Descending Thoracic and Thoracoabdominal Aortic Aneurysms: Open and Endovascular Repair

2013 ◽  
Author(s):  
Naveed U. Saqib ◽  
Robert Y. Rhee
Keyword(s):  
Imaging Techniques ◽  
Artery Bypass ◽  
Preoperative Evaluation ◽  
Aortic Aneurysms ◽  
Visceral Artery ◽  
Thoracoabdominal Aneurysm ◽  
Management Options ◽  
Thoracic Aortic Aneurysms ◽  
Fenestrated Endograft

The prevalence of descending thoracic aortic aneurysms (DTAs) and thoracoabdominal aortic aneurysms (TAAAs) are described. Imaging techniques and classification is given. Preoperative evaluation is described in detail, as prior to proceeding with repair of a DTA or a TAAA, patients must be thoroughly evaluated medically to determine if they are physiologically fit enough for repair. Indications for repair, primarily relating to size of aneurysm, are listed for both DTAs and TAAAs. Repair options and management for DTAs now includes thoracic endovascular aortic repair (TEVAR); its outcomes, benefits, and drawbacks are discussed in detail. The discussion of TAAAs is similar, with indications for repair and surgical management options given: direct open repair; a debranching procedure with subsequent endograft repair; and branched or fenestrated endograft repair. A table lists the symptoms attributable to thoracic and thoracoabdominal aortic aneurysms. Figures show the classification of DTAs; the evaluation of a patient with a thoracic aortic aneurysm; available thoracic endografts; anatomic restrictions for TEVAR; evaluation of a patient with a thoracoabdominal aneurysm; regional spinal cord hypothermic protection; distal aortic perfusion; visceral artery bypass; and a branched endograft.  This review contains 8 figures, 3 tables, and 125 references.

Impact of Image Analysis Methodology on Diagnostic and Surgical Classification of Patients With Thoracic Aortic Aneurysms

2011 ◽  
Vol 92 (3) ◽  
pp. 904-912 ◽  
Author(s):  
Dorinna D. Mendoza ◽  
Minisha Kochar ◽  
Richard B. Devereux ◽  
Craig T. Basson ◽  
James K. Min ◽  
...  
Keyword(s):  
Image Analysis ◽  
Aortic Aneurysms ◽  
Thoracic Aortic Aneurysms ◽  
Analysis Methodology

Visceral Artery Aneurysms

2015 ◽  
Author(s):  
Louise A. Corle ◽  
Erica L. Mitchell
Keyword(s):  
Early Recognition ◽  
Imaging Techniques ◽  
Celiac Artery ◽  
Liver Trauma ◽  
Preoperative Imaging ◽  
Visceral Artery ◽  
Management Options ◽  
Visceral Artery Aneurysms ◽  
Arterial Trauma ◽  
Splanchnic Artery

Although rare, visceral artery aneurysms are being increasingly identified with the widespread use of advanced imaging techniques. Their incidence, based on routine autopsies, has been estimated at 0.01 to 0.2% but is thought to be increasing with the rise in percutaneous biliary procedures, endovascular chemoembolization therapies, liver transplantation, arterial trauma secondary to laparoscopic manipulation of vessels, and a trend toward nonoperative management of blunt liver trauma. The morbidity and mortality associated with visceral aneurysms remain high—up to 22% in some reports. Therefore, early recognition and treatment prior to rupture are a priority. Management is evolving and includes open repair, laparoscopic and robotic-assisted repair, and a more important role for endovascular therapies. This review covers splenic artery aneurysms, hepatic artery aneurysms, superior mesenteric artery aneurysms, celiac artery aneurysms, and gastroduodenal and pancreaticoduodenal artery aneurysms. Tables highlight the estimated frequency of aneurysms by anatomic distribution, current management options, etiology of splanchnic artery aneurysms, average visceral artery diameters, and preoperative imaging options. Angiographic images and intraoperative photos are provided. This review contains 12 figures, 5 tables, and 25 references.

Clinical Application of an Original Flexible MK Stent-Graft for Nonruptured Thoracic Aortic Aneurysms: Early Experience

2006 ◽  
Vol 1 (3) ◽  
pp. 119-122 ◽  
Author(s):  
Hiroshi Ohtake ◽  
Keiichi Kimura ◽  
Go Watanabe ◽  
Junichiro Sanada ◽  
Osamu Matsui
Keyword(s):  
Stent Graft ◽  
Bypass Surgery ◽  
Thrombus Formation ◽  
Perioperative Complications ◽  
Artery Bypass ◽  
Polyester Fabric ◽  
Aortic Aneurysms ◽  
Stent Grafts ◽  
Stent Grafting ◽  
Thoracic Aortic Aneurysms

Objective To obtain early MK stent-grafting results for nonruptured thoracic aortic aneurysms and thoracoabdominal aortic aneurysms. Methods The authors analyzed 47 patients who underwent treatment using MK stent-grafting. All patients (40 men and 7 women; mean age, 70.8 years) underwent elective procedures. Straight, curved, or tapered MK stents were constructed from a nitinol wire and covered with seamless, cylindrical woven polyester fabric grafts. The mean stent-graft diameter was 24 to 48 mm. In cases where the aneurysm had a short proximal neck (under 15 mm), supraaortic arch artery bypass surgery was planned to lengthen the neck. Results Simple stent-grafting without bypass was performed in 26 patients, whereas stent-grafting with supraaortic arch artery bypass was performed in 21 patients. An 18 or 20 F sheath was used as the delivery system in 46 patients (96%). In all 47 patients, the stent-grafts were successfully deployed. Two patients died while in hospital, and another 2 patients suffered a stroke. No other perioperative complications were observed. Postoperative computed tomography after 3 months showed complete thrombus formation in 42 patients (93.3%; 42/45 patients). Conclusions Forty-seven patients with thoracic aortic aneurysm were treated with our original flexible MK stent-graft system. Using a small sheath system, straight or curved M-K stent-grafts could be deployed to adequately fit to the aorta as planned. Furthermore, simultaneous bypass surgery widened the application of stent-grafting. However, careful long-term observation is necessary, and further studies are needed to assess such stent-grafting with bypass surgery.

Cannulation of the Ascending Aorta in Left Thoracotomy for Thoracic Aortic Aneurysms

2007 ◽  
Vol 10 (1) ◽  
pp. E81-E83 ◽  
Author(s):  
Riza Turkoz ◽  
Oner Gulcan ◽  
Orhan Demirturk ◽  
Ayda Turkoz
Keyword(s):  
Ascending Aorta ◽  
Aortic Aneurysms ◽  
Left Thoracotomy ◽  
Thoracic Aortic Aneurysms

Diagnosis of coronary affection in patients with AADA and treatment of postcardiotomy myocardial failure using extracorporeal life support (ECLS)

2014 ◽  
Vol 17 (5) ◽  
pp. 253 ◽  
Author(s):  
Sabina P W Guenther ◽  
Sven Peterss ◽  
Angela Reichelt ◽  
Frank Born ◽  
Matthias Fischer ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Artery ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Artery Bypass ◽  
Preoperative Evaluation ◽  
Left Heart Failure ◽  
Myocardial Failure ◽  
Coronary Abnormalities ◽  
Ventricular Support

<p><b>Background:</b> Myocardial ischemia due to concomitant coronary artery disease (CAD) or coronary dissection in patients with acute aortic dissection type Stanford A (AADA) is associated with myocardial failure and poor outcomes. Preoperative coronary angiography in this group of patients is still debated. The use of CT scan to diagnose coronary affection along with the establishment of high-pitched dual-spiral CT protocols are essential for improving outcomes.</p><p><b>Methods:</b> We retrospectively analyzed six AADA patients with heart failure who were treated using extracorporeal life support (ECLS). Options for diagnosing coronary affection and different therapeutic strategies for postcardiotomy cardiogenic shock in this patient cohort are discussed.</p><p><b>Results:</b> Retrospective review of CT images showed coronary abnormalities in 83% (n = 5). Four patients (67%) underwent unplanned coronary artery bypass grafting (CABG). ECLS was instituted in 67% (n = 4) due to left heart failure and in 33% (n = 2) due to right heart failure. Thirty day mortality was 67% (n = 4). The two patients that received ECLS for right ventricular support survived and both had undergone CABG.</p><p><b>Conclusion:</b> Besides preoperative evaluation of the extent of the dissection, focus on coronary affection in CT-scans helps to triage the operative procedure. Hybrid operating rooms allow for immediate interventional and/or surgical treatment and enable for immediate control of revascularization results. The use of ECLS over other types of ventricular support systems may allow for myocardial recovery in selected cases.</p>

Complications After Endovascular Treatment of Thoracic Aortic Aneurysms

2003 ◽  
Vol 10 (4) ◽  
pp. 711-718 ◽  
Author(s):  
Reinhard Scharrer-Pamler ◽  
Thomas Kotsis ◽  
Xaver Kapfer ◽  
Johannes Görich ◽  
Karl-Heinz Orend ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Aortic Aneurysms ◽  
Thoracic Aortic Aneurysms

Marfan Syndrome and Related Heritable Thoracic Aortic Aneurysms and Dissections

2015 ◽  
Vol 21 (28) ◽  
pp. 4061-4075 ◽  
Author(s):  
Julie Backer ◽  
Marjolijn Renard ◽  
Laurence Campens ◽  
Laura Mosquera ◽  
Anne Paepe ◽  
...  
Keyword(s):  
Marfan Syndrome ◽  
Aortic Aneurysms ◽  
Thoracic Aortic Aneurysms
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