descending thoracic aorta
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2022 ◽  
pp. 152660282110687
Author(s):  
Marcelo Ferreira ◽  
Matheus Mannarino ◽  
Rodrigo Cunha ◽  
Diego Ferreira ◽  
Luis Fernando Capotorto

Purpose: To demonstrate an alternative access to perform directional branch catheterization during complex endovascular aortic repair. Technique: Urgent endovascular aortic repair was indicated to treat a symptomatic post dissection thoracoabdominal aneurysm with large infrarenal dilatation with an off-the-shelf t-Branch endograft (Cook Medical, Bloomington, IN, USA). Traditional proximal arterial accesses were not suitable due to a previous aortic arch endograft. A novel approach was performed through a left postero-lateral thoracotomy, isolation of the descending thoracic aorta and anastomosed a polyester graft conduit to allow sheaths passage to the thoracoabdominal aorta with subsequently directional branch catheterization. Conclusion: The descending thoracic aortic conduit technique is an effective alternative for directional branch catheterization and should be considered whenever traditional proximal arterial accesses are not suitable and other endografts configurations not considered due to anatomic limitations.


Author(s):  
Neeraj Kumar ◽  
Mini Sharma ◽  
Nishant Nayyar ◽  
Lokesh Rana ◽  
Dinesh Sood

AbstractWe have reported rare case of tubercular aortic aneurysm which has developed as complication of spinal tuberculosis. Imaging of patient is available prior to starting of antitubercular treatment which showed vertebral tuberculosis with absence of aortic aneurysm. However, patient defaulted on treatment after taking antitubercular chemotherapy only for 2 months. Patient again reported after 14 months with chest pain. At this stage, imaging showed progression of spinal tuberculosis with development of pseudoaneurysm in adjacent descending thoracic aorta. This contiguous spread of tuberculosis from spine to aorta may have been prevented if patient had completed complete course of antitubercular therapy with regular follow-ups. Patient of spinal tuberculosis need to be counselled and informed regarding its various complications, so that they remain adhered to antitubercular chemotherapy and timely follow-ups to prevent complications.


2021 ◽  
pp. 152660282110659
Author(s):  
Peyton Tharp ◽  
Ryan W. King ◽  
Bruce M. Frankel ◽  
Mathew D. Wooster

Purpose: Address iatrogenic injury to the descending thoracic aorta by breached spinal screws through a novel approach of concomitant spinal screw removal and thoracic endovascular repair (TEVAR) placement. Case Report: A 36-year-old female with idiopathic scoliosis underwent T4 to L3 bilateral pedicle instrumentation with spinal fusion and correction of scoliosis deformity. Ten months post-operative, she continued to complain of mid-thoracic pain; computed tomography (CT) angiography revealed protrusion of the left T5 and T6 transpedicular screws into her descending thoracic aorta by 3 and 5 mm, respectively. She was taken to the odds ratio (OR) in a combination case with vascular and neurosurgery. Positioned in the right lateral decubitus position, TEVAR was successfully deployed while neurosurgery concurrently removed the invading spinal screws via posterior spinal exposure. Neurosurgery then completely revised the spinal hardware during the same operation. The patient progressed well throughout the remainder of her hospital stay and was discharged on postoperative day 4. Two-year angiography demonstrated a well-placed TEVAR with no extravasation or aortic abnormality. Conclusions: In the setting of iatrogenic aortic injury due to pedicle screws, concomitant TEVAR and spinal screw removal is a safe and feasible treatment option that allows for spinal reconstruction to occur without multiple trips to the operating room.


Aorta ◽  
2021 ◽  
Vol 09 (06) ◽  
pp. 228-230
Author(s):  
Mariano Camporrotondo ◽  
Sebastian Pagni

AbstractComplex pathology of the distal arch and proximal descending thoracic aorta is usually approached by stent endografting or in situ graft replacement. Oftentimes, these options are not feasible due to unfavorable anatomy, multiple previous procedures, active infection, or presence of concomitant cardiac disease. Thoracic aortic extra-anatomic bypass, as part of an open surgical strategy, is a useful and often the only curative option left for the treatment in these patients. Herein, we describe two cases that illustrate the utility of extra-anatomic thoracic aortic bypass for complex aortic disease.


2021 ◽  
Vol 25 (3 (99)) ◽  
pp. 42-47
Author(s):  
V. Kravchenko ◽  
I. Dytkivski ◽  
V. Lybavka

The purpose of the study – study and demonstration of the possibilities of the technique of complete replacement of the ascending, arch, vessels of the arch and descending thoracic aorta "elephant trunk" surgery in patients with aortic arch aneurysms.Material and methods. The paper describes the technique and demonstrates the results of the first 29 operations of prosthetics of the ascending, arch, vessels of the arch and descending thoracic aorta, which were performed by the staff of the Department of Surgical Treatment of Aortic Pathology National M.Amosov ICVS of the NAMS of Ukraine" in 2016-2020. Results. Hospital mortality was 10.3%, three patients died. The causes of death were: the following acute cardiovascular failure, uncontrolled bleeding, and multiple organ failure in each case. In none of the operated patients the level of postoperative blood loss did not require rethoracotomies.Conclusions. The optimal way to correct aneurysms of the aortic arch is the operation of prosthetics of the ascending, arch and descending thoracic aorta - "elephant trunk". Improvement of preoperative diagnostics, surgical equipment, optimization of methods of protection of the brain, spinal cord and visceral organs, the possibility of using hybrid / endovascular techniques to treat patients with complex lesions of the aortic arch pool with hospital mortality within 10.3%.


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