Delayed Aortic Stent Collapse in Blunt Traumatic Aortic Injury Repair

Abstract Background Endovascular stent grafting has emerged as an option to treat traumatic aorta injuries with reported significantly low mortality and morbidity. Stent collapse is one of the complications that can occur in this type of treatment. The aim of this article is to analyze the expected cause of stent collapse and to draw attention to the importance of the surveillance follow-up, as this phenomenon may occur late postdeployment. Methods A retrospectively collected dataset from the two highest volume trauma centers in Saudi Arabia was analyzed between April 2007 and October 2012. A total of 66 patients received stent grafts for traumatic aortic injury and were included in the study. We apply Ishimaru's anatomical aortic arch zones and Benjamin's aortic injury grading systems. There were 35 patients with aortic injury at zone 2, 26 patients in zone 3, and 5 patients in zone 4. About 96% (63) of the injuries were grades 2 and 3, including large intimal flap or aortic wall pseudoaneurysm with change in wall contour. The technical success rate, as defined by complete exclusion of lesions without leaks, stroke, arm ischemia or stent-related complications, was 90%. Results Proximal stent collapse occurred in 4.5% of patients (3 of 66 inserted stents) during follow-up of 4 to 8 years (mean, 6 years). Patients with stent collapse tended to have an acute aortic arch angle with long-intraluminal stent lip, when compared with patients with noncollapsed stents. Intraluminal lip protrusion more than 10-mm increased collapse (p < 0.001). Stent-grafts sizes larger than 28 mm also demonstrated a higher collapse rate (p < 0.001). Conclusions The risk of stent collapse appears related to poor apposition of the stent due to severe aortic arch angulation in young patients and to large stent sizes (>28 mm). Such age groups may have more anatomical and aortic size changes during the growth. Clinical and radiological surveillance is essential in follow-up after stent-graft treatment for traumatic aortic injury.

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Potential Long-Term Complications of Endovascular Stent Grafting for Blunt Thoracic Aortic Injury

The Scientific World JOURNAL ◽

10.1100/2012/897489 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5 ◽

Cited By ~ 13

Author(s):

Larry E. Miller

Keyword(s):

Standard Of Care ◽

Aortic Injury ◽

Convincing Evidence ◽

Mortality And Morbidity ◽

Stent Grafting ◽

Blunt Thoracic Aortic Injury ◽

Thoracic Aortic Injury ◽

Rapid Deceleration

Blunt thoracic aortic injury (BTAI) is a rare, but lethal, consequence of rapid deceleration events. Most victims of BTAI die at the scene of the accident. Of those who arrive to the hospital alive, expedient aortic intervention significantly improves survival. Thoracic endovascular aortic repair (TEVAR) has been accepted as the standard of care for BTAI at many centers, primarily due to the convincing evidence of lower mortality and morbidity in comparison to open surgery. However, less attention has been given to potential long-term complications of TEVAR for BTAI. This paper focuses on these complications, which include progressive aortic expansion with aging, inadequate stent graft characteristics, device durability concerns, long-term radiation exposure concerns from follow-up computed tomography scans, and the potential for (Victims of Modern Imaging Technology) VOMIT.

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Long-Term Outcomes of Thoracic Endovascular Repair for Aortic Arch Dissection Using Customized Single-Branched Fenestrated Stent-Graft

Vascular and Endovascular Surgery ◽

10.1177/15385744211010446 ◽

2021 ◽

pp. 153857442110104

Author(s):

Xiaoye Li ◽

Lei Zhang ◽

Chao Song ◽

Hao Zhang ◽

Shibo Xia ◽

...

Keyword(s):

Aortic Arch ◽

Stent Graft ◽

Endovascular Repair ◽

Artery Occlusion ◽

Stent Grafts ◽

Technical Success Rate ◽

Thoracic Endovascular Repair ◽

Subclavian Artery Occlusion ◽

Fenestrated Stent Graft

Objectives: To report outcomes of thoracic endovascular repair using customized single-branched fenestrated stent-grafts in treatment of aortic arch dissections. Materials and Methods: Between November 2009 and November 2011, 16 patients with aortic arch dissections underwent thoracic endovascular aortic repair utilizing customized unibody single-branched fenestrated stent-graft (UBFSG) in our institution. Results: All 16 patients were male with mean age of 54.50 ± 11.33. The technical success rate was 100%. 30-day mortality rate was 6.25% (n = 1). The median follow-up period was 98 months (range, 0-119). During follow-up, 4 nonaorta-related deaths were recorded. Two (2) cases of left subclavian artery occlusion were observed 12 and 14 months after the operation. Two (2) patients had another successful endovascular repair in time, including one case of type Ib endoleak occurred 100 months after the operation and one case of stent-graft induced new entry tear 38 months after the operation. No stroke and migration of stent-grafts were observed. Conclusions: The branched fenestrated stent-graft may be an effective alternative treatment for aortic arch dissections unfit for open surgery.

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Aortic Arch Reconstruction by Transluminally Placed Endovascular Branched Stent Graft

Circulation ◽

10.1161/circ.100.suppl_2.ii-316 ◽

1999 ◽

Vol 100 (suppl_2) ◽

Author(s):

Kanji Inoue ◽

Hiroaki Hosokawa ◽

Tomoyuki Iwase ◽

Mitsuru Sato ◽

Yuki Yoshida ◽

...

Keyword(s):

Aortic Arch ◽

Stent Graft ◽

Aortic Aneurysms ◽

Therapeutic Modality ◽

Stent Grafts ◽

Stent Grafting ◽

Thoracic Aortic Aneurysms ◽

Stent Graft Repair ◽

Aortic Dissections

Background —Recently, thoracic aortic stent grafting has emerged as an alternative therapeutic modality for patients with thoracic aortic aneurysms and aortic dissections. However, its application has been limited to descending thoracic aortic aneurysms distal to the aortic arch. We report our initial clinical experience of endovascular branched stent graft repair for aortic arch aneurysms. Methods and Results —Endovascular grafting with Inoue branched stent grafts was attempted for 15 patients with thoracic aortic aneurysms and aortic dissections under local anesthesia (n=14) or general anesthesia (n=1). Single-branched stent grafts were used in 14 patients, and a triple-branched stent graft in one. The branched stent grafts were delivered through a 22F or a 24F sheath under fluoroscopic guidance and implanted across the aneurysmal aortic arch. In 2 patients, the single-branched stent graft did not pass through the 22F sheath used. Complete thrombosis of the aneurysm was ultimately achieved in 11 patients (73%). Of 4 persistent leaks, 1 minor leak spontaneously thrombosed and 1 major leak was successfully treated by additional straight stent graft placement. In 1 patient, the right external iliac artery ruptured during the withdrawal of the sheath and was successfully repaired by the implantation of a straight stent graft. One patient with severe stenosis of the aortic graft section was successfully managed by additional stent deployment. Peripheral microembolization to a toe occurred in 1 patient, and cerebral infarction occurred in 1 other patient. Two patients who had failed to receive endovascular stent grafts died during an average follow-up of 12.6 months, 1 of pneumonia and the other of rupture of a concomitant abdominal aortic aneurysm. Conclusions —This report demonstrates the technical feasibility of endovascular branched stent graft repair for aneurysms located at the aortic arch. Careful, longer follow-up and further extensive clinical trials are awaited toward establishing this technique as a recommendable alternative to surgical treatment of thoracic aortic aneurysms.

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P6496Endovascular reconstruction from aortic valve to aortic arch by one-piece valved-fenestrated-bifurcated endografting in animal experiments

European Heart Journal ◽

10.1093/eurheartj/ehz746.1086 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

Z P Jing ◽

J X Feng ◽

X H Bao ◽

T Li ◽

Y Zhao ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Arch ◽

Aortic Root ◽

Animal Experiments ◽

Proximal Part ◽

Minimal Invasive ◽

Left Ventricular ◽

Technical Success Rate

Abstract Aims The possibility of endovascular reconstruction of aortic valve, sinus of Valsalva, and ascending aorta by a minimal-invasive single endograft has not been proven in vivo. Combining our own long-term experiences from transcatheter aortic valve replacement (TAVR) and Thoracic Endovascular Repair (TEVAR) for ascending and arch dissection, we designed the special endo-graft: a novel one-piece valved-fenestrated-bifurcated endografting, and tried to endovascularly reconstruct the area from Left ventricular outflow tract to aortic arch in animal experiments. Methods and results For 20 healthy adult female pigs weighed between 62.3±2.2 kilograms, we did aortic compute tomography angiography (CTA) examinations and measured morphologic parameters of aortic root. Then we accordingly customized the valved-fenestrated-bifurcated endograft. The endograft was delivered through transapical access and endovascularly reconstructed the segment from aortic valve to proximal part of aortic arch. The overall technical success rate was 95% because of one case of delivery system failure. Instant transesophageal echography (TEE) and aortic CTA confirmed ideal position of the endograft, satisfactory function of aortic valve, and the patency of coronary arteries in all subjects. During follow-up, 12 subjects were sacrificed according to the plan and seven were followed up for 8.1±3.6 months. There was one unplanned death of cardiac infection (unplanned mortality: 5.3%). Follow-up re-examinations (aortic CTA, cardiac ultrasound, and electrocardiogram) found no adverse events. Among 12 sacrificed subjects, there was no evidence of fenestrations alignment lost and no myocardial ischemia according to the pathological analysis. Conclusion The novel one-piece valved-fenestrated-bifurcated endografting might be feasible for minimal-invasive reconstruction of aortic root in animal models, thus provided a prospect to simultaneously treat pathologies involving aortic valve and aortic root in endovascular way.

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Midterm Outcomes of Thoracic Aortic Stent-Grafts: Complications and Imaging Techniques

Journal of Endovascular Therapy ◽

10.1177/152660280301000314 ◽

2003 ◽

Vol 10 (3) ◽

pp. 494-504 ◽

Cited By ~ 13

Author(s):

Valérie Chabbert ◽

Philippe Otal ◽

Louis Bouchard ◽

Philippe Soula ◽

Tuan Tran Van ◽

...

Keyword(s):

Stent Graft ◽

Chest Radiography ◽

Imaging Techniques ◽

Traumatic Rupture ◽

Entire Group ◽

Stent Grafts ◽

Elliptical Cross ◽

Stent Grafting ◽

Subgroup Analyses

Purpose: To evaluate the midterm outcomes of thoracic aortic stent-grafting and the performance of computed tomographic angiography (CTA), radiography, and magnetic resonance angiography (MRA) in endograft surveillance. Methods: Forty-seven patients with traumatic thoracic aortic ruptures (n=16), aneurysms (n=14), false aneurysms (n=3), penetrating ulcers (n=3), and dissections (n=11) treated with stent-grafts were monitored in follow-up using chest radiography and CTA in all patients and MRA in 23 patients. Two perpendicular maximal aortic diameters, the sum of these diameters, and the elliptical cross-sectional area were determined and compared to baseline for the entire group and in subgroup analyses according to lesion type. CTA, MRA, and radiography were compared for their ability to detect endoleak, monitor stent-graft configuration, and measure aortic diameters. Results: The mortality rate was 8.5%. Severe complications were observed in 14.8% (6% neurological complications); 12 (25.5%) patients had primary endoleaks. Over a mean 11-month follow-up (range 0.25–46 months), the aortic diameters decreased for all patients without endoleak (p<0.001). In the diameter/area subgroup analyses, only the traumatic rupture cohort demonstrated significant decreases in all 4 measurements. CTA and MRA measurements correlated well, but chest radiography was superior to both for visualizing stent-graft shape. In terms of endoleak detection, MRA missed only 1 (12.5%) endoleak (type II) seen on CTA; there were no false positive results with MRA. Conclusions: Morbidity and mortality observed after thoracic stent-grafting are acceptable. Radiography is better for monitoring stent-graft conformation, while CTA provides the best overall morphological information. The performance of MRA in endoleak detection is encouraging.

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Radiological Evaluation of Abdominal Endovascular Aortic Aneurysm Repair

Canadian Association of Radiologists Journal ◽

10.1016/j.carj.2014.12.003 ◽

2015 ◽

Vol 66 (3) ◽

pp. 277-290 ◽

Cited By ~ 1

Author(s):

Avnesh S. Thakor ◽

James Tanner ◽

Shao J. Ong ◽

Ynyr Hughes-Roberts ◽

Shahzad Ilyas ◽

...

Keyword(s):

Aortic Aneurysm ◽

Imaging Modality ◽

Aortic Aneurysms ◽

Stent Grafts ◽

Mortality And Morbidity ◽

Endovascular Aortic Aneurysm Repair ◽

Plain Films ◽

Aneurysm Repair ◽

Aortic Aneurysm Repair

Endovascular aortic aneurysm repair (EVAR) is an alternative to open surgical repair of aortic aneurysms offering lower perioperative mortality and morbidity. As experience increases, clinicians are undertaking complex repairs with hostile aortic anatomy using branched or fenestrated devices or extra components such as chimneys to ensure perfusion to visceral branch vessels whilst excluding the aneurysm. Defining the success of EVAR depends on both clinical and radiographic criteria, but ultimately depends on complete exclusion of the aneurysm from the circulation. Aortic stent grafts are monitored using a combination of imaging modalities including computed tomography angiography (CTA), ultrasonography, magnetic resonance imaging, plain films, and nuclear medicine studies. This article describes when and how to evaluate aortic stent grafts using each of these modalities along with the characteristic features of several of the main stent grafts currently used in clinical practice. The commonly encountered complications from EVAR are also discussed and how they can be detected using each imaging modality. As the radiation burden from serial follow up CTA imaging is now becoming a concern, different follow-up imaging strategies are proposed depending on the complexity of the repair and based on the relative merits and disadvantages of each imaging modality.

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Outcomes of Total Endovascular Aortic Arch Repair with Surgeon-Modified Fenestrated Stent-Grafts on Zone 0 Landing for Aortic Arch Pathologies

Journal of Endovascular Therapy ◽

10.1177/15266028211036478 ◽

2021 ◽

pp. 152660282110364

Author(s):

Xiaoye Li ◽

Lei Zhang ◽

Chao Song ◽

Hao Zhang ◽

Shibo Xia ◽

...

Keyword(s):

Aortic Arch ◽

Stent Graft ◽

Artery Occlusion ◽

Technical Success ◽

Stent Grafts ◽

Landing Zone ◽

Subclavian Artery Occlusion ◽

Fenestrated Stent Graft ◽

Aortic Arch Repair

Objectives This study evaluated the feasibility and safety of total endovascular aortic arch repair with surgeon-modified fenestrated stent-graft on zone 0 landing for aortic arch pathologies. Methods Between June 2016 and October 2019, 37 consecutive patients underwent total endovascular arch repair with surgeon-modified fenestrated stent-grafts on zone 0 landing. Outcomes included technical success, perioperative and follow-up morbidity and mortality, and branch artery patency. Results During the study period, 37 patients were treated with total endovascular aortic arch repair with surgeon-modified fenestrated stent-graft. Twenty-one (56.8%) patients were diagnosed with aortic dissections, 15 (40.5%) patients with aneurysms, and 1 (2.7%) patient required reintervention due to endoleak and sac expansion from previous thoracic endovascular aortic repair for thoracoabdominal aneurysm. The proximal landing zone for all patients were in zone 0, and all branch arteries of aortic arch were reconstructed. Technical success was achieved in 34 cases (91.9%). Three (8.1%) patients had fenestrations misaligned with target arteries, and the chimney technique was applied as a complementary measure. Thirty-day mortality rate was 5.4% (n=2). Thirty-day stroke rate was 5.4% (n=2). Thirty-day reintervention rate was 2.7% (n=1). At a median follow-up of 20 months (range, 3–49 months), 5 (13.5%) patients died, including 2 aortic-related deaths, 1 nonaortic-related death, and 2 deaths of unknown reason. One (2.7%) patient had stroke. Four patients (10.8%) had reintervention during the follow-up, including 2 cases of left subclavian artery occlusion and 2 cases of type II endoleak. The estimated survival (±SE) at 2 years was 72.4%±9.7% (95% CI 53.4%–91.4%). The estimated freedom from reintervention (±SE) at 2 years was 87.4%±5.9% (95% CI 75.84%–98.96%). Conclusions Total endovascular aortic arch repair with surgeon-modified fenestrated stent-grafts on zone 0 landing is an alternate option for the treatment of aortic arch pathologies in experienced centers.

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Endovascular Stent Grafting for Aortic Arch Aneurysm in Aortoiliac Occlusive Disease following Aortic Arch Debranching and Aortobifemoral Reconstruction

Case Reports in Medicine ◽

10.1155/2017/6568028 ◽

2017 ◽

Vol 2017 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Didem Melis Oztas ◽

Cagla Canbay ◽

Yilmaz Onal ◽

Metin Onur Beyaz ◽

Omer Ali Sayin ◽

...

Keyword(s):

Aortic Arch ◽

Alternative Therapy ◽

Aortic Arch Aneurysm ◽

Aortic Aneurysms ◽

Endovascular Stent ◽

Aortoiliac Occlusive Disease ◽

Mortality And Morbidity ◽

Stent Grafting ◽

Endovascular Stent Grafting ◽

Arch Aneurysm

Treatment of thoracic aortic aneurysms constitutes high mortality and morbidity rates despite improvements in surgery, anesthesia, and technology. Endovascular stent grafting may be an alternative therapy with lower risks when compared with conventional techniques. However, sometimes the branches of the aortic arch may require transport to the proximal segments prior to successful thoracic aortic endovascular stent grafting. Atherosclerosis is accounted among the etiology of both aneurysms and occlusive diseases that can coexist in the same patient. In these situations stent grafting may even be more complicated. In this report, we present the treatment of a 92-year-old patient with aortic arch aneurysm and proximal descending aortic aneurysm. For successful thoracic endovascular stent grafting, the patient needed an alternative route other than the native femoral and iliac arteries for the deployment of the stent graft. In addition, debranching of left carotid and subclavian arteries from the aortic arch was also required for successful exclusion of the thoracic aneurysm.

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Stent-Graft Treatment of Pseudoaneurysms and Arteriovenous Fistulae in the Carotid Artery

Vascular ◽

10.2310/6670.2006.00034 ◽

2006 ◽

Vol 14 (3) ◽

pp. 123-129 ◽

Cited By ~ 18

Author(s):

Claudio Schönholz ◽

Zvonimir Krajcer ◽

Juan Carlos Parodi ◽

Esteban Mendaro ◽

Christopher Hannegan ◽

...

Keyword(s):

Carotid Artery ◽

Doppler Ultrasound ◽

Stent Graft ◽

Venous Catheter ◽

Stent Grafts ◽

Arteriovenous Fistulae ◽

Autologous Vein ◽

Graft Placement ◽

Stent Grafting

The purpose of this study was to assess the safety and efficacy of stent-graft placement in the management of arteriovenous fistulae (AVF) and pseudoaneurysms (PAs) involving the carotid artery (CA). Twenty-two patients (16 men, 6 women) with a CA AVF ( n = 5) or PA ( n = 17) owing to a gunshot or stab wound, carotid endarterectomy, blunt trauma, a tumor, spontaneous dissection, or a central venous catheter were treated with percutaneous placement of stent grafts. The patients presented with tumor, bruit, headache, mouth and tracheostomy bleeding, transitory hemiparesis, seizure, or stroke. Diagnoses were made by using computed tomographic angiography (CTA) and digital subtraction angiography. Fourteen lesions were in the common CA; eight were in the internal CA. Homemade devices and stent grafts from a variety of manufacturers were employed. Follow-up evaluations included clinical, CTA, and Doppler ultrasound assessments. All patients had resolution of the PA or AVF. In one patient with a large petrous PA, acute occlusion of the CA developed after placement of three balloon-expandable stent grafts, but there were no neurologic complications because the circle of Willis was functional. During follow-up ranging from 2 months to 13 years, asymptomatic 90% stenosis owing to stent compression was observed on Doppler ultrasound and angiographic examinations in a patient with an autologous vein–covered stent graft in the internal CA. Three other patients died of causes unrelated to stent-graft placement. In all other patients, the stent graft remained patent. Our results indicate that stent grafting is an acceptable alternative to surgery in the treatment of AVF and PAs in the CA.

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Endovascular Grafting of Traumatic Aortic Aneurysms in Contaminated Fields

Journal of Endovascular Therapy ◽

10.1177/152660280100800305 ◽

2001 ◽

Vol 8 (3) ◽

pp. 262-267 ◽

Cited By ~ 19

Author(s):

Stefan Krämer ◽

Reinhard Pamler ◽

Harald Seifarth ◽

Hans-Jürgen Brambs ◽

Ludger Sunder-Plassmann ◽

...

Keyword(s):

Aortic Rupture ◽

Aortic Aneurysms ◽

Long Term Results ◽

White Blood Count ◽

Stent Grafts ◽

Transfemoral Approach ◽

Aortic Lesion ◽

Stent Grafting ◽

Reactive Protein

Purpose: To evaluate the potential of endovascular stent-grafts to treat traumatic aortic lesions in contaminated areas. Methods: Four patients (3 women; ages 26–78 years) underwent stent-grafting to repair an aortic rupture sustained in a motorcycle accident, aortic lacerations secondary to surgical treatment of spondylitis in 2 patients, and an aortobronchial fistula following surgical thoracic aortic repair 10 years earlier. Stent-grafts (2 Corvita, 1 Talent, and 1 Vanguard) were placed endoluminally into the infected areas via a transfemoral approach. Follow-up included erythrocyte sedimentation rate, white blood count, C-reactive protein, blood cultures, and computed tomography (CT). Results: The stent-grafts were successfully placed in all cases and excluded the aortic lesion. Under supportive antibiotic therapy, inflammation parameters returned to normal. CT imaging showed no evidence of paraprosthetic infection, nor were there any other complications over a follow-up that ranged from 3 to 34 months. Conclusions: Endovascular therapy may be an alternative in the acute management of aortic ruptures in the setting of infection. Long-term results are required for definitive evaluation of the method.

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