Endovascular Repair of a Tracheoinnominate Fistula with a Stent Graft

Massive bleeding from a tracheostomy developed in a 65-year-old woman with stroke after successful conservative management of a minor tracheostomy bleeding episode. Temporary hemostasis was achieved, and angiography showed a tracheoinnominate fistula (TIF), a rare complication of tracheostomy. Open surgery was contraindicated in this patient, so endovascular repair using a stent graft was performed. Permanent hemostasis was obtained, and there were no immediate complications from the procedure. The patient never recovered from her stroke and died 2 weeks later. The endovascular approach may be a feasible alternative to surgical repair of TIF, especially in patients unable to tolerate an open procedure.

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Endovascular Repair of Axillary Artery Transection with a Stent Graft following Blunt Trauma

American Journal of Interventional Radiology ◽

10.25259/ajir-1-2019 ◽

2019 ◽

Vol 3 ◽

pp. 5

Author(s):

Rami Sartawi ◽

Shadi Abu-Halimah ◽

Sultan Abdelhamid ◽

Ahmad Yanis

Keyword(s):

High Risk ◽

Endovascular Treatment ◽

Blunt Trauma ◽

Treatment Option ◽

Stent Graft ◽

Endovascular Repair ◽

Open Surgery ◽

Surgical Repair ◽

Axillary Artery

Transection injuries of the axillary artery are rare and typically involve surgical repair. This case describes an emergent endovascular treatment option, using a stent graft, in a patient that was deemed as high risk for open surgery.

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Endovascular strategies for post-dissection aortic aneurysm (PDAA)

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-020-01331-8 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Zhaoxiang Zeng ◽

Yuxi Zhao ◽

Mingwei Wu ◽

Xianhao Bao ◽

Tao Li ◽

...

Keyword(s):

Aortic Aneurysm ◽

Stent Graft ◽

Endovascular Repair ◽

Open Surgery ◽

Primary Repair ◽

False Lumen ◽

Term Survival ◽

Mortality And Morbidity ◽

First Choice ◽

Minimal Invasion

Abstract Residual patent false lumen (FL) after type B aortic dissection (TBAD) repair is independently associated with poor long-term survival. Open surgery and endovascular repair result in good clinical outcomes in patients with AD. However, both treatments focus on proximal dissection but not distal dissection. About 13.4–62.5% of these patients present with different degrees of distal aneurysmal dilatation after primary repair. Although open surgery is the first-choice treatment for post-dissection aortic aneurysm (PDAA), there is a need for high technical demand since open surgery is associated with high mortality and morbidity. As a treatment strategy with minimal invasion, endovascular repair shows early benefits and low morbidity. For PDAA, the narrow true lumen (TL), rigid initial flap and branch arteries originating from FL have increased difficulties in operation. The aim of endovascular treatment is to promote FL thrombosis and aortic remodeling. Endovascular repair includes intervention from FL and TL sides. TL intervention techniques (parallel stent-graft, branched and fenestrated stent-graft among others) have been proven to be safe and effective in PDAA. Other FL intervention techniques that have been used in selected patients include FL embolization and candy-plug techniques. This article introduces available endovascular techniques and their outcomes for the treatment of PDAA.

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Primary Endovascular Repair of the Ascending Aorta

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000561 ◽

2018 ◽

Vol 13 (6) ◽

pp. 448-450

Author(s):

Bruno Borrello ◽

Davide Carino ◽

Andrea Agostinelli ◽

Alessandro Maria Budillon ◽

Francesco Nicolini

Keyword(s):

Stent Graft ◽

Endovascular Repair ◽

Open Surgery ◽

Case Series ◽

Ascending Aorta ◽

Off Label

Different case series have been published demonstrating the feasibility of endovascular repair of the ascending aorta in selected patients deemed unfit for open surgery. However, the use of commercially available stent graft in the ascending aorta remains off-label, and their excessive length often prevents their deployment in the ascending aorta. Here we report a case of successful primary endovascular repair of the ascending aorta using a physician modified off-the-shelf device.

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Endovascular Solutions for Aortic Arch Diseases: Total and Hybrid

Surgical Technology Online ◽

10.52198/21.sti.38.cv1415 ◽

2021 ◽

Author(s):

Luca Marco ◽

Giacomo Murana ◽

Luigi Lovato ◽

Gregorio Gliozzi ◽

Francesco Buia ◽

...

Keyword(s):

Aortic Arch ◽

Stent Graft ◽

Open Surgery ◽

New Technologies ◽

Therapeutic Option ◽

Circulatory Arrest ◽

Acute Type ◽

Aortic Diseases ◽

Increased Risk ◽

Endovascular Approach

Although the endovascular approach is the therapeutic option of choice for thoracic and abdominal aortic diseases, open surgery is still the treatment of choice for aortic arch diseases. While open surgical repair remains the gold standard treatment for complete aortic arch replacement, it continues to be burdened by high mortality and neurologic complications, especially for patients who require redo surgery. Therefore, in the era of endovascular surgery, it is not surprising that hybrid operating rooms, new technologies, and new approaches are strongly challenging open surgery. Less-invasive endovascular procedures, when used to treat aortic arch diseases, when feasible and indicated, have clear advantages over open surgery, primarily because there is no need for cardiopulmonary bypass, hypothermic circulatory arrest, or cerebral protection. Moreover, patients who have already been treated for acute type A aortic dissection continue to have a considerable risk for future aortic reintervention, which is associated with increased risk for short- and long-term mortality. In light of these advantages, it is clear how selected high-risk patients with aortic arch disease could benefit from the endovascular approach. However, the hemodynamic and anatomic characteristics of the aortic arch make the endovascular approach in this region challenging. In fact, uncorrected stent-graft placement can have fatal consequences for the patient and increase the risk of endoleaks and stroke. To minimize these potential risks, precise and accurate preoperative planning to achieve optimal stent-graft dimensions and implantation is essential together with careful patient selection. Endovascular options for the treatment of aortic arch disease include both hybrid procedures and total endovascular solutions. This manuscript provides an overview of the current strategies for endovascular aortic arch treatment, including the most recent available series on this topic. In addition, a literature search offers insight into the current state of the art.

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Endovascular Repair Reduces Early and Late Morbidity Compared to Open Surgery for Abdominal Aortic Aneurysm

Journal of Endovascular Therapy ◽

10.1177/152660280200900601 ◽

2002 ◽

Vol 9 (6) ◽

pp. 711-718 ◽

Cited By ~ 23

Author(s):

Frank R. Arko ◽

Bradley B. Hill ◽

Cornelius Olcott ◽

E. John Harris ◽

Thomas J. Fogarty ◽

...

Keyword(s):

Stent Graft ◽

Endovascular Repair ◽

Open Surgery ◽

Group Versus ◽

Aortic Aneurysms ◽

Open Group ◽

Systemic Complications ◽

Abdominal Aortic ◽

Late Morbidity ◽

Secondary Procedures

Purpose: To compare systemic complications between standard surgery and endovascular repair of abdominal aortic aneurysms (AAA) for both primary and late secondary procedures. Methods: At a single center between July 1993 and May 2000, 297 patients (255 men; mean age 73.4 ± 8.1 years, range 50–93) were treated with open surgical repair; beginning in 1996, 200 (166 men; mean age 73.6 ± 8.0 years, range 45–96) patients were treated with the AneuRx stent-graft. In a comparison of the cohorts, which were similar in terms of age, gender, and aneurysm diameter, the main outcomes were early major systemic morbidity following the primary procedure to treat the aneurysm and late (>30 days) organ system morbidity for any secondary procedures. Results: Mean length of follow-up for open patients was 20.1 ± 17.1 months (range 1–150) compared to 12.4 ± 9.6 months (range 1–60) after endovascular repair (p<0.05). There were 36 (12.1%) systemic complications after the primary open surgery and 15 (7.5%) after endovascular repair (p=NS). There were 43 (14.5%) combined primary and secondary morbidities in the open surgery group versus 15 (7.5%) for patients undergoing endovascular repair (p<0.01). The need for invasive procedures to treat these primary and secondary systemic complications was 4 times greater in the open group (17, 5.7%) than in endograft patients (3, 1.5%) (p<0.05). After secondary procedures (32 in the open group and 30 in the endovascular patients) for graft-related complications, there were 7 (21.9%) adverse events in the open group versus none (0%) for endograft patients (p<0.01). Hospital lengths of stay following both primary and secondary procedures were lower for the endograft patients (p<0.01 and p<0.001, respectively). Conclusions: Endovascular stent-graft repair compared to open surgery has reduced the early and late morbidity by half. Complications that require invasive or secondary surgical procedures and hospitalization are reduced with endovascular repair.

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An IVUS-Based Approach to Traumatic Aortic Rupture, with a Look at the Lesion from inside

Journal of Endovascular Therapy ◽

10.1177/152660280701400514 ◽

2007 ◽

Vol 14 (5) ◽

pp. 689-697 ◽

Cited By ~ 7

Author(s):

Bettina Marty ◽

Piergiorgio Tozzi ◽

Patrick Ruchat ◽

Christoph Huber ◽

Francesco Doenz ◽

...

Keyword(s):

Stent Graft ◽

Endovascular Repair ◽

Aortic Rupture ◽

Minor Stroke ◽

Technical Success ◽

Traumatic Aortic Rupture ◽

Aortic Lesion ◽

Abdominal Bleeding ◽

Navigation Tool ◽

A Minor

Purpose: To review a single-institution experience with endovascular repair of acute traumatic aortic rupture (ATAR) performed on an emergency basis using intravascular ultrasound (IVUS) exclusively as the navigation tool for stent-graft implantation (no arteriography). Methods: Between September 1998 and November 2006, 26 consecutive patients (19 men; mean age 38619 years, range 15 to 83) underwent endovascular repair of ATAR performed by a surgical team using IVUS and fluoroscopy for lesion characterization and stent-graft deployment guidance. Transesophageal echocardiography was routinely used in all patients to visualize the aortic lesion and rule out residual flow after device deployment. Sealing of the aortic tear was evaluated by postoperative contrast-enhanced computed tomography. Results: IVUS revealed an extensive disruption of the tunica intima and media (>180°) in 46% (12/26) of patients; the disruption was circumferential in 3 cases, with pseudocoarctation. The aortic diameter at the site of rupture measured 24±4 mm. Primary technical success was 92% (24/26); 1 persistent but small proximal endoleak and an intraoperative death (4% in-hospital mortality) from abdominal bleeding in an octogenarian accounted for the failures. Procedure-related complications (2, 8%) included the aforementioned endoleak and a minor stroke secondary to cerebral embolization. There was no paraplegia associated with the repairs. Conclusion: Endovascular repair of acute traumatic aortic disruption yields promising results, with high technical success and minimal procedure-related morbidity. IVUS as the primary navigation tool for device implantation allows prompt endovascular setup, instant aortic measurements, and precise visualization of the aortic disruption.

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Endovascular Repair of Aortobronchial Fistula after Bentall Procedure

Case Reports in Cardiology ◽

10.1155/2018/1975756 ◽

2018 ◽

Vol 2018 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Dane D. Gruenebaum ◽

Ray Graf ◽

Thomas Alexander ◽

Sergio Tavares ◽

Salim Surani

Keyword(s):

Case Report ◽

Endovascular Repair ◽

Multidisciplinary Team ◽

Surgical Repair ◽

Rare Complication ◽

Massive Hemoptysis ◽

Multidisciplinary Collaboration ◽

Bentall Procedure ◽

Aortobronchial Fistula ◽

First Case

Aortobronchial fistula (ABF) is a rare complication of aortic repair seen with both surgical and endovascular manipulation. The available literature largely refers to the need for surgical repair. We are not aware of any reports of endovascular repair after the Bentall procedure. This report describes a patient who after the Bentall procedure presented with massive hemoptysis from ABF, a multidisciplinary team decided on endovascular repair due to patient frailty to avoid redo sternotomy. We believe this is the first case report of endovascular repair and represents the success of multidisciplinary collaboration.

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Cost-effectiveness of abdominal aortic aneurysm repair: A systematic review

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462307070316 ◽

2007 ◽

Vol 23 (2) ◽

pp. 205-215 ◽

Cited By ~ 23

Author(s):

Yvonne C. Jonk ◽

Robert L. Kane ◽

Frank A. Lederle ◽

Roderick MacDonald ◽

Andrea H. Cutting ◽

...

Keyword(s):

Systematic Review ◽

Cost Effectiveness ◽

Endovascular Repair ◽

Open Surgery ◽

Surgical Repair ◽

Treatment Options ◽

Case Series ◽

Repair Costs ◽

Abdominal Aortic ◽

The Cost

Objectives: A systematic review of the cost-effectiveness of abdominal aortic aneurysm (AAA) repair was conducted. Although open surgery has been considered the gold standard for prevention of AAA rupture, emerging less-invasive endovascular treatments have led to increased interest in evaluating the cost and cost-effectiveness of treatment options.Methods: A systematic review of studies published in MEDLINE between 1999 and 2005 reporting the cost and/or cost-effectiveness of endovascular and/or open surgical repair of nonruptured AAAs was conducted. Case series studies with less than fifty patients per treatment were excluded.Results: Of twenty eligible articles, three were randomized controlled trials, twelve case series, four Markov models, and one systematic review. Regardless of time frame, all studies found that endovascular repair costs more than open surgery. Although the high cost of the endovascular prosthesis was partially offset by reduced intensive care, hospital length of stay, operating time, blood transfusions, and perioperative complications, hospital costs were still greater for endovascular than open surgical repair. For patients medically fit for open surgery, mid-term costs were greater for endovascular repair with no difference in overall survival or quality of life. For patients medically unfit for open surgery, endovascular repair costs more than no intervention with no difference in survival.Conclusions: Although conclusions regarding the cost-effectiveness of AAA treatment options are time dependent and vary by institutional perspective, from a societal perspective, endovascular repair is not currently cost-effective for patients with large AAA regardless of medical fitness.

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Pseudoaneurysm of the left internal carotid artery following tonsillectomy

VASA ◽

10.1024/0301-1526/a000153 ◽

2011 ◽

Vol 40 (6) ◽

pp. 491-494 ◽

Cited By ~ 4

Author(s):

Vávrová ◽

Slezácek ◽

Vávra ◽

Karlová ◽

Procházka

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Rare Complication ◽

Left Internal Carotid Artery ◽

Acute Tonsillitis ◽

Artery Pseudoaneurysm ◽

Complete Occlusion ◽

Endovascular Approach ◽

Deep Neck Infections

Internal carotid artery pseudoaneurysm is a rare complication of deep neck infections. The authors report the case of a 17-year-old male who presented to the Department of Otorhinolaryngology with an acute tonsillitis requiring tonsillectomy. Four weeks after the surgery the patient was readmitted because of progressive swallowing, trismus, and worsening headache. Computed tomography revealed a pseudoaneurysm of the left internal carotid artery in the extracranial segment. A bare Wallstent was implanted primarily and a complete occlusion of the pseudoaneurysm was achieved. The endovascular approach is a quick and safe method for the treatment of a pseudoaneurysm of the internal carotid artery.

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