Ten-Year Follow-Up after Endovascular Repair of Traumatic Abdominal Aortic Rupture

2011 ◽  
Vol 6 (1) ◽  
pp. 51-53
Author(s):  
Stephen Nicholls ◽  
Riyad Karmy-Jones
Keyword(s):  
Endovascular Repair ◽  
Aortic Rupture ◽  
Graft Infection ◽  
Aortic Injury ◽  
Bowel Injury ◽  
Operative Repair ◽  
Abdominal Aortic ◽  
Aortic Injuries ◽  
And Migration

Blunt abdominal aortic injury is often associated with bowel injury that precludes operative repair because of the risk of graft infection. Endovascular repair has been reported but with limited follow-up. We present a case of a 15-year-old boy who underwent endovascular repair of blunt abdominal aortic rupture and whom we were able to follow up over a decade. Our experience with this case and three others, as well as the experience reported in the literature, suggests that endovascular repair is a reasonable option in the setting of concomitant bowel injury. The risk of over sizing, collapse, and migration may be less than that described for thoracic aortic injuries because there is no need to deploy the endograft across an angle.

Use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) as a bridge to endovascular aortic repair (EVAR) in blunt abdominal aortic injury (BAAI).

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Valentina Chiarini
Keyword(s):  
Trauma Center ◽  
Aortic Rupture ◽  
Damage Control ◽  
Aortic Injury ◽  
Balloon Occlusion ◽  
Traumatic Lesion ◽  
Abdominal Aortic ◽  
Aortic Injuries ◽  
Accepted Practice ◽  
Endovascular Balloon Occlusion

BAAI is a rare but challenging traumatic lesion. Since BAAI is difficult to suspect and diagnose, frequently lethal and associated to multiorgan injuries, its management is objective of research and discussion. REBOA is an accepted practice in ruptured abdominal aortic aneurysm. Conversely, blunt aortic injuries are the currently most cited contraindications for the use of REBOA in trauma, together with thoracic lesions. We reported a case of BAAI safely managed in our Trauma Center at Maggiore Hospital in Bologna (Italy) utilizing REBOA as a bridge to endovascular repair, since there were no imminent indications for laparotomy. Despite formal contraindication to placing REBOA in aortic rupture, we hypothesized that this approach could be feasible and relatively safe when introduced in a resuscitative damage control protocol.

Emergent Endoluminal Repair of Delayed Abdominal Aortic Rupture after Blunt Trauma

1998 ◽  
Vol 5 (2) ◽  
pp. 134-137 ◽  
Author(s):  
Reinhard Scharrer-Pamler ◽  
Johannes Görich ◽  
Karl H. Orend ◽  
Roman Sokiranski ◽  
Ludger Sunder-Plassmann
Keyword(s):  
Bacterial Contamination ◽  
Aortic Rupture ◽  
Good Health ◽  
Aortic Injury ◽  
Abdominal Injuries ◽  
Hepatic Rupture ◽  
Motorcycle Accident ◽  
Endoluminal Repair ◽  
Abdominal Aortic ◽  
Aortic Injuries

Purpose: To report the emergency repair of a traumatic abdominal aortic rupture using endoluminal techniques. Methods and Results: A 25-year-old female sustained multiple head, chest, and abdominal injuries in a motorcycle accident. Six days after emergency treatment (including splenectomy and repair of a superficial hepatic rupture and lacerations to the stomach, small bowel, and colon), she became hemodynamically unstable. A massive retroperitoneal hematoma had evolved from a distal aortic rupture. Owing to a hostile abdomen and possibility of bacterial contamination, a self-expanding stent-graft was inserted transfemorally to repair the aortic injury. The patient recovered uneventfully and continues in good health with a patent endograft repair 2 years after treatment. Conclusions: This experience would support the efficacy of endograft implantation for emergent repair of trauma aortic injuries; however, proper facilities, an experienced interventional team, and an assortment of endografts and stents must be available.

scholarly journals Late surgical conversions after abdominal endovascular aortic repair: underlying mechanisms, clinical results and strategies for prevention

2019 ◽  
Vol 29 (6) ◽  
pp. 944-949
Author(s):  
Andrzej Juraszek ◽  
Bartosz Rylski ◽  
Stoyan Kondov ◽  
Johannes Scheumann ◽  
Maximilian Kreibich ◽  
...  
Keyword(s):  
Aortic Rupture ◽  
Graft Infection ◽  
Endovascular Aneurysm Repair ◽  
Clinical Results ◽  
Late Complications ◽  
Landing Zone ◽  
Trade Offs ◽  
Abdominal Aortic ◽  
The Mean

Abstract OBJECTIVES Our goal was to report our results of late surgical conversion after endovascular aneurysm repair (EVAR). METHODS Variables analysed included baseline data, preinterventional anatomy, type of endovascular intervention, indications for conversion, operative technique, postoperative complications and follow-up survival rate. RESULTS Between April 2011 and May 2018, 16 patients with late complications after EVAR underwent open surgical conversion at our institution. The mean age was 73.6 [standard deviation (SD) 8.9] years. There were 3 (18.8%) female patients. In 15 patients, the indication for primary EVAR was abdominal aortic aneurysm, and in 1 patient, chronic abdominal aortic dissection. Five patients underwent secondary EVAR service interventions for endoleak treatment between the index EVAR and the final secondary surgical conversion. Thirteen patients underwent surgery in an elective setting and 3 patients underwent emergency surgery. The mean time from EVAR to open surgical conversion was 6.31 (SD 4.0) years (range 1.2–16.0 years). The most common indication for conversion was endoleak formation (n = 12, 75%), followed by 3 cases of aortic rupture (1 patient with primary type 1 endoleak) and 2 cases of stent graft infection—1 with and 1 without an aortoduodenal fistula. One patient died during emergency open surgery of cardiopulmonary instability. Three patients developed postoperative renal dysfunction with recovery of their renal function before discharge. The in-hospital mortality rate was 12.5%. The median follow-up was 16.5 months (interquartile range 21 months). Freedom from death and aortic reintervention was 100%, respectively. After careful review of the index computed tomography scans for EVAR, the majority of failures could have been anticipated due to trade-offs with regard to length, diameter, morphology, shape and angulation of the proximal and/or distal landing zone. CONCLUSIONS Despite being a challenging operation, late surgical conversion after EVAR yields excellent results with regard to outcome and freedom from the need for further aortic interventions. An anticipative strategy adhering to current recommendations for using or refraining from using EVAR in patients with anatomical challenges will help reduce the need for secondary surgical conversions and keep them to minimum.

scholarly journals Delayed Graft Dislocation After Thoracic Aortic Endovascular Repair

2015 ◽  
Vol 12 (2) ◽  
pp. 97-100 ◽  
Author(s):  
G Piffaretti ◽  
S Negri ◽  
S Ferraro ◽  
M Bossi ◽  
N Rivolta ◽  
...  
Keyword(s):  
Endovascular Repair ◽  
Aortic Disease ◽  
Anatomical Landmarks ◽  
Predisposing Factor ◽  
Imaging Protocol ◽  
Aortic Lesion ◽  
Landing Zone ◽  
Abdominal Aortic ◽  
And Migration

Background Endograft dislocation in thoracic aorta has not been widely studied.Objectives The purpose of this study is to analyze the incidence and predisposing factor in a single centre experience after 117 procedures.Method Between November 2000 and December 2011, all consecutive patients undergoing endovascular repair for descending thoracic or thoraco-abdominal aortic disease were identified. Follow-up imaging protocol included triple-phase CT-angiography at 1, 4, and 12 months, and annually thereafter. Migration was defined as proximal/ distal movements >10 mm relative to anatomical landmarks or any movement leading to symptoms or reintervention.Result We identified 117 patients. Mean follow-up was 32 months (range, 1-144). Overall, five (4.3%) patients with thoracic EG dislocation were identified. Dislocation was classified as collapse/infolding in 3 cases and migration in 2. Mean delay of the dislocation was 12.7 months. Only one patient developed symptoms and required an additional endograft. In the group of dislocated endografts, mean age (53 ± 20 vs. 68 ± 15, P = .032) and the diameter of the aortic lesion were lower (4.1cm ± 1.6 vs. 5.6cm ± 1.8, P = .069), and the proximal landing zone at “zones 2 and 3” were more frequently used (5 vs. 65, P = 0.81). All but one patient with collapse/infolding are still alive and doing well at a mean follow-up of 80 months.Conclusion Dislocation is an infrequent complication, but not so rare. Young age, small aortic diameter , and proximal sealing at the distal arch were the most important data associated with this complication.Kathmandu University Medical Journal Vol.12(2) 2014: 97-100

scholarly journals Endovascular Repair of a Blunt Abdominal Aortic Injury

2012 ◽  
Vol 21 (02) ◽  
pp. 117-120 ◽  
Author(s):  
William Tobler ◽  
Tze-Woei Tan ◽  
Alik Farber
Keyword(s):  
Endovascular Repair ◽  
Aortic Injury ◽  
Abdominal Aortic

Transcatheter, Endovascular Repair of Abdominal Aortic Aneurysm: Feasibility, Noninvasive Diagnosis, Problems, and Follow-Up

1999 ◽  
Vol 16 (6) ◽  
pp. 617-623
Author(s):  
ITZHAK KRONZON ◽  
MATHEW VARKEY ◽  
PAUL A. TUNICK ◽  
THOMAS RILES ◽  
ROBERT ROSEN
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Endovascular Repair ◽  
Noninvasive Diagnosis ◽  
Abdominal Aortic

Aortic graft infection and mycotic aneurysm with Streptococcus equi zooepidemicus: two cases with favorable outcome of antibiotic treatment

Vascular ◽  
2012 ◽  
Vol 21 (1) ◽  
pp. 6-9 ◽  
Author(s):  
Martin Altreuther ◽  
Conrad Lange ◽  
Hans Olav Myhre ◽  
Raisa Hannula
Keyword(s):  
Graft Infection ◽  
Endovascular Aneurysm Repair ◽  
Prolonged Treatment ◽  
Animal Products ◽  
Open Operation ◽  
Abdominal Aortic ◽  
Streptococcus Equi ◽  
Aortic Graft Infection ◽  
Aneurysm Repair

Infections with Streptococcus equi zooepidemicus are rare and are associated with contact with animals or animal products. There are very few reports about infected vascular grafts or aneurysms with this etiology. We present two patients. The first is a 77-year-old man with an infected bifurcated graft four years after an open operation for an abdominal aortic aneurysm (AAA). The second is a 72-year-old man with a symptomatic mycotic AAA, treated with endovascular aneurysm repair. Both received prolonged treatment with bactericidal antibiotics and responded well. Follow-up time at present is 5.5 years for the first, and 4.5 years for the second, patient.

scholarly journals Endovascular repair of thoraco-abdominal aortic aneurysms by fenestrated and branched endografts†

2019 ◽  
Vol 56 (5) ◽  
pp. 993-1000 ◽  
Author(s):  
Enrico Gallitto ◽  
Gianluca Faggioli ◽  
Rodolfo Pini ◽  
Chiara Mascoli ◽  
Stefano Ancetti ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Hospital Mortality ◽  
Endovascular Repair ◽  
Endovascular Aneurysm Repair ◽  
Abdominal Aortic Aneurysms ◽  
Aortic Aneurysms ◽  
Abdominal Aortic ◽  
The Mean ◽  
Aneurysm Repair

Abstract OBJECTIVES Our objective was to report the outcomes of fenestrated/branched endovascular aneurysm repair of thoraco-abdominal aortic aneurysms (TAAAs) with endografts. METHODS Between January 2010 and April 2018, patients with TAAAs, considered at high surgical risk for open surgery and treated by Cook-Zenith fenestrated/branched endovascular aneurysm repair, were prospectively enrolled and retrospectively analysed. The early end points were 30-day/hospital mortality rate, spinal cord ischaemia and 30-day cardiopulmonary and nephrological morbidity. Follow-up end points were survival, patency of target visceral vessels and freedom from reinterventions. RESULTS Eighty-eight patients (male: 77%; mean age: 73 ± 7 years; American Society of Anesthesiologists 3/4: 58/42%) were enrolled. Using Crawford’s classification, 43 (49%) were types I–III and 45 (51%) were type IV TAAAs. The mean aneurysm diameter was 65 ± 15 mm. Custom-made and off-the-shelf endografts were used in 60 (68%) and 28 (32%) cases, respectively. Five (6%) patients had a contained ruptured TAAA. The procedure was performed in multiple steps in 42 (48%) cases. There was 1 (1%) intraoperative death. Five (6%) patients suffered spinal cord ischaemia with permanent paraplegia in 3 (3%) cases. Postoperative cardiac and pulmonary complications occurred in 7 (8%) and 12 (14%) patients, respectively. Worsening of renal function (≥30% of baseline level) was detected in 11 (13%) cases, and 2 (2%) patients required haemodialysis. The 30-day and hospital mortality rates were 5% and 8%, respectively. The mean follow-up was 36 ± 22 months. Survival at 12, 24 and 36 months was 89%, 75% and 70%, respectively. The patency of target visceral vessels at 12, 24 and 36 months was 92%, 92% and 92%, respectively. Freedom from reinterventions at 12, 24 and 36 months was 85%, 85% and 83%, respectively. CONCLUSIONS The endovascular repair of TAAAs with fenestrated/branched endovascular aneurysm repair is feasible and effective with acceptable technical/clinical outcomes at early/midterm follow-up.

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