Is late open conversion after TEVAR more risky than primary open repair of descending thoracic aneurysms?

2019 ◽  
Vol 60 (1) ◽  
Author(s):  
Lazar B. Davidovic ◽  
Stefan M. Ducic ◽  
Aleksandra D. Vujcic
Keyword(s):  
Open Repair ◽  
Open Conversion ◽  
Thoracic Aneurysms

scholarly journals Late open conversion after endovascular repair of abdominal aneurysm failure: Better and easier option than complex endovascular treatment

2018 ◽  
Vol 7 ◽  
pp. 204800401775283 ◽  
Author(s):  
Stefano Bonardelli ◽  
Franco Nodari ◽  
Maurizio De Lucia ◽  
Emanuele Botteri ◽  
Alice Benenati ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Endovascular Repair ◽  
Open Repair ◽  
Multiple Organ ◽  
Type I ◽  
Abdominal Aneurysm ◽  
Open Conversion ◽  
Technical Errors ◽  
Report Data

Aim Conversion to open repair becomes the last option in case of endovascular repair of abdominal aneurysm failure, when radiological interventional procedures are unfeasible. While early conversion to open repair generally derives from technical errors, aetiopathogenesis and results of late conversion to open repair often remain unclear. Methods We report data from our Institute’s experience on late conversion to open repair. Twenty-two late conversion to open repairs out of 435 consecutive patients treated during a 18 years period, plus two endovascular repair of abdominal aneurysms performed in other centres, are analysed. The indication for conversion to open repair was aneurysm enlargement because of type I, type III, type II endoleak and endotension. Even if seven cases (23%) had shown an initial aneurysmal shrinkage, in a later phase, the sac began to enlarge again. In 12 patients, conversion to open repair was the last chance after unsuccessful secondary endovascular procedures. Results Three cases (12.5%) were treated in emergency. Aortic cross-clamping was only infrarenal in 10 cases, only or temporarily suprarenal in 14 and temporarily supraceliac in 9 cases, for 19 total and 5 partial endograft excisions. Two patients died for Multiple Organ Failure (MOF), on 42nd (endovascular repair of abdominal aneurysm infection) and 66th postoperative day. No other conversion to open repair-related deaths or major complications were revealed by follow-up post-conversion to open repair (mean: 68 months ranging from 24 to 180 months). Conclusion Late conversion to open repair is often an unpredictable event. It represents a technical challenge: specifically, the most critical point is the proximal aortic clamping that often temporarily excludes the renal circulation. In our series, conversion to open repair can be performed with a low rate of complications. In response to an endovascular repair of abdominal aneurysm failure, before applying complex procedures of endovascular treatment, conversion to open repair should be taken into account.

Glutathione system participation in thoracic aneurysms from patients with Marfan syndrome

VASA ◽  
2017 ◽  
Vol 46 (3) ◽  
pp. 177-186 ◽  
Author(s):  
Alejandra María Zúñiga-Muñoz ◽  
Israel Pérez-Torres ◽  
Verónica Guarner-Lans ◽  
Elías Núñez-Garrido ◽  
Rodrigo Velázquez Espejel ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Marfan Syndrome ◽  
Aortic Aneurysms ◽  
Aortic Dilatation ◽  
Glutathione S Transferase ◽  
Reduced And Oxidized Glutathione ◽  
Total Antioxidant ◽  
Elevated Activity ◽  
Acute Dissection ◽  
Thoracic Aneurysms

Abstract. Background: Aortic dilatation in Marfan syndrome (MFS) is progressive. It is associated with oxidative stress and endothelial dysfunction that contribute to the early acute dissection of the vessel and can result in rupture of the aorta and sudden death. We evaluated the participation of the glutathione (GSH) system, which could be involved in the mechanisms that promote the formation and progression of the aortic aneurysms in MFS patients. Patients and methods: Aortic aneurysm tissue was obtained during chest surgery from eight control subjects and 14 MFS patients. Spectrophotometrical determination of activity of glutathione peroxidase (GPx), glutathione-S-transferase (GST), glutathione reductase (GR), lipid peroxidation (LPO) index, carbonylation, total antioxidant capacity (TAC), and concentration of reduced and oxidized glutathione (GSH and GSSG respectively), was performed in the homogenate from aortic aneurysm tissue. Results: LPO index, carbonylation, TGF-β1, and GR activity were increased in MFS patients (p < 0.04), while TAC, GSH/GSSG ratio, GPx, and GST activity were significantly decreased (p < 0.04). Conclusions: The depletion of GSH, in spite of the elevated activity of GR, not only diminished the activity of GSH-depend GST and GPx, but increased LPO, carbonylation and decreased TAC. These changes could promote the structural and functional alterations in the thoracic aorta of MFS patients.

Treatment of an asymptomatic penetrating aortic ulcer in a young patient

VASA ◽  
2010 ◽  
Vol 39 (2) ◽  
pp. 175-179
Author(s):  
Hakimi ◽  
Geisbüsch ◽  
Gross ◽  
Hyhlik-Dürr ◽  
Hausser ◽  
...  
Keyword(s):  
Electron Microscopy ◽  
Connective Tissue ◽  
Aortic Arch ◽  
Open Surgery ◽  
Open Repair ◽  
Thoracic Endovascular Aortic Repair ◽  
Concomitant Disease ◽  
Connective Tissue Disorders ◽  
Penetrating Aortic Ulcer ◽  
Pathological Analysis

We want to report and discuss the indication for open surgery for an asymptomatic penetrating aortic ulcer (PAU) in the era of thoracic endovascular aortic repair (TEVAR). A 31-year-old female presented with the diagnosis of an aneurysm in the distal aortic arch. With respect to the patient’s young age, the controversial status of connective tissue disorders and in the absence of concomitant disease, open repair was indicated. There was no proof of a mycotic plaque or connective tissue disease in the microbiological-, pathological analysis and at electron-microscopy. The patient was discharged on the thirteenth postoperative day. In spite of good preliminary results of TEVAR in PAU, in selective cases there is still an indication for open surgery.

LAPAROSCOPIC REPAIR OF PERFORATED DUODENAL ULCER PATCH VERSUS CONVENTIONAL SURGERY

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Dr. Anil Kumar Saxena ◽  
Dr. Devi Das Verma
Keyword(s):  
Duodenal Ulcer ◽  
Laparoscopic Repair ◽  
Open Repair ◽  
Wound Dehiscence ◽  
Duodenal Perforation ◽  
Perforated Duodenal Ulcer ◽  
Conventional Surgery ◽  
Duodenal Ulcers ◽  
Duration Of Operation ◽  
Repair Group

Introduction: For many surgeries for duodenal ulcer Laparoscopic repair has become gold standard for many elective procedures such as ant reflux procedures, laparoscopic cholecystectomy and in colorectal surgery. Although in the emergency setting such as in the management of perforated duodenal ulcer Laparoscopic repair has been slow and limited. Since 1990, for the treatment of perforated peptic ulcer Laparoscopic repair has been used which has been widely accepted as an effective method. Duodenal ulcer is defined as a peptic ulcer which develops in the first part of the small intestine called duodenum and usually present as a perforation of acute abdomen. In perforated duodenal symptoms as severe and sudden onset abdominal pain that is worse in right upper quadrant and epigastrium and usually followed by nausea and vomiting. In this situation there is rapid generalization of pain and in examination shows peritonitis with lack of bowel sounds. Aim: The main objective of this study is to evaluate outcome of laparoscopic surgery in comparison with conventional surgery. Material and methods: All the patients with clinically diagnosed with perforated duodenal ulcers presenting within 24 hours of symptoms and undergoing surgery were included during the study period. Total 50 patients were included with age group 15-65 years. All the patients with perforated duodenal ulcers were included which go through either conventional open or laparoscopic without omental patch repair. Result: Total 50 patients were included in these studies which were divided into two group with 25 patients in each group as laparoscopic duodenal perforation repair group and conventional open repair group. Mean duration of operation (in minutes) was 105.4±10.4 in laparoscopic duodenal perforation repair group whereas mean duration of operation (in minutes) was 67.3±8.6 in conventional open repair group. Mean duration of number of doses of analgesics required in laparoscopic group and conventional open group as 9.5±1.7 and 17.2± 3.1 respectively. Out of 25 patients in each group of laparoscopic duodenal perforation repair group and the conventional open repair group the outcome were noted with their post operative complication as shown in table no 5 below.   In Post-operative complications 21(84%) patients in laparoscopic duodenal perforation repair group and 14(56%) patients in conventional open repair group had no complications. 4 (16%) patients in the laparoscopic duodenal perforation repair group and 2(8%) patients in conventional open repair group showed Post-operative complications as chest infection. In the conventional open repair group  patients present with wound dehiscence and wound infection and Wound dehiscence and chest infection were 4(16%) and 5(20%) respectively whereas nil in Laparoscopic duodenal perforation repair group. Conclusion: Duodenal ulcer perforation is a life-threatening emergency which required urgent management for the patients. Due to the advance in duodenal ulcer perforation closure by laparoscopy it becomes popular and favorite choice. With certain criteria, laparoscopic closure of perforated duodenal ulcer is safe and effective though it was associated with longer operating time and had no impact on the outcome. Hence laparoscopic closure was better in comparison to open repair for the earlier returns to normal daily activities. Keywords:  Duodenal ulcer, Laparoscopic repair, Post-operative analgesia, conventional surgery

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