scholarly journals CT-fusion-guided thoracic endovascular aortic repair: Case report and literature review

2021 ◽  
Vol 16 (3) ◽  
pp. 180-189
Author(s):  
Anton Khilchuk ◽  
◽  
Artyom Payvin ◽  
Sergey Scherbak ◽  
Valentin Guryev ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Hybrid Methods ◽  
Imaging Techniques ◽  
Endovascular Aneurysm Repair ◽  
Endovascular Aortic Repair ◽  
High Dose ◽  
Routine Practice ◽  
Thoracoabdominal Aorta ◽  
Traumatic Diaphragmatic Hernia ◽  
Aortic Repair

Interventional and hybrid methods of treatment, combining open surgical and endovascular repairs, are the most promising areas in the surgery of the thoracoabdominal aorta. Recent studies, however, have demonstrated that complex thoracic endovascular aneurysm repair (TEVAR) is one of the most high-dose endovascular interventions. In addition, TEVAR is associated with the use of a significant volume of contrast media (CM), which can lead to contrast-induced acute kidney injury (CI-AKI). The use of advanced imaging techniques and computed tomographic fusion (CT-fusion) in routine practice can potentially reduce operation duration, radiation exposure and CM volume usage. We analyzed the literature on CTfusion in endovascular aortic repair and present a clinical case of a 50-year-old male with a history of concomitant blunt chest trauma. CT of the chest revealed an aneurysm of the arch and descending aorta after traumatic dissection of the aorta (IIIa DeBakey, type B Stanford), post-traumatic diaphragmatic hernia of the left dome of the diaphragm with stomach and intestinal loops prolapse. The patient underwent a staged hybrid intervention — subtotal aortic arch debranching followed by CT-fusion-guided semi-arch TEVAR. CT-fusion is a dynamically developing technology, may reduce the CM volume, the duration of the procedure and radiation exposure and requires further research.

Single-center experience with simultaneous thoracic endovascular aortic repair and abdominal endovascular aneurysm repair

Vascular ◽  
2016 ◽  
Vol 25 (2) ◽  
pp. 157-162 ◽  
Author(s):  
Qinglong Zeng ◽  
Xi Guo ◽  
Lianjun Huang ◽  
Lizhong Sun
Keyword(s):  
Endovascular Aneurysm Repair ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
High Dose ◽  
Single Center ◽  
Blood Pressure Elevation ◽  
High Dose Corticosteroid ◽  
Aortic Repair ◽  
Dose Corticosteroid ◽  
Aneurysm Repair

Objective To evaluate the efficacy and outcomes of simultaneous thoracic endovascular aortic repair (TEVAR) and abdominal endovascular aneurysm repair (EVAR). Methods A total of 21 patients (20 men; mean 65 ± 7 years, range 54–77) underwent simultaneous TEVAR and EVAR between September 2010 and June 2015 at a single center were retrospectively reviewed. All patients had concomitant thoracic pathologies (aneurysm, penetrating aortic ulcer, intramural hematoma, or dissection) and abdominal aortic aneurysm. The abdominal aneurysms diameters ranged from 5.9 cm to 10 cm. Thoracic lesions in 17 patients were complicated with acute aortic syndrome, and the remainders had indications for simultaneous repair. All patients were followed up postoperative at 1 month, 6 months, and yearly thereafter. Technique success, procedure-related complications were evaluated. Results All patients received local anesthesia, perioperative relative high arterial pressure (above 130/80 mmHg) maintenance, and prophylactic high-dose corticosteroid. The technical success rate was 100%. Average procedural time was 157.6 ± 45.6 min. The length of thoracic coverage was 20.4 ± 4.7 cm (range 15–27). Two patients required left subclavian artery coverage during TEVAR and two patients required lowest renal artery coverage during EVAR. Chimney stents were deployed simultaneously. Patients were followed between 2 and 59 months postoperatively. No patients developed acute cardiopulmonary complications and contrast-induced nephropathy. Two patients developed transient lower extremity weakness that resolved with blood pressure elevation, cerebrospinal fluid drainage, and intravenous drips of high-dose corticosteroid. The average hospital stay was 10.7 ± 7.9 days (range 4–30). During follow-up, one patient died of aneurysm rupture at postoperative 6 months, two patients developed type Ib endoleak at 9 months and 48 months respectively, one was successfully sealed with iliac stent-graft extension, the other received conservative treatment and is symptom free till now. Conclusion Combined TEVAR and EVAR can be performed safely with minimal morbidity and mortality. When anatomically feasible, simultaneous TEVAR and EVAR can be considered as an acceptable alternative for multilevel aortic diseases.

scholarly journals Impact of Hybrid Rooms with Image Fusion on Radiation Exposure during Endovascular Aortic Repair

2014 ◽  
Vol 48 (4) ◽  
pp. 382-390 ◽  
Author(s):  
A. Hertault ◽  
B. Maurel ◽  
J. Sobocinski ◽  
T. Martin Gonzalez ◽  
M. Le Roux ◽  
...  
Keyword(s):  
Image Fusion ◽  
Radiation Exposure ◽  
Endovascular Aortic Repair ◽  
Aortic Repair

scholarly journals Impact of onlay fusion and cone beam computed tomography on radiation exposure and technical assessment of fenestrated-branched endovascular aortic repair

2019 ◽  
Vol 69 (4) ◽  
pp. 1045-1058.e3 ◽  
Author(s):  
Emanuel R. Tenorio ◽  
Gustavo S. Oderich ◽  
Giuliano A. Sandri ◽  
Pinar Ozbek ◽  
Jussi M. Kärkkäinen ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Radiation Exposure ◽  
Cone Beam Computed Tomography ◽  
Endovascular Aortic Repair ◽  
Cone Beam ◽  
Aortic Repair ◽  
Technical Assessment

Preliminary Outcomes of Viabahn Balloon-Expandable Endoprosthesis as Bridging Stent in Renal Arteries During Fenestrated Endovascular Aortic Repair

2021 ◽  
pp. 152660282110124
Author(s):  
Luca Mezzetto ◽  
Davide Mastrorilli ◽  
Nicola Leone ◽  
Stefano Gennai ◽  
Roberto Silingardi ◽  
...  
Keyword(s):  
Renal Artery ◽  
Endovascular Aneurysm Repair ◽  
Renal Arteries ◽  
Endovascular Aortic Repair ◽  
Type I ◽  
Target Vessel ◽  
Technical Success ◽  
Transverse Axis ◽  
Aortic Repair

Purpose: To report preliminary outcomes of Viabahn Balloon-Expandable Endoprosthesis (VBX) stent-graft as bridging stent for renal arteries in fenestrated endovascular aneurysm repair (FEVAR). Materials and Methods: Between 2018 and 2019, patients undergoing FEVAR at 3 referral Italian university hospitals were prospectively collected. During the study period, VBX was the first-line choice as bridging stent for renal arteries. Procedural and anatomical data were analyzed, including renal artery (RA) configuration. A dedicated software (3Mensio, Vascular Imaging, Bilthoeven, The Netherlands) was used and RA anatomy classified as follow: upward-oriented in case of any angle >30° above the horizontal or transverse axis perpendicular to the aortic axis, downward-oriented if there was an angle >30° measured below the transverse axis and downward + upward in case of an angle <30° associated with a renal artery angulation >90°. Primary endpoints were technical success, defined as complete deployment of the fenestrated endograft without target vessel (TV) loss, limb stenosis or occlusion and type I or III endoleak, and freedom from target artery instability (TAI), defined by target vessel-related death, occlusion, rupture or reintervention for stenosis, endoleak or disconnection. Secondary endpoints were target artery patency rate and freedom from reinterventions. Results: A total of 26 elective FEVAR for juxta/pararenal aneurysm (20), thoracoabdominal type II (3) and type IV (3) were included. Fifty-one RA were planned for revascularization. Of these, 32 were downward, 10 horizontal, 6 upward, 4 were downward + upward. Technical success was achieved in 88.5% (23/26) of patients and 94.2% (48/51) of the TVs. One occlusion (2.1%) occurred within 30 days in a patient with previous endovascular aortic repair and suprarenal fixation. During follow-up (median 10 months), there was 1 type IC endoleak after 6 months (2.1%) in a patient with upward plus downward arterial orientation. Freedom from TAI was 96.1% (CI = 0.89 to 1.04) at first month and 92.3% (CI = 0.82 to 1.03) at 6 months. No aneurysm-related mortality and renal insufficiency occurred during follow-up. Conclusion: The use of VBX as bridging stent of RA in FEVAR is safe and feasible. Previous EVAR and tortuosity of RA may be a challenging on target vessel fate.

scholarly journals Three-dimensional fusion computed tomography decreases radiation exposure, procedure time, and contrast use during fenestrated endovascular aortic repair

2015 ◽  
Vol 61 (2) ◽  
pp. 309-316 ◽  
Author(s):  
Michael M. McNally ◽  
Salvatore T. Scali ◽  
Robert J. Feezor ◽  
Daniel Neal ◽  
Thomas S. Huber ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Radiation Exposure ◽  
Three Dimensional ◽  
Endovascular Aortic Repair ◽  
Procedure Time ◽  
Aortic Repair

scholarly journals Salvage endovascular septectomy in patients with chronic abdominal aortic dissection after failed endovascular aneurysm repair

2019 ◽  
Vol 29 (4) ◽  
pp. 621-624
Author(s):  
Hui Zhuang ◽  
Fanggang Cai ◽  
Zhixian Wu ◽  
Tenghui Zhan ◽  
Hongyu Chen ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Abdominal Aorta ◽  
Endovascular Aneurysm Repair ◽  
False Lumen ◽  
Endovascular Aortic Repair ◽  
Study Cohort ◽  
Aortic Repair ◽  
Abdominal Aortic ◽  
Abdominal Aortic Dissection ◽  
Aneurysm Repair

Abstract This study aimed to investigate the efficacy and safety of salvage endovascular septectomy in patients with abdominal chronic aortic dissection (CAD) after endovascular aneurysm repair. A study cohort comprising 6 patients with chronic abdominal aortic dissection after failed endovascular aortic repair [mean age 62.5 (36–69) years] were enrolled to undergo salvage endovascular septectomy. The procedure involved entering the false lumen via the intrinsic visceral entry to perform a confined septectomy using a ‘Gigli wire’ to merge the true and false lumens. The outcomes were assessed by Digital angiography and computed tomography angiography. All 6 patients were successfully operated on; the diameters of the visceral abdominal aorta and the infrarenal abdominal aorta were similar at 1, 3, 6 and 12 months compared with the baseline; the patency of the visceral branch arteries was also stable at 1, 3, 6 and 12 months compared with the baseline; no occlusion of the visceral branch arteries was noted; no major vascular adverse events or deaths were observed. In this preliminary study, it was proven that salvage endovascular septectomy is a potentially advantageous technique that is safe and effective in the treatment of patients with CAD after failed endovascular aortic repair.

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