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Gonzalez-Urquijo M, Marine L, Valdes F, Vargas JF, Bergoeing M, Mertens R. Isolated Abdominal Aortic Dissection With and Without Abdominal Aortic Aneurysm. Vasc Endovascular Surg 2024:15385744241276648. [PMID: 39155127 DOI: 10.1177/15385744241276648] [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: 08/20/2024]
Abstract
OBJECTIVE The aim of this study was to report the clinical presentation and treatment outcomes of patients treated for IAAD with and without abdominal aortic aneurysm (AAA) in a single academic institution in South America. MATERIALS AND METHODS A retrospective review of all patients with IAAD with or without concomitant AAA between January 2002 and December 2023 from a single academic hospital was performed. RESULTS Eighteen patients with IAAD were diagnosed of whom 13 (72.2%) were males. Median age was 63 years (range: 43-88 years). Sixteen (88.8%) patients presented with symptoms, and in two (11.1%) asymptomatic patients IAAD was an incidental finding. Ten (55.5%) patients had concomitant abdominal aortic aneurysm (AAA), with a median size of the aneurysm of 49.5 mm (range: 44-66 mm). No statistical differences in baseline characteristics were seen between patients with concomitant IAAD and AAA and patients with only IAAD. Seven (38.8%) patients presented chronic dissection, and 11 (61.1%) patients had acute dissection. Five (27.7%) patients were treated conservatively with blood pressure, pain control, and antiplatelets; endovascular surgery was performed in eight (44.4%) patients and open surgery in five (27.7%) patients. The complication rate was 22.2% (n = 4), and the mortality rate was 0%. Median follow-up was 36 months (range: 6-240 months). Complete remodeling was seen in all patients except two patients who underwent conservative treatment. Of those, one had partial remodeling, and the other no changed. CONCLUSION Isolated aortic dissection of the abdominal aorta is an uncommon condition, with acceptable different treatment strategies, from conservative to invasive treatments. Sometimes IAAD can concur with AAA, and when so, invasive treatment might be considered. More studies describing the natural history of AAA and its association with IAAD are warranted, as well as further research reporting long-term outcomes on aortic remodeling after different treatment modalities.
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Affiliation(s)
- Mauricio Gonzalez-Urquijo
- Departamento de Cirugía Vascular y Endovascular, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Leopoldo Marine
- Departamento de Cirugía Vascular y Endovascular, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Francisco Valdes
- Departamento de Cirugía Vascular y Endovascular, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Jose Francisco Vargas
- Departamento de Cirugía Vascular y Endovascular, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Michel Bergoeing
- Departamento de Cirugía Vascular y Endovascular, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Renato Mertens
- Departamento de Cirugía Vascular y Endovascular, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
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Shimoda T, D'Oria M, Kuno T, Heindel P, Lepidi S, Hussain MA, Takagi H, Secemsky EA. Comparative Effectiveness of Intravascular Ultrasound Versus Angiography in Abdominal and Thoracic Endovascular Aortic Repair: Systematic Review and Meta-Analysis. Am J Cardiol 2024; 223:81-91. [PMID: 38768845 PMCID: PMC11214883 DOI: 10.1016/j.amjcard.2024.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/03/2024] [Accepted: 05/11/2024] [Indexed: 05/22/2024]
Abstract
The effectiveness of intravascular ultrasound (IVUS) with angiography compared with angiography guidance alone in treating aortic conditions, such as dissections, aneurysms, and blunt traumatic injuries, remains unclear. This systematic review and meta-analysis evaluates the current literature for IVUS use during thoracic endovascular aortic repair (TEVAR) and abdominal endovascular aortic repair (EVAR). A comprehensive search of MEDLINE, EMBASE, and Cochrane CENTRAL databases was conducted in March 2024 adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies comparing outcomes of TEVAR/EVAR with and without IVUS were identified. The outcomes of interest included contrast volume, fluoroscopy and procedural time, perioperative endoleak, and reinterventions and all-cause mortality during follow-up. Data with 95% confidence intervals (CIs) were extracted. Pooled analysis was performed using a random-effect model. Subgroup analysis was performed stratified by the condition being treated. Risk of bias was assessed using the Newcastle-Ottawa Scale for observational studies. A total of 4,219 patients (n = 2,655 IVUS and n = 1,564 non-IVUS) from 9 observational studies were included. The IVUS group exhibited a reduction in contrast agent volume (weighted mean difference -34.65 mL, 95% CI -54.73 to -14.57) and fluoroscopy time (weighted mean difference -6.13 minutes, 95% CI -11.10 to -1.15), with no difference in procedural time. The perioperative type I and III endoleak occurrences were similar (risk ratio 2.36, 95% CI 0.55 to 10.11; risk ratio 0.72, 95% CI 0.09 to 5.77, respectively). Reintervention and mortality during follow-up were comparable (hazard ratio 0.80, 95% CI 0.33 to 1.97; hazard ratio 0.75, 95% CI 0.47 to 1.18, respectively). All the included studies had small risks of bias. In conclusion, this meta-analysis provides evidence that IVUS enables the safe deployment of TEVAR/EVAR with reduced contrast agent and radiation exposure.
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Affiliation(s)
- Tomonari Shimoda
- Department of Cardiovascular Surgery, University of Tsukuba Hospital, Ibaraki, Japan
| | - Mario D'Oria
- Division of Vascular and Endovascular Surgery, Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy; Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center; Division of Cardiology, Jacobi Medical Center, Albert Einstein College of Medicine, New York, New York.
| | - Patrick Heindel
- Division of Vascular and Endovascular Surgery; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts
| | - Sandro Lepidi
- Division of Vascular and Endovascular Surgery, Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Mohamad A Hussain
- Division of Vascular and Endovascular Surgery; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts
| | - Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Eric A Secemsky
- Richard A and Susan F Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
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Bissacco D, de Kort JF, Ramella A, Allievi S, Bellotti P, Casana R, Domanin M, Migliavacca F, Trimarchi S. Discussing on the Aortic Coverage in Type B Aortic Dissection Treatment: A Comprehensive Scoping Review. J Clin Med 2024; 13:3897. [PMID: 38999462 PMCID: PMC11242050 DOI: 10.3390/jcm13133897] [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: 05/23/2024] [Revised: 06/25/2024] [Accepted: 06/27/2024] [Indexed: 07/14/2024] Open
Abstract
OBJECTIVE The objective of this study is to investigate and address the question surrounding the determination of the optimal endograft length of coverage during TEVAR for type B aortic dissection (TBAD), with a particular emphasis on the distal landing zone (DLZ). DATA SOURCES MEDLINE, Scopus, and Web of Science databases were used. METHODS The PRISMA-ScR statement was followed. RESULTS Several variables can contribute to the length of coverage during TEVAR in TBAD patient. Baseline patient's characteristics, TBAD-related features, the type of endoprosthesis, and postoperative graft behaviour may contribute to the choice of coverage. CONCLUSIONS No robust data have been published regarding the optimal length of TEVAR. Therefore, reporting the percentage of covered aorta and improving computational studies should be valorised to improve postoperative outcomes.
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Affiliation(s)
- Daniele Bissacco
- Department of Clinical Sciences and Community Health, University of Milan, 20148 Milan, Italy
| | - Jasper F de Kort
- Section of Vascular Surgery, Cardio Thoracic Vascular Department, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Chemistry, Materials and Chemical Engineering "G. Natta", Politecnico di Milano, 20133 Milan, Italy
| | - Anna Ramella
- Department of Chemistry, Materials and Chemical Engineering "G. Natta", Politecnico di Milano, 20133 Milan, Italy
| | - Sara Allievi
- Department of Vascular Surgery, Santa Chiara Hospital, 38122 Trento, Italy
| | - Paolo Bellotti
- Section of Vascular Surgery, Cardio Thoracic Vascular Department, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Renato Casana
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, 20145 Milan, Italy
| | - Maurizio Domanin
- Department of Clinical Sciences and Community Health, University of Milan, 20148 Milan, Italy
- Section of Vascular Surgery, Cardio Thoracic Vascular Department, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Francesco Migliavacca
- Department of Chemistry, Materials and Chemical Engineering "G. Natta", Politecnico di Milano, 20133 Milan, Italy
| | - Santi Trimarchi
- Department of Clinical Sciences and Community Health, University of Milan, 20148 Milan, Italy
- Section of Vascular Surgery, Cardio Thoracic Vascular Department, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
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4
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Kyriakou A, Ibrahim A, Oberhuber A. Intravascular Ultrasound Enhances the PETTICOAT Technique in Endovascular Therapy for Complicated Type B Aortic Dissection with Malperfusion Syndrome. Ann Vasc Surg 2024; 108:228-238. [PMID: 38964443 DOI: 10.1016/j.avsg.2024.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 04/27/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND To present the value of intravascular ultrasound (IVUS) in diagnosis and treatment of complicated type B aortic dissection with malperfusion. Especially, the value of IVUS regarding the treatment strategy, reoperation rate, acute kidney injury, and false lumen thrombosis was investigated. METHODS Retrospective analysis of 25 type B aortic dissection cases with malperfusion treated with endovascular therapy from April 2019 to August 2022. In 17 cases, angiography and IVUS were applied during the operation (IVUS group), and in 8 cases, angiography was used without IVUS (control group) for final intraoperative control. IVUS was used to assess the true lumen collapse and to decide if additional bare stenting was necessary or not. Details from patients' charts and documentation from surgeries were analyzed. The endovascular technique included thoracic endovascular aortic repair with primary entry sealing and-if needed-bare stenting of the true lumen distal of the entry tears using the Provisional Extension To Induce Complete Attachment (PETTICOAT) technique. RESULTS All patients presented with pain localized mostly (48%) in thorax and abdomen. In all patients, the proximal entry tear of the dissection was covered using thoracic endovascular aortic repair. The PETTICOAT technique was applied in 13 cases (52%), whereas most combined procedures were applied in the IVUS group (12 compared to 1; P = 0.02). A total of 3 patients (1 in the control group, 12.5% and 2 in the IVUS group, 11.8%) underwent a bowel resection. Totally 8 patients (32%) underwent a reoperation in aorta (3 during the hospital stay). There were no statistical differences between IVUS and control group regarding the preoperative findings, the reoperation rates, and the postoperative complications. Five patients died (4 during the hospital stay); 1 in control and 4 in IVUS group; P = 0.53. The follow-up included a clinical and a computed tomography angiography examination. No statistically significant difference regarding occurrence and extension of false lumen thrombosis was observed between the 2 groups. CONCLUSIONS The IVUS and control groups showed no difference in survival rates. The use of IVUS extended the indication for PETTICOAT technique with statistically significant difference. A milder form of acute kidney injury presented in the IVUS group compared to the control group. In addition, a stronger correlation between IVUS and the avoidance of an aorta reoperation was observed, although it did not reach statistical significance.
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Affiliation(s)
- Andreas Kyriakou
- Department of Vascular and Endovascular Surgery, University Hospital Muenster, Muenster, Germany.
| | - Abdulhakim Ibrahim
- Department of Vascular and Endovascular Surgery, University Hospital Muenster, Muenster, Germany
| | - Alexander Oberhuber
- Department of Vascular and Endovascular Surgery, University Hospital Muenster, Muenster, Germany
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5
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Modarai B, Patel AS, Haulon S. The Role of Intravascular Ultrasound (IVUS) in Image Guidance and Radiation Protection. Eur J Vasc Endovasc Surg 2024; 67:524. [PMID: 37939815 DOI: 10.1016/j.ejvs.2023.10.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 10/30/2023] [Indexed: 11/10/2023]
Affiliation(s)
- Bijan Modarai
- School of Cardiovascular and Metabolic Medicine and Sciences, BHF Centre of Excellence, London, UK.
| | - Ashish S Patel
- School of Cardiovascular and Metabolic Medicine and Sciences, BHF Centre of Excellence, London, UK
| | - Stéphan Haulon
- Aortic Centre, Hôpital Marie Lannelongue, Groupe Hospitalier Paris St Joseph, Université Paris Saclay, Paris, France
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6
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Tessarek J, Flores Herrero A. Intravascular Ultrasound (IVUS) Image Guidance: Does Current Practice Already Have a Lead Over the ESVS Guideline Recommendations? Eur J Vasc Endovasc Surg 2024; 67:523-524. [PMID: 37923189 DOI: 10.1016/j.ejvs.2023.07.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 07/23/2023] [Accepted: 07/28/2023] [Indexed: 11/07/2023]
Affiliation(s)
- Jörg Tessarek
- Department Vascular and Endovascular Surgery, Bonifatius Hospital, Lingen, Germany.
| | - Angel Flores Herrero
- Department Vascular and Endovascular Surgery and Angiology, Hospital Quironsalud, Toledo, Spain
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Secemsky EA, Aronow HD, Kwolek CJ, Meissner M, Muck PE, Parikh SA, Winokur RS, George JC, Salazar G, Murphy EH, Costantino MM, Zhou W, Li J, Lookstein R, Desai KR. Intravascular Ultrasound Use in Peripheral Arterial and Deep Venous Interventions: Multidisciplinary Expert Opinion From SCAI/AVF/AVLS/SIR/SVM/SVS. J Vasc Interv Radiol 2024; 35:335-348. [PMID: 38206255 DOI: 10.1016/j.jvir.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/21/2023] [Accepted: 10/03/2023] [Indexed: 01/12/2024] Open
Abstract
Percutaneous revascularization is the primary strategy for treating lower extremity venous and arterial disease. Angiography is limited by its ability to accurately size vessels, precisely determine the degree of stenosis and length of lesions, characterize lesion morphology, or correctly diagnose postintervention complications. These limitations are overcome with use of intravascular ultrasound (IVUS). IVUS has demonstrated the ability to improve outcomes following percutaneous coronary intervention, and there is increasing evidence to support its benefits in the setting of peripheral vascular intervention. At this stage in its evolution, there remains a need to standardize the use and approach to peripheral vascular IVUS imaging. This manuscript represents considerations and consensus perspectives that emerged from a roundtable discussion including 15 physicians with expertise in interventional cardiology, interventional radiology, and vascular surgery, representing 6 cardiovascular specialty societies, held on February 3, 2023. The roundtable's aims were to assess the current state of lower extremity revascularization, identify knowledge gaps and need for evidence, and determine how IVUS can improve care and outcomes for patients with peripheral arterial and deep venous pathology.
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Affiliation(s)
- Eric A Secemsky
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology and Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Herbert D Aronow
- Department of Medicine, Michigan State University, East Lansing, Michigan; Heart & Vascular Services, Henry Ford Health, Detroit, Michigan
| | - Christopher J Kwolek
- Harvard Medical School, Boston, Massachusetts; Newton-Wellesley Hospital, Wellesley, Massachusetts
| | - Mark Meissner
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Patrick E Muck
- Department of Vascular Surgery, Good Samaritan Hospital, Cincinnati, Ohio
| | - Sahil A Parikh
- Center for Interventional Cardiovascular Care, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Ronald S Winokur
- Weill Cornell Vein Treatment Center and Division of Interventional Radiology, Department of Radiology, Weill Cornell Medicine, New York, New York
| | - Jon C George
- Division of Interventional Cardiology and Endovascular Medicine, Pennsylvania Hospital, Philadelphia, Pennsylvania
| | - Gloria Salazar
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Erin H Murphy
- Venous and Lymphatic Center, Division of Vascular Surgery, Sanger Heart and Vascular, Atrium Health, Charlotte, North Carolina
| | | | - Wei Zhou
- Division of Vascular Surgery, University of Arizona and Banner University Medical Center, Tucson, Arizona
| | - Jun Li
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio
| | | | - Kush R Desai
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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8
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Secemsky EA, Aronow HD, Kwolek CJ, Meissner M, Muck PE, Parikh SA, Winokur RS, George JC, Salazar G, Murphy EH, Costantino MM, Zhou W, Li J, Lookstein R, Desai KR. Intravascular Ultrasound Use in Peripheral Arterial and Deep Venous Interventions: Multidisciplinary Expert Opinion From SCAI/AVF/AVLS/SIR/SVM/SVS. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2024; 3:101205. [PMID: 39131984 PMCID: PMC11307416 DOI: 10.1016/j.jscai.2023.101205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/21/2023] [Accepted: 10/03/2023] [Indexed: 08/13/2024]
Abstract
Percutaneous revascularization is the primary strategy for treating lower extremity venous and arterial disease. Angiography is limited by its ability to accurately size vessels, precisely determine the degree of stenosis and length of lesions, characterize lesion morphology, or correctly diagnose postintervention complications. These limitations are overcome with use of intravascular ultrasound (IVUS). IVUS has demonstrated the ability to improve outcomes following percutaneous coronary intervention, and there is increasing evidence to support its benefits in the setting of peripheral vascular intervention. At this stage in its evolution, there remains a need to standardize the use and approach to peripheral vascular IVUS imaging. This manuscript represents considerations and consensus perspectives that emerged from a roundtable discussion including 15 physicians with expertise in interventional cardiology, interventional radiology, and vascular surgery, representing 6 cardiovascular specialty societies, held on February 3, 2023. The roundtable's aims were to assess the current state of lower extremity revascularization, identify knowledge gaps and need for evidence, and determine how IVUS can improve care and outcomes for patients with peripheral arterial and deep venous pathology.
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Affiliation(s)
- Eric A. Secemsky
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology and Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Herbert D. Aronow
- Department of Medicine, Michigan State University, East Lansing, Michigan
- Heart & Vascular Services, Henry Ford Health, Detroit, Michigan
| | - Christopher J. Kwolek
- Harvard Medical School, Boston, Massachusetts
- Newton-Wellesley Hospital, Wellesley, Massachusetts
| | - Mark Meissner
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Patrick E. Muck
- Department of Vascular Surgery, Good Samaritan Hospital, Cincinnati, Ohio
| | - Sahil A. Parikh
- Center for Interventional Cardiovascular Care, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Ronald S. Winokur
- Weill Cornell Vein Treatment Center and Division of Interventional Radiology, Department of Radiology, Weill Cornell Medicine, New York, New York
| | - Jon C. George
- Division of Interventional Cardiology and Endovascular Medicine, Pennsylvania Hospital, Philadelphia, Pennsylvania
| | - Gloria Salazar
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Erin H. Murphy
- Venous and Lymphatic Center, Division of Vascular Surgery, Sanger Heart and Vascular, Atrium Health, Charlotte, North Carolina
| | | | - Wei Zhou
- Division of Vascular Surgery, University of Arizona and Banner University Medical Center, Tucson, Arizona
| | - Jun Li
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio
| | | | - Kush R. Desai
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Sakakibara S, Nishi H, Kitahara M, Goto T, Nakazato T. Successful "PETTICOAT" procedure assisted by aortic angioscopy for complicated type B aortic dissection: Case report. Int J Surg Case Rep 2023; 109:108475. [PMID: 37481972 PMCID: PMC10369472 DOI: 10.1016/j.ijscr.2023.108475] [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: 05/09/2023] [Revised: 06/18/2023] [Accepted: 06/27/2023] [Indexed: 07/25/2023] Open
Abstract
INTRODUCTION Thoracic endovascular aortic repair (TEVAR) is a useful treatment for acute type B aortic dissection (TBAD). A PETTICOAT (Provisional ExTension to Induce COmplete ATtachment) procedure can be an alternative surgical option for a patent false lumen. Non-obstructive aortic angioscopy is an attractive modality that can visualize the aortic intima for things such as entry or re-entry tears that are difficult to detect with computed tomography (CT). Herein, we describe a successful PETTICOAT procedure assisted by aortic angioscopy for subacute TBAD complicated by lower limb ischemia. PRESENTATION OF CASE A 63-year-old man who had been treated with conservative therapy for subacute TBAD had intermittent claudication. Enhanced CT revealed a primary entry tear at the distal arch, and the true lumen at the thoracoabdominal level was narrowed by the patent false lumen. Therefore, the PETTICOAT procedure was performed. The postoperative course was uneventful, with normalized lower limb pressure. DISCUSSION Although PETTICOAT procedure is effective for treating complicated TBAD, there is no consensus on where and how far the proximal stent graft or distal bare stent should be implanted. Non-obstructive aortic angioscopy during PETTICOAT is useful to detect and cover the entry and re-entry tears. The PETTICOAT procedure assisted by aortic angioscopy could contribute to determining the appropriate coverage range of the stent graft. CONCLUSION Aortic angioscopy could contribute to the surgical success of PETTICOAT procedure for complicated subacute TBAD.
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Affiliation(s)
- Satoshi Sakakibara
- Department of Cardiovascular Surgery, Osaka General Medical Center, Osaka, Japan
| | - Hiroyuki Nishi
- Department of Cardiovascular Surgery, Osaka General Medical Center, Osaka, Japan.
| | - Mutsunori Kitahara
- Department of Cardiovascular Surgery, Osaka General Medical Center, Osaka, Japan
| | - Takasumi Goto
- Department of Cardiovascular Surgery, Osaka General Medical Center, Osaka, Japan
| | - Taro Nakazato
- Department of Cardiovascular Surgery, Osaka General Medical Center, Osaka, Japan
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10
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Sulzer T, Tenorio ER, Mesnard T, Vacirca A, Baghbani-Oskouei A, de Bruin JL, Verhagen HJM, Oderich GS. Intraoperative complications during standard and complex endovascular aortic repair. Semin Vasc Surg 2023; 36:189-201. [PMID: 37330233 DOI: 10.1053/j.semvascsurg.2023.04.002] [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: 02/17/2023] [Revised: 03/30/2023] [Accepted: 04/04/2023] [Indexed: 06/19/2023]
Abstract
This study aimed to provide a comprehensive overview of the most common intraoperative adverse events that occur during standard endovascular repair and fenestrated-branched endovascular repair to treat abdominal aortic aneurysms, thoracoabdominal aortic aneurysms, and aortic arch aneurysms. Despite advancements in endovascular techniques, sophisticated imaging and improved graft designs, intraoperative difficulties still occur, even in highly standardized procedures and high-volume centers. This study emphasized that with the increased adoption and complexity of endovascular aortic procedures, strategies to minimize intraoperative adverse events should be protocolized and standardized. There is a need for robust evidence on this topic, which could potentially optimize treatment outcomes and durability of the available techniques.
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Affiliation(s)
- Titia Sulzer
- The University of Texas Health Science Center at Houston, Houston, TX 77030; Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Emanuel R Tenorio
- The University of Texas Health Science Center at Houston, Houston, TX 77030
| | - Thomas Mesnard
- The University of Texas Health Science Center at Houston, Houston, TX 77030
| | - Andrea Vacirca
- The University of Texas Health Science Center at Houston, Houston, TX 77030
| | | | - Jorg L de Bruin
- Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Hence J M Verhagen
- Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Gustavo S Oderich
- The University of Texas Health Science Center at Houston, Houston, TX 77030
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11
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Taalab MA, Kamal AM, Mohammad AF, Zaki MM. Intravascular Ultrasound Versus Computed Tomography Angiography in Sizing and Operative Management of Endovascular Aortic Aneurysm Repair. J Endovasc Ther 2023:15266028231158964. [PMID: 36927269 DOI: 10.1177/15266028231158964] [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: 03/18/2023]
Abstract
OBJECTIVES An abdominal aortic aneurysm (AAA) is a potentially life-threatening condition, the management of which has dramatically evolved over the past 2 decades with an increasing tendency toward endovascular repair (EVAR) rather than open surgical repair. Classically, contrast-enhanced multislice computed tomography (CT) angiography (CTA) is performed preoperatively for procedure sizing and EVAR planning. This entails voluminous contrast injection with risk of allergic reaction, nephropathy, and radiation exposure. Intra-vascular ultrasound (IVUS) has been increasingly used to guide EVAR procedures intraoperatively. The aim of this study is to investigate the accuracy of IVUS in sizing AAAs, device selection, and EVAR planning compared to the gold standard CTA. DESIGN This is a prospective observational study enrolling 10 patients who underwent standard infrarenal EVAR procedures performed for unruptured infrarenal AAAs over the course of 1 year. All patients had a preoperative CTA done upon which aneurysm sizing and device planning were performed, and the measurements obtained were compared to those obtained from intraoperative IVUS. METHODS All participating patients had unruptured infrarenal AAA, had no renal impairment, and had anatomical suitability for EVAR according to the instructions for use (IFU) of the device manufacturer. Primary endpoint was comparing anatomical measurements recorded by IVUS with those obtained from the preoperative CTA. RESULTS Mean age was 65.6 (±6.19), all patients were males and hypertensives and 4 (40%) had a positive family history for AAA. On comparing mean measurements taken by CTA and IVUS, there was no statistically significant differences with exception of maximal aortic diameter and aortic diameter at site of bifurcation (both p-values <.001). There were no statistically significant differences in length measurements between the 2 imaging modalities. Computed tomography angiography was more associated with neck thrombus detection, and IVUS was more associated with calcification detection. CONCLUSION Although CT angiography is still the gold standard imaging modality for AAA, IVUS use is very beneficial in EVAR sizing and planning, in addition to intra-operative guidance of the procedure, saving the patient significant time, contrast administration, and radiation exposure, especially in patients with renal impairment and contrast allergy. CLINICAL IMPACT A preoperative CT angiogram is the gold standard required investigation for planning and sizing EVARs, with subsequent contrast injection entailing a risk of contrast induced nephropathy and allergic reactions. IVUS has been used as an adjuvant technique to guide EVAR stent graft deployment. However, our study concluded that it can also be reliably used in sizing and planning of the EVAR stent graft along with complementary non contrast imaging, especially in patients with high risk for contrast induced nephropathy and contrast allergy.
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Affiliation(s)
- Mohammad A Taalab
- Vascular Surgery Department, Nasr City Hospital for Health Insurance, Cairo, Egypt
| | - Ahmed M Kamal
- General Surgery Department, El Demerdash University Hospital, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed F Mohammad
- Vascular Surgery Department, El Demerdash University Hospital, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed M Zaki
- Vascular Surgery Department, El Demerdash University Hospital, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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12
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Stern JR, Pham XBD, Lee JT. Reverse Cheese-Wire Septotomy to Create a Distal Landing Zone for Thoracic Endovascular Aortic Repair. J Endovasc Ther 2023; 30:38-44. [PMID: 35018867 DOI: 10.1177/15266028211070966] [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: 02/02/2023]
Abstract
PURPOSE The objective of this study is to describe a novel method for creating a distal landing zone for thoracic endovascular aortic repair (TEVAR) in chronic aortic dissection. The technique is described in a patient with prior total arch and descending aortic replacement, with false lumen expansion. TECHNIQUE A cheese-wire endovascular septotomy was desired to create a single lumen above the celiac axis. To avoid dividing the septum caudally across the visceral segment, we performed a modified septotomy in a cephalad direction. Stiff wires were passed into the prior surgical graft, through true lumen on the right and false lumen on the left. An additional wire was passed across an existing fenestration at the level of the celiac axis, and snared and externalized. 7F Ansel sheaths were advanced and positioned tip-to-tip at the fenestration. Using the stiff wires as tracks, the through-wire was pushed cephalad to endovascularly cut the septum. Angiogram demonstrated successful septotomy, and TEVAR was performed to just above the celiac with successful aneurysm exclusion and no endoleak or retrograde false lumen perfusion. Follow-up computed tomography angiogram (CTA) showed continued exclusion without false lumen perfusion. CONCLUSIONS This novel modification in a reverse direction provides an alternative method for endovascular septotomy, when traditional septotomy may threaten the visceral vessels.
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Affiliation(s)
- Jordan R Stern
- Division of Vascular & Endovascular Surgery, Stanford University, Stanford, CA, USA
| | - Xuan-Binh D Pham
- Division of Vascular & Endovascular Surgery, Stanford University, Stanford, CA, USA.,Division of Vascular Surgery, Swedish Hospital, Seattle, WA, USA
| | - Jason T Lee
- Division of Vascular & Endovascular Surgery, Stanford University, Stanford, CA, USA
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13
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Oberhuber A, Raddatz A, Betge S, Ploenes C, Ito W, Janosi RA, Ott C, Langheim E, Czerny M, Puls R, Maßmann A, Zeyer K, Schelzig H. Interdisciplinary German clinical practice guidelines on the management of type B aortic dissection. GEFASSCHIRURGIE 2023; 28:1-28. [PMCID: PMC10123596 DOI: 10.1007/s00772-023-00995-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/14/2023] [Indexed: 08/13/2023]
Affiliation(s)
- A. Oberhuber
- German Society of Vascular Surgery and Vascular Medicine (DGG); Department of Vascular and Endovascular Surgery, University Hospital of Münster, Münster, Germany
| | - A. Raddatz
- German Society of Anaesthesiology and Intensive Care Medicine (DGAI); Department of Anaesthesiology, Critical Care and Pain Medicine, Saarland University Hospital, Homburg, Germany
| | - S. Betge
- German Society of Angiology and Vascular Medicine (DGG); Department of Internal Medicine and Angiology, Helios Hospital Salzgitter, Salzgitter, Germany
| | - C. Ploenes
- German Society of Geriatrics (DGG); Department of Angiology, Schön Klinik Düsseldorf, Düsseldorf, Germany
| | - W. Ito
- German Society of Internal Medicine (GSIM) (DGIM); cardiovascular center Oberallgäu Kempten, Hospital Kempten, Kempten, Germany
| | - R. A. Janosi
- German Cardiac Society (DGK); Department of Cardiology and Angiology, University Hospital Essen, Essen, Germany
| | - C. Ott
- German Society of Nephrology (DGfN); Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
- Department of Nephrology and Hypertension, Paracelsus Medical University, Nürnberg, Germany
| | - E. Langheim
- German Society of prevention and rehabilitation of cardiovascular diseaese (DGPR), Reha Center Seehof, Teltow, Germany
| | - M. Czerny
- German Society of Thoracic and Cardiovascular Surgery (DGTHG), Department University Heart Center Freiburg – Bad Krozingen, Freiburg, Germany
- Albert Ludwigs University Freiburg, Freiburg, Germany
| | - R. Puls
- German Radiologic Society (DRG); Institute of Diagnostic an Interventional Radiology and Neuroradiology, Helios Klinikum Erfurt, Erfurt, Germany
| | - A. Maßmann
- German Society of Interventional Radiology (DeGIR); Department of Diagnostic an Interventional Radiology, Saarland University Hospital, Homburg, Germany
| | - K. Zeyer
- Marfanhilfe e. V., Weiden, Germany
| | - H. Schelzig
- German Society of Surgery (DGCH); Department of Vascular and Endovascular Surgery, University Hospital of Düsseldorf, Düsseldorf, Germany
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14
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Russo M, Boehler-Tatman M, Albright C, David C, Kennedy L, Roberts AW, Shalhub S, Afifi R. Aortic dissection in pregnancy and the postpartum period. Semin Vasc Surg 2022; 35:60-68. [PMID: 35501042 DOI: 10.1053/j.semvascsurg.2022.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/16/2022] [Accepted: 02/16/2022] [Indexed: 01/18/2023]
Abstract
Pregnancy-associated aortic dissection (AD) is a rare event, with an incidence of 0.0004% per pregnancy. The work of the Aortic Dissection Collaborative identified pregnancy-associated AD as a high-priority topic, despite its rarity. The Pregnancy Working Group, which included physicians and patient stakeholders, performed a systematic literature review of pregnancy-associated AD from 1960 to 2021 and identified 6,333 articles through PubMed, OVID MEDLINE, Cochrane, Embase, CINAHL and Web of Science. The inclusion criterion was AD in pregnant populations and exclusion criteria were case reports, conference abstracts, and languages other than English. Assessment of full-text articles for eligibility after removal of duplicates from all databases yielded 68 articles to be included in the final review. Topics included were timing of AD in pregnancy, type of AD, and management considerations of pregnancy-associated AD. The Pregnancy Working Group identified gaps in knowledge and future areas of research for pregnancy-associated AD, including clinical management, mental health outcomes post AD, reproductive and genetic counseling, and contraception after AD. Future collaborative projects could be a multicenter, international registry for all pregnancy-associated AD to refine the risk factors, best practice and management of AD in pregnancy. In addition, future mixed methodology studies may be useful to explore social, mental, and emotional factors related to pregnancy-associated AD and to determine support groups' effect on anxiety and depression related to these events in the pregnancy and postpartum period.
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Affiliation(s)
- Melissa Russo
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Women and Infants Hospital, Providence, Warren Alpert Medical School of Brown University, Providence, RI
| | | | - Catherine Albright
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Washington Medical Center, Seattle, WA
| | - Carmen David
- Aortic Dissection Collaborative Patient Stakeholder Group, Bedford, TX
| | | | - Aaron W Roberts
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center, Houston, TX
| | - Sherene Shalhub
- Division of Vascular Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA
| | - Rana Afifi
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), 6400 Fannin Street, Suite #2850, Houston, TX 77030.
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15
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Weaver JJ, Shin DS, Chick JFB, Monroe EJ. Intravascular ultrasound for endovascular precision in pediatrics. Pediatr Radiol 2022; 52:559-569. [PMID: 34716455 DOI: 10.1007/s00247-021-05220-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/30/2021] [Accepted: 10/05/2021] [Indexed: 11/25/2022]
Abstract
Intravascular ultrasound (IVUS) is used as a diagnostic adjunct to angiography and has become a valuable diagnostic and interventional tool with a well-documented safety profile. The American College of Cardiology and the European Society of Cardiology have published guidelines regarding the use of IVUS in the setting of percutaneous coronary intervention. IVUS has gained popularity in the interventional radiology (IR) community in recent years; however, there are no consensus guidelines for utilization. Furthermore, IVUS remains an infrequently used modality in pediatric IR, likely because of unfamiliarity with the equipment and techniques, as well as concerns over the compatibility of these instruments with pediatric anatomy. IVUS can be safely used as a helpful and sometimes necessary tool for pediatric interventions in appropriately selected patients. The utility of IVUS for reducing both fluoroscopy time and contrast agent volume makes it particularly valuable in pediatric practice. This article presents an overview of both the rotational and phased-array IVUS types and an in-depth discussion on the most common applications of these techniques in the pediatric setting across multiple procedure categories.
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Affiliation(s)
- John J Weaver
- Section of Vascular and Interventional Radiology, Department of Radiology, University of Washington, Seattle, WA, USA
| | - David S Shin
- Section of Vascular and Interventional Radiology, Department of Radiology, University of Washington, Seattle, WA, USA
| | - Jeffrey Forris Beecham Chick
- Section of Vascular and Interventional Radiology, Department of Radiology, University of Washington, Seattle, WA, USA
- Section of Vascular and Interventional Radiology, Department of Radiology, Seattle Children's Hospital, Seattle, WA, USA
| | - Eric J Monroe
- Section of Vascular and Interventional Radiology, Department of Radiology, American Family Children's Hospital, 1675 Highland Ave., Madison, WI, 53792, USA.
- Section of Vascular and Interventional Radiology, Department of Radiology, University of Wisconsin, Madison, WI, USA.
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16
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Alagoz M, Ikeno Y, Tanaka A, Estrera AL, Afifi RO. Intraoperative antegrade intravascular ultrasound examination in acute type A aortic dissection with suspected visceral malperfusion. JTCVS Tech 2021; 10:183-187. [PMID: 34977723 PMCID: PMC8691799 DOI: 10.1016/j.xjtc.2021.08.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 08/25/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
| | | | | | | | - Rana O. Afifi
- Address for reprints: Rana O. Afifi, MD, Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at UTHealth, 6400 Fannin St, Ste. #2850, Houston, TX 77030.
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17
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Smith JA, Bose S, Sarode A, Cho JS, Colvard B. Effect of intravascular ultrasound on clinical outcomes after thoracic endovascular aortic repair for blunt thoracic aortic injury. J Vasc Surg 2021; 75:448-454.e2. [PMID: 34506893 DOI: 10.1016/j.jvs.2021.08.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Thoracic endovascular aortic repair (TEVAR) for blunt traumatic aortic injuries (BTAIs) can be complicated by inaccurate aortic measurements at the initial computed tomography angiography secondary to hypovolemic shock. The use of intravascular ultrasound (IVUS) has been proposed for more accurate aortic sizing, with prior data demonstrating larger aortic sizes measured by IVUS, potentially altering the vast majority of chosen endograft sizes. At present, and to the best of our knowledge, no studies have examined whether IVUS affects the clinical outcomes. The purpose of the present study was to examine the effect of IVUS on the clinical outcomes after TEVAR for BTAIs. METHODS A retrospective cohort study was performed of patients who had undergone TEVAR for BTAIs in the VQI registry. The cohorts were defined by the use of IVUS. The primary outcomes were mortality and reintervention at 1 year. RESULTS A total of 919 patients who had undergone TEVAR for BTAIs were included in the present analysis. The IVUS patients had presented with higher injury severity scores (36.2 vs 42; P = .0004) largely because of more extremity and external trauma. IVUS was more often used for patients with grade III injuries (49.1% vs 56.9%; P = .02) and less often for patients with rupture (21.1% vs 12.4%; P = .001). A trend toward a delay in TEVAR was seen for the patients for whom IVUS was used (1.8 vs 3.5 days; P = .38), with additional trends toward reduced intraoperative resuscitation and blood loss. The hemodynamic status of the patients and differences in aortic or endograft sizes could not be assessed with the available data. IVUS use was not associated with any differences in survival or reintervention rates in-hospital or at 1 year (Kaplan-Meier survival estimates: 0.91 no IVUS vs 0.92 IVUS; P = .46). Fifteen aortic-related reinterventions occurred across the entire patient cohort for all-available follow-up with comparable rates of type I endoleaks (1 no IVUS vs 2 IVUS), with no recorded cases of sizing-related complications such as device rupture, migration, or dissection. CONCLUSIONS IVUS usage during TEVAR for BTAIs was associated with clinical scenarios in which patients were more stable and interventions to address BTAIs can be delayed. Despite this, the overall clinical outcomes were similar between cases in which IVUS was used and for which it was not.
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Affiliation(s)
- Justin A Smith
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Saideep Bose
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Anuja Sarode
- Research in Surgical Outcomes and Effectiveness, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jae S Cho
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Benjamin Colvard
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
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18
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Mezzetto L, Mastrorilli D, Abatucci G, Scorsone L, Macrì M, Criscenti P, Onorati F, Gennai S, Veraldi E, Veraldi GF. Impact of Cone Beam Computed Tomography in Advanced Endovascular Aortic Aneurysm Repair Using Last Generation 3D C-arm. Ann Vasc Surg 2021; 78:132-140. [PMID: 34175420 DOI: 10.1016/j.avsg.2021.04.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/15/2021] [Accepted: 04/17/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND To report the early outcomes of cone beam computed tomography (CBCT) using last generation 3D C-arm in patients undergone advanced endovascular aortic aneurysm repair (AdEVAR) and to identify risk factors that may predict any un-planned procedures. METHODS Patients undergone AdEVAR between December 2017 and December 2018 were enrolled. Final CBCT was performed in all patients after digital subtraction angiography. Primary end points were the incidence of any positive findings and the following unplanned procedures intended as any endovascular manoeuvre performed to fix such technical defect. The secondary endpoints were comparison of outcomes between patients with positive findings undergone unplanned procedure (Group A) versus patients without findings (Group B). RESULTS 132 patients underwent endovascular treatment for aortic aneurysm. Of these, 22 (33%) fenestrated-branched endovascular aneurysm repairs (F-BEVAR), 21 (29%) EVAR with iliac branch devices, 19 (26%) abdominal and 10 (14%) thoracic EVAR were included in the study. Unplanned procedures after CBCT were necessary in 22 patients (31%). Patients in both groups were similar excepted for BMI >25 kg/m2 (55% vs. 26%), hostile iliac anatomy (64% vs. 32%) and previous aortic treatment (73% vs. 32%) (P < 0.05). The odds ratios for unplanned procedure in case of previous aortic treatment was 6.76 (95% CI, 1.97-23.16; P = 0.002). CONCLUSION The use of CBCT, especially in challenging scenarios, can reveal technical defects and may potentially limit the need for late reintervention. Patients undergone previous aortic surgery should be carefully evaluated and routine CBCT should be performed.
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Affiliation(s)
- Luca Mezzetto
- Department of Vascular Surgery; Integrated University Hospital of Verona, School of Medicine, Verona, Italy.
| | - Davide Mastrorilli
- Department of Vascular Surgery; Integrated University Hospital of Verona, School of Medicine, Verona, Italy
| | - Giacomo Abatucci
- Department of Vascular Surgery; Integrated University Hospital of Verona, School of Medicine, Verona, Italy
| | - Lorenzo Scorsone
- Department of Vascular Surgery; Integrated University Hospital of Verona, School of Medicine, Verona, Italy
| | - Marco Macrì
- Department of Vascular Surgery; Integrated University Hospital of Verona, School of Medicine, Verona, Italy
| | - Paolo Criscenti
- Department of Vascular Surgery; Integrated University Hospital of Verona, School of Medicine, Verona, Italy
| | - Francesco Onorati
- Department of Cardiac Surgery; Integrated University Hospital of Verona, Italy
| | - Stefano Gennai
- Department of Vascular Surgery; Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Edoardo Veraldi
- Department of Vascular Surgery; Integrated University Hospital of Verona, School of Medicine, Verona, Italy
| | - Gian Franco Veraldi
- Department of Vascular Surgery; Integrated University Hospital of Verona, School of Medicine, Verona, Italy
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