Custom-made Stent Grafts for the Treatment of Pseudoaneurysms after Childhood Coarctation Surgery

2018 ◽  
Vol 67 (01) ◽  
pp. 050-054 ◽  
Author(s):  
Andreas Hornung ◽  
Michael Hofbeck ◽  
Christian Schlensak ◽  
Mario Lescan
Keyword(s):  
Endovascular Repair ◽  
Complete Resolution ◽  
Open Surgery ◽  
Open Repair ◽  
Clinical Success ◽  
Coarctation Of The Aorta ◽  
Morbidity And Mortality ◽  
Thoracic Cavity ◽  
Stent Grafts ◽  
Custom Made

Background Post-coarctation of the aorta (CoA) pseudoaneurysms is a complication of open repair. Thoracic endovascular repair (TEVAR) is feasible but complicated by proximity to the supra-aortic trunks and severe arch angulation. Methods We describe three cases of post-CoA pseudoaneurysms treated with custom-made Relay stent grafts (Vascutek, Scotland). Results Technical and clinical success was achieved in all three cases with no mortality, morbidity, endoleaks, or complications. In all three, pseudoaneurysm sac shrinkage was observed at the follow-ups; in one case, there was complete resolution. Conclusion Redo open surgery is challenging because of adhesions of the thoracic cavity and associated morbidity and mortality. TEVAR is less invasive and offers fewer complications. Custom-made modifications overcome difficult anatomies including short landing zones and diameter variability.

Acute Type A Aortic Dissection Treated Using a Tubular Stent-Graft in the Ascending Aorta and a Multibranched Stent-Graft in the Aortic Arch

2016 ◽  
Vol 24 (1) ◽  
pp. 75-80 ◽  
Author(s):  
Tilo Kölbel ◽  
Christian Detter ◽  
Sebastian W. Carpenter ◽  
Fiona Rohlffs ◽  
Yskert von Kodolitsch ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Stent Graft ◽  
Open Surgery ◽  
Type A ◽  
Ascending Aorta ◽  
Type I ◽  
Acute Type ◽  
Stent Grafts ◽  
Type A Aortic Dissection ◽  
Custom Made

Purpose: To describe the combined use of a tubular stent-graft for the ascending aorta and an inner-branched arch stent-graft for patients with acute type A aortic dissection. Technique: The technique to deploy these modular, custom-made stent-grafts is demonstrated in 2 patients with acute DeBakey type I aortic dissections and significant comorbidities precluding open surgery. Both emergent procedures were made possible by the availability of suitable devices manufactured for elective repair in other patients. After preliminary carotid-subclavian bypass, a long Lunderquist guidewire was introduced from the right femoral artery to the left ventricle for delivery of the Zenith Ascend and Zenith Branched Arch Endovascular Grafts under inflow occlusion. Bridging stent-grafts were delivered to the innominate and left common carotid arteries to connect to the 2 inner branches; the left subclavian artery was occluded. Both cases were technically successful and resulted in exclusion of the false lumen in the ascending aorta. The operating and fluoroscopy times did not exceed those of comparable elective procedures. The patients were rapidly extubated shortly after the procedure and without serious immediate complications. One patient survived 11 months with a satisfactory repair; the other succumbed to complications of recurrent pneumonia after 23 days. Conclusion: Endovascular treatment of patients with acute type A aortic dissection using a combination of tubular and branched stent-grafts in the ascending aorta is feasible and offers an alternative strategy to open surgery.

Evaluating the Evolving Morbidity of Omentoplasty for Perforated Peptic Ulcer Disease

2020 ◽  
Vol 86 (10) ◽  
pp. 1289-1295
Author(s):  
Noah Swann ◽  
Nobel LeTendre ◽  
Brian Cox ◽  
James Recabaren
Keyword(s):  
Laparoscopic Surgery ◽  
Laparoscopic Repair ◽  
Open Surgery ◽  
Surgical Repair ◽  
Open Repair ◽  
Perforated Peptic Ulcer ◽  
Morbidity And Mortality ◽  
Patch Repair ◽  
Perioperative Morbidity ◽  
Graham Patch

Mortality for perforated peptic ulcer (PPU) surgery ranges from 2-22% with morbidity ranging from 15-45%. Traditionally, these had been repaired with vagotomy and antrectomy or pyloroplasty with smaller perforations repaired with an omentoplasty. Laparoscopic repair has become increasingly prevalent and demonstrated to have shorter length of stay (LOS) and fewer complications. We are evaluating the surgical repair of PPU with omentoplasty to determine trends of utilization and surgical outcomes. We conducted a 13-year (2005-2017) retrospective review, utilizing the National Surgical Quality Improvement Program database. A total of 6873 patients had open or laparoscopic repair of a PPU, with 2285 patients identified as utilizing omentoplasty. Five hundred eighty-eight omentoplasty patients were further identified as having a laparoscopic technique. We compared patient demographics, comorbidities, and perioperative morbidity and mortality for surgical patients between 2005-2011 and 2012-2017. We trended the perioperative outcomes across the study intervals. Parametric and nonparametric tests were used to evaluate outcomes. Between 2005 and between 2017, laparoscopic surgical repair with omentoplasty has increased from 3.8% to 34.6%. Overall mortality for open operations declined during this interval (12.7%-9.3%) while it remained unchanged for laparoscopic operations (4.6%-4.2%), there was not a significant difference between the laparoscopic and open 30-day mortality. Both open surgery and laparoscopic surgery are being used on an increasingly healthy cohort (increased functional status decreased predicted perioperative morbidity). Relative to the 2005-2011, the laparoscopic surgery 2012-2017 cohort had increases in both serious and overall morbidity, although this was not statistically significant. Compared to the 2005-2011, the 2012-2017 open surgery cohort had increasing serious morbidity (OR 2.03) and overall morbidity (OR 1.91). There was a trend of decreasing LOS and increased return to the operating room for patients with laparoscopic surgery. Laparoscopic Graham patch repair of peptic ulcers significantly increased, although open repair still constitutes the majority of the cases. Despite Graham patch repair being utilized on a healthier patient population, morbidity and mortality for laparoscopic repair have remained unchanged. Postoperative morbidity and mortality for open surgery have increased. This indicates that laparoscopic repair is more commonly utilized for low- or medium risk patients, leaving an increasingly sick patient population selected to open repair.

A Simulation Tool for Virtual Stent Graft Deployment in Patient-Specific Abdominal Aortic Aneurysms

2011 ◽  
Author(s):  
S. De Bock ◽  
M. De Beule ◽  
G. De Santis ◽  
F. Vermassen ◽  
P. Segers ◽  
...  
Keyword(s):  
Open Surgery ◽  
Open Repair ◽  
Length Of Hospital Stay ◽  
Aortic Aneurysms ◽  
Patient Specific ◽  
Simulation Tool ◽  
Aortic Bifurcation ◽  
Stent Grafts ◽  
Abdominal Aortic ◽  
High Degree

An Abdominal Aortic Aneurysm (AAA) is a pathological dilatation of the aorta, commonly involving the region between the renal arteries and the aortic bifurcation, with a high degree of mortality. Endovascular repair of AAA has proven to be a valid alternative for the conventional open repair, with clear benefits in terms of length of hospital stay, reduced operational mortality and less trauma [1]. However, stent grafts are still associated with various problems and failings, which may lead to AAA rupture or rise the need for an additional open surgery.

Endovascular Repair With Fenestrated-Branched Stent Grafts Improves 30-Day Outcomes for Complex Aortic Aneurysms Compared With Open Repair

2013 ◽  
Vol 27 (3) ◽  
pp. 267-273 ◽  
Author(s):  
Nikolaos Tsilimparis ◽  
Sebastian Perez ◽  
Anand Dayama ◽  
Joseph J. Ricotta
Keyword(s):  
Endovascular Repair ◽  
Open Repair ◽  
Aortic Aneurysms ◽  
Stent Grafts

scholarly journals Temporary Perfusion Branches to Decrease Spinal Cord Ischemia in the Endovascular Treatment of Thoraco-Abdominal Aortic Aneurysms

Aorta ◽  
2015 ◽  
Vol 03 (02) ◽  
pp. 56-60 ◽  
Author(s):  
Parveen Jayia ◽  
Jason Constantinou ◽  
Hamish Hamilton ◽  
Krassi Ivancev
Keyword(s):  
Spinal Cord ◽  
New York ◽  
Endovascular Repair ◽  
Spinal Cord Ischemia ◽  
Abdominal Aortic Aneurysms ◽  
Aortic Aneurysms ◽  
Stent Grafts ◽  
Abdominal Aortic ◽  
Custom Made ◽  
Complete Exclusion

Based on a Presentation at the 2013 VEITH Symposium, November 19–23, 2013 (New York, NY, USA) Background: Spinal cord ischemia (SCI) is one of the most feared complications following the repair of thoraco- abdominal aortic aneurysms (TAAA). Endovascular repair of TAAA is now possible with branched stent grafts, but spinal cord ischaemia rates are still unacceptably high. A number of techniques have been utilized to reduce these levels, however, SCI remains a challenge to endovascular repair of TAAA. The use of sac perfusion branches aims to reduce the incidence of this catastrophic complication. Methods: A retrospective analysis of all patients undergoing branched endovascular aortic repair for all thoraco-abdominal aneurysms (TAAA) using custom made devices during January 2008 to August 2014. We describe a two staged technique in which perfusion of segmental vessels is maintained by a temporary endoleak through an open perfusion branch, incorporated within the branched stent graft, followed by a closure of this branch at a later date to complete exclusion of the aneurysm. Results: Forty-seven patients underwent TAAA repair. Twenty-five (53%) had a two-stage procedure using either a sac perfusion branch or a target vessel to perfuse the sac. Nine patients (19.15%) suffered some form of SCI with eight patients having temporary SCI (lasting less than 72 hours) and one patient having permanent SCI. Of eight patients that had temporary spinal cord ischemia, all had a perfusion strategy. There was one case of permanent SCI (2.13%). Conclusion: Sac perfusion branches provide a safe method for preventing SCI, however this needs to be used in conjunction with controlling MAP and CSF drainage.

Two-Vessel Branched Stent Graft for Severely Angulated Aortic Arch Aneurysm in a Jehovah’s Witness

2018 ◽  
Vol 52 (2) ◽  
pp. 154-158 ◽  
Author(s):  
Chung S. Lim ◽  
A. Dhutia ◽  
Celia Riga ◽  
A. Dharmadasa ◽  
Richard G. J. Gibbs ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Open Surgery ◽  
Open Repair ◽  
Significant Risk ◽  
Mortality And Morbidity ◽  
Jehovah’S Witness ◽  
Jehovah's Witness ◽  
Risk Of Mortality ◽  
Custom Made ◽  
Arch Aneurysm

Aneurysmal disease involving the origins of supra aortic vessels often requires complex open and/or endovascular repair that is not only associated with significant risk of mortality and morbidity but also often with perioperative blood loss requiring transfusion. We report a successful repair of a large thoracic aortic aneurysm (TAA) involving the aortic arch with a custom-made Bolton Relay 2-vessel branched thoracic aortic endograft in a 42-year-old Jehovah’s Witness who would otherwise be very unlikely to survive an open repair. Branched thoracic aortic endografting offers a potentially safe, minimally invasive, and effective alternative for TAA disease involving the supra-aortic arteries, especially in patients who are at high risk of open surgery.

Endovascular repair of ascending aortic diseases with custom-made endografts

2021 ◽  
Author(s):  
Gabriele Piffaretti ◽  
Martin Czerny ◽  
Vicente Riambau ◽  
Roman Gottardi ◽  
Thomas Wolfgruber ◽  
...  
Keyword(s):  
Endovascular Repair ◽  
Open Surgery ◽  
Ascending Aorta ◽  
Thoracic Endovascular Aortic Repair ◽  
Interquartile Range ◽  
Endovascular Aortic Repair ◽  
Aortic Lesion ◽  
Aortic Repair ◽  
Custom Made

Abstract OBJECTIVES The aim of this article is to report the mid-term results of ascending thoracic endovascular aortic repair using a custom-made device (CMD). METHODS This was a retrospective study performed at tertiary centres. Nine patients considered unfit for open surgery received elective total endovascular repair of the ascending aorta with a Relay® (Terumo Aortic, Sunrise; FL, USA) CMD: pseudoaneurysn (n = 5), localized dissection (n =3) and contained rupture (n = 1). RESULTS Primary clinical success was achieved in all patients with no major complications and no early conversion to open surgery. All patients were discharged home and independent: median length of stay was 7 days (interquartile range, 6–18). No patient was lost to follow-up at a median 26 months (interquartile range, 12–36). Three patients died 2, 6 and 24 months after intervention; 1 was aorta related (late aorto-atrial fistula due to infection that required open surgery). At the last follow-up available, no endoleaks, migrations, fractures or ruptures were observed in the remaining 6 patients. CONCLUSIONS Ascending thoracic endovascular aortic repair with Terumo Aortic CMDs was technically feasible, effective and safe in very selected lesions. CMDs showed good ascending aorta conformability with different configurations and diameters, and satisfactory mid-term durability as shown by both structural integrity and aortic lesion exclusion.

Treatment of an asymptomatic penetrating aortic ulcer in a young patient

VASA ◽  
2010 ◽  
Vol 39 (2) ◽  
pp. 175-179
Author(s):  
Hakimi ◽  
Geisbüsch ◽  
Gross ◽  
Hyhlik-Dürr ◽  
Hausser ◽  
...  
Keyword(s):  
Electron Microscopy ◽  
Connective Tissue ◽  
Aortic Arch ◽  
Open Surgery ◽  
Open Repair ◽  
Thoracic Endovascular Aortic Repair ◽  
Concomitant Disease ◽  
Connective Tissue Disorders ◽  
Penetrating Aortic Ulcer ◽  
Pathological Analysis

We want to report and discuss the indication for open surgery for an asymptomatic penetrating aortic ulcer (PAU) in the era of thoracic endovascular aortic repair (TEVAR). A 31-year-old female presented with the diagnosis of an aneurysm in the distal aortic arch. With respect to the patient’s young age, the controversial status of connective tissue disorders and in the absence of concomitant disease, open repair was indicated. There was no proof of a mycotic plaque or connective tissue disease in the microbiological-, pathological analysis and at electron-microscopy. The patient was discharged on the thirteenth postoperative day. In spite of good preliminary results of TEVAR in PAU, in selective cases there is still an indication for open surgery.

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