic kidney disease (p=0.001) and cardiovascular risk factors including hypertension, chronic obstructive pulmonary disease, and smoking history (p<0.001). These patients presented with larger maximal aortic diameters (6.06±1.47 cm versus 5.15±1.76 cm; p<0.001) and required more stent grafts (p<0.001) with increased intraoperative blood transfusion requirements (p<0.001), and longer procedure times (p<0.001). Univariate analysis demonstrated no difference in postoperative SCI, postoperative hospital LOS, bowel ischemia, or renal ischemia between the two groups. Thirty-day mortality was significantly higher in patients with prior infrarenal repair (p=0.001). On multivariate regression, prior infrarenal aortic repair was not a predictor of postoperative SCI, while aortic dissection (odds ratio [OR] 1.65; 95% confidence interval [CI] 1.26-2.16, p<0.001), number of stent grafts deployed (OR 1.45; 95% CI 1.30-1.62, p<0.001), and units of packed red blood cells transfused intraoperatively (OR 1.33; 95% CI 1.03-1.73, p=0.032) were independent predictors of SCI. CONCLUSIONS Although TEVAR/complex EVAR patients with prior infrarenal aortic repair constituted a sicker cohort with higher 30-day mortality, the rate of SCI was comparable to patients without prior repair. Previous infrarenal repair was not associated with risk of SCI.
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