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Gomero-Cure W, Lowery RC, O'Donnell S. Stent graft-induced new entry tear after endoluminal grafting for aortic dissection repaired with open interposition graft. J Vasc Surg 2013; 58:1652-6. [DOI: 10.1016/j.jvs.2012.12.084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 12/19/2012] [Accepted: 12/28/2012] [Indexed: 10/26/2022]
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52
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Cochennec F. Reply: To PMID 23395206. J Vasc Surg 2013; 58:1742-3. [PMID: 24280335 DOI: 10.1016/j.jvs.2013.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 08/16/2013] [Accepted: 08/16/2013] [Indexed: 11/18/2022]
Affiliation(s)
- Frédéric Cochennec
- Department of Vascular Surgery, Hôpital Henri Mondor, University of Paris XII, Créteil, France
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53
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Endovascular Treatment of Thoracic Aortic Aneurysm: A Single-Center Experience. Ann Vasc Surg 2013; 27:1020-8. [DOI: 10.1016/j.avsg.2012.07.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 07/05/2012] [Accepted: 07/31/2012] [Indexed: 11/21/2022]
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Abstract
BACKGROUND Thoracic aortic aneurysm (TAA) is an uncommon disease with an incidence of 10.4 per 100,000 inhabitants. It occurs mainly in older individuals and is evenly distributed among both sexes. There are no signs or symptoms indicative of the presence of the disease. Progressive but unpredictable enlargement of the dilated aorta is the natural course of the disease and can lead to rupture. Open chest surgical repair using prosthetic graft interposition has been a conventional treatment for TAAs. Despite improvements in surgical procedures perioperative complications remain significant. The alternative option of thoracic endovascular aneurysm repair (TEVAR) is considered a less invasive and potentially safer technique, with lower morbidity and mortality compared with conventional treatment. Evidence is needed to support the use of TEVAR for these patients, rather than open surgery. OBJECTIVES The aim of this review is to assess the efficacy of TEVAR versus conventional open surgery in patients with TAAs. SEARCH METHODS For this update the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched March 2013) and CENTRAL (2013, Issue 2). SELECTION CRITERIA Randomised controlled trials in which patients with TAAs were randomly assigned to TEVAR or open surgical repair. DATA COLLECTION AND ANALYSIS Two review authors independently identified and evaluated potential trials for eligibility. Excluded studies were further checked by another author. We did not perform any statistical analyses as no randomised controlled trials were identified. MAIN RESULTS We did not find any published or unpublished randomised controlled trials comparing TEVAR with conventional open surgical repair for the treatment of thoracic aortic aneurysms. AUTHORS' CONCLUSIONS Though stent grafting of the thoracic aorta is technically feasible and non-randomised studies suggest reduction of early outcomes such as paraplegia, mortality and hospital stay, high quality randomised controlled trials assessing all clinically relevant outcomes including open-conversion, aneurysm exclusion, endoleaks, and late mortality are needed.
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Affiliation(s)
- Iosief Abraha
- Epidemiology Department, Regional Health Authority of Umbria, Via Mario Angeloni, 61, Perugia, Italy, 06124
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55
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Bashir M, McWilliams RG, Desmond M, Kuduvalli M, Oo A, Field M. Blunt aortic injury secondary to fragmented tenth thoracic vertebral body. Ann Thorac Surg 2013; 95:2161-4. [PMID: 23706439 DOI: 10.1016/j.athoracsur.2012.09.065] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Revised: 09/17/2012] [Accepted: 09/25/2012] [Indexed: 11/17/2022]
Abstract
We present a case of blunt traumatic aortic laceration following a motor vehicle crash. The aortic laceration was 4.5 cm above the coeliac axis and occurred because of an unstable tenth thoracic vertebral body. Open surgery was considered high risk, whereas an endovascular approach with an endoprosthesis placed at the exact anatomic location of the laceration was advocated.
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Affiliation(s)
- Mohamad Bashir
- Institute of Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Thoracic Aortic Aneurysm Service, Liverpool, United Kingdom.
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Patel VI, Mukhopadhyay S, Ergul E, Aranson N, Conrad MF, LaMuraglia GM, Kwolek CJ, Cambria RP. Impact of hospital volume and type on outcomes of open and endovascular repair of descending thoracic aneurysms in the United States Medicare population. J Vasc Surg 2013; 58:346-54. [DOI: 10.1016/j.jvs.2013.01.035] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Revised: 01/15/2013] [Accepted: 01/15/2013] [Indexed: 11/16/2022]
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Low incidence of paraplegia after thoracic endovascular aneurysm repair with proactive spinal cord protective protocols. J Vasc Surg 2013; 57:1537-42. [DOI: 10.1016/j.jvs.2012.12.032] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 12/05/2012] [Accepted: 12/06/2012] [Indexed: 11/17/2022]
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58
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Miyahara S, Nomura Y, Shirasaka T, Taketoshi H, Yamanaka K, Omura A, Sakamoto T, Inoue T, Minami H, Okada K, Okita Y. Early and Midterm Outcomes of Open Surgical Correction After Thoracic Endovascular Aortic Repair. Ann Thorac Surg 2013; 95:1584-90. [DOI: 10.1016/j.athoracsur.2013.02.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Revised: 02/12/2013] [Accepted: 02/15/2013] [Indexed: 10/27/2022]
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Thoracic Endovascular Aortic Repair in 300 Patients: Long-Term Results. Ann Thorac Surg 2013; 95:1577-83. [DOI: 10.1016/j.athoracsur.2013.02.043] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Revised: 02/16/2013] [Accepted: 02/19/2013] [Indexed: 11/21/2022]
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Restrictive bare stent for prevention of stent graft-induced distal redissection after thoracic endovascular aortic repair for type B aortic dissection. J Vasc Surg 2013; 57:44S-52S. [PMID: 23336855 DOI: 10.1016/j.jvs.2012.06.117] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 06/20/2012] [Accepted: 06/29/2012] [Indexed: 11/21/2022]
Abstract
BACKGROUND Stent graft-induced distal redissection (SIDR) is one of the major concerns in the durability of endovascular repair for complicated Stanford type B aortic dissection. The characteristics and means of prevention of this complication remain unknown. METHODS From April 1997 to March 2010, 674 patients with type B aortic dissections were treated primarily by thoracic endovascular aortic repair (TEVAR) at our center. Criteria for inclusion in this study were treatment primarily with TEVAR and an estimated mismatch rate (ratio of distal diameter of stent graft to long diameter of true lumen) greater than 120%. By this protocol, 465 patients were included in this study and were retrospectively analyzed. Among them, 266 patients were treated in the acute phase, and 199 were treated in the chronic phase. RESULTS A total of 311 patients were treated with standard TEVAR and 154 patients with TEVAR + restrictive bare stent (RBS). The preoperative mismatch rate (measured as the preoperative long diameter of the true lumen at the level of the intended distal end of the stent graft) of the SIDR was significantly higher than that of the non-SIDR (192.7 ± 54.9% vs 131.9 ± 10.4%; P < .05). The follow-up mismatch rate of the SIDR was significantly higher than that of the non-SIDR (145.4 ± 34.6 vs 120.3 ± 16.1; P < .05). Compared with the standard TEVAR, TEVAR + RBS was associated with a lower incidence of SIDR (0% vs 2.9%; P = .033) and less secondary intervention (3.9% vs 9.3%; P = .040). Placement of the RBS significantly expanded the true lumen at the level of the descending aorta with the narrowest true lumen and at the level of the distal end of the stent graft. CONCLUSIONS The mismatch between the distal diameter of the stent graft and the diameter of the compressed true lumen seems to be the major factor in the occurrence of SIDR. Placement of an RBS, as an adjunctive technique to TEVAR, could reduce the incidence of SIDR. On the basis of early- to midterm observations, RBSs may improve morphological remodeling of the dissected aorta at certain levels.
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Wong S, Mastracci TM, Katsargyris A, Verhoeven ELG. The role of mandatory lifelong annual surveillance after thoracic endovascular repair. J Vasc Surg 2013. [PMID: 23182490 DOI: 10.1016/j.jvs.2012.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Thoracic endovascular aortic repair (TEVAR) has become an attractive and well-accepted option for the management of the various thoracic aortic pathologies that vascular surgeons are confronted with. As in the abdominal aorta, current management trends include the treatment of younger patients with longer life expectancies, raising the issue of postoperative surveillance. There are several relevant differences between these anatomic areas when it comes to surveillance, including the relative inaccessibility of the thoracic aorta to ultrasound interrogation and the increased variability of thoracic aortic pathologies and post-TEVAR complications. In addition, concerns regarding radiation-induced carcinogenesis and contrast-induced nephropathy reduce the enthusiasm of many surgeons for regular computed tomography surveillance. Most agree that surveillance is important after TEVAR, but the method, duration, and frequency of that surveillance is much less clear and is the topic of this debate.
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Affiliation(s)
- Shen Wong
- Department of Vascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio 44106, USA
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62
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Ehrlich MP, Rousseau H, Heijmen R, Piquet P, Beregi JP, Nienaber CA, Sodeck G, Fattori R. Midterm results after endovascular treatment of acute, complicated type B aortic dissection: The Talent Thoracic Registry. J Thorac Cardiovasc Surg 2013; 145:159-65. [DOI: 10.1016/j.jtcvs.2011.10.093] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Revised: 09/22/2011] [Accepted: 10/05/2011] [Indexed: 10/28/2022]
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63
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Weng SH, Weng CF, Chen WY, Huang CY, Chen IM, Chen CK, Hsu CP, Shih CC. Reintervention for distal stent graft-induced new entry after endovascular repair with a stainless steel-based device in aortic dissection. J Vasc Surg 2013; 57:64-71. [DOI: 10.1016/j.jvs.2012.07.006] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 07/05/2012] [Accepted: 07/11/2012] [Indexed: 10/27/2022]
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64
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von Allmen RS, Anjum A, Powell JT. Incidence of descending aortic pathology and evaluation of the impact of thoracic endovascular aortic repair: a population-based study in England and Wales from 1999 to 2010. Eur J Vasc Endovasc Surg 2012; 45:154-9. [PMID: 23280314 DOI: 10.1016/j.ejvs.2012.12.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 12/10/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate population trends in thoracic aortic disease (dissections and aneurysms) in England and Wales, with focus on the impact of thoracic endovascular aortic repair on procedure numbers and age at repair. MATERIALS AND METHODS Routine hospital statistics of England and Wales provided admission, procedure and mortality data from 1999 to 2010. All data were age-standardised, reported per 100,000 population, by age bands (>50 years or 50-74 years versus 75+ years) and gender. Only patients 50+ years were included, to focus on degenerative disease. RESULTS Between 1999 and 2010 hospital admissions for total (ascending and descending) have risen steadily for thoracic aortic dissection (TAD) from 7.2 to 8.8 and thoracic aortic aneurysm (TAA) from 4.4 to 9.0, principally attributable to increased admissions in those 75+ years. Total mortality declined steadily over the same period, for TAD from 4.4 to 3.2 and for TAA from 10.4 to 7.5. Procedure rates have risen sharply, driven by the implementation of TEVAR from 2006, for type B dissection from 0.06 to 0.53 and for descending TAA from 0.76 to 1.89. All figures are per 100,000 population with P <0.005. CONCLUSION Improvements in case ascertainment may have contributed to the increase in hospital admissions. The increased application of TEVAR, particularly for dissections, is mainly in those above 75 years and has not yet translated into an accelerated survival benefit.
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Affiliation(s)
- R S von Allmen
- Vascular Surgery Research Group, Imperial College, Charing Cross Campus, St Dunstan's Road, London W6 8RF, UK.
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65
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Ullery BW, McGarvey M, Cheung AT, Fairman RM, Jackson BM, Woo EY, Desai ND, Wang GJ. Vascular distribution of stroke and its relationship to perioperative mortality and neurologic outcome after thoracic endovascular aortic repair. J Vasc Surg 2012; 56:1510-7. [DOI: 10.1016/j.jvs.2012.05.086] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 05/18/2012] [Accepted: 05/23/2012] [Indexed: 10/28/2022]
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66
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Pacini D, Leone A, Belotti LMB, Fortuna D, Gabbieri D, Zussa C, Contini A, Di Bartolomeo R. Acute type A aortic dissection: significance of multiorgan malperfusion. Eur J Cardiothorac Surg 2012; 43:820-6. [DOI: 10.1093/ejcts/ezs500] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Wong S, Mastracci TM. Part One: For the motion. All TEVAR patients must be followed lifelong by annual CTA/MRA. [Pro]. Eur J Vasc Endovasc Surg 2012; 44:534-7. [PMID: 23040296 DOI: 10.1016/j.ejvs.2012.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- S Wong
- Department of Vascular Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
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68
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Novero ER, Metzger PB, Obregon J, Marco VLAD, Rossi FH, Moreira SM, Izukawa NM, Kambara AM. Tratamento endovascular das doenças da aorta torácica: análise dos resultados de um centro. Radiol Bras 2012. [DOI: 10.1590/s0100-39842012000500004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Analisar os resultados do tratamento de uma série consecutiva de pacientes submetidos a tratamento endovascular de doenças da aorta torácica. Foram observados o sucesso técnico, o sucesso terapêutico, a morbimortalidade e a taxa de complicações perioperatórias e de reintervenções. MATERIAIS E MÉTODOS: Estudo retrospectivo, realizado em um centro de referência, no período de janeiro de 2010 a julho de 2011, em que foram analisados pacientes submetidos a correção endovascular de doenças da aorta torácica. A população foi dividida em dois grupos: grupo 1 (G1) - aneurismas de aorta torácica verdadeiros, úlcera aórtica e pseudoaneurisma; grupo 2 (G2) - dissecção aórtica tipo B crônica. RESULTADOS: Em um total de 55 pacientes tratados, 29 pertenciam ao G1 e 26, ao G2. As idades médias foram 66,8 ± 10 e 56,4 ± 7 anos, respectivamente. Os sucessos técnico e terapêutico foram, respectivamente, 86,3% e 68,6% no G1 e 100% e 74% no G2. A mortalidade perioperatória foi 10,3% no G1 e 7,6% no G2, com taxa de mortalidade anual de 10,3% no G1 e de 19,3% no G2. As taxas de reintervenções foram 10,3% e 15,3%, respectivamente. CONCLUSÃO: Em nosso estudo, o tratamento endovascular das doenças da aorta torácica demonstrou ser um método viável e associado a aceitáveis taxas de complicações.
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69
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Holloway BJ, Rosewarne D, Jones RG. Imaging of thoracic aortic disease. Br J Radiol 2012; 84 Spec No 3:S338-54. [PMID: 22723539 DOI: 10.1259/bjr/30655825] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Aortic pathology can be more complex to understand on imaging than is initially appreciated. There are a number of imaging modalities that provide excellent assessment of aortic pathology and enable the accurate monitoring of disease. This review discusses the imaging of the most common disease processes that affect the aorta in adults, with the primary focus being on CT and MRI.
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Affiliation(s)
- B J Holloway
- University Hospital Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK.
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70
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Foley PJ, Criado FJ, Farber MA, Kwolek CJ, Mehta M, White RA, Lee WA, Tuchek JM, Fairman RM. Results with the Talent thoracic stent graft in the VALOR trial. J Vasc Surg 2012; 56:1214-21.e1. [PMID: 22925732 DOI: 10.1016/j.jvs.2012.04.071] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 04/13/2012] [Accepted: 04/27/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We report the 5-year outcomes of thoracic endovascular aneurysm repair (TEVAR) using the Medtronic Vascular Talent Thoracic Stent Graft System (Medtronic Vascular, Santa Rosa, Calif) in patients considered low or moderate risk for open surgical repair. METHODS The Evaluation of the Medtronic Vascular Talent Thoracic Stent Graft System for the Treatment of Thoracic Aortic Aneurysms (VALOR) trial was a prospective, nonrandomized, multicenter, pivotal study conducted at 38 U.S. sites. Between December 2003 and June 2005, VALOR enrolled 195 patients who were low or moderate risk (0, 1, and 2) per the modified Society for Vascular Surgery and American Association for Vascular Surgery criteria. The patients had fusiform thoracic aortic aneurysms (TAAs) and/or focal saccular TAAs/penetrating atherosclerotic ulcers. Standard follow-up interval examinations were conducted at 1 month, 6 months, 1 year, and annually thereafter. RESULTS Over the 5-year follow-up, 76 deaths occurred (43.9%). Freedom from all-cause mortality was 83.9% at 1 year and 58.5% at 5 years. Most deaths were due to cardiac, pulmonary or cancer-related causes. Freedom from aneurysm-related mortality (ARM) was 96.9% at 1 year and 96.1% at 5 years. There was only 1 case of ARM after the first year of follow-up. Over the 5-year follow-up period, four patients were converted to open surgery and four patients experienced aneurysm rupture. The 5-year freedom from aneurysm rupture was 97.1% and the 5-year freedom from conversion to surgery was 97.1%. The incidence of stent graft migration (>10 mm) was ≤ 1.8% in each year of follow-up. The rate of type I endoleak was 4.6% at 1 month, 6.3% from 1 month to 1 year, and 3.8% during year 5. The rate of type III endoleak was 1.3% at 1 month, 1.9% from 1 month to 1 year, and 1.9% during year 5. Through 5 years, 28 patients (14.4%) underwent 31 additional endovascular procedures on the original target lesion. The 5-year freedom from secondary endovascular procedures was 81.5%. CONCLUSIONS Through 5-year follow-up in patients who were candidates for open surgical repair, TEVAR using the Talent Thoracic Stent Graft System has demonstrated sustained protection from ARM, aneurysm rupture, and conversion to surgery, and durable stent graft performance. Close patient follow-up remains essential after TEVAR.
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Affiliation(s)
- Paul J Foley
- Hospital of the University of Pennsylvania, Philadelphia, Pa, USA.
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71
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Lee SH, Song PS, Kim WS, Park KB, Choi SH. A case of stent graft infection coupled with aorto-esophageal fistula following thoracic endovascular aortic repair in a complex patient. Korean Circ J 2012. [PMID: 22701140 DOI: 10.4070/kcj.2012.42.5.36] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The incidence of peri-stent graft infection (PGI) following thoracic endovascular aortic repair (TEVAR) is low, but the associated mortality rates are extremely high. The diagnosis of this complication can be difficult due to nonspecific symptoms. Here, we report a case of PGI combined with an aorto-esophageal fistula (AEF) diagnosed by computed tomography (CT) and positron emission tomography (PET) imaging after TEVAR. A 50-year-old woman with a history of diabetes mellitus and chronic hemodialysis had received a stent graft for a contained rupture of a pseudoaneurysm of the descending thoracic aorta. Three months after stent-grafting, she experienced back pain. CT and PET imaging suggested a PGI. The patient underwent surgical treatment for PGI with AEF.
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Affiliation(s)
- Sung Ho Lee
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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72
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Lee SH, Song PS, Kim WS, Park KB, Choi SH. A case of stent graft infection coupled with aorto-esophageal fistula following thoracic endovascular aortic repair in a complex patient. Korean Circ J 2012; 42:366-8. [PMID: 22701140 PMCID: PMC3369972 DOI: 10.4070/kcj.2012.42.5.366] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2011] [Revised: 10/17/2011] [Accepted: 10/25/2011] [Indexed: 11/11/2022] Open
Abstract
The incidence of peri-stent graft infection (PGI) following thoracic endovascular aortic repair (TEVAR) is low, but the associated mortality rates are extremely high. The diagnosis of this complication can be difficult due to nonspecific symptoms. Here, we report a case of PGI combined with an aorto-esophageal fistula (AEF) diagnosed by computed tomography (CT) and positron emission tomography (PET) imaging after TEVAR. A 50-year-old woman with a history of diabetes mellitus and chronic hemodialysis had received a stent graft for a contained rupture of a pseudoaneurysm of the descending thoracic aorta. Three months after stent-grafting, she experienced back pain. CT and PET imaging suggested a PGI. The patient underwent surgical treatment for PGI with AEF.
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Affiliation(s)
- Sung Ho Lee
- Division of Cardiology, Department of Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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73
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Kim KY, Byun SJ, Yun KH, Lee SY, Ryu DW, Rhee SJ, So BJ. Early experience of thoracic endovascular aortic repair: a local single hospital experience. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2012; 82:302-5. [PMID: 22563537 PMCID: PMC3341479 DOI: 10.4174/jkss.2012.82.5.302] [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: 01/09/2012] [Revised: 02/22/2012] [Accepted: 03/02/2012] [Indexed: 11/30/2022]
Abstract
Purpose The purpose of this retrospective study was to evaluate the short- to mid-term results of thoracic endovascular aortic repair (TEVAR) in Wonkwang University School of Medicine & Hospital. Methods Between February 2009 and May 2011, 8 consecutive patients had undergone endovascular stent-grafting for thoracic aortic diseases. Five patients were treated for traumatic thoracic aortic injuries, two patients were treated for thoracic aneurysms and one patient was treated for a pseudoaneurysm due to penetrating aortic ulcers. Attempted stent-graft deployment was performed electively in 6 patients and emergently in 2. Follow-up was performed at 1-month, 6-month, 1-year, and annually thereafter. Results Technical success rates were achieved in 87.5% and the 30-day mortality rate was 0%. Mean hospital length of stay after TEVAR was 30 days in traumatic thoracic aortic injuries and 10 days in thoracic aneurismal diseases. Intra-operative Type I endoleak due to migration at deflation was visualized in 1 patient, which was treated by insertion of another stent-graft. During follow-up, a major complication was encountered in one patient who received carotid-subclavian bypass to relieve left arm ischemia. After 5 months he was treated with arch replacement for aortic arch aneurysm with type I endoleak at proximal site after endovascular treatment. The 30-day mortality rate was 0%. However, 1 case of mortality (12.5%) was observed during the follow-up period. Conclusion The short and mid-term results of endovascular repair of thoracic aortic diseases are promising. TEVAR is an effective procedure in the management of thoracic aortic diseases.
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Affiliation(s)
- Kyung Yun Kim
- Department of Vascular Surgery, Wonkwang University School of Medicine & Hospital, Iksan, Korea
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74
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Heijmen RH, Thompson MM, Fattori R, Goktay Y, Teebken OE, Orend KH. Valiant Thoracic Stent-Graft Deployed With the New Captivia Delivery System:Procedural and 30-Day Results of the Valiant Captivia Registry. J Endovasc Ther 2012; 19:213-25. [DOI: 10.1583/11-3652mr.1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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75
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Etezadi V, Schiro B, Peña CS, Kovacs M, Benenati JF, Katzen BT. Endovascular treatment of descending thoracic aortic disease: single-center, 15-year experience. J Vasc Interv Radiol 2012; 23:468-75. [PMID: 22301335 DOI: 10.1016/j.jvir.2011.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Revised: 12/01/2011] [Accepted: 12/07/2011] [Indexed: 10/14/2022] Open
Abstract
PURPOSE To report the experience with thoracic endovascular aortic repair (TEVAR) in a single center over a 15-year period. MATERIALS AND METHODS All patients undergoing TEVAR during the period 1994-2009 were retrospectively evaluated. RESULTS The study comprised 133 patients (96 men, age 69.5 years ± 14.7) who underwent 21 emergency and 112 elective TEVAR procedures. Aortic pathologies included 91 aneurysms, 14 pseudoaneurysms, 14 penetrating ulcers with or without pseudoaneurysms or intramural hematomas, 8 type B dissections (3 acute and 5 chronic), and 6 traumatic transections. Technical success was 97.7% with a 30-day mortality of 7.5%. There were 101 patients followed to 1 year, 35 patients followed to 5 years, and 6 patients followed to 10-15 years. The overall estimated survivals at 1 year, 5 years, and 10 years were 81%, 48%, and 36%. The 30-day mortality rates in emergency and elective TEVAR procedures were 23.9% and 4.5% (P = .005). However, among patients who survived > 30 days, there was no significant difference in mortality between groups undergoing emergency and elective TEVAR procedures (P = .9, hazard ratio [HR] 0.94, confidence interval [CI] 0.4-2.2). There was no significant gender survival difference. The 30-day mortality rate in octogenarians (n = 31) was higher than in younger patients (P = .03). Incidences of stroke and paraplegia within 30 days of TEVAR were 6.8% and 2.2%. Endoleaks were found in 39 (29%) patients, and secondary interventions were performed in 6 (4.5%) patients. CONCLUSIONS The data support the safety and efficacy of TEVAR for aortic pathologies with a low mortality rate. Younger patients have fewer complications after TEVAR. After the acute perioperative period, TEVAR procedures performed emergently are as durable as the procedures performed electively.
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Affiliation(s)
- Vahid Etezadi
- Division of Vascular and Interventional Radiology, Baptist Cardiac and Vascular Institute, Baptist Hospital of Miami, 8900 North Kendall Drive, Miami, FL 33176, USA
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76
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Yavuz S, Kanko M, Ciftci E, Parlar H, Agirbas H, Berki T. Aortoesophageal fistula secondary to thoracic endovascular aortic repair of a descending aortic aneurysm rupture. Heart Surg Forum 2012; 14:E249-51. [PMID: 21859645 DOI: 10.1532/hsf98.20101179] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE We present the case of a patient who developed an aortoesophageal fistula (AEF) 4 years after thoracic endovascular aortic repair (TEVAR) of a descending thoracic aortic aneurysm rupture. CASE REPORT A 60-year-old female patient underwent emergency stent graft placement in December 2006 because of rupture of a distal descending aortic aneurysm. The patient was discharged uneventfully. Four years later, the patient was readmitted because of recurrent hematemesis, weight loss, and malaise. A computed tomography scan and an upper gastrointestinal system (GIS) endoscopy examination revealed an AEF located at the midportion of the esophagus and at the caudal end of the stent graft. An emergency stent graft was re-replaced into the previous graft. The patient died from hemorrhagic shock due to massive GIS bleeding while she was being prepared for secondary major esophageal surgery. CONCLUSION AEF is a catastrophic complication of TEVAR. Conservative treatment is often associated with fatal results. If possible, these patients should be treated with secondary major surgical procedures.
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Affiliation(s)
- Sadan Yavuz
- Department of Cardiovascular Surgery, Kocaeli University School of Medicine, Kocaeli, Turkey.
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77
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Valente T, Rossi G, Lassandro F, Rea G, Marino M, Dialetto G, Muto R, Scaglione M. Unusual complications of endovascular repair of the thoracic aorta: MDCT findings. Radiol Med 2012; 117:831-54. [PMID: 22228128 DOI: 10.1007/s11547-011-0771-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 06/20/2011] [Indexed: 11/26/2022]
Abstract
With the development of minimally invasive surgical techniques, endovascular stent-graft placement has become an accepted and widely used alternative to the traditional surgical repair of aortic disease and is gaining acceptance as the treatment of choice. Many studies show that endovascular stent-graft therapy is safe and effective, although complications related to this treatment are also recognised. Although the incidence of major complication is low, neurological sequelae remain the major concern of endovascular repair. With growing experience, however, the spectrum of mid- and long-term complications has broadened to include potentially disastrous events, other than paraplegia or stroke, that require diligent surveillance. Three-dimensional data sets acquired quickly by multidetector computed tomography (MDCT) allow multiplanar reformations and 3D viewing, as well as quantitative assessment of vessel lumens, walls and surroundings. Although a large portion of radiologists will not be involved in the actual endograft deployment, many will be involved in the interpretation of postprocedural surveillance studies. Accordingly, the goal of this report is to summarise our experience with the presentation, diagnostic approach, management and outcomes of these unusual, but potentially catastrophic, postendovascular aortic repair complications to highlight their significance and increase familiarity with them among the imaging community. Increasing awareness of these complications may facilitate rapid diagnosis and/or triage and treatment.
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Affiliation(s)
- T Valente
- Dipartimento di Diagnostica per Immagini, Servizio di Radiologia, A.O.R.N. Monaldi, 80131, Napoli, Italy
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78
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Barrera JG, Espinel C, Amarillo J, Castillo VR, Figueredo A, Gentile J, Mosquera W, Balestrini S, Salazar L, Murcia AS. Tratamiento endovascular del aneurisma de aorta descendente en el adolescente con síndrome de Marfan. Reporte de un caso. REVISTA COLOMBIANA DE CARDIOLOGÍA 2012. [DOI: 10.1016/s0120-5633(12)70103-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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79
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Goodney PP, Travis L, Lucas FL, Fillinger MF, Goodman DC, Cronenwett JL, Stone DH. Survival after open versus endovascular thoracic aortic aneurysm repair in an observational study of the Medicare population. Circulation 2011; 124:2661-9. [PMID: 22104552 PMCID: PMC3281563 DOI: 10.1161/circulationaha.111.033944] [Citation(s) in RCA: 207] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The goal of this study was to describe short- and long-term survival of patients with descending thoracic aortic aneurysms (TAAs) after open and endovascular repair (TEVAR). METHODS AND RESULTS Using Medicare claims from 1998 to 2007, we analyzed patients who underwent repair of intact and ruptured TAA, identified from a combination of procedural and diagnostic International Classification of Disease, ninth revision, codes. Our main outcome measure was mortality, defined as perioperative mortality (death occurring before hospital discharge or within 30 days), and 5-year survival, from life-table analysis. We examined outcomes across repair type (open repair or TEVAR) in crude, adjusted (for age, sex, race, procedure year, and Charlson comorbidity score), and propensity-matched cohorts. Overall, we studied 12 573 Medicare patients who underwent open repair and 2732 patients who underwent TEVAR. Perioperative mortality was lower in patients undergoing TEVAR compared with open repair for both intact (6.1% versus 7.1%; P=0.07) and ruptured (28% versus 46%; P<0.0001) TAA. However, patients with intact TAA selected for TEVAR had significantly worse survival than open patients at 1 year (87% for open, 82% for TEVAR; P=0.001) and 5 years (72% for open; 62% for TEVAR; P=0.001). Furthermore, in adjusted and propensity-matched cohorts, patients selected for TEVAR had worse 5-year survival than patients selected for open repair. CONCLUSIONS Although perioperative mortality is lower with TEVAR, Medicare patients selected for TEVAR have worse long-term survival than patients selected for open repair. The results of this observational study suggest that higher-risk patients are being offered TEVAR and that some do not benefit on the basis of long-term survival. Future work is needed to identify TEVAR candidates unlikely to benefit from repair.
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Affiliation(s)
- Philip P Goodney
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03766, USA.
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80
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Ullery BW, Wang GJ, Low D, Cheung AT. Neurological complications of thoracic endovascular aortic repair. Semin Cardiothorac Vasc Anesth 2011; 15:123-40. [PMID: 22025398 DOI: 10.1177/1089253211424224] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Thoracic endovascular aortic repair (TEVAR) has decreased the morbidity and mortality associated with open surgical repair of descending thoracic aortic diseases, but important complications unique to the procedure remain. Spinal cord ischemia and infarction is a recognized complication caused by endovascular coverage or injury to spinal cord collateral vessels. Stroke is a consequence of thromboembolism or coverage of aortic arch branch vessels with insufficient collateral circulation. Understanding the risk factors and the pathophysiology of neurological complications of TEVAR are important for the successful anesthetic and surgical management and treatment of patients undergoing endovascular procedures involving the thoracic aorta.
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Affiliation(s)
- Brant W Ullery
- Department of Anesthesiology and Critical Care, University of Pennsylvania, 3400 Spruce Street, Dulles 680, Philadelphia, PA 19104-4283, USA
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81
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Neo WT, Pua U, Wong DES. Thoracic Endovascular Aortic Repair: A Local Single Institution Experience. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2011. [DOI: 10.47102/annals-acadmedsg.v40n9p414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Introduction: The purpose of this retrospective study was to evaluate the short- to mid-term results of the endovascular repair of thoracic aortic disease and to present an overview of our experience with thoracic endovascular aortic repair (TEVAR) in our institution. Materials and Methods: A retrospective review of all patients who were treated and underwent TEVAR in our institution between August 2004 and November 2009 was conducted. Results: Technical success was achieved in 100% of the patients and the 30-day mortality rate was 0%. Perioperative endoleak was visualised at the end of the procedure in 4 patients. Secondary endoleak was observed in 2 patients. Mean hospital length of stay post-TEVAR was 15.4 days. Postoperative major complications were observed in 4 patients. The 30-day mortality rate was 0%, with 2 mortalities (11.1%) during the follow-up period. Conclusion: This study adds to the growing body of literature that support TEVAR as an effective procedure in the management of thoracic aortic diseases and reflects its feasibility in our population. Further technical advancement in stent grafts, careful selection of patients and standardised peri-procedural care would contribute to further improvements in clinical outcomes.
Key words: Endovascular, Stent graft, TEVAR, Thoracic aneurysm, Thoracic dissection
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Affiliation(s)
| | - Uei Pua
- Tan Tock Seng Hospital, Singapore
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82
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Jackson BM, Woo EY, Bavaria JE, Fairman RM. Gender analysis of the pivotal results of the Medtronic Talent Thoracic Stent Graft System (VALOR) trial. J Vasc Surg 2011; 54:358-63, 363.e1. [DOI: 10.1016/j.jvs.2010.12.064] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2010] [Revised: 12/06/2010] [Accepted: 12/18/2010] [Indexed: 11/27/2022]
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83
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Clouse WD. Endovascular repair of thoracic aortic injury: current thoughts and technical considerations. Semin Intervent Radiol 2011; 27:55-67. [PMID: 21359015 DOI: 10.1055/s-0030-1247889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Thoracic aortic traumatic injury is a highly morbid event. Mortality and paraplegia rates after emergent open repair remain high. Now, however, thoracic aortic endografting for trauma (TAET) is commonly used. It is appealing due to reduction of operative stress for the multiply injured trauma victim. This minimizing of stress and risk is secondary to avoidance of thoracotomy, single-lung ventilation, aortic cross-clamping, and the more complex anesthetic techniques required. Early and midterm results from TAET delineate improved outcomes, yet access and aortic constraints continue to challenge TAET. Questions regarding longer-term durability of endografts in younger patients remain unanswered. Broader application of TAET within endovascular programs is challenged by appropriate imaging, operating suite inventories, and the logistics and personnel required for TAET. Currently developed thoracic endograft devices are not ideal for TAET due to platform size and graft diameter. This is changing, however, as new modifications have been developed and trials are ongoing. In light of these collective factors, the management paradigm for traumatic aortic injury is beginning to favor TAET.
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84
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Patel VI, Conrad MF, Kwolek CJ, Ouriel K, Fairman RM, Cambria RP. Propensity-matched cohort validates findings of the VALOR trial. J Vasc Surg 2011; 54:22-9. [DOI: 10.1016/j.jvs.2010.12.052] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2009] [Revised: 12/13/2010] [Accepted: 12/14/2010] [Indexed: 11/28/2022]
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85
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Midulla M, Renaud A, Martinelli T, Koussa M, Mounier-Vehier C, Prat A, Beregi JP. Endovascular fenestration in aortic dissection with acute malperfusion syndrome: Immediate and late follow-up. J Thorac Cardiovasc Surg 2011; 142:66-72. [DOI: 10.1016/j.jtcvs.2010.07.081] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Revised: 06/22/2010] [Accepted: 07/31/2010] [Indexed: 10/18/2022]
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86
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Melissano G, Kahlberg A, Bertoglio L, Chiesa R. Endovascular Exclusion of Thoracic Aortic Aneurysms With the 1- and 2-Component Zenith TX2 TAA Endovascular Grafts: Analysis of 2-Year Data From the TX2 Pivotal Trial. J Endovasc Ther 2011; 18:338-49. [DOI: 10.1583/10-3340.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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87
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Management of the Left Subclavian Artery during Endovascular Stent Grafting for Traumatic Aortic Injury – A Systematic Review. Eur J Vasc Endovasc Surg 2011; 41:758-69. [DOI: 10.1016/j.ejvs.2011.01.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Accepted: 01/04/2011] [Indexed: 11/19/2022]
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88
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Wang GJ, Jackson BM, Woo EY, Bavaria JE, Desai ND, Pochettino A, Fairman RM. ''Relining'' of thoracic aortic stent grafts for patients presenting with rupture/impending rupture. Vasc Endovascular Surg 2011; 45:438-41. [PMID: 21576209 DOI: 10.1177/1538574411408744] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To report a series of patients following thoracic endovascular aortic repair (TEVAR) presenting with rupture, who were effectively treated with TEVAR relining. METHODS Five patients who underwent repeat TEVAR in an urgent fashion were identified. Chart review was performed to identify demographics, device type, aneurysm characteristics, and postoperative course. RESULTS Mean time to relining procedure was 5.8 (range 2-10) years. All patients had ≥3 device components originally placed. Mean size of the original aneurysm was 7.2 cm (range 6.6-8). All patients underwent relining with proximal and distal extension with immediate technical success. At a mean follow-up of 1.3 years, there was no evidence of endoleak and no patients required repeat intervention. CONCLUSIONS Complete relining with proximal and distal extension was effective in treating patients presenting with rupture. These findings suggest that proximal and distal landing zones provided, relining should be considered the initial management strategy in patients s/p TEVAR re-presenting with rupture.
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Affiliation(s)
- Grace J Wang
- Division of Vascular Surgery and Endovascular Therapy, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
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89
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Jonker FHW, Schlosser FJV, Geirsson A, Sumpio BE, Moll FL, Muhs BE. Endograft collapse after thoracic endovascular aortic repair. J Endovasc Ther 2011; 17:725-34. [PMID: 21142480 DOI: 10.1583/10-3130.1] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To provide insight into the causes, timing, and optimal management of endograft collapse after thoracic endovascular aortic repair (TEVAR). METHODS A comprehensive review was conducted of all published cases of endograft collapse after TEVAR identified using Medline, Cochrane Library Central, and EMBASE. In total, 32 articles describing 60 patients (45 men; mean age 40.6 ± 17.2 years, range 17-78) with endograft collapse were included. All data were extracted from the articles and systematically entered into a database for meta-analysis. RESULTS In the 60 cases of endograft collapse, TEVAR had most commonly been applied to repair traumatic thoracic aortic injuries (39, 65%), followed by acute and chronic type B aortic dissections (9, 15%). The median time interval between TEVAR and diagnosis of endograft collapse was 15 days (range 1 day to 79 months). On average, the collapsed endografts were oversized by 26.7% ± 12.0% (range 8.3%-60.0%). Excessive oversizing was reported as the primary cause of endograft collapse in 20%, and a small radius of curvature of the aortic arch was responsible for 48% of the cases. The 30-day mortality was 8.3%, and the freedom from procedure-related death at 3 years after diagnosis of stent-graft collapse was 83.1% for asymptomatic patients compared with 72.7% for patients who had symptoms at diagnosis (p=0.029). CONCLUSION Endograft collapse typically occurs shortly after TEVAR, most frequently after endovascular repair of traumatic aortic injury. A high level of suspicion for endograft collapse in the first month after TEVAR, as well as further improvement of current endovascular devices, may be required to improve the long-term outcomes of patients after TEVAR.
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Affiliation(s)
- Frederik H W Jonker
- Section of Vascular Surgery and Interventional Radiology, Yale University School of Medicine, New Haven, Connecticut 06510, USA
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90
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Clough R, Modarai B, Topple J, Bell R, Carrell T, Zayed H, Waltham M, Taylor P. Predictors of Stroke and Paraplegia in Thoracic Aortic Endovascular Intervention. Eur J Vasc Endovasc Surg 2011; 41:303-10. [DOI: 10.1016/j.ejvs.2010.12.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 12/13/2010] [Indexed: 02/08/2023]
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91
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Riambau V, Zipfel B, Coppi G, Czerny M, Tealdi DG, Ferro C, Chiesa R, Sassi C, Rousseau H, Berti S. Final operative and midterm results of the European experience in the RELAY Endovascular Registry for Thoracic Disease (RESTORE) study. J Vasc Surg 2011; 53:565-73. [DOI: 10.1016/j.jvs.2010.09.050] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 09/14/2010] [Accepted: 09/15/2010] [Indexed: 11/28/2022]
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Endovascular management of thoracic aortic aneurysms. Cardiovasc Intervent Radiol 2011; 34:1137-42. [PMID: 21290125 DOI: 10.1007/s00270-011-0101-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Accepted: 12/31/2010] [Indexed: 10/18/2022]
Abstract
The overall survival of patients with thoracic aortic aneurysm (TAA) has improved significantly in the past few years. Endovascular treatment, proposed as an alternative to surgery, has been considered a therapeutic innovation because of its low degree of invasiveness, which allows the treatment of even high-surgical risk patients with limited complications and mortality. A major limitation is the lack of adequate evidence regarding long-term benefit and durability because follow-up has been limited to just a few years even in the largest series. The combination of endovascular exclusion with visceral branch revascularization for the treatment of thoraco-abdominal aortic aneurysms involving the visceral aorta has also been attempted. As an alternative, endografts with branches represent a technological evolution that allows treatment of complex anatomy. Even if only small numbers of patients and short follow-up are available, this technical approach, which has with limited mortality (<10%) and paraplegia rates, to expand endovascular treatment to TAA seems feasible. With improved capability to recognize proper anatomy and select clinical candidates, the choice of endovascular stent-graft placement may offer a strategy to optimize management and improve prognosis.
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93
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The VIRTUE Registry Investigators. The VIRTUE Registry of Type B Thoracic Dissections – Study Design and Early Results. Eur J Vasc Endovasc Surg 2011; 41:159-66. [DOI: 10.1016/j.ejvs.2010.08.016] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Accepted: 08/17/2010] [Indexed: 10/18/2022]
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94
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Endovascular Repair of Ruptured Thoracic Aortic Aneurysms: Predictors of Procedure-Related Stroke. Ann Vasc Surg 2011; 25:3-8. [DOI: 10.1016/j.avsg.2010.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Revised: 04/02/2010] [Accepted: 05/16/2010] [Indexed: 11/20/2022]
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95
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Cao CQ, Bannon PG, Shee R, Yan TD. Thoracic Endovascular Aortic Repair-indications and Evidence. Ann Thorac Cardiovasc Surg 2011; 17:1-6. [DOI: 10.5761/atcs.ra.10.01612] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Accepted: 12/06/2010] [Indexed: 11/16/2022] Open
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Beregi JP, Mounier-Vehier C, Koussa M, Goyault G, Prat A, Martinelli T, Midulla M. [Chronic aortic syndrome: how to follow patients, which complications and when to treat?]. Presse Med 2010; 40:88-93. [PMID: 21144696 DOI: 10.1016/j.lpm.2010.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Accepted: 10/18/2010] [Indexed: 11/19/2022] Open
Abstract
After the acute phase, if patient survives, the disease is still present. Chronic stage is defined as the period after the first month following the acute phase. Follow-up of the thoracic aorta is mandatory and even at the abdominal level to check the risk of rupture. In case of aortic dissection, late complications such as chronic malperfusion syndrome, but also secondary localisation of the disease, the risk factor indicate a role for the global management of the patient. The main objective of this article is to insist on the necessity to a close follow-up.
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Affiliation(s)
- Jean-Paul Beregi
- CHU Carémeau, service de radiologie et imagerie médicale, 30029 Nîmes cedex 9, France.
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Cassagnes L, Chabrot P, Ravel A, Dumousset E, Boyer L. [Acute aortic syndrome and endovascular treatment: good indications of stent-graft, stent and aortic fenestration]. Presse Med 2010; 40:62-71. [PMID: 21126849 DOI: 10.1016/j.lpm.2010.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Accepted: 10/20/2010] [Indexed: 10/18/2022] Open
Abstract
Acute aortic syndrome of the descending aorta can be treated with stent-graft thanks to technical and material development. Ruptured aneurysms, aortic dissection, wall hematoma and penetrating ulcers can be treated with stent-graft. According to the type of initial lesion, and the clinical tolerance, the emergency of treatment can be different. Non covered stent and aortic fenestration are used in case of visceral ischemia in aortic dissection, according to the type of ischemia.
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Affiliation(s)
- Lucie Cassagnes
- Centre hospitalier universitaire, pôle d'imagerie, service de radiologie B, Université d'Auvergne Clermont 1, faculté de médecine, EA 3295, BP 38, 63001 Clermont-Ferrand cedex 1, France
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98
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Nienaber CA, Kische S, Akin I, Rousseau H, Eggebrecht H, Fattori R, Rehders TC, Kundt G, Scheinert D, Czerny M, Kleinfeldt T, Zipfel B, Labrousse L, Ince H. Strategies for subacute/chronic type B aortic dissection: The Investigation of Stent Grafts in Patients with Type B Aortic Dissection (INSTEAD) trial 1-year outcome. J Thorac Cardiovasc Surg 2010; 140:S101-8; discussion S142-S146. [DOI: 10.1016/j.jtcvs.2010.07.026] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 07/12/2010] [Indexed: 10/18/2022]
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Pisimisis GT, Khoynezhad A, Bashir K, Kruse MJ, Donayre CE, White RA. Incidence and risk factors of renal dysfunction after thoracic endovascular aortic repair. J Thorac Cardiovasc Surg 2010; 140:S161-7. [DOI: 10.1016/j.jtcvs.2010.10.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Revised: 08/17/2010] [Accepted: 10/15/2010] [Indexed: 02/06/2023]
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100
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Long-term results of thoracic endovascular aortic repair in atherosclerotic aneurysms involving the descending aorta. J Thorac Cardiovasc Surg 2010; 140:S179-84; discussion S185-S190. [DOI: 10.1016/j.jtcvs.2010.06.031] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Revised: 05/31/2010] [Accepted: 06/21/2010] [Indexed: 11/19/2022]
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