Thoracic Endovascular Repair for Acute Traumatic Transection of the Descending Thoracic Aorta and Postendovascular Remodeling Change

Background The recently developed thoracic endovascular repair (TEVAR) technique seems to offer a good alternative for treating acute traumatic transection of the thoracic aorta (TTA). We reviewed our experience of TEVAR in cases of acute traumatic transection and analyzed the subsequent remodeling changes. Methods The medical records of 17 patients who underwent TEVAR for TTA were reviewed. The trauma mechanisms, anatomical characteristics of the transected aortas, technical details of TEVAR, and postprocedural results were reviewed. Results The overall mean injury severity score was 53 ± 12. On three-dimensional computed tomography (CT), the mean distance of transection from the left subclavian artery was 14 ± 9 (0–31) mm. Fifteen patients presented an aortic pseudoaneurysm and two patients had impending rupture. TEVAR was performed emergently under general endotracheal induction. Technical success was achieved and complete pseudoaneurysm sealing was confirmed with aortography in all 17 patients. Two patients (12%) died of hypovolemic shock and hyperkalemia; however, no late death or stent-related complication occurred during the 45 ± 32 (6–102) months of follow-up. During a mean CT follow-up of 35 months, the mean aortic diameter increased by 2 (0–5) mm and pseudoaneurysm lesions completely disappeared in all patients. Conclusions TEVAR resulted in good early survival in patients with TTA. No late or stent graft-related event was encountered up to a maximum of 9 years after surgery. We recommend that patients with grade III or higher TTA should undergo emergency surgery. Moreover, we consider that long-term follow-up and blood pressure management are essential when the proximal aortic diameter is found to increase slightly after TEVAR on follow-up CT.

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Minimum 10-Year Follow-up of Endovascular Repair for Acute Traumatic Transection of the Thoracic Aorta

European Journal of Vascular and Endovascular Surgery ◽

10.1016/j.ejvs.2014.06.026 ◽

2014 ◽

Vol 48 (3) ◽

pp. 347

Author(s):

L. Canaud ◽

C. Marty-Ané ◽

V. Ziza ◽

P. Branchereau ◽

P. Alric

Keyword(s):

Thoracic Aorta ◽

Endovascular Repair ◽

Traumatic Transection

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Minimum 10-year follow-up of endovascular repair for acute traumatic transection of the thoracic aorta

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2014.10.113 ◽

2015 ◽

Vol 149 (3) ◽

pp. 825-829 ◽

Cited By ~ 32

Author(s):

Ludovic Canaud ◽

Charles Marty-Ané ◽

Vincent Ziza ◽

Pascal Branchereau ◽

Pierre Alric

Keyword(s):

Thoracic Aorta ◽

Endovascular Repair ◽

Traumatic Transection

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Endovascular repair for acute traumatic transection of the descending thoracic aorta: experience of a single centre with a 12-years follow up

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-015-0388-5 ◽

2015 ◽

Vol 10 (1) ◽

Cited By ~ 13

Author(s):

Raffaele Serra ◽

Stefano de Franciscis ◽

Raffaele Grande ◽

Lucia Butrico ◽

Paolo Perri ◽

...

Keyword(s):

Thoracic Aorta ◽

Endovascular Repair ◽

Descending Thoracic Aorta ◽

Single Centre ◽

Traumatic Transection

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Hybrid Endovascular Repair of Thoracoabdominal Aorta: Early Results

The Heart Surgery Forum ◽

10.1532/hsf98.2014315 ◽

2014 ◽

Vol 17 (3) ◽

pp. 146

Author(s):

Osman Tansel Darcin ◽

Mehmet Kalender ◽

Ayse Gul Kunt ◽

Okay Guven Karaca ◽

Ata Niyazi Ecevit ◽

...

Keyword(s):

Endovascular Repair ◽

Therapeutic Option ◽

Complete Recovery ◽

Aortic Aneurysms ◽

Thoracoabdominal Aorta ◽

Mortality And Morbidity ◽

Early Results ◽

The Mean ◽

Procedural Success

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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Ultrasound Surveillance of Ectatic Abdominal Aortas

Annals of The Royal College of Surgeons of England ◽

10.1308/003588408x301064 ◽

2008 ◽

Vol 90 (6) ◽

pp. 477-482 ◽

Cited By ~ 24

Author(s):

S Devaraj ◽

SR Dodds

Keyword(s):

Growth Rate ◽

Growth Rates ◽

Screening Programme ◽

T Test ◽

Aortic Aneurysms ◽

Aortic Diameter ◽

Ultrasound Screening ◽

The Mean ◽

Clinically Significant

INTRODUCTION Some studies have considered abdominal aortas of 2.6–2.9 cm diameter (ectatic aortas) at age 65 years as being abnormal and have recommended surveillance, whereas others have considered these normal and surveillance unnecessary. It is, therefore, not clear how to manage patients with an initial aortic diameter between 2.6–2.9 cm detected at screening. The aim of this study was to evaluate growth rates of ectatic aortas detected on initial ultrasound screening to determine if any developed into clinically significant abdominal aortic aneurysms (AAAs; > 5.0 cm) and clarify the appropriate surveillance intervals for these patients. PATIENTS AND METHODS Data were obtained from a prospective AAA screening programme which commenced in 1992. The group of patients with initial aortic diameters of 2.6–2.9 cm with a minimum of 1-year follow-up were included in this study (Group 2). This was further divided into two subgroups (Groups 3a and 3b) based on a minimum follow-up interval obtained from outcome analysis. Mean growth rate was calculated as change in aortic diameter with time. The comparison of growth rates in Groups 3a and 3b was performed using the t-test. The number and proportion of AAAs that expanded to ≥ 3.0 cm and ≥ 5.0 cm in diameter were also calculated. RESULTS Out of 999 patients with AAA ≥ 2.6 cm with minimum 1-year follow-up, 358 (36%) were classified as ectatic aortas (2.6–2.9 cm) at initial ultrasound screening with the mean growth rate of 1.69 mm/year (95% CI, 1.56–1.82 mm/year) with a mean follow-up of 5.4 years. Of these 358 ectatic aortas, 314 (88%) expanded into ≥ 3.0 cm, 45 (13%) expanded to ≥ 5.0 cm and only 8 (2%) expanded to ≥ 5.5 cm over a mean follow-up of 5.4 years (range, 1–14 years). No ectatic aortas expanded to ≥ 5.0 cm within the first 4 years of surveillance. Therefore, the minimum follow-up interval was set at 4 years and this threshold was then used for further analysis. The mean growth rate in Group 3a (< 5.0 cm at last scan) was 1.33 mm/year (95% CI, 1.23–1.44 mm/year) with a mean follow-up of 7 years compared to Group 3b (≥ 5.0 cm at last scan) with the mean growth rate of 3.33 mm/year (95% CI 3.05–3.61 mm/year) and a mean follow-up of 8 years. The comparison of mean growth rates between Groups 3a and 3b is statistically significant (t-test; T = 13.00; P < 0.001). CONCLUSIONS One-third of patients undergoing AAA screening will have ectatic aortas (2.6–2.9 cm) and at least 13% of these will expand to a size of ≥ 5.0 cm over a follow-up of 4–14 years. A threshold diameter of 2.6 cm for defining AAAs in a screening programme is recommended and ectatic aortas detected at age 65 years can be re-screened at 4 years after the initial scan. A statistically significant difference was found in the growth rates of ectatic aortas with minimum 4 years follow-up, expanding to ≥ 5.0 cm compared to those less than 5.0 cm at last surveillance scan. Further studies are required to test the hypothesis of whether growth rate over the first 4 years of surveillance will identify those who are most likely to expand to a clinically significant size (> 5.0 cm).

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Twelve-year Follow-up Post–Thoracic Endovascular Repair in Type B Aortic Dissection Shown by Three-dimensional Printing

Annals of Vascular Surgery ◽

10.1016/j.avsg.2018.07.057 ◽

2019 ◽

Vol 55 ◽

pp. 309.e13-309.e19 ◽

Cited By ~ 2

Author(s):

Alice Finotello ◽

Stefania Marconi ◽

Bianca Pane ◽

Michele Conti ◽

Valerio Gazzola ◽

...

Keyword(s):

Aortic Dissection ◽

Endovascular Repair ◽

Three Dimensional ◽

Type B ◽

Type B Aortic Dissection ◽

Three Dimensional Printing ◽

Thoracic Endovascular Repair ◽

Dimensional Printing

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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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