scholarly journals Complex Regional Pain Syndrome with Aortic Distress after Thoracic Endovascular Aortic Repair and False Lumen Exclusion with “Candy Plug” Technique

Aorta ◽  
2021 ◽  
Author(s):  
Valerio S. Tolva ◽  
Andrea Kahlberg ◽  
Luca Bertoglio ◽  
Santi Trimarchi ◽  
Riccardo Miloro ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Complex Regional Pain Syndrome ◽  
False Lumen ◽  
Pain Syndrome ◽  
Thoracic Endovascular Aortic Repair ◽  
Intercostal Space ◽  
Endovascular Aortic Repair ◽  
Recurrent Pain ◽  
Aortic Repair ◽  
Thoracoabdominal Incision

AbstractA 41-year-old male presented for pain treated with oxycodone. A zone-2 thoracic endovascular aortic repair with distal PETTICOAT (provisional extension to induce complete attachment) for complicated Type-IIIb aortic dissection was performed 18 months before. Repeated hospitalizations did not show any issues to justify the recurrent pain. The aortic nature of the pain was suspected considering the plug as a pain trigger. Through a left thoracoabdominal incision in the eighth intercostal space, the candy plug was removed. Pain diminished after thoracoabdominal surgery steadily.

Safety and Effectiveness of TEVAR in Native Proximal Landing Zone 2 for Chronic Type B Aortic Dissection in Patients With Genetic Aortic Syndrome

2021 ◽  
pp. 152660282110612
Author(s):  
Ahmed Eleshra ◽  
Giuseppe Panuccio ◽  
Konstantinos Spanos ◽  
Fiona Rohlffs ◽  
Yskert von Kodolitsch ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
False Lumen ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Chronic Type ◽  
Ehlers Danlos Syndrome ◽  
Landing Zone ◽  
Aortic Repair

Objectives The aim of this study is to report the safety and effectiveness of thoracic endovascular aortic repair (TEVAR) in a native proximal landing zone (PLZ) 2 for chronic type B aortic dissection (TBAD) patients with genetic aortic syndrome (GAS). Methods A retrospective review of a single center database to identify patients with GAS treated with TEVAR in native PLZ 2 for chronic TBAD and thoracic false lumen aneurysm between February 2012 and February 2018 was undertaken. Results In total, 31 patients with GAS (24 Marfan syndrome [MFS], 5 Loeys-Dietz syndrome [LDS], and 2 vascular Ehlers-Danlos syndrome [vEDS]) were treated by endovascular repair. Nineteen patients were treated by TEVAR as index procedures with 8 patients (5 females, mean age = 55, range = 36–79 years old) receiving TEVAR in native PLZ 2. Left subclavian artery (LSA) perfusion was preserved in all 8 patients: by left common carotid artery-LSA bypass in 6 patients, chimney stenting of the LSA in 1 patient, and partial coverage of LSA ostium in 1 patient. Technical success was achieved in all patients (100%). There was no 30 day mortality (0%). The 30 day morbidity (0%) was free from major complications. The median follow-up was 40 months (range = 7–79). One patient died due to non-aortic-related cause. Native PLZ 2 was free from complications in MFS patients (5/8). Two patients with LDS developed type Ia endoleak with aneurysmal progression. One patient was treated by proximal extension with a double inner branched arch stent-graft landing in the replaced ascending aorta. The other one was treated with frozen elephant trunk. Conclusion Thoracic endovascular aortic repair in native PLZ 2 was safe and effective with no early or midterm PLZ complications in patients with MFS with chronic TBAD in this limited series. Native PLZ 2 is not safe in patients with LDS and should only be used in emergencies as a bridging to open repair.

Right Axillary Artery Cannulation for Endovascular Repair of an Acute type a Aortic Dissection

2017 ◽  
Vol 12 (2) ◽  
pp. 140-143 ◽  
Author(s):  
Corbin E. Muetterties ◽  
Jeremy H. Conklin ◽  
G. William Moser ◽  
Grayson H. Wheatley
Keyword(s):  
Aortic Dissection ◽  
Endovascular Repair ◽  
Axillary Artery ◽  
False Lumen ◽  
Type A ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Aortic Repair

We present the case of a 48-year-old woman with an acute type A aortic dissection that was treated with thoracic endovascular aortic repair at our institution. The patient was found to have a focal type A dissection with pericardial effusion but no tamponade physiology and no involvement of the aortic valve or root. We elected to treat the patient's type A aortic dissection with an endovascular stent because of the patient's favorable anatomy and no evidence of neurologic deficits or signs of distal malperfusion. The patient was successfully treated with an abdominal aortic cuff deployed through the axillary artery. An axillary approach was necessary because of the short length of the delivery sheath preventing a transfemoral delivery. At 2-year follow-up, the patient remains free of complications with computed tomography scan revealing complete false lumen thrombosis and a stable endovascular repair. This report demonstrates a case of acute type A aortic dissection successfully treated using thoracic endovascular aortic repair and illustrates the utility of axillary cannulation for precise deployment of stent grafts in the ascending aorta.

Esophageal necrosis after endovascular repair for ruptured aortic dissection

2016 ◽  
Vol 25 (9) ◽  
pp. 638-641 ◽  
Author(s):  
Shintaro Koizumi ◽  
Seiichi Yamaguchi ◽  
Soichi Asano ◽  
Hisanori Fujita ◽  
Tomonori Sueta ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Management Strategy ◽  
False Lumen ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Descending Thoracic Aorta ◽  
Fatal Complication ◽  
Esophageal Necrosis ◽  
Aortic Repair ◽  
The Right

A 78-year-old man presented with back pain and shock and was transferred to our hospital. Computed tomography showed a ruptured aortic dissection in which the false lumen was thrombosed with an ulcer-like projection, and the mid-esophagus was shifted to the right due to a mediastinal hematoma. He underwent emergency thoracic endovascular aortic repair of the descending thoracic aorta. One week later, esophageal necrosis occurred, and he died of mediastinitis and sepsis on postoperative day 16. Although esophageal necrosis is a rare and fatal complication after thoracic endovascular aortic repair, a management strategy has not yet been established.

scholarly journals Staged coil embolization after thoracic endovascular stent grafting for aneurysmal chronic type B aortic dissection: A case report

2019 ◽  
Vol 7 ◽  
pp. 2050313X1982890
Author(s):  
Takuya Nakayama ◽  
Koji Hattori ◽  
Takuya Hashizume ◽  
Miki Asano
Keyword(s):  
Computed Tomography ◽  
Aortic Dissection ◽  
Coil Embolization ◽  
False Lumen ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Chronic Type ◽  
Aortic Repair

We herein describe a 38-year-old woman with Marfan syndrome and chronic type A aortic dissection. Computed tomography showed that the sinus of Valsalva and thoracoabdominal aorta had a diameter of 62 and 55 mm, respectively. After 7 months of a Bentall operation and total arch replacement with the elephant trunk technique, we performed thoracic endovascular aortic repair for an aneurysm of the descending aorta, but we preserved the retrograde flow into the false lumen because it supplied vessels perfusing the spinal cord. Computed tomography angiography 14 months after thoracic endovascular aortic repair showed that the thoracic aortic diameter had increased to 68 mm. We then performed partial (proximal only) coil embolization of the false lumen. After 6 months, the thoracic aortic diameter had decreased to 60 mm and the spinal cord remained perfused via the distal false lumen. Staged coil embolization after thoracic endovascular aortic repair for aneurysmal chronic type B aortic dissection is feasible and can be beneficial.

Outcomes and aortic remodelling after proximal thoracic endovascular aortic repair of post type B aortic dissection thoracic aneurysm

VASA ◽  
2016 ◽  
Vol 45 (4) ◽  
pp. 331-336 ◽  
Author(s):  
Zhenyu Shi ◽  
Jun Yang ◽  
Weiguo Fu ◽  
Daqiao Guo ◽  
Xin Xu ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
False Lumen ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Maximum Diameter ◽  
Thoracic Aneurysm ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Aortic Repair ◽  
Type B Dissection

Abstract. Background: The objective was to explore the outcomes and aortic remodelling after proximal thoracic endovascular aortic repair (TEVAR) in post type B aortic dissection thoracic aneurysm with a maximal diameter ≥ 5.5cm. Patients and methods: 34 cases of type B aortic dissection thoracic aneurysm undergoing proximal TEVAR (coverage of the primary entry and the aneurysm extent) from 2008 to 2013 were retrospectively reviewed with follow-up for at least 2 years. The primary endpoints were 30-day mortality and survival at 2 years. The secondary endpoints were major complication and re-intervention. The aortic remodelling was investigated by comparison of the maximum diameter of the aneurysm and the diameter of true and false lumen at the same level between baseline and 2 years after TEVAR. Besides, we also analysed the possible relevant factors of aortic remodelling including the course of dissection, the involvement of dissection, and the length and shape of the stent graft. Results: The 30 day mortality was 2.9 % (1/34). The paraplegia rate post-TEVAR was 2.9 % (1/34). Overall, 32 out of the 34 cases were followed-up for 24 - 79 months. At 2 years, the overall and aortic specific survival were 87.5 % and 90.3 % respectively. The two year freedom from re-intervention rate was 87.5 %. Compared to the preoperative data, maximum diameter of descending aorta at 2 years demonstrated a slight increase (65.4±14.1mm Vs 63.9±9.1mm), but without significance (P>0.05). Meanwhile, we noticed a significant increase of true lumen (P < 0.01) and decrease of false lumen (P < 0.01) at the same level. Relevant analysis showed that positive aortic remodelling of the maximum diameter was associated with chronic phase (≥ 90 days of dissection onset) (P < 0.05) and the application of 150 - 170mm stent grafts (P < 0.05). Conclusions: Proximal TEVAR of post type B dissection thoracic aneurysm had generally favourable short- and mid-term outcomes with low paraplegia rate. Besides, it can achieve a certain extent of aortic remodelling.

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