1
|
Dev R, Gitanjali K, Anshuman D. Demystifying penetrating atherosclerotic ulcer of aorta: unrealised tyrant of senile aortic changes. J Cardiovasc Thorac Res 2021; 13:1-14. [PMID: 33815696 PMCID: PMC8007901 DOI: 10.34172/jcvtr.2021.15] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/09/2021] [Indexed: 12/14/2022] Open
Abstract
This review article describes demographic features, comorbidities, clinical and imaging findings, prognosis, and treatment strategies in penetrating atherosclerotic ulcer (PAU) and closely related entities using google scholar web search. PAU is one of the manifestations of the acute aortic syndrome (AAS) spectrum. The underlying aorta invariably shows atherosclerotic changes or aneurysmal dilatation. Hypertension is the most common contributing factor, with chest or back pain being the usual manifestation. Intramural hematoma (IMH) is the second entity associated with both PAU and aortic dissection (AD), more so with the latter. Chest radiograph can show mediastinal widening, pleural, or pericardial fluid in rupture. Computed tomography angiography (CTA) is the imaging modality of choice to visualize PAU, with magnetic resonance imaging (MRI) and transoesophageal echocardiography (TEE) adding diagnostic value. Lesser-known entities of intramural blood pool (IBP), limited intimal tears (LITs), and focal intimal disruptions (FID) are also encountered. PAU can form fistulous communication with adjacent organs whereas IMH may propagate to dissection. CTA aids in defining the management, open or endovascular options in surgical candidates.
Collapse
Affiliation(s)
- Rahul Dev
- Department of Radiodiagnosis and Imaging, All India Institute of Medical Sciences, Rishikesh, Uttarakhand-249203, India
| | - Khorwal Gitanjali
- Department of Anatomy, All India Institute of Medical Sciences, Rishikesh, Uttarakhand-249203, India
| | - Darbari Anshuman
- Department of Cardiothoracic and Vascular Surgery (CTVS), All India Institute of Medical Sciences, Rishikesh, Uttarakhand-249203, India
| |
Collapse
|
2
|
Jiang X, Pan T, Zou L, Chen B, Jiang J, Shi Y, Ma T, Lin C, Guo D, Xu X, Yang J, Shi Z, Zhu T, Dong Z, Fu W. Outcomes of endovascular stent graft repair for penetrating aortic ulcers with or without intramural hematoma. J Vasc Surg 2020; 73:1541-1548. [PMID: 33091512 DOI: 10.1016/j.jvs.2020.10.022] [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] [Received: 04/25/2020] [Accepted: 10/04/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We investigated the outcomes of endovascular repair for penetrating aortic ulcers (PAUs) with and without intramural hematoma (IMH). METHODS Patients with PAUs who had undergone thoracic endovascular aortic repair (TEVAR) or endovascular abdominal aortic repair (EVAR) at our center were enrolled. Patient demographics, presenting symptoms, and anatomic characteristics were collected and analyzed to investigate the TEVAR/EVAR indications, perioperative complications, and mortality. RESULTS We identified 138 patients with PAU. Of the 138 patients, 58 (42.0%) had also had IMH. Compared with the patients without IMH, the patients with IMH had had significantly greater emergency admission rates (P < .01), a larger aortic diameter (P = .03), and a greater incidence of stent-induced new entry development (P = .02). No significant differences were found in mortality or freedom from reintervention between patients with PAUs with and without IMH during follow-up. However, the cumulative survival rates calculated using Kaplan-Meier analysis for patients who had undergone TEVAR/EVAR during their first hospitalization were significantly greater than those who had undergone delayed TEVAR/EVAR during follow-up. CONCLUSIONS TEVAR/EVAR was safe and effective, with encouraging outcomes for patients with PAUs with or without IMH, and can be used more aggressively for symptomatic patients. The presence of PAUs with IMH did not seem to adversely affect long-term mortality. However, but stent-induced new entry was more likely to develop.
Collapse
Affiliation(s)
- Xiaolang Jiang
- Institute of Vascular Surgery, Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tianyue Pan
- Institute of Vascular Surgery, Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lingwei Zou
- Institute of Vascular Surgery, Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Bin Chen
- Institute of Vascular Surgery, Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Junhao Jiang
- Institute of Vascular Surgery, Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yun Shi
- Institute of Vascular Surgery, Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tao Ma
- Institute of Vascular Surgery, Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Changpo Lin
- Institute of Vascular Surgery, Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Daqiao Guo
- Institute of Vascular Surgery, Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xin Xu
- Institute of Vascular Surgery, Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jue Yang
- Institute of Vascular Surgery, Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhenyu Shi
- Institute of Vascular Surgery, Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ting Zhu
- Institute of Vascular Surgery, Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhihui Dong
- Institute of Vascular Surgery, Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Weiguo Fu
- Institute of Vascular Surgery, Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
3
|
Lee WMM, Wong OF, Fung HT. Penetrating Atherosclerotic Ulcer - an Increasingly Recognized Entity of the Acute Aortic Syndrome: Case Report and Literature Review. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790901600409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
With the advance in diagnostic radiology, penetrating atherosclerotic ulcers of the aorta become increasingly recognised in our daily practice. However, their natural history and treatment are not well defined. We report a case of penetrating atherosclerotic ulcer at the aortic arch and review the literature.
Collapse
|
4
|
Kos X, Bouchard L, Otal P, Chabbert V, Chemla P, Soula P, Meites G, Joffre F, Rousseau H. Stent-Graft Treatment of Penetrating Thoracic Aortic Ulcers. J Endovasc Ther 2016. [DOI: 10.1177/15266028020090s205] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To evaluate the efficacy of stent-graft placement for the treatment of penetrating thoracic aortic ulcers. Methods: Ten patients (7 men; mean age 73.8 years, range 69–79) were treated for penetrating thoracic aortic ulcers using Talent or Excluder stent-grafts. Preoperative examinations included computed tomographic angiography (CTA), transesophageal echography, and digital subtraction angiography (DSA). Follow-up included predischarge multimodal imaging and periodic CTA scans after discharge. Endoleaks, aortic diameter changes, and clinical complications were tracked. Results: Technical success was achieved in 100%, but 1 major neurological complication led to death 3 months after the procedure. Radiological follow-up detected 4 early endoleaks (3 type I and a type II), all of which spontaneously regressed, and 1 secondary type II endoleak. The mean aortic diameter decreased by 22% over a mean 9-month follow-up. Conclusions: Aortic ulcers are potentially lethal lesions. Considering its low morbidity and mortality, endovascular repair could widen the treatment options for these lesions.
Collapse
Affiliation(s)
| | | | | | | | | | - Philippe Soula
- Department of Vascular Surgery, University Hospital of Rangueil, Toulouse, France
| | | | | | | |
Collapse
|
5
|
Faries PL, Lang E, Ramdev P, Hollier LH, Marin ML, Pomposelli FB. Endovascular Stent-Graft Treatment of a Ruptured Thoracic Aortic Ulcer. J Endovasc Ther 2016. [DOI: 10.1177/15266028020090s204] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To describe a ruptured ulcer of the descending thoracic aorta treated with an endovascular stent-graft deployed under transesophageal echocardiographic (TEE) guidance. Case Report: An 82-year-old man with severe chronic obstructive pulmonary disease and congestive heart failure presented with sharp pain in the back radiating to the left flank. Computed tomography (CT) and angiography demonstrated a penetrating ulcer of the descending thoracic aorta associated with aortic dissection commencing 6 cm from the origin of the left subclavian artery with extravasation of contrast outside the aortic wall. The patient remained symptomatic with a decrease in hematocrit from 36% to 23%. Endovascular repair was performed using self-expanding nitinol stents sutured to a 35-mm × 12-cm Dacron conduit. The device was deployed with a 24-F delivery system under TEE guidance and fluoroscopy. Successful exclusion of the ruptured ulcer was demonstrated by TEE Doppler, arteriography, and CT. The patient remains asymptomatic 18 months after the procedure with no CT evidence of endoleak. Conclusions: Endovascular stent-graft repair under TEE guidance assists in the oftentimes difficult treatment of ruptured penetrating thoracic aortic ulcer.
Collapse
Affiliation(s)
| | - Elvira Lang
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Pranay Ramdev
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Frank B. Pomposelli
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
6
|
Alric P, Berthet JP, Branchereau P, Veerapen R, Marty-Ané CH. Endovascular Repair for Acute Rupture of the Descending Thoracic Aorta. J Endovasc Ther 2016. [DOI: 10.1177/15266028020090s209] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To report the endovascular treatment of acute descending thoracic aortic rupture as an alternative to open surgery in high-risk patients. Methods: Between November 1999 and April 2001, 10 patients (7 men; median age 75 years) underwent endovascular stent-grafting of the descending thoracic aorta for acute rupture from an aneurysm (n = 7) or blunt trauma (n = 3). All patients were evaluated as high operative risk. The aortic rupture was associated with isolated mediastinal hematomas (n = 7), left hemothorax (n = 2), or aortobronchial fistula (n = 1). The Excluder Thoracic Endoprosthesis was used predominantly. Results: The mean interval to the endovascular repair was 45.3 ± 28.4 hours. All stent-grafts were successfully deployed. Two patients required common iliac artery access, and 2 needed covered stents for iatrogenic iliac artery rupture. There was 1 postoperative death (myocardial infarction) and no renal failure, neurological complications, embolization, stent-graft migration, or perigraft leak. One patient died 4 months later from an unrelated cause. At a mean follow-up of 7.9 ± 5.1 months, all aneurysms and rupture sites were excluded with no evidence of endoleak or hematoma. Conclusions: Endoluminal treatment is a feasible technique for the management of acute rupture of the descending thoracic aorta. Long-term studies are required to assess the effectiveness and durability of this technique in comparison to open repair.
Collapse
Affiliation(s)
- Pierre Alric
- Service de Chirurgie Vasculaire, Hôpital Arnaud de Villeneuve, Montpellier, France
| | | | - Pascal Branchereau
- Service de Chirurgie Vasculaire, Hôpital Arnaud de Villeneuve, Montpellier, France
| | - Reuben Veerapen
- Service de Chirurgie Vasculaire, Hôpital Arnaud de Villeneuve, Montpellier, France
| | | |
Collapse
|
7
|
D'Annoville T, Ozdemir BA, Alric P, Marty-Ané CH, Canaud L. Thoracic Endovascular Aortic Repair for Penetrating Aortic Ulcer: Literature Review. Ann Thorac Surg 2016; 101:2272-8. [DOI: 10.1016/j.athoracsur.2015.12.036] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 12/09/2015] [Accepted: 12/14/2015] [Indexed: 01/16/2023]
|
8
|
The natural history and outcomes for thoracic and abdominal penetrating aortic ulcers. J Vasc Surg 2016; 63:1182-8. [DOI: 10.1016/j.jvs.2015.11.050] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 11/12/2015] [Indexed: 11/16/2022]
|
9
|
Hoarseness and hematemesis: a deadly combination. Am J Gastroenterol 2014; 109:299-300. [PMID: 24496432 DOI: 10.1038/ajg.2013.418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
10
|
Kazan V, Jamil T, Beyrouti R, Nazzal M. Penetrating abdominal aortic ulcers: case reports and review of the literature. Vascular 2011; 19:346-50. [PMID: 21940759 DOI: 10.1258/vasc.2011.cr0278] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Atherosclerotic abdominal aortic ulcers are uncommon in contrast to those of the thoracic aorta. They present with a variety of symptoms. Computed tomography (CT) scans and magnetic resonance imaging (MRI) are the methods of diagnosis. Treatment is made easier with the use of endovascular techniques, which have less mortality and morbidity than open repair. In this paper, we present three cases of penetrating aortic ulcers presenting with abdominal pain. In two of those cases, the diagnosis was made by MRI and missed by CT scan. We present a review of the literature.
Collapse
Affiliation(s)
- Viviane Kazan
- Division of Vascular and Endovascular Surgery, University of Toledo Medical Center, Toledo, OH 43614, USA
| | | | | | | |
Collapse
|
11
|
Rousseau H, Cosin O, Marcheix B, Chabbert V, Midulla M, Dambrin C, Cron C, Leobon B, Conil C, Massabuau P, Otal P, Joffre F. Endovascular treatment of thoracic dissection. Semin Intervent Radiol 2011; 24:167-79. [PMID: 21326794 DOI: 10.1055/s-2007-980041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Type A aortic dissection remains fatal if untreated. Although classical medical therapy for type B dissection is considered the therapy of choice in uncomplicated cases, the paradigm is changing as greater experience is accrued with endovascular treatments and technical advances improve the long-term outlook. Diagnosis is also becoming more sophisticated, allowing greater appreciation of the anatomy of dissections and improving the knowledge base as their natural history is assessed.
Collapse
Affiliation(s)
- H Rousseau
- Department of Radiology, Cardio-Vascular Surgery and Cardiology, Hôpital Rangueil, Toulouse, France
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Alsac JM, Coscas R, Paraskevas N, Francis F, Castier Y, Leseche G. Acute Debranching and Stent Grafting for a Ruptured Penetrating Ulcer of the Aortic Arch. Ann Vasc Surg 2009; 23:687.e5-8. [DOI: 10.1016/j.avsg.2009.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2008] [Accepted: 03/26/2009] [Indexed: 11/16/2022]
|
13
|
Monnin-Bares V, Thony F, Rodiere M, Bach V, Hacini R, Blin D, Ferretti G. Endovascular stent-graft management of aortic intramural hematomas. J Vasc Interv Radiol 2009; 20:713-21. [PMID: 19398351 DOI: 10.1016/j.jvir.2009.02.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2008] [Revised: 01/30/2009] [Accepted: 02/04/2009] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To report initial experience with endovascular stent-grafting in aortic intramural hematoma (IMH). MATERIALS AND METHODS From 2000 to 2006, 15 patients (mean age, 67 years; range, 54-83 y) underwent endovascular treatment of aortic IMH. Thirteen patients were admitted for acute aortic syndrome and two for traumatic aortic injury. An endovascular procedure was performed as primary treatment for four patients (type A IMH, n = 3; type B IMH, n = 1) and as a second-line therapy in 11 patients because of unfavorable evolution (type A IMH, n = 1; type B IMH, n = 10). All stent-grafts were placed in the descending aorta, even for type A IMH. The mean follow-up was 21 months (range, 6-72 months). RESULTS The primary success rate was 93%, with complete exclusion of the lesion (n = 14). Exclusion was partial for one patient with a type I endoleak (7%). The 30-day mortality rate was zero. IMH evolution was favorable in all cases, with decreased aortic wall thickening (n = 8) or complete regression (n = 7). Complications associated with endovascular repair were mainly related to aneurysm formation (20%). The late death rate was 7%. CONCLUSIONS Endovascular stent-graft treatment can be performed in the management of complicated IMH, even in some cases of type A IMH, when an intimal lesion is located in the isthmus or descending aorta with contraindications to surgery. This procedure offers low morbidity and mortality rates, representing a feasible therapeutic option especially for elderly patients with comorbidities. Further studies are necessary to confirm these preliminary results.
Collapse
Affiliation(s)
- Valérie Monnin-Bares
- Department of Radiology, Centre Hospitalier Universitaire A. Michallon, Grenoble University 1, La Tronche, BP217, Grenoble 38043, France.
| | | | | | | | | | | | | |
Collapse
|
14
|
Svensson LG, Kouchoukos NT, Miller DC, Bavaria JE, Coselli JS, Curi MA, Eggebrecht H, Elefteriades JA, Erbel R, Gleason TG, Lytle BW, Mitchell RS, Nienaber CA, Roselli EE, Safi HJ, Shemin RJ, Sicard GA, Sundt TM, Szeto WY, Wheatley GH. Expert Consensus Document on the Treatment of Descending Thoracic Aortic Disease Using Endovascular Stent-Grafts⁎⁎Expert Consensus Document on the Treatment of Descending Thoracic Aortic Disease Using Endovascular Stent-Grafts has been supported by Unrestricted Educational Grants from Cook, Inc and Medtronic, Inc. Ann Thorac Surg 2008; 85:S1-41. [PMID: 18083364 DOI: 10.1016/j.athoracsur.2007.10.099] [Citation(s) in RCA: 550] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2007] [Revised: 10/17/2007] [Accepted: 10/18/2007] [Indexed: 01/15/2023]
Affiliation(s)
- Lars G Svensson
- Center for Aortic Surgery and Marfan Syndrome Clinic, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio 44195, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Pauls S, Orend KH, Sunder-Plassmann L, Kick J, Schelzig H. Endovascular Repair of Symptomatic Penetrating Atherosclerotic Ulcer of the Thoracic Aorta. Eur J Vasc Endovasc Surg 2007; 34:66-73. [PMID: 17324593 DOI: 10.1016/j.ejvs.2006.12.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2006] [Accepted: 12/20/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND In this study we evaluate published and personal experience of Endovascular Repair (EVAR) of penetrating atherosclerotic ulcers (PAU). PATIENTS AND METHOD In 12 patients (mean 74 years, 58-87 years) PAU was diagnosed with computer tomography (CT). Symptomatic ulcers were treated by vascular surgeons using stentgrafts via a femoral access route. Patients were followed up clinically and with CT for an average of 849 days (186-1968 days). RESULTS 11 patients had severe acute thoracic pain, one patient presented with hemoptysis. CT showed well outlined ulcer, intramural hematoma, and contrast enhancement of the aortic wall (n=12), pseudoaneurysm (n=11), intimal calcification adjoining the ulcer (n=10), pleural (n=9) and mediastinal fluid (n=4). Mean duration of surgery was 68min (32-120min). Primary technical success was achieved in all patients. There was no perioperative complications except one acute hemorrhage from an intercostal artery and one iliac dissection. 3 months after stentgraft application owing to a severe stenosis of the right common femoral artery, an iliofemoral bypass was performed in one patient. All patients were free of symptoms after the procedure. There was incomplete sealing of PAU in 2 of 12 patients, but no re-intervention was needed. All patients were alive during follow-up. CONCLUSION Symptomatic PAU is a potentially fatal lesion. Considering the low morbidity and mortality of EVAR, this option might be first choice.
Collapse
Affiliation(s)
- S Pauls
- Department of Diagnostic and Interventional Radiology, University of Ulm, Germany
| | | | | | | | | |
Collapse
|
16
|
Endovascular repair of abdominal infrarenal penetrating aortic ulcers: A prospective observational study. Int J Surg 2007; 5:172-5. [DOI: 10.1016/j.ijsu.2006.06.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2006] [Revised: 06/06/2006] [Accepted: 06/07/2006] [Indexed: 11/17/2022]
|
17
|
Piffaretti G, Tozzi M, Lomazzi C, Rivolta N, Riva F, Maida S, Caronno R, Laganà D, Carrafiello G, Cuffari S, Castelli P. Penetrating ulcers of the thoracic aorta: results from a single-centre experience. Am J Surg 2007; 193:443-7. [PMID: 17368285 DOI: 10.1016/j.amjsurg.2006.08.073] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2006] [Revised: 08/02/2006] [Accepted: 08/02/2006] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To report our mid-term results of stent-graft (SG) placement for the treatment of penetrating thoracic aortic ulcers. METHODS In the last 30 months, 11 patients (9 men; mean age 73 years; range 55 to 81) were treated for 12 penetrating thoracic aortic ulcers using SGs. Five patients were symptomatic: 2 had ruptured ulcers and 2 cases were complicated with dissection. Mean European System for Cardiac Operative Risk Evaluation (EuroSCORE) was 10. Three patients had concomitant endovascular repair for an infrarenal abdominal aortic aneurysm (AAA). Follow-up included periodic computed tomography angiography (CT-A) scans at 1, 4, and 12 months after the intervention, and yearly thereafter. RESULTS Primary technical success was achieved in 100% of patients; no conversion was required. In-hospital mortality did not occur. Paraplegia was not observed. Mean follow-up was 15 months (range 2 to 36). One patient died of respiratory failure 2 months after the intervention. Radiologic follow-up did not detect endoleaks. Survival was 90% at 1 and 3 years. CONCLUSIONS Our experience confirms the feasibility of SG treatment for elective and urgent repair of penetrating aortic ulcers. Our current attitude is to treat all the ulcers of the descending aorta using an endovascular technique, since SG treatment represents a good treatment option, as the morbidity and mortality are low.
Collapse
Affiliation(s)
- Gabriele Piffaretti
- Vascular Surgery-Department of Surgery, University of Insubria, Varese, Italy.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Aidinian G, Massimiano PS, Speir AM, Mukherjee D. Endovascular stent-graft repair of penetrating descending thoracic aortic ulcer. Vasc Endovascular Surg 2007; 41:83-6. [PMID: 17277250 DOI: 10.1177/1084713806296075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article presents a case in which covered stent-graft cuffs were used to treat a penetrating ulcer of the descending thoracic aorta. An 80-year-old woman presented with penetrating ulcer in the descending thoracic aorta. Two endovascular stent graft cuffs were used for total exclusion of the penetrating ulcer, because the patient had a high operative risk. Her postoperative course was uneventful, and follow-up computed tomographic angiography showed complete coverage of the ulcer without evidence of leak. This case demonstrates that endoluminal stent-graft repair of penetrating descending thoracic aortic ulcers is a safe, less-invasive treatment, especially for elderly, high-risk patients.
Collapse
Affiliation(s)
- Gilbert Aidinian
- Department of Surgery, Walter Reed Army Medical Center, Washington, DC, USA.
| | | | | | | |
Collapse
|
19
|
Nasser F, Neser A, Ingrund JC, Zurstrassen CE, Ribeiro FDMC, Moreira RV, Arcenio Neto E, Burihan MC, Barros OC. Fístula aorto-esofágica secundária a fratura de endoprótese torácica: relato de caso. J Vasc Bras 2006. [DOI: 10.1590/s1677-54492006000400013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
O tratamento endovascular dos aneurismas aórticos torácicos tem se desenvolvido consideravelmente nos últimos anos. No entanto, complicações tardias desta nova modalidade terapêutica apenas agora estão sendo observadas e analisadas. Fístulas aorto-esofágicas são complicações raras do tratamento endovascular dos aneurismas aórticos, sendo encontrados poucos relatos na literatura. O presente caso reporta um paciente com aneurisma aórtico torácico tratado há 4 anos e complicado com fratura da endoprótese. Após nova intervenção endovascular, foi observada extrusão da antiga endoprótese através do esôfago com formação de fístula. Apesar do tratamento realizado, o paciente evoluiu a óbito 9 dias após por hemorragia digestiva maciça. Aspectos técnicos e revisão de literatura são discutidos.
Collapse
|
20
|
Veeraswamy RK, Sanchez LA, Rubin BG, Moon MR, Curci J, Flye MW, Geraghty PJ, Parodi J, Sicard GA. Endovascular Repair of Thoracic Aortic Lesions Using Infrarenal Devices: Lessons Learned and Continued Applications. Ann Vasc Surg 2006; 20:330-7. [PMID: 16779514 DOI: 10.1007/s10016-006-9068-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2006] [Revised: 01/11/2006] [Accepted: 02/17/2006] [Indexed: 10/24/2022]
Abstract
The application of endovascular devices for the treatment of a variety of thoracic aortic lesions has flourished worldwide over the past decade. Until physicians become facile with recently approved thoracic devices and these devices are immediately available even in emergency situations, the use of endovascular abdominal components offers physicians more options in managing thoracic lesions. We evaluated the safety, efficacy, and outcomes of commercially available, infrarenal endovascular graft components for managing lesions of the thoracic aorta. Nineteen patients were treated outside of a clinical trial using commercially available endovascular devices. The indications for treatment included acute traumatic lesions (n = 7), symptomatic ulcers (n = 4), focal aneurysms or pseudoaneurysms (n = 7), and symptomatic type B dissection (n = 1). The endovascular components included Excluder Aortic Cuffs (n = 9), AneuRx Aortic Cuffs (n = 5), Zenith Aortic Cuffs (n = 2), Zenith Aortic Tube Grafts (n = 2), and graft combinations (n = 1). Seventeen patients (89%) underwent successful endovascular treatment of their thoracic lesion. One patient required elective surgical conversion, and a second patient had a dissection that was not completely sealed endovascularly. There was no periprocedural mortality, and the major complication rate was 16% (3/19). Two patients had asymptomatic troponin leaks, and one patient developed an iliac rupture at the device introduction site, hypotension, and paraplegia. At a mean follow-up of 12.3 months, all successfully treated patients continue to have complete exclusion of the treated lesion. Infrarenal endovascular graft components can be very useful in the treatment of selected patients with amenable thoracic lesions until thoracic devices are available in all necessary sizes, readily accessible to treating physicians, and cost-effective.
Collapse
Affiliation(s)
- Ravi K Veeraswamy
- Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Schelzig H, Pauls S, Kick J, Orend KH, Sunder-Plassmann L, Scharrer-Pamler R. Symptomatisches infrarenales penetrierendes Aortenulkus (PAU) — endovaskuläre Therapie. GEFASSCHIRURGIE 2005. [DOI: 10.1007/s00772-005-0412-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
22
|
Garzón G, Fernández-Velilla M, Martí M, Acitores I, Ybáñez F, Riera L. Endovascular Stent-Graft Treatment of Thoracic Aortic Disease. Radiographics 2005; 25 Suppl 1:S229-44. [PMID: 16227493 DOI: 10.1148/rg.25si055513] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Aneurysmal diseases of the thoracic aorta are life-threatening conditions. In such cases, stent-graft treatment has been proposed as an alternative to surgery. The morbidity and mortality associated with endovascular repair are significantly lower than those associated with open surgery. In the largest surgical series, the mortality ranged from 5% to 20%. In studies of endovascular repair, the 30-day mortality was 0%-20% and the periprocedural stroke rate was 0%-7%. Often, open surgery is prohibited in patients with these high-risk lesions; thus, in many cases endovascular treatment is the only alternative. Thoracic aortic diseases that can be treated with endovascular stent-graft placement include aneurysms, dissection, traumatic rupture, traumatic pseudoaneurysms, intramural hematoma, penetrating atherosclerotic ulcers, and aortic rupture. Thorough preprocedure imaging is essential for selecting patients, choosing the stent-graft devices, and planning the intervention. Prerequisites for endovascular stent-graft placement are an adequate neck for graft attachment and adequate vascular access. When the ascending aorta or aortic arch is involved, surgical and endovascular procedures can be combined and performed simultaneously, allowing treatment of a wider range of cases. An experienced interdisciplinary team is needed to manage such cases.
Collapse
Affiliation(s)
- Gonzalo Garzón
- Department of Radiology, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain
| | | | | | | | | | | |
Collapse
|
23
|
Melissano G, Astore D, Civilini E, Chiesa R. Endovascular Treatment of Ruptured Penetrating Aortic Ulcers. Ann Vasc Surg 2005; 19:270-5. [PMID: 15770363 DOI: 10.1007/s10016-004-0177-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Penetrating aortic ulcer (PAU) is a potentially lethal lesion that should be promptly diagnosed and treated. Because of the older age and serious comorbidity of these patients, outcome with rupture of the ulcer is often ominous, even when appropriate conventional surgical treatment is given. In this study we report our experience with two cases of endovascular treatment of ruptured PAU in two elderly female patients who had evident signs of intrathoracic bleeding. Endovascular treatment was performed with a stent-graft device advanced through a 24-F sheath. The graft successfully covered the PAU in both cases and the postoperative course was uneventful. Both patients were alive and well at follow-up, with regression of the hematomas and correct positioning of the grafts. Because of the reduced invasiveness of endovascular stent-graft repair, it is an alternative therapeutic option to conventional surgery in the treatment of ruptured PAU.
Collapse
Affiliation(s)
- Germano Melissano
- Department of Vascular Surgery, Scientific Institute H. San Raffaele, Università Vita Salute--San Raffaele, Milano, Italy.
| | | | | | | |
Collapse
|
24
|
Batt M, Haudebourg P, Planchard PF, Ferrari E, Hassen-Khodja R, Bouillanne PJ. Penetrating Atherosclerotic Ulcers of the Infrarenal Aorta: Life-threatening Lesions. Eur J Vasc Endovasc Surg 2005; 29:35-42. [PMID: 15570269 DOI: 10.1016/j.ejvs.2004.09.025] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To analyze the incidence, clinical features, natural history, and treatment of penetrating atherosclerotic ulcers (PAU) of the abdominal aorta. MATERIAL AND METHODS From January 2000 to June 2003, an abdominal PAU was diagnosed at our institution in eight patients (seven men, one woman; mean age 70 year). These eight cases were analyzed together with 38 additional cases found in a review of the literature (total 46 cases). RESULTS Occurring at an incidence of approximately 1%, abdominal PAU are less common than thoracic PAU. Seventy percent of cases are symptomatic: pain 52.5% (n =21), acute lower limb ischemia due to distal embolism 12.5% (n =5), shock 5% (n =2). Diagnosis is usually made by CT (66%) (n =26) that demonstrates a PAU in 35% (n =16) of cases, a subadventitial pseudoaneurysm in 28% (n =13), and rupture in 37% (n =17). An intramural hematoma (IMH) is observed in 9% (n =4) of cases. There were no cases of aortic dissection in this series. Calcifications of the abdominal aorta were frequent (56%) (n =26); while intra-aortic mural thrombus was found in 24% of cases (n =11), and 46% of patients (n =21) had an associated aneurysm. Twelve patients were treated medically while 34 underwent surgery (one postoperative death). CONCLUSION Review of the literature and this series suggests that PAU of the abdominal aorta is a life-threatening lesion, the main risk being rupture. Surgical management is recommended owing to its low morbidity and mortality.
Collapse
Affiliation(s)
- M Batt
- Department of Vascular Surgery, Hôpital Saint-Roch, 0600 Nice Cedex 1, France.
| | | | | | | | | | | |
Collapse
|
25
|
Abstract
The advent and success of endovascular repair of abdominal aneurysms had led to the development of catheter-based techniques to treat thoracic aortic pathology. Such diseases, including thoracic aortic aneurysms, acute and chronic type B dissections,penetrating aortic ulcers, and traumatic aortic transection, challenge surgeons to perform complex operative repairs in high-risk patients. The minimally invasive nature of thoracic endografting may provide an attractive alternative therapy especially in patients deemed unfit for thoracotomy. A worldwide review of thoracic endografting demonstrates encouraging short- and midterm outcomes with significant reductions in morbidity and early mortality.Long-term surveillance will be crucial to discover complications unique to thoracic endovascular interventions and to determine which patients are appropriate candidates for stent-graft therapy.
Collapse
Affiliation(s)
- Jason T Lee
- Division of Vascular Surgery H3600, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305-5642, USA.
| | | |
Collapse
|
26
|
D'Ancona G, Bauset R, Normand JP, Turcotte R, Dagenais F. Endovascular stent-graft repair of a complicated penetrating ulcer of the descending thoracic aorta: a word of caution. J Endovasc Ther 2004; 10:928-31. [PMID: 14656180 DOI: 10.1177/152660280301000513] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To report a pitfall encountered during stenting of a complicated penetrating ulcer of the descending thoracic aorta. CASE REPORT A 65-year-old man was diagnosed with a complicated penetrating ulcer of the thoracic aorta. A 38-mm Talent endograft was implanted. On balloon dilation of the distal end of the endoprosthesis, the terminal bare stent became distorted and penetrated the aortic wall. A 42-mm endoprosthesis was immediately placed to exclude the aortic perforation. Control aortography demonstrated exclusion of the original proximal aortic ulcer and the distal iatrogenic aortic tear. CONCLUSIONS Endoprostheses may present some drawbacks in terms of elasticity and adaptability to tortuous and angulated diseased aortas. Caution is advised in the treatment of penetrating aortic ulcers where the aortic wall is diffusely friable. In this condition, balloon dilation should be limited to the covered portion of the stent-graft to prevent stent distortion and erosion through the aortic wall.
Collapse
Affiliation(s)
- Giuseppe D'Ancona
- Department of Cardiovascular Surgery, Quebec Heart Institute, Sainte-Foy, Canada
| | | | | | | | | |
Collapse
|
27
|
Demers P, Miller DC, Mitchell RS, Kee ST, Chagonjian L, Dake MD. Stent-graft repair of penetrating atherosclerotic ulcers in the descending thoracic aorta: mid-term results. Ann Thorac Surg 2004; 77:81-6. [PMID: 14726040 DOI: 10.1016/s0003-4975(03)00816-6] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Localized aortic pathoanatomic abnormalities are good targets for endovascular stent-grafting but only short-term results have been reported. Our objective was to determine the effectiveness of endovascular stent-graft treatment of patients with descending thoracic atherosclerotic penetrating atherosclerotic ulcers (PAU) and to identify risk factors for treatment failure. METHODS Between 1993 and 2000 endovascular repair of PAU with first-generation (custom-fabricated) and second-generation (commercial) stent-grafts was performed in 26 patients (mean age, 70 years), 6 (23%) of whom had rupture. Fourteen patients (54%) were not candidates for open surgical repair. Follow-up was 100% complete (average, 51 months; maximum, 114 months). Outcome variables considered in the multivariable analysis included death and treatment failure (composite end-point comprising early death, endoleak, stent-graft mechanical fault, late aortic event, reintervention, and aortic-related or sudden death). RESULTS Three patients (12% +/- 7% [+/-70% confidence limits]) died within 30 days and 2 had an early type I endoleak. Primary success rate was 92%. Actuarial survival estimates at 1, 3, and 5 years were 85% +/- 8%, 76% +/- 8% and 70% +/- 10% respectively and actuarial freedom from treatment failure was 81% +/- 8%, 71% +/- 9% and 65% +/- 10%. Multivariable analyses identified previous cerebrovascular accident (hazard ratio [HR] 17.1, p = 0.02) and female sex (HR 7.4, p = 0.08) as independent risk factors for death. For treatment failure the predictors were increasing aortic diameter (HR 1.1 [per mm above the mean value], p = 0.01) and female sex (HR 5.5, p = 0.09). CONCLUSIONS Endovascular stent-graft repair is effective but not curative treatment for selected, high surgical risk, elderly patients with a descending aortic PAU over the medium term. Assiduous serial follow-up imaging after stent-grafting is mandatory to detect late complications especially in those with a large aorta.
Collapse
Affiliation(s)
- Philippe Demers
- Department of Thoracic and Cardiovascular Surgery, Stanford University School of Medicine, Stanford, California 94305-5247, USA
| | | | | | | | | | | |
Collapse
|
28
|
Eggebrecht H, Baumgart D, Schmermund A, Herold U, Hunold P, Jakob H, Erbel R. Penetrating atherosclerotic ulcer of the aorta: treatment by endovascular stent-graft placement. Curr Opin Cardiol 2003; 18:431-5. [PMID: 14597882 DOI: 10.1097/00001573-200311000-00002] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF THE REVIEW To summarize the current clinical experience with endovascular stent-graft repair in patients presenting with penetrating atherosclerotic ulcer of the descending thoracic aorta. RECENT FINDINGS Penetrating atherosclerotic ulcer is increasingly acknowledged as a pathologic variant of classic false lumen aortic dissection with a high incidence of bleeding complications and rupture in up to 40% of patients. So far, no generally accepted therapeutic regimen has been established, as the natural history of penetrating atherosclerotic ulcer is not yet fully understood. Recently, however, penetrating atherosclerotic ulcer is increasingly considered to be treated more aggressively (preferentially surgically). Given the high morbidity and mortality of aortic surgery, endovascular stent-graft repair may be an attractive, less invasive alternative in selected patients with penetrating atherosclerotic ulcer. Sealing of a penetrating ulcer by the stent-graft reduces wall stress and thus provides stabilization of the diseased aortic segment. SUMMARY To date, there is limited experience with endovascular repair in penetrating atherosclerotic ulcer, suggesting that endovascular stent-graft repair is safe and effective. Long-term results are, however, required to fully establish the efficacy of endovascular repair in penetrating atherosclerotic ulcer.
Collapse
Affiliation(s)
- Holger Eggebrecht
- Department of Cardiology, West-German Heart Center, University of Duisburg-Essen, Essen, Germany.
| | | | | | | | | | | | | |
Collapse
|
29
|
D'Ancona G, Bauset R, Normand JP, Turcotte R, Dagenais F. Endovascular Stent-Graft Repair of a Complicated Penetrating Ulcer of the Descending Thoracic Aorta: A Word of Caution. J Endovasc Ther 2003. [DOI: 10.1583/1545-1550(2003)010<0928:esroac>2.0.co;2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
30
|
Vasquez J, Poultsides GA, Lorenzo AC, Foster JE, Drezner AD, Gallagher J. Endovascular stent-graft placement for nonaneurysmal infrarenal aortic rupture: a case report and review of the literature. J Vasc Surg 2003; 38:836-9. [PMID: 14560239 DOI: 10.1016/s0741-5214(03)00557-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Penetrating atheromatous ulceration of the infrarenal aorta is a rare entity. There are few reported cases of this lesion, and most of the published data is in regards to the thoracic aorta. Spontaneous rupture of a nonaneurysmal noninfected atherosclerotic infrarenal aorta is a rare event. We report the eleventh case of this occurrence and present the first reported case of endovascular stent-graft placement in treating this entity. We review the literature regarding ulcerative disease of the aorta and specifically discuss the published data on spontaneous rupture of the nondilated, noninfected infrarenal aorta secondary to penetrating atheromatous ulceration.
Collapse
Affiliation(s)
- Jay Vasquez
- Division of Vascular Surgery, Department of Surgery, Hartford Hospital, University of Connecticut School of Medicine, 80 Seymour Street, Hartford, CT 06102, USA
| | | | | | | | | | | |
Collapse
|
31
|
Abstract
BACKGROUND Thoracic aortic dissections, ruptures, fistulae, and aneurysms pose a unique surgical challenge. Traditional repair of thoracic aortic aneurysms involves thoracotomy with graft interposition. Despite advances in perioperative care and both total and partial cardiopulmonary bypass, conventional surgery carries a significant morbidity and mortality. Principal complications include bleeding, paraplegia, stroke, cardiac events, pulmonary insufficiency, and renal failure. Recent enthusiasm for innovative endovascular therapies to treat aortic disease has spurred many centers to investigate endoluminal grafting of the thoracic aorta. Early reports on endovascular repair using custom made "first generation devices" demonstrated the technique to be feasible with a mortality and morbidity comparable to open repair. METHODS AND RESULTS From February 2000 to February 2001, endovascular stent graft repair of the thoracic aorta was performed in 46 patients (mean age 70; 29 male and 17 female) using the Gore Excluder. Twenty-three patients (50%) had atherosclerotic aneurysms, fourteen patients (30%) had dissections, three patients (7%) had aortobronochial fistulas, three patients (7%) had pseudoaneurysms, two patients (4%) had traumatic ruptures, and one patient (2%) had a ruptured aortic ulcer. Patient characteristics, procedural variables, outcomes, and complications were recorded. All patients were followed with chest CT scans at 1, 3, 6, and 12 months. Mean follow up was 9 months ranging from 1 to 15 months. All procedures were technically successful. There were no conversions. Average duration of the procedure was 120 minutes. Average length of stay was 6 days, but most patients left the hospital within 4 days (64%) after endoluminal grafting. Overall morbidity was 23%. Two patients (4%) had endoleaks that required a second procedure for successful repair. Two patients (4%) died in the immediate postoperative period. There were no cases of paraplegia. At follow-up, one patient had an endoleak found the day after the procedure and another patient had an endoleak 6 moths post procedure. Both were treated successfully with additional stent grafts. There were no cases of migration. One patient died of a myocardial infarction 6 months after graft placement. The Gore Excluder device was voluntarily recalled on February 26, 2001. Therefore, from June 2000 to January 2001, 37 patients underwent endovascular stent graft repair of the thoracic aorta for various disease entities using our customized thoracic graft (Endomed). Twenty-seven patients (73%) had aneurysms, six (16%) had dissections, two (5%) had pseudoaneurysms, one (2%) had a traumatic transection, and one patient (2%) had an embolizing ulcer. Patients were followed with CT scans at 1, 3, 6, and 12 months. All procedures were technically successful. There were no conversions. The average age was 68 years.(17-87). And the male and female ratio was 24/13. One patient died in the operating room from iliac rupture and one died from embolization/stroke in the immediate postoperative period. Two patients died within 30 days from comorbid factors. The total 30-day mortality was 10%. Two patients had endoleaks. One returned to the operating room and needed an additional cuff. The other had a small leak in a proximal dissection that is being followed. There were no cases of paraplegia. CONCLUSION Thoracic endoluminal grafting is a safe and feasible alternative to open graft repair and can be performed successfully with good results. Early data suggest that an endoluminal approach to these disease entities maybe favorable to open resection and graft replacement. Technical details of Endoluminal stent grafting of the thoracic aorta for different disease entities have been discussed at length.
Collapse
Affiliation(s)
- Venkatesh Ramaiah
- Department of Cardiovascular and Endovascular Surgery, Arizona Heart Institute, 2632 N. 20th Street, Phoenix, AZ 85006, USA.
| | | | | |
Collapse
|
32
|
Tsuji Y, Tanaka Y, Kitagawa A, Hino Y, Taniguchi T, Sugimoto K, Matsuda H, Okita Y. Endovascular stent-graft repair for penetrating atherosclerotic ulcer in the infrarenal abdominal aorta. J Vasc Surg 2003; 38:383-8. [PMID: 12891125 DOI: 10.1016/s0741-5214(03)00139-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE Penetrating atherosclerotic ulcer (PAU) is an ulceration of an atherosclerotic plaque penetrating through the intima, which may lead to intramural hematoma, aneurysm formation, or rupture. This disease is predominantly found in the thoracic aorta and is uncommon in the infrarenal aorta. The effectiveness of endovascular repair of PAU in the infrarenal aorta was retrospectively investigated. METHODS From 1999 to 2002, PAU was diagnosed with computed tomography and magnetic resonance imaging in the abdominal aorta in four patients. All patients were men; their average age was 78 years. All four patients had hypertension, and two patients had concomitant coronary artery disease. Three patients had abdominal pain or lumbago. RESULTS All patients underwent endovascular grafting with a Gianturco Z-stent covered with thin-wall woven Dacron graft. Indications for endovascular intervention were aneurysm formation with or without intramural hematoma in two patients and contained rupture with extraaortic hematoma in two patients. The postoperative course was uneventful in all cases, and no endoleak or aneurysm expansion was recognized during follow-up (4-32 months; average, 14 months). CONCLUSIONS Infrarenal aortic lesions caused by PAU were generally localized, and endovascular grafting appears to be a feasible alternative to surgical repair.
Collapse
Affiliation(s)
- Yoshihiko Tsuji
- Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | | | | | | | | | | | | | | |
Collapse
|
33
|
Chabbert V, Otal P, Bouchard L, Soula P, Van TT, Kos X, Meites G, Claude C, Joffre F, Rousseau H. Midterm outcomes of thoracic aortic stent-grafts: complications and imaging techniques. J Endovasc Ther 2003; 10:494-504. [PMID: 12932160 DOI: 10.1177/152660280301000314] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the midterm outcomes of thoracic aortic stent-grafting and the performance of computed tomographic angiography (CTA), radiography, and magnetic resonance angiography (MRA) in endograft surveillance. METHODS Forty-seven patients with traumatic thoracic aortic ruptures (n=16), aneurysms (n=14), false aneurysms (n=3), penetrating ulcers (n=3), and dissections (n=11) treated with stent-grafts were monitored in follow-up using chest radiography and CTA in all patients and MRA in 23 patients. Two perpendicular maximal aortic diameters, the sum of these diameters, and the elliptical cross-sectional area were determined and compared to baseline for the entire group and in subgroup analyses according to lesion type. CTA, MRA, and radiography were compared for their ability to detect endoleak, monitor stent-graft configuration, and measure aortic diameters. RESULTS The mortality rate was 8.5%. Severe complications were observed in 14.8% (6% neurological complications); 12 (25.5%) patients had primary endoleaks. Over a mean 11-month follow-up (range 0.25-46 months), the aortic diameters decreased for all patients without endoleak (p<0.001). In the diameter/area subgroup analyses, only the traumatic rupture cohort demonstrated significant decreases in all 4 measurements. CTA and MRA measurements correlated well, but chest radiography was superior to both for visualizing stent-graft shape. In terms of endoleak detection, MRA missed only 1 (12.5%) endoleak (type II) seen on CTA; there were no false positive results with MRA. CONCLUSIONS Morbidity and mortality observed after thoracic stent-grafting are acceptable. Radiography is better for monitoring stent-graft conformation, while CTA provides the best overall morphological information. The performance of MRA in endoleak detection is encouraging.
Collapse
Affiliation(s)
- Valérie Chabbert
- Department of Radiology, University of Rangueil, Toulouse, France.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Chabbert V, Otal P, Bouchard L, Soula P, Van TT, Kos X, Meites G, Claude C, Joffre F, Rousseau H. Midterm Outcomes of Thoracic Aortic Stent-Grafts:Complications and Imaging Techniques. J Endovasc Ther 2003. [DOI: 10.1583/1545-1550(2003)010<0494:mootas>2.0.co;2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
35
|
Eggebrecht H, Baumgart D, Schmermund A, von Birgelen C, Herold U, Wiesemes R, Barkhausen J, Jakob H, Erbel R. Endovascular stent-graft repair for penetrating atherosclerotic ulcer of the descending aorta. Am J Cardiol 2003; 91:1150-3. [PMID: 12714170 DOI: 10.1016/s0002-9149(03)00173-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
36
|
Ventura M, Mastromarino A, Cucciolillo L, Calvisi G, Spartera C. Abdominal aortic intramural hematoma related to penetrating ulcer: an inappropriate indication for endovascular repair? J Endovasc Ther 2003; 10:392-6. [PMID: 12877630 DOI: 10.1177/152660280301000237] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To present a rare case of abdominal aortic intramural hematoma with penetrating ulcer. CASE REPORT A 68-year-old hypertensive lady was admitted with chest pain. An echo Doppler abdominal study showed a 2.5-cm-diameter abdominal aorta with periaortic blood flow. Urgent computed tomography documented a 4-cm aneurysmal dilatation, 4 cm long, at the infrarenal level of the inferior mesenteric artery origin, which appeared on the angiogram as a very short lateral bleb. At elective open laparotomy, no true abdominal atherosclerotic aneurysm was found in the retroperitoneal space, but rather, an intramural hematoma with ulcer. An aortobi-iliac graft was inserted, and the patient was discharged with a good outcome. Histological examination of the explanted tissue confirmed adventitial calcifications, organized thrombus in the hematoma, and intimal neovascularization. CONCLUSIONS Considering the pathology, this case was more appropriately treated with open surgery, although endovascular repair was not excluded as an option.
Collapse
Affiliation(s)
- Marco Ventura
- Department of Vascular Surgery, University of L'Aquila, Italy.
| | | | | | | | | |
Collapse
|
37
|
Ventura M, Mastromarino A, Cucciolillo L, Calvisi G, Spartera C. Abdominal Aortic Intramural Hematoma Related to Penetrating Ulcer:An Inappropriate Indication for Endovascular Repair? J Endovasc Ther 2003. [DOI: 10.1583/1545-1550(2003)010<0392:aaihrt>2.0.co;2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
38
|
Jain D, Gehl HB, Katus HA, Richardt G. Penetrating atherosclerotic ulcer of the ascending aorta: a delayed complication of coronary artery bypass surgery--a case report. Angiology 2003; 54:251-5. [PMID: 12678203 DOI: 10.1177/000331970305400217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A 71-year-old woman, undergoing coronary angiography during preoperative evaluation for a major noncardiac surgery, was fortuitously detected as having penetrating atherosclerotic ulcer of the ascending aorta 5 years after coronary artery bypass surgery. While acute aortic dissections have been described after coronary bypass grafting, penetrating atherosclerotic ulcer of the ascending aorta as a delayed complication of bypass surgery has never been reported. The patient was treated conservatively and closely observed. A brief review of literature is also presented.
Collapse
Affiliation(s)
- Deepak Jain
- Medizinische Klinik II, Universitätsklinikum Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany.
| | | | | | | |
Collapse
|
39
|
Feld RS, Sullivan E, Morrison P. Thrombin injection for failed stent graft repair of perforated atherosclerotic aortic ulcer. J Vasc Surg 2003; 37:194-7. [PMID: 12514600 DOI: 10.1067/mva.2003.19] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We used direct thrombin injection to occlude a pseudoaneurysm that formed from a contained rupture of a penetrating atherosclerotic ulcer at the junction of the thoracic and abdominal aorta after we failed to seal the perforation with an endovascular stent graft. The principles of thrombin injection and the technical modifications specific for use in a false aneurysm of aortic origin are described. An evolving role for thrombin in endovascular therapy is suggested.
Collapse
Affiliation(s)
- Robert S Feld
- Vascular Center of Connecticut and the Department of Radiology and the Division of Vascular Surgery, St Francis Hospital and Medical Center, Hartford, CT 06105, USA.
| | | | | |
Collapse
|
40
|
Sáez-Martín L, Gutiérrez-Nistal M, Riera de Cubas L, Garzón-Moll G, García-Fresnillo B, Cañibano-Domínguez C. Rotura espontánea aortoilíaca: presentación de dos casos. ANGIOLOGIA 2003. [DOI: 10.1016/s0003-3170(03)74835-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
41
|
Czermak BV, Waldenberger P, Perkmann R, Rieger M, Steingruber IE, Mallouhi A, Fraedrich G, Jaschke WR. Placement of endovascular stent-grafts for emergency treatment of acute disease of the descending thoracic aorta. AJR Am J Roentgenol 2002; 179:337-45. [PMID: 12130430 DOI: 10.2214/ajr.179.2.1790337] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the feasibility, safety, and effectiveness of endovascular stent-graft placement for the emergency treatment of acute descending thoracic aortic disease. MATERIALS AND METHODS From January 1996 through November 2001, 18 patients underwent emergency endovascular stent-graft placement for various types of acute descending thoracic aortic disease. Five patients had Stanford type B aortic dissection, six had traumatic ruptures of the thoracic aorta, five had ruptured aortic aneurysms, and two had penetrating atherosclerotic aortic ulcers. All patients presented with life-threatening symptoms requiring treatment with stent-grafts from the emergency kit. All were at high surgical risk due to serious comorbidities. The efficacy of the procedure was assessed at follow-up studies before discharge and at 3, 6, and 12 months after intervention and yearly thereafter. RESULTS The primary technical success rate was 78%. Four patients had primary perigraft leaks. The secondary technical success rate was 83%. One patient died 20 hr after intervention from stent-graft-related causes. Follow-up studies revealed stent-graft migration in one patient. Progression of disease was observed in one patient treated for dissection and in both patients treated for penetrating ulcers. One patient died 7 months after intervention of unknown reasons; all other patients are alive. The mean follow-up time was 17.4 months (range, 0-38 months). CONCLUSION Emergency repair of acute descending thoracic aortic disease with stent-graft placement can be successfully accomplished and may be a promising alternative to open-chest surgery, especially in patients at high risk.
Collapse
Affiliation(s)
- Benedikt V Czermak
- Department of Radiology, Kurt Amplatz Center, Leopold-Franzens Medical School and University Hospital Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | | | | | | | | | | | | | | |
Collapse
|
42
|
Faries PL, Lang E, Ramdev P, Hollier LH, Marin ML, Pomposelli Jr. FB. Endovascular Stent-Graft Treatment of a Ruptured Thoracic Aortic Ulcer. J Endovasc Ther 2002. [DOI: 10.1583/1545-1550-9.sp3.20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
43
|
Alric P, Berthet JP, Branchereau P, Veerapen R, Marty-Ané CH. Endovascular Repair for Acute Rupture of the Descending Thoracic Aorta. J Endovasc Ther 2002. [DOI: 10.1583/1545-1550-9.sp3.51] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
44
|
Kos X, Bouchard L, Otal P, Chabbert V, Chemla P, Soula P, Meites G, Joffre F, Rousseau H. Stent-Graft Treatment of Penetrating Thoracic Aortic Ulcers. J Endovasc Ther 2002. [DOI: 10.1583/1545-1550-9.sp3.25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
45
|
Thompson CS, Gaxotte VD, Rodriguez JA, Ramaiah VG, Vranic M, Ravi R, DiMugno L, Shafique S, Olsen D, Diethrich EB. Endoluminal stent grafting of the thoracic aorta: initial experience with the Gore Excluder. J Vasc Surg 2002; 35:1163-70. [PMID: 12042726 DOI: 10.1067/mva.2002.122885] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE The purpose of this study was to describe our experience with endoluminal graft repair of a variety of thoracic aorta pathologies with a commercially developed device currently under investigation. Our patient population included patients eligible for open surgical repair and those with prohibitive surgical risk. METHODS From February 2000 to February 2001, endovascular stent-graft repair of the thoracic aorta was performed in 46 patients (mean age, 70 years; 29 male and 17 female patients) with the Gore Excluder. Twenty-three patients (50%) had atherosclerotic aneurysms, 14 patients (30%) had dissections, three patients (7%) had aortobronchial fistulas, three patients (7%) had pseudoaneurysms, two patients (4%) had traumatic ruptures, and one patient (2%) had a ruptured aortic ulcer. Patient characteristics, procedural variables, outcome, and complications were recorded. All patients were followed with chest computed tomographic scans at 1, 3, 6, and 12 months. Follow-up period ranged from 1 month to 15 months, with a mean of 8.5 months. RESULTS All the procedures were technically successful. There were no conversions. Average duration of the procedure was 120 minutes. Average length of stay was 6 days, but most patients (64%) left the hospital within 4 days after endoluminal grafting. The overall morbidity rate was 23%. Two patients (4%) had endoleaks that necessitated a second procedure for successful repair. Two patients (4%) died in the immediate postoperative period. There were no cases of paraplegia. At follow-up examination, one patient had an endoleak found the day after the procedure and another patient had an endoleak 6 months after the procedure. Both cases were treated successfully with additional stent-grafts. There were no cases of migration. One patient died of a myocardial infarction 6 months after graft placement. In patients treated for aneurysm (n = 23), the aneurysm diameter ranged from 5.0 to 9.5 cm (mean, 6.8 cm). Residual sac measurements were obtained at 1, 6, and 12 months, with mean sac reductions of 0.59 cm, 0.77 cm, and 0.85 cm, respectively. In three cases, the sac remained unchanged, without evidence of endoleak. CONCLUSION Thoracic endoluminal grafting with the Gore Excluder is a safe and feasible alternative to open graft repair and can be performed successfully with good results. Early data suggest an endoluminal approach to these disease entities may be favorable over classical resection and graft replacement.
Collapse
Affiliation(s)
- Charles S Thompson
- Department of Cardiovascular and Endovascular Surgery, Arizona Heart Institute and Hospital, 2632 N 20th Street, Phoenix, AZ 85006, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Ochi M, Tabata M, Sakamoto S, Ishii Y, Tanaka S, Ichikawa K, Kumasaki T. Surgical endovascular stent grafting for a ruptured penetrating atherosclerotic ulcer of the aortic arch. J NIPPON MED SCH 2002; 69:49-52. [PMID: 11847510 DOI: 10.1272/jnms.69.49] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Penetrating atherosclerotic ulcer (PAU) is defined as an atherosclerotic lesion in which an ulceration occurs in the diseased aortic intima leading to disruption of the internal elastic lamina. It may cause a pseudoaneurysm formation or transmural aortic rupture. We describe a patient in whom a ruptured PAU in the distal aortic arch was treated successfully by a surgical endovascular stent graft. Through a median sternotomy and under deep hypothermic circulatory arrest, the aorta was transected between the left common carotid and subclavian arteries. A dacron prosthetic graft with self-expanding original Z type stents attached inside of the distal half was inserted through the aortotomy to exclude the PAU. By performing the procedure through a median sternotomy, we could eliminate dissection around the ruptured aortic wall. The stented graft was secured safely in the thoracic aorta to exclude the ruptured ulceration located distal to the left subclavian artery. PAU should be recognized widely as a distinct cardiovascular surgical problem which may lead to intramural hematoma with or without dissection or rupture.
Collapse
Affiliation(s)
- Masami Ochi
- Department of Surgery II, Division of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan.
| | | | | | | | | | | | | |
Collapse
|
47
|
|
48
|
Abstract
PURPOSE To describe a case of penetrating atherosclerotic ulcer of the aorta with a review of its natural history, diagnosis and management. CASE REPORT An elderly patient with a history of hypertension presented to the emergency room with the sudden onset of severe chest pain radiating to the back. The electrocardiogram showed left ventricular hypertrophy; the chest radiograph revealed mediastinal widening. Computed tomography was suspicious for a mediastinal hematoma without aortic dissection. Transesophageal echocardiography was also negative for dissection. An aortogram revealed a penetrating atherosclerotic ulcer of the descending thoracic aorta. The patient underwent successful resection and repair of the lesion. CONCLUSIONS Penetrating atherosclerotic ulcer of the aorta is a potentially lethal lesion that must be promptly diagnosed and treated.
Collapse
Affiliation(s)
- A K Samal
- Department of Cardiology, Ochsner Clinic and Alton Ochsner Medical Foundation, New Orleans, Louisiana 70121, USA
| | | | | |
Collapse
|
49
|
Abstract
BACKGROUND Penetrating aortic ulcers burrow into the aortic wall and can have fatal consequences. Although they were first described as long ago as 1934 they have only recently been recognized as a distinct pathological entity. METHOD A review of the current literature was undertaken, based primarily on an English language Medline search with secondary references obtained from key articles. RESULTS Penetrating aortic ulcer is principally a disease of elderly hypertensive men. It may run a benign course or may produce complications such as aortic rupture, embolization and aneurysm formation. Presentation may be identical to that of classical aortic dissection, but the distinction is important because an ulcer may be more likely to cause rupture. CONCLUSION Open surgical repair has been the 'gold standard' of treatment but endovascular stenting is an attractive option in this group of frail patients.
Collapse
Affiliation(s)
- M Troxler
- Vascular Surgical Unit, The General Infirmary at Leeds, Great George Street, Leeds LS1 3EX, UK.
| | | | | |
Collapse
|
50
|
White RA, Donayre CE, Walot I, Lippmann M, Woody J, Lee J, Kim N, Kopchok GE, Fogarty TJ. Endovascular exclusion of descending thoracic aortic aneurysms and chronic dissections: Initial clinical results with the AneuRx device. J Vasc Surg 2001; 33:927-34. [PMID: 11331830 DOI: 10.1067/mva.2001.114998] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective of this study was to analyze a single-center experience in which descending thoracic aortic aneurysms (TAAs) were treated with a new self-expanding endovascular prosthesis (Medtronic AVE). METHODS Twenty-six patients (13 men, 13 women) with American Society of Anesthesiology grades II to IV and ages ranging from 53 to 92 years (average, 74 years) consented as part of a Phase I Food and Drug Administration-approved trial. Treated lesions included TAAs that were 5 to 10 cm in diameter, 12 diffuse dilations or fusiform aneurysms, and four saccular aneurysms. There were also nine chronic dissections (2 aneurysmal dilations and 7 symptomatic acute recurrent dissections). Three patients (2 with diffuse/fusiform and 1 with dissection) presented with hemothorax, contrast extravasation, or both. RESULTS Twenty-five of the 26 patients who consented (96% technical success) were treated successfully with no surgical conversions. Eighteen patients have been followed up from 1 to 22 months (average, 9 months). One patient is lost to follow-up, and six patients have died (24%). One procedure-related death (4%) occurred within the 30-day postoperative period and was caused by diffuse embolization. There were no device-related deaths. Five additional patients (20%) have died during the study of comorbid conditions. Complications included one massive myocardial infarction 24 hours after the procedure requiring balloon counterpulsation and long-term dialysis, one cardiac tamponade resulting from central line placement before the procedure, one progression of aneurysm dilation proximal to the device at 1 year, and one bilateral lower extremity paralysis occurring 12 hours after successful deployment. Seven patients (5 women) had femoral artery reconstructions or iliac artery grafts to repair injuries during deployment catheter passage. Other significant parameters included average procedure time (2 hours 40 minutes; range, 1 hour 30 minutes to 5 hours 30 minutes), 450 cc average blood loss (n = 25; 100-3000 cc) being replaced by means of autotransfusion with only two patients receiving banked blood products, and an average 2 days to resumption of normal diet, 1 day in the intensive care unit, and 5 days' hospitalization postprocedure in uncomplicated cases (n = 22). One patient had an endoleak immediately after the procedure that sealed without treatment. Follow-up of all patients ranging from 1 to 22 months (average, 9 months; n = 18) demonstrates continued exclusion of the aneurysm with no endoleaks and either stable or decreasing aneurysm volume, except in one patient with volume increase and no obvious etiology who continues to be investigated. CONCLUSIONS The study suggests that endovascular prosthesis exclusion of TAAs with an AneuRx self-expanding tubular device may be effective in many patients who are at significant risk for open surgical repair and substantiates further clinical investigation to confirm these findings.
Collapse
Affiliation(s)
- R A White
- Department of Surgery, Harbor-UCLA Medical Center, CA, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|