Endovascular repair of the ascending aorta in patients at high risk for open repair

Abstract Background An endovascular approach to the management of a ruptured plaque in the ascending aorta may be an alternative to open surgery in high-risk patients. This option may become inevitable due to the number of elderly patients unfit for open cardiac surgery. There are very few stent grafts able to fit the ascending aorta and in emergency cases, most medical teams have been limited to current thoracic aortic endografts, the shortest of which measure 10 cm. Case summary We report a case of an endovascular repair of a ruptured penetrating atherosclerotic ulcer of the ascending aorta. The patient was considered for open cardiac surgery but was evaluated at a high mortality risk based on his age, his medical history, and significant calcifications on his aorta. Our vascular surgical team decided then to perform an endovascular repair with extending the length of the aortic coverage by debranching the innominate artery. Discussion Endovascular treatment of an acute ruptured aorta is feasible in high-risk patients with thoracic endovascular stent grafts and coverage of the innominate artery. Endovascular treatment of the ascending aorta is at its infancy and in need of further research. New stent grafts designed for the ascending aorta are in progress and should increase the numbers of interventions in the years to come.

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Fenestrated/Branched Endovascular Repair for Complex Aortic Aneurysms Among Standard and High-risk Patients for Open Repair

European Journal of Vascular and Endovascular Surgery ◽

10.1016/j.ejvs.2019.09.054 ◽

2019 ◽

Vol 58 (6) ◽

pp. e581

Author(s):

Carlos Timaran ◽

David Timaran ◽

Marilisa Soto-Gonzalez ◽

Fatemah Malekpour

Keyword(s):

High Risk ◽

Endovascular Repair ◽

Open Repair ◽

Aortic Aneurysms ◽

High Risk Patients ◽

Risk Patients

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Endovascular Repair of an Aortoenteric Fistula in a High-Risk Patient

Journal of Endovascular Surgery ◽

10.1583/1074-6218(1999)006<0379:eroaaf>2.0.co;2 ◽

1999 ◽

Vol 6 (4) ◽

pp. 379-384 ◽

Cited By ~ 48

Author(s):

Arvind Deshpande ◽

Mark Lovelock ◽

Peter Mossop ◽

Michael Denton ◽

John Vidovich ◽

...

Keyword(s):

High Risk ◽

Endovascular Repair ◽

High Risk Patient ◽

Aortoenteric Fistula ◽

Risk Patient

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Endovascular Repair of an Ascending Aorta-to-Left Common Femoral Artery Graft with Aneurysmal Degeneration

Journal of Endovascular Surgery ◽

10.1583/1074-6218(1995)002<0189:eroaaa>2.0.co;2 ◽

1995 ◽

Vol 2 (2) ◽

pp. 189-195 ◽

Cited By ~ 3

Author(s):

Michael R. Jaff ◽

Gerald Dorros ◽

Krishna Kumar ◽

Gerardo Caballero ◽

Alfred Tector

Keyword(s):

Femoral Artery ◽

Endovascular Repair ◽

Common Femoral Artery ◽

Ascending Aorta ◽

Artery Graft

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Late Presentation of Penetrating Ulcers at the Ascending Aorta Associated With Intra-Mural Haematoma

Journal of Surgical Case Reports and Images ◽

10.31579/2690-1897/015 ◽

2020 ◽

Vol 3 (2) ◽

pp. 01-05

Author(s):

Ayman Kenawy

Keyword(s):

High Risk ◽

Disease Progression ◽

Surgical Repair ◽

Surgical Intervention ◽

Late Presentation ◽

Ascending Aorta ◽

Chronic Type ◽

Penetrating Aortic Ulcer ◽

Good Outcome ◽

Pseudo Aneurysm

The combined pathology of intra-mural haematoma (IMH) and penetrating aortic ulcer (PAU) represents disease progression of the PAU with high risk for further progression to either rupture or pseudo-aneurysm formation, and hence surgical intervention should be offered once diagnosis is made regardless of the presentation. We present a 70-year-old fit lady with chronic type A IMH associated with multiple PAUs, diagnosed incidentally, the patient underwent urgent surgical repair with good outcome.

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Back-Table Modified Stent-Graft for Endovascular Repair of Ascending Aorta

Journal of Endovascular Therapy ◽

10.1177/15266028211028201 ◽

2021 ◽

pp. 152660282110282

Author(s):

Juan Shi ◽

Ligang Liu ◽

Xiang Wei ◽

Mingjia Ma

Keyword(s):

Endovascular Repair ◽

Survival Rates ◽

Ascending Aorta ◽

Cerebellar Infarction ◽

Type Ia ◽

Risk Patients ◽

Aorta Replacement ◽

Aortic Dissections ◽

Event Rates

Objectives To investigate the effectiveness of modified stent-grafts (SGs) for the management of ascending aortic pathologies. Materials and Methods From January 2015 to December 2019, 31 individuals were treated by ascending aortic endovascular repair with a back-table modified SG for acute (n=4) or chronic (n=1) type A aortic dissections, penetrating aortic ulcers (n=18), pseudoaneurysms (n=2), anastomotic fistula (n=1), and endoleaks after thoracic endovascular aortic repair (TEVAR) (n=5). The commercially available thoracic aortic SGs were modified with a fenestration or truncation technique on the back-table according to aortography during the operation. Results The 30-day mortality and aorta-related mortality rates were 12.9% and 6.5%, respectively. There were 2 strokes, 3 respiratory insufficiencies, and 6 endoleaks during hospitalization. During a mean follow-up of 28.8±16.6 months, the overall survival rates at 1 year and 3 years were both 80.6%. Free from adverse event rates at 1 year and 3 years were 88.9% and 84.7%, respectively. There were 2 deaths during follow-up: One patient died of cachexia 1 month after discharge, and the other patient died of acute myocardial infarction 3 months after discharge. One patient with a pseudoaneurysm underwent open ascending aorta replacement 3 months after discharge for a type Ia endoleak. Another patient suffered from cerebellar infarction 17 months after discharge. Conclusion The modified SG for endovascular repair of the ascending aorta is a practicable alternative and presents acceptable outcomes in high-risk patients.

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SS28. Long-Term Survival After Endovascular Repair and Open Repair in Patients With Anatomy Outside Endovascular Repair Indications for Use Criteria

Journal of Vascular Surgery ◽

10.1016/j.jvs.2018.03.364 ◽

2018 ◽

Vol 67 (6) ◽

pp. e238

Author(s):

Philippe Charbonneau ◽

Christine Herman ◽

Kiattisak Hongku ◽

Mohammed Habib ◽

Luc Dubois ◽

...

Keyword(s):

Endovascular Repair ◽

Open Repair ◽

Term Survival ◽

Long Term Survival ◽

Indications For Use

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Complications of endovascular repair of high-risk and emergent descending thoracic aortic aneurysms and dissections

Journal of Vascular Surgery ◽

10.1016/j.jvs.2004.03.051 ◽

2004 ◽

Vol 40 (2) ◽

pp. 228-234 ◽

Cited By ~ 116

Author(s):

Christopher J Hansen ◽

Hao Bui ◽

Carlos E Donayre ◽

Ihab Aziz ◽

Benjamin Kim ◽

...

Keyword(s):

High Risk ◽

Endovascular Repair ◽

Aortic Aneurysms ◽

Thoracic Aortic Aneurysms

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Open versus Endovascular AAA Repair in Patients Who are Morphological Candidates for Endovascular Treatment

Journal of Endovascular Therapy ◽

10.1177/152660280200900301 ◽

2002 ◽

Vol 9 (3) ◽

pp. 255-261 ◽

Cited By ~ 15

Author(s):

Bradley B. Hill ◽

Yehuda G. Wolf ◽

W. Anthony Lee ◽

Frank R. Arko ◽

Cornelius Olcott ◽

...

Keyword(s):

Length Of Stay ◽

Outcome Measures ◽

Endovascular Repair ◽

Open Repair ◽

Aneurysm Rupture ◽

Term Outcome ◽

Long Term Outcome ◽

Morphological Criteria ◽

Secondary Procedures ◽

Open Versus

Purpose: To compare the outcomes of open versus endovascular repair of abdominal aortic aneurysm (AAA) in a cohort of patients who fulfill morphological criteria for endovascular repair. Methods: A retrospective review of 229 consecutive AAA patients treated over a 3-year period identified 149 patients who were candidates for endovascular repair based on preoperative computed tomography and angiography. Of the 149 patients, 79 (68 men; mean age 74 ± 8 years) underwent endovascular repair with the AneuRx stent-graft; the remaining 70 (56 men; mean age 72 ± 8 years) had open repair. Short-term outcome measures were 30-day mortality and procedure-related morbidity, length of stay in the intensive care unit and hospital, intraoperative blood loss, interval to oral diet, and time to ambulation. Long-term outcome measures included death and secondary procedures. Results: There was no difference in the 30-day mortality between endovascular repair (2, 2.5%) and open repair (2, 2.9%), even though endovascular patients had more comorbidities (p<0.05). Overall length of stay was reduced for endovascular patients (3.9 ± 2.4 days versus 7.7 ± 3.1 days for surgical patients, p<0.0001). Fewer endograft patients had complications (24% versus 40% for open repair, p<0.05), and the severity of these complications was less, as evidenced by the shorter hospital stays for endovascular patients with complications compared to conventionally treated patients with complications (6.7 ± 2.4 days versus 22.5 ± 35.2 days, p<0.05). There were no aneurysm ruptures or late surgical conversions in either group. Conclusions: Patients with AAA who were endograft candidates but who were treated with open repair experienced more morbidity and had more complications than patients treated with stent-grafts. Despite increased comorbidities in the endograft patients, there was no increase in mortality compared to open repair. Both treatments required secondary procedures and appeared to be equally effective in preventing aneurysm rupture up to 3 years.

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