Thoracic Endovascular Aortic Repair in the Ascending Aorta

2015 ◽  
Vol 10 (5) ◽  
pp. 363-367 ◽  
Author(s):  
Anja Muehle ◽  
Aamir Shah ◽  
Ali Khoynezhad
Keyword(s):  
Treatment Options ◽  
Aortic Disease ◽  
Ascending Aorta ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Attractive Alternative ◽  
Aortic Repair ◽  
Alternative Treatment Option ◽  
Risk Patients ◽  
Aortic Pathologies

Thoracic endovascular aortic repair has become an attractive alternative treatment option for thoracic aortic disease. New devices and advanced image-guided procedures are continuously expanding the indications. This article focuses on technical aspects of transapical stent graft deployment for ascending aortic pathologies. With improving device technology, diverse available stent grafts, and imaging modalities, thoracic endovascular aortic repair has become safer and holds promising potential to expand treatment options, especially for high-risk patients requiring ascending aorta treatment.

scholarly journals Perioperative Hemodynamic Management and Pharmacotherapeutics of Patients Undergoing Thoracic Endovascular Aortic Repair

2014 ◽  
Vol 2014 ◽  
pp. 1-6
Author(s):  
Anja Muehle ◽  
Isil Uzun ◽  
Ziba Jalali ◽  
Ali Khoynezhad
Keyword(s):  
Blood Pressure ◽  
Aortic Disease ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Long Term Results ◽  
Safe Procedure ◽  
Thoracic Aortic Disease ◽  
Hemodynamic Management ◽  
Aortic Repair ◽  
Alternative Treatment Option

Thoracic endovascular aortic repair (TEVAR) has become an attractive alternative treatment option for many patients with specific thoracic aortic disease. New devices and advanced image-guided procedures are continuously expanding the indications and improve neurological outcomes. Hemodynamic management of these patients is a critical aspect in reducing neurological deficit and it is different compared to patients undergoing open thoracic aortic operations. There are two different phases of blood pressure management for patients with thoracic aortic disease. Before and during the critical steps of TEVAR anti-impulsive therapy facilitates safe positioning and stent deployment. After stent grafts are deployed, controlled hypertensive blood pressure levels are achieved to avoid spinal cord ischemia. This precise blood pressure strategy is essential to ensure a safe procedure and good long-term results.

scholarly journals Kissing Intravascular Balloon Lithoplasty and Endovascular Aortic Repair as a Treatment of Severe Distal Aorto-Iliac Occlusive Disease to Ensure a Safe Conduit to Facilitate Thoracic Endovascular Aort

2020 ◽  
Vol 3 (12) ◽  
pp. 01-06
Author(s):  
Pankaj Khullar
Keyword(s):  
Chest Pain ◽  
Treatment Options ◽  
Thoracic Endovascular Aortic Repair ◽  
Occlusive Disease ◽  
Endovascular Aortic Repair ◽  
Endovascular Stent Graft ◽  
Surgical Risk ◽  
Descending Thoracic Aortic Aneurysm ◽  
Aortic Repair ◽  
Artery Disease

Background: We describe a novel case of treating severe distal aorto-illiac occlusive disease and endovascular aortic repair with kissing endoluminal lithoplasty balloons. This ensured a safe conduit to facilitate thoracic endovascular aortic repair. Case Presentation: A patient with multiple comorbidities including coronary artery disease and peripheral artery disease (Rutherford 4 symptoms bilaterally) presented to the emergency room with chest pain and dyspnea on exertion. The patient was found to have a 3.5 cm descending thoracic aortic aneurysm, multiple penetrating aortic ulcers (PAU’s) within the descending thoracic aorta which was felt to be the cause of her chest pain along with heavily calcified occlusive aorto-iliac disease. The patient was deemed high surgical risk for open repair and the patient’s severe calcific distal aortic stenosis and bilateral severe ostial iliac stenosis was deemed a barrier for endovascular repair. Therefore, the patient was successfully treated with kissing balloon lithoplasty for lesion preparation of the heavy calcification and placement of an endovascular stent graft (EVAR) in the distal aorta, which ensured a safe conduit for thoracic endovascular aortic repair (TEVAR) procedure. Conclusion: As patients become more and more complex it is important to explore endovascular treatment options especially when surgical risk is high. Balloon lithoplasty and graft placement of calcified aorto-iliac bifurcation is a safe approach to develop a clear conduit for TEVAR.

scholarly journals Outcomes of single physician-modified fenestrated stent grafts for endovascular repair of thoracic aortic lesions involving the distal aortic arch

2020 ◽  
Author(s):  
Jiechang Zhu ◽  
Chao Ma ◽  
Xiangchen Dai ◽  
Zheng Wang ◽  
Hailun Fan ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Acute Type ◽  
Type B ◽  
Stent Grafts ◽  
Aortic Repair ◽  
Type B Dissection ◽  
Aortic Pathologies ◽  
Aortic Lesions

Abstract OBJECTIVES Our goal was to evaluate the outcomes of fenestrated thoracic endovascular aortic repair of thoracic aortic lesions involving the distal aortic arch using single physician-modified stent grafts. METHODS This single-centre, retrospective study included 58 consecutive patients (mean age, 57 ± 14 years; 11 women) who underwent fenestrated thoracic endovascular aortic repair for thoracic aortic pathologies involving the distal aortic arch using single physician-modified stent grafts between November 2015 and December 2018. Indications included complicated acute type B dissection or intramural haematoma with an unfavourable proximal landing zone (n = 49), type Ia endoleak subsequent to thoracic endovascular aortic repair due to acute type B dissection (n = 1) and distal arch degenerative aneurysms <15 mm from the left subclavian artery (n = 8). RESULTS The technical success rate was 94.8%. The 30-day mortality was 1.7%, and the perioperative ischaemic stroke rate was 1.7%. The incidence of perioperative complications was 10.3%. At a mean follow-up of 26.3 months (range, 7–44), all target vessels were patent. All-cause mortality was 5.2%. Estimated 1-, 2- and 3-year survival was 98.3 ± 1.7%, 96.4 ± 2.5% and 93.2 ± 3.9%, respectively. CONCLUSION The single fenestrated stent graft technique is feasible and effective for endovascular repair of thoracic aortic pathologies involving the distal aortic arch.

scholarly journals PC076. Thoracic Sarcopenia Is a Specific Predictor of Late Mortality After Thoracic Endovascular Aortic Repair in Patients With Chronic Aortic Disease

2018 ◽  
Vol 67 (6) ◽  
pp. e195-e196
Author(s):  
Sydney Olson ◽  
Annalise Panthofer ◽  
Donald Harris ◽  
William D. Jordan ◽  
Mark A. Farber ◽  
...  
Keyword(s):  
Aortic Disease ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Late Mortality ◽  
Aortic Repair

Impact of Thoracic Endovascular Aortic Repair on Pulsatile Circumferential and Longitudinal Strain in Patients With Aneurysm

2017 ◽  
Vol 24 (2) ◽  
pp. 281-289 ◽  
Author(s):  
Foeke J. H. Nauta ◽  
Guido H. W. van Bogerijen ◽  
Chiara Trentin ◽  
Michele Conti ◽  
Ferdinando Auricchio ◽  
...  
Keyword(s):  
Longitudinal Strain ◽  
Celiac Trunk ◽  
Ascending Aorta ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Sinotubular Junction ◽  
Aortic Repair ◽  
Brachiocephalic Trunk ◽  
The Impact ◽  
Longitudinal Strains

Purpose: To quantify both pulsatile longitudinal and circumferential aortic strains before and after thoracic endovascular aortic repair (TEVAR), potentially clarifying TEVAR-related complications. Methods: This retrospective study assessed the impact of TEVAR on pulsatile aortic strains through custom developed software and cardiac-gated computed tomography imaging of 8 thoracic aneurysm patients (mean age 71.0±8.2 years; 6 men) performed before TEVAR and during follow-up (median 0.1 months, interquartile range 0.1–5.8). Lengths of the ascending aorta, the aortic arch, and the descending aorta were measured. Diameters and areas were computed at the sinotubular junction, brachiocephalic trunk, left subclavian artery, and the celiac trunk. Pulsatile longitudinal and circumferential strains were quantified as systolic increments of length and circumference divided by the corresponding diastolic values. Results: Average pulsatile longitudinal strain ranged from 1.4% to 7.1%, was highest in the arch (p<0.001), and increased after TEVAR by 77% in the arch (7.1%±2.5% vs 12.5%±5.1%, p=0.04) and by 69% in the ascending aorta (5.6±2.3% vs 9.4±4.4%, p=0.06). Average pulsatile circumferential strain ranged from 3.6% to 5.0% before TEVAR and did not differ significantly throughout the thoracic aorta; there was a nonsignificant increase after TEVAR at the unstented sinotubular junction (5.0%±1.4% vs 6.3%±1.0%, p=0.18), with a significant increase at the celiac trunk (3.6%±1.8% vs 6.2%±1.8%, p=0.02). Pulsatile circumferential strains within stented segments were deemed unreliable due to image artifacts. Conclusion: TEVAR was associated with an increase of pulsatile longitudinal strains (in the arch) and circumferential strains (at the celiac trunk) in unstented aortic segments. These observations suggest increased pulsatile wall stress after TEVAR in segments adjacent to the device, which may contribute to the understanding of stent-graft–related complications such as retrograde dissection, aneurysm formation, and rupture.

Sign in / Sign up

Export Citation Format

Share Document