Endovascular Treatment of Aortic Pathologies in Patients With Marfan Syndrome: Single-Center Experience

Objectives: To study the outcome of endovascular treatment of aortic pathologies in patients with Marfan syndrome (MFS) at a single institution. Methods: Consecutive MFS patients who underwent endovascular repair or hybrid procedures for aortic pathologies from January 2010 to May 2020 were identified. Several endovascular and hybrid strategies have been used. Technical success, short- and mid-term survival, complications, and re-interventions were retrospectively analyzed. Results: During the study period, 24 patients with MFS (median age, 48 [13–78] years; 58% males) were treated. Indications for intervention were chronic aortic dissection with aneurysm degeneration in 16 patients (67%), acute type B aortic dissection in 4 patients (17%), aortic aneurysm without any dissection in 3 patients (13%), and aortic intramural hematoma in 1 patient (4%). Most patients were asymptomatic (83%), three (13%) were symptomatic and one (4%) had a contained rupture. The median aneurysm diameter was 56 (35–86) mm. Hybrid procedures were performed in 7 (29%) patients. Thoracic endovascular repair was performed in 12 (50%) patients, a fenestrated or branched endovascular aortic repair in 4 (17%) patients, and placement of an iliac artery stent-graft in 1 (4%) patient. Procedures were staged in 12 (50%) patients. Technical success was achieved in all patients. The median intensive care unit stay was 6 (range, 1–30) days, and the median hospital stay was 23 (range, 3–112) days. Early mortality was reported in 1 (4%) patient. Wound infection was seen in 7 (29%) patients and gastrointestinal complications in 3 (13%) patients. The median follow-up was 42 (range, 1–127) months. The cumulative survival rate was 87% at 24 months. The cumulative freedom from re-intervention was 77% at 12 months. Conclusions: Endovascular treatment of aortic pathologies in patients with MFS appears feasible with acceptable early and mid-term outcomes in terms of mortality and re-intervention rates. Endovascular therapy plays an increasing role in MFS patients with aortic pathology.

Thoracic Endovascular Aortic Repair for Penetrating Aortic Ulcer in a Patient with Renal Failure: A Case Report

Thoracic Endovascular Aortic Repair (TEVAR) is a state-of-the art endovascular intervention used to treat various thoracic aortic pathologies such as aneurysm, dissection and penetrating aortic ulcers (PAU). The procedure demands significant technical skill and involves considerable cost burden for the patients. The latter is the main reason why the procedure has not yet made it to the routine clinical practice in Bangladesh. We recently performed TEVAR for the successful treatment of an ominous-looking PAU in the descending thoracic aorta in a patient with renal failure. Cardiovasc j 2021; 14(1): 88-92

Review of Malpractice Lawsuits in the Diagnosis and Management of Aortic Aneurysms and Aortic Dissections

Objective: Aortic aneurysms and dissections are prevalent causes of morbidity and mortality. The management of aortic pathologies may be called into question in malpractice suits. Malpractice claims were analyzed to understand common reasons for litigation, medical specialties involved, patient injuries, and outcomes. Methods: Litigation cases in the Westlaw database from September 1st, 1987 to October 23 rd, 2019 were analyzed. Search terms included “aortic aneurysm” and “aortic dissection.” Data on plaintiff, defendant, litigation claims, patient injuries, misdiagnoses, and case outcomes were collected and compared for aortic aneurysms, aortic dissections, and overall cases. Results: A total of 346 cases were identified, 196 involving aortic aneurysms and 150 aortic dissections. Physician defendants were emergency medicine (29%), cardiology (20%), internal medicine (14%), radiology (11%), cardiothoracic (10%) and vascular surgery (10%). Litigation claims included “failure to diagnose and treat” (61%), “delayed diagnosis and treatment” (21%), “post-operative complications after open repair” (10%) and “negligent post-operative care” (10%). Patients with aneurysms presented with abdominal (63%) and back pain (37%), while dissections presented with chest pain (78%), abdominal pain (15%), and shortness of breath (14%). Misdiagnoses included gastrointestinal (12%), other cardiovascular (9%), and musculoskeletal conditions (9%), but many were not specified (58%). Overall, 83% of cases were wrongful death suits. Injuries included loss of consortium (23%), emotional distress (19%), and bleeding (17%). In 53% of the cases, the jury ruled in favor of the defendant. 25% of cases ruled for the plaintiff. 22% of cases resulted in a settlement. The mean rewarded for each case was $1,644,590.66 (SD: $5,939,134.58; Range: $17,500-$68,035,462). Conclusion: For aortic pathologies, post-operative complications were not prominent among the reasons why suits were brought forth. This suggests improvements in education across all involved medical specialties may allow for improved diagnostic accuracy and efficient treatment, which could then translate to a decrease in associated litigation cases.

Stenotic lesions of aorta: Imaging evaluation using multidetector computed tomography angiography

Aortic involvement can be secondary to various pathologic disease processes. These may result in stenotic or aneurysmal aortic lesions with a varied spectrum of imaging findings including intra-luminal, mural, and periaortic changes along with associated loco-regional or distal changes, depending on the etiology. Multidetector computer tomography with its recent advances has become the frontline imaging modality for the evaluation of aortic pathologies. Comprehensive evaluation of the aortic pathology with simultaneous evaluation of lungs, bones, and visceral organs is possible with a single multidetector computer tomography acquisition. It allows accurate primary diagnosis, identifies important anatomic landmarks and relationships, and identifies associated cardiovascular anomalies. Moreover, it serves as an adjunct in diagnosis of various complications, helps in treatment planning and detection of disease progression during follow-up.