Endovascular repair of descending thoracic aortic aneurysms: an early experience with intermediate-term follow-up

Background: Thoracoabdominal aortic aneurysms (TAAA) present a significant clinical challenge, as they are complex and require invasive surgery. In an attempt to prevent considerably high mortality and morbidity in open repair, hybrid endovascular repair has been developed by many authors. In this study, we evaluated the early-term results obtained from this procedure.Methods: From November 2010 to February 2013, we performed thoracoabdominal hybrid aortic repair in 18 patients. The mean age was 68 years (12 men, 6 women). All of the patients had significant comorbidities. Follow-up computed tomography (CT) scans were performed at 1 week, 3 months, 6 months, and annually thereafter.Results: All patients were operated on in a staged procedure and stent graft deployment was achieved. Procedural success was achieved in all cases. All patients were discharged with complete recovery. No endoleaks weres detected in further CT examination.Conclusion: Our results suggests that hybrid debranching and endovascular repair of extensive thoracoabdominal aneurysms represents a suitable therapeutic option to reduce the morbidity and mortality of TAAA repair, particularly in those typically considered at high risk for standard repair.

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Endovascular repair of de novo post-stenotic aortic coarctation aneurysms with complex collateral supply: two cases with long and medium term follow-up

CVIR Endovascular ◽

10.1186/s42155-020-00193-4 ◽

2021 ◽

Vol 4 (1) ◽

Author(s):

Omar Abdel-Hadi ◽

John Thomson ◽

Simon J. McPherson

Keyword(s):

Stent Graft ◽

Endovascular Repair ◽

Aortic Coarctation ◽

De Novo ◽

Aortic Aneurysms ◽

Medium Term ◽

First Case ◽

Case Presentations ◽

Selective Embolisation

Abstract Purpose To report the technical details and outcomes of the endovascular repair of two cases of de novo post-stenotic aortic coarctation aneurysms complicated by complex collateral supply. Case presentations Two patients with thoracic aortic aneurysms complicated by complex aneurysm sac collaterals distal to a previously untreated thoracic aortic coarctation have been treated at our institution. Open surgical intervention was deemed to carry a high risk of haemorrhage due to the degree and complexity of arterial collateralisation. In the first case, selective embolisation of collateral vasculature was performed prior to successful exclusion of the aneurysm with a thoracic endovascular stent-graft and then balloon-expandable stent dilatation of the coarctation stenosis. In the second case, the additional technique of using a jailed sheath within the aneurysm sac allowed for selective embolisation of previously inconspicuous collaterals after deployment of the stent-graft and stent combination. Results Technical success was achieved in both patients with successful occlusion of the aneurysm, with no recorded complications or aneurysm sac perfusion in the long and medium term follow up periods respectively. Conclusion De novo post stenotic aortic coarctation aneurysms are rare. Endovascular repair is a safe and durable technique that provides a less invasive alternative to open surgical repair. The use of a jailed sheath allows for complete selective embolisation of complex collaterals avoiding a type II aneurysm endoleak.

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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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The Importance of Intraoperative Transesophageal Echocardiography in Endovascular Repair of Thoracic Aortic Aneurysms

Anesthesia & Analgesia ◽

10.1213/01.ane.0000086894.01129.93 ◽

2003 ◽

Vol 97 (6) ◽

pp. 1566-1572 ◽

Cited By ~ 43

Author(s):

Madhav Swaminathan ◽

Catherine K. Lineberger ◽

Richard L. McCann ◽

Joseph P. Mathew

Keyword(s):

Transesophageal Echocardiography ◽

Endovascular Repair ◽

Aortic Aneurysms ◽

Thoracic Aortic Aneurysms ◽

Intraoperative Transesophageal Echocardiography

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Stent graft types for endovascular repair of thoracic aortic aneurysms

10.1002/14651858.cd008448.pub2 ◽

2013 ◽

Cited By ~ 3

Author(s):

Rachel Rolph ◽

James MN Duffy ◽

Bijan Modarai ◽

Rachel E Clough ◽

Peter Taylor ◽

...

Keyword(s):

Stent Graft ◽

Endovascular Repair ◽

Aortic Aneurysms ◽

Thoracic Aortic Aneurysms

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Endovascular Repair of Thoracic Aortic Aneurysms

Medical Radiology - Vascular Interventional Radiology ◽

10.1007/978-3-540-33255-8_13 ◽

2006 ◽

pp. 101-113

Author(s):

H. Rousseau ◽

J. P. Bolduc ◽

C. Dambrin ◽

B. Marcheix ◽

G. Canevet ◽

...

Keyword(s):

Endovascular Repair ◽

Aortic Aneurysms ◽

Thoracic Aortic Aneurysms

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Endovascular repair of thoraco-abdominal aortic aneurysms by fenestrated and branched endografts†

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezz125 ◽

2019 ◽

Vol 56 (5) ◽

pp. 993-1000 ◽

Cited By ~ 5

Author(s):

Enrico Gallitto ◽

Gianluca Faggioli ◽

Rodolfo Pini ◽

Chiara Mascoli ◽

Stefano Ancetti ◽

...

Keyword(s):

Spinal Cord ◽

Hospital Mortality ◽

Endovascular Repair ◽

Endovascular Aneurysm Repair ◽

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Abdominal Aortic ◽

The Mean ◽

Aneurysm Repair

Abstract OBJECTIVES Our objective was to report the outcomes of fenestrated/branched endovascular aneurysm repair of thoraco-abdominal aortic aneurysms (TAAAs) with endografts. METHODS Between January 2010 and April 2018, patients with TAAAs, considered at high surgical risk for open surgery and treated by Cook-Zenith fenestrated/branched endovascular aneurysm repair, were prospectively enrolled and retrospectively analysed. The early end points were 30-day/hospital mortality rate, spinal cord ischaemia and 30-day cardiopulmonary and nephrological morbidity. Follow-up end points were survival, patency of target visceral vessels and freedom from reinterventions. RESULTS Eighty-eight patients (male: 77%; mean age: 73 ± 7 years; American Society of Anesthesiologists 3/4: 58/42%) were enrolled. Using Crawford’s classification, 43 (49%) were types I–III and 45 (51%) were type IV TAAAs. The mean aneurysm diameter was 65 ± 15 mm. Custom-made and off-the-shelf endografts were used in 60 (68%) and 28 (32%) cases, respectively. Five (6%) patients had a contained ruptured TAAA. The procedure was performed in multiple steps in 42 (48%) cases. There was 1 (1%) intraoperative death. Five (6%) patients suffered spinal cord ischaemia with permanent paraplegia in 3 (3%) cases. Postoperative cardiac and pulmonary complications occurred in 7 (8%) and 12 (14%) patients, respectively. Worsening of renal function (≥30% of baseline level) was detected in 11 (13%) cases, and 2 (2%) patients required haemodialysis. The 30-day and hospital mortality rates were 5% and 8%, respectively. The mean follow-up was 36 ± 22 months. Survival at 12, 24 and 36 months was 89%, 75% and 70%, respectively. The patency of target visceral vessels at 12, 24 and 36 months was 92%, 92% and 92%, respectively. Freedom from reinterventions at 12, 24 and 36 months was 85%, 85% and 83%, respectively. CONCLUSIONS The endovascular repair of TAAAs with fenestrated/branched endovascular aneurysm repair is feasible and effective with acceptable technical/clinical outcomes at early/midterm follow-up.

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