Search

Objective: To analyze radiation exposure during endovascular aortic sealing (EVAS) in comparison with standard endovascular aortic repair (EVAR) in clinical practice., Methods: From December 2013 to October 2016 (35 months), 60 patients were analyzed for intraoperative radiation exposure during EVAR: 30 consecutive patients (mean age, 73.10 years; 28 male) received EVAS (Nellix Endologix); within the same time frame, 30 patients were treated with standard EVAR (mean age, 71.87 years; 30 male). An indirect dose analysis was performed for both groups of patients, including effective dose and cumulative air kerma. Furthermore, fluoroscopy time (FT), dose area product, and time of procedure were included in the study., Results: The effective dose was significantly reduced in the EVAS group (3.72 mSv) compared with the group treated with standard EVAR (6.8 mSv; P ≤ .001). The cumulative air kerma was also lowered in EVAS (67.65 mGy vs 139 mGy in EVAR; P ≤ .001). FT for the entire group was 13 minutes and was shorter (P < .001) for EVAS (9 minutes) in comparison with EVAR (19 minutes). The dose area product for the entire cohort was 16.95 Gy.cm 2 and was lower during EVAS (12.4 Gy.cm 2 ) than during EVAR (22.6 Gy.cm 2 ; P < .001). The median operating time for the entire group was 123.5 minutes and was significantly shorter (P < .01) for EVAS (119 minutes vs EVAR at 132 minutes). The FT shows a significant correlation with the patient's weight (P = .022), body mass index (P = .004), and time of procedure (P = .005)., Conclusions: EVAS is associated with a relevant decrease in indirect measured radiation dose and time of procedure compared with standard EVAR. A relevant reduction in dose during EVAS is highly likely to result in lower exposure to radiation for physicians and staff. Such a result would be highly advantageous and calls for further analysis., (Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

In polytraumatized patients, traumatic rupture of the thoracic aorta is usually caused by blunt vascular injuries due to deceleration. The aortic injury is generally located distal to the left subclavian artery. Even without further thoracic lesions, a computer tomography should be performed in the emergency room, because a rupture can exist even in the absence of symptoms. The traditional therapeutic option is open, left thoracotomy followed by direct aortic reconstruction. Alternatively, endovascular implantation of a thoracic stent graft can be performed immediately in urgent situations or, with delayed priority, under systematically management of the blood pressure. In this article, not only the mechanisms of injury but also diagnostic and therapeutic options of traumatic rupture of the thoracic aorta are described. As depicted by two case histories, potential symptoms and prognosis of patients with this life-threatening vascular lesion depend on accompanying injuries. With rapid diagnosis and treatment, there is the possibility of good recovery from traumatic aortic rupture.

Inflammatory aortic aneurysms (IAAs) represent a rare form of aortic aneurysms. Compared with atherosclerotic aneurysms, patients with IAA have an increased risk of perioperative and long-term morbidity. This retrospective clinical study analyzed the outcome after conventional and endovascular repair of IAAs. Patients treated for an abdominal IAA between January 1995 and November 2004 were included. Imaging (computed tomographic angiography or magnetic resonance angiography) was performed preoperatively and at the time of follow-up (mean 2.7 years). Transperitoneal open repair and endovascular aortic repair were the operative procedures used. Over 10 years, 40 patients were treated with conventional and 5 patients with endovascular repair. The in-hospital morbidity rate was 11.1% (five patients; four conventional, one endovascular). On 10 patients (47.6%), the retroperitoneal fibrosis was no longer detectable. After operative repair, the majority of cases presented with a distinct regression of inflammation. Endovascular treatment of IAA represents a feasible alternative procedure to open aortic repair.