Tuberculous False Aneurysm of the Aortic Isthmus Treated Using Stent Grafts

Purpose: Traumatic false aneurysms of the thoracic aorta presenting at a time remote from the original injury are a rare but complex problem. The treatment of a traumatic false aneurysm by endovascular techniques may offer many advantages over conventional open surgery. Methods and Results: Two male patients presented with traumatic false aneurysm of the thoracic aorta after being treated emergently for visceral injuries from a gunshot wound in one and an automobile accident in the other. In both cases, the aneurysm was situated so that only the T11 intercostal artery would be sacrificed by endoluminal exclusion. Commercially available endoluminal stent-grafts (Talent) were deployed successfully. Recovery in both patients was rapid and uneventful with no neurological sequelae. Spiral computed tomographic scans at 1 year indicated sustained aneurysm exclusion and satisfactory endograft position. Conclusions: A customized endoluminal stent-graft can be used with great accuracy to exclude thoracic false aneurysms, avoiding the potential complexity and morbidity of an open thoracic approach.

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Chronic False Aneurysm after a Healed Rupture of the Aortic Isthmus: TEVAR, Hybrid Surgery, or Open Arch Repair?

Annals of Vascular Surgery ◽

10.1016/j.avsg.2015.07.048 ◽

2016 ◽

Vol 31 ◽

pp. 205.e11-205.e16 ◽

Cited By ~ 3

Author(s):

Christophe Nizet ◽

Hendrik Van Damme ◽

Evelyne Boesmans ◽

Jean-Paul Lavigne ◽

Etienne Creemers ◽

...

Keyword(s):

False Aneurysm ◽

Hybrid Surgery ◽

Aortic Isthmus ◽

Open Arch

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Thoracic Aortic Stent Grafting in Patients with Connective Tissue Disorders: A Word of Caution

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0b013e31815887e0 ◽

2007 ◽

Vol 2 (4) ◽

pp. 184-187 ◽

Cited By ~ 3

Author(s):

Siamak Mohammadi ◽

Jean-Pierre Normand ◽

Pierre Voisine ◽

François Dagenais

Keyword(s):

Connective Tissue ◽

Stent Graft ◽

Balloon Dilatation ◽

False Aneurysm ◽

Type I ◽

Connective Tissue Disorders ◽

Stent Grafts ◽

Descending Aorta ◽

Stent Grafting ◽

Marfan Patient

Objective Use of thoracic Stent-graft in patients with connective tissue disorders (CTD) remains limited. We herein report 3 patients with CTD who underwent stent grafting. Methods and Results Case 1; A male Marfan patient was operated for thoraco-abdominal aneurysm. On computed tomography (CT), large false aneurysm at the proximal anastomosis was documented which was excluded with a 30 mm Talent stent-graft with 10–15% oversize. Case 2; A female with Ehlers-Danlos syndrome had undergone resection of descending aortic thoracic aneurysm presented with an enlarging aneurysm distal to the graft. Three Talent stent-grafts (15% oversize) were deployed with balloon dilatation to exclude the aneurysm. The immediate postoperative period was complicated by an extensive intramural hematoma of the descending aorta with hemothorax, managed conservatively. Case 3; A female Marfan patient had undergone Bentall procedure and mitral repair followed with resection of the proximal descending aorta. Three months later a false aneurysm at the distal anastomosis was treated with a 24 mm Valiant stent-graft (30% oversize). Aortic dissection distal to stent was documented on the early postoperative CT. The dissected aneurysm enlarged significantly with a type I distal endoleak during follow-up. Concomitantly, the patient presented a class III dyspnea owing to a severe mitral regurgitation. The patient underwent a successful MVR and stent-graft explantation with replacement of the descending aorta. Conclusion Significant complications supervened when stent-grafts were deployed in native aorta. We thus recommend that deploying a stent-graft in a CTD diseased aorta should be considered a relative contraindication. In cases with prohibitive or high risk surgery, use of a stent-graft with minimal radial force and minimal oversizing without balloon dilatation should be considered.

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Case Report: Aberrant Left Vertebral Artery Management in Traumatic Transection of the Aortic Isthmus

The Heart Surgery Forum ◽

10.1532/hsf.2677 ◽

2019 ◽

Vol 22 (6) ◽

pp. E481-E485

Author(s):

Ovidiu Stiru ◽

Liana Valeanu ◽

Catalina Andreea Parasca ◽

Roxana Carmen Geana ◽

Platon Pavel ◽

...

Keyword(s):

Vertebral Artery ◽

Preoperative Planning ◽

Left Subclavian Artery ◽

Left Vertebral Artery ◽

Stent Grafts ◽

Landing Zone ◽

Aortic Isthmus ◽

Traumatic Pseudoaneurysm ◽

Post Traumatic ◽

Traumatic Transection

Association of elective debranching and endovascular thoracic aortic repair (TEVAR) with aberrant left vertebral artery (AVA) revascularization and supra-aortic left carotid-subclavian bypass in post-traumatic pseudoaneurysm of the distal aortic arch are extremely rare procedures that can minimize unnecessary neurologic complications. The patient was a 42-year-old man, stable, with a post-traumatic transection of the aortic isthmus, with origin of the AVA between the left common carotid artery (LCCA) and left subclavian artery (LSA). Preoperative planning and proper sizing of the stent-grafts were evaluated by means of computed tomography angiography (CT scan) images. The patient underwent a hybrid procedure that included TEVAR with landing zone 2, covering the origin of both the AVA and LSA and concomitant supra-aortic reimplantation of the AVA in the LCCA and left carotid-subclavian bypass combined with both ligation of the AVA and LSA proximally. Postoperative arteriography images confirmed the exclusion of the aneurysm and the patency of all arch vessels, including the AVA. No endoleak was reported.

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Transluminal Stent-Graft Repair for Pseudoaneurysm of PTFE Hemodialysis Grafts

Journal of Endovascular Therapy ◽

10.1177/152660289800500208 ◽

1998 ◽

Vol 5 (2) ◽

pp. 138-141

Author(s):

Prem Rabindranauth ◽

Larry Shindelman

Keyword(s):

Endovascular Repair ◽

False Aneurysm ◽

Ptfe Graft ◽

Normal Flow ◽

Endovascular Techniques ◽

Stent Grafts ◽

Stented Graft ◽

Stent Graft Repair ◽

Flow Through

Purpose: To report the use of endovascular techniques to treat two cases of nonanastomotic pseudoaneurysm of a bridge graft fistula (BGF). Methods and Results: Two men with fully functional polytetrafluoroethylene (PTFE) BGFs both presented with an enlarging mass adjacent to their arteriovenous shunt. The false aneurysm in both instances was located by ultrasound and confirmed by shunt angiography at the time of surgery. Both fistulas were repaired by transluminally introducing a stented graft composed of a balloon-expandable Palmaz stent covered with a PTFE graft. Completion arteriography confirmed normal flow through the graft with no communication between the lumen and the aneurysmal cavity. Both patients recovered without complications and were discharged on the day of the procedure. Follow-up data reveal that both fistulas remain fully functional up to 5 and 6 months, respectively. Conclusions: Endovascular repair using stent-grafts can be a safe and effective method of excluding pseudoaneurysms associated with PTFE BGFs.

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Endovascular stent-graft treatment for graft-vein anastomotic stenosis in haemodialysis patients with arteriovenous grafts

VASA ◽

10.1024/0301-1526/a000470 ◽

2015 ◽

Vol 44 (6) ◽

pp. 466-472 ◽

Cited By ~ 1

Author(s):

Chia-Hsun Lin ◽

Yen-Yang Chen ◽

Chai-Hock Chua ◽

Ming-Jen Lu

Keyword(s):

Risk Factors ◽

Stent Graft ◽

Target Lesion ◽

Primary Patency ◽

Anastomotic Stenosis ◽

Secondary Patency ◽

Endovascular Stent ◽

Stent Grafts ◽

Venous Anastomosis ◽

Arteriovenous Grafts

Abstract. Background: In this study, we investigated the patency of endovascular stent grafts in haemodialysis patients with arteriovenous grafts, the modes of patency loss, and the risk factors for re-intervention. Patients and methods: Haemodialysis patients with graft-vein anastomotic stenosis of their arteriovenous grafts who were treated with endovascular stent-grafts between 2008 and 2013 were entered into this retrospective study. Primary and secondary patency, modes of patency loss, and risk factors for intervention were recorded. Results: Cumulative circuit primary patency rates decreased from 40.0 % at 6 months to 7.3 % at 24 months. Cumulative target lesion primary patency rates decreased from 72.1 % at 6 months to 22.0 % at 24 months. Cumulative secondary patency rates decreased from 81.3 % at 12 months to 31.6 % at 36 months. Patients with a history of cerebrovascular accident had a significantly higher risk of secondary patency loss, and graft puncture site stenosis jeopardised the results of stent-graft treatment. Conclusions: Our data can help to improve outcomes in haemodialysis patients treated with stent-grafts for venous anastomosis of an arteriovenous graft.

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