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.

Evaluation of EndoAnchor Aortic Wall Penetration After Thoracic Endovascular Aortic Repair

2020 ◽  
Vol 27 (2) ◽  
pp. 240-247
Author(s):  
Andrés Reyes Valdivia ◽  
Sara Busto Suárez ◽  
África Duque Santos ◽  
Ahmad Amer Zanabili Al-Sibbai ◽  
Claudio Gandarias Zúñiga ◽  
...  
Keyword(s):  
Thoracic Aorta ◽  
Aortic Wall ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Descending Thoracic Aorta ◽  
Aortic Repair ◽  
Type Ia ◽  
Endograft Infection ◽  
Academic Vascular Surgery

Purpose: To analyze aortic wall penetration of Heli-FX EndoAnchors after use in seal zones in the aortic arch or descending thoracic aorta during thoracic endovascular aortic repair (TEVAR). Materials and Methods: From May 2014 to May 2019, 25 patients (mean age 70.5±10 years; 16 women) were treated with TEVAR and adjunctive use of the Heli-FX device in 3 academic vascular surgery departments. Computed tomography scans were retrospectively reviewed to determine the location [arch or descending thoracic aorta (DTA)] of the EndoAnchors and the adequacy of aortic wall penetration, defined as adequate (≥2 mm), partial (<2 mm), or inadequate wall penetration (including loss). Endoleaks, reinterventions, and mortality were assessed. Results: A total of 161 EndoAnchors were deployed (median 7 per patient, range 4–9). Twenty-two EndoAnchors were place in the arch (zones 0–2) and 139 in the DTA (zones 3–5). A larger proportion of arch deployments (27%) had suboptimal penetration compared with the DTA (6.5%; p<0.005), resulting in a 91% adequate wall penetration rate for the series overall. Three EndoAnchors were lost (and only 1 retrieved) in 3 different patients, with no additional morbidity; thus, an overall deployment success rate of 88% was achieved. At a mean follow-up of 16.6±14 months, 4 patients required 5 (successful) reinterventions, including one for a type Ia endoleak treated with chimney TEVAR. One patient died 10 months after treatment due to endograft infection, without an opportunity for surgical correction. Conclusion: EndoAnchors have a higher risk of maldeployment in the arch, though this may be attributable to the small learning curve experience in this location. The best aortic wall penetration for this series was in the DTA, where EndoAnchors proved useful for distal endograft fixation during TEVAR.

scholarly journals Thoracic Endovascular Aortic Repair in a Patient with Mobile Aortic Thrombosis

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Graham M. Lohrmann ◽  
Ferande Peters
Keyword(s):  
Multimodality Imaging ◽  
Splenic Infarction ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Clinical Scenario ◽  
Descending Thoracic Aorta ◽  
Aortic Repair ◽  
Arterial Insufficiency ◽  
One Year ◽  
Cardiovascular Evaluation

A 58-year-old female presented with acute arterial insufficiency to her left leg. Following cardiovascular evaluation using multimodality imaging, it was discovered that she had mobile thoracic thrombi overlying a normal descending thoracic aorta which had also caused a splenic infarction. This patient was treated with unfractionated heparin for three days and underwent subsequent thoracic endovascular aortic repair (TEVAR) uneventfully with no subsequent complications at one-year followup. This case highlights the diagnostic and therapeutic challenges in treating patients with this uncommon challenging clinical scenario.

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 Thirty-day outcomes from the Society for Vascular Surgery Vascular Quality Initiative thoracic endovascular aortic repair for type B dissection project

2019 ◽  
Vol 69 (3) ◽  
pp. 680-691 ◽  
Author(s):  
Grace J. Wang ◽  
Richard P. Cambria ◽  
Joseph V. Lombardi ◽  
Ali Azizzadeh ◽  
Rodney A. White ◽  
...  
Keyword(s):  
Vascular Surgery ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Type B ◽  
Aortic Repair ◽  
Type B Dissection

scholarly journals A New Methodology to Determine Apposition, Dilatation, and Position of Endografts in the Descending Thoracic Aorta After Thoracic Endovascular Aortic Repair

2019 ◽  
Vol 26 (5) ◽  
pp. 679-687 ◽  
Author(s):  
Kim van Noort ◽  
Richte C. L. Schuurmann ◽  
Gersom Post Hospers ◽  
Emma van der Weijde ◽  
Hans G. Smeenk ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Thoracic Aorta ◽  
Thoracic Aortic Aneurysm ◽  
Interobserver Agreement ◽  
Interobserver Variability ◽  
Thoracic Endovascular Aortic Repair ◽  
Descending Thoracic Aorta ◽  
Applied Software ◽  
Shortest Distance ◽  
The Mean

Purpose: To validate computed tomography angiography (CTA)–applied software to assess apposition, dilatation, and position of endografts in the proximal and distal landing zones after thoracic endovascular aortic repair (TEVAR) of thoracic aortic aneurysm. Materials and Methods: Twenty-two patients (median age 75.5 years; 11 men) with a degenerative descending thoracic aortic aneurysm treated with TEVAR with at least one postoperative CTA were selected from a single center’s database. New CTA-applied software was used to determine the available apposition surface in the proximal and distal landing zones, apposition of the endograft fabric with the aortic wall, shortest apposition length, endograft inflow and outflow diameters, shortest distance between the left subclavian artery and the proximal endograft fabric, and shortest distance between the celiac trunk and the distal endograft fabric on each CTA. Interobserver variability for these parameters was assessed with the repeatability coefficient and the intraclass correlation coefficient. Results: Excellent interobserver agreement was found for all measurements. Interobserver variability of surface and shortest apposition length calculations was larger for the distal site compared with the proximal site, with a mean difference of 10% vs 2% of the mean available apposition surface, 12% vs 5% of the endograft apposition surface, and 16% vs 8% of the shortest apposition length, respectively. Inflow and outflow diameters of the endograft showed low variability, with a mean difference of 0.1 mm with 95% of the interobserver difference within 1.8 mm. Mean interobserver differences of the proximal and distal shortest fabric distances were 1.0 and 0.9 mm (both 2% of the mean lengths). Conclusion: Assessment of apposition, dilatation, and position of the proximal and distal parts of an endograft in the descending thoracic aorta is feasible after TEVAR with the new software. Interobserver agreement for all measured parameters was excellent for the proximal and distal landing zones. The new method allows detection of subtle changes during follow-up. However, a larger study is needed to quantify how parameters change over time in complicated and uncomplicated TEVAR cases and to define the real added value of the new methodology.

Endovascular versus open treatment of degenerative aneurysms of the descending thoracic aorta: a single center experience

Vascular ◽  
2011 ◽  
Vol 19 (1) ◽  
pp. 8-14 ◽  
Author(s):  
Joachim Andrassy ◽  
Rolf Weidenhagen ◽  
Georgios Meimarakis ◽  
M Rentsch ◽  
K-W Jauch ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Thoracic Aorta ◽  
Open Surgery ◽  
Aortic Aneurysms ◽  
Descending Thoracic Aorta ◽  
Entire Cohort ◽  
Thoracic Aortic Aneurysms ◽  
Asymptomatic Patients ◽  
Open Treatment ◽  
One Year

Multiple reports could show a reduced risk for thoracic endovascular aortic repair (TEVAR) compared with open treatment. The aim of this study was to evaluate our twelve-year TEVAR experience for thoracic aortic aneurysms and compare these results with open repair. All patients who had received either open or endovascular surgery for a degenerative aortic aneurysm of the descending thoracic aorta in our center were evaluated retrospectively. N = 53 TEVAR patients (1997–2008) were included and their course was compared with an open-surgery group of n = 24 patients (1992–2002). The percentage of symptomatic patients was 43% (TEVAR) and 42% (open surgery). Endovascular treatment resulted in a significantly reduced 30-day (5.7% versus 25% P = 0.02) and one-year mortality (19% versus 42% P = 0.05) in the entire cohort. Symptomatic patients benefited the most from TEVAR (30-day mortality: 9% versus 40%, P = 0.06; one-year mortality: 27% versus 70%, P = 0.049) whereas the survival of our asymptomatic patients was not significantly different (30-day mortality: 3% versus 14%, P = 0.22; one-year mortality: 13% versus 21%, P = 0.65). Lastly, Kaplan–Meier analysis showed a significantly improved survival after TEVAR ( P = 0.05) and in particular for the symptomatic patients ( P = 0.003). In conclusion, endovascular treatment for patients with degenerative thoracic aortic aneurysms has significant advantages over open surgery.

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