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Minici R, Serra R, Ierardi AM, Petullà M, Bracale UM, Carrafiello G, Laganà D. Thoracic endovascular repair for blunt traumatic thoracic aortic injury: Long-term results. Vascular 2024; 32:5-18. [PMID: 36121832 DOI: 10.1177/17085381221127740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study aims to evaluate the endoprosthesis complications in patients undergoing TEVAR for blunt traumatic thoracic aortic injury, through long-term clinical and diagnostic follow-up. METHODS During the study interval (November 2000-October 2020), a total of 38 patients (63% male; average age 37.5 years) with thoracic aortic injury underwent thoracic endovascular aortic repair. Patients underwent routine follow-up with clinical examination and radiological evaluation (CT-angiography or MRI-angiography plus chest radiograph), scheduled at 1 month, at 6 months (only in the cases of thoracic aortic dissection), at 1 year after the procedure and every 1 year thereafter. RESULTS Technical success was achieved in 38 procedures (100%). The TEVAR-related mortality rate was 0%. No immediate major complications related to the endovascular procedure were observed. The median duration of diagnostic follow-up was 80 months. A total of four procedure-related complications (10.5%) were identified at the follow-up. Three (7.9%) distal infoldings and collapses of the thoracic endoprosthesis and one (2.6%) type Ia endoleak were observed. No thrombosis of the prosthesis, nor signs of aortic pseudocoarctation were identified. No further complications related to endograft (endoleaks, infections, rupture, partial or complete thrombosis) occurred. No changes in the native aorta, stenosis, or increases in the endograft's diameters were observed. A total of 20 patients (52.6%) underwent MRI-angiography examinations, while a total of 34 patients (89.5%) underwent chest radiographs at the follow-up. In all cases, CT-angiography examinations were performed at the follow-up. CONCLUSIONS Procedure-related complications were observed within one year of TEVAR, limiting concerns related to the durability of the prosthesis. No morphological changes in the aorta were observed despite long-term follow-up. The consequences of lifelong surveillance in terms of radiation exposure deserve special consideration, especially in younger patients treated for TAI.
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Affiliation(s)
- Roberto Minici
- Radiology Division, Department of Experimental and Clinical Medicine, University Hospital Mater Domini, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Raffaele Serra
- Vascular Surgery Division, Department of Medical and Surgical Sciences, University Hospital Mater Domini, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Anna Maria Ierardi
- Radiology Division, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Maria Petullà
- Radiology Division, Department of Experimental and Clinical Medicine, University Hospital Mater Domini, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Umberto M Bracale
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Gianpaolo Carrafiello
- Radiology Division, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
- Department of Health Sciences, Università Degli Studi di Milano, Milan, Italy
| | - Domenico Laganà
- Radiology Division, Department of Experimental and Clinical Medicine, University Hospital Mater Domini, Magna Graecia University of Catanzaro, Catanzaro, Italy
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Badalamenti G, Ferrer C, Calvagna C, Franchin M, Piffaretti G, Taglialavoro J, Bassini S, Griselli F, Grando B, Lepidi S, D'Oria M. Major vascular traumas to the neck, upper limbs, and chest: Clinical presentation, diagnostic approach, and management strategies. Semin Vasc Surg 2023; 36:258-267. [PMID: 37330239 DOI: 10.1053/j.semvascsurg.2023.04.010] [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: 02/03/2023] [Revised: 04/14/2023] [Accepted: 04/17/2023] [Indexed: 06/19/2023]
Abstract
Major vascular traumas to the neck, upper limbs, and chest may arise from penetrating and/or blunt mechanisms, resulting in a range of clinical scenarios. Lesions to the carotid arteries may also lead to neurologic complications, such as stroke. The increasing use of invasive arterial access for diagnostic and/or interventional purposes has increased the rate of iatrogenic injuries, which usually occur in older and hospitalized patients. Bleeding control and restoration of perfusion represent the two main goals of treatment for vascular traumatic lesions. Open surgery still represents the gold standard for most lesions, although endovascular approaches have increasingly emerged as feasible and effective options, particularly for management of subclavian and aortic injuries. In addition to advanced imaging (including ultrasound, contrast-enhanced cross-sectional imaging, and arteriography) and life support measures, multidisciplinary care is required, particularly in the setting of concomitant injuries to the bones, soft tissues, or other vital organs. Modern vascular surgeons should be familiar with the whole armamentarium of open and endovascular techniques needed to manage major vascular traumas safely and promptly.
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Affiliation(s)
- Giovanni Badalamenti
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Strada di Fiume 447, Trieste, Italy
| | - Ciro Ferrer
- Vascular and Endovascular Surgery Unit, 90352 San Giovanni - Addolorata Hospital, Roma, Italy
| | - Cristiano Calvagna
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Strada di Fiume 447, Trieste, Italy
| | - Marco Franchin
- Vascular Surgery Unit, Circolo University Teaching Hospital, University of Insubria - ASST Settelaghi, Varese, Italy
| | - Gabriele Piffaretti
- Vascular Surgery Unit, Circolo University Teaching Hospital, University of Insubria - ASST Settelaghi, Varese, Italy
| | - Jacopo Taglialavoro
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Strada di Fiume 447, Trieste, Italy
| | - Silvia Bassini
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Strada di Fiume 447, Trieste, Italy
| | - Filippo Griselli
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Strada di Fiume 447, Trieste, Italy
| | - Beatrice Grando
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Strada di Fiume 447, Trieste, Italy
| | - Sandro Lepidi
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Strada di Fiume 447, Trieste, Italy
| | - Mario D'Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste ASUGI, Strada di Fiume 447, Trieste, Italy.
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Late Stent Thrombosis in a Patient with Endovascular Aortic Repair for Blunt Thoracic Aortic Injury. Case Rep Vasc Med 2022; 2022:5583120. [PMID: 35198259 PMCID: PMC8860563 DOI: 10.1155/2022/5583120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 01/03/2022] [Accepted: 01/06/2022] [Indexed: 11/18/2022] Open
Abstract
Blunt thoracic aortic injury (BTAI) is associated with high mortality and morbidity. Thoracic endovascular aortic repair has become the recommended treatment modality given improved short-term results compared to open repair. We present a case of a 19-year-old male who presented with acute paralysis and multiorgan dysfunction from acute TEVAR thrombosis. Systemic thrombolysis, catheter-directed thrombolysis followed by aspiration thrombectomy, and angioplasty were initially successful in restoring perfusion. However, he developed progressive multiorgan failure related to prompt reocclusion within 48 hours. This case is the first to describe thrombolysis and angioplasty as a management strategy for acute TEVAR thrombosis. We also review the literature surrounding this uncommon complication.
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Beijer E, Scholtes VPW, Truijers M, Nederhoed JH, Yeung KK, Blankensteijn JD. Intragraft Obstructive Thrombus Two Years After Endovascular Repair of Traumatic Aortic Injury: A Case Report and Review of the Literature. EJVES Vasc Forum 2021; 53:36-41. [PMID: 34927115 PMCID: PMC8652008 DOI: 10.1016/j.ejvsvf.2021.10.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 08/07/2021] [Accepted: 10/20/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction Thoracic endovascular aortic repair (TEVAR) is the treatment of choice for blunt thoracic aortic injury (BTAI) and has proven to be a good alternative to open surgery. TEVAR requires less operation time, has fewer complications, can be used for relatively unstable patients, and is associated with a significantly lower mortality rate. Moreover, long term follow up data demonstrate low re-intervention rates and stentgraft failure. Report The case of a 21 year old man who sustained severe trauma, including a traumatic pseudoaneurysm of the descending thoracic aorta distal to the left subclavian artery in 2016, is presented. The patient was treated by TEVAR. Two years later, he presented with progressive paraplegia due to stentgraft occlusion occurring four days after a new high velocity motor vehicle accident. An axillofemoral bypass was performed to assure blood flow to the lower body. Two days later the stentgraft was removed via left thoracotomy and replaced by a Dacron graft. Gross examination showed severe thrombus formation at the proximal edge, and a thrombotic occlusion in the middle and distal third of the stent. After three months of hospitalisation the patient was discharged to a rehabilitation clinic with partial recovery of his paraplegia. As of June 2020, the patient was able to walk without assistance and his paraplegia improved with only loss of sensation of his lower legs. Conclusion A serious thrombotic complication two years after TEVAR is described. Although TEVAR is the currently preferred treatment for BTAI, more research is needed to examine the mechanisms behind this thrombotic complication and to elucidate whether TEVAR is definitive treatment or a “bridge to further surgery”. Smaller diameter stentgrafts, anticoagulation, regular (lifelong) follow up imaging, and prophylactic surgical conversion in (selected) patients might help to prevent this serious complication. Although thoracic endovascular aortic repair is the first choice treatment for blunt thoracic aortic injury, the cause of intragraft thrombus is unknown. Nine cases have been reported with thrombotic (near) occlusions of thoracic stentgrafts. This is the first reported total occlusion following a second trauma. Oversizing and trauma can potentially play a role in the formation and progression of obstructive thrombus in thoracic stentgrafts. Follow up is important to detect intragraft thrombus deposition and to prevent major complications by adjusting anticoagulation or performing prophylactic removal of thrombotic stentgrafts.
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Affiliation(s)
- E Beijer
- Department of Surgery, Amsterdam University Medical Centre, location VUmc, Amsterdam, the Netherlands
| | - V P W Scholtes
- Department of Surgery, Amsterdam University Medical Centre, location VUmc, Amsterdam, the Netherlands
| | - M Truijers
- Department of Surgery, Amsterdam University Medical Centre, location VUmc, Amsterdam, the Netherlands
| | - J H Nederhoed
- Department of Surgery, Amsterdam University Medical Centre, location VUmc, Amsterdam, the Netherlands
| | - K K Yeung
- Department of Surgery, Amsterdam University Medical Centre, location VUmc, Amsterdam, the Netherlands
| | - J D Blankensteijn
- Department of Surgery, Amsterdam University Medical Centre, location VUmc, Amsterdam, the Netherlands
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5
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Kuo MC, Meena RA, Ramos CR, Benarroch-Gampel J, Leshnower BG, Duwayri Y, Jordan WD, Rajani RR. Female gender is associated with increased late luminal narrowing within the stent graft after thoracic endovascular aortic repair. J Vasc Surg 2021; 75:67-73. [PMID: 34450242 DOI: 10.1016/j.jvs.2021.07.226] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 07/21/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Luminal narrowing, suspected secondary to thrombus, occurs within stent grafts at an unclear incidence after thoracic endovascular aortic repair (TEVAR). The significance of this phenomenon has not been determined, nor have the risk factors for development of intragraft luminal narrowing. Small graft diameter is hypothesized to be a risk factor for the development of ingraft stenosis. METHODS A retrospective analysis was performed of a multicenter healthcare system including all patients who underwent TEVAR between July 2011 and July 2019 with at least 1 year of subsequently available surveillance contrast-enhanced computed tomography imaging. Standard demographic, preoperative, intraoperative, and postoperative variables were collected. Measurements were obtained via direct off-line images from computed tomography scans. Patent intragraft diameters were compared with baseline and interval change values were normalized to time to follow-up. The primary outcome measure was annual rate of intragraft luminal narrowing. RESULTS There were 208 patients who met the inclusion criteria (94 women, 114 men) with a median follow-up of 822 days. The mean annual rate of percent intragraft diameter reduction was 10.5 ± 7.7% for women and 7.6 ± 5.6% for men (P = .0026). Multivariate analysis demonstrated female gender (P = .0283), preoperative diagnosis of hypertension (P = .0449), and need for coverage of the left subclavian artery (P = .0328) were all significant predictors of intragraft luminal narrowing. Small aortic diameters were not found to be associated independently with ingraft luminal narrowing nor was the concomitant use of antiplatelet or anticoagulation medications. Significant amounts of ingraft luminal narrowing, defined as a greater than 20% intragraft diameter decrease, were associated with an increased need for any reintervention, including for malperfusion, endoleak, and symptomatic aneurysm (P = .0249). Kaplan-Meier estimates demonstrated a significant gender-associated difference in high rates of intragraft luminal narrowing (P = .00189). CONCLUSIONS In this analysis, female gender is shown to be a significant nonmodifiable risk factor for intragraft luminal narrowing after TEVAR. The development of this phenomenon is not benign; as such, these findings were associated with an increased need for reintervention. This finding may be attributable to differences in aortic compliance or gender-associated differences in coagulation pathways and merits further investigation. Surveillance after thoracic stent grafting must account for patient-specific variations in complication risk.
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Affiliation(s)
| | - R Anthony Meena
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Christopher R Ramos
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Jaime Benarroch-Gampel
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Bradley G Leshnower
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Yazan Duwayri
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Emory University School of Medicine, Atlanta, Ga
| | - William D Jordan
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Ravi R Rajani
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Emory University School of Medicine, Atlanta, Ga
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Beropoulis E, Fazzini S, Austermann M, Torsello GB, Damerau S, Torsello GF. Long-term Results of Thoracic Endovascular Aortic Repair Using a Low-Profile Stent-Graft. J Endovasc Ther 2020; 28:56-62. [PMID: 32942922 DOI: 10.1177/1526602820952416] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate the long-term results associated with the Zenith Alpha thoracic stent-graft, which was designed to address challenging access vessel anatomy. MATERIALS AND METHODS A retrospective analysis was conducted of 44 consecutive patients (mean age 72.5±8.3 years; 25 men) treated in a single center between August 2010 and October 2014 with a minimum follow-up of 5 years in survivors. The Zenith Alpha thoracic stent-graft was used to treat thoracic aortic aneurysms (n=37), thoracoabdominal aortic aneurysm (n=5), or penetrating aortic ulcer (n=2). Ten patients (23%) were American Society of Anesthesiologists class IV, and 9 (20%) had nonelective procedures. Access vessel anatomy was demanding (mean minimum diameter 5.4 mm, tortuosity index 1.3). The primary endpoint at 5 years was ongoing clinical success (freedom from aneurysm-/procedure-related death, secondary intervention, type I or III endoleak, infection, thrombosis, aneurysm expansion, rupture, or conversion). Secondary endpoints were freedom from all-cause mortality, device migration, stent fractures, fabric erosions, endoleaks, neurological events, and access vessel complications. RESULTS The ongoing clinical success was 84% (37 of 44 patients) owing to 4 aneurysm-related deaths (9%), 3 type I or III endoleaks (1 in a deceased patient), and 1 aneurysm expansion without detectable endoleak. There were 3 access vessel complications (7%), and no postoperative neurological events. Migration was observed in 2 cases (5%). There were no stent fractures or fabric tears. CONCLUSION Despite the alterations in stent-graft design and material to reduce profile, the Zenith Alpha thoracic stent-graft showed favorable long-term results even in multimorbid patients with demanding iliac anatomy.
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Affiliation(s)
| | - Stefano Fazzini
- Department of Vascular Surgery, St Franziskus Hospital Münster, Germany.,Vascular Surgery, La Sapienza University of Rome, Italy
| | - Martin Austermann
- Department of Vascular Surgery, St Franziskus Hospital Münster, Germany
| | | | - Sarah Damerau
- Department of Vascular Surgery, St Franziskus Hospital Münster, Germany
| | - Giovanni Federico Torsello
- Department of Vascular Surgery, St Franziskus Hospital Münster, Germany.,Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Charité Campus Virchow-Klinikum, Charité University Medicine Berlin, Germany
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Endovascular repair of traumatic aortic isthmic rupture: Early and mid-term results. JOURNAL DE MÉDECINE VASCULAIRE 2020; 45:254-259. [PMID: 32862982 DOI: 10.1016/j.jdmv.2020.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/13/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Conventional open repair of a traumatic aortic isthmic rupture is associated with a significantly high mortality and morbidity rates. Thoracic endovascular aortic repair (TEVAR) is currently often performed because it is a less invasive treatment than surgery. The aim of this study was to evaluate short and mid-term results of TEVAR in traumatic aortic isthmic rupture. METHODS This is a retrospective study conducted between 2010 and 2018 including patients who underwent TEVAR for traumatic aortic isthmic rupture. RESULTS Thirty-six consecutive patients were included. All patients had sustained a violent blunt chest trauma after a sudden deceleration with associated injuries. The injury severity score (ISS) was 40 (14-66). All patients were hemodynamically stable at admission. We deployed thoracic aorta stent grafts with a mean diameter of 26mm (18-36). The procedural success rate was 100%. We reported one intra-operative complication which was a distal migration of the graft, managed by an implantation of an aortic extension graft. On the first postoperative day, one patient presented an acute lower limb ischemia, probably due to the surgical femoral access, treated with an embolectomy with a Fogarty catheter with satisfactory results. The mean follow-up was 40.41 months (6.5-96). The mortality and paraplegia rates were 0% at one month and during the follow-up period. We reported a case of kinking of the graft that occurred at 6 months. No cases of endoleak neither re-intervention were reported. CONCLUSION TEVAR is a safe and a reliable method for the treatment of sub-acute traumatic thoracic aortic injuries.
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8
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Updated outcomes from the TRANSFIX study to evaluate endovascular repair of blunt thoracic aortic injuries with the Zenith Alpha thoracic device. J Vasc Surg 2020; 71:1851-1857. [DOI: 10.1016/j.jvs.2019.05.070] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 05/03/2019] [Indexed: 11/23/2022]
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9
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Zoulati M, Bakkali T, Aghoutane N, Lyazidi Y, Chtata H, Taberkant M. [Acute post-trauma dissection of the descending thoracic aorta]. JOURNAL DE MÉDECINE VASCULAIRE 2019; 44:367-373. [PMID: 31761303 DOI: 10.1016/j.jdmv.2019.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 08/03/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Traumatic injury to the descending thoracic aorta other than the isthmus is rare, and little known. Acute post-trauma rupture may occur in a context of multiple or rarely unique localizations. CASE REPORT We report the case of a young man who was the victim of multiple injuries with an isolated rupture of the descending thoracic aorta. Early diagnosis and adapted endovascular treatment led to favorable outcome. CONCLUSION In 90% of cases, acute post-trauma rupture of the aorta in a single localization involve the isthmus. Rupture of the descending aorta is more exceptional but must not be missed. The pathophysiological mechanism and appropriate management are discussed in light of a review of the literature.
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Affiliation(s)
- M Zoulati
- Service de chirurgie vasculaire, hôpital militaire d'instruction Mohammed V, Hay Riad, Rabat, Maroc.
| | - T Bakkali
- Service de chirurgie vasculaire, hôpital militaire d'instruction Mohammed V, Hay Riad, Rabat, Maroc
| | - N Aghoutane
- Service de chirurgie vasculaire, hôpital militaire d'instruction Mohammed V, Hay Riad, Rabat, Maroc
| | - Y Lyazidi
- Service de chirurgie vasculaire, hôpital militaire d'instruction Mohammed V, Hay Riad, Rabat, Maroc
| | - H Chtata
- Service de chirurgie vasculaire, hôpital militaire d'instruction Mohammed V, Hay Riad, Rabat, Maroc
| | - M Taberkant
- Service de chirurgie vasculaire, hôpital militaire d'instruction Mohammed V, Hay Riad, Rabat, Maroc
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Brewer JM, Grout S, Cheema M, Divinagracia T, Webster-Lake C, Moote D, Kryzman NI, Cortland E, Campbell BT. Hybrid open and endovascular repair of a blunt traumatic thoracic aortic injury in a 7 year old boy. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2019. [DOI: 10.1016/j.epsc.2019.101217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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García Reyes ME, Gonçalves Martins G, Fernández Valenzuela V, Domínguez González JM, Maeso Lebrun J, Bellmunt Montoya S. Long-Term Outcomes of Thoracic Endovascular Aortic Repair Focused on Bird Beak and Oversizing in Blunt Traumatic Thoracic Aortic Injury. Ann Vasc Surg 2018; 50:140-147. [DOI: 10.1016/j.avsg.2018.02.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 10/22/2017] [Accepted: 02/08/2018] [Indexed: 10/18/2022]
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Fontana F, Macchi E, Piacentino F, Cardim LN, Marchi GD, Barbosa F, Piffaretti G, Novario R, Rampoldi AG, Fugazzola C. The Evaluation of Aortic Diameter Changes During Long-Term Follow-Up After Endovascular Treatment of Acute Blunt Traumatic Thoracic Aortic Injuries. Vasc Endovascular Surg 2018; 52:335-343. [DOI: 10.1177/1538574418765385] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To evaluate the variations in aortic diameters and long-term results in patients who underwent thoracic endovascular aortic repair (TEVAR) for acute blunt traumatic thoracic aortic injuries (BTTAIs). Materials and Methods: We retrospectively evaluated 23 patients with a mean age of 39 years (range: 17-74 years) who underwent TEVAR for BTTAI between October 2000 and November 2014. All of the patients underwent computed tomography angiography (CTA) before hospital discharge as a baseline imaging for the subsequent follow-up examinations. The technical success, overall survival, and complications were evaluated. Furthermore, the aortic diameters outside of the stent-graft (1 cm proximal and 1 cm distal to the stent-graft) and the aortic diameters within the stent-graft (2 cm distal to the proximal end and 2 cm proximal to the distal end) were assessed. The diameters at baseline on CTA were compared with those of the latest available follow-up examination. Results: Technical success was 100% with a mean follow-up of 65.4 months (range: 12-171 months). No death was registered, and 2 (8.7%) of 23 endograft-related complications (1 stent-graft distal infolding and 1 endoleak 2 and 4 months after the procedure, respectively) were observed. An increase in aortic diameter either proximal or distal to the stent-graft (mean value 0.7 and 0.5 mm, respectively) or within the stent-graft (mean value of 0.5 mm for both proximal and distal diameters) was registered (mean follow-up at 65.4 months, range: 12-171 months). Conclusion: Aortic dilatation following TEVAR for BTTAI is minimal during long-term follow-up. Endovascular treatment represents a durable and safe option in acute BTTAIs.
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Affiliation(s)
- Federico Fontana
- Department of Radiology, University of Insubria, Circolo Hospital, Varese, Italy
| | - Edoardo Macchi
- Department of Radiology, University of Insubria, Circolo Hospital, Varese, Italy
| | - Filippo Piacentino
- Department of Radiology, University of Insubria, Circolo Hospital, Varese, Italy
| | | | - Giuseppe De Marchi
- Department of Radiology, University of Insubria, Circolo Hospital, Varese, Italy
| | - Fabiane Barbosa
- Department of Radiology, Niguarda Ca’Granda Hospital, Milano, Italy
| | - Gabriele Piffaretti
- Department of Surgery and Morphological Sciences, University of Insubria, Circolo Hospital, Varese, Italy
| | - Raffaele Novario
- Department of Clinical and Biological Sciences, University of Insubria,Circolo Hospital, Varese, Italy
| | | | - Carlo Fugazzola
- Department of Radiology, University of Insubria, Circolo Hospital, Varese, Italy
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van der Zee CP, Vainas T, van Brussel FA, Tielliu IF, Zeebregts CJ, van der Laan MJ. Endovascular treatment of traumatic thoracic aortic lesions: a systematic review and meta-analysis. THE JOURNAL OF CARDIOVASCULAR SURGERY 2017; 60:100-110. [PMID: 28471152 DOI: 10.23736/s0021-9509.17.09942-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION To provide an overview of the experience of endovascular treatment for traumatic thoracic aortic lesions (TTAL). Thoracic aortic injury secondary to high-energy chest trauma constitutes an emergency situation with potentially devastating outcome. In the present time, the majority of patients are treated with thoracic endovascular aortic repair. The aim of this study was to provide a systematic overview of endovascular aortic repair in patients with TTAL with special attention to perioperative mortality, paraplegia, stroke, influence of left subclavian artery (LSA) coverage herein, and long-term stent-related complications. EVIDENCE ACQUISITION PubMed and Embase were searched for studies describing endovascular treatment of TTAL in the period between January 1st, 2000 and January 30th, 2016. The methodological quality of articles was assessed using the MINORS score and PRISMA guidelines. Data on early mortality, perioperative complications, and long-term stent-related complications were extracted. EVIDENCE SYNTHESIS A total of 2005 reports were screened, and 74 publications were finally included in the analysis describing treatment of 1882 patients. Early mortality rate, paraplegia rate, and stroke rate were 7.5%, 0.4%, and 1.5%, respectively. LSA coverage did not increase the risk of stroke. The severity of injuries had a positive association on early mortality. Late stent related mortality and morbidity were uncommon. CONCLUSIONS TTAL can be treated endovascularly with low mortality and (neurological) morbidity. LSA coverage does not increase the risk of neurological complications but is associated with a moderate risk of left arm ischemia. Long-term stent-related complications are rare, but the available data is limited.
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Affiliation(s)
- Cornelis P van der Zee
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands -
| | - Tryfon Vainas
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Ignace F Tielliu
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Clark J Zeebregts
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Maarten J van der Laan
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Abdoli S, Ham SW, Wilcox AG, Fleischman F, Lam L. Symptomatic Intragraft Thrombus following Endovascular Repair of Blunt Thoracic Aortic Injury. Ann Vasc Surg 2017; 42:305.e7-305.e12. [PMID: 28389290 DOI: 10.1016/j.avsg.2016.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 11/23/2016] [Accepted: 12/11/2016] [Indexed: 11/25/2022]
Abstract
Thoracic endovascular aortic repair (TEVAR) can be complicated by graft collapse, endoleaks, and stent migration. The incidence of these complications and other outcomes is poorly understood in young trauma victims who receive endovascular aortic repair of blunt thoracic aortic injury (BTAI). A 29-year-old pedestrian was struck by a vehicle resulting in polytrauma including BTAI with transection distal to the left subclavian artery origin. The patient underwent successful TEVAR. Nine months later, the patient developed transient paresthesia below the waist that progressed to bilateral lower extremity paralysis and malperfusion syndrome below the diaphragm including nonpalpable pulses in the lower extremities, acute renal failure, and ischemic colitis. Imaging demonstrated near occlusive thrombosis of the distal end of the thoracic endograft. An emergent axillobifemoral bypass resolved the organ malperfusion and acute limb ischemia. Patients who have undergone TEVAR for BTAI may develop asymptomatic or symptomatic intragraft thrombosis. In patients presenting with malperfusion syndrome below the diaphragm, extra-anatomic bypass can expeditiously resolve symptoms until definitive treatment can be performed. Oversizing of thoracic stents in trauma patient may lead to intragraft thrombosis.
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Affiliation(s)
- Sherwin Abdoli
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Southern California, Los Angeles, CA
| | - Sung Wan Ham
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Southern California, Los Angeles, CA
| | - Alison G Wilcox
- Department of Radiology, University of Southern California, Los Angeles, CA
| | - Fernando Fleischman
- Division of Cardiothoracic Surgery, Department of Surgery, University of Southern California, Los Angeles, CA
| | - Lydia Lam
- Division of Acute Care Surgery, Department of Surgery, University of Southern California, Los Angeles, CA.
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Review of short-term outcomes for TEVAR after blunt traumatic aortic injury. J Trauma Acute Care Surg 2015; 78:1210-5. [PMID: 26151524 DOI: 10.1097/ta.0000000000000659] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Rimon U, Shinfeld A, Gayer G. Traumatic injury of the thoracic aorta treated with stent-graft: Is long-term CT angiography follow-up justified? Clin Radiol 2014; 69:e207-10. [DOI: 10.1016/j.crad.2013.12.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 12/19/2013] [Accepted: 12/20/2013] [Indexed: 11/16/2022]
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17
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Kumpati GS, Patel AN, Bull DA. Thrombosis of a descending thoracic aortic endovascular stent graft in a patient with factor V Leiden: case report. J Cardiothorac Surg 2014; 9:47. [PMID: 24618347 PMCID: PMC3984718 DOI: 10.1186/1749-8090-9-47] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 03/04/2014] [Indexed: 11/10/2022] Open
Abstract
We present a case of a 14 year old Caucasian male who underwent initially successful endovascular repair of a traumatic injury to the descending thoracic aorta. The patient had undiagnosed Factor V Leiden at the time of the endovascular repair. He later presented with thrombosis of the endovascular stent graft, necessitating open removal of the stent graft and replacement of the involved aorta with a Dacron graft.
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Affiliation(s)
- Ganesh S Kumpati
- Division of Cardiothoracic Surgery, University of Utah, 30 N, 1900 E,, #3C-127, Salt Lake City, UT 84132, USA.
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18
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Piffaretti G, Benedetto F, Menegolo M, Antonello M, Tarallo A, Grego F, Spinelli F, Castelli P. Outcomes of endovascular repair for blunt thoracic aortic injury. J Vasc Surg 2013; 58:1483-9. [DOI: 10.1016/j.jvs.2013.05.096] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Revised: 05/03/2013] [Accepted: 05/20/2013] [Indexed: 10/26/2022]
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19
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A hybrid therapy as a third approach for type 1 proximal endoleak of thoracic endovascular aortic replacement: Caroticocarotid bypass and re-redo endovascular therapy. J Saudi Heart Assoc 2013; 25:273-6. [PMID: 24198453 DOI: 10.1016/j.jsha.2013.04.005] [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: 12/12/2012] [Revised: 03/18/2013] [Accepted: 04/01/2013] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION In selected cases with thoracic aortic aneurysm (TAA), thoracic endovascular aortic replacement (TEVAR) is commonly used and shall be proper therapy method. We are presenting a case of TAA previously treated twice by endovascular aortic approaches and complicated by type 1 endoleak. CASE A 67-year-old male patient was admitted to our clinic with back pain at rest. He underwent TEVAR five years ago, twice in 6 month. With contrasted computed tomography of chest and abdomen, a new type 1 proximal endoleak was diagnosed, and after routine preoperative follow up, the patient was operated on. At the same session right to left caroticocarotid bypass and re-redo TEVAR were performed. The new endovascular graft was placed as the proximal landing zone to be set between left carotid artery and brachiocephalic truncus. The patient was discharged on postoperative day 4 without any problems. CONCLUSION As new techniques and methods have been developed, mortality rates have decreased to 2-3% but in older and high risk patients, mortality rates still remain high [1]. TEVAR is a safe and effective treatment method in the proper and selected patients with thoracic artery aneurysm [2]. Moreover, TEVAR can also be performed as a part of hybrid procedures for arcus aortic aneurysms [3]. But it should be kept in mind that late secondary intervention rates are higher in TEVAR.
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20
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[Traumatic injuries of the descending thoracic aorta apart from the isthmus: diagnosis and therapeutic approach]. ACTA ACUST UNITED AC 2013; 32:799-802. [PMID: 24161295 DOI: 10.1016/j.annfar.2013.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 08/20/2013] [Indexed: 11/23/2022]
Abstract
Lesions involving the descending thoracic aorta apart from isthmus are rare and less known by anesthetists. We report the clinical course of two severely injured patients who sustained a thoracic aortic rupture in whom favorable outcome was achieved with endovascular treatment. Mechanisms, diagnosis and therapeutics aspects of these rare lesions are discussed according to literature.
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Marino M, Kasemi H, Martinelli O, Bresadola L, Salvatori FM, Irace L. Re-TEVAR for Complications After Blunt Aortic Traumatic Injury Stenting. Cardiovasc Intervent Radiol 2013; 37:519-22. [DOI: 10.1007/s00270-013-0655-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Accepted: 04/28/2013] [Indexed: 11/27/2022]
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22
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Celis RI, Park SC, Shukla AJ, Zenati MS, Chaer RA, Rhee RY, Makaroun MS, Cho JS. Evolution of treatment for traumatic thoracic aortic injuries. J Vasc Surg 2012; 56:74-80. [DOI: 10.1016/j.jvs.2012.01.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Revised: 01/04/2012] [Accepted: 01/05/2012] [Indexed: 10/28/2022]
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23
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Surgical conversion for intragraft thrombosis following endovascular repair of traumatic aortic injury. J Vasc Surg 2012; 55:538-41. [DOI: 10.1016/j.jvs.2011.07.075] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 07/14/2011] [Accepted: 07/15/2011] [Indexed: 11/21/2022]
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24
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Demetriades D. Blunt thoracic aortic injuries: crossing the Rubicon. J Am Coll Surg 2012; 214:247-59. [PMID: 22265808 DOI: 10.1016/j.jamcollsurg.2011.11.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Accepted: 11/28/2011] [Indexed: 11/24/2022]
Affiliation(s)
- Demetrios Demetriades
- Department of Surgery, Division of Acute Care Surgery, University of Southern California, LAC+USC Medical Center, Los Angeles, CA 90033-4525, USA.
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25
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Maleux G, Vaninbroukx J, Heye S. Failed surgical ligation of the proximal left subclavian artery during hybrid thoracic endovascular aortic repair successfully managed by percutaneous plug or coil occlusion: a report of 3 cases. J Cardiothorac Surg 2011; 6:45. [PMID: 21477301 PMCID: PMC3090327 DOI: 10.1186/1749-8090-6-45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Accepted: 04/08/2011] [Indexed: 11/28/2022] Open
Abstract
Open surgical rerouting and proximal ligation of one or more supra-aortic vessels prior to endovascular stent-graft placement has become an alternative to major open thoracic surgery in the treatment of complex thoracic aortic disease. Complications owing to failed surgical ligation of the left subclavian artery are rare. In this report, 3 cases of failed ligation are presented. Diagnosis was made by CT-scan and treatment was performed by transcatheter coil and plug embolization, avoiding redo neck surgery.
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Affiliation(s)
- Geert Maleux
- Department of Radiology, University Hospitals Leuven, Belgium.
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26
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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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27
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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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28
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Vulev I, Klepanec A, Balázs T, Holomáň M. Endovascular treatment of late in-stent-graft dissection after thoracic endovascular aneurysm repair. Cardiovasc Intervent Radiol 2010; 34:864-7. [PMID: 21191589 DOI: 10.1007/s00270-010-0087-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Accepted: 12/03/2010] [Indexed: 11/25/2022]
Abstract
Complications after endovascular repair of thoracic aortic pathologies may be devastating. We report the case of endovascular treatment of late in-stent-graft dissection after thoracic endovascular aneurysm repair (TEVAR). A 25-year-old man was admitted to our hospital 2 years after endovascular treatment of posttraumatic aortic pseudoaneurysm using stent-graft implantation with an acute sudden onset of ischemia in both legs with absent femoral pulses, numbness, and renal functions deterioration. Multidetector computed tomography (MDCT) angiography showed an intimal flap in the distal part of the stent-graft with critical stenosis of the residual lumen. The patient was successfully treated with stent-graft implantation by way of percutaneous approach while under local anesthesia. The risk of this late complication after TEVAR should be considered during follow-up, especially in young patients with increased physical activity. Endovascular treatment can be the method of choice for these patients.
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Affiliation(s)
- Ivan Vulev
- Department of Diagnostic and Interventional Radiology, National Institute of Cardiovascular Diseases 83348, Bratislava, Slovakia.
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29
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Gopaldas RR, Huh J, Dao TK, LeMaire SA, Chu D, Bakaeen FG, Coselli JS. Superior nationwide outcomes of endovascular versus open repair for isolated descending thoracic aortic aneurysm in 11,669 patients. J Thorac Cardiovasc Surg 2010; 140:1001-10. [DOI: 10.1016/j.jtcvs.2010.08.007] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Revised: 08/03/2010] [Accepted: 08/10/2010] [Indexed: 11/28/2022]
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30
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Starnes BW. Treating blunt aortic injuries with endografts: pros and cons of a meta-analysis. Semin Vasc Surg 2010; 23:176-81. [PMID: 20826295 DOI: 10.1053/j.semvascsurg.2010.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Modern management of blunt aortic injury (BAI) is based on evidence from mostly well-conducted meta-analyses as surrogates for prospective randomized controlled trials. There are several obvious pros and cons to this strategy. The advantages rest on the fact that it is unlikely that a prospective randomized trial comparing open surgical repair with endovascular repair will ever be conducted based on ethical grounds and the apparent survival advantage and reduced paraplegia rates associated with an endovascular approach; pooled data from high-volume studies provides for higher statistical power; and a well-conducted meta-analysis provides the ability to control for inter-study variation. The disadvantages of this approach are that meta-analyses are statistical examinations of scientific studies and not scientific studies in and of themselves; sources of bias cannot be controlled by the method of the analysis; and a heavy reliance on published studies can create exaggerated outcomes. Nonetheless, the studies reviewed in this article offer the best glimpse yet at the truth. The evidence grade to support endovascular over open repair for BAI is Level II (intermediate), which suggests that the described effect is plausible but is not quantified precisely or may be vulnerable to bias. The recommendation grade is B (provisional recommendation), which suggests that on balance of the evidence, endovascular repair for BAI is recommended with caution.
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Affiliation(s)
- Benjamin W Starnes
- Division of Vascular Surgery, University of Washington, Harborview Medical Center, 325 9th Avenue, Box 359796, Seattle, WA 98104, USA.
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