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Reinfeld ST, Blakeslee-Carter J, Beck AW. Retrograde aortic dissection following fenestrated and branched endovascular aortic repair for an extent III thoracoabdominal aneurysm. J Vasc Surg Cases Innov Tech 2023; 9:101329. [PMID: 37928560 PMCID: PMC10624575 DOI: 10.1016/j.jvscit.2023.101329] [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: 07/16/2023] [Accepted: 08/31/2023] [Indexed: 11/07/2023] Open
Abstract
Retrograde aortic dissection is a rare but potentially catastrophic complication after endovascular aortic repair. Reports in the literature regarding retrograde dissection after fenestrated and branched endovascular abdominal aortic repair are rare, and the incidence, risk factors, and treatment options for this complication have not yet been clearly established. Additionally, retrograde dissection after previous intervention can pose technical challenges and increases the risk of spinal cord ischemia during subsequent repair. We present a patient with an acute retrograde dissection after a fenestrated and branched endovascular aortic repair for an extent III thoracoabdominal aortic aneurysm successfully managed with proximal endovascular extension.
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Affiliation(s)
- Susanne T. Reinfeld
- Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, AL
| | - Juliet Blakeslee-Carter
- Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, AL
| | - Adam W. Beck
- Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, AL
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2
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Ali-Hasan-Al-Saegh S, Halloum N, Scali S, Kriege M, Abualia M, Stamenovic D, Bashar Izzat M, Bohan P, Kloeckner R, Oezkur M, Dorweiler B, Treede H, El Beyrouti H. A systematic review and meta-analysis of retrograde type A aortic dissection after thoracic endovascular aortic repair in patients with type B aortic dissection. Medicine (Baltimore) 2023; 102:e32944. [PMID: 37058052 PMCID: PMC10101253 DOI: 10.1097/md.0000000000032944] [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: 09/25/2022] [Accepted: 01/23/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Retrograde type A dissection (RTAD) is a devastating complication of thoracic endovascular repair (TEVAR) with low incidence but high mortality. The objective of this study is to report the incidence, mortality, potential risk factors, clinical manifestation and diagnostic modalities, and medical and surgical treatments. METHODS A systematic review and single-arm and two-arm meta-analyses evaluated all published reports of RTAD post-TEVAR through January 2021. All study types were included, except study protocols and animal studies, without time restrictions. Outcomes of interest were procedural data (implanted stent-grafts type, and proximal stent-graft oversizing), the incidence of RTAD, associated mortality rate, clinical manifestations, diagnostic workouts and therapeutic management. RESULTS RTAD occurred in 285 out of 10,600 patients: an estimated RTAD incidence of 2.3% (95% CI: 1.9-2.8); incidence of early RTAD was approximately 1.8 times higher than late. Wilcoxon signed-rank testing showed that the proportion of RTAD patients with acute type B aortic dissection (TBAD) was significantly higher than those with chronic TBAD (P = .008). Pooled meta-analysis showed that the incidence of RTAD with proximal bare stent TEVAR was 2.1-fold higher than with non-bare stents: risk ratio was 1.55 (95% CI: 0.87-2.75; P = .13). Single arm meta-analysis estimated a mortality rate of 42.2% (95% CI: 32.5-51.8), with an I2 heterogeneity of 70.11% (P < .001). CONCLUSION RTAD is rare after TEVAR but with high mortality, especially in the first month post-TEVAR with acute TBAD patients at greater risk as well as those treated with proximal bare stent endografts.
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Affiliation(s)
- Sadeq Ali-Hasan-Al-Saegh
- Department of Cardiac and Vascular Surgery, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Nancy Halloum
- Department of Cardiac and Vascular Surgery, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Salvatore Scali
- Division Vascular Surgery, University of Florida College of Medicine, Gainesville, FL
| | - Marc Kriege
- Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Mohannad Abualia
- Department of Cardiac and Vascular Surgery, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Davor Stamenovic
- Division of Thoracic Surgery, Academic Thoracic Center Mainz, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
| | | | | | - Roman Kloeckner
- Department of Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Mehmet Oezkur
- Department of Cardiac and Vascular Surgery, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Bernhard Dorweiler
- Department of Vascular Surgery, Faculty of Medicine, University of Cologne, Koln, Germany
| | - Hendrik Treede
- Department of Cardiac and Vascular Surgery, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Hazem El Beyrouti
- Department of Cardiac and Vascular Surgery, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
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Koudounas G, Giannopoulos S, Volteas P, Karkos C, Virvilis D, Tassiopoulos AK. De Novo Acute Type B Aortic Dissection in Two Patients with Previous Infrarenal Endovascular Aortic Aneurysm Repair with Endo-Anchors. J Vasc Surg Cases Innov Tech 2023. [DOI: 10.1016/j.jvscit.2023.101120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
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4
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Zlatanovic P, Dragas M, Cvetkovic S, Dimic A, Mitrovic A, Vujcic A, Trailovic R, Stevanovic K, Davidovic L. Open Surgical Treatment of Acute Spontaneous Isolated Abdominal Aortic Dissection. Ann Vasc Surg 2021; 74:525.e13-525.e21. [PMID: 33836227 DOI: 10.1016/j.avsg.2021.02.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 01/05/2021] [Accepted: 02/16/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aim of this paper is to report our single-center experience in the open surgical treatment of acute spontaneous infrarenal isolated abdominal aortic dissection (siIAAD). METHODS This was a single center retrospective study. Between January 2015 and 2020 ten patients were treated due to acute siIAAD with open surgery. There were no patients treated for chronic siIAAD in this time period. Patients who had concomitant thoracic aortic involvement were excluded from this report. RESULTS The group consisted of 7 male and 3 female patients. History of hypertension was present in nine patients and six were active smokers. The abdominal/back pain was described in 9 patients, two had acute limb ischemia and three had aortic rupture. Median dissection length was 91 mm (65.7 - 106), median distance from the lowest renal artery was 30 mm (20.7 - 49.3) and median abdominal aortic diameter was 58.5 mm (32.5 - 66.2). Supracoeliac clamp was used in three cases with a ruptured aorta and suprarenal in two patients. The mean duration of proximal clamping time was 24.3 ± 7.49 min. One patient died of postoperative acute myocardial infarction, one suffered nonfatal pulmonary embolism and one had deep venous thrombosis. No aortic-related deaths and/or reinterventions occurred during the median follow-up of 32 months. CONCLUSIONS Acute siIAAD is a rare event which affects mostly male smokers with hypertension. Open surgery is a technically demanding procedure with acceptable complication rates and should be performed in specialized high-volume centers for the treatment of aortic disease. Future efforts to establish a multicenter registry to evaluate the prevalence of the disease and treatment options could provide better and more comprehensive guidelines for the treatment of acute siIAAAD.
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Affiliation(s)
- Petar Zlatanovic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade.
| | - Marko Dragas
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade; Faculty of Medicine, University of Belgrade, Serbia
| | - Slobodan Cvetkovic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade; Faculty of Medicine, University of Belgrade, Serbia
| | - Andreja Dimic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade; Faculty of Medicine, University of Belgrade, Serbia
| | - Aleksandar Mitrovic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade
| | - Aleksandra Vujcic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade
| | - Ranko Trailovic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade
| | - Ksenija Stevanovic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade; Faculty of Medicine, University of Belgrade, Serbia
| | - Lazar Davidovic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade; Faculty of Medicine, University of Belgrade, Serbia
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Townsley MM, Soh IY, Ramakrishna H. Endovascular Versus Open Aortic Reconstruction: A Comparison of Outcomes. J Cardiothorac Vasc Anesth 2020; 35:1875-1883. [PMID: 32741610 DOI: 10.1053/j.jvca.2020.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Matthew M Townsley
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL
| | - Ina Y Soh
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Phoenix, AZ
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
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6
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Chinsakchai K, Suksusilp P, Wongwanit C, Hongku K, Hahtapornsawan S, Puangpunngam N, Moll FL, Sermsathanasawadi N, Ruangsetakit C, Mutirangura P. Early and late outcomes of endovascular aneurysm repair to treat abdominal aortic aneurysm compared between severe and non-severe infrarenal neck angulation. Vascular 2020; 28:683-691. [DOI: 10.1177/1708538120924552] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Abdominal aortic aneurysm with severe infrarenal neck angle (>60°) has long been thought to be an obstacle to endovascular aneurysm repair. However, some previous studies reported endovascular aneurysm repair to be safe and efficacious for treating abdominal aortic aneurysm in patients with severe neck angulation. The aim of this study was to investigate the early and late outcomes of endovascular aneurysm repair to treat abdominal aortic aneurysm compared between patients with severe and non-severe infrarenal neck angulation. Methods Fifty-four severe and 144 non-severe neck angulation patients who were treated at Siriraj Hospital (Bangkok, Thailand) during January 2010–October 2013 were recruited. The primary endpoints were intraoperative neck complications (e.g., type 1A endoleak or proximal graft migration) and immediate adjunct aortic neck procedures. The secondary endpoints included perioperative mortality, overall survival, and the proportion of patients that were reintervention-free at five years compared between the severe and non-severe groups. Results Severe angulation patients were significantly older than non-severe angulation patients (77 ± 6.3 vs. 74 ± 7.9 years; p = 0.021). The median proximal angle was significantly greater in the severe group (82° vs. 13.5°; p < 0.001). Intraoperative proximal neck complications developed in 29.6% of patients in the severe angulation group compared with 9.0% in the non-severe group ( p < 0.001). Significantly more patients in the severe group required intraoperative adjunct procedures (29.6% vs. 7.6%; p < 0.001). There was no significant difference in perioperative mortality between groups. At the five-year follow-up, there was no significant difference between groups for overall survival or the proportion of patients that remained reintervention-free. Conclusions Endovascular aneurysm repair to treat abdominal aortic aneurysm in patients with severe proximal neck angulation is technically feasible and safe Although the severe angulation group had a higher rate of intraoperative neck complications and immediate adjunct neck procedures than the non-severe group, there was no significant difference between groups for 30-day mortality, overall survival or the proportion of patients who remained reintervention-free at five years.
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Affiliation(s)
- Khamin Chinsakchai
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pichawat Suksusilp
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chumpol Wongwanit
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kiattisak Hongku
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Suteekhanit Hahtapornsawan
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nattawut Puangpunngam
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Frans L Moll
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Nuttawut Sermsathanasawadi
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chanean Ruangsetakit
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pramook Mutirangura
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Sirignano P, Mansour W, Baldassarre V, Porreca CF, Cuozzo S, Miceli F, Capoccia L, Sbarigia E, Speziale F. Infrarenal Abdominal Aortic Aneurysm Endovascular Treatment: Long-term Results From a Single-Center Experience in an Unselected Patient Population. Ann Vasc Surg 2020; 67:274-282. [PMID: 32209404 DOI: 10.1016/j.avsg.2020.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/05/2020] [Accepted: 03/06/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The aim of the present study was to evaluate early-, mid-, and long-term outcomes in an unselected population of patients treated for abdominal aortic aneurysms (AAAs) by endovascular aneurysm repair (EVAR) with different commercially available off-the-shelf devices. MATERIALS AND METHODS A retrospective study was conducted on a prospectively compiled computerized database on patients presenting an infrarenal AAA treated between January 2008 and December 2015 in a high-volume Italian tertiary referral Center. Demographic, clinical, and specific morphological features were considered as potentially influencing the outcomes and the type of the implanted device. Outcome measures were procedure-related reintervention, AAA-related, and all-cause mortality rates at 30-day, 12-month, and long-term follow-up. Reinterventions considered for the analysis were AAA rupture, graft infection, type I or III endoleaks, type II endoleaks with sac enlargement > 5 mm, graft stenosis or occlusions, procedures related to renal or visceral ischemia, and reintervention for access vessel injury. RESULTS Of 498 EVAR procedures performed for elective infrarenal AAA treatment during the entire study period, 479 patients were enrolled, the mean age was 73.5 ± 7.34 years (range 51-91), and 416 (86.84%) were men. The mean maximum AAA diameter was 52.02 ± 8.04 mm (range 39-90.2), a maximum AAA diameter ≥59 mm was recorded in 107 patients (22.33%), and an aortic neck length was <10 mm in 137 (28.60%). Technical success was achieved in all patients. At a mean follow-up of 52.97 ± 26.16 months (range 1-120), overall reintervention and death rates were 8.14% and 20.04%, respectively, without AAA-related deaths. At univariate analysis, hypertension was the only demographical variable found to be associated with higher risk of reintervention, P = 0.04 (OR: 2.34; CI 95%: 1.00-5.42). Furthermore, male sex (P = 0.02; OR: 2.62; CI 95%: 1.09-6.27) and chronic renal insufficiency (P = 0.003; OR: 2.08; CI 95%: 1.27-3.42) were associated with higher mortality rates. AAA diameter ≥59 mm was statistically associated with a higher rate of both reintervention and mortality: P < 0.001 (OR: 9.05; CI 95%: 4.52-18.11) and <0.001 (4.00; 2.46-6.49), respectively. CONCLUSIONS Our experience seems to suggest that EVAR could be safely and effectively performed in an unselected patients' population, with encouraging results up to a ten-year follow-up.
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Affiliation(s)
- Pasqualino Sirignano
- Vascular and Endovascular Surgery Unit, Department of Surgery "Paride Stefanini", Policlinico Umberto I of Rome, "Sapienza" University of Rome, Rome, Italy.
| | - Wassim Mansour
- Vascular and Endovascular Surgery Unit, Department of Surgery "Paride Stefanini", Policlinico Umberto I of Rome, "Sapienza" University of Rome, Rome, Italy
| | - Virgilio Baldassarre
- Vascular and Endovascular Surgery Unit, Department of Surgery "Paride Stefanini", Policlinico Umberto I of Rome, "Sapienza" University of Rome, Rome, Italy
| | - Carlo Filippo Porreca
- Vascular and Endovascular Surgery Unit, Department of Surgery "Paride Stefanini", Policlinico Umberto I of Rome, "Sapienza" University of Rome, Rome, Italy
| | - Simone Cuozzo
- Vascular and Endovascular Surgery Unit, Department of Surgery "Paride Stefanini", Policlinico Umberto I of Rome, "Sapienza" University of Rome, Rome, Italy
| | - Francesca Miceli
- Vascular and Endovascular Surgery Unit, Department of Surgery "Paride Stefanini", Policlinico Umberto I of Rome, "Sapienza" University of Rome, Rome, Italy
| | - Laura Capoccia
- Vascular and Endovascular Surgery Unit, Department of Surgery "Paride Stefanini", Policlinico Umberto I of Rome, "Sapienza" University of Rome, Rome, Italy
| | - Enrico Sbarigia
- Vascular and Endovascular Surgery Unit, Department of Surgery "Paride Stefanini", Policlinico Umberto I of Rome, "Sapienza" University of Rome, Rome, Italy
| | - Francesco Speziale
- Vascular and Endovascular Surgery Unit, Department of Surgery "Paride Stefanini", Policlinico Umberto I of Rome, "Sapienza" University of Rome, Rome, Italy
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Acute Type B Aortic Dissection One Month After Fenestrated EVAR Procedure. EJVES Short Rep 2019; 44:38-43. [PMID: 31497658 PMCID: PMC6719283 DOI: 10.1016/j.ejvssr.2019.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 07/22/2019] [Accepted: 07/24/2019] [Indexed: 11/29/2022] Open
Abstract
Introduction Acute aortic dissection after endovascular repair of an aortic aneurysm is a rare but serious condition, with potential complications that can result in the death of the patient. Report This is the case of a patient diagnosed with a type IV thoraco-abdominal aneurysm with involvement of both iliac arteries who underwent endovascular repair with a four fenestration device and a left iliac branch. One month after the procedure, the patient presented with a type B acute aortic dissection that extended from the left subclavian artery to the proximal stent of the fenestrated graft. This dissection was treated by thoracic endovascular aortic repair, and after a problematic post-operative period, the patient was discharged after 30 days. Discussion Occurrence of an acute aortic dissection after endovascular repair of an aortic aneurysm has rarely been reported in the literature. Development of these dissections has been related to factors such as excessive oversizing, use of devices with active fixation systems, or injuries during the procedure, although it is believed that the late onset would indicate that it was a de novo dissection. The presence of an aortic dissection can lead to the collapse and occlusion of the previous endograft and even to aortic rupture, and mortality in reported cases reaches 30%. The authors suggest that endovascular treatment should be considered in these patients. Aortic dissection in a patient with previous endovascular aneurysm repair is rare. Anatomic, device, and procedure factors could be the cause of this situation. Type B dissections could lead to collapse of the graft, sac growth, and rupture. Aggressive treatment must be considered to prevent serious complications.
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Affiliation(s)
- Nicholas J. Swerdlow
- From the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Winona W. Wu
- From the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Marc L. Schermerhorn
- From the Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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10
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Sirignano P, Capoccia L, Pranteda C, Montelione N, Mansour W, d’Adamo A, Formiconi M, Speziale F. Aortic Bifurcation Morphology Alone is Not Able to Predict Outcome in Patients Submitted to Elective Endovascular Abdominal Aortic Aneurysm Repair. Cardiovasc Intervent Radiol 2017; 41:218-224. [DOI: 10.1007/s00270-017-1831-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 10/25/2017] [Indexed: 12/01/2022]
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11
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Park SH, Rha SW. Acute Type B Aortic Dissection in a Patient with Previous Endovascular Abdominal Aortic Aneurysm Repair. Vasc Specialist Int 2017; 33:43-46. [PMID: 28377913 PMCID: PMC5374961 DOI: 10.5758/vsi.2017.33.1.43] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 02/05/2017] [Accepted: 02/08/2017] [Indexed: 11/20/2022] Open
Abstract
Endovascular aortic repair (EVAR) was relatively safe, and became a widely performed procedure. If aortic dissection (AD) occurred in patient with previous EVAR, it could cause fatal complications like endograft collapse. Surgical treatment was limited in this situation for comorbidities and complex anatomies. Here we report a rare case of acute type B AD developed following trans-radial coronary intervention in a patient with previous EVAR of abdominal aortic aneurysm, which was treated with thoracic EVAR.
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Affiliation(s)
- Sung Hun Park
- Department of Cardiology, Korea University Guro Hospital, Seoul, Korea
| | - Seung-Woon Rha
- Department of Cardiology, Korea University Guro Hospital, Seoul, Korea
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12
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Jayakumar L, Lombardi JV, Caputo FJ. Type B Dissection Resulting in Acute Limb Ischemia in a Patient With a History of EVAR. Vasc Endovascular Surg 2017; 51:98-102. [PMID: 28110619 DOI: 10.1177/1538574417689983] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Type B aortic dissection (TBAD) can be complicated due to visceral and limb malperfusion. We present the case of a patient with a TBAD 5 months after endovascular aneurysm repair (EVAR) for an infrarenal aortic aneurysm, which resulted in a right leg acute limb ischemia due to impingement of the EVAR from to the dissection. In the following discussion, we will review the literature and describe our technique for the treatment of this infrequent problem.
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Affiliation(s)
- Lalithapriya Jayakumar
- 1 Division of Vascular Surgery, Department of Surgery, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Joseph V Lombardi
- 1 Division of Vascular Surgery, Department of Surgery, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Francis J Caputo
- 1 Division of Vascular Surgery, Department of Surgery, Cooper Medical School of Rowan University, Camden, NJ, USA
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Shintani T, Atsuta K, Saito T. Successful Hybrid Treatment of Stent-Graft Migration Caused by Type B Aortic Dissection after Endovascular Aortic Aneurysm Repair: A Case Report. Ann Vasc Dis 2017; 10. [PMID: 29147158 PMCID: PMC5684157 DOI: 10.3400/avd.cr.17-00044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Herein, we report a rare case of type B aortic dissection that occurred after endovascular aortic aneurysm repair (EVAR). A 66-year-old man underwent successful EVAR for an abdominal aortic aneurysm (AAA). Computed tomography (CT) 2 years after EVAR showed a type B aortic dissection with stent-graft migration and AAA expansion. Juxtarenal aortic expansion precluded simple stent-graft placement. He underwent hepato-spleno-renal bypass followed by stent-graft placement just below the superior mesenteric artery. Postoperative CT showed no endoleaks. This case reconfirms the importance of regular follow-up after EVAR and illustrates the usefulness of a hybrid approach.
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Affiliation(s)
- Tsunehiro Shintani
- Department of Vascular Surgery, Shizuoka Red Cross Hospital, Shizuoka, Japan
| | - Kouji Atsuta
- Department of Vascular Surgery, Shizuoka Red Cross Hospital, Shizuoka, Japan
| | - Takaaki Saito
- Department of Vascular Surgery, Shizuoka Red Cross Hospital, Shizuoka, Japan
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