Native and prosthetic graft infections of the thoracic aorta: surgical management

2021 ◽  
Author(s):  
Saad Rustum ◽  
Erik Beckmann ◽  
Andreas Martens ◽  
Heike Krüger ◽  
Morsi Arar ◽  
...  
Keyword(s):  
Thoracic Aorta ◽  
Surgical Management ◽  
Open Repair ◽  
Perioperative Period ◽  
Prosthetic Graft ◽  
Thoracic Endovascular Aortic Repair ◽  
Descending Aorta ◽  
Aortic Repair ◽  
Group A ◽  
Group B

Abstract OBJECTIVES Infection of the native aorta or after previous open or endovascular repair of the thoracic aorta is associated with high risks for morbidity and mortality. We analysed the outcome after surgical management of a native mycotic aneurysm or of prosthetic graft infection of the descending aorta. METHODS From June 2000 to May 2019, a total of 39 patients underwent surgery in our centre for infection of the native descending aorta (n = 19 [49%], group A) or a prosthetic descending aorta [n = 20 (51%), group B]. In the 20 patients in group B, a total of 8 patients had prior open aortic repair with a prosthesis and 12 patients had a previous endovascular graft repair. RESULTS The cohort patients had a mean age of 57 ± 14; 62% were men (n = 24). The most common symptoms at the time of presentation included fever, thoracic or abdominal pain and active bleeding. Emergency surgery was performed in 11 patients (28%); 3 patients had emergency endovascular stent grafts implanted during thoracic endovascular aortic repair for aortic rupture before further open repair. The 30-day mortality was 42% in group A and 35% in group B. The 90-day mortality was 47% in group A and 45% in group B. Pathogens could be identified in approximately half of the patients (46%). The most commonly identified pathogens were Staphylococcus aureus in 6 patients (15%) and Staphylococcus epidermidis in 4 patients (10%). Survival of the entire group (including patients with both native and prosthetic graft infections) was 44 ± 8%, 39 ± 8% and 39 ± 8% at 1, 2 and 3 years after surgery. The percentage of patients who survived the initial perioperative period was 81 ± 9%, 71 ± 9% and 71 ± 10% at 1, 2 and 3 years after surgery. CONCLUSIONS Patients with infection of the descending aorta, either native or prosthetic, are associated with both high morbidity and mortality. However, patients who survive the initial perioperative period have an acceptable long-term prognosis. In emergency situations, thoracic endovascular aortic repair may help to stabilize patients and serve as bridge to open repair.

scholarly journals DynaCT-guided thoracic endovascular aortic repair in a patient with para-aortic malignant lymphoma

2019 ◽  
Vol 29 (3) ◽  
pp. 491-492
Author(s):  
Kenta Masada ◽  
Toru Kuratani ◽  
Kazuo Shimamura ◽  
Yoshiki Sawa
Keyword(s):  
Malignant Lymphoma ◽  
Thoracic Aorta ◽  
Aortic Rupture ◽  
Thoracic Endovascular Aortic Repair ◽  
Good Option ◽  
Endovascular Aortic Repair ◽  
Descending Aorta ◽  
Aortic Repair ◽  
Tumour Location

Abstract Para-aortic malignant lymphoma invading the thoracic aorta can cause aortic rupture. Thoracic endovascular aortic repair (TEVAR) is a good option to treat aortic rupture associated with para-aortic malignancies. It is essential to detect the exact tumour location during TEVAR; however, it is often difficult to confirm the location with conventional 2-dimensional fluoroscopic or angiographic images. We describe successful TEVAR using syngo DynaCT (Siemens AG, Forchheim, Germany) in a 64-year-old man with para-aortic malignant lymphoma invading the descending aorta.

scholarly journals A review of endovascular treatment of thoracic aorta disease

2018 ◽  
Vol 100 (8) ◽  
pp. 662-668 ◽  
Author(s):  
GJS Tan ◽  
PLZ Khoo ◽  
KMJ Chan
Keyword(s):  
Thoracic Aorta ◽  
Open Repair ◽  
Aortic Disease ◽  
Thoracic Endovascular Aortic Repair ◽  
Aortic Aneurysms ◽  
Endovascular Aortic Repair ◽  
Aortic Diseases ◽  
Thoracic Aortic Disease ◽  
Thoracic Aortic Aneurysms ◽  
Aortic Repair

Introduction The development of thoracic endovascular aortic repair has altered the approach and reduced the risk of treating the majority of descending thoracic aortic conditions. Primarily developed for the exclusion of thoracic aortic aneurysms, it is now used in place of open repair surgery for most descending thoracic aortic diseases, and has also been used to treat aortic arch diseases in selected cases. Methods A literature search was conducted of Medline and Embase databases from January 2007 to February 2017, using the key words ‘aortic disease’, ‘thoracic aorta’ and ‘endovascular repair’; 205 articles were identified, of which 25 studies were selected for review based on their relevance. Findings The key findings of the indications, techniques, outcomes, complications and comparisons with open surgical repair were extracted from the published studies and are summarised in this review. Thoracic endovascular aortic repair is the preferred choice of intervention for patients with descending thoracic aortic disease. With time, it has improved to be safer and has the potential to expand aortic treatment choices in future.

Aortic Arch and Thoracic Aorta Curvature Remodeling after Thoracic Endovascular Aortic Repair

2017 ◽  
Vol 38 ◽  
pp. 233-241 ◽  
Author(s):  
Gaspar Mestres ◽  
Marvin E. Garcia ◽  
Xavier Yugueros ◽  
Rodrigo Urrea ◽  
Paolo Tripodi ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Thoracic Aorta ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Aortic Repair

scholarly journals The surgical management of type IA endoleak after thoracic endovascular aortic repair

2020 ◽  
Vol 31 (3) ◽  
pp. 346-353
Author(s):  
Yaojun Dun ◽  
Yi Shi ◽  
Hongwei Guo ◽  
Yanxiang Liu ◽  
Xiangyang Qian ◽  
...  
Keyword(s):  
Surgical Management ◽  
Circulatory Arrest ◽  
Artery Bypass ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Elephant Trunk ◽  
Direct Closure ◽  
Aortic Repair ◽  
Type Ia

Abstract OBJECTIVES Our goal was to investigate the surgical strategy for type Ia endoleak after thoracic endovascular aortic repair (TEVAR) by reporting our experiences. METHODS From November 2012 to September 2019, a total of 23 patients received surgical management for type Ia endoleak after TEVAR. RESULTS The operations included total arch replacement with the frozen elephant trunk technique in 15 patients, direct closure of the endoleak in 2 patients, hybrid aortic arch repair in 4 patients, arch debranching with TEVAR in 1 patient and left common carotid artery to left subclavian artery bypass with TEVAR in 1 patient. Among 21 patients with cardiopulmonary bypass (CPB), the mean CPB and aortic cross-clamp times were 146.7 ± 42.2 and 81.0 ± 43.3 min, respectively. The selective cerebral perfusion time was 18.8 ± 8.2 min in 17 patients with hypothermic circulatory arrest. The in-hospital mortality was 8.7% (2/23). Type Ia endoleak was sealed successfully after surgery in 95.5% (21/22) of patients. The follow-up data were available for all 21 survivors. The median follow-up period was 18 months (range 1–84 months). During the follow-up period, a total of 8 patients died or had aortic events, including 5 deaths and 6 aortic events. CONCLUSIONS Different surgical strategies could be selected to treat patients with type Ia endoleak after TEVAR, with acceptable early and late outcomes.

Lethal aorto-oesophageal fistula 16 years after aortic prosthetic reconstruction: Delayed rupture as cause of death

2020 ◽  
pp. 002580242093679
Author(s):  
Beatrice Benedetti ◽  
Marica Felice ◽  
Francesco Locco ◽  
Paola Roberti ◽  
Roberto Demontis
Keyword(s):  
Vascular Surgery ◽  
Thoracic Aorta ◽  
Surgical Complications ◽  
Rare Complication ◽  
Thoracic Endovascular Aortic Repair ◽  
Descending Thoracic Aorta ◽  
Prosthetic Reconstruction ◽  
Clinical Onset ◽  
Aortic Repair ◽  
One Year

The development of aorto-oesophageal fistula (AOF) is a rare complication following thoracic aortic repair. Mortality is high, in most cases due to fatal haematemesis. The clinical onset is variable, occurring approximately one year after surgery. We report a case of a lethal AOF in a 58-year-old man. He underwent open vascular surgery 16 years prior to his death due to a rupture of the descending thoracic aorta. In the early 2000s, the open vascular approach was replaced by thoracic endovascular aortic repair. As a result of this approach, the number of surgical complications has reduced, with the exception of AOF.

Midterm Cost and Effectiveness of Thoracic Endovascular Aortic Repair Versus Open Repair

2012 ◽  
Vol 93 (2) ◽  
pp. 473-479 ◽  
Author(s):  
Ashkan Karimi ◽  
Karen L. Walker ◽  
Tomas D. Martin ◽  
Philip J. Hess ◽  
Charles T. Klodell ◽  
...  
Keyword(s):  
Open Repair ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Aortic Repair

scholarly journals Through and through suturing vs. window resection method in surgical management of seroma pinna: a comparative study

2017 ◽  
Vol 4 (1) ◽  
pp. 112
Author(s):  
Raisa Priyadarshini ◽  
Subhalaxmi Rautray ◽  
Rajat Kumar Dash
Keyword(s):  
Comparative Study ◽  
Recurrence Rate ◽  
Surgical Management ◽  
High Rate ◽  
Auricular Cartilage ◽  
Suction Drain ◽  
Group A ◽  
Group B ◽  
Positive Factor ◽  
Window Resection

<p class="abstract"><strong>Background:</strong> Seroma pinna is a collection of fluid between the auricular cartilage and the perichondrium. Seromas can occur spontaneously or after surgery or trauma. Depending on the nature of swellings and the symptoms, they can be distinguished from other conditions of the pinna. Successful treatment is challenging because of high rate of recurrence. Usual treatment used to consist of aspiration of the fluid and pressure bandage. Methods include using buttons as pressure splints, excising a piece of cartilage and perichondrium to cure recurrent seromas<sup>4</sup>,placement of a continuous portable suction drain has also been advised, suturing through and though after aspiration.</p><p class="abstract"><strong>Methods:</strong> In the first group of patients through and through suturing was done and in the second group window resection was done.  </p><p class="abstract"><strong>Results:</strong> The recurrence rate was 5% for the first group patients while 20% for the second group. The percentage of development of perichondritis was 5% for group A and 15% for group B.</p><p><strong>Conclusions:</strong> The method put forward in this study is a simple and effective way for its management. The avoidance of dressing is a positive factor and positive factor is that it can be done on an OPD basis.</p>

scholarly journals Surgical management of traumatic pancreatic injuries and their consequences.

2020 ◽  
Vol 7 (11) ◽  
pp. 3555
Author(s):  
Ashraf Mohammad El-badry ◽  
Mohamed Mahmoud Ali
Keyword(s):  
Surgical Management ◽  
Damage Control ◽  
Pancreatic Injury ◽  
Hemodynamic Instability ◽  
University Hospital ◽  
Pancreatic Trauma ◽  
Surgical Interventions ◽  
Pancreatic Injuries ◽  
Group A ◽  
Group B

Background: Management of pancreatic trauma remains challenging due to difficulty in diagnosis and complexity of surgical interventions. In Egypt, reports on pancreatic trauma are scarce.Methods: Medical records of adult patients with pancreatic trauma who were admitted at Sohag University Hospital (2012-2019) were retrospectively studied. Patients were categorized into group A of non-operative management (NOM), group B which required upfront exploratory laparotomy due to hemodynamic instability and group C in which surgical management was implemented after thorough preoperative assessment. Pancreatic injuries were ranked by the pancreas injury scale (PIS).Results: Thirty-two patients (25 males and 7 females) were enrolled, and median age of 36 (range: 23-68) years. Twenty-eight patients (87.5%) had blunt trauma whereas penetrating injury occurred in 4 (12.5%). There were 9 patients in group A, 7 in group B and 16 in group C. High grades of pancreatic injury ≥3 occurred in 4 patients from group B and 5 from group C. Distal pancreatectomy was performed in 7 patients while central resection and panceatico-gastrostomy in one. Grade IV injury occurred only in one patient who received damage-control laparotomy. Post-operative complication were significantly increased in group B compared with C, in correlation worse hemodynamic status and increased severity of PIS. Post-operative mortality occurred in 2 patients (6%), both from group B. Late consequences included pancreatic pseudocyst (4 cases) and walled off pancreatic necrosis (2 cases).Conclusions: High grades of pancreatic injury and hemodynamic instability correlate with worse outcome after surgery for pancreatic trauma.

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