scholarly journals Secondary Aortic Dissection after Endoluminal Treatment of an Intramural Hematoma of the Thoracoabdominal Aorta: Endovascular Extension with Two Stent Grafts and Scarce Distal Landing

2013 ◽  
Vol 2013 ◽  
pp. 1-4
Author(s):  
Peter I. Kalmar ◽  
Peter Oberwalder ◽  
Peter Schedlbauer ◽  
Jürgen Steiner ◽  
Rupert H. Portugaller
Keyword(s):  
Vessel Wall ◽  
Interventional Procedures ◽  
Intramural Hematoma ◽  
Stent Grafts ◽  
Thoracoabdominal Aorta ◽  
Descending Aorta ◽  
Significant Challenge ◽  
Aortic Stent Graft ◽  
Endoluminal Treatment

Secondary dissection in the descending aorta after endovascular therapy may demand subsequent interventional procedures. This can set a particularly significant challenge for the endovascular specialist. When implanting an aortic prosthesis, a sufficient contact between the covered segment and the healthy vessel wall is advisable. However, our case shows that, in individual cases, it is indeed efficient to place an aortic stent graft on top of the distal end of the dissection. This is proven by a three-year follow-up CT-angiography.

scholarly journals Endovascular Aneurysm Sealing of a Collapsed and Thrombosed Aortic Stent-Graft With Renovisceral Chimney Stent-Grafts

2018 ◽  
Vol 26 (1) ◽  
pp. 72-75
Author(s):  
Fabien Lareyre ◽  
Claude Mialhe ◽  
Carine Dommerc ◽  
Juliette Raffort
Keyword(s):  
Stent Graft ◽  
Mesenteric Artery ◽  
Endovascular Aneurysm Repair ◽  
Stent Grafts ◽  
Aortic Thrombosis ◽  
Aortic Stent Graft ◽  
Aneurysm Repair ◽  
Stent Graft Implantation ◽  
Graft Implantation

Purpose: To report the use of the Nellix endovascular aneurysm sealing (EVAS) system in the management of proximal stent-graft collapse associated with thrombosis following endovascular aneurysm repair (EVAR). Case Report: A 76-year-old man was admitted for proximal collapse of an aortic extension following bifurcated AFX stent-graft implantation associated with chimney grafts in both renal arteries and the superior mesenteric artery 1 month prior. Imaging identified thrombosis of the aortic stent-graft and the iliac limbs. A Nellix EVAS was placed into the AFX stent-graft to recanalize the aneurysm lumen and address the aortic thrombosis. There was no endoleak, and the renovisceral chimney stent-grafts remained patent over a follow-up of 25 months. Conclusion: While further studies are required to generalize its use, EVAS appears to be feasible in the management of aortic stent-graft collapse.

Use of 3D Printing to Guide Creation of Fenestrations in Physician-Modified Stent-Grafts for Treatment of Thoracoabdominal Aortic Disease

2020 ◽  
Vol 27 (3) ◽  
pp. 385-393 ◽  
Author(s):  
Yuan-Hao Tong ◽  
Tong Yu ◽  
Min-Jie Zhou ◽  
Chen Liu ◽  
Min Zhou ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Stent Graft ◽  
Aortic Disease ◽  
Covered Stents ◽  
Stent Grafts ◽  
Aortic Stent Graft ◽  
Computed Tomography Images ◽  
Thoracoabdominal Aortic Disease ◽  
3D Printed

Purpose: To summarize the experience and outcomes of total endovascular repair of thoracoabdominal aortic disease using 3-dimensional (3D) printed models to guide on-site creation of fenestrations in aortic stent-grafts. Materials and Methods: From April 2018 to March 2019, 34 patients (mean age 58±14 years; 24 men) with thoracoabdominal aortic disease were treated in our department. Nineteen patients had thoracoabdominal aortic dissection and 15 had thoracoabdominal aortic aneurysm. Preoperatively, a 3D printed model of the aorta was made according to computed tomography images. In the operating room, the main aortic stent-graft was completely released in the 3D printed model, and the position of each fenestration or branch was marked on the stent-graft. The fenestrations were then made using an electric pen. Wires were sewn to the edge of the fenestrations using nonabsorbable sutures. After customization, the aortic stent-graft was reloaded into the delivery sheath and deployed. Results: The printing process took ~5 hours (1 hour for image reconstruction, 3 hours for printing, and 1 hour for postprocessing). The physician-modified stent-grafts had a total of 107 fenestrations secured by 102 bridging stent-grafts, including 73 covered stents and 29 bare stents. The average procedure time was 5.6±1.2 hours, including a mean 1.3 hours for stent-graft customization. No renal insufficiency or paraplegia occurred. Two branch arteries were lost during the operation. One patient (3%) died 1 week after surgery from a retrograde dissection rupture. One patient developed a minor cerebral infarction postoperatively. The mean follow-up time was 8.5 months. There was 1 endoleak from a fenestration (coil embolized) and 4 distal ruptures of the aortic dissection (3 treated and 1 observed). Conclusion: Three-dimensional printing can be used to guide creation of fenestrated stent-grafts for the treatment of thoracoabdominal aortic diseases involving crucial branches. This technique appears to be more accurate than the traditional measurement method, with short-term follow-up demonstrating the safety and reliability of the method. However, further research and development are needed.

Thoracic Endovascular Aortic Repair for Retrograde Type A Intramural Hematoma With Intimal Disruption in the Descending Aorta

2021 ◽  
pp. 152660282110612
Author(s):  
Yingliang Wang ◽  
Songlin Song ◽  
Chen Zhou ◽  
Wenying Zhu ◽  
Jiacheng Liu ◽  
...  
Keyword(s):  
Adverse Events ◽  
Intramural Hematoma ◽  
Type A ◽  
Ascending Aorta ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Descending Aorta ◽  
Aortic Repair ◽  
Intimal Tear

Purpose: To evaluate the safety and efficacy of thoracic endovascular aortic repair (TEVAR) for retrograde type A intramural hematoma (IMH) with intimal disruption in the descending aorta and report our endovascular therapeutic experience. Materials and Methods: From January 2014 to October 2020, a total of 24 consecutive patients with retrograde type A IMH with intimal disruption (intimal tear or ulcer-like projection) in the descending aorta underwent TEVAR. The demographics, clinical characteristics, treatment details, imaging information, and follow-up results were reviewed. Results: Among all patients with retrograde type A IMH, 13 (54.2%) patients presented with ulcer-like projection and 11 (45.8%) with intimal tear (aortic dissection) in the descending aorta. Successful TEVAR was achieved in all patients. There was no 30-day mortality. During a mean follow-up of 37.5 months, 1 patient (4.2%) developed permanent paralysis, 1 patient (4.2%) underwent reintervention due to the expansion of the aorta distal to the stent resulting from the enlargement of distal intimal tear at the 2 month follow up, and no other adverse events were observed. The latest computed tomographic angiography images showed that the maximum diameter of the ascending aorta and descending aorta significantly decreased after TEVAR (both p<0.001), and the IMH/false lumen in the ascending aorta and the descending thoracic aorta were completely absorbed. Conclusion: Thoracic endovascular aortic repair for selected patients with retrograde type A intramural hematoma that presented with intimal disruption in the descending aorta is feasible and efficient, but close surveillance is needed to manage aortic-related adverse events.

Acute retrograde type A intramural hematoma treated with an endovascular approach

2018 ◽  
Vol 26 (4) ◽  
pp. 308-310 ◽  
Author(s):  
Anh T Vo ◽  
Khoi M Le ◽  
Trang T Nguyen ◽  
Thanh T Vu ◽  
Thien T Vu ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Intramural Hematoma ◽  
Type A ◽  
Sudden Onset ◽  
Ascending Aorta ◽  
Acute Type ◽  
Descending Aorta ◽  
Severe Chest Pain ◽  
Endovascular Approach

A 71-year-old woman was admitted with sudden onset of severe chest pain. Computed tomography demonstrated acute type A intramural hematoma with an entry tear in the first part of the descending aorta. The patient refused an operation. Endovascular repair was performed to prevent conversion to a typical dissection of the ascending aorta. At the 1-year follow-up, computed tomography showed total resolution of the intramural hematoma.

scholarly journals P.115 Vessel Wall Imaging of Unusual Childhood Strokes: a Pediatric Case Series

2021 ◽  
Vol 48 (s3) ◽  
pp. S51-S52
Author(s):  
FF Albassam ◽  
P Muthusami ◽  
N Dlamini
Keyword(s):  
Vessel Wall ◽  
Internal Carotid ◽  
Anticoagulation Therapy ◽  
Case Series ◽  
Intramural Hematoma ◽  
Vessel Wall Imaging ◽  
Left Middle Cerebral Artery ◽  
Conventional Angiography ◽  
Wall Imaging

Background: MR-based vessel wall imaging (VWI) has gained influence in the clinical investigations, and management of pediatric strokes. Limitations still exist in interpreting it as a singular modality. Methods: We present 4 pediatric stroke cases with VWI enhancement. Results: Case 1. 4-year old boy with sickle cell anemia, who developed encephalopathy during a hemolytic crisis. MR-VWI revealed bilateral extracranial internal carotid enhanced narrowing, deemed a secondary vasculopathy, with resolution upon follow-up. Case 2. 16-year old male presented with left middle cerebral artery (MCA) infarction. VWI revealed left internal carotid terminus and proximal MCA enhancement. Conventional angiography showed abnormalities in mesentric and hepatic arteries. Stability sustained on anticoagulation and immunosuppressive therapy. Case 3. 10-year old girl, developed bilateral MCA infarctions with enhanced extracranial segments of both ICAs, and narrow PCAs, consistent with Moyamoya vasculopathy. Improved on combined immunosuppressive and anticoagulation therapy. Case 4. 13-year old boy had an episode of right facial weakness, with a normal neurological exam; with enhancement and narrowing in the left extracranial ICA, likely an intramural hematoma from dissection. He responded to dual anticoagulation therapy. Conclusions: In conclusion, these cases illustrate similarities in vessel wall imaging abnormalities under different clinical contexts, with practical utility in longitudinal follow-up and prognostication.

Hybrid Endovascular Repair of Thoracoabdominal Aorta: Early Results

2014 ◽  
Vol 17 (3) ◽  
pp. 146
Author(s):  
Osman Tansel Darcin ◽  
Mehmet Kalender ◽  
Ayse Gul Kunt ◽  
Okay Guven Karaca ◽  
Ata Niyazi Ecevit ◽  
...  
Keyword(s):  
Endovascular Repair ◽  
Therapeutic Option ◽  
Complete Recovery ◽  
Aortic Aneurysms ◽  
Thoracoabdominal Aorta ◽  
Mortality And Morbidity ◽  
Early Results ◽  
The Mean ◽  
Procedural Success

<p><b>Background:</b> Thoracoabdominal aortic aneurysms (TAAA) present a significant clinical challenge, as they are complex and require invasive surgery. In an attempt to prevent considerably high mortality and morbidity in open repair, hybrid endovascular repair has been developed by many authors. In this study, we evaluated the early-term results obtained from this procedure.</p><p><b>Methods:</b> From November 2010 to February 2013, we performed thoracoabdominal hybrid aortic repair in 18 patients. The mean age was 68 years (12 men, 6 women). All of the patients had significant comorbidities. Follow-up computed tomography (CT) scans were performed at 1 week, 3 months, 6 months, and annually thereafter.</p><p><b>Results:</b> All patients were operated on in a staged procedure and stent graft deployment was achieved. Procedural success was achieved in all cases. All patients were discharged with complete recovery. No endoleaks weres detected in further CT examination.</p><p><b>Conclusion:</b> Our results suggests that hybrid debranching and endovascular repair of extensive thoracoabdominal aneurysms represents a suitable therapeutic option to reduce the morbidity and mortality of TAAA repair, particularly in those typically considered at high risk for standard repair.</p>

Transbrachial and transfemoral approaches combined with visceral protection for the treatment of juxtarenal aortoiliac occlusive disease: Technical issues and clinical outcomes

Vascular ◽  
2021 ◽  
pp. 170853812110232
Author(s):  
Peixian Gao ◽  
Changliang Li ◽  
Xuejun Wu ◽  
Gang Li ◽  
Dianning Dong ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Bare Metal Stents ◽  
Covered Stent ◽  
Occlusive Disease ◽  
Metal Stents ◽  
Infrarenal Aorta ◽  
Bare Metal ◽  
Stent Grafts ◽  
Aortoiliac Occlusive Disease

Purpose To evaluate the safety and efficacy of transbrachial and transfemoral approaches combined with visceral protection for the endovascular treatment of juxtarenal aortoiliac occlusive disease (AIOD) over an average 19-month follow-up period. Methods In this retrospective analysis, all patients with juxtarenal AIOD at a single institution were reviewed from June 2015 to January 2020. Patient characteristics, angiographic results, and follow-up outcomes were retrospectively recorded. The indications for treatment were critical limb threatening ischemia in 12 patients and bilateral claudication in five patients. Percutaneous access via the left brachial artery was first obtained to recanalize the infrarenal occluded lesions. After that, femoral accesses were achieved. A 4-Fr catheter, a 4 mm balloon, or a 6-Fr 90-cm-long sheath was used to complete visceral artery protection. Results A total of 17 juxtarenal AIOD patients (14 males; mean age, 63.4 ± 8.1 years) underwent endovascular treatment. The technical success rate was 100%. Complete reconstruction was achieved in 15 (88.2%) patients. The infrarenal aorta was reconstructed with kissing covered stent grafts ( n = 7), kissing bare-metal stents ( n = 2), covered stent grafts ( n = 2), bare-metal stents ( n = 1), or the off-label use of iliac limb stent grafts ( n = 5). Renal embolization was found in 3 (17.6%) patients during intraoperative angiography. There was 1 (5.9%) case of distal runoff embolization after CDT and 1 (5.9%) case of left iliac artery rupture. One (5.9%) death occurred due to acute myocardial infarction 20 days after the operation. The average follow-up period was 19.3 ± 16.7 months (range, 1–54 months) in the remaining 16 cases. The renal artery patency rate was 100%. The estimated cumulative primary patency rates were 92.3% at 12 months and 59.3% at 36 months according to the Kaplan–Meier method. Conclusions Transbrachial and transfemoral approaches combined with visceral protection offer a safe and effective alternative to open revascularization for the endovascular treatment of juxtarenal AIOD.

scholarly journals Fate of the Arterial Origin of Major Aortopulmonary Collateral Arteries After Unifocalization

2021 ◽  
Vol 12 (2) ◽  
pp. 230-233
Author(s):  
P.C. van de Woestijne ◽  
J.A.A.E. Cuypers ◽  
W.A. Helbing ◽  
A.J.J.C. Bogers
Keyword(s):  
Pulmonary Atresia ◽  
Descending Aorta ◽  
Major Aortopulmonary Collateral Arteries ◽  
Collateral Arteries ◽  
Collateral Artery ◽  
Median Diameter ◽  
Aortopulmonary Collateral ◽  
Median Interval

Background: During unifocalization procedures for pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries, collateral arteries are either ligated or detached. Not much is known of the fate of the remaining arterial origins in the long term. Available computed tomography (CT) or magnetic resonance (MR) imaging of the intrathoracic arteries was examined to investigate possible abnormalities at the former position of the collateral arteries as well as ascending aortic diameters. Methods: From 1989 to 2018, we performed 66 unifocalization procedures in 39 patients. One hundred and twenty-nine collateral arteries were ligated or detached. In 52% (15) of the surviving patients (with a total of 55 ligated or detached collaterals), sufficient imaging of the thoracic aorta from CT (11) and/or MR (9) was available for evaluation. Results: The median interval between unifocalization procedure and imaging was 15 years (interquartile range [IQR]: 9-19 years). In 93% (14) of the scanned patients, 18 blunt ends were detected at the location of a former collateral artery. No aneurysm formation of the descending aorta was observed. The median diameter of the ascending aorta was 35 mm (IQR: 31-40 mm). During follow-up, no aortic dissection or rupture occurred. Conclusions: Aortic imaging late after unifocalization showed abnormalities in 93% of the scanned patients. Abnormalities consisted mostly of blunt ends of the former collateral artery. We recommend to include routine imaging of the aorta during late follow-up to detect eventual future abnormalities and monitor aortic diameters. Ascending aortic diameters showed slight dilatation with no clinical implications so far.

Frozen elephant trunk infection: to defrost or to debranch?

2020 ◽  
Author(s):  
Joseph Nader ◽  
Yuthiline Chabry ◽  
Houda Nazih ◽  
Thierry Caus
Keyword(s):  
Proximal Part ◽  
Acute Type ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Aortic Arch Replacement ◽  
Descending Aorta ◽  
Type A Aortic Dissection ◽  
Hybrid Prosthesis

Abstract Infections of frozen elephant trunk hybrid prosthesis (HP) are not well documented in the literature and their management is not standardized yet. We report herein the case of a 59-year-old patient who benefited from a Thoraflex™ HP aortic arch replacement for an acute type A aortic dissection. He presented a year later with a Staphylococcus aureus infection of the proximal part of this prosthesis. We performed a replacement of the proximal compound of the HP accompanied by a complete debranching of the 3 supra-aortic vessels with an inter-carotidal retro-oesophageal bypass. As we left in situ the endovascular graft within the descending aorta, a life-long antibiotic therapy was introduced. The postoperative follow-up was uneventful, and the patient discharged home 2 weeks after his surgery. As an alternative to a more radical redo surgery with major risk, a hybrid medical and surgical treatment of infected frozen elephant trunk could be considered.

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