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Aortic arch aneurysm

Dimos Karangelis, Apostolos Roubelakis, Dimitris Mikroulis, Matthew Panagiotou
Aortic arch pathologies such as acute aortic dissection and aneurysmal disease represent surgical challenges. Various emerging techniques and surgical prostheses have expanded the therapeutic armamentarium over the last years with one principal objective; to simplify the operation and reduce the surgical time. Besides the classic elephant trunk which has been regarded as an evolutionary leap in the treatment of extensive thoracic disease, other novel surgical approaches such as the frozen elephant trunk, the thoracic endovascular aortic repair (TEVAR) and the hybrid open branched stent grafts have been introduced...
March 20, 2018: Journal of Investigative Surgery: the Official Journal of the Academy of Surgical Research
Theodorus M van Bakel, Christopher J Arthurs, Joost A van Herwaarden, Frans L Moll, Kim A Eagle, Himanshu J Patel, Santi Trimarchi, C Alberto Figueroa
OBJECTIVES: Aortic arch repair remains a major surgical challenge. Multiple manufacturers are developing branched endografts for Zone 0 endovascular repair, extending the armamentarium for minimally invasive treatment of aortic arch pathologies. We hypothesize that the design of the Zone 0 endograft has a significant impact on the postoperative haemodynamic performance, particularly in the cervical arteries. The goal of our study was to compare the postoperative haemodynamic performance of different Zone 0 endograft designs...
March 15, 2018: European Journal of Cardio-thoracic Surgery
Hyun-Chel Joo, Young-Nam Youn, Seung-Hyun Lee, Sak Lee, Byung-Chul Chang, Kyung-Jong Yoo
BACKGROUND: The aim of this study was to evaluate clinical outcomes of different approaches to patients with proximal descending thoracic aneurysm (DTA) involving the distal arch. METHODS: From January 2002 to December 2016, 229 consecutive patients with proximal descending aorta aneurysm involving the distal arch underwent surgery using different approaches: total arch and DTA replacement via sternotomy (TAR group; n = 98), hemiarch and DTA replacement via thoracotomy (DTR group; n = 84), or hybrid arch repair (HAR group; n = 47)...
February 20, 2018: Journal of Thoracic and Cardiovascular Surgery
Leili Pourafkari, Samad Ghaffari, Mojan Ahmadi, Rezvaniye Salehi, Sarvin Mazani, Raziyeh Parizad, Nader D Nader
OBJECTIVE: Aortic dissection is an uncommon and potentially fatal complication of pregnancy; however, the association of the number of pregnancies with the indexed and absolute size of ascending aorta in patients without aortic aneurysm or connective tissue disorders is not well elucidated. RESEARCH DESIGN AND METHODS: In this prospective observational study, women aged 18-80 years old undergoing transesophageal echocardiography in a university-affiliated echocardiography laboratory between January 1st 2015 and September 1st 2015 were enrolled...
March 16, 2018: Current Medical Research and Opinion
Athanasios Katsargyris, Pablo Marques de Marino, Hozan Mufty, Luis Mendes Pedro, Ruy Fernandes, Eric L G Verhoeven
OBJECTIVES: Visceral arteries in fenestrated and branched endovascular repair (F/BEVAR) have been addressed by fenestrations or directional side branches. Inner branches, as used in the arch branched device, could provide an extra option for visceral arteries "unsuitable" for fenestrations or directional side branches. Early experience with the use of inner branches for visceral arteries in F/BEVAR is described. METHODS: All consecutive patients treated by F/BEVAR for complex abdominal aortic aneurysm (AAA) or thoraco-abdominal aneurysm (TAAA) using stent grafts with inner branches were included...
March 12, 2018: European Journal of Vascular and Endovascular Surgery
Yuki Tanaka, Tadashi Kitamura, Yusuke Irisawa, Kagami Miyaji
We present a case of Kommerell's diverticulum with the aberrant left subclavian artery and a right-sided aortic arch in a 70-year-old male patient who was treated with total arch replacement using the Gelweave Lupiae graft. The Lupiae graft fitted well to total arch replacement for this pathology because the structure was consistent with the anatomical features.
March 12, 2018: Interactive Cardiovascular and Thoracic Surgery
Takayuki Shijo, Takashi Shirakawa, Masao Yoshitatsu, Keiji Iwata
Stent grafting for complex aortic anatomy remains a challenge. In particular, stent graft collapse (i.e. infolding) is possible when an excessive oversized device is needed. We describe a case of preoperative stent grafting simulation using a three-dimensional (3D) printed model for extensive aortic arch repair in a 69-year-old woman with multiple aneurysms combined with coarctation. The patient was scheduled to undergo staged hybrid repair. A stent graft larger than 28 mm in diameter was needed to deploy into a coarctation of 15 mm in diameter during the 2nd stage of the operation...
March 8, 2018: European Journal of Cardio-thoracic Surgery
Nilukshana Yogendranathan, H M M T B Herath, W D Jayamali, Anne Thushara Matthias, Aruna Pallewatte, Aruna Kulatunga
BACKGROUND: Spinal cord infarction is an uncommon condition. Anterior cord syndrome present with paraparesis or quadriparesis with sparing of vibration and proprioceptive senses. The common causes of anterior cord syndrome are aortic dissection and aortic surgical interventions. Spontaneous unruptured nondissected aortic aneurysms with intramural thrombus can rarely cause anterior cord infarctions. CASE PRESENTATION: We report a case of anterior spinal cord syndrome due to aneurysm of the thoracic aorta with a mural thrombus...
March 5, 2018: BMC Cardiovascular Disorders
Luca Bertoglio, Daniele Mascia, Tommaso Cambiaghi, Andrea Kahlberg, Germano Melissano, Roberto Chiesa
OBJECTIVE: The aim of this study was to assess the safety and effectiveness of upper extremity access (UEA) with percutaneous closure of the axillary artery (AxA) during endovascular treatment of thoracoabdominal aortic aneurysms with fenestrated and branched endografts. METHODS: Between January 2014 and 2017, 34 out of 37 patients (92%) required UEA during a staged branched and fenestrated endovascular approach. A percutaneous AxA (pAxA) approach was used in 14 consecutive patients (41%) with the off-label use of two Perclose ProGlide (Abbott Vascular, Santa Clara, Calif) devices...
March 1, 2018: Journal of Vascular Surgery
Keisuke Miyake, Toshihiro Funatsu, Haruhiko Kondoh, Kazuhiro Taniguchi
INTRODUCTION: Despite the technical improvements, redo surgery on the aortic root and arch is still associated with high morbidity and mortality due to the trauma of repeat open-heart surgery and technical complexity. We present the case of extended chronic type A dissecting aneurysm that developed after a Bentall operation, which was successfully treated by applying a modified long elephant trunk technique and surgical aortic fenestration. CASE PRESENTATION: A 77-year-old man, who had previously undergone a Bentall procedure and an abdominal surgery, developed a type A aortic dissection...
December 12, 2017: International Journal of Surgery Case Reports
R E Clough, R Spear, K Van Calster, A Hertault, R Azzaoui, J Sobocinski, D Fabre, S Haulon
BACKGROUND: Surgical repair of aortic arch pathology is complex and associated with significant morbidity and mortality. Alternative approaches have been developed to reduce these risks, including the use of thoracic stent-grafts with fenestrations or in combination with bypass procedures to maintain supra-aortic trunk blood flow. Branched stent-grafts are a novel approach to treat aortic arch pathology. METHODS: Consecutive patients with aortic arch disease presenting to a single university hospital vascular centre were considered for branched stent-graft repair (October 2010 to January 2017)...
March 2018: British Journal of Surgery
Micaela De Palo, Manuela Conte, Antonio Cricco, Domenico Benvenuto, Giampiero Esposito
Aortic diseases, especially when the entire aorta is involved, are often challenging to treat since they frequently require invasive interventions. Minimally invasive hybrid treatment of such pathologies is proving to be a valid option for complex cases (for example, dilation involving the entire aorta) and is improving postoperative outcomes. It consists of a minimally invasive opening stage, where ascending aorta and aortic arch replacement and epiaortic vessel rerouting is performed using a multibranched graft equipped with a radiopaque marker...
September 1, 2017: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Yoshinori Kuroda, Tetsuro Uchida, Azumi Hamasaki, Atsushi Yamashita, Masahiro Mizumoto, Jun Hayashi, Ai Ishizawa, Kentaro Akabane, Mitsuaki Sadahiro
A 45 year-old-man who had undergone ventricular septal defect repair during childhood presented with hoarseness. He was diagnosed as having a distal aortic arch aneurysm by using computed tomography, and was referred to our hospital for surgical treatment. The operation was performed via a 4th intercostal thoracotomy in the right lateral position. The aortic aneurysm occupied the upper pleural cavity. The aortic arch was pressed up by the aortic aneurysm, so visual identification and clamping of the proximal aorta and the left subclavian artery were extremely difficult...
February 2018: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Yosuke Kugo, Hiroyuki Nishi, Naosumi Sekiya, Mitsutomo Yamada, Toshiki Takahashi
PURPOSE: Postoperative atrial fibrillation (POAF) is a very common and important complication occurring after open heart surgery. Risk factors and prevention measure including β blocker use have been reported mainly in regard to patients who underwent coronary artery bypass grafting, while little is known about POAF following thoracic aortic surgery. In the present study, we examined risk factors related to POAF and effective prevention of POAF in patients who underwent thoracic aortic surgery...
February 2018: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Ludovic Canaud, Pierre Alric
Degenerative aneurysms of the thoracic aorta are increasing in prevalence. The recognition of the decreased morbidity of this approach compared with open repair was readily apparent, as it avoided left thoracotomy, aortic cross-clamping, and left heart bypass. Repair of isolated descending thoracic aortic aneurysms using stent grafts was introduced in 1995, and in an anatomically suitable subgroup of patients with thoracic aortic aneurysm, repair with endovascular stent graft provides favorable outcomes, with decreased perioperative morbidity and mortality relative to open repair...
February 23, 2018: La Presse Médicale
Raphael Soler, Aurelien Vallee, Dominique Fabre, Stéphan Haulon
Endovascular treatment of thoracoabdominal aneurysms: what's new? Thoracoabdominal aneurysms (T-AAA) are aortic aneurysms that involve both the thoracic and abdominal segments of the aorta and its associated visceral branches. Although the first successful open repair was reported over 50 years ago, the risks of treatment remain considerable. As the first generations of devices available for endovascular aneurysm repair (EVAR) were relatively simple tubes or bifurcated grafts, initial attempts to extend the benefits of EVAR to patients with T-AAA lead to "hybrid solution"...
February 22, 2018: La Presse Médicale
Hiroshi Furukawa, Takeshi Honda, Takahiko Yamasawa, Hisao Masaki, Kazuo Tanemoto
BACKGROUND: We retrospectively evaluated the initial clinical experience of the surgical management of extensive dissecting thoracic aortic aneurysm (TAA) via the semi-clamshell approach. METHODS: Thirteen patients (3 women and 10 men, mean age 67 ± 15 years) who underwent elective surgical intervention for extensive dissecting TAA via semi-clamshell approach in our institute between May 2007 and April 2017 participated in this study. Regarding surgical techniques, left thoracotomy with transverse sternotomy was initially performed via the third or fourth intercostal space following an incision from the right sternal borderline to the anterior axillary line on the left sternal borderline...
February 22, 2018: General Thoracic and Cardiovascular Surgery
Nikolaos Lazaridis, Maria Piagkou, Marios Loukas, Evangelia-Theophano Piperaki, Trifon Totlis, Georgios Noussios, Konstantinos Natsis
Several congenital anomalies regarding the right (RVA) and left (LVA) vertebral artery have been described. The current paper aims to perform a systematic literature review of the variable vertebral artery (VA) origin from the aortic arch (AOA) and its branches. The incidence of these variants and the ensuing AOA branching pattern are highlighted. Atypical origin cases were found more commonly unilaterally, while LVA presented the majority of the aberrancies. The LVA emersion from the AOA (3.6%) and the RVA from the right common carotid artery (RCCA) (0...
February 19, 2018: Surgical and Radiologic Anatomy: SRA
Hironobu Sugiyama, Ryo Tohma, Takuya Misato, Kazuma Okamoto, Taro Hayashi, Satoshi Tobe, Tatsuro Matsuo, Kotaro Tsunemi, Takanori Oka, Nobuhiro Tanimura
We report a rare case of right heart failure caused by distal aortic aneurysm. Although aortopulmonary fistula is a common complication of giant aortic arch aneurysm, right heart failure caused by mechanical pressure by aneurysm is very rare. A 79-year-old female patient presented dyspnea. Contrast computed tomography (CT) of the thorax delineated a 78 mm aortic arch aneurysm pressing the main to left pulmonary artery and a 40 mm pericardial effusion at maximum depth at posterior side. Echocardiography showed the acceleration flow from main to left pulmonary artery and moderate pulmonary hypertension...
February 17, 2018: General Thoracic and Cardiovascular Surgery
Mohammed Mohsin Uzzaman, Natasha E Khan, Ben Davies, John Stickley, Timothy J Jones, William J Brawn, David J Barron
BACKGROUND: We analysed outcomes of IAA repair using a standardised technique in order to interpret the role of the arch repair on late outcomes in this complex and heterogeneous group. METHODS: Single institution study from 1988-2015. 120 cases of IAA were divided into four groups: IAA with VSD (iVSD, n=38), IAA with Norwood/DKS (iNor, n=41), IAA with Truncus (iTruncus, n=24) and miscellaneous group (iMisc, n=17). Arch repair performed using a standard technique of direct anastomosis with homograft patch augmentation...
February 13, 2018: Annals of Thoracic Surgery
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