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Your search keyword '"Fleischman F"' showing total 3 results
Start Over Author "Fleischman F" Journal annals of vascular surgery
3 results on '"Fleischman F"'

1. In-Situ Fenestration of a PTFE Thoracic Aortic Stent Graft for Delayed Left Subclavian Artery Revascularization Following Frozen Elephant Trunk Repair of Type A Aortic Dissection.

Author

Veranyan N, Dunn J, Bowdish M, Magee GA, Weaver FA, Fleischman F, and Han SM

Subjects
Aged, Aortic Dissection diagnostic imaging, Aortic Dissection physiopathology, Aortic Aneurysm, Thoracic diagnostic imaging, Aortic Aneurysm, Thoracic physiopathology, Blood Vessel Prosthesis Implantation adverse effects, Endovascular Procedures adverse effects, Humans, Male, Prosthesis Design, Subclavian Artery diagnostic imaging, Subclavian Artery physiopathology, Subclavian Steal Syndrome diagnostic imaging, Subclavian Steal Syndrome etiology, Subclavian Steal Syndrome physiopathology, Thrombectomy, Thrombosis diagnostic imaging, Thrombosis etiology, Thrombosis physiopathology, Time Factors, Treatment Outcome, Aortic Dissection surgery, Aortic Aneurysm, Thoracic surgery, Blood Vessel Prosthesis, Blood Vessel Prosthesis Implantation instrumentation, Endovascular Procedures instrumentation, Stents, Subclavian Artery surgery, Subclavian Steal Syndrome surgery, Thrombosis surgery
Abstract

Left subclavian artery revascularization during endovascular repair of aortic dissection is often accomplished by left carotid-subclavian artery bypass or transposition. In situ fenestration of thoracic stent grafts provides an alternative method of revascularization without manipulation of the left carotid artery. We describe a case whereby in situ laser fenestration, combined with catheter-directed thrombectomy, was utilized to revascularize a thrombosed left subclavian artery following a frozen elephant trunk repair of type A aortic dissection. A 75-year-old male presented with pericardial tamponade and aortic insufficiency, secondary to type A aortic dissection. Patient underwent an emergent replacement of the aortic root, valve, arch, and ascending aorta in the frozen elephant trunk configuration. The innominate and left carotid arteries were revascularized with a bifurcated bypass graft from the ascending aortic graft. The left subclavian artery (LSCA) was covered with an antegrade deployment of a cTAG stent graft. During the immediate postoperative period, the patient was found to have a dissection of the left common carotid artery (LCCA) and pseudoaneurysm of the bypass graft anastomosis. The left carotid artery was replaced up to the proximal internal carotid. During rehabilitation, the patient developed left subclavian steal syndrome, with a CT angiography demonstrating thrombosis of the subclavian origin, and duplex ultrasound showing a reversal of the left vertebral flow. In order to revascularize the left subclavian artery without using the left carotid as the inflow, the in situ laser fenestration technique was planned. The vertebral artery origin was protected with a neuroclip through a supraclavicular incision. Through a brachial artery cutdown, a 9Fr flex sheath was positioned at the origin of the subclavian artery. A suction thrombectomy catheter was used to create a central channel in the thrombus. A 0.035″ 3.2 mm over-the-wire laser atherectomy catheter was used to create a fenestration through the cTAG stent graft. The subclavian branch stent was stented with an iCast balloon-expandable covered stent, excluding the mural thrombus. The patient recovered well with resolution of symptoms and was discharged home. Postoperative CT scan showed patent left subclavian branch stent and no endoleak across the fenestration of the aortic stent graft. Delayed laser in situ fenestration of a PTFE stent graft can be performed safely. The vertebral artery protection and catheter-directed thrombectomy are important adjuncts to reduce the risk of posterior stroke., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Published
2020
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2. Lift Sandwich Grafting Enables Transfemoral Abdominal Aortic Branch Incorporation during Endovascular Aortic Repair for Chronic Type B Aortic Dissection.

Author

Johnson CE, Ham SW, Ziegler KR, Magee GA, Weaver FA, Fleischman F, and Han SM

Subjects
Aortic Dissection diagnostic imaging, Aorta, Abdominal diagnostic imaging, Aorta, Thoracic diagnostic imaging, Aortic Aneurysm, Thoracic diagnostic imaging, Aortography methods, Blood Vessel Prosthesis, Blood Vessel Prosthesis Implantation instrumentation, Chronic Disease, Computed Tomography Angiography, Endovascular Procedures instrumentation, Humans, Male, Middle Aged, Prosthesis Design, Stents, Treatment Outcome, Aortic Dissection surgery, Aorta, Abdominal surgery, Aorta, Thoracic surgery, Aortic Aneurysm, Thoracic surgery, Blood Vessel Prosthesis Implantation methods, Endovascular Procedures methods
Abstract

Chronic type B aortic dissections with continued aneurysmal expansion of the thoracoabdominal aorta after the initial thoracic endovascular aortic repair represent a subset of aortic pathology in which staged distal extension to seal additional septal tears can be advantageous. This approach may require incorporation of visceral or renal branches into the distal seal zone, while maintaining the possibility of further distal extension in the future. We describe a novel technique for incorporation of the celiac axis, with a branch stent graft delivered from a transfemoral approach, then lifted cranially to create an antegrade sandwich graft configuration in a 59-year-old male who presented with a complicated type B aortic dissection requiring coverage of the celiac artery. Utilizing the previous thoracic endograft as a platform for sandwich grafting, a self-expanding stent graft was deployed into the celiac artery from a femoral approach. A steerable sheath with an anchoring balloon was used to lift the stent into an up-facing snorkel position, which was subsequently sandwiched with another thoracic stent graft terminating proximal to the superior mesenteric artery. When single visceral or renal branch incorporation is desired, sandwich grafting via a "lift" technique limits the extent of aortic coverage and reduces the number of branch components, without increasing the complexity of additional visceral and renal branch incorporation during future endovascular aortic repair., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Published
2019
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3. Symptomatic Intragraft Thrombus following Endovascular Repair of Blunt Thoracic Aortic Injury.

Author

Abdoli S, Ham SW, Wilcox AG, Fleischman F, and Lam L

Subjects
Accidents, Traffic, Adult, Aorta, Thoracic diagnostic imaging, Aorta, Thoracic injuries, Aortography methods, Blood Vessel Prosthesis Implantation adverse effects, Computed Tomography Angiography, Endovascular Procedures adverse effects, Graft Occlusion, Vascular diagnostic imaging, Graft Occlusion, Vascular surgery, Humans, Ischemia diagnostic imaging, Ischemia surgery, Male, Pedestrians, Prosthesis Design, Thrombosis diagnostic imaging, Thrombosis surgery, Treatment Outcome, Vascular System Injuries diagnostic imaging, Vascular System Injuries etiology, Wounds, Nonpenetrating diagnostic imaging, Wounds, Nonpenetrating etiology, Aorta, Thoracic surgery, Blood Vessel Prosthesis, Blood Vessel Prosthesis Implantation instrumentation, Endovascular Procedures instrumentation, Graft Occlusion, Vascular etiology, Ischemia etiology, Stents, Thrombosis etiology, Vascular System Injuries surgery, Wounds, Nonpenetrating surgery
Abstract

Thoracic endovascular aortic repair (TEVAR) can be complicated by graft collapse, endoleaks, and stent migration. The incidence of these complications and other outcomes is poorly understood in young trauma victims who receive endovascular aortic repair of blunt thoracic aortic injury (BTAI). A 29-year-old pedestrian was struck by a vehicle resulting in polytrauma including BTAI with transection distal to the left subclavian artery origin. The patient underwent successful TEVAR. Nine months later, the patient developed transient paresthesia below the waist that progressed to bilateral lower extremity paralysis and malperfusion syndrome below the diaphragm including nonpalpable pulses in the lower extremities, acute renal failure, and ischemic colitis. Imaging demonstrated near occlusive thrombosis of the distal end of the thoracic endograft. An emergent axillobifemoral bypass resolved the organ malperfusion and acute limb ischemia. Patients who have undergone TEVAR for BTAI may develop asymptomatic or symptomatic intragraft thrombosis. In patients presenting with malperfusion syndrome below the diaphragm, extra-anatomic bypass can expeditiously resolve symptoms until definitive treatment can be performed. Oversizing of thoracic stents in trauma patient may lead to intragraft thrombosis., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Published
2017
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