Balloon occlusion and stent-graft for aortic trauma

2021 ◽  
Author(s):  
Julien Ghelfi ◽  
Alice Chopin ◽  
Jules Greze ◽  
Frederic Thony ◽  
Pierre Bouzat
Keyword(s):  
Stent Graft ◽  
Balloon Occlusion ◽  
Aortic Trauma

scholarly journals Early outcome of aortic balloon occlusion during total aortic arch replacement with the frozen elephant trunk technique for aortic dissection

2019 ◽  
Author(s):  
Yunfeng Li ◽  
Hongwei Guo ◽  
Yi Shi ◽  
Yanxiang Liu ◽  
Xiaogang Sun
Keyword(s):  
Stent Graft ◽  
Circulatory Arrest ◽  
Balloon Occlusion ◽  
Frozen Elephant Trunk ◽  
Selective Cerebral Perfusion ◽  
Elephant Trunk ◽  
Total Aortic Arch Replacement ◽  
Aortic Balloon Occlusion ◽  
Occlusion Technique ◽  
Antegrade Selective Cerebral Perfusion

Abstract OBJECTIVES The aim of this study was to propose and evaluate the new operative technique of aortic balloon occlusion in total aortic arch replacement (TAR) with the frozen elephant trunk that can significantly decrease the time of circulatory arrest and increase the hypothermic cardiopulmonary bypass (CPB) temperature. METHODS Between 2010 and 2018, 1335 patients with aortic dissection who underwent TAR with the frozen elephant trunk were included in the study. The newest 80 cases were treated with aortic balloon occlusion. To illustrate the difference with the new procedure, 1255 conventional TAR cases served as the historical control. Femoral and right axillary artery cannulations were used for CPB and antegrade selective cerebral perfusion. Circulatory arrest was implemented at the nasopharyngeal temperature of 28°C with continuous antegrade selective cerebral perfusion. After the stent graft was inserted into the true lumen of the descending aorta, the aortic balloon in a sheath was deployed into the stent graft and positioned at the metal part of the stent graft. When the balloon was inflated with enough saline to compress the stent graft, the sheath was simultaneously pressed by hand to properly fix the balloon and avoid displacement. Then femoral perfusion could be resumed. RESULTS The aortic balloon occlusion technique was successful in all patients, with the median duration of circulatory arrest being 5 (interquartile range 3–7) min. The 30-day mortality rate was 6.25% (5/80), whereas with the conventional method it was 9.40% (118/1255). The postoperative conscious revival (8.67 vs 11.40 h, P < 0.001) and mechanical ventilation times (19.70 vs 24.45 h, P = 0.02) were significantly shorter. Decreases in postoperative acute kidney injuries (13.75% vs 32.11%, P = 0.001) and liver injuries (8.75% vs 37.61%, P < 0.001) were also observed. The patients were transfused with lesser quantities of red blood cells, plasma and platelets. CONCLUSIONS The aortic balloon occlusion technique is a feasible way to shorten circulatory arrest significantly, to obviate the need for deep hypothermia in TAR with the frozen elephant trunk and to provide favourable protective effects on the central nervous, haematological and visceral systems. With these satisfactory results, this technique deserves further investigation.

RECONSTRUCTIVE TREATMENT USING A STENT GRAFT FOR A DURAL ARTERIOVENOUS FISTULA OF THE TRANSVERSE SINUS IN THE CASE OF HYPOPLASIA OF THE CONTRALATERAL VENOUS SINUSES

Neurosurgery ◽  
2009 ◽  
Vol 65 (5) ◽  
pp. E994-E996 ◽  
Author(s):  
Beom Jin Choi ◽  
Tae Hong Lee ◽  
Chang Won Kim ◽  
Chang Hwa Choi
Keyword(s):  
Stent Graft ◽  
Coil Embolization ◽  
Transarterial Embolization ◽  
Transverse Sinus ◽  
Balloon Occlusion ◽  
Sigmoid Sinus ◽  
Venous Sinus ◽  
Venous Sinuses ◽  
Balloon Occlusion Test ◽  
The Right

Abstract OBJECTIVE Transvenous coil embolization for transverse sinus (TS) and sigmoid sinus dural arteriovenous fistulae (DAVFs) is now recognized as one of the most effective treatment modalities. However, in the case of hypoplasia of the contralateral venous sinuses and internal jugular vein, complete occlusion of the ipsilateral sinus may cause fatal consequences. We describe a case of combined intravenous graft stent placement and transarterial coil embolization for DAVFs that involved the dominant right TS in a patient with hypoplasia of the contralateral venous sinuses. CLINICAL PRESENTATION A 50-year-old man presented with headache, left hand tremor, and pulsatile right tinnitus. A cerebral angiogram demonstrated a right TS DAVF that was supplied by tentorial branches of both internal carotid arteries, multiple branches of the right external carotid artery, and branches of the left occipital artery. Unfortunately, left TS and sigmoid sinus hypoplasia were observed. INTERVENTION A right TS balloon occlusion test revealed contrast stagnation of the cortical veins and of the right TS and superior sagittal sinus. In this case, the use of transvenous stent graft placement with or without transarterial embolization is safer and more effective than sacrifice of the right TS. We therefore performed balloon-expandable stent graft deployment at the right TS, and the remnant DAVF flow between the stent graft and venous sinus was treated with transarterial coil embolization. Postprocedural angiograms showed patent right TS outflow with disappearance of retrograde cortical venous drainage as well as complete eradication of the fistulous connections. CONCLUSION In a DAVF involving the dominant TS or sigmoid sinus in a patient with hypoplasia of the contralateral venous sinuses and an intolerable balloon occlusion test for the ipsilateral venous sinuses, the complete occlusion of the diseased venous sinus may cause hazardous consequences. In this situation, the use of a stent graft with or without transarterial embolization to preserve venous sinus flow can be an effective treatment.

Endovascular resuscitation for ruptured abdominal aortic aneurysms with main stent-graft and REBOA via single-sided access

2018 ◽  
Vol 2 (3) ◽  
Author(s):  
David T McGreevy ◽  
Tal M Hörer ◽  
Artai Pirouzram
Keyword(s):  
Stent Graft ◽  
Vascular Access ◽  
Abdominal Aortic Aneurysms ◽  
Balloon Occlusion ◽  
Aortic Aneurysms ◽  
Team Approach ◽  
Femoral Access ◽  
Aortic Stent Graft ◽  
Abdominal Aortic ◽  
Ruptured Abdominal Aortic Aneurysms

Background Aortic Balloon Occlusion or Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for hemorrhage control during endovascular aortic repair (EVAR) is a technique that has been used for decades for ruptured abdominal aortic aneurysms (rAAA). This usually requires bilateral femoral access, however, when only single-sided vascular access can be obtained this complicates the procedure if these techniques are to be used. We present two cases of single-sided vascular access, recently performed at our institution, using simultaneous REBOA and aortic stent-graft placement during EVAR in rAAA.   Methods and Results This is a description of two clinical cases where REBOA and EVAR were performed through single-sided vascular access for the treatment of rAAA at Örebro University Hospital between March 2018 and June 2018.   Conclusion This case report demonstrates that despite the limitation of single-sided access, an aortic stent-graft can be placed for treatment of a rAAA during continuous aortic occlusion with REBOA, facilitated by using a multidisciplinary EVTM team approach.

Endovascular stent-graft as a bridge to definitive repair of aortic trauma

2001 ◽  
Vol 8 (4) ◽  
pp. 233-236 ◽  
Author(s):  
E. Hoffer ◽  
R. Karmy-Jones ◽  
K. Gibson ◽  
J. J. Borsa
Keyword(s):  
Stent Graft ◽  
Endovascular Stent ◽  
Endovascular Stent Graft ◽  
Definitive Repair ◽  
Aortic Trauma

Endovascular Treatment of a Blunt Thoracic Aortic Laceration Due to Thoracolumbar Spine Fracture

2006 ◽  
Vol 1 (3) ◽  
pp. 123-125
Author(s):  
François Dagenais ◽  
Geneviève Nadeau ◽  
Jean-Pierre Normand ◽  
Roc Turcotte ◽  
Patrick Mathieu ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Stent Graft ◽  
Thoracolumbar Spine ◽  
Spine Fracture ◽  
First Case ◽  
Aortic Trauma ◽  
Thoracic Stent Graft

A 36-year-old woman sustained an aortic laceration at the level of the diaphragmatic hiatus owing to a displaced thoracolumbar spine fracture (TLS). We herein report the first case of aortic trauma secondary to a TLS fracture treated with a thoracic stent-graft.

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