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Yamanaka K, Hasegawa S, Kawabata R, Shiraki H, Chomei S, Inoue T, Tsujimoto T, Miyahara S, Takahashi H, Okada K. Anterolateral thoracotomy with partial sternotomy: a feasible approach for treating the complex pathology of the aortic arch. Eur J Cardiothorac Surg 2024; 65:ezae138. [PMID: 38597899 DOI: 10.1093/ejcts/ezae138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/20/2024] [Accepted: 04/06/2024] [Indexed: 04/11/2024] Open
Abstract
OBJECTIVES Our goal was to review our surgical experiences in patients with complex pathologies of the aortic arch who have undergone anterolateral thoracotomy with a partial sternotomy (ALPS). METHODS From October 2019 to November 2023, a total of 23 patients underwent one-stage repairs of complex pathologies of the aortic arch through the ALPS approach. The mean age was 61.9 ± 16.7 years old. The aortic pathologies were as follows: aorta-related infection in 11 (aorto-oesophageal fistula: 4, graft infection: 6, native aortic infection: 1); aortic dissection in 9 including shaggy aorta in 2, non-dissecting aneurysm in 1, and coarctation of the aorta (CoA) in 2. RESULTS Eighteen patients underwent aortic replacement from either the sinotubular junction or the ascending aorta to the descending aorta; 1 patient underwent it from the aortic root to the descending aorta (redo Bentall procedure and extensive aortic arch replacement); 3 patients underwent it from the aortic arch between the left carotid artery and left subclavian artery to the descending aorta; and 1 patient underwent a descending aortic replacement. Ten patients underwent omentopexy, latissimus dorsi muscle flap installation or both procedures. The hospital mortality rate was 13.0% (3/23). The overall survival and freedom from aortic events were 73.3%±10.2% and 74.1%±10.2%, respectively, at the 3-year follow-up. There was an absence of aorta-related deaths, and no recurrent infections were identified. CONCLUSIONS The short-term outcomes using the ALPS approach for the treatment of complex pathologies of the aortic arch were acceptable. Further studies will be required to determine the long-term results.
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Affiliation(s)
- Katsuhiro Yamanaka
- The Department of Surgery, Division of Cardiovascular Surgery, University of Kobe, Kobe, Japan
| | - Shota Hasegawa
- The Department of Surgery, Division of Cardiovascular Surgery, University of Kobe, Kobe, Japan
| | - Ryo Kawabata
- The Department of Surgery, Division of Cardiovascular Surgery, University of Kobe, Kobe, Japan
| | - Hironaga Shiraki
- The Department of Surgery, Division of Cardiovascular Surgery, University of Kobe, Kobe, Japan
| | - Shunya Chomei
- The Department of Surgery, Division of Cardiovascular Surgery, University of Kobe, Kobe, Japan
| | - Taishi Inoue
- The Department of Surgery, Division of Cardiovascular Surgery, University of Kobe, Kobe, Japan
| | - Takanori Tsujimoto
- The Department of Surgery, Division of Cardiovascular Surgery, University of Kobe, Kobe, Japan
| | - Shunsuke Miyahara
- The Department of Surgery, Division of Cardiovascular Surgery, University of Kobe, Kobe, Japan
| | - Hiroaki Takahashi
- The Department of Surgery, Division of Cardiovascular Surgery, University of Kobe, Kobe, Japan
| | - Kenji Okada
- The Department of Surgery, Division of Cardiovascular Surgery, University of Kobe, Kobe, Japan
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2
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Lee CC, Chen DY, Chan YH, Wu VCC, Cheng YT, Hung KC, Lin CP, Tung YC, Hsiao FC, Yeh JK, Chu PH, Chen SW. Outcomes of Endovascular Treatment for Infective Aortic Aneurysms - A Multicenter Retrospective Study. Circ J 2024; 88:309-318. [PMID: 37648519 DOI: 10.1253/circj.cj-23-0146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
BACKGROUND In Taiwan, infective native aortic aneurysms (INAAs) are relatively common, so the aim of present study was to demonstrate the comparative outcomes of endovascular repair for thoracic and abdominal INAAs.Methods and Results: Patients with naïve thoracic or abdominal INAAs managed with endovascular repair between 2001 and 2018 were included in this multicenter retrospective cohort. The confounding factors were adjusted with propensity score (PS). Of the 39 thoracic and 43 abdominal INAA cases, 41 (50%) presented with aneurysmal rupture, most of which were at the infrarenal abdominal (n=35, 42.7%) or descending thoracic aorta (n=25, 30.5%). Salmonella spp. was the most frequently isolated pathogen. The overall in-hospital mortality rate was 18.3%. The risks of in-hospital death and death due to rupture were significantly lower with thoracic INAAs (12.8% vs. 23.3%; PS-adjusted odds ratio (OR) 0.24, 95% confidence interval (CI) 0.06-0.96; 0.1% vs. 9.3%; PS-adjusted OR 0.11, 95% CI 0.01-0.90). During a mean follow-up of 2.5 years, the risk of all-cause death was significantly higher with thoracic INAAs (35.3% vs. 15.2%; PS-adjusted HR 6.90, 95% CI 1.69-28.19). Chronic kidney disease (CKD) was associated with death. CONCLUSIONS Compared with thoracic INAAs, endovascular repair of abdominal INAAs was associated with a significantly higher in-hospital mortality rate. However, long-term outcomes were worse for thoracic INAAs, with CKD and infections being the most important predictor and cause of death, respectively.
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Affiliation(s)
- Chih-Chun Lee
- Department of Medical Education, Chang Gung Memorial Hospital
| | - Dong-Yi Chen
- Department of Cardiology, Chang Gung Memorial Hospital, Chang Gung University
| | - Yi-Hsin Chan
- Department of Cardiology, Chang Gung Memorial Hospital, Chang Gung University
| | | | - Yu-Ting Cheng
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University
| | - Kuo-Chun Hung
- Department of Cardiology, Chang Gung Memorial Hospital, Chang Gung University
| | - Chia-Pin Lin
- Department of Cardiology, Chang Gung Memorial Hospital, Chang Gung University
| | - Ying-Chang Tung
- Department of Cardiology, Chang Gung Memorial Hospital, Chang Gung University
| | - Fu-Chih Hsiao
- Department of Cardiology, Chang Gung Memorial Hospital, Chang Gung University
| | - Jih-Kai Yeh
- Department of Cardiology, Chang Gung Memorial Hospital, Chang Gung University
| | - Pao-Hsien Chu
- Department of Cardiology, Chang Gung Memorial Hospital, Chang Gung University
| | - Shao-Wei Chen
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital
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Chellasamy RT, Krishnaswami M. Reinterventions after TEVAR. Indian J Thorac Cardiovasc Surg 2023; 39:325-332. [PMID: 38093920 PMCID: PMC10713966 DOI: 10.1007/s12055-023-01646-w] [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: 08/25/2023] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 12/17/2023] Open
Abstract
Thoracic cardiovascular aortic repair is an alternative procedure to open surgery for degenerative thoracic aortic aneurysm and thoracic aortic dissection. The advancements in graft design and imaging techniques have expanded its utility. However, the long-term patency of thoracic endovascular aortic repair (TEVAR) graft is still a concern. This review delves into the literature on re-intervention following TEVAR, highlighting factors that influence the re-intervention rate.
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Affiliation(s)
| | - Murali Krishnaswami
- Department of Radiology, Institute of Cardiac and Aortic Disorders, SIMS Hospital, Chennai, 600026 India
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4
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Ogino H, Iida O, Akutsu K, Chiba Y, Hayashi H, Ishibashi-Ueda H, Kaji S, Kato M, Komori K, Matsuda H, Minatoya K, Morisaki H, Ohki T, Saiki Y, Shigematsu K, Shiiya N, Shimizu H, Azuma N, Higami H, Ichihashi S, Iwahashi T, Kamiya K, Katsumata T, Kawaharada N, Kinoshita Y, Matsumoto T, Miyamoto S, Morisaki T, Morota T, Nanto K, Nishibe T, Okada K, Orihashi K, Tazaki J, Toma M, Tsukube T, Uchida K, Ueda T, Usui A, Yamanaka K, Yamauchi H, Yoshioka K, Kimura T, Miyata T, Okita Y, Ono M, Ueda Y. JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection. Circ J 2023; 87:1410-1621. [PMID: 37661428 DOI: 10.1253/circj.cj-22-0794] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | - Koichi Akutsu
- Cardiovascular Medicine, Nippon Medical School Hospital
| | - Yoshiro Chiba
- Department of Cardiology, Mito Saiseikai General Hospital
| | | | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University
| | | | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | - Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine
| | | | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
| | - Hirooki Higami
- Department of Cardiology, Japanese Red Cross Otsu Hospital
| | | | - Toru Iwahashi
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kentaro Kamiya
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine
| | | | - Takuya Matsumoto
- Department of Vascular Surgery, International University of Health and Welfare
| | | | - Takayuki Morisaki
- Department of General Medicine, IMSUT Hospital, the Institute of Medical Science, the University of Tokyo
| | - Tetsuro Morota
- Department of Cardiovascular Surgery, Nippon Medical School Hospital
| | | | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kenji Okada
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | | | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Masanao Toma
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Takuro Tsukube
- Department of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center
| | - Tatsuo Ueda
- Department of Radiology, Nippon Medical School
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kazuo Yamanaka
- Cardiovascular Center, Nara Prefecture General Medical Center
| | - Haruo Yamauchi
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Yutaka Okita
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
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5
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Yumoto K, Hattori T, Hasegawa H, Matsushita A, Saitou F, Mihara W. A Case of Postthoracic Endovascular Aortic Repair Stent-Graft Infection Caused by Campylobacter insulaenigrae. Ann Vasc Dis 2023; 16:230-233. [PMID: 37779654 PMCID: PMC10539121 DOI: 10.3400/avd.cr.23-00006] [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: 01/25/2023] [Accepted: 06/25/2023] [Indexed: 10/03/2023] Open
Abstract
An 81-year-old Japanese man who had distal aortic arch dilatation at age 77 had thoracic endovascular aortic surgery. The patient developed a fever and was taken to the hospital. Reduced diffusion in the descending aortic wall along the stent graft was discovered using whole-body diffusion-weighted imaging with background body signal suppression, and stent-graft infection was identified. The 16S ribosomal RNA gene analysis and blood culture results identified Campylobacter insulaenigrae as the etiological bacterial species. The patient was released from the hospital after 6 weeks of antibiotic treatment since the swelling and inflammatory response had decreased.
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Affiliation(s)
- Keita Yumoto
- Department of Cardiovascular Surgery, Seikeikai Chiba Medical Center, Chiba, Chiba, Japan
| | - Takashi Hattori
- Department of Cardiovascular Surgery, Seikeikai Chiba Medical Center, Chiba, Chiba, Japan
| | - Hideomi Hasegawa
- Department of Cardiovascular Surgery, Seikeikai Chiba Medical Center, Chiba, Chiba, Japan
| | - Akihito Matsushita
- Department of Cardiovascular Surgery, Seikeikai Chiba Medical Center, Chiba, Chiba, Japan
| | - Fumie Saitou
- Department of Cardiovascular Surgery, Seikeikai Chiba Medical Center, Chiba, Chiba, Japan
| | - Wahei Mihara
- Department of Cardiovascular Surgery, Seikeikai Chiba Medical Center, Chiba, Chiba, Japan
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6
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Milam AJ, Hung P, Bradley AS, Herrera-Quiroz D, Soh I, Ramakrishna H. Open Versus Endovascular Repair of Descending Thoracic Aneurysms: Analysis of Outcomes. J Cardiothorac Vasc Anesth 2023; 37:483-492. [PMID: 36522256 DOI: 10.1053/j.jvca.2022.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Adam J Milam
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ
| | - Penny Hung
- Medical Student, Mayo Clinic Alix School of Medicine, Scottsdale, AZ
| | - A Steven Bradley
- Department of Anesthesiology, Uniformed Services University of Health Sciences, Bethesda, MD
| | | | - Ina Soh
- Division of Vascular Surgery, Department of Surgery, Mayo Clinic, Phoenix, AZ
| | - Harish Ramakrishna
- Division of Cardiovascular Anesthesia, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
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7
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Molano F, Rey Chaves CE, Conde D, Girón F, Núñez-Rocha RE, Ayala D, González J, Cortés F, Cortés D, Fajardo E, Barón V. The Clinical Impact of Thoracic Endovascular Aortic Repair in the Management of Thoracic Aortic Diseases. J Endovasc Ther 2023:15266028221148381. [PMID: 36609171 DOI: 10.1177/15266028221148381] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE Thoracic endovascular aortic repair (TEVAR) has been described to be superior to an open surgical approach, and previous studies have found superiority in TEVAR by reducing overall morbidity and mortality rates. This study aimed to describe the outcomes of TEVAR for patients with thoracic aortic disease at a high complexity. MATERIALS AND METHODS Descriptive study, developed by a retrospective review of a prospectively collected database. Patients aged above 18 years who underwent TEVAR between 2012 and 2022 were included. Patient demographics, perioperative data, surgical outcomes, morbidity, and mortality were described. Statistical and multivariate analyses were made. Statistical significance was reached when p values were <0.05. RESULTS A total of 66 patients were included. Male patients were 60.61% and the mean age was 69.24 years. Associated aortic diseases were aneurysms (68.18%), ulcer-related (4.55%), intramural-related hematoma (7.58%), trauma-related pathology (1.52%), and aortic dissection (30.30%). The mean hospital stay was 18.10 days, and intensive care unit was required for 98.48%. At 30 days, the mortality rate was 10.61% and the reintervention rate was 21.21%. Increased intraoperative blood loss (p=0.001) and male sex (p=0.04) showed statistical relationship with mortality. Underweight patients have 6.7 and 11.4 times more risk of complications and endoleak compared with higher body mass index values (p=0.04, 95% confidence interval [CI]=0.82-7.21) and (p=0.02, 95% CI=1.31-12.57), respectively. CONCLUSION Thoracic endovascular aortic repair seems to be a feasible option for patients with thoracic aortic pathologies, with adequate rates of mortality and morbidity. Underweight patients seem to have an increased risk of overall morbidity and increased risk for endoleak. Further prospective studies are needed to prove our results. CLINICAL IMPACT Obesity and BMI are widely studied in the surgical literature. According to our study, there is a paradox regarding the outcomes of patients treated with TEVAR in terms of postoperative complications and mortality related to the body mass index. And shouldn't be considered as a high-risk feature in terms of postoperative morbidity and mortality in this procedure.
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Affiliation(s)
- Fernando Molano
- Hospital Militar Central, Bogotá, D.C., Colombia
- Department of Surgery, Hospital Universitario Mayor-Méderi, Bogotá. D.C., Colombia
| | | | - Danny Conde
- Department of Surgery, Hospital Universitario Mayor-Méderi, Bogotá. D.C., Colombia
- School of Medicine, Universidad del Rosario, Bogotá, D.C., Colombia
| | - Felipe Girón
- School of Medicine, Universidad del Rosario, Bogotá, D.C., Colombia
| | | | - Daniela Ayala
- School of Medicine, Universidad del Rosario, Bogotá, D.C., Colombia
| | - Juliana González
- School of Medicine, Universidad del Rosario, Bogotá, D.C., Colombia
| | - Felipe Cortés
- Department of Surgery, Hospital Universitario Mayor-Méderi, Bogotá. D.C., Colombia
| | - Diana Cortés
- School of Medicine, Universidad del Rosario, Bogotá, D.C., Colombia
| | - Ernesto Fajardo
- Department of Surgery, Hospital Universitario Mayor-Méderi, Bogotá. D.C., Colombia
- School of Medicine, Universidad del Rosario, Bogotá, D.C., Colombia
| | - Vladimir Barón
- Department of Surgery, Hospital Universitario Mayor-Méderi, Bogotá. D.C., Colombia
- School of Medicine, Universidad del Rosario, Bogotá, D.C., Colombia
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8
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Shiiya N, Washiyama N, Takahashi D, Tsuda K, Ohashi Y, Natsume K, Hirano M. Surgical Approaches to Single-Stage Extended Aortic Repair from the Ascending to the Distal Descending Aorta. Ann Thorac Cardiovasc Surg 2023; 29:1-10. [PMID: 36104188 PMCID: PMC9939677 DOI: 10.5761/atcs.ra.22-00148] [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] [Indexed: 11/16/2022] Open
Abstract
Single-stage extended replacement from the ascending to the distal descending aorta or beyond is a formidable operation that should be preserved for those who have no other option or those who are physically fit, and should be performed in the experienced centers. Hybrid operations combining open surgical repair with thoracic endovascular aortic repair through a median sternotomy incision are preferable because these operations are less invasive than the extended open aortic repair and the risk of spinal cord ischemia is lower compared with the frozen elephant trunk operation. However, these operations are associated with the inherent demerits of endovascular aneurysm exclusion. When the underlying aortic pathology necessitates extended open aortic repair in a single stage, approaches such as the anterolateral partial sternotomy, straight incision with rib cross, and extended thoracotomy with sternal transection may be useful to provide sufficient exposure for both aortic reconstruction and organ protection, with less surgical stress to the patients.
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Affiliation(s)
- Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan,Corresponding author: Norihiko Shiiya. First Department of Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, Shizuoka 431-3192, Japan
| | - Naoki Washiyama
- First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Daisuke Takahashi
- First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Kazumasa Tsuda
- First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Yuko Ohashi
- First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Kayoko Natsume
- First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Masahiro Hirano
- First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
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9
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Nakatsu T, Kikuchi S, Miyamoto H, Kimura F. Endovascular Reintervention for Stent-Graft Dislocation after Open Surgical Conversion for Thoracoabdominal Aortic Aneurysm Treated by Thoracic Endovascular Aortic Repair. Vasc Specialist Int 2022; 38:38. [PMID: 36594196 PMCID: PMC9808497 DOI: 10.5758/vsi.220049] [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: 10/28/2022] [Revised: 12/07/2022] [Accepted: 12/27/2022] [Indexed: 01/04/2023] Open
Abstract
Complex anatomical restrictions can lead to further interventions after the emergence of a postoperative aneurysm enlargement in thoracic endovascular aortic repair (TEVAR) for a thoracoabdominal aortic aneurysm (TAAA). A 75-year-old male underwent a TEVAR for a Crawford extent I TAAA. The main device and the distal extension were placed using a fenestrated technique, outside of the instructions for use. The aneurysm expanded because of an endoleak and stent graft migration; and was surgically repaired by fully salvaging the previous endografts 38 months after the first TEVAR. However, the distal extension, which was the proximal anastomosis site with a prosthetic graft, became completely dislocated from the main device eight months after the open surgical conversion, resulting again in the enlargement of the aneurysm. An additional TEVAR was successfully performed to correct the dislocated stent graft. An appropriate treatment strategy is crucial to prevent multiple reinterventions for TAAA with complex anatomical restrictions.
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Affiliation(s)
- Tomoki Nakatsu
- Department of Cardiovascular Surgery, Kushiro Kojinkai Memorial Hospital, Kushiro, Japan,Departments of Vascular Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Shinsuke Kikuchi
- Departments of Vascular Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Hiroyuki Miyamoto
- Department of Cardiovascular Surgery, Kushiro Kojinkai Memorial Hospital, Kushiro, Japan,Departments of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Fumiaki Kimura
- Department of Cardiovascular Surgery, Kushiro Kojinkai Memorial Hospital, Kushiro, Japan,Corresponding author: Fumiaki Kimura, Department of Cardiovascular Surgery, Kushiro Kojinkai Memorial Hospital, 191-212 Aikoku, Kushiro, Hokkaido 085-0062, Japan, Tel: 81-154-39-1222, Fax: 81-154-39-0330, E-mail: , https://orcid.org/0000-0001-9490-4606
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10
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Jonsson M, Blohmé L, Daryapeyma A, Günther A, Lundberg G, Nilsson L, Wahlgren CM, Franco-Cereceda A, Olsson C. Outcomes of descending and thoracoabdominal aortic repair in connective tissue disorder patients. SCAND CARDIOVASC J 2022; 56:352-359. [PMID: 36151718 DOI: 10.1080/14017431.2022.2125174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 08/17/2022] [Accepted: 09/10/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Open surgical repair (OSR) of descending and thoracoabdominal aortic aneurysms carries risks of mortality and major complications. Patients with connective tissue disorders (CTD) are younger and require safe, efficient treatment with long-term durability. This study provides current outcome data to help inform treatment decisions. METHODS All OSRs of descending thoracic aortic aneurysm (DTAA) or thoracoabdominal aortic aneurysm (TAAA) from January 2011 to July 2021 were included in a retrospective cohort study. Primary outcome measures were early and follow-up mortality and reintervention. Secondary outcome measures were major complications. Kaplan-Meier methods were used to estimate reintervention-free survival. RESULTS A total of 26 OSRs (7 DTAA, 19 TAAA) were performed in 23 patients: 20 (77%) Marfan and 6 (23%) Loeys-Dietz syndrome; median age 43 years. Aortic dissection was present in 100% and 3/26 (12%) were urgent. Early mortality was 1/26 (3.8%). No patient suffered spinal cord ischemia, stroke, vocal cord paralysis, or re-exploration for bleeding. The transient respiratory failure occurred in 19% (5/26) and transient renal replacement therapy in 15% (4/26). Renal function normalized in all patients within 3 months. During follow-up (median 4.6, range 0-11 years) there were no deaths and only one re-intervention on a previously operated aortic segment, resulting in 92% reintervention-free survival at 5 years. CONCLUSIONS In dedicated units, open surgical DTAA and TAAA repair in patients with CTD can be performed with a very low risk of death, severe complications and, late re-intervention. For CTD patients with reasonable risk, OSR should remain the first line of treatment.
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Affiliation(s)
- Magnus Jonsson
- Department of Vascular Surgery, Karolinska University Hospital,, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Linus Blohmé
- Department of Vascular Surgery, Karolinska University Hospital,, Stockholm, Sweden
| | - Alireza Daryapeyma
- Department of Vascular Surgery, Karolinska University Hospital,, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Anders Günther
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiothoracic Anesthesia, Karolinska University Hospital, Stockholm, Sweden
| | - Göran Lundberg
- Department of Vascular Surgery, Karolinska University Hospital,, Stockholm, Sweden
| | - Lena Nilsson
- Department of Cardiothoracic Anesthesia, Karolinska University Hospital, Stockholm, Sweden
| | - Carl-Magnus Wahlgren
- Department of Vascular Surgery, Karolinska University Hospital,, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Anders Franco-Cereceda
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Sweden
| | - Christian Olsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Sweden
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11
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Melloni A, Kahlberg A, Rinaldi E, Bilman V, Favia N, Melissano G, Chiesa R. Open Thoracoabdominal Aortic Procedures following Endovascular Intervention. AORTA (STAMFORD, CONN.) 2022; 10:162-168. [PMID: 36521807 PMCID: PMC9754861 DOI: 10.1055/s-0042-1750117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 04/12/2022] [Indexed: 12/23/2022]
Abstract
Open conversion of thoracoabdominal aortic (TAA) disease after failed attempts of endovascular treatment is increasingly required. The main causes are endoleak, endograft failure, infection, disease progression, or persistent false lumen perfusion in dissected aortas. Mortality and morbidity rates are high, higher than after standard TAA open repair. Therefore, this surgery should be performed only in dedicated centers by experienced teams. Specific perioperative organ protection protocols, as well as surgical techniques, are crucial to guarantee acceptable results.
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Affiliation(s)
- Andrea Melloni
- Division of Vascular Surgery, Vita-Salute San Raffaele University, Ospedale San Raffaele, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Kahlberg
- Division of Vascular Surgery, Vita-Salute San Raffaele University, Ospedale San Raffaele, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Milan, Italy
| | - Enrico Rinaldi
- Division of Vascular Surgery, Vita-Salute San Raffaele University, Ospedale San Raffaele, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Milan, Italy
| | - Victor Bilman
- Division of Vascular Surgery, Vita-Salute San Raffaele University, Ospedale San Raffaele, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Favia
- Division of Vascular Surgery, Vita-Salute San Raffaele University, Ospedale San Raffaele, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Milan, Italy
| | - Germano Melissano
- Division of Vascular Surgery, Vita-Salute San Raffaele University, Ospedale San Raffaele, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Milan, Italy
| | - Roberto Chiesa
- Division of Vascular Surgery, Vita-Salute San Raffaele University, Ospedale San Raffaele, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Milan, Italy
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Gu Y, Tian C, Qin Y, Sun Y, Liu S, Li H, Duan X, Shu C, Ouyang C. The novel hybrid polycarbonate polyurethane / polyester three-layered large-diameter artificial blood vessel. J Biomater Appl 2021; 36:965-975. [PMID: 34284662 DOI: 10.1177/08853282211033415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The most common materials of artificial blood vessels are polyethylene terephthalate and polytetrafluoroethylene. But polycarbonate polyurethane (PCU) is an ideal material for vascular prostheses because of their excellent characteristics. As far as we know, our artificial blood vessel is the first type of hybrid PCU/polyester three-layered large-diameter artificial blood vessel in the world. OBJECTIVE The purpose of this preclinical animal experiment is to evaluate the hemocompatibility, histocompatibility, effectiveness, and safety of the three-layered large-diameter artificial blood vessel in sheep. METHODS The artificial blood vessels took place of the initial segments of the sheep's thoracic aorta by end-to-end anastomosis. RESULTS All of the 14 sheep are male, their average body weight (BW) was 30.57 ± 3.95 kg. All 14 artificial blood vessels successfully replaced the thoracic aortas. 5 sheep did not survive to the end of the experiment, while the remaining 9 sheep did. After the surgery, the blood biochemical and blood routine indicators fluctuate slightly within the normal range. The angiography showed that the implanted artificial blood vessels were unobstructed without obvious stenosis or expansion. 24 weeks after surgery, the lumen surfaces of the artificial blood vessels were covered by endothelia in different degrees, and the average endothelialization rate was 69.44% (range: 20% to 100%). CONCLUSIONS This artificial blood vessel is the first to use PCU in large-diameter artificial vascular grafts. It has excellent blood compatibility, wonderful biocompatibility, high endothelialization rate, and 100% patency.
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Affiliation(s)
- Yuanrui Gu
- Department of Vascular, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chen Tian
- Department of Vascular, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yilang Qin
- Department of Vascular, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yangxue Sun
- 2nd Department of Pediatric Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sishi Liu
- Wuhan Yangsen Biotechnology Co., Ltd, Wuhan, China
| | - Huichai Li
- Wuhan Yangsen Biotechnology Co., Ltd, Wuhan, China
| | - Xuejing Duan
- Department of Pathology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chang Shu
- Department of Vascular, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Vascular Surgery, The Second Xiangya Hospital, Vascular Disease Institute, Central South University, Changsha, China
| | - Chenxi Ouyang
- Department of Vascular, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Infections of the aorta. Indian J Thorac Cardiovasc Surg 2021; 38:101-114. [PMID: 35463716 PMCID: PMC8980989 DOI: 10.1007/s12055-021-01173-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/21/2021] [Accepted: 02/23/2021] [Indexed: 10/21/2022] Open
Abstract
Infection of the aorta continues to be a clinical challenge with high morbidity and mortality. The incidence varies between 0.6 and 2.6%. There has been a steady increase in graft infections, especially endograft infections, due to increased procedures (0.2 to 5%). Staphylococcus species remains the most common organism; however, gram-negative and rare causative agents are also reported. The clinical presentation can be very diverse and a high degree of suspicion is necessary to diagnose them. Sometimes, they may present as an emergency with rupture or fistulation. Diagnosis is based on a triad of clinical features, microbial cultures and imaging. Culture-specific antibiotics are mandatory during the entire course, but seldom cure alone. Surgical management remains the standard of care and involves an integrated approach involving debridement, reconstruction and use of adjuncts. Various aortic substitutes have been described with advantages and limitations. Pericardial tube grafts have emerged as a good option. Endo-vascular options are practiced mostly as a bridge to definitive surgery. A small role for conservative management is described. Aortic fistulation to the gut and airway carries a very high mortality. There are no large series in the literature to define guideline-directed treatment and most often it is a customized solution. The 30-day mortality remains close to 30%. Outcomes depend on multiple factors including patient's age, the timing of presentation, diagnosis, causative organism, host status and the treatment strategy adopted.
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von der Höh NH, Pieroh P, Henkelmann J, Branzan D, Völker A, Wiersbicki D, Heyde CE. Spondylodiscitis due to transmitted mycotic aortic aneurysm or infected grafts after endovascular aortic aneurysm repair (EVAR): A retrospective single-centre experience with short-term outcomes. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 30:1744-1755. [PMID: 32895774 DOI: 10.1007/s00586-020-06586-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/25/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE To report the challenging therapeutic approach and the clinical outcome of patients with pyogenic spondylodiscitis transmitted due to infected retroperitoneal regions of primary infected mycotic aortic aneurysms (MAAs) or secondary infected aortic stent grafts after endovascular aneurysm repair (EVAR). METHODS Between 2012 and 2019, all patients suffering from spondylodiscitis based on a transmitted infection after the EVAR procedure were retrospectively identified. Patient data were analysed regarding the time between primary and secondary EVAR infection and spondylodiscitis detection, potential source of infection, pathogens, antibiotic treatment, complications, recovery from infection, mortality, numeric rating scale (NRS), COBB angle and cage subsidence. RESULTS Fifteen patients with spondylodiscitis transmitted from primary or secondary infected aortic aneurysms after EVAR were included. The median follow-up time was 8 months (range 1-47). Surgery for spondylodiscitis was performed in 12 patients. In 9 patients, the infected graft was treated conservatively. MAAs were treated in 4 patients first with percutaneous aortic stent graft implantation followed by posterior surgery of the infected spinal region in a two-step procedure. Infection recovery was recorded in 11 patients during follow-up. The overall mortality rate was 27% (n = 4). The mean pain intensity improved from an NRS score of 8.4 (3.2-8.3) to 3.1 (1.3-6.7) at the last follow-up. CONCLUSION EVAR was used predominantly to treat primary infected MAAs. Secondary infected grafts were treated conservatively. Independent of vascular therapy, surgery of the spine led to recovery in most cases. Thus, surgery should be considered for the treatment of EVAR- and MAA-related spondylodiscitis.
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Affiliation(s)
- Nicolas Heinz von der Höh
- Department of Orthopaedic, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstr. 18, 04103, Leipzig, Germany.
| | - Philipp Pieroh
- Department of Orthopaedic, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstr. 18, 04103, Leipzig, Germany
| | - Jeanette Henkelmann
- Department for Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstr. 18, 04103, Leipzig, Germany
| | - Daniela Branzan
- Department of Visceral, Transplant, Thorax and Vascular Surgery, University Hospital Leipzig, Liebigstr. 18, 04103, Leipzig, Germany
| | - Anna Völker
- Department of Orthopaedic, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstr. 18, 04103, Leipzig, Germany
| | - Dina Wiersbicki
- Department of Orthopaedic, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstr. 18, 04103, Leipzig, Germany
| | - Christoph-Eckhard Heyde
- Department of Orthopaedic, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstr. 18, 04103, Leipzig, Germany
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Late Open Conversion Following Failure of EVAR and TEVAR: “State of the Art”. Cardiovasc Intervent Radiol 2020; 43:1855-1864. [DOI: 10.1007/s00270-020-02636-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/26/2020] [Indexed: 12/19/2022]
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Dziekiewicz M, Laska G, Makowski K. Undersized Stentgraft Placement for Traumatic Descending Aorta Rupture, and What Is Next? AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e926299. [PMID: 32728016 PMCID: PMC7417028 DOI: 10.12659/ajcr.926299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/20/2020] [Accepted: 06/24/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Traumatic injury of the thoracic aorta is proving to be not only the most lethal of traumatic injuries, but also the most urgent reason for vascular intervention among all trauma patients. Endovascular aortic repair is used increasingly often to treat traumatic injuries. We report a case of endovascular treatment and its use as a delayed correction (two-stage treatment) for a traumatic aortic isthmus rupture. CASE REPORT A 20-year-old Asian male was admitted to our department after a car accident presenting symptoms of ischemic shock. Among multiple injuries, a traumatic descending aorta rupture was diagnosed. The patient was referred directly to the operating room for a thoracic endovascular aortic repair (TEVAR). The patient's other trauma-related injuries required additional interventions in the following days. Thirty days after the emergent TEVAR operation, the patient required reintervention due to a major type-I endoleak. Computed tomography angiography revealed a failed stentgraft deployment. We removed the mismatched endovascular equipment and deployed an appropriately sized stentgraft during a hybrid procedure, excluding the ruptured aortic wall altogether. CONCLUSIONS Endovascular treatment of both children and small-framed adults remains a challenge for operating teams. First, no dedicated equipment can be found on the market. Second, measuring and fitting endovascular equipment constitutes a sore point in treatment, so in emergency situations, only off-the-shelf tools are accessible. We assert that, in such cases, the primary procedure should be understood as a lifesaving intervention, awaiting a final and long-lasting solution.
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Affiliation(s)
- Mirosław Dziekiewicz
- Department of Vascular and Endovascular Surgery, Military Institute of Medicine, Warsaw, Poland
| | - Grażyna Laska
- Department of Vascular and Endovascular Surgery, Military Institute of Medicine, Warsaw, Poland
| | - Karol Makowski
- Department of Military Health Service, Ministry of Defense, Warsaw, Poland
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Nogami E, Takeuchi Y, Koga Y, Kitsuka T, Amamoto S, Takahashi B, Uchino M, Yoshitake S, Takamatsu M, Itoh M, Yunoki J, Tanaka A, Kamohara K. Placement of a Zenith® Dissection Endovascular System in the Descending Thoracic Aorta Can Hamper Further Surgical Aortic Operations. EJVES Vasc Forum 2020; 48:1-4. [PMID: 33937893 PMCID: PMC8077723 DOI: 10.1016/j.ejvsvf.2020.05.006] [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: 12/20/2019] [Revised: 04/20/2020] [Accepted: 05/18/2020] [Indexed: 11/28/2022] Open
Abstract
Introduction The efficacy of endovascular treatment for complicated Stanford type B acute aortic dissection is being established. However, aortic events sometimes occur, and some cases require surgical intervention. Report A 52 year old man underwent ascending aorta replacement for Stanford type A acute aortic dissection in August 2016. Post-operative computed tomography (CT) showed residual dissection from the aortic arch to the right common iliac artery and a large re-entry in the right common iliac artery (RCIA). Two months after the operation, CT revealed enlargement of the false lumen of the thoracic aorta and the thoracic aortic diameter. Aiming to reduce the false lumen and remodel the aorta, a three stage operation was performed, as described below. Four months after the dissection, total aortic arch replacement and a frozen elephant trunk insertion were performed as the first stage. Subsequently, as a second stage operation, thoracic endovascular repair (TEVAR) was performed using a Zenith® Dissection Endovascular System (Cook Japan Co., Ltd, Tokyo, Japan), with the aim of expanding the true aortic lumen. The implanted devices were a stent graft for the proximal part and two bare stents for the middle and distal part. As a third stage operation, abdominal aortic endovascular treatment was performed with the purpose of closing the re-entry from the RCIA. However, two years after the three stage operation, CT showed that the thoracic aorta was over 60 mm in diameter. Graft replacement of the thoraco-abdominal aorta was performed. The bare stents were expected to be easily removable from the aorta, but unexpectedly, they were strongly attached to the intima, which made it extremely difficult to perform surgical and aortic operations. Discussion Surgical operations for the aorta can become more difficult after bare stent placement in the aorta. Surgical operations on the aorta can be hampered after intra-aortic bare stent placement. The bare stents and the intima of the true lumen were integrated. Operability seemed to be relatively smooth when the electric cautery was operated at a high output.
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Affiliation(s)
- Eijiro Nogami
- Corresponding author. Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga City 840-8571, Japan.
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Chakfé N, Diener H, Lejay A, Assadian O, Berard X, Caillon J, Fourneau I, Glaudemans AWJM, Koncar I, Lindholt J, Melissano G, Saleem BR, Senneville E, Slart RHJA, Szeberin Z, Venermo M, Vermassen F, Wyss TR, de Borst GJ, Bastos Gonçalves F, Kakkos SK, Kolh P, Tulamo R, Vega de Ceniga M, von Allmen RS, van den Berg JC, Debus ES, Koelemay MJW, Linares-Palomino JP, Moneta GL, Ricco JB, Wanhainen A. Editor's Choice - European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Vascular Graft and Endograft Infections. Eur J Vasc Endovasc Surg 2020; 59:339-384. [PMID: 32035742 DOI: 10.1016/j.ejvs.2019.10.016] [Citation(s) in RCA: 266] [Impact Index Per Article: 66.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Trahanas JM, Kwolek CJ, Tolis G. Open Tacking of a Migrated Thoracic Endovascular Aortic Graft. Ann Vasc Surg 2019; 63:461.e7-461.e9. [PMID: 31629854 DOI: 10.1016/j.avsg.2019.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 09/01/2019] [Accepted: 09/13/2019] [Indexed: 11/18/2022]
Abstract
Complications of thoracic endovascular aortic repair (TEVAR) are beginning to emerge as novel vascular issues. While endovascular solutions exist for most, some graft complications require a more traditional open solution. These operations are most commonly performed for endoleak or disease progression. Much less frequently observed is the migration of the endograft requiring open reintervention. Herein we present a case of a proximally migrated TEVAR graft, which required open fixation under deep hypothermic circulatory arrest (DHCA).
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Affiliation(s)
- John M Trahanas
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, MA.
| | - Christopher J Kwolek
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA
| | - George Tolis
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, MA
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20
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Late open conversion after thoracic endovascular aortic repair. J Vasc Surg 2019; 70:439-448.e1. [DOI: 10.1016/j.jvs.2018.11.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 11/05/2018] [Indexed: 11/17/2022]
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21
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Okita Y, Yamanaka K, Okada K. Opinion: Aortic Graft Infection—Any Guidelines or Just Surgeon's Experience Lines! Semin Thorac Cardiovasc Surg 2019; 31:674-678. [DOI: 10.1053/j.semtcvs.2019.05.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 05/02/2019] [Indexed: 11/11/2022]
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Hattori S, Noguchi K, Gunji Y, Nagatsuka M, Yamabe T, Ogino H, Katayama I. Descending aortic banding for re-rupture of retrograde aortic dissection after emergency thoracic endovascular aortic repair. Gen Thorac Cardiovasc Surg 2018; 68:70-73. [PMID: 30244366 DOI: 10.1007/s11748-018-1016-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 09/15/2018] [Indexed: 11/30/2022]
Abstract
Conversion to open repair after thoracic endovascular aortic repair (TEVAR) for acute type B aortic dissection is rare, but inevitable. We present a case of an 86-year-old man with ruptured type B aortic dissection after TEVAR. He received a successful stent-graft implantation of the descending aorta without any type of endoleak. After the patient was transferred to the intensive care unit, he went into a shock state. Contrast-enhanced CT revealed a re-rupture of acute retrograde type B aortic dissection. The false lumen was patent and perforated to the left thorax. Left thoracotomy and descending aortic banding was performed. Descending aorta was encircled with a woven Dacron graft at the distal part of the rupture site to compress the patent false lumen. The bleeding was stopped, and the follow-up CT showed false lumen thrombosis. Descending aortic banding is one of the quick and effective open conversion techniques.
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Affiliation(s)
- Shigeru Hattori
- Department of Cardiovascular Surgery, Aortic Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan.
| | - Kenichiro Noguchi
- Department of Cardiovascular Surgery, Aortic Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Yusuke Gunji
- Department of Cardiovascular Surgery, Aortic Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Motoki Nagatsuka
- Department of Cardiovascular Surgery, Aortic Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Tsuyoshi Yamabe
- Department of Cardiovascular Surgery, Aortic Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Hidemitsu Ogino
- Department of Cardiovascular Surgery, Aortic Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Ikuo Katayama
- Department of Cardiovascular Surgery, Aortic Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
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Yu B, Liu Z, Xue C, Liu J, Yang J, Jin Z, Yu S, Duan W. Total arch repair with open placement of a novel double-branched stent graft for acute Type A aortic dissection: a single-centre experience with 21 consecutive patients. Interact Cardiovasc Thorac Surg 2018; 28:262-269. [PMID: 30084994 DOI: 10.1093/icvts/ivy243] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 06/27/2018] [Indexed: 01/12/2023] Open
Affiliation(s)
- Bo Yu
- Department of Cardiovascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, China
| | - ZhenHua Liu
- Department of Cardiovascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Chao Xue
- Department of Cardiovascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, China
| | - JinCheng Liu
- Department of Cardiovascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Jian Yang
- Department of Cardiovascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, China
| | - ZhenXiao Jin
- Department of Cardiovascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, China
| | - ShiQiang Yu
- Department of Cardiovascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, China
| | - WeiXun Duan
- Department of Cardiovascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, China
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Masaki N, Kumagai K, Sasaki K, Matsuo S, Motoyoshi N, Adachi O, Akiyama M, Kawamoto S, Tabayashi K, Saiki Y. Suppressive effect of pitavastatin on aortic arch dilatation in acute stanford type B aortic dissection: analysis of STANP trial. Gen Thorac Cardiovasc Surg 2018; 66:334-343. [PMID: 29626287 DOI: 10.1007/s11748-018-0916-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 03/27/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Medical therapy for patients with uncomplicated acute type B aortic dissection (ABAD) is essentially accepted for its excellent early outcome; however, long-term outcomes have not been satisfactory due to aorta-related complications. This trial was performed to investigate the efficacy of a statin as an additive that may enhance the effectiveness of conventional medical treatment in patients with ABAD. METHODS This was a multi-center, prospective, and randomized comparative investigation of patients with uncomplicated ABAD. Fifty patients with ABAD compatible with inclusion criteria were randomly assigned to two groups and then received administration of pitavastatin (group P) or not (group C). We followed up the patients for 1 year from study onset. RESULTS Two patients demised during the follow-up period (both were in group C). In addition, aorta-related interventions were performed in two patients (entry closure for aortic dissection by endovascular repair in one patient in each group). Aortic arch diameters at 1 year in group P tended to be smaller than in group C (P = 0.17), and the rate of change of the aortic arch diameters from onset to 1 year was significantly lower in group P (P = 0.046). Multivariate analysis identified patency of the false lumen was detected as a risk factor for aortic arch dilatation (P = 0.02), and pitavastatin intake was a negative risk factor (P = 0.03). CONCLUSIONS Pitavastatin treatment, in addition to the standard antihypertensive therapy, may have a suppressive effect on aortic arch dilatation in patients with ABAD.
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Affiliation(s)
- Naoki Masaki
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Seiryocho, Aoba-ku, Sendai, 980-8574, Japan
| | - Kiichiro Kumagai
- Research Division of Sciences for Aortic Disease, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Konosuke Sasaki
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Seiryocho, Aoba-ku, Sendai, 980-8574, Japan
| | - Satoshi Matsuo
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Seiryocho, Aoba-ku, Sendai, 980-8574, Japan
| | - Naotaka Motoyoshi
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Seiryocho, Aoba-ku, Sendai, 980-8574, Japan
| | - Osamu Adachi
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Seiryocho, Aoba-ku, Sendai, 980-8574, Japan
| | - Masatoshi Akiyama
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Seiryocho, Aoba-ku, Sendai, 980-8574, Japan
| | - Shunsuke Kawamoto
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Seiryocho, Aoba-ku, Sendai, 980-8574, Japan
| | - Koichi Tabayashi
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Seiryocho, Aoba-ku, Sendai, 980-8574, Japan
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Seiryocho, Aoba-ku, Sendai, 980-8574, Japan.
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Davidovic L, Sladojevic M, Koncar I, Markovic M, Ulus T, Ilic N, Dragas M, Cvetic V, Rancic Z. Late Complication after Thoracic Endovascular Aortic Repair: What Is the Role of an Open Surgical Conversion? Ann Vasc Surg 2018; 47:238-246. [DOI: 10.1016/j.avsg.2017.08.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 08/12/2017] [Accepted: 08/31/2017] [Indexed: 01/16/2023]
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Tian Y, Zhang W, Sun J, Zhai H, Yu Y, Qi X, Jones JA, Zhong H. A reproducible swine model of proximal descending thoracic aortic aneurysm created with intra-adventitial application of elastase. J Vasc Surg 2018; 67:300-308.e2. [PMID: 28479097 DOI: 10.1016/j.jvs.2016.12.120] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 12/29/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Animal models are required to explore the mechanisms of and therapy for proximal descending thoracic aortic aneurysm (TAA). This study aimed to establish a reproducible swine model of proximal descending TAA that can further explain the occurrence and progression of proximal descending TAA. METHODS Eighteen Chinese Wuzhishan miniature pigs (30.32 ± 1.34 kg) were randomized into the elastase group (n = 12) and the control group (n = 6). The elastase group received intra-adventitial injections of elastase (5 mL, 20 mg/mL), and the control group received injections of physiologic saline solution. A 4-cm descending thoracic aortic segment proximal to the left subclavian artery was isolated. The distance between the left subclavian artery and the injection starting point of the descending thoracic aorta was 0.5 cm. Elastic protease was circumferentially injected intra-adventitially into the isolated segment of the aortic wall in the elastase group by a handmade bent syringe. The length of the elastic protease injection was 2 cm. An average of 12 injection points were distributed in this 2-cm aortic segment. Each injection point used about 0.4 mL of elastic protease. The distance between two injection points was about 1.5 cm. All animals underwent digital subtraction angiography preoperatively and 3 weeks after operation. Three weeks after TAA induction, aortas were harvested for biochemical and histologic measurements. RESULTS All animals in the elastase group developed TAAs. No aneurysms were observed in the control group. The distance between the left subclavian artery and the TAA was 8.00 ± 4.19 mm. Preoperative and postoperative aortic diameters of the elastase group were 15.42 ± 0.43 mm and 24.53 ± 1.41 mm, respectively (P < .0001). Preoperative and postoperative aortic diameters of the control group were 15.31 ± 0.33 mm and 15.57 ± 0.40 mm, respectively (P = .5211). The changes of aortic structure and composition included reduction of smooth muscle cells and degradation of elastic fibers. Levels of matrix metalloproteinases 2 and 9 were increased in TAA tissue. CONCLUSIONS This study established a reproducible large animal model of proximal descending TAA. This model has the same biochemical characteristics as human aneurysms in the aspects of aortic expansion, aortic middle-level degeneration, and changes in the levels of matrix metalloproteinases and provides a platform for further study.
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MESH Headings
- Adventitia/drug effects
- Adventitia/pathology
- Angiography, Digital Subtraction
- Animals
- Aorta, Thoracic/diagnostic imaging
- Aorta, Thoracic/drug effects
- Aorta, Thoracic/pathology
- Aortic Aneurysm, Thoracic/chemically induced
- Aortic Aneurysm, Thoracic/diagnostic imaging
- Aortic Aneurysm, Thoracic/pathology
- Disease Models, Animal
- Disease Progression
- Elastic Tissue/drug effects
- Elastic Tissue/pathology
- Humans
- Male
- Matrix Metalloproteinase 2/metabolism
- Matrix Metalloproteinase 9/metabolism
- Pancreatic Elastase/pharmacology
- Random Allocation
- Swine/physiology
- Swine, Miniature/anatomy & histology
- Swine, Miniature/physiology
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Affiliation(s)
- Yulong Tian
- Department of Interventional Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China; Laboratory of Medical Imaging and Interventional Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Wei Zhang
- Department of Intervention and Department of Shenzhen Medical Intervention Engineering Center, The Second Clinical Medical College, Jinan University, Shenzhen, China
| | - Jun Sun
- Department of Interventional Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China; Laboratory of Medical Imaging and Interventional Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Huan Zhai
- Department of Interventional Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China; Laboratory of Medical Imaging and Interventional Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yang Yu
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Xingshun Qi
- Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, China
| | - Jeffrey A Jones
- Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC
| | - Hongshan Zhong
- Department of Interventional Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China; Laboratory of Medical Imaging and Interventional Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China.
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Open descending thoracic or thoracoabdominal aortic approaches for complications of endovascular aortic procedures: 19-year experience. J Thorac Cardiovasc Surg 2018; 155:10-18. [DOI: 10.1016/j.jtcvs.2017.08.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 07/20/2017] [Accepted: 08/11/2017] [Indexed: 11/19/2022]
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Sica G, Rea G, Bocchini G, Lombardi R, Muto M, Valente T. Aortopulmonary Fistula Presenting without an Endoleak after Thoracic Endovascular Aortic Repair. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2017; 50:287-290. [PMID: 28795035 PMCID: PMC5548206 DOI: 10.5090/kjtcs.2017.50.4.287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 02/22/2017] [Accepted: 03/29/2017] [Indexed: 01/16/2023]
Abstract
Herein, we report the case of a 60-year-old man, a smoker with a history of arterial hypertension and diabetes mellitus. After computed tomography (CT) for an episode of hemoptysis, the patient underwent elective thoracic endovascular aortic repair (TEVAR) because of a degenerative aneurysm of the descending thoracic aorta. The area of perianeurysmal pulmonary atelectasis reported on the CT scan was not considered. Three months later, he developed an aortopulmonary fistula without endoleaks. Although TEVAR is a relatively safe procedure, no detail should be overlooked in the preoperative evaluation in order to avoid life-threatening complications. Further, the effectiveness and modality of prolonged antibiotic prophylaxis and/or preoperative respiratory physiotherapy should be assessed in such cases.
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Affiliation(s)
- Giacomo Sica
- Division of Radiology, Department of Diagnostic Imaging, Monaldi Hospital
| | - Gaetano Rea
- Division of Radiology, Department of Diagnostic Imaging, Monaldi Hospital
| | - Giorgio Bocchini
- Division of Radiology, Department of Diagnostic Imaging, Monaldi Hospital
| | - Romilda Lombardi
- Division of Radiology, Department of Diagnostic Imaging, AO Rummo
| | - Massimo Muto
- Division of Radiology, Department of Diagnostic Imaging, Monaldi Hospital
| | - Tullio Valente
- Division of Radiology, Department of Diagnostic Imaging, Monaldi Hospital
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Comparison of endovascular repair with branched stent graft and open repair for aortic arch aneurysm†. Interact Cardiovasc Thorac Surg 2017; 25:246-253. [DOI: 10.1093/icvts/ivx111] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 03/07/2017] [Indexed: 11/14/2022] Open
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30
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Sodha NR. Complex homograft aortic reconstruction: New recipes from old ingredients. J Thorac Cardiovasc Surg 2017; 153:e77-e79. [PMID: 28411752 DOI: 10.1016/j.jtcvs.2017.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 01/05/2017] [Indexed: 10/20/2022]
Affiliation(s)
- Neel R Sodha
- Department of Surgery, Lifespan Thoracic Aortic Center, Providence, RI; Division of Cardiac Surgery, Alpert Medical School, Brown University, Providence, RI.
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31
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Megaloikonomos PD, Antoniadou T, Dimopoulos L, Liontos M, Igoumenou V, Panagopoulos GN, Giannitsioti E, Lazaris A, Mavrogenis AF. Spondylitis transmitted from infected aortic grafts: a review. J Bone Jt Infect 2017; 2:96-103. [PMID: 28540144 PMCID: PMC5441139 DOI: 10.7150/jbji.17703] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Graft infection following aortic aneurysms repair is an uncommon but devastating complication; its incidence ranges from <1% to 6% (mean 4%), with an associated perioperative and overall mortality of 12% and 17.5-20%, respectively. The most common causative organisms are Staphylococcus aureus and Escherichia coli; causative bacteria typically arise from the skin or gastrointestinal tract. The pathogenetic mechanisms of aortic graft infections are mainly breaks in sterile technique during its implantation, superinfection during bacteremia from a variety of sources, severe intraperitoneal or retroperitoneal inflammation, inoculation of bacteria during postoperative percutaneous interventions to manage various types of endoleaks, and external injury of the vascular graft. Mechanical forces in direct relation to the device were implicated in fistula formation in 35% of cases of graft infection. Partial rupture and graft migration leading to gradual erosion of the bowel wall and aortoenteric fistulas have been reported in 30.8% of cases. Rarely, infection via continuous tissues may affect the spine, resulting in spondylitis. Even though graft explantation and surgical debridement is usually the preferred course of action, comorbidities and increased perioperative risk may preclude patients from surgery and endorse a conservative approach as the treatment of choice. In contrast, conservative treatment is the treatment of choice for spondylitis; surgery may be indicated in approximately 8.5% of patients with neural compression or excessive spinal infection. To enhance the literature, we searched the related literature for published studies on continuous spondylitis from infected endovascular grafts aiming to summarize the pathogenesis and diagnosis, and to discuss the treatment and outcome of the patients with these rare and complex infections.
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Affiliation(s)
- Panayiotis D Megaloikonomos
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
| | - Thekla Antoniadou
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
| | - Leonidas Dimopoulos
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
| | - Marcos Liontos
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
| | - Vasilios Igoumenou
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
| | - Georgios N Panagopoulos
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
| | - Efthymia Giannitsioti
- Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
| | - Andreas Lazaris
- Department of Vascular Surgery, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University Hospital, Athens, Greece
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