Surgical debranching for endovascular arch penetrating ulcer management

ASVIDE ◽  
2019 ◽  
Vol 6 ◽  
pp. 217-217
Author(s):  
Tim Smith ◽  
Emma van der Weijde ◽  
Robin H. Heijmen
Keyword(s):  
Penetrating Ulcer

Customized CT angiogram planning for intraoperative transesophageal echography-guided endovascular exclusion of thoracic aorta penetrating ulcer

Vascular ◽  
2014 ◽  
Vol 23 (2) ◽  
pp. 161-164
Author(s):  
Michele Piazza ◽  
Mario Lupia ◽  
Franco Grego ◽  
Michele Antonello
Keyword(s):  
Thoracic Aorta ◽  
Maximum Diameter ◽  
Pigtail Catheter ◽  
Descending Thoracic Aorta ◽  
Ct Angiogram ◽  
Penetrating Ulcer ◽  
Preoperative Ct ◽  
Cook Medical ◽  
Longitudinal Extension ◽  
Graft Positioning

The technique is demonstrated in a 78-year-old man; the preoperative CT angiogram showed a descending thoracic aorta ulcer of 5.9 cm in maximum diameter and 3.8 cm longitudinal extension. A ZTEG-2P-36-127-PF (Cook Medical) single tubular endograft was planned to be deployed. From the preoperative CT angiogram we planned to land 4.7 cm above the midline of the descending thoracic aorta ulcer and 8.0 cm below. In the operating room, under radioscopic vision the centre of the transesophageal echography probe was used as marker to identify the correspondent midline of the descending thoracic aorta ulcer and a centimeter-sized pigtail catheter in the aorta was used to calculate the desired length above and below the ulcer midline. The endograft was introduced and placed in the desired position compared to the transesophageal echography probe and the catheter; under transesophageal echography vision the graft was finally deployed. The CT angiogram at 1 month showed the correct endograft position, descending thoracic aorta ulcer exclusion with no signs of endoleak. In selected cases, this method allows planning in advance safe stent graft positioning and deployment totally assisted by transesophageal echography, with no risk of periprocedural contrast-related renal failure and reduced radiation exposure for the patient and operators.

scholarly journals SIMPLE PENETRATING ULCER OF THE CECUM

1944 ◽  
Vol 119 (3) ◽  
pp. 377-383 ◽  
Author(s):  
CURTICE ROSSER
Keyword(s):  
Penetrating Ulcer

The thoracic aorta

2018 ◽  
Author(s):  
David Sidebotham ◽  
Alan Merry ◽  
Malcolm Legget ◽  
Gavin Wright
Keyword(s):  
Aortic Aneurysm ◽  
Thoracic Aorta ◽  
Aortic Root ◽  
Surgical Techniques ◽  
Aortic Injury ◽  
Intramural Haematoma ◽  
Aortic Atheroma ◽  
Acute Aortic Syndromes ◽  
Penetrating Ulcer ◽  
Large Airways

The first section of Chapter 12 details an approach to a systematic examination of the aortic root and thoracic aorta. The limitations (due to interposition of the large airways) and artefacts encountered when assessing the thoracic aorta are discussed. Normal aortic dimensions are listed in tabular format. The remainder of the chapter is concerned with the pathologies affecting the thoracic aorta, namely: aortic atheroma, aortic aneurysm, acute aortic syndromes (dissection, intramural haematoma, and penetrating ulcer), and traumatic aortic injury. Where relevant, reference to appropriate guidelines and surgical techniques are made.

Endovascular Stent-Graft Treatment of a Ruptured Thoracic Aortic Ulcer

2002 ◽  
Vol 9 (2_suppl) ◽  
pp. II-20-II-24 ◽  
Author(s):  
Peter L. Faries ◽  
Elvira Lang ◽  
Pranay Ramdev ◽  
Larry H. Hollier ◽  
Michael L. Marin ◽  
...  
Keyword(s):  
Thoracic Aorta ◽  
Stent Graft ◽  
Chronic Obstructive ◽  
Endovascular Stent ◽  
Descending Thoracic Aorta ◽  
Obstructive Pulmonary Disease ◽  
Endovascular Stent Graft ◽  
Nitinol Stents ◽  
Penetrating Ulcer ◽  
Stent Graft Repair

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.

Abdominal Aortic Intramural Hematoma Related to Penetrating Ulcer: An Inappropriate Indication for Endovascular Repair?

2003 ◽  
Vol 10 (2) ◽  
pp. 392-396 ◽  
Author(s):  
Marco Ventura ◽  
Alessandro Mastromarino ◽  
Lucia Cucciolillo ◽  
Giuseppe Calvisi ◽  
Carlo Spartera
Keyword(s):  
Endovascular Repair ◽  
Mesenteric Artery ◽  
Intramural Hematoma ◽  
Aneurysmal Dilatation ◽  
Abdominal Aortic ◽  
Penetrating Ulcer ◽  
Atherosclerotic Aneurysm ◽  
Open Laparotomy ◽  
Organized Thrombus ◽  
Aortic Intramural Hematoma

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.

scholarly journals Penetrating ulcer of the ascending aorta without rupture

2009 ◽  
Vol 35 (3) ◽  
pp. 550-551 ◽  
Author(s):  
Nadjib Hammoudi ◽  
Peter Dorfmuller ◽  
Emmanuel Corvol ◽  
Christophe Acar
Keyword(s):  
Ascending Aorta ◽  
Penetrating Ulcer
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