Customized CT angiogram planning for intraoperative transesophageal echography-guided endovascular exclusion of thoracic aorta penetrating ulcer

Vascular ◽  
2014 ◽  
Vol 23 (2) ◽  
pp. 161-164
Author(s):  
Michele Piazza ◽  
Mario Lupia ◽  
Franco Grego ◽  
Michele Antonello
Keyword(s):  
Thoracic Aorta ◽  
Maximum Diameter ◽  
Pigtail Catheter ◽  
Descending Thoracic Aorta ◽  
Ct Angiogram ◽  
Penetrating Ulcer ◽  
Preoperative Ct ◽  
Cook Medical ◽  
Longitudinal Extension ◽  
Graft Positioning

The technique is demonstrated in a 78-year-old man; the preoperative CT angiogram showed a descending thoracic aorta ulcer of 5.9 cm in maximum diameter and 3.8 cm longitudinal extension. A ZTEG-2P-36-127-PF (Cook Medical) single tubular endograft was planned to be deployed. From the preoperative CT angiogram we planned to land 4.7 cm above the midline of the descending thoracic aorta ulcer and 8.0 cm below. In the operating room, under radioscopic vision the centre of the transesophageal echography probe was used as marker to identify the correspondent midline of the descending thoracic aorta ulcer and a centimeter-sized pigtail catheter in the aorta was used to calculate the desired length above and below the ulcer midline. The endograft was introduced and placed in the desired position compared to the transesophageal echography probe and the catheter; under transesophageal echography vision the graft was finally deployed. The CT angiogram at 1 month showed the correct endograft position, descending thoracic aorta ulcer exclusion with no signs of endoleak. In selected cases, this method allows planning in advance safe stent graft positioning and deployment totally assisted by transesophageal echography, with no risk of periprocedural contrast-related renal failure and reduced radiation exposure for the patient and operators.

Endovascular Stent-Graft Treatment of a Ruptured Thoracic Aortic Ulcer

2002 ◽  
Vol 9 (2_suppl) ◽  
pp. II-20-II-24 ◽  
Author(s):  
Peter L. Faries ◽  
Elvira Lang ◽  
Pranay Ramdev ◽  
Larry H. Hollier ◽  
Michael L. Marin ◽  
...  
Keyword(s):  
Thoracic Aorta ◽  
Stent Graft ◽  
Chronic Obstructive ◽  
Endovascular Stent ◽  
Descending Thoracic Aorta ◽  
Obstructive Pulmonary Disease ◽  
Endovascular Stent Graft ◽  
Nitinol Stents ◽  
Penetrating Ulcer ◽  
Stent Graft Repair

Purpose: To describe a ruptured ulcer of the descending thoracic aorta treated with an endovascular stent-graft deployed under transesophageal echocardiographic (TEE) guidance. Case Report: An 82-year-old man with severe chronic obstructive pulmonary disease and congestive heart failure presented with sharp pain in the back radiating to the left flank. Computed tomography (CT) and angiography demonstrated a penetrating ulcer of the descending thoracic aorta associated with aortic dissection commencing 6 cm from the origin of the left subclavian artery with extravasation of contrast outside the aortic wall. The patient remained symptomatic with a decrease in hematocrit from 36% to 23%. Endovascular repair was performed using self-expanding nitinol stents sutured to a 35-mm × 12-cm Dacron conduit. The device was deployed with a 24-F delivery system under TEE guidance and fluoroscopy. Successful exclusion of the ruptured ulcer was demonstrated by TEE Doppler, arteriography, and CT. The patient remains asymptomatic 18 months after the procedure with no CT evidence of endoleak. Conclusions: Endovascular stent-graft repair under TEE guidance assists in the oftentimes difficult treatment of ruptured penetrating thoracic aortic ulcer.

scholarly journals Sequential ruptures of penetrating atherosclerotic ulcers of ascending aorta, aortic arch and descending thoracic aorta

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Pankaj Kaul ◽  
Rodolfo Paniagua ◽  
Afroditi Petsa ◽  
Raj Singh
Keyword(s):  
Renal Cell Carcinoma ◽  
Case Report ◽  
Thoracic Aorta ◽  
Renal Cell ◽  
Ascending Aorta ◽  
Descending Thoracic Aorta ◽  
Graft Replacement ◽  
Penetrating Ulcer ◽  
Similarities And Differences ◽  
Aortic Dissections

Abstract Background Penetrating ulcers of aorta, aortic dissections and intramural hematomas all come under acute aortic syndromes and have important similarities and differences. Case report We report a 67 year old man with rupture of a large penetrating ulcer of the distal ascending aorta with hemopericardium and left hemothorax. He underwent interposition graft replacement of ascending aorta and hemi-arch with a 30 mm Gelweave Vascutek graft but represented 6 months later with development of a penetrating ulcer which ruptured into a huge 14 cm pseudoaneurysm. This was repaired with a 28 mm Vascutek Gelseal graft replacement of arch and interposition graft reconstruction of innominate and left common carotid arteries. 6 weeks later, however, he ruptured his proximal descending aorta and underwent TEVAR satisfactorily. Unfortunately, 2 days later, he developed a pathological fracture of left proximal tibia with metastasis from a primary renal cell carcinoma. He died 3 weeks later from respiratory failure. We shall briefly outline the similarities and differences in presentation and management of penetrating aortic ulcers, aortic dissections and intramural haematomas. We shall discuss, in greater detail, penetrating ulcers of thoracic aorta, their natural history, location, complications and management. Conclusion This case report is unique on account of initial successful surgical redressal following rupture of penetrating ulcer of distal ascending aorta into left pleural and pericardial cavities, normally associated with instant death. The haemodynamic effects of the rupture were staggered due to initial contained rupture into a smaller pseudoaneurysm, followed by a further rupture into a false aneurysmal sac followed eventually by generalised rupture into the pleural and pericardial cavities - a unique way of aortic rupture. Further development of another penetrating ulcer and a small pseudoaneurysm in the distal arch 6 months later which further ruptured into a larger 14 cm false aneurysmal sac, which again did not result in exsanguination, is again extraordinarily rare. Thereafter he underwent emergency thoracic endovascular aortic repair (TEVAR) for a further rupture of descending thoracic aorta. All three ruptures were managed successfully and would usually be associated with near-certain death, only for the patient to succumb eventually to the complications of metastatic renal cell carcinoma.

scholarly journals Sequential ruptures of penetrating atherosclerotic ulcers of ascending aorta, aortic arch and descending thoracic aorta

2020 ◽  
Author(s):  
Pankaj Kaul ◽  
Rodolfo Paniagua ◽  
Afroditi Petsa ◽  
Raj Singh
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Thoracic Aorta ◽  
Renal Cell ◽  
Ascending Aorta ◽  
Descending Thoracic Aorta ◽  
Graft Replacement ◽  
Interposition Graft ◽  
Penetrating Ulcer ◽  
Aortic Dissections

Abstract BackgroundPenetrating ulcers of aorta, aortic dissections and intramural hematomas all come under acute aortic syndromes and have important similarities and differences.Case ReportWe report a 67 year old man with rupture of a large penetrating ulcer of the distal ascending aorta with hemopericardium and left hemothorax. He underwent interposition graft replacement of ascending aorta and hemi-arch with a 30 mm Gelweave Vascutek graft but represented 6 months later with development of a penetrating ulcer which ruptured into a huge 14 cm pseudoaneurysm. This was repaired with a 28 mm Vascutek Gelseal graft replacement of arch and interposition graft reconstruction of innominate and left common carotid arteries. 6 weeks later, however, he ruptured his proximal descending aorta and underwent TEVAR satisfactorily. Unfortunately, 2 days later, he developed a pathological fracture of left proximal tibia with metastasis from a primary renal cell carcinoma. He died 3 weeks later from respiratory failure.We shall briefly outline the similarities and differences in presentation and management of penetrating aortic ulcers, aortic dissections and intramural haematomas. We shall discuss, in greater detail, penetrating ulcers of thoracic aorta, their natural history, location, complications and management.ConclusionThis case report is unique on account of initial successful surgical redressal following rupture of penetrating ulcer of distal ascending aorta into left pleural and pericardial cavities, normally associated with instant death. The haemodynamic effects of the rupture were staggered due to initial contained rupture into a smaller pseudoaneurysm, followed by a further rupture into a false aneurysmal sac followed eventually by generalised rupture into the pleural and pericardial cavities - a unique way of aortic rupture. Further development of another penetrating ulcer and a small pseudoaneurysm in the distal arch 6 months later which further ruptured into a larger 14 cm false aneurysmal sac, which again did not result in exsanguination, is again extraordinarily rare. Thereafter he underwent emergency thoracic endovascular aortic repair (TEVAR) for a further rupture of descending thoracic aorta. All three ruptures were managed successfully and would usually be associated with near-certain death, only for the patient to succumb eventually to the complications of metastatic renal cell carcinoma.

Endovascular Stent-Graft Repair of a Complicated Penetrating Ulcer of the Descending Thoracic Aorta: A Word of Caution

2003 ◽  
Vol 10 (5) ◽  
pp. 928-931 ◽  
Author(s):  
Giuseppe D'Ancona ◽  
Richard Bauset ◽  
Jean-Pierre Normand ◽  
Roc Turcotte ◽  
François Dagenais
Keyword(s):  
Thoracic Aorta ◽  
Stent Graft ◽  
Aortic Wall ◽  
Balloon Dilation ◽  
Endovascular Stent ◽  
Descending Thoracic Aorta ◽  
Endovascular Stent Graft ◽  
Penetrating Ulcer ◽  
Stent Graft Repair ◽  
Endovascular Stent Graft Repair

Purpose: To report a pitfall encountered during stenting of a complicated penetrating ulcer of the descending thoracic aorta. Case Report: A 65-year-old man was diagnosed with a complicated penetrating ulcer of the thoracic aorta. A 38-mm Talent endograft was implanted. On balloon dilation of the distal end of the endoprosthesis, the terminal bare stent became distorted and penetrated the aortic wall. A 42-mm endoprosthesis was immediately placed to exclude the aortic perforation. Control aortography demonstrated exclusion of the original proximal aortic ulcer and the distal iatrogenic aortic tear. Conclusions: Endoprostheses may present some drawbacks in terms of elasticity and adaptability to tortuous and angulated diseased aortas. Caution is advised in the treatment of penetrating aortic ulcers where the aortic wall is diffusely friable. In this condition, balloon dilation should be limited to the covered portion of the stent-graft to prevent stent distortion and erosion through the aortic wall.

scholarly journals Acute Aortic Syndrome in Marfan Syndrome with Chest Pain and Negative Initial Imaging

2021 ◽  
Author(s):  
Sorush Rokui ◽  
Edward Percy ◽  
Joel Price
Keyword(s):  
Chest Pain ◽  
Marfan Syndrome ◽  
Thoracic Aorta ◽  
Acute Chest Pain ◽  
Aortic Dilatation ◽  
Descending Thoracic Aorta ◽  
Ct Angiogram ◽  
Aortic Root Surgery ◽  
Acute Dissection ◽  
Initial Imaging

A 25-year-old male with Marfan Syndrome and previous aortic root surgery presented with severe chest and upper back pain. Initial CT angiogram showed mild aortic dilatation but no acute dissection. Anti-impulse therapy was initiated. Five days after presentation, follow-up CT angiography revealed a new pseudoaneurysm of the descending thoracic aorta. The patient underwent replacement of the mid-descending thoracic aorta with a collagen-impregnated woven polyester tube graft without complication. Despite negative initial imaging and relatively small aortic size, patients with Marfan Syndrome with acute chest pain should be treated with high suspicion and may benefit from admission and serial imaging.

scholarly journals Sequential ruptures of penetrating atherosclerotic ulcers of ascending aorta, aortic arch and descending thoracic aorta

2020 ◽  
Author(s):  
Pankaj Kaul ◽  
Rodolfo Paniagua ◽  
Afroditi Petsa ◽  
Raj Singh
Keyword(s):  
Renal Cell Carcinoma ◽  
Case Report ◽  
Thoracic Aorta ◽  
Renal Cell ◽  
Ascending Aorta ◽  
Descending Thoracic Aorta ◽  
Graft Replacement ◽  
Penetrating Ulcer ◽  
Similarities And Differences ◽  
Aortic Dissections

Abstract BackgroundPenetrating ulcers of aorta, aortic dissections and intramural hematomas all come under acute aortic syndromes and have important similarities and differences. Case ReportWe report a 67 year old man with rupture of a large penetrating ulcer of the distal ascending aorta with hemopericardium and left hemothorax. He underwent interposition graft replacement of ascending aorta and hemi-arch with a 30 mm Gelweave Vascutek graft but represented 6 months later with development of a penetrating ulcer which ruptured into a huge 14 cm pseudoaneurysm. This was repaired with a 28 mm Vascutek Gelseal graft replacement of arch and interposition graft reconstruction of innominate and left common carotid arteries. 6 weeks later, however, he ruptured his proximal descending aorta and underwent TEVAR satisfactorily. Unfortunately, 2 days later, he developed a pathological fracture of left proximal tibia with metastasis from a primary renal cell carcinoma. He died 3 weeks later from respiratory failure.We shall briefly outline the similarities and differences in presentation and management of penetrating aortic ulcers, aortic dissections and intramural haematomas. We shall discuss, in greater detail, penetrating ulcers of thoracic aorta, their natural history, location, complications and management.ConclusionThis case report is unique on account of initial successful surgical redressal following rupture of penetrating ulcer of distal ascending aorta into left pleural and pericardial cavities, normally associated with instant death. The haemodynamic effects of the rupture were staggered due to initial contained rupture into a smaller pseudoaneurysm, followed by a further rupture into a false aneurysmal sac followed eventually by generalised rupture into the pleural and pericardial cavities - a unique way of aortic rupture. Further development of another penetrating ulcer and a small pseudoaneurysm in the distal arch 6 months later which further ruptured into a larger 14 cm false aneurysmal sac, which again did not result in exsanguination, is again extraordinarily rare. Thereafter he underwent emergency thoracic endovascular aortic repair (TEVAR) for a further rupture of descending thoracic aorta. All three ruptures were managed successfully and would usually be associated with near-certain death, only for the patient to succumb eventually to the complications of metastatic renal cell carcinoma.

Treatment of a Complicated Penetrating Ulcer of the Descending Thoracic Aorta Using a Scalloped Stent Graft

2014 ◽  
Vol 28 (1) ◽  
pp. 264.e9-264.e11 ◽  
Author(s):  
Carlos Esteban ◽  
Paulina Pérez ◽  
Jordi Muchart ◽  
Jaume Sampere ◽  
Alberto Martorell ◽  
...  
Keyword(s):  
Thoracic Aorta ◽  
Stent Graft ◽  
Descending Thoracic Aorta ◽  
Penetrating Ulcer

Management of thoracic aortic lesions - the future is endovascular

VASA ◽  
2012 ◽  
Vol 41 (3) ◽  
pp. 163-176 ◽  
Author(s):  
Weidenhagen ◽  
Bombien ◽  
Meimarakis ◽  
Geisler ◽  
A. Koeppel
Keyword(s):  
Thoracic Aorta ◽  
Clinical Decision Making ◽  
Treatment Options ◽  
Clinical Decision ◽  
Clinical Results ◽  
Treatment Modalities ◽  
Traumatic Rupture ◽  
Descending Thoracic Aorta ◽  
New Treatment ◽  
Aneurysm Dissection

Open surgical repair of lesions of the descending thoracic aorta, such as aneurysm, dissection and traumatic rupture, has been the “state-of-the-art” treatment for many decades. However, in specialized cardiovascular centers, thoracic endovascular aortic repair and hybrid aortic procedures have been implemented as novel treatment options. The current clinical results show that these procedures can be performed with low morbidity and mortality rates. However, due to a lack of randomized trials, the level of reliability of these new treatment modalities remains a matter of discussion. Clinical decision-making is generally based on the experience of the vascular center as well as on individual factors, such as life expectancy, comorbidity, aneurysm aetiology, aortic diameter and morphology. This article will review and discuss recent publications of open surgical, hybrid thoracic aortic (in case of aortic arch involvement) and endovascular repair in complex pathologies of the descending thoracic aorta.

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