scholarly journals Kissing Intravascular Balloon Lithoplasty and Endovascular Aortic Repair as a Treatment of Severe Distal Aorto-Iliac Occlusive Disease to Ensure a Safe Conduit to Facilitate Thoracic Endovascular Aort

2020 ◽  
Vol 3 (12) ◽  
pp. 01-06
Author(s):  
Pankaj Khullar
Keyword(s):  
Chest Pain ◽  
Treatment Options ◽  
Thoracic Endovascular Aortic Repair ◽  
Occlusive Disease ◽  
Endovascular Aortic Repair ◽  
Endovascular Stent Graft ◽  
Surgical Risk ◽  
Descending Thoracic Aortic Aneurysm ◽  
Aortic Repair ◽  
Artery Disease

Background: We describe a novel case of treating severe distal aorto-illiac occlusive disease and endovascular aortic repair with kissing endoluminal lithoplasty balloons. This ensured a safe conduit to facilitate thoracic endovascular aortic repair. Case Presentation: A patient with multiple comorbidities including coronary artery disease and peripheral artery disease (Rutherford 4 symptoms bilaterally) presented to the emergency room with chest pain and dyspnea on exertion. The patient was found to have a 3.5 cm descending thoracic aortic aneurysm, multiple penetrating aortic ulcers (PAU’s) within the descending thoracic aorta which was felt to be the cause of her chest pain along with heavily calcified occlusive aorto-iliac disease. The patient was deemed high surgical risk for open repair and the patient’s severe calcific distal aortic stenosis and bilateral severe ostial iliac stenosis was deemed a barrier for endovascular repair. Therefore, the patient was successfully treated with kissing balloon lithoplasty for lesion preparation of the heavy calcification and placement of an endovascular stent graft (EVAR) in the distal aorta, which ensured a safe conduit for thoracic endovascular aortic repair (TEVAR) procedure. Conclusion: As patients become more and more complex it is important to explore endovascular treatment options especially when surgical risk is high. Balloon lithoplasty and graft placement of calcified aorto-iliac bifurcation is a safe approach to develop a clear conduit for TEVAR.

scholarly journals Old Solutions for New Troubles in Complications after Thoracic Endovascular Aortic Repair

2017 ◽  
Vol 06 (01) ◽  
pp. e25-e28
Author(s):  
German Fortunato ◽  
Guillermo Stöger ◽  
Ricardo Marenchino ◽  
Vadim Kotowicz
Keyword(s):  
Aortic Aneurysm ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Type B ◽  
Ascending Aortic Aneurysm ◽  
Endovascular Stent Graft ◽  
Aortic Repair ◽  
First Case ◽  
Type B Dissection

Background The authors present two cases with type B aortic dissection initially treated by endovascular stent graft who developed aortic complications posttreatment and required surgical treatment. Case Description A 50-year-old woman and a 65-year-old man underwent endovascular treatment for thoracic aortic aneurysm associated with type B dissection and —both of them evolved with endoleak type 1. The first case was related to aortobronchial fistula, and the second one was associated with ascending aortic aneurysm. An extra-anatomical ascending aorta-supraceliac aorta bypass grafting was decided due to the persistent leak. Conclusion Surgery is an excellent choice for complex complications after thoracic endovascular aortic repair with previous failed attempts of endovascular resolution.

scholarly journals Predictors and Outcomes of Cardiac Events following Thoracic Endovascular Aortic Repair in Descending Thoracic Aortic Aneurysm and Dissection

Aorta ◽  
2020 ◽  
Vol 08 (01) ◽  
pp. 006-013
Author(s):  
Derrick O. Acheampong ◽  
Philip Paul ◽  
Percy Boateng ◽  
I. Michael Leitman
Keyword(s):  
Risk Factors ◽  
Aortic Aneurysm ◽  
Blood Transfusion ◽  
Thoracic Aortic Aneurysm ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Cardiac Events ◽  
Descending Thoracic Aortic Aneurysm ◽  
Aortic Repair ◽  
Significant Difference

Abstract Background Cardiac events following thoracic endovascular aortic repair (TEVAR) have been associated with significant morbidity and mortality. However, predictors of post-TEVAR cardiac events in descending thoracic aortic aneurysm or dissection are poorly understood. Methods A retrospective analysis of completed TEVAR procedures performed from 2010 to 2016 was conducted using the ACS-NSQIP (American College of Surgeons National Surgical Quality Improvement Program) participant user file database. Adult patients (≥18 years) who underwent TEVAR for descending thoracic aortic aneurysm or dissection were identified and 30-day outcomes were examined. An initial univariate analysis was performed to determine associations between all patient variables and cardiac events, defined as myocardial infarction or cardiac arrest that occurred ≤30 days of surgery. Multivariate logistic regression was subsequently performed to identify independent risk factors for cardiac events following TEVAR. Results The study identified 150 out of 2,905 (5.2%) patients who underwent TEVAR for descending thoracic aortic aneurysm or dissection who developed cardiac events. No significant difference in incidence of cardiac events was noted among patients presenting with aortic aneurysm or dissection (p = 0.339). The overall 30-day mortality rate for all patients was 9.1%. Independent preoperative predictors of post-TEVAR cardiac events included emergency procedure (odds ratio [OR] 2.80, 95% confidence interval [CI] 1.9–4.1, p < 0.01); American Society of Anesthesiologists score >3 (OR 1.71, 95% CI 1.1–2.6, p = 0.01), ventilator dependence (OR 2.33, 95% CI 1.3–4.2, p < 0.01), renal failure (OR 2.53, 95% CI 1.50–4.3, p < 0.01), blood transfusion (OR 1.84, 95% CI 1.1–3.2, p = 0.03), and preoperative leukocytosis (OR 2.45, 1.6–3.8, p < 0.01). After TEVAR, unplanned reintubation (OR 5.52, 95% CI 3.5–8.8, p < 0.01), prolonged mechanical ventilation (OR 1.94, 95% CI 1.2–3.2, p = 0.011), and postoperative blood transfusion (OR 4.02, 95% CI 2.70–6.0, p < 0.01) were independent predictors of cardiac events. Cardiac events greatly increased mortality (60.7 vs. 5.5%), total length of hospital stay (13.2 ± 14.7 days vs. 8.3 ± 9.3 days), and readmission rates (19.3 vs. 8.2%, p < 0.01). Conclusions Cardiac events following TEVAR are associated with significant mortality. Patients with these risk factors should be appropriately monitored to improve outcomes.

scholarly journals Kissing Intravascular Balloon Lithoplasty and Endovascular Aortic Repair as a Treatment of Severe Distal Aorto-Iliac Occlusive Disease to Ensure a Safe Conduit to Facilitate Thoracic Endovascular Aortic Repair

2020 ◽  
Vol 16 (4) ◽  
Author(s):  
Pankaj Khullar
Keyword(s):  
Thoracic Endovascular Aortic Repair ◽  
Occlusive Disease ◽  
Endovascular Aortic Repair ◽  
Aortic Repair

We describe a novel case of treating severe distal aorto-illiac occlusive disease and endovascular aortic repair with kissing endoluminal lithoplasty balloons. This ensured a safe conduit to facilitate thoracic endovascular aortic repair.

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