scholarly journals Dual aortic aneurysms with coronary artery and multiple cerebrovascular stenoses

2021 ◽  
Author(s):  
Masafumi Hashimoto ◽  
Kenji Mogi ◽  
Manabu Sakurai ◽  
Kengo Tani ◽  
Shuntaro Ito ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Cerebral Arteries ◽  
Thoracic Endovascular Aortic Repair ◽  
Aortic Aneurysms ◽  
Endovascular Aortic Repair ◽  
Reconstruction Method ◽  
Off Pump ◽  
Aortic Repair ◽  
Triple Vessel Disease

Simultaneous thoracic and abdominal aneurysms comprise approximately 10–20% of all cases of aortic aneurysms. Whether simultaneous or staged therapy can be used to treat multilevel aortic aneurysms remains controversial. Herein, we report the case of a 79-year-old woman with both huge abdominal and saccular thoracic aortic aneurysms who was referred to our hospital. Multiple stenotic lesions were observed in the major cerebral arteries; moreover, triple-vessel disease was observed on the coronary angiogram. Although this case required immediate primary surgery, cardiopulmonary bypass was difficult due to multiple stenoses in the cerebral arteries. We performed simultaneous surgery with total debranching thoracic endovascular aortic repair, endovascular aortic repair, and off-pump coronary artery grafting. Total debranching thoracic endovascular aortic repair is useful for avoiding neurological complications in cases where cardiopulmonary bypass is difficult. Furthermore, it helps devise an intraoperative cervical branch reconstruction method.

Off-Pump Debranching and Thoracic Endovascular Aortic Repair for Aortic Arch Pathology

2015 ◽  
Vol 10 (3) ◽  
pp. 163-169 ◽  
Author(s):  
Tamer Ghazy ◽  
Ahmed Mashhour ◽  
Torsten Schmidt ◽  
Adrian Mahlmann ◽  
Ahmed Ouda ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Aortic Arch ◽  
Circulatory Arrest ◽  
Deep Hypothermic Circulatory Arrest ◽  
Thoracic Endovascular Aortic Repair ◽  
Hypothermic Circulatory Arrest ◽  
Endovascular Aortic Repair ◽  
Operative Risk ◽  
Off Pump ◽  
Aortic Repair

Objective This study aimed to simplify an until-now complex procedure for the treatment of proximal aortic arch pathology (zones 0 and 1), where a deep hypothermic circulatory arrest even with selective cerebral perfusion is still a high-risk procedure with accompanying splanchnic and spinal cord ischemia. Methods From June 2012 until March 2013, 106 patients underwent aortic surgery in our institution, of whom, 20 patients underwent aortic arch surgery. Of the 20 patients, 7 with multiple comorbidities and a high operative risk and no other indication for a cardiopulmonary bypass were selected to undergo an off-pump aortic arch debranching and thoracic endovascular aortic repair: 4 patients had chronic dissections, and 3 patients had arch aneurysms. The procedure was performed through median sternotomy. The supraaortic branches were rerouted to the ascending aorta, and this process was followed by thoracic endovascular aortic repair of the aortic arch and proximal descending aorta. Transaortic antegrade stenting was performed in 5 cases. Cerebral protection and perfusion monitoring were achieved by biradial pressure monitoring, electroencephalogram, and online transcranial duplex sonography. The preoperative, operative, and postoperative data were collected and analyzed retrospectively. Results All procedures were successful. There were no conversions to cardiopulmonary bypass support. The mean operative time was 184 ± 24 minutes. Postoperatively, there was 1 rethoracotomy for bleeding and 1 cerebrovascular insult. The 30-day mortality was 1 patient. Conclusions Off-pump aortic debranching with arch stenting is a reproducible procedure that could be favorable in certain situations, such as in patients with a higher operative risk profile, thereby reducing the risks associated with deep hypothermic circulatory arrest and also yielding favorable outcomes, even in an older patient cohort with more comorbidities.

Off-Pump Debranching and Thoracic Endovascular Aortic Repair for Aortic Arch Pathology

2015 ◽  
Vol 10 (3) ◽  
pp. 163-169
Author(s):  
Tamer Ghazy ◽  
Ahmed Mashhour ◽  
Torsten Schmidt ◽  
Adrian Mahlmann ◽  
Ahmed Ouda ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Off Pump ◽  
Aortic Repair

scholarly journals Thoracic endovascular aortic repair with branched Inoue Stent Graft for arch aortic aneurysms

2017 ◽  
Vol 66 (5) ◽  
pp. 1340-1348.e5 ◽  
Author(s):  
Junichi Tazaki ◽  
Kanji Inoue ◽  
Hirooki Higami ◽  
Nobuya Higashitani ◽  
Masanao Toma ◽  
...  
Keyword(s):  
Stent Graft ◽  
Thoracic Endovascular Aortic Repair ◽  
Aortic Aneurysms ◽  
Endovascular Aortic Repair ◽  
Aortic Repair

Hybrid procedures combining conventional and thoracic endovascular aortic repair for thoracic aortic aneurysms

Surgery Today ◽  
2011 ◽  
Vol 41 (7) ◽  
pp. 922-927 ◽  
Author(s):  
Yukio Obitsu ◽  
Nobusato Koizumi ◽  
Satoshi Takahashi ◽  
Yasunori Iida ◽  
Naozumi Saiki ◽  
...  
Keyword(s):  
Thoracic Endovascular Aortic Repair ◽  
Aortic Aneurysms ◽  
Endovascular Aortic Repair ◽  
Hybrid Procedures ◽  
Thoracic Aortic Aneurysms ◽  
Aortic Repair

scholarly journals Aortoesophageal and aortobronchial fistula caused by Candida albicans after thoracic endovascular aortic repair

2016 ◽  
Vol 73 (9) ◽  
pp. 864-867 ◽  
Author(s):  
Igor Koncar ◽  
Marko Dragas ◽  
Predrag Sabljak ◽  
Predrag Pesko ◽  
Miroslav Markovic ◽  
...  
Keyword(s):  
Candida Albicans ◽  
Surgical Treatment ◽  
Stent Graft ◽  
Thoracic Endovascular Aortic Repair ◽  
Thin Layers ◽  
Aortic Aneurysms ◽  
Endovascular Aortic Repair ◽  
Aortoesophageal Fistula ◽  
Multicentric Study ◽  
Aortic Repair

Introduction. Endovascular stent-graft placement has emerged as a minimally invasive alternative to open surgery for the treatment of aortic aneurysms and dissections. There are few reports of stent graft infections and aortoenteric fistula after endovascular thoracic aortic aneurysm repair, and the first multicentric study (Italian survey) showed the incidence of about 2%. Case report. We presented a 69-year-old male patient admitted to our hospital 9 months after thoracic endovascular aortic repair, due to severe chest pain in the left hemithorax and arm refractory to analgesic therapy. Multislice computed tomography (MSCT) showed a collection between the stent graft and the esophagus with thin layers of gas while gastroendoscopy showed visible blood jet 28 cm from incisive teeth. Surgical treatment was performed in collaboration of two teams (esophageal and vascular surgical team). After explantation of the stent graft and in situ reconstruction by using Dacron graft subsequent esophagectomy and graft omentoplasty were made. After almost four weeks patient developed hemoptisia as a sign of aorto bronchial fistula. Treatment with implantation of another aortic cuff of 26 mm was performed. The patient was discharged to the regional center with negative blood culture, normal inflammatory parameters and respiratory function. Three months later the patient suffered deterioration with the severe weight loss and pneumonia caused by Candida albicans and unfortunately died. The survival time from the surgical treatment of aortoesophageal fistula was 4 months. Conclusion. Even if endovascular repair of thoracic aortic diseases improves early results, risk of infection should not be forgotten. Postoperative respiratory deterioration and finally hemoptisia could be the symptoms of another fistula.

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