Surgical repair after failed thoracic endovascular aortic repair for severe blunt traumatic descending thoracic aorta injury in a young patient

2020 ◽  
Author(s):  
Andrei M. Beliaev ◽  
Colleen J. Bergin ◽  
Mark W. I. Webster ◽  
David A. Haydock
Keyword(s):  
Young Patient ◽  
Thoracic Aorta ◽  
Surgical Repair ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Descending Thoracic Aorta ◽  
Aortic Repair ◽  
Aorta Injury

Evaluation of EndoAnchor Aortic Wall Penetration After Thoracic Endovascular Aortic Repair

2020 ◽  
Vol 27 (2) ◽  
pp. 240-247
Author(s):  
Andrés Reyes Valdivia ◽  
Sara Busto Suárez ◽  
África Duque Santos ◽  
Ahmad Amer Zanabili Al-Sibbai ◽  
Claudio Gandarias Zúñiga ◽  
...  
Keyword(s):  
Thoracic Aorta ◽  
Aortic Wall ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Descending Thoracic Aorta ◽  
Aortic Repair ◽  
Type Ia ◽  
Endograft Infection ◽  
Academic Vascular Surgery

Purpose: To analyze aortic wall penetration of Heli-FX EndoAnchors after use in seal zones in the aortic arch or descending thoracic aorta during thoracic endovascular aortic repair (TEVAR). Materials and Methods: From May 2014 to May 2019, 25 patients (mean age 70.5±10 years; 16 women) were treated with TEVAR and adjunctive use of the Heli-FX device in 3 academic vascular surgery departments. Computed tomography scans were retrospectively reviewed to determine the location [arch or descending thoracic aorta (DTA)] of the EndoAnchors and the adequacy of aortic wall penetration, defined as adequate (≥2 mm), partial (<2 mm), or inadequate wall penetration (including loss). Endoleaks, reinterventions, and mortality were assessed. Results: A total of 161 EndoAnchors were deployed (median 7 per patient, range 4–9). Twenty-two EndoAnchors were place in the arch (zones 0–2) and 139 in the DTA (zones 3–5). A larger proportion of arch deployments (27%) had suboptimal penetration compared with the DTA (6.5%; p<0.005), resulting in a 91% adequate wall penetration rate for the series overall. Three EndoAnchors were lost (and only 1 retrieved) in 3 different patients, with no additional morbidity; thus, an overall deployment success rate of 88% was achieved. At a mean follow-up of 16.6±14 months, 4 patients required 5 (successful) reinterventions, including one for a type Ia endoleak treated with chimney TEVAR. One patient died 10 months after treatment due to endograft infection, without an opportunity for surgical correction. Conclusion: EndoAnchors have a higher risk of maldeployment in the arch, though this may be attributable to the small learning curve experience in this location. The best aortic wall penetration for this series was in the DTA, where EndoAnchors proved useful for distal endograft fixation during TEVAR.

Aortic Arch and Thoracic Aorta Curvature Remodeling after Thoracic Endovascular Aortic Repair

2017 ◽  
Vol 38 ◽  
pp. 233-241 ◽  
Author(s):  
Gaspar Mestres ◽  
Marvin E. Garcia ◽  
Xavier Yugueros ◽  
Rodrigo Urrea ◽  
Paolo Tripodi ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Thoracic Aorta ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Aortic Repair

Lethal aorto-oesophageal fistula 16 years after aortic prosthetic reconstruction: Delayed rupture as cause of death

2020 ◽  
pp. 002580242093679
Author(s):  
Beatrice Benedetti ◽  
Marica Felice ◽  
Francesco Locco ◽  
Paola Roberti ◽  
Roberto Demontis
Keyword(s):  
Vascular Surgery ◽  
Thoracic Aorta ◽  
Surgical Complications ◽  
Rare Complication ◽  
Thoracic Endovascular Aortic Repair ◽  
Descending Thoracic Aorta ◽  
Prosthetic Reconstruction ◽  
Clinical Onset ◽  
Aortic Repair ◽  
One Year

The development of aorto-oesophageal fistula (AOF) is a rare complication following thoracic aortic repair. Mortality is high, in most cases due to fatal haematemesis. The clinical onset is variable, occurring approximately one year after surgery. We report a case of a lethal AOF in a 58-year-old man. He underwent open vascular surgery 16 years prior to his death due to a rupture of the descending thoracic aorta. In the early 2000s, the open vascular approach was replaced by thoracic endovascular aortic repair. As a result of this approach, the number of surgical complications has reduced, with the exception of AOF.

P22 PRELIMINARY EXPERIENCE WITH PROPHYLACTIC THORACIC ENDOVASCULAR AORTIC REPAIR (PRO-TEAVAR) IN PATIENTS AFFECTED BY ADVANCED ESOPHAGEAL CANCER

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Maria Clelia Gervasi ◽  
Carlo Alberto De Pasqual ◽  
Jacopo Weindelmayer ◽  
Luca Mezzetto ◽  
Lorenzo Scrsone ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Thoracic Aorta ◽  
Aortic Wall ◽  
Tertiary Hospital ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Invasive Technique ◽  
Esophageal Fistula ◽  
Advanced Esophageal Cancer ◽  
Aortic Repair

Abstract Bleeding from the thoracic aorta is potentially fatal in patients with advanced esophageal cancer (AEC). Esophageal malignancy is the third most common cause of aorto-esophageal fistula (AEF), after thoracic aortic aneurysm and ingestion of foreign body. The involvement of aortic wall often contraindicates chemo-radiotherapy (CRT) treatment, thus reducing life expectancy of these patients. Thoracic endovascular aortic repair (TEVAR) is a well described mini-invasive technique that can be also applied for coverage of aortic lumen in case of invasion by esophageal cancer (EC). Only few cases have been published with this atypical indication. Between 2016 and 2018, in our tertiary hospital three patients affected by AEC involving the thoracic aorta were treated by means of prophylactic TEVAR (ProTEVAR). We did not observe procedure-related complications and all patients were reconsidered fit for preoperative or definitive CRT.

Retrograde Ascending Dissection After Thoracic Endovascular Aortic Repair Combined With the Chimney Technique and Successful Open Repair Using the Frozen Elephant Trunk Technique

2017 ◽  
Vol 52 (1) ◽  
pp. 80-85 ◽  
Author(s):  
Koji Hirano ◽  
Toshiya Tokui ◽  
Bun Nakamura ◽  
Ryosai Inoue ◽  
Masahiro Inagaki ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Surgical Repair ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Chimney Technique ◽  
Aortic Repair ◽  
Elephant Trunk Technique ◽  
Frozen Elephant Trunk Technique

The chimney technique can be combined with thoracic endovascular aortic repair (TEVAR) to both obtain an appropriate landing zone and maintain blood flow of the arch vessels. However, surgical repair becomes more complicated if retrograde type A aortic dissection occurs after TEVAR with the chimney technique. We herein report a case involving a 73-year-old woman who developed a retrograde ascending dissection 3 months after TEVAR for acute type B aortic dissection. To ensure an adequate proximal sealing distance, the proximal edge of the stent graft was located at the zone 2 level and an additional bare stent was placed at the left subclavian artery (the chimney technique) at the time of TEVAR. Enhanced computed tomography revealed an aortic dissection involving the ascending aorta and aortic arch. Surgical aortic repair using the frozen elephant trunk technique was urgently performed. The patient survived without stroke, paraplegia, renal failure, or other major complications. Retrograde ascending dissection can occur after TEVAR combined with the chimney technique. The frozen elephant trunk technique is useful for surgical repair in such complicated cases.

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