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endovascular aortic procedures

Ryan C Shelstad, Justin G Reeves, Katsuhiro Yamanaka, T Brett Reece
We review the operative techniques of aortic arch replacement. Aortic arch replacement presents several formidable challenges, as it requires arresting the circulation to the body and replacement of the brachiocephalic vessels with special consideration for protecting the central nervous system. Perfusion strategies, selective antegrade cerebral perfusion, and operative graft selection are key elements in aortic arch replacement surgery. Standard approaches include the island technique, the branched graft technique, and the "Spielvogel" trifurcated graft technique-each having its own advantages...
October 7, 2016: Seminars in Cardiothoracic and Vascular Anesthesia
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
J J Jiang, H K Qing, X M Zhang, X M Zhang, W Li, C Y Shen, Q L Li, Y Jiao
OBJECTIVE: To compare total percutaneous access using preclose technique with femoral artery cut-down in endovascular aneurysm repair (EVAR) and assess the safety and feasibility of preclose technique. METHODS: In the study, 81 cases undergoing EVAR from Dec. 2011 to Nov. 2014 in Peking University People's Hospital were retrospectively reviewed. Preoperative CT angiography (CTA) showed presence of infrarenal abdominal aortic aneurysm or descending aortic aneurysm in all the cases...
October 18, 2016: Beijing da Xue Xue Bao. Yi Xue Ban, Journal of Peking University. Health Sciences
Ahmet Karabulut, Selim Aydın
Ruptured abdominal aortic aneurysm (rAAA) is an emergent condition that carries higher mortality rate. Although there had been development of interventional and surgical technique besides improved critical care, mortality rates were still varied between 35 and 53% in the reported series. Preoperative shock was reported as a major factor predicting mortality rate. Feasibility of simultaneous endovascular repair of rAAA and silent thoracic aortic aneurysm (TAA) is not known. Herein, we aimed to demonstrate the advantage of simultaneous endovascular repair of rAAA and silent TAA in the settling of hemodynamic and neurologic instability...
September 2016: Indian Heart Journal
Martijn L Dijkstra, Peter C J M Goverde, Andrew Holden, Clark J Zeebregts, Michel M P J Reijnen
PURPOSE: To show feasibility of the covered endovascular repair of the aortic bifurcation (CERAB) technique in conjunction with chimney grafts in aortic side branches for complex aortoiliac occlusive disease. METHODS: Two European centers and one facility located in New Zealand participated in a retrospective observational study that enrolled 14 consecutive patients (mean age 61.2±8.9 years; 11 men) treated with CERAB in conjunction with chimney graft(s) between December 2012 and May 2015...
October 14, 2016: Journal of Endovascular Therapy
Toshio Doi, Kimimasa Sakata, Takayuki Gyoten, Saori Nagura, Akio Yamashita, Kazuaki Fukahara, Keiju Kotoh, Naoki Yoshimura
Right aortic arch with aberrant left subclavian artery and Kommerell diverticulum are rare anomalies. A 42-year-old man was referred with sudden-onset chest pain. Enhanced computed tomography (CT) showed a right aortic arch with early thrombosed acute type A aortic dissection and an aberrant left subclavian artery arising from a Kommerell diverticulum. Medical therapy was instituted; however, follow-up CT revealed an ulcer-like projection. The patient was managed with a two-stage hybrid procedure comprising total arch replacement and endovascular repair and experienced no postoperative complications...
2016: Annals of Vascular Diseases
Nikolaos A Papakonstantinou, Nikolaos G Baikoussis, Panagiotis Dedeilias, Michalis Argiriou, Christos Charitos
A hybrid strategy, firstly performed in the 1990s, is a combination of tools available only in the catheterization laboratory with those available only in the operating room in order to minimize surgical morbidity and face with any cardiovascular lesion. The continuous evolution of stent technology along with the adoption of minimally invasive surgical approaches, make hybrid approaches an attractive alternative to standard surgical or transcatheter techniques for any given set of cardiovascular lesions. Examples include hybrid coronary revascularization, when an open surgical anastomosis of the left internal mammary artery to the left anterior descending coronary artery is performed along with stent implantation in non-left anterior descending coronary vessels, open heart valve surgery combined with percutaneous coronary interventions to coronary lesions, hybrid aortic arch debranching combined with endovascular grafting for thoracic aortic aneurysms, hybrid endocardial and epicardial atrial fibrillation procedures, and carotid artery stenting along with coronary artery bypass grafting...
October 8, 2016: Journal of Cardiology
Mohammad H Eslami, Denis V Rybin, Gheorghe Doros, Alik Farber
OBJECTIVE: Despite vast improvement in the field of vascular surgery, elective abdominal aortic aneurysm (AAA) repair still leads to perioperative death. Patients with asymptomatic AAAs, therefore, would benefit from an individual risk assessment to help with decisions regarding operative intervention. The purpose of this study was to describe such a 30-day postoperative (POD) risk prediction model using American College of Surgeons National Surgical Quality Improvement Project (NSQIP) data...
October 5, 2016: Journal of Vascular Surgery
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
Jia Liu, Zhengzheng Yan, Yuehua Pu, Wen-Shin Shiu, Jianhuang Wu, Rongliang Chen, Xinyi Leng, Haiqiang Qin, Xin Liu, Baixue Jia, Ligang Song, Yilong Wang, Zhongrong Miao, Yongjun Wang, Liping Liu, Xiao-Chuan Cai
The fractional pressure ratio is introduced to quantitatively assess the hemodynamic significance of severe intracranial stenosis. A computational fluid dynamics-based method is proposed to non-invasively compute the FPRCFD and compared against fractional pressure ratio measured by an invasive technique. Eleven patients with severe intracranial stenosis considered for endovascular intervention were recruited and an invasive procedure was performed to measure the distal and the aortic pressure (Pd and Pa). The fractional pressure ratio was calculated as [Formula: see text] The computed tomography angiography was used to reconstruct three-dimensional (3D) arteries for each patient...
October 4, 2016: Journal of Cerebral Blood Flow and Metabolism
Daniele Bissacco, Maurizio Domanin, Giuseppina Schinco, Livio Gabrielli
Anatomical variations of carotid arteries may be related to their development (agenesis, aplasia, hypoplasia) or course (coiling, kinking, tortuosity). Partial or total aberrancies in carotid vessel anatomy rarely occur. We describe the case of a 95-year-old woman presented with sudden onset of confusion and disorientation together with upper limb clonus. Computed tomography (CT)-scan revealed a left frontal brain injury with a not conclusive carotid doppler ultrasound. CT angiography reported a bovine aortic arch with bilateral retroesophageal course of both common carotid arteries and left severe (>70%) internal carotid artery stenosis...
September 2016: Vascular Specialist International
Kimihiro Igari, Toshifumi Kudo, Takahiro Toyofuku, Yoshinori Inoue
Juxtarenal aortic aneurysms (JRAAs) are challenging to treat by endovascular aneurysm repair (EVAR) procedures. The chimney technique with EVAR (Ch-EVAR) is one of the feasible and less invasive treatments for JRAAs. However, the main concern of Ch-EVAR is the potential risk of "gutters," which can lead to type Ia endoleak (EL). Most type Ia ELs after Ch-EVAR procedures occurred intraoperatively, and these ELs could be treated using an endovascular technique. However, late-onset type Ia ELs could be extremely rare, which might have a fear of conservative treatment...
2016: Case Reports in Vascular Medicine
Konstantinos Spanos, Christos Karathanos, Athanasios Athanasoulas, Vasileios Saleptsis, Ioannis Vasilopoulos, Sokol Xhepa, Miltiadis Matsagkas, Athanasios D Giannoukas
BACKGROUND: Endovascular (EVAR) or open surgical (OSR) repair are current treatment options for abdominal aortic aneurysm (AAA). OBJECTIVE: To produce a systematic review comparing the impact of these 2 treatment options on renal function during mid- and long term follow up. METHODS: The MEDLINE, EMBASE and Cochrane databases and key references were searched. RESULTS: Six studies were included from 2000 to 2016, (4 retrospective and 2 RCT studies) reporting on 2,102 patients (54%; 1096 EVAR, 46%; 1006 OSR)...
October 2, 2016: Current Vascular Pharmacology
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
Adil H Al Kindi, Faiza A Al Kindi, Qasim S Al Abri, Nasser A Al Kemyani
72-year-old hypertensive presented with two weeks history of left sided chest pain and hoarseness. Workup demonstrated a pseudoaneurysm in the lesser curvature of the distal aortic arch opposite the origin of the left subclavian artery from a penetrating atherosclerotic ulcer. Following a left carotid-subclavian bypass, endovascular stenting of the aorta was performed excluding the pseudoaneurysm. Patient had excellent angiographic results post-stenting. Follow up at 12 weeks demonstrated complete resolution of his symptoms and good stent position with no endo-leak...
October 2016: Journal of the Saudi Heart Association
Benjamin W Starnes, Rachel E Heneghan, Billi Tatum
OBJECTIVE: The objective of this study was to report midterm results of an ongoing physician-sponsored investigational device exemption pivotal clinical trial using physician-modified endovascular grafts (PMEGs) for treatment of patients with juxtarenal aortic aneurysms who are deemed unfit for open repair. METHODS: Data from a nonrandomized, prospective, consecutively enrolling investigational device exemption clinical trial were used. Data collection began on April 1, 2011, and data lock occurred on May 31, 2015, with outcomes analysis through December 31, 2015...
September 26, 2016: Journal of Vascular Surgery
Tim Seidler, Mark Hünlich, Miriam Puls, Gerd Hasenfuß, Claudius Jacobshagen
BACKGROUND: Despite the completion of more than 60,000 transcutaneous aortic valve implantations (TAVI) per year and an approximately 10-15 % incidence of vascular access site complications (VAC), there is a paucity of data on the efficacy and safety of percutaneous VAC treatment. HYPOTHESIS: Percutaneous endovascular treatment will be an effective treatment of VAC and associated with a low rate of surgical repair. Despite stent placement in proximity to the hip joint, endovascular treatment will be only rarely associated with disabling symptoms or complications...
September 29, 2016: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
H W Wu, L Sun, D M Li, H Jing, B Xu, C T Wang, L Zhang
Objective: To summarize the short- and mid-term results on endovascular repair of primary retrograde Stanford type A aortic dissection with an entry tear in distal aortic arch or descending aorta. Methods: Between December 2009 and December 2014, 21 male patients of primary retrograde Stanford type A aortic dissection with a mean age of (52±9) years received endovascular repair in Department of Cardiothoracic Surgery, Jinling Hospital. Among the 21 cases, 17 patients were presented as ascending aortic intramural hematoma, 4 patients as active blood flow in false lumen and partial thrombosis, 8 patients as ulcer on descending aorta combined intramural hematoma in descending aorta, and 13 patients as typical dissection changes...
October 1, 2016: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
Cynthia de Almeida Mendes, Alexandre de Arruda Martins, Marcelo Passos Teivelis, Sergio Kuzniec, Andrea Yasbek Monteiro Varella, Nelson Wolosker
BACKGROUND: Iodine contrast medium (ICM) is considered gold standard in endovascular procedures, but nephrotoxicity and hypersensitivity limit its widespread use. Carbon dioxide (CO2) is considered an alternative for endovascular procedures in patients with contraindication to ICM. However no studies have compared the outcomes of EVAR (endovascular aneurysm repair) performed with ICM or CO2 in patients with no contraindication to ICM. METHODS AND RESULTS: From May 2012 to April 2014, 36 patients with abdominal aortic aneurysms underwent EVAR in a prospective, randomized and controlled study...
September 23, 2016: Annals of Vascular Surgery
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