Endovascular Grafting of Traumatic Aortic Aneurysms in Contaminated Fields

Purpose: To evaluate the potential of endovascular stent-grafts to treat traumatic aortic lesions in contaminated areas. Methods: Four patients (3 women; ages 26–78 years) underwent stent-grafting to repair an aortic rupture sustained in a motorcycle accident, aortic lacerations secondary to surgical treatment of spondylitis in 2 patients, and an aortobronchial fistula following surgical thoracic aortic repair 10 years earlier. Stent-grafts (2 Corvita, 1 Talent, and 1 Vanguard) were placed endoluminally into the infected areas via a transfemoral approach. Follow-up included erythrocyte sedimentation rate, white blood count, C-reactive protein, blood cultures, and computed tomography (CT). Results: The stent-grafts were successfully placed in all cases and excluded the aortic lesion. Under supportive antibiotic therapy, inflammation parameters returned to normal. CT imaging showed no evidence of paraprosthetic infection, nor were there any other complications over a follow-up that ranged from 3 to 34 months. Conclusions: Endovascular therapy may be an alternative in the acute management of aortic ruptures in the setting of infection. Long-term results are required for definitive evaluation of the method.

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Aortic Arch Reconstruction by Transluminally Placed Endovascular Branched Stent Graft

Circulation ◽

10.1161/circ.100.suppl_2.ii-316 ◽

1999 ◽

Vol 100 (suppl_2) ◽

Author(s):

Kanji Inoue ◽

Hiroaki Hosokawa ◽

Tomoyuki Iwase ◽

Mitsuru Sato ◽

Yuki Yoshida ◽

...

Keyword(s):

Aortic Arch ◽

Stent Graft ◽

Aortic Aneurysms ◽

Therapeutic Modality ◽

Stent Grafts ◽

Stent Grafting ◽

Thoracic Aortic Aneurysms ◽

Stent Graft Repair ◽

Aortic Dissections

Background —Recently, thoracic aortic stent grafting has emerged as an alternative therapeutic modality for patients with thoracic aortic aneurysms and aortic dissections. However, its application has been limited to descending thoracic aortic aneurysms distal to the aortic arch. We report our initial clinical experience of endovascular branched stent graft repair for aortic arch aneurysms. Methods and Results —Endovascular grafting with Inoue branched stent grafts was attempted for 15 patients with thoracic aortic aneurysms and aortic dissections under local anesthesia (n=14) or general anesthesia (n=1). Single-branched stent grafts were used in 14 patients, and a triple-branched stent graft in one. The branched stent grafts were delivered through a 22F or a 24F sheath under fluoroscopic guidance and implanted across the aneurysmal aortic arch. In 2 patients, the single-branched stent graft did not pass through the 22F sheath used. Complete thrombosis of the aneurysm was ultimately achieved in 11 patients (73%). Of 4 persistent leaks, 1 minor leak spontaneously thrombosed and 1 major leak was successfully treated by additional straight stent graft placement. In 1 patient, the right external iliac artery ruptured during the withdrawal of the sheath and was successfully repaired by the implantation of a straight stent graft. One patient with severe stenosis of the aortic graft section was successfully managed by additional stent deployment. Peripheral microembolization to a toe occurred in 1 patient, and cerebral infarction occurred in 1 other patient. Two patients who had failed to receive endovascular stent grafts died during an average follow-up of 12.6 months, 1 of pneumonia and the other of rupture of a concomitant abdominal aortic aneurysm. Conclusions —This report demonstrates the technical feasibility of endovascular branched stent graft repair for aneurysms located at the aortic arch. Careful, longer follow-up and further extensive clinical trials are awaited toward establishing this technique as a recommendable alternative to surgical treatment of thoracic aortic aneurysms.

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Endovascular repair of aortic aneurysm: Preliminary results

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh0902010d ◽

2009 ◽

Vol 137 (1-2) ◽

pp. 10-17 ◽

Cited By ~ 1

Author(s):

Lazar Davidovic ◽

Momcilo Colic ◽

Igor Koncar ◽

Dejan Markovic ◽

Dusan Kostic ◽

...

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Stent Graft ◽

Endovascular Aneurysm Repair ◽

Aortic Aneurysms ◽

Endovascular Stent ◽

Stent Grafts ◽

Graft Thrombosis ◽

Abdominal Aortic

Introduction. Endovascular aneurysm repair (EVAR) has been introduced into clinical practice at the beginning of the 90's of the last century. Because of economic, political and social problems during the last 25 years, the introduction of this procedure in Serbia was not possible. Objective. The aim of this study was to present preliminary experiences and results of the Clinic for Vascular Surgery of the Serbian Clinical Centre in Belgrade in endovascular treatment of thoracic and abdominal aortic aneurysms. Methods. The procedure was performed in 33 patients (3 female and 30 male), aged from 42 to 83 years. Ten patients had a descending thoracic aorta aneurysm (three atherosclerotic, four traumatic - three chronic and one acute as a part of polytrauma, one dissected, two penetrated atherosclerotic ulcers), while 23 patients had the abdominal aortic aneurysm, one ruptured and two isolated iliac artery aneurysms. The indications for EVAR were isthmic aneurismal localisation, aged over 80 years and associated comorbidity (cardiac, pulmonary and cerebrovasular diseases, previous thoracotomy or multiple laparotomies associated with abdominal infection, idiopatic thrombocitopaenia). All of these patients had three or more risk factors. The diagnosis was established using duplex ultrasonography, angiography and MSCT. In the case of thoracic aneurysm, a Medtronic-Valiant? endovascular stent graft was implanted, while for the abdominal aortic aneurysm Medtronic-Talent? endovascular stent grafts with delivery systems were used. In three patients, following EVAR a surgical repair of the femoral artery aneurysm was performed, and in another three patients femoro-femoral cross over bypass followed implantation of aortouniiliac stent graft. Results. During procedure and follow-up period (mean 1.6 years), there were: one death, one conversion, one endoleak type 1, six patients with endoleak type 2 that disappeared during the follow-up period, one early graft thrombosis. No other complications, including aneurysm expansion, collapse, deformity and migration of the endovascular stent grafts, were registered. Conclusion. According to all medical and economic aspects, we recommend EVAR to treat acute traumatic thoracic aortic aneurysm, as well as in elderly and high-risk patients with abdominal or thoracic aneurysms, when open surgery is related to a significantly higher mortality and morbidity.

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Delayed Aortic Stent Collapse in Blunt Traumatic Aortic Injury Repair

Aorta ◽

10.1055/s-0039-3401022 ◽

2019 ◽

Vol 07 (05) ◽

pp. 129-136

Author(s):

Abdullah Alhaizaey ◽

Badr Aljabri ◽

Musaad Alghamdi ◽

Ali AlAhmari ◽

Ahmed Abulyazied ◽

...

Keyword(s):

Aortic Arch ◽

Age Groups ◽

Young Patients ◽

Aortic Injury ◽

Stent Grafts ◽

Mortality And Morbidity ◽

Technical Success Rate ◽

Stent Grafting ◽

Blunt Traumatic Aortic Injury

Abstract Background Endovascular stent grafting has emerged as an option to treat traumatic aorta injuries with reported significantly low mortality and morbidity. Stent collapse is one of the complications that can occur in this type of treatment. The aim of this article is to analyze the expected cause of stent collapse and to draw attention to the importance of the surveillance follow-up, as this phenomenon may occur late postdeployment. Methods A retrospectively collected dataset from the two highest volume trauma centers in Saudi Arabia was analyzed between April 2007 and October 2012. A total of 66 patients received stent grafts for traumatic aortic injury and were included in the study. We apply Ishimaru's anatomical aortic arch zones and Benjamin's aortic injury grading systems. There were 35 patients with aortic injury at zone 2, 26 patients in zone 3, and 5 patients in zone 4. About 96% (63) of the injuries were grades 2 and 3, including large intimal flap or aortic wall pseudoaneurysm with change in wall contour. The technical success rate, as defined by complete exclusion of lesions without leaks, stroke, arm ischemia or stent-related complications, was 90%. Results Proximal stent collapse occurred in 4.5% of patients (3 of 66 inserted stents) during follow-up of 4 to 8 years (mean, 6 years). Patients with stent collapse tended to have an acute aortic arch angle with long-intraluminal stent lip, when compared with patients with noncollapsed stents. Intraluminal lip protrusion more than 10-mm increased collapse (p < 0.001). Stent-grafts sizes larger than 28 mm also demonstrated a higher collapse rate (p < 0.001). Conclusions The risk of stent collapse appears related to poor apposition of the stent due to severe aortic arch angulation in young patients and to large stent sizes (>28 mm). Such age groups may have more anatomical and aortic size changes during the growth. Clinical and radiological surveillance is essential in follow-up after stent-graft treatment for traumatic aortic injury.

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Elective and Emergent Endovascular Treatment of Subclavian Artery Aneurysms and Injuries

Journal of Endovascular Therapy ◽

10.1177/152660280301000113 ◽

2003 ◽

Vol 10 (1) ◽

pp. 58-65 ◽

Cited By ~ 29

Author(s):

Maria Schoder ◽

Manfred Cejna ◽

Thomas Hölzenbein ◽

Georg Bischof ◽

Fritz Lomoschitz ◽

...

Keyword(s):

Stent Graft ◽

Subclavian Artery ◽

Artery Aneurysm ◽

Graft Patency ◽

Long Term Results ◽

Stent Grafts ◽

Central Venous ◽

Luminal Narrowing

Purpose: To demonstrate our short and long-term results after transbrachial treatment of subclavian artery aneurysms and injuries with stent-grafts in elective and emergency settings. Methods: Ten of 12 consecutive patients (6 men; mean age 63.8 years, range 38–80) were treated electively with commercially prepared endografts delivered via a transbrachial access to repair a subclavian artery aneurysm (n = 3) or an injury from a misplaced central venous catheter (n = 7). Two patients required emergency treatment for a ruptured atherosclerotic aneurysm in one and an unintentional arterial puncture during placement of a central venous access in the other. Stent-graft patency during follow-up was assessed by physical examination with comparison of brachial blood pressures in all patients; computed tomography angiography (CTA) was performed in available patients. Results: Successful deployment of stent-grafts with sealing of the lesion was achieved in all cases. There were 2 (17%) procedural complications. One patient developed an access-site hematoma that required surgical revision. The second patient, who had a right subclavian injury, suffered an embolic cerebral infarction. The primary stent-graft patency during follow-up (mean 11.6 months) was 100%. CTA examinations in 7 patients at a mean 18 months showed strut dislocation at the thoracic outlet without luminal narrowing in 1 patient. A 50% intraluminal narrowing due to compression between the clavicle and the first rib occurred in another patient. Six patients with a mean follow-up of 23 months (range 0.3–4.5 years) are still alive with patent stent-grafts. Conclusions: Endovascular stent-graft treatment of subclavian artery aneurysms and injuries is a less invasive alternative to surgical repair. Long-term results must still be confirmed in further studies.

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Midterm Outcomes of Thoracic Aortic Stent-Grafts: Complications and Imaging Techniques

Journal of Endovascular Therapy ◽

10.1177/152660280301000314 ◽

2003 ◽

Vol 10 (3) ◽

pp. 494-504 ◽

Cited By ~ 13

Author(s):

Valérie Chabbert ◽

Philippe Otal ◽

Louis Bouchard ◽

Philippe Soula ◽

Tuan Tran Van ◽

...

Keyword(s):

Stent Graft ◽

Chest Radiography ◽

Imaging Techniques ◽

Traumatic Rupture ◽

Entire Group ◽

Stent Grafts ◽

Elliptical Cross ◽

Stent Grafting ◽

Subgroup Analyses

Purpose: To evaluate the midterm outcomes of thoracic aortic stent-grafting and the performance of computed tomographic angiography (CTA), radiography, and magnetic resonance angiography (MRA) in endograft surveillance. Methods: Forty-seven patients with traumatic thoracic aortic ruptures (n=16), aneurysms (n=14), false aneurysms (n=3), penetrating ulcers (n=3), and dissections (n=11) treated with stent-grafts were monitored in follow-up using chest radiography and CTA in all patients and MRA in 23 patients. Two perpendicular maximal aortic diameters, the sum of these diameters, and the elliptical cross-sectional area were determined and compared to baseline for the entire group and in subgroup analyses according to lesion type. CTA, MRA, and radiography were compared for their ability to detect endoleak, monitor stent-graft configuration, and measure aortic diameters. Results: The mortality rate was 8.5%. Severe complications were observed in 14.8% (6% neurological complications); 12 (25.5%) patients had primary endoleaks. Over a mean 11-month follow-up (range 0.25–46 months), the aortic diameters decreased for all patients without endoleak (p<0.001). In the diameter/area subgroup analyses, only the traumatic rupture cohort demonstrated significant decreases in all 4 measurements. CTA and MRA measurements correlated well, but chest radiography was superior to both for visualizing stent-graft shape. In terms of endoleak detection, MRA missed only 1 (12.5%) endoleak (type II) seen on CTA; there were no false positive results with MRA. Conclusions: Morbidity and mortality observed after thoracic stent-grafting are acceptable. Radiography is better for monitoring stent-graft conformation, while CTA provides the best overall morphological information. The performance of MRA in endoleak detection is encouraging.

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Radiological Evaluation of Abdominal Endovascular Aortic Aneurysm Repair

Canadian Association of Radiologists Journal ◽

10.1016/j.carj.2014.12.003 ◽

2015 ◽

Vol 66 (3) ◽

pp. 277-290 ◽

Cited By ~ 1

Author(s):

Avnesh S. Thakor ◽

James Tanner ◽

Shao J. Ong ◽

Ynyr Hughes-Roberts ◽

Shahzad Ilyas ◽

...

Keyword(s):

Aortic Aneurysm ◽

Imaging Modality ◽

Aortic Aneurysms ◽

Stent Grafts ◽

Mortality And Morbidity ◽

Endovascular Aortic Aneurysm Repair ◽

Plain Films ◽

Aneurysm Repair ◽

Aortic Aneurysm Repair

Endovascular aortic aneurysm repair (EVAR) is an alternative to open surgical repair of aortic aneurysms offering lower perioperative mortality and morbidity. As experience increases, clinicians are undertaking complex repairs with hostile aortic anatomy using branched or fenestrated devices or extra components such as chimneys to ensure perfusion to visceral branch vessels whilst excluding the aneurysm. Defining the success of EVAR depends on both clinical and radiographic criteria, but ultimately depends on complete exclusion of the aneurysm from the circulation. Aortic stent grafts are monitored using a combination of imaging modalities including computed tomography angiography (CTA), ultrasonography, magnetic resonance imaging, plain films, and nuclear medicine studies. This article describes when and how to evaluate aortic stent grafts using each of these modalities along with the characteristic features of several of the main stent grafts currently used in clinical practice. The commonly encountered complications from EVAR are also discussed and how they can be detected using each imaging modality. As the radiation burden from serial follow up CTA imaging is now becoming a concern, different follow-up imaging strategies are proposed depending on the complexity of the repair and based on the relative merits and disadvantages of each imaging modality.

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Three-year follow-up of composite stent grafts used in the repair of Crawford Type III thoracoabdominal aortic aneurysms; A case report

Journal of International Medical Research ◽

10.1177/0300060519848627 ◽

2019 ◽

Vol 48 (1) ◽

pp. 030006051984862

Author(s):

Yuan-hao Tong ◽

Tong Yu ◽

Min Zhou ◽

Chen Liu ◽

Xiao-qiang Li ◽

...

Keyword(s):

Computed Tomography ◽

Case Report ◽

Endovascular Repair ◽

Mesenteric Artery ◽

Aortic Aneurysms ◽

Stent Grafts ◽

Management Options ◽

Off Label ◽

Visceral Arteries

Complex aortic aneurysms are difficult to treat endovascularly and so techniques have been developed to broaden the management options. We report a case of 51-year-old man with several thoracoabdominal aortic aneurysms (TAAAs) who underwent endovascular repair with “off-label” stent grafts. Three aortic stent grafts and four branched stent grafts were used in the procedure using chimney and periscope techniques. The patient was followed for three years with regular computed tomography angiography (CTA). Scans at 3 and 12 months showed that the TAAAs were repaired and all visceral arteries were patent. Although, scans at the two- and three-year follow-ups showed that the stent graft in the superior mesenteric artery was occluded, the patient did not have any complications probably as a result of coeliac artery compensation.

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Type III Endoleak from a Thoracic Aortic Stent-Graft

Journal of Endovascular Therapy ◽

10.1177/152660280200900424 ◽

2002 ◽

Vol 9 (4) ◽

pp. 535-538 ◽

Cited By ~ 2

Author(s):

Conrad Lange ◽

Asbjørn Ødegård ◽

Jan Lundbom ◽

Staal Hatlinghus ◽

Hans O. Myhre

Keyword(s):

Stent Graft ◽

Late Complication ◽

Thoracoabdominal Aortic Aneurysm ◽

Aortic Aneurysms ◽

Stent Grafts ◽

Stent Grafting ◽

Thoracic Aortic Aneurysms ◽

Type Iii ◽

Aortic Stent Graft ◽

Type V

Purpose: To present an as yet unreported late complication of an Excluder thoracic endograft. Case Report: A 78-year-old man underwent surgery for a ruptured type V thoracoabdominal aortic aneurysm in 1996. Four years later, an aneurysm was detected in the proximal thoracic aorta and repaired with 2 Excluder endoprostheses. At 12 months, computed tomography showed an increase in the aneurysm sac diameter and a type III endoleak, which was traced to a hole in the stent-graft fabric on arteriography. No fracture of the metal components was detected in the stent-grafts. Another Excluder device was implanted within the distal endograft. Satisfactory exclusion of the leak has been maintained for 6 months. Conclusions: The risk of type III leaks must be minimized before stent-grafting can be regarded as a routine procedure in the treatment of thoracic aortic aneurysms.

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Early stent fracture and collapse of a Zenith TX2 thoracic stent graft used for traumatic aortic rupture

Vascular ◽

10.1258/vasc.2010.cr0246 ◽

2011 ◽

Vol 19 (5) ◽

pp. 287-290 ◽

Cited By ~ 2

Author(s):

Mårten Falkenberg ◽

Jonas Cronqvist ◽

Martin Malina

Keyword(s):

Stent Graft ◽

Aortic Rupture ◽

Stent Fracture ◽

X Rays ◽

Structural Failure ◽

Stent Grafts ◽

Lethal Outcome ◽

Retrospective Assessment ◽

Aortic Transection

Structural failure and collapse of thoracic stent grafts may cause fatal complications that are easily overlooked on follow-up imaging. A young man with multiple injuries from a motorcycle crash was treated with endografting for an aortic transection. The clinical course was initially satisfactory but deteriorated one week after the injury and the patient died two weeks later. Autopsy and retrospective assessment of chest X-rays revealed early fractures and collapse of the stent graft that had been overlooked and may have contributed to the lethal outcome. The design of thoracic stent grafts needs to be improved for treatment of traumatic aortic transection. Careful follow-up of these patients is warranted.

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Plasma presepsin in determining gastric leaks following bariatric surgery

Turkish Journal of Biochemistry ◽

10.1515/tjb-2018-0220 ◽

2019 ◽

Vol 44 (4) ◽

pp. 565-573

Author(s):

Sinan Binboga ◽

Nilgun Isiksacan ◽

Pinar Kasapoglu ◽

Elif Binboga ◽

Murat Koser ◽

...

Keyword(s):

Morbid Obesity ◽

Sleeve Gastrectomy ◽

White Blood Count ◽

Surgical Interventions ◽

Neutrophil Lymphocyte Ratio ◽

Reactive Protein ◽

Stapler Line

Abstract Background To be able to prevent morbid obesity in the long-term, laparoscopic sleeve gastrectomy (LSG) is one of the most effective surgical interventions. However, leakage and bleeding from the stapler line are significant complications. The aim of this study was to determine the role of the levels of plasma presepsin in the detection of stapler leakage. Materials and methods The study included 300 patients with LSG due to morbid obesity and 40 control subjects. Before any medical treatment was applied, blood samples were taken from patients at 12 h preoperatively and on days 1, 3, and 5 postoperatively. Evaluation was made of plasma presepsin levels, white blood count (WBC), C-reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR), in all patients with sleeve gastrectomy line leakage. Results The WBC, CRP, NLR and presepsin values measured on days 1, 3 and 5 postoperatively were determined to be higher in patients with leakage compared to those without. The predictive value of presepsin (p = 0.001), CRP (p = 0.001) and NLR (p = 0.001) was determined to be statistically significantly higher than that of WBC (p = 0.01). Conclusion The results of the study suggest that presepsin levels could have a role in the detection and follow-up of stapler line leaks after LSG. Elevated presepsin levels, on postoperative day 1 in particular, could have a key role in the early detection of possible complications which are not seen clinically.

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