Endovascular Re-routing the Errant Aortic Endoprosthesis

The anatomic complexity of aortic dissection remains a challenge in endovascular treatment. The dissection flap may contain defects allowing accidental guidewire passage from one lumen into the other, and inadvertent device placement into the false lumen can occur. The description of this complication and its bail-out maneuvers are sparse in the literature. Herein, we describe seven patients with errant endoprosthesis re-routed with minimally invasive intervention into the true lumen.

Bedside intravascular ultrasound-guided fibrin sheath balloon maceration and inferior vena cava filter placement during extracorporeal membranous oxygenation decannulation

Inferior vena cava filter placement during extracorporeal membranous oxygenation decannulation has been described as a technique to prevent potentially lethal pulmonary embolism in this critically ill population. With long-standing extracorporeal membranous oxygenation cannulae, venous fibrin sheaths may develop, which may predispose to filter maldeployment or inadequate embolus filtration. This report describes the use of a balloon catheter to disrupt a fibrin sheath at patient bedside using intravascular ultrasound guidance to facilitate inferior vena cava filter placement.

Percutaneous Transesophageal Access for Enteral Feeding Tube Placement

BACKGROUND

The purpose of this study was to describe our experience with percutaneous transesophageal enteral feeding tube placement when percutaneous gastrostomy tube placement is not feasible.

MATERIALS AND METHODS

A retrospective review was performed from July 2018 to March 2019. Thirteen patients (9 females, 4 males), (age range 22-80 years; mean age, 55 years; mean body mass index of 24.6) underwent placement of 14 percutaneous transesophageal enteral feeding tubes. Relative contraindications to standard gastrostomy tube placement included: prior gastric surgery (5 patients), severe contractures/large body habitus (2), abdominal mesh (1), high riding stomach (1), interposition of bowel (1), ascites (1), and refractory gastrostomy tract leak (1). Patients were evaluated for functionality of the tube, complications, and patients' satisfaction with physical examination at 24 h, review of electronic medical record and phone interviews at 1 month, and 3-month follow-up. Complications were classified according to the CIRSE guidelines.

RESULTS

Technical success rate was 100% with placement of seven percutaneous transesophageal gastrostomy tubes and seven percutaneous transesophageal jejunostomy tubes. One patient underwent tube placement twice after dislodgement. At 3-month follow-up, two patients had died, one patient was lost to follow-up, and 11 patients had properly working tubes. No major complications occurred. Minor complication rate was 43% (6/14). Patient's satisfaction scores ranged from "poor" 2/11 (18%) or "neutral" 4/11 (36.4%) to "satisfied/very satisfied" 5/11 (45.3%).

CONCLUSION

Percutaneous transesophageal enteral feeding tube placement is feasible with a low complication rate. A majority of patients were either satisfied or neutral with the transesophageal enteral tube.

Computed Tomography of Acquired Aortic Diseases

Computed tomography angiography (CTA) has the ability to evaluate the aortic wall and the lumen easily, quickly, and reproducibly without the need for invasive techniques. The images are isotropic, allowing several reconstructions. When imaging the aorta, CTA has replaced catheter angiography in the diagnosis of acquired disease such as aortoiliac disease, aneurysm, and infectious and inflammatory disease of the aorta.