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Moussa Abi Ghanem, Mario Gomez-Sanchez, Xavier Chaufour, Bertrand Marcheix
Thoracic endovascular aortic repair (TEVAR) is recognized as an attractive option to treat complicated Type B aortic dissection. Nevertheless, TEVAR is not always technically possible. We report the case of a 53-year-old male with complicated Type B aortic dissection, in the setting of a complex anomalous aortic arch anatomy with an aneurysmal aberrant right subclavian artery. He was successfully treated by the frozen elephant trunk technique using the Thoraflex hybrid graft.
February 2016: Aorta (Stamford, Conn.)
Yuji Kanaoka, Takao Ohki, Koji Maeda, Takeshi Baba
PURPOSE: To evaluate risk factors for early (<30 days) type I endoleak following thoracic endovascular aortic repair (TEVAR). METHODS: A retrospective study was conducted of 439 consecutive patients (mean age 74.0±10.0 years; 333 men) who underwent TEVAR at a single center between June 2006 and June 2013. Pathologies included 237 aortic arch aneurysms and 202 descending thoracic aortic aneurysms (dTAA). Maximum TAA diameter was 63.6±13.7 mm. Among the distal aortic arch aneurysms, 124 required coverage of the left subclavian artery (LSA), while the remaining 113 arch aneurysms had debranching (n=40), the chimney technique (n=52), and a branched stent-graft (n=13)...
October 19, 2016: Journal of Endovascular Therapy
Rongjie Zhang, Jian Zhou, Jiaxuan Feng, Zhiqing Zhao, Junjun Liu, Zhenjiang Li, Rui Feng, Zaiping Jing
BACKGROUND: How to choose the proximal landing zone in endovascular interventions for a patient with a patent retrograde false lumen in dissection of the ascending aorta and aortic arch remains unclear. This study sought to report the safety and efficiency of inducing thrombosis of the retrograde false lumen to enhance a proximal landing zone to treat retrograde type A aortic dissection. METHODS: This study included 9 patients with retrograde type A aortic dissection treated with a 2-stage operation strategy between January 2015 and January 2016...
September 22, 2016: Journal of Thoracic and Cardiovascular Surgery
V Pompa, P Papi, M Coletti, L Bresadola
OBJECTIVE: Acute aortic dissection (AAD) is one of the most frequent aortic emergencies, which occurs to the vascular specialist. Endovascular reconstruction of the true lumen using minimally invasive stent grafting or stenting has become increasingly popular and widespread among institutions. The aim of this paper is to report a case series composed by twenty-eight patients, who underwent endovascular intervention for acute type B aortic dissections complicated by rupture using thoracic endovascular aortic repair (TEVAR)...
September 2016: European Review for Medical and Pharmacological Sciences
Yanfei Chen, Bryan W Tillman, Sung Kwon Cho, Tara D Richards, Amit D Tevar, Xinzhu Gu, William R Wagner, Youngjae Chun
Donation after cardiac death has been adopted to address the critical shortage of donor organs for transplant. Recovery of these organs is hindered by low blood flow that leads to permanent organ injury. We propose a novel approach to isolate the perfusion of the abdominal organs from the systemic malperfusion of the dying donor. We reasoned that this design could improve blood flow to organs without open surgery, while respecting the ethical principle that cardiac stress not be increased during organ recovery...
October 7, 2016: Journal of Medical Engineering & Technology
Ana Isabel Azevedo, Pedro Braga, Alberto Rodrigues, Nuno Ferreira, Marlene Fonseca, Adelaide Dias, Vasco Gama Ribeiro
Thoracic endovascular aortic repair (TEVAR) is increasingly used in the treatment of acute type B aortic dissection. Type Ia endoleaks are a common complication of the procedure, but its clinical significance and the best treatment strategy remain poorly defined. We present a case of a type Ia endoleak following TEVAR in the treatment of acute type B aortic dissection. Chimney technique approach was used in an attempt to seal the endoleak. Although technical success was suboptimal, the patient remained clinically stable and event free...
2016: Frontiers in Cardiovascular Medicine
Gabriele Piffaretti, Stefania Ferraro, Gianpaolo Carrafiello, Edoardo Macchi, Alessandro Bacuzzi, Patrizio Castelli
Primary malignant tumors of the aorta are extremely rare, and the diagnosis is difficult from the clinical onset. Accordingly to the principles of cancer surgery, "en bloc" resection of the tumor-involved aorta and graft interposition is the gold-standard, but it is still technically challenging and co-morbidities may rule out some patients from an operative treatment. Thoracic endovascular aortic repair has been reported anecdotally but it is an ease and rapid alternative in urgent circumstances, and proved to be effective to relieve symptoms caused by these lesions...
October 1, 2016: Annals of Vascular Surgery
Marina Dias-Neto, Pedro Videira Reis, Dalila Rolim, José Fernando Ramos, José Fernando Teixeira, Sérgio Sampaio
Spinal cord ischemia remains the Achilles' heel of thoracic and thoracoabdominal diseases management. Great improvements in morbidity and mortality have been obtained with the endovascular approach TEVAR (Thoracic Endovascular Aortic Repair) but this devastating complication continues to severely affect the quality of life, even if the primary success of the procedure - dissection/aneurysm exclusion - has been achieved.Several strategies to deal with this complication have been published in the literature over the time...
September 30, 2016: Vascular
Christoph A Nienaber, Natzi Sakalihasan, Rachel E Clough, Mohamed Aboukoura, Enrico Mancuso, James S M Yeh, Jean-Olivier Defraigne, Nick Cheshire, Ulrich Peter Rosendahl, Cesare Quarto, John Pepper
OBJECTIVE: Thoracic endovascular aortic repair (TEVAR) has demonstrated encouraging results and is gaining increasing acceptance as a treatment option for aortic aneurysms and dissections. Yet, its role in managing proximal aortic pathologies is unknown-this is important because in proximal (Stanford type A) aortic dissections, 10% to 30% are not accepted for surgery and 30% to 50% are technically amenable for TEVAR. We describe our case series of type A aortic dissections treated by using TEVAR...
August 29, 2016: Journal of Thoracic and Cardiovascular Surgery
Ludovic Canaud, Vincent Ziza, Baris Ata Ozdemir, Jean-Philippe Berthet, Charles-Henri Marty-Ané, Pierre Alric
BACKGROUND: The aim of this study was to evaluate outcomes of left subclavian artery (LSA) revascularization for hybrid aortic arch debranching. METHODS: Between 1998 and 2015, 68 patients (41 men, mean age 67+/-16 years) underwent TEVAR with LSA coverage, 19.2% (n = 13) were never revascularized and the remaining patients underwent LSA revascularization (n = 55; 80.8%) . Revascularization was achieved by LSA-carotid transposition via a medial approach in 81.8% (n = 45) and a lateral approach in 18...
September 23, 2016: Annals of Vascular Surgery
Yuji Kanaoka, Takao Ohki, Hirotsugu Ozawa
We report a case in which a stent graft and an Amplatzer® vascular plug (AVP) were effective for the treatment of chronic aneurysmal aortic dissection. The patient was a 52-year-old man. At 45 years of age, he developed acute aortic dissection, for which he underwent surgery four times with prosthetic graft replacement in the abdominal aorta, descending thoracic, ascending aorta (without neck branch reconstruction), and thoracoabdominal aorta with the reconstruction of the celiac, superior mesenteric and bilateral renal arteries...
September 23, 2016: Annals of Vascular Surgery
H Etienne, M Majewski, F Cochennec, L Segaux, J-P Becquemin
INTRODUCTION: Ruptured descending thoracic aneurysm (rDAA) is a rare but devastating condition. Open aortic surgery which uses cardiopulmonary bypass is associated with a high mortality. Thoracic Endovascular Aortic Repair (TEVAR) is a less invasive approach for which it remains unclear whether outcomes are superior or equivalent to open aortic surgery. In this study, we report our early and midterm outcomes with TEVAR for rDAA. METHODS: This is an observational, retrospective, single center study which included patients with rDAA and treated by TEVAR...
September 23, 2016: Annals of Vascular Surgery
Prashanth Vallabhajosyula, Jean Paul Gottret, Rohan Menon, Ibrahim Sultan, Zara Abbas, Mary Siki, Matthew Kramer, Aaron Pulsipher, Suveeksha Naidu, Alberto Pochettino, Kariana Milewski, Wilson Y Szeto, Joseph E Bavaria
BACKGROUND: In acute DeBakey I aortic dissection presenting with malperfusion syndromes, we assessed whether standard open repair with concomitant antegrade stent grafting (thoracic endovascular aneurysm repair; TEVAR) of the descending thoracic aorta (DTA) improves outcomes compared with standard repair alone. METHODS: From 2005 to 2012, 277 patients with acute DeBakey I dissection underwent emergent operation. Of these, 104 patients (37%) presenting with end-organ malperfusion were divided into those undergoing standard distal repair entailing transverse hemiarch replacement (Standard group, n = 65) versus standard repair with concomitant DTA TEVAR during circulatory arrest (TEVAR group, n = 39)...
September 22, 2016: Annals of Thoracic Surgery
N Fatic, N Ilić, D Markovic, A Nikolic, I Končar, R Lazovic, I Banzic, G Vuktsevich, B Pajovic, D Kostic
INTRODUCTION: In-hospital mortality of acute aortic type III dissection ranged about 12%. Complicated dissections represent about 18% of all cases, and require open surgery or TEVAR. More morphological predictors of in hospital mortality are needed to differentiate patients who should be selected for immediate, surgical or endovascular intervention. METHODS: From January 2009 to December 2014, 74 patients with acute aortic type III dissection were enrolled at Clinic of Vascular and Endovascular Surgery in Belgrade Serbia and retrospectively analyzed...
2016: Angiologii︠a︡ i Sosudistai︠a︡ Khirurgii︠a︡, Angiology and Vascular Surgery
Taro Hayashi, Satoshi Tobe, Hironobu Sugiyama, Shinichi Ijyuin, Masahiro Yamaguchi, Masato Yamaguchi, Takanori Oka, Takuya Misato, Kotaro Tsunemi, Nobuhiro Tanimura
A 77-year-old man with a history of stent implantation in the right common iliac artery(CIA) and the left external iliac artery(EIA) was admitted to our hospital for a rapid growth of an aneurysm( max 53 mm) at Th11 level of the descending aorta. Although thoracic endovascular aortic repair (TEVAR) was required, there were many problems about access rout. The infrarenal abdominal aorta and the left EIA were severely calcified, and the lumens of the right CIA stent(5.3 mm) and the left EIA stent( 4.3 mm) were small in size...
September 2016: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Moritz S Bischoff, Katrin Meisenbacher, Michael Wehrmeister, Dittmar Böckler, Drosos Kotelis
OBJECTIVE: The aim of this study was to analyze the outcome of thoracic endovascular aortic repair (TEVAR) and medical therapy in patients with aortic intramural hematoma type B (IMHB). METHODS: Between January 2004 and January 2014, 41 IMHB patients were treated; 28 underwent TEVAR (16 male; median age, 69 years; group I) plus best medical therapy (BMT), whereas 13 had BMT alone (6 male; median age, 69 years; group II). Study end points were assessment of indications for TEVAR and BMT, clinical outcome, and evaluation of aortic morphology over time...
August 27, 2016: Journal of Vascular Surgery
Michael A Dunn, Deborah A Josbeno, Amit D Tevar, Vikrant Rachakonda, Swaytha R Ganesh, Amy R Schmotzer, Elizabeth A Kallenborn, Jaideep Behari, Douglas P Landsittel, Andrea F DiMartini, Anthony Delitto
OBJECTIVES: Frailty is a known risk factor for major life-threatening liver transplant complications, deaths, and waitlist attrition. Whether frailty indicates risk for adverse outcomes in cirrhosis short of lethality is not well defined. We hypothesized that clinical measurements of frailty using gait speed and grip strength would indicate the risk of subsequent hospitalization for the complications of cirrhosis. METHODS: We assessed frailty as gait speed and grip strength in a 1-year prospective study of 373 cirrhotic patients evaluated for or awaiting liver transplantation...
August 30, 2016: American Journal of Gastroenterology
Benjamin Bottet, François Bouchard, Christophe Peillon, Jean-Marc Baste
A best evidence topic in cardiovascular surgery was written according to a structured protocol. The question addressed was what are the optimum treatment modality and timing of intervention for blunt thoracic aortic injury (BTAI) in the modern era? Of the 697 papers found using the reported search, 14 (5 meta-analyses, 2 prospective and 7 retrospective studies) represented the best evidence to answer the clinical question. The author, journal, country, date of publication, patient group studied, study type, relevant outcomes, results and weakness of these papers are tabulated...
August 29, 2016: Interactive Cardiovascular and Thoracic Surgery
Aamir Shah, Ali Khoynezhad
Acute type A aortic dissection is a potentially lethal condition which requires immediate diagnostic and therapeutic intervention. Open surgical repair remains the standard of care as survival rates continue to improve in the modern surgical era. Unfortunately, up to twenty percent of patients are denied surgical therapy because they are deemed medically unfit to undergo open repair. The application of thoracic endovascular aortic repair (TEVAR) has changed the treatment paradigm for aortic disease involving the descending thoracic aorta and may be a viable rescue option for patients with type A dissection who are not eligible for open surgical repair...
July 2016: Annals of Cardiothoracic Surgery
B Reutersberg, B Haller, J Mariss, H-H Eckstein, S Ockert
OBJECTIVES: Precise pre-procedural anatomical analysis of aneurysmal anatomy is essential for successful thoracic endovascular aortic repair (TEVAR). Since surgeons and radiologists have to perform multiple measurements in the same patient, high intra-observer reliability of any imaging method is mandatory. Commercially available three dimensional (3D) post-processing techniques are expected to be superior to conventional two dimensional multiplanar reconstructions (MPRs) derived from computed tomography angiograms (CTAs)...
October 2016: European Journal of Vascular and Endovascular Surgery
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