Endovascular stent grafting for chronic proximal thoracic aortic pseudoaneurysm

Chronic descending aortic pseudoaneurysm generally result from traumatic and can spontaneously progress to rupture. We report the case of a 70-year-old patient presenting a chronic pseudoaneurysm of the thoracic aorta treated by endovascular stent-grafting. The patient underwent imaging evaluation for endoluminal repair: thoracic aorta was evaluated by contrast-enhanced CT scan and supra-aortic and iliac vessels were evaluated by MRI-imaging. Stent-graft was deployed under fluoroscopic guidance across the aneurysmal defect. The left sub-clavian artery was covered, but no ischemic symptoms appeared and transposition of the left sub-clavian artery was not necessary. Clinical and radiological follow-up at 6 and 30 months showed total exclusion and thrombosis of the pseudoaneurysm. Chronic pseudoaneurysm of the thoracic aorta do benefit from endoluminal repair, which is adapted to patients with high surgical risk.     

Endovascular repair of thoracic aortic aneurysms.

The standard technique for the treatment of descending thoracic aortic aneurysms is elective open surgical repair with graft interposition. This standard approach, although steadily improving, is associated with high morbidity and substantial mortality rates and implies a major surgical procedure with lateral thoracotomy, use of cardiopulmonary bypass, long operation times and a variety of peri- and postoperative complications. This and the success of the first endoluminal treatment of abdominal aortic aneurysms by Parodi et al. prompted the attention to be thrown on the treatment of descending thoracic aortic aneurysms with endoluminal stent-grafts in many large centres. The aim of this new minimally invasive technique is to exclude the aneurysm from blood flow and in consequence to avoid pressure stress on the aneurysmatic aortic wall, by avoiding a large open operation with significant perioperative morbidity. The potentially beneficial effect of this new treatment approach was evaluated in the course of this study.     

管腔内支架人工血管治疗急性胸降主动脉夹层动脉瘤

目的 探讨管腔内支架替代传统手术治疗急性胸降主动脉夹层动脉瘤的可行性及效果.方法 从2003年6月至2005年6月,12例急性胸降主动脉夹层动脉瘤患者接受管腔内支架人工血管治疗.结果 12例患者无死亡.共放支架12支,胸降主动脉受压夹层真腔全部恢复正常管径,无中转手术.术后3个月、1年随访,行CTA检查未发现与支架有关的并发症.结论管腔内支架人工血管治疗急性胸降主动脉夹层动脉瘤是一种有效的治疗方法.     

Endovascular repair of a ruptured descending thoracic aortic aneurysm

Endovascular aneurysm repair has considerable potential advantages over the surgical approach as a treatment for thoracic aortic rupture, in part because open surgical repair of ruptured thoracic aortic aneurysms is associated with high mortality and morbidity rates. We describe the successful endovascular deployment of stent-grafts to repair a contained rupture of a descending thoracic aortic aneurysm in an 86-year-old man whose comorbidities prohibited surgery. Two months after the procedure, magnetic resonance angiography showed a patent stent-graft, a patent left subclavian artery, and complete exclusion of the aneurysm.     

腔内血管支架植入治疗胸主动脉夹层

目的：总结腔内血管支架植入治疗主动脉夹层临床经验。方法：胸主动脉夹层5例,男3例,女2例,平均年龄(53.5±4.5)岁。经多排 CT 增强扫描或磁共振成像确诊。切开右侧股动脉,植入腔内血管带膜支架,封堵原发破口。植入后重复造影检查。随访行胸部 X 线平片与多排螺旋 CT 检查。结果：支架植入均成功,术后即刻造影5例均无内漏。降主动脉及腹主动脉真腔均明显扩大,远端降主动脉及分支供血均有明显改善。术后3月随访,降主动脉及腹主动脉真腔扩大,近端夹层动脉瘤消失。结论：腔内血管带膜支架植入治疗胸主动脉夹层近期疗效满意。     

Endovascular repair for thoracic aortic arch aneurysms.

AIM: The aim of this study was to report our experience with total and subtotal endovascular stent-grafting combined with aortic arch branch surgical revascularization for thoracic aortic arch aneurysms in high-risk patients. METHODS: From December 2000 to June 2005, among 38 patients treated with thoracic stent-grafts in our department, 10 patients (9 men; mean age 71+/-6 years) at high risk for open repair were candidates for endovascular repair and/or aortic arch branch extra-anatomical reconstruction due to inadequate proximal landing zones. The left subclavian artery was over-stented 6 cases for zone 2 aneurysms, and partial or total arch stent-grafting with simultaneous revascularization of the arch branches was performed in 4 cases for zones 0-1 aneurysms. RESULTS: Primary technical success rate was 100%. In-hospital mortality rate was 10%. Neither paraplegia, nor acute renal failure were recorded. Immediate or late surgical conversion was never required. One type 1b was successfully treated with additional stent-graft and 2 type-2 endoleaks were sealed by coil embolization. Mean follow-up was 21-months (range 3-48 months); overall, survival rate at 12, 26, and 36 months was 90%, 60%, and 30%, respectively. CONCLUSIONS: Endovascular repair for thoracic aortic arch aneurysms is feasible. However, our experience suggests stent-grafting is not free of risk, and long-term and larger follow-up is required.     

Endovascular repair of lesions of descending thoracic aorta: aneurysms and dissections

The morbidity and mortality of open repair of descending thoracic aortic lesions remains uncomfortably high. Shortly after the advent of an endovascular approach for infrarenal abdominal aortic aneurysms, attempts have been made to apply similar technologies to the thoracic aorta. Early experiences with endovascular grafts for thoracic aortic aneurysms have met with good to moderate success but have provided a framework for development of improved technologies specifically designed for this anatomic region. Early studies with second generation devices have shown more promise. Aortic dissections, a disease state associated with an exceptionally high morbidity and mortality, represent another condition that is readily treated with an endovascular approach.     

Percutaneous cardiopulmonary support in surgery for descending thoracic aortic aneurysms

There is uncertainty regarding the optimal method of intraoperative management of patients with aneurysm of the descending thoracic aorta. Although the percutaneous cardiopulmonary support (PCPS) was developed for use in patients with severe heart failure, it has been applied during the resection of descending thoracic aortic aneurysms in our department since 1993. The purpose of this study was to retrospectively compare conventional axillo-iliac temporary bypass to PCPS in patients undergoing repair of a thoracic aortic aneurysm. We retrospectively reviewed 18 consecutive patients with thoracic aortic aneurysms who underwent repair between January 1989 and March 1995. There were 10 patients who underwent aneurysm resection using axillo-iliac temporary bypass (Group I) and 8 who underwent resection using PCPS (Group II). The clamp time, bypass time, estimated blood loss and transfusion requirement did not differ significantly between the two groups. The operating and anesthesia times in Group II (390±91 minutes and 598.8±26.3 minutes, respectively) were significantly shorter than those in Group I (514±100 minutes and 821.5±32.5 minutes, respectively). The duration of postoperative intubation, intensive care unit (ICU) stay, and postoperative hospitalization were significantly shorter in Group II (1.6±0.9, 5.3±1.0, and 17.6±5.6 days, respectively) than in Group I (5.0±2.4, 2.8±0.3, and 24.3±4.8 days, respectively). Percutaneous cardiopulmonary support is a useful technique in surgery for thoracic aortic aneurysms. The advantages of this technique over conventional axillo-iliac temporary bypass are shortened operative time, duration of intubation, ICU stay, and postoperative hospitalization. In addition, it is easy to maintain the bypass flow using a centrifugal pump, and to maintain the body temperature using a heating exchanger.This work was supported in part by a Grant-in-aid for General Scientific Research from the Ministry of Education, Science and Culture of Japan     

Endovascular transluminal stent grafting

Iliac vessels are prone to injury during lumbar spine surgery due to their proximity to the lumbar spine. Arterio‐venous fistula formation during lumbar spine surgery is an uncommon complication and can present as an asymptomatic incidental finding to rapidly deteriorating hemodynamics leading to cardiopulmonary collapse. We have reported three patients who had symptomatic iliac arterio‐venous fistula detected soon after lumbar spine surgery. All these patients were successfully treated by endovascular transluminal stent grafting. © 2013 Wiley Periodicals, Inc.     

Endovascular treatment of aneurysms of the descending thoracic aorta--a new therapeutic perspective]

Endovascular treatment of aneurysmal disease of descending thoracic aorta and infra-renal abdominal aorta, has become an accepted technique, in selected cases due to the reduction of neurological morbidity, paraparesis or paraplegic and renal ischemia, associated with conventional surgery. The authors describe the first case performed in Portugal of a 75-year-old female with an expanding thoracic aneurysm managed by endovascular exclusion of the aneurysm with an EXCLUDER endoprosthesis, without any complications or evidence of endoleak, achieving complete exclusion of the aneurysm.     

血管腔内隔绝术治疗DeBakey Ⅲ型动脉瘤疗效分析

目的探讨血管腔内隔绝术治疗降主动脉夹层动脉瘤的方法和疗效。方法DeBakeyⅢ型主动脉夹层患者8例,进行血管腔内隔绝术(其中2例为DeBakeyⅢa型,6例为DeBakeyⅢb型)。结果8例均成功行血管腔内隔绝术,出现I型内漏4例,经球囊扩张后2例内漏消失,2例仍有少量内漏。进行22～36个月的临床随访。1例于术后23个月死于颅内出血,余7例均存活。结论血管腔内置入带膜支架型人工血管是治疗主动脉夹层动脉瘤简便、安全、有效的方法。