INCIDENCE AND RISK FACTORS OF PERIOPERATIVE STROKE IN THORACIC ENDOVASCULAR AORTIC REPAIR (TEVAR) AND ENDOVASCULAR ANEURYSM REPAIR (EVAR) IN SONGKLANAGARIND HOSPITAL

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.

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Stent graft in abdominal aortic aneurysm collapsed suddenly after thoracic endovascular aortic repair

BMJ Case Reports ◽

10.1136/bcr-2021-246798 ◽

2021 ◽

Vol 14 (12) ◽

pp. e246798

Author(s):

Sho Takagi ◽

Yoshihiro Goto ◽

Junji Yanagisawa ◽

Akio Nakasu

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Stent Graft ◽

Endovascular Aneurysm Repair ◽

Rare Event ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Aortic Repair ◽

Abdominal Aortic ◽

Aneurysm Repair

Stent graft collapse due to aortic dissection is an extremely rare event. Although endovascular aneurysm repair (EVAR) and thoracic endovascular aortic repair (TEVAR) are increasingly being performed, various complications can occur. We report a case of collapse of a stent graft, which was used to repair an abdominal aortic aneurysm (AAA) after TEVAR for thoracic aortic aneurysm (TAA). A 72-year-old man with a 77 mm AAA and 60 mm TAA underwent EVAR and a TEVAR 2 months later, respectively. CT performed after the TEVAR showed thoracic aorta dissection with associated AAA stent graft collapse. The graft collapsed was due to superior mesenteric artery obstruction. An emergency TEVAR was performed, and the procedure improved the collapsed graft; however, the endoleak of the AAA stent graft persisted. The AAA expanded over several days, warranting an open repair. Our case provides an insight into the cautionary indications for endovascular therapy.

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VS02. Endovascular Docking Station Minimizes Gutter Endoleaks During Parallel Stent Graft Thoracic Endovascular Aortic Repair-Endovascular Aneurysm Repair

Journal of Vascular Surgery ◽

10.1016/j.jvs.2018.03.080 ◽

2018 ◽

Vol 67 (6) ◽

pp. e85

Author(s):

Manish Mehta

Keyword(s):

Stent Graft ◽

Endovascular Aneurysm Repair ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Aortic Repair ◽

Aneurysm Repair

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Combined thoracic endovascular aortic repair and endovascular aneurysm repair and the long-term consequences of altered cardiovascular haemodynamics on morbidity and mortality: case series and literature review

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab339 ◽

2021 ◽

Vol 5 (10) ◽

Author(s):

Sherif Sultan ◽

Yogesh Acharya ◽

Mohiey Hazima ◽

Hiba Salahat ◽

Juan Carlos Parodi ◽

...

Keyword(s):

Aortic Aneurysm ◽

Endovascular Aneurysm Repair ◽

Left Ventricular ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Coronary Perfusion ◽

Aortic Repair ◽

Abdominal Aortic ◽

Aneurysm Repair ◽

Compliance Mismatch

Abstract Background Thoracic and abdominal aortic stent grafts are firmer and more rigid than the native aorta. Aortic implanted devices have been implicated in the development of acute systolic hypertension, elevated pulse pressure, and reduced coronary perfusion. Case summary We report four cases of staged thoracic endovascular aortic repair (TEVAR) and then endovascular aneurysm repair (EVAR). All patients had TEVAR first for thoracic aortic aneurysm and later on developed infra-renal abdominal aortic aneurysm (AAA) that required EVAR. There were three males and one female with a median age of 74.5 years (range 67.5–78.5). None of the patients developed aortic-related major clinical adverse effects or required any aortic intervention during their follow-up. However, within 2 years, all patients developed symptomatic left ventricular hypertrophy with diastolic dysfunction. All patients had bilateral lower limb oedema, with on and off chest pain and shortness of breath (SOB), necessitating coronary angiograms, which showed no evidence of coronary artery disease. Three patients died from cardiovascular-related morbidities, and the fourth patient is still complaining of SOB despite a normal coronary angiogram. Discussion Aortic-endograft compliance mismatch is an invisible enemy, with troubling consequences for the aorta proximal and distal to the endograft. Aortic stiffness due to vascular endograft could lead to cardiovascular adverse events, even in the absence of direct aortic-related complications. After combined TEVAR and EVAR, the compliance mismatch and elasticity loss are even more pronounced than with TEVAR alone, which necessitates patient monitoring for the development of cardiovascular complications.

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