scholarly journals Stent graft in abdominal aortic aneurysm collapsed suddenly after thoracic endovascular aortic repair

2021 ◽  
Vol 14 (12) ◽  
pp. e246798
Author(s):  
Sho Takagi ◽  
Yoshihiro Goto ◽  
Junji Yanagisawa ◽  
Akio Nakasu
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Stent Graft ◽  
Endovascular Aneurysm Repair ◽  
Rare Event ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Aortic Repair ◽  
Abdominal Aortic ◽  
Aneurysm Repair

Stent graft collapse due to aortic dissection is an extremely rare event. Although endovascular aneurysm repair (EVAR) and thoracic endovascular aortic repair (TEVAR) are increasingly being performed, various complications can occur. We report a case of collapse of a stent graft, which was used to repair an abdominal aortic aneurysm (AAA) after TEVAR for thoracic aortic aneurysm (TAA). A 72-year-old man with a 77 mm AAA and 60 mm TAA underwent EVAR and a TEVAR 2 months later, respectively. CT performed after the TEVAR showed thoracic aorta dissection with associated AAA stent graft collapse. The graft collapsed was due to superior mesenteric artery obstruction. An emergency TEVAR was performed, and the procedure improved the collapsed graft; however, the endoleak of the AAA stent graft persisted. The AAA expanded over several days, warranting an open repair. Our case provides an insight into the cautionary indications for endovascular therapy.

scholarly journals Combined thoracic endovascular aortic repair and endovascular aneurysm repair and the long-term consequences of altered cardiovascular haemodynamics on morbidity and mortality: case series and literature review

2021 ◽  
Vol 5 (10) ◽  
Author(s):  
Sherif Sultan ◽  
Yogesh Acharya ◽  
Mohiey Hazima ◽  
Hiba Salahat ◽  
Juan Carlos Parodi ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Endovascular Aneurysm Repair ◽  
Left Ventricular ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Coronary Perfusion ◽  
Aortic Repair ◽  
Abdominal Aortic ◽  
Aneurysm Repair ◽  
Compliance Mismatch

Abstract Background Thoracic and abdominal aortic stent grafts are firmer and more rigid than the native aorta. Aortic implanted devices have been implicated in the development of acute systolic hypertension, elevated pulse pressure, and reduced coronary perfusion. Case summary We report four cases of staged thoracic endovascular aortic repair (TEVAR) and then endovascular aneurysm repair (EVAR). All patients had TEVAR first for thoracic aortic aneurysm and later on developed infra-renal abdominal aortic aneurysm (AAA) that required EVAR. There were three males and one female with a median age of 74.5 years (range 67.5–78.5). None of the patients developed aortic-related major clinical adverse effects or required any aortic intervention during their follow-up. However, within 2 years, all patients developed symptomatic left ventricular hypertrophy with diastolic dysfunction. All patients had bilateral lower limb oedema, with on and off chest pain and shortness of breath (SOB), necessitating coronary angiograms, which showed no evidence of coronary artery disease. Three patients died from cardiovascular-related morbidities, and the fourth patient is still complaining of SOB despite a normal coronary angiogram. Discussion Aortic-endograft compliance mismatch is an invisible enemy, with troubling consequences for the aorta proximal and distal to the endograft. Aortic stiffness due to vascular endograft could lead to cardiovascular adverse events, even in the absence of direct aortic-related complications. After combined TEVAR and EVAR, the compliance mismatch and elasticity loss are even more pronounced than with TEVAR alone, which necessitates patient monitoring for the development of cardiovascular complications.

Fatal Complications of New-Onset Complicated Type B Aortic Dissection After Endovascular Abdominal Aortic Aneurysm Repair: Report of 2 Cases and Literature Review

2018 ◽  
Vol 53 (3) ◽  
pp. 255-258 ◽  
Author(s):  
Yoshikatsu Nomura ◽  
Kanetsugu Nagao ◽  
Shota Hasegawa ◽  
Motoharu Kawashima ◽  
Takanori Tsujimoto ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Aortic Dissection ◽  
Stent Graft ◽  
Endovascular Aneurysm Repair ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Abdominal Aortic ◽  
Aneurysm Repair ◽  
New Onset

New-onset antegrade Stanford type B aortic dissection (TBAD) after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) is rare. The extension of aortic dissection leads to various symptoms and affects the stent graft. Moreover, various symptoms may arise owing to a stent graft being present. We describe 2 cases of complicated acute TBAD occurring after EVAR, which were ultimately fatal. The case in which rupture occurred could not be treated and the patient died. In another case with bilateral lower extremity malperfusion caused by collapse and occlusion of the endograft, extra-anatomical bypass was performed. Although the collapsed endograft gradually re-expanded, the patient ultimately died because of multiorgan failure. We have reviewed the literature and analyzed the treatment of complicated TBAD after EVAR.

3D printing guiding stent graft fenestration: A novel technique for fenestration in endovascular aneurysm repair

Vascular ◽  
2016 ◽  
Vol 25 (4) ◽  
pp. 442-446 ◽  
Author(s):  
Jianhua Huang ◽  
Gan Li ◽  
Wei Wang ◽  
Keming Wu ◽  
Tianming Le
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
3D Printing ◽  
Aortic Aneurysm ◽  
Stent Graft ◽  
Endovascular Aneurysm Repair ◽  
Novel Approach ◽  
Abdominal Aortic ◽  
Bilateral Renal Artery ◽  
Aneurysm Repair ◽  
Aneurysm Model

Objective To describe a novel approach, 3D printing guiding stent graft fenestration, for fenestration during endovascular aneurysm repair for juxtarenal abdominal aortic aneurysm. Methods A 69-year-old male with juxtarenal abdominal aortic aneurysm underwent endovascular aneurysm repair with “off the label” fenestrated stent graft. To precisely locate the fenestration position, we reconstructed a 3D digital abdominal aortic aneurysm model and created a skin template covering this abdominal aortic aneurysm model. Then the skin template was physically printed and the position of the visceral vessel was hollowed out, thereby helping in locating the fenestration on stent graft. Results and conclusions With the help of this 3D printed skin template, we fenestrated the stent graft accurately and rebuilt the bilateral renal artery successfully. This is the first clinical case that used 3D printing guiding stent graft fenestration, which is a novel approach for precise fenestration on stent graft on the table during endovascular aneurysm repair.

Affect of Abdominal Aortic Aneurysm Stent-Graft Design on Arterial Haemodynamics

2008 ◽  
Author(s):  
David S. Molony ◽  
Anthony Callanan ◽  
Barry J. Doyle ◽  
Liam G. Morris ◽  
Michael T. Walsh ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Stent Graft ◽  
Large Diameter ◽  
Endovascular Aneurysm Repair ◽  
Abdominal Aortic ◽  
Repair Procedure ◽  
Arterial Haemodynamics ◽  
Surgical Treatments ◽  
Aneurysm Repair

Abdominal Aortic Aneurysm is an irreversible dilation of the abdominal aorta. If left untreated the aneurysm may rupture possibly leading to death. There are currently two surgical treatments for AAA, the traditional open surgery and the minimally invasive repair also known as the endovascular aneurysm repair procedure (EVAR) [1–2]. The endovascular technique having been introduced in 1991 is still beset by problems [3]. These problems mainly consist of graft migration, endoleaks and occlusion. It has been suggested that redesigning current stent-graft devices is the best method of remedying these problems [4]. Conventional graft design has normally revolved around a constant proximal diameter which includes a sudden large diameter reduction at the iliac bifurcation. In the naturally occurring case the aorta tapers into the iliac arteries.

The impact of preoperative statin therapy on open and endovascular abdominal aortic aneurysm repair outcomes

Vascular ◽  
2014 ◽  
Vol 23 (4) ◽  
pp. 344-349 ◽  
Author(s):  
Edgar Luis Galiñanes ◽  
Shaun Reynolds ◽  
Viktor Y Dombrovskiy ◽  
Todd R Vogel
Keyword(s):  
Logistic Regression ◽  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Odds Ratio ◽  
Abdominal Aortic Aneurysm Repair ◽  
Endovascular Aortic Repair ◽  
Aortic Repair ◽  
Abdominal Aortic ◽  
Aneurysm Repair ◽  
Aortic Aneurysm Repair

Objectives This study evaluated the utilization of preoperative statins and their impact on perioperative outcomes in patients undergoing open or endovascular aortic repair. Methods Patients ≥50 years of age with non-ruptured abdominal aortic aneurysm repair were identified in MedPAR files 2007–2008 utilizing ICD-9-CM codes. Preoperative statins use was identified using National Drug Codes in Part D. Chi-square test, multivariable logistic regression, Kaplan-Meier and Cox regression modeling were performed. Results In all, 19,323 patients were identified undergoing abdominal aortic aneurysm repair (14,602 endovascular aortic repair and 4721 open aortic repair); 9913 (50.3%) used statins before surgery. Bivariate analysis demonstrated lower rates of hospital, 30-, 90-day and 1-year mortality in patients with statins compared to those without statins after endovascular aortic repair (1.0% vs. 1.45%, p = 0.01; 1.51% vs. 2.3%, p = 0.0004; 3.05% vs. 4.66%, p < 0.0001; 7.91% vs. 11.56%, p < 0.0001, respectively). Multivariable logistic regression adjusting for age, gender, race, comorbidities and procedure demonstrated preoperative statins use was associated with a mortality reduction at 90-days postoperatively (odds ratio = 0.80; 95% CI 0.70–0.91, p = 0.0014) and 1-year postoperatively (odds ratio = 0.76; 95% CI 0.69–0.84, p = 0.0001). Conclusions Only half of the patients undergoing abdominal aortic aneurysm repair were prescribed preoperative statins. After adjustment, statins were significantly associated with improved survival during 1 year after surgery and a decreased incidence of lower extremity embolic complications after endovascular aortic repair. These data support a beneficial role of statin use prior to surgery for patients undergoing abdominal aortic aneurysm repair. Further prospective studies are needed to assess the benefit of statins in the perioperative period after 365 days.

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