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Lumbar drains for aortic endovascular procedures

Jennifer Mancio, Gustavo Pires-Morais, Nuno Bettencourt, Marco Oliveira, Lino Santos, Bruno Melica, Alberto Rodrigues, José Pedro Braga, Vasco Gama Ribeiro
Thoracic endovascular aortic repair (TEVAR) has shown lower mortality compared with open surgical repair (OSR). However, the risk of spinal cord ischaemia (SCI) remains similar than OSR. As a prophylactic measure to reduce the risk of SCI, cerebrospinal fluid (CSF) drainage has been widely used in OSR. In TEVAR, the utility of this adjunct is still controversial. We report a case of a 56-year-old man referred for TEVAR for a descending thoracic aneurysm that previously underwent an abdominal aneurysmectomy with aortobifemoral bypass graft...
June 2014: Oxford Medical Case Reports
Drosos Kotelis, Claudio Bianchini, Bence Kovacs, Thomas Müller, Moritz Bischoff, Dittmar Böckler
PURPOSE: To report initial experience with automatic pressure-controlled cerebrospinal fluid drainage (CSFD) during thoracic endovascular aortic repair (TEVAR). METHODS: A prospective nonrandomized study enrolled 30 consecutive patients (median age 68 years, range 42-89; 18 men) who underwent TEVAR between March 2012 and July 2013 and were considered to be at high risk for postoperative spinal cord ischemia (SCI), fulfilling 2 of the following criteria: stent-graft length >20 cm, left subclavian artery coverage, and previous infrarenal aortic repair...
June 2015: Journal of Endovascular Therapy
René Müller-Wille, Sophie Schötz, Florian Zeman, Wibke Uller, Oliver Güntner, Karin Pfister, Piotr Kasprzak, Christian Stroszczynski, Walter A Wohlgemuth
PURPOSE: To determine computed tomographic (CT) features of early type II endoleaks associated with aneurysm sac enlargement after endovascular aortic aneurysm repair (EVAR) of abdominal aortic aneurysm. MATERIALS AND METHODS: Institutional review board approval was not required for this retrospective study. The authors reviewed imaging and clinical data from 56 patients (seven women, 49 men; mean age ± standard deviation, 71 years ± 7.9; age range, 52-85 years) with early type II endoleak who had undergone EVAR between December 2002 and December 2011 and who had been followed up with imaging and clinical evaluation for at least 6 months...
March 2015: Radiology
Mark A Farber, Joseph S Giglia, Benjamin W Starnes, Scott L Stevens, Jeremiah Holleman, Rabih Chaer, Jon S Matsumura
OBJECTIVE: To evaluate the safety and effectiveness of the conformable GORE TAG thoracic endoprosthesis (CTAG) device (W. L. Gore and Associates, Flagstaff, Ariz) for the endovascular repair of traumatic aortic transections. METHODS: A prospective, nonrandomized, multicenter trial was conducted at 21 sites. Primary safety end points included 30-day all-cause mortality. The effectiveness end point was freedom from a major device event requiring reintervention through 1-month follow-up...
September 2013: Journal of Vascular Surgery
Jennifer M Hanna, Nicholas D Andersen, Hamza Aziz, Asad A Shah, Richard L McCann, G Chad Hughes
BACKGROUND: The optimal use of lumbar cerebrospinal fluid drainage for the prevention of spinal cord ischemia (SCI) with thoracic endovascular aortic repair (TEVAR) remains unclear. Here, we report our experience with selective preoperative lumbar drain placement with TEVAR. METHODS: Between May 2002 and January 12, 381 TEVAR procedures were performed at a single referral institution. Preoperative lumbar drains were placed selectively in patients considered high-risk for SCI due to planned long-segment aortic coverage with a history of prior aortic intervention or planned hybrid Crawford extent I to III thoracoabdominal aortic aneurysm repair...
June 2013: Annals of Thoracic Surgery
Masashi Shimohira, Takuya Hashizume, Yosuke Suzuki, Kenichiro Kurosaka, Masahiro Muto, Masanori Kitase, Masaru Mizutani, Yuta Shibamoto
PURPOSE: To demonstrate the utility of a triaxial catheter system for embolization of type II endoleak after endovascular aneurysm repair. TECHNIQUE: The technique is illustrated in 2 patients with sac enlargement owing to persistent type II endoleak of lumbar artery origin. In both cases, the access to the iliolumbar and lumbar arteries was very long and tortuous. For selective catheterization in this situation, a 4-F catheter is advanced through the access site, and 2...
April 2013: Journal of Endovascular Therapy
Joel S Corvera, John W Fehrenbacher
BACKGROUND: There has been great enthusiasm for thoracic endograft repair of chronic thoracic or thoracoabdominal aortic dissection (ChAD) given the low operative morbidity and mortality. However long-term results are unknown and early reintervention is common. This study examines the early and late results of open repair of ChAD using deep hypothermia and circulatory arrest (DHCA). METHODS: From January 1995 to December 2009, 343 patients had open repair of descending thoracic or thoracoabdominal aneurysms using DHCA...
July 2012: Annals of Thoracic Surgery
Nao Hamabe, Takeshi Iritakenishi, Tatsuyuki Imada, Takashi Mashimo
We report a case of acute subdural hematoma which occurred following cerebrospinal fluid (CSF) drainage during thoracic endovascular aortic repair (TEVAR) surgery. A 63-year-old woman was scheduled to receive TEVAR for thoracic-abdominal aneurysm extending from the descending aorta (T10) to 15 mm above the celiac trunk. Before the TEVAR operation, a lumbar cerebrospinal drain was inserted at L4-5. CSF pressure was maintained at 10cmH2O throughout the operation. The surgical procedure was completed uneventfully...
December 2011: Masui. the Japanese Journal of Anesthesiology
Charles J Keith, Marc A Passman, Martin J Carignan, Gaurav M Parmar, Shardul B Nagre, Mark A Patterson, Steven M Taylor, William D Jordan
BACKGROUND: Spinal cord ischemia (SCI) remains a significant concern in patients undergoing endovascular repair involving the thoracic aorta (thoracic endovascular aortic repair [TEVAR]). Perioperative lumbar spinal drainage has been widely practiced for open repair, but there is no consensus treatment protocol using lumbar drainage for SCI associated with TEVAR. This study analyzes the efficacy of an institutional protocol using selective lumbar drainage reserved for patients experiencing SCI following TEVAR...
January 2012: Journal of Vascular Surgery
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