Endovascular Treatment for Nontraumatic Rupture of the Descending Thoracic Aorta: Long-Term Results

Background Replacement of the descending thoracic aorta is traditionally performed via a left thoracotomy. Endovascular treatment of descending thoracic aortic aneurysms has recently evolved as an alternative treatment for selected patients, yet no long-term results are available. The authors replaced the descending thoracic aorta in a group of pigs with an interposition Dacron graft using a closed-chest, totally robotic technique. Methods Ten pigs, weighing 25 to 45 kg, underwent surgery using the DaVinci robotic surgical system. Under single-lung ventilation and CO2 insufflation, the descending thoracic aorta was completely mobilized. Proximal and distal cross-clamps were applied through separate accessory stab wounds. The mid-descending thoracic aorta was excised. An interposition Dacron graft was robotically sewn in an end-to-end fashion to the descending thoracic aorta using interrupted nitinol clips. Results All animals survived the procedure. Mean aortic clamp time was 55 ± 14 minutes. All anastomoses were completed without difficulty with a mean total anastomotic time of 42 ± 11 minutes. The anastomoses were challenged for bleeding by administrating α1-adrenergic receptor agonists to a systolic blood pressure of 200 mm Hg with no evidence of leak. Discussion Robotic replacement of the thoracic aorta is feasible and reproducible. This procedure provides the standard Dacron graft repair with its known long-term results. The added value of robotic technology to the therapeutic armamentarium in the treatment of thoracic aortic aneurysms may be worth the effort required for procedural development. Furthermore, it may serve as a valid alternative to endovascular treatment of thoracic aortic aneurysms.

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Use of the Descending Thoracic Aorta as an Inflow Source in Aortoiliac Reconstruction: Indications and Long-Term Results

Annals of Vascular Surgery ◽

10.1007/bf02133404 ◽

1994 ◽

Vol 8 (1) ◽

pp. 38-47 ◽

Cited By ~ 21

Author(s):

Enrique Criado ◽

Blair A. Keagy

Keyword(s):

Thoracic Aorta ◽

Long Term Results ◽

Descending Thoracic Aorta ◽

Aortoiliac Reconstruction

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Long-term Results of the Surgical Treatment of Intra-mural Hematomas of the Descending Thoracic Aorta

Annals of Vascular Surgery ◽

10.1016/j.avsg.2014.06.042 ◽

2014 ◽

Vol 28 (6) ◽

pp. 1371

Author(s):

Aurélien Felisaz ◽

Olivier Coffin ◽

Djelloul Gouicem ◽

Laura Palcau ◽

Elise Mackowiak ◽

...

Keyword(s):

Surgical Treatment ◽

Thoracic Aorta ◽

Long Term Results ◽

Descending Thoracic Aorta

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Mid- and Long-Term Results of Endovascular Treatment in Thoracic Aorta Blunt Trauma

The Scientific World JOURNAL ◽

10.1100/2012/396873 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4 ◽

Cited By ~ 7

Author(s):

Luigi Irace ◽

Antonella Laurito ◽

Salvatore Venosi ◽

Francesco Giosuè Irace ◽

Alban Malay ◽

...

Keyword(s):

Endovascular Treatment ◽

Thoracic Aorta ◽

Long Term Results ◽

Blunt Injury ◽

Type I ◽

Ischemic Complications ◽

Type I Endoleak ◽

Low Incidence ◽

Good Patency

Study Aim. Evaluation of results in blunt injury of the thoracic aorta (BAI) endovascular treatment.Materials and Methods. Sixteen patients were treated for BAI. Thirteen patients had associated polytrauma, 4 of these had a serious hypotensive status and 4 had an hemothorax. In the remaining 3, two had a post-traumatic false aneurysm of the isthmus and 1 had a segmental dissection. In those 13 patients a periaortic hematoma was associated to hemothorax in 4. All patients were submitted to an endovascular treatment, in two cases the subclavian artery ostium was intentionally covered.Results. One patient died for disseminated intravascular coagulation. No paraplegia was recorded. No ischemic complications were observed. A type I endoleak was treated by an adjunctive cuff. During the followup (1–9 years) 3 patients were lost. A good patency and no endoleaks were observed in all cases. One infolding and 1 migration of the endografts were corrected by an adjunctive cuff.Conclusion. The medium and long term results of the endovascular treatment of BAI are encouraging with a low incidence rate of mortality and complications. More suitable endo-suite and endografts could be a crucial point for the further improvement of these results.

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Endovascular treatment of an aneurysm of the descending thoracic aorta in a heart transplant recipient: long-term result

European Journal of Cardio-Thoracic Surgery ◽

10.1016/j.ejcts.2007.12.029 ◽

2008 ◽

Vol 33 (3) ◽

pp. 518-520

Author(s):

Louis Labrousse ◽

Michel Montaudon ◽

Marc-Alain Billes ◽

Claude Deville

Keyword(s):

Transplant Recipient ◽

Endovascular Treatment ◽

Thoracic Aorta ◽

Heart Transplant ◽

Heart Transplant Recipient ◽

Descending Thoracic Aorta ◽

Term Result ◽

Long Term Result

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Treatment of traumatic rupture of the thoracic aorta

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh0810498d ◽

2008 ◽

Vol 136 (9-10) ◽

pp. 498-504 ◽

Cited By ~ 1

Author(s):

Lazar Davidovic ◽

Miroslav Markovic ◽

Momcilo Colic ◽

Nikola Ilic ◽

Igor Koncar ◽

...

Keyword(s):

Surgical Treatment ◽

Mortality Rate ◽

Endovascular Treatment ◽

Thoracic Aorta ◽

Good Condition ◽

Long Term Results ◽

Traumatic Rupture ◽

Published Data ◽

Aorta Rupture

INTRODUCTION Interest for traumatic thoracic aorta rupture stems from the fact that its number continually increases, and it can be rapidly lethal. OBJECTIVE The aim of this study is to present early and long term results as well as experiences of our team in surgical treatment of traumatic thoracic aorta rupture. METHOD Our retrospective study includes 12 patients with traumatic thoracic aorta rupture treated between 1985 and 2007. There were 10 male and two female patients of average age 30.75 years (18-74). RESULTS In six cases, primary diagnosis was established during the first seven days days after trauma, while in 6 more than one month later. In 11 cases, classical open surgical procedure was performed, while endovascular treatment was used in one patient. Three (25%) patients died, while two (16.6%) had paraplegia. Nine patients (75%) were treated without complications, and are in good condition after a mean follow-up period of 9.7 years (from one month to 22 years). CONCLUSION Surgical treatment requires spinal cord protection to prevent paraplegia, using cardiopulmonary by-pass (three of our cases) or external heparin-bonded shunts (five of our cases). Cardiopulmonary by-pass is followed with lower incidence of paraplegia, however it is not such a good solution for patients with polytrauma because of hemorrhage. The endovascular repair is a safe and feasible procedure in the acute phase, especially because of traumatic shock and polytrauma which contributes to higher mortality rate after open surgery. On the other hand, in chronic postrauamatic aortic rupture, open surgical treatment is connected with a lower mortality rate and good long-term results. There have been no published data about long-term results of endovascular treatment in the chronic phase.

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