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《Journal of vascular and interventional radiology : JVIR》2020,31(1):150-154.e2
Thoracic endovascular aortic repair (TEVAR) for aneurysmal chronic dissection is often complicated by retrograde filling of the false lumen and dissected distal landing zone. A “cheese wire”-style fenestration of the dissection intimal flap can create a landing zone facilitating TEVAR. This technique successfully aided TEVAR in 3 patients with an average age of 57.3 years. Complications included type III endoleak requiring relining and renal artery occlusion requiring stent placement. Average duration of clinical follow-up was 19 ± 4 months. Imaging follow-up was 8 ± 10 months. All patients have survived for more than 1 year without aneurysm enlargement. 相似文献
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Bin-Shan Zha Hua-Gang Zhu Yu-Sheng Ye Yong-Sheng Li Zhi-Gong Zhang Wen-Tao Xie 《Cardiovascular and interventional radiology》2017,40(3):455-459
Thoracic aortic aneurysms are now routinely repaired with endovascular repair if anatomically feasible because of advantages in safety and recovery. However, intraoperative aneurysm rupture is a severe complication which may have an adverse effect on the outcome of treatment. Comprehensive preoperative assessment and considerate treatment are keys to success of endovascular aneurysm repair, especially during unexpected circumstances. Few cases have reported on intraoperative aortic rupture, which were successfully managed by endovascular treatment. Here, we present a rare case of an intraoperative aneurysm rupture during endovascular repair of thoracic aortic aneurysm with narrow neck and angulated aorta arch (coarctation-associated aneurysm), which was successfully treated using double access route approach and iliac limbs of infrarenal devices. Level 5. 相似文献
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Gianpaolo Carrafiello Monica Mangini Elena Bracchi Chiara Recaldini Eugenio Cocozza Gabriele Piffaretti Carlo Pellegrino Domenico Laganà Carlo Fugazzola 《Cardiovascular and interventional radiology》2010,33(4):857-860
Elective endovascular treatment of thoracic aortic pathology has been applied in a variety of conditions. The complications
of thoracic aortic stenting are also well recognized. Endoleak after endovascular repair of thoracic aortic aneurysms is the
most frequent complication; among them, type III is the least frequent. Endovascular treatment of type III endoleak is generally
performed under elective conditions; less frequently, in emergency. We report a successful emergency endovascular management
of post-thoracic endovascular repair for thoracic aortic aneurysm rupture due to type IIIa endoleak. 相似文献
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《Journal of vascular and interventional radiology : JVIR》2022,33(2):136-140
This study explored the feasibility of a totally percutaneous approach to perform in situ microneedle puncture fenestration during thoracic endovascular aortic repair (TEVAR) via access from the left subclavian artery (LSA). In total, 23 patients with either thoracic aortic dissection or thoracic aortic aneurysm were treated with in situ LSA fenestration during TEVAR. The procedure was technically successful in all the patients. No serious complications occurred during a mean 9-month follow-up period. In situ microneedle puncture fenestration during TEVAR via the LSA is a feasible and effective method for LSA reconstruction. 相似文献
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Donald M. L. Tse Charles R. Tapping Rafiuddin Patel Robert Morgan Mark J. Bratby Susan Anthony Raman Uberoi 《Cardiovascular and interventional radiology》2014,37(4):875-888
Surveillance after endovascular abdominal aortic aneurysm repair (EVAR) is widely considered mandatory. The purpose of surveillance is to detect asymptomatic complications, so that early secondary intervention can prevent late aneurysm rupture. CT angiography has been taken as the reference standard imaging test, but there is increasing interest in using other modalities to reduce the use of ionising radiation and iodinated contrast. As a result, there is wide heterogeneity in surveillance strategies used among EVAR centres. We reviewed the current evidence available on the outcomes of different imaging modalities and surveillance strategies following EVAR. 相似文献
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Uotani Kensuke Hamanaka Akihiro Matsushiro Keigo Idaka Erika Ito Kiyo Yamasaki Yuko Kushima Takeyuki Sugimoto Takaki Sugimoto Koji 《Cardiovascular and interventional radiology》2018,41(1):182-185
CardioVascular and Interventional Radiology - Acute occlusion of abdominal aortic aneurysm (AAA) is a rare complication and is usually treated with surgical reconstruction. We present a case of... 相似文献
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Robert Juszkat Jerzy Kulesza Anna Zarzecka Marek Jemielity Ryszard Staniszewski Wac?aw Majewski 《Cardiovascular and interventional radiology》2011,34(1):67-73
To describe a technique for the preservation of the left common carotid artery (CCA) in zone 2 endovascular repair of thoracic
aortic aneurysm. This technique involves the placement of a guide wire into the left CCA via the right brachial artery before
stent graft deployment to enable precise visualization and protection of the left CCA during the whole procedure. Of the 107
patients with thoracic endovascular aortic repair in our study, 32 (30%) had the left subclavian artery intentionally covered
(landing zone 2). Eight (25%) of those 32 had landing zone 2a—the segment distally the origin of the left CCA, halfway between
the origin of the left CCA and the left subclavian artery. In all patients, a guide wire was positioned into the left CCA
via the right brachial artery before stent graft deployment. It is a retrospective study in design. In seven patients, stent
grafts were positioned precisely. In the remaining patient, the positioning was imprecise; the origin of the left CCA was
partially covered by the graft. A stent was implanted into the left CCA to restore the flow into the vessel. All procedures
were performed successfully. The technique of placing a guide wire into the left CCA via the right brachial artery before
stent graft deployment is a safe and effective method that enables the precise visualization of the left CCA during the whole
procedure. Moreover, in case of inadvertent complete or partial coverage of the origin of the left CCA, it supplies safe and
quick access to the artery for stent implantation. 相似文献
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Seung Hyun Lee Cheol Hyun Chung Sung Ho Jung Jae Won Lee Ji Hoon Shin Ki young Ko Hyun Ki Yoon Suk Jung Choo 《Korean journal of radiology》2012,13(4):476-482
Objective
This study aimed to assess the surgical morbidity and mortality of thoracic endovascular repair (TEVAR) as compared with open surgical repair (OSR) for isolated descending thoracic aortic disease.Materials and Methods
From January 1, 2006 through May 31, 2010, a total of 68 patients with isolated descending thoracic aortic disease were retrospectively reviewed for the presence of perioperative complication, 30-day mortality, and clinical success. The patients were divided into two groups (group 1, OSR, n = 40 vs. group 2, TEVAR, n = 28) and these groups were compared for major variables and late outcomes.Results
The mean age was 58 years (group I = 54 vs. group II = 63 years, p = 0.011). Significant perioperative complications occurred in 12 patients: 8 (20%) in group I and 4 (13%) in group II (p = 0.3). There were five 30 day mortalities of which 4 occurred in group I and 1 in group II (p = 0.23). Clinical success (effective aortic remodeling and complete false lumen obliteration or thrombosis) was achieved in 20 patients (71%). Mean Kaplan-Meier survival rate at 1 year was similar for both groups (group 1 = 87% vs. group 2 = 80%, p = 0.65).Conclusion
Thoracic endovascular repair for isolated thoracic aortic disease shows comparable results to OSR. However, the potential for endoleak or rupture remains a challenge that needs to be addressed in the future. Therefore, close follow-up study is needed for the evaluation of satisfactory long-term outcomes. 相似文献13.
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《Journal of vascular and interventional radiology : JVIR》2023,34(7):1135-1142
PurposeTo analyze the risk factors for access-related adverse events (AEs) of the preclose technique in thoracic endovascular aortic repair (TEVAR).Materials and MethodsNinety-one patients with Stanford type B aortic dissection who underwent the preclose technique in TEVAR between January 2013 and December 2021 were included. According to the occurrence of access-related AEs, the patients were divided into 2 groups: those with AE and those without AE. Age, sex, combined diseases, body mass index, skin depth, femoral artery diameter, access calcification, iliofemoral artery tortuosity, and sheath size were recorded for risk factor analysis. The sheath–to–femoral artery ratio (SFAR), the ratio of the femoral artery inner diameter (in millimeters) to the sheath’s outer diameter (in millimeters), was also included in the analysis.ResultsSFAR was identified as an independent risk factor for AEs using multivariable logistic analysis (odds ratio, 251.748; 95% CI, 7.004–9,048.534; P = .002). The cutoff value of SFAR was 0.85 and was related to a higher incidence of access-related AEs (5.2% vs 33.3%, P = .001), especially to a higher stenosis rate (0.0% vs 21.2%, P = .001).ConclusionsSFAR is an independent risk factor for access-related AEs of preclose in TEVAR with a cutoff value of 0.85. SFAR could be a new criterion for preoperative access evaluation in high-risk patients that may allow the detection and treatment of access-related AEs at the early stage. 相似文献
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Rao M Arya N Lee B Hannon RJ Loan W Soong CV 《Cardiovascular and interventional radiology》2004,27(5):523-524
Patients with functioning renal transplant who develop abdominal aortic aneurysm can safely be treated with endovascular repair. Endovascular repair of aneurysm avoids renal ischemia associated with cross-clamping of aorta.
Correspondence to: N. Arya, Specialist Registrar, Level 5, Regional Vascular and Endovascular Unit, Belfast City Hospital, Lisburn Road, Belfast, Northern Ireland, United Kingdom, BT9 7AB. Tel: 0044-2890263632; Fax: 0044-2890263951; Email: nityaarya@aol.com. 相似文献
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《Journal of vascular and interventional radiology : JVIR》2020,31(8):1334-1341
PurposeTo evaluate feasibility and efficacy of thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD) associated with retrograde type A intramural hematoma (IMH).Materials and MethodsFrom April 2013 to January 2017, 15 consecutive patients with TBAD associated with retrograde type A IMH who underwent TEVAR were reviewed retrospectively. There was no cardiac tamponade, aortic regurgitation, involvement of coronary artery, or sign of cerebral ischemia in these patients. Enhanced CT was used in 4 patients to diagnose malperfusion of abdominal visceral arteries or lower extremity artery and underwent emergent TEVAR. For the remaining 11 patients, repeated enhanced CT after initial medical treatment within 24 hours from onset of pain showed expansion of IMH in 8 patients or presence of periaortic hematoma in 3 patients. Delayed TEVAR was scheduled for these cases.ResultsSuccessful deployment of the stent graft was achieved in all patients. There were no severe postoperative complications, such as retrograde type A aortic dissection or aortic rupture. Sudden death occurred in 1 patient 3 months after the procedure. Thrombosis of the false lumen, shrinkage of the diameter of the aorta, and complete absorption of the IMH were observed in the remaining patients at a mean follow-up of 19.8 months ± 6.57.ConclusionsTEVAR for treatment of TBAD with retrograde type A IMH is feasible and effective. It represents a treatment option for patients with TBAD associated with type A IMH with a proximal entry tear located in the descending aorta. 相似文献
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Jessica S Lester MM Johanna L Bosch PhD John A Kaufman MD Elkan F Halpern PhD G.Scott Gazelle MD MPH PhD 《Academic radiology》2001,8(7):639-646
RATIONALE AND OBJECTIVES: The purpose of this study was to determine the inpatient cost of routine (ie, without emergent conversion to open repair during the hospital stay) endovascular stent-graft placement in a consecutive series of patients undergoing elective endovascular repair of abdominal aortic aneurysm (AAA) at a single institution. MATERIALS AND METHODS: Inpatient hospital costs of 91 patients who underwent initial elective endovascular repair of AAA were analyzed retrospectively. All patients had participated in clinical trials at the authors' institution during the previous 6 years. Financial data were derived from the hospital's cost-accounting system; additional procedural data were collected from a departmental database and with chart review. Stent-graft and professional costs were excluded. RESULTS: The mean total cost for endovascular repair was $11,842 (standard deviation [SD], $5,127), mean procedure time was 149 minutes (SD, 79 minutes), and mean length of stay was 3.5 days (SD, 2.3 days). Total cost depended on stent-graft type (means, $12,428 [bifurcated] vs $9,622 [tube]; P = .0002) and strongly correlated with procedure time and length of hospital stay (r = 0.78 and 0.66, respectively; P < .0001). Ninety-six percent of total costs for all patients were attributable to the following departments: operating theater (31%), radiology (31%), nursing (22%), and anesthesia (12%). CONCLUSION: Overall costs are greater with bifurcated than with tube stent-grafts. Total procedure-related costs are divided relatively equally between the operating theater, the radiology department, and the combination of the nursing and anesthesia departments. 相似文献
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Hiroyuki Ishibashi Tsuneo Ishiguchi Takashi Ohta Ikuo Sugimoto Hirohide Iwata Tetsuya Yamada Masao Tadakoshi Noriyuki Hida Yuki Orimoto Seiji Kamei 《Cardiovascular and interventional radiology》2010,33(5):939-942
Purpose
Intraoperative sac pressure was measured during endovascular abdominal aortic aneurysm repair (EVAR) to evaluate the clinical significance of sac pressure measurement. 相似文献20.
Choke E Munneke G Morgan R Belli AM Loftus I McFarland R Loosemore T Thompson MM 《Cardiovascular and interventional radiology》2006,29(6):975-980
Purpose The principal anatomic contraindication to endovascular aneurysm repair (EVR) is an unfavorable proximal aortic neck. With
increasing experience, a greater proportion of patients with unfavorable neck anatomy are being offered EVR. This study aimed
to evaluate outcomes in patients with challenging proximal aortic neck anatomy.
Methods Prospectively collected data from 147 consecutive patients who underwent EVR between December 1997 and April 2005 were supplemented
with a retrospective review of medical records and radiological images. Unfavorable anatomic features were defined as neck
diameter >28 mm, angulation >60°, circumferential thrombus >50%, and length <10 mm. Eighty-seven patients with 0 adverse features
(good necks) were compared with 60 patients with one or more adverse features (hostile necks).
Results Comparing the good neck with the hostile neck group, there were no significant differences in the incidence of primary technical
success (p = 0.15), intraoperative adjunctive procedures (p = 0.22), early proximal type I endoleak (<30 days) (p = 1.0), late proximal type I endoleak (>30 days) (p = 0.57), distal type I endoleak (p = 0.40), type III endoleak (p = 0.51), secondary interventions (p = 1.0), aneurysm sac expansion (p = 0.44), or 30 day mortality (p = 0.70). The good neck group had a significantly increased incidence of type II endoleak
(p = 0.023). By multivariate analysis, the incidence of intraoperative adjunctive procedures was significantly increased in
the presence of severe angulation (p = 0.041, OR 3.08, 95% CI 1.05–9.04).
Conclusion Patients with severely hostile proximal aortic neck anatomy may be treated with EVR, although severely angulated necks require
additional intraoperative procedures. Early outcomes are encouraging and suggest that indications for EVR may be expanded
to include patients with hostile neck anatomy. 相似文献