Search

Introduction: Thoracic aortic aneurysms (TAAs) are an increasingly prevalent pathology with significant associated morbidity and mortality. Thoracic endovascular aortic repair (TEVAR) is the primary line of treatment. The purpose of this study was to analyse a single center's experience in the treatment of TAAs and identify possible risk factors for worse outcomes. Methods: A retrospective review of our institutional database was done to identify all patients treated for TAAs in a 10-year period, from 1 January 2012 to 31 December 2022. Data were extracted from patients' medical records. Primary outcome was all-cause mortality and secondary outcomes were procedure related morbidity (vascular access complications, medullary ischaemia, stroke, endoleaks, migration, aneurysm sac enlargement >5 mm) and need for reintervention at 1-, 6- and 12-month follow-up. A descriptive and inferential analysis of the data was performed. Statistical analyses were conducted using the IBM Statistical Package for Social Sciences (SPSS) software. Results: We identified 34 patients treated for TAAs in this period. Mean age was 68 years [47–87] and 79.4% of patients were male. Mean aneurysm diameter was 63 mm [35–100], 55.9% fusiform and 44.1% saccular. The majority (91.2%) were located at the descending thoracic aorta and 3 (8.8%) of them extended to the aortic arch. The most common aetiology was degenerative in 22 patients (64.7%), followed by aortic dissection in 8 patients (23.5%). Elective surgery was performed in 19 (61.3%) patients and 12 (38.7%) had urgent repair. TEVAR was the treatment of choice in 24 (77.4%) patients, and the remaining 7 (22.6%) were treated with hybrid surgery. Mean length of hospital stay was 10 days [2–80] (6 days for elective repair versus 16 days for urgent repair, p =.016). Follow-up period ranged from 1 month to 10 years. At 1 year follow-up, all-cause mortality was 15%, morbidity was 30% (with 6 (22%) patients having a type Ia endoleak) and need for reintervention was 22%. Aneurysm diameter was a significant risk factor for procedure related morbidity (median diameter of 73.5 mm versus 56.0 mm in patients with no morbidity; p =.027). The presence of type Ia endoleak was significantly associated with higher reintervention rates (p =.001), but not with higher mortality rates (p =.515). Age, female sex, aetiology and urgent repair weren't associated with any significant differences in the outcomes. Conclusions: TEVAR proved to be effective in the treatment of TAAs, with good outcomes at short and mid-term follow-up. TAAs should be diagnosed earlier and be promptly treated when meeting criteria to prevent worse outcomes. [ABSTRACT FROM AUTHOR]

Background: It is challenging to simultaneously conduct total endovascular repair and reconstruct the left subclavian artery (LSA) and isolated left vertebral artery (ILVA) in patients who had an ILVA and required zone 2 anchoring. This pilot study reported the initial application experience of thoracic endovascular aortic repair (TEVAR) with a proximal zone 2 landing for aortic arch reconstruction in patients with ILVA. Methods: This study was a retrospective consecutive single-center case series analysis, which involved four patients with ILVA who required zone 2 anchoring and received TEVAR combined with a single-branched stent graft and concomitant on-table fenestration between March 2021 and December 2022. Results: The postoperative follow-up period was 6–27 months, and no postoperative deaths or other primary complications occurred. There were no signs of a stroke or spinal cord ischemia, as well as no chest or back pain. The postoperative computed tomography angiography showed unobstructed ILVA and LSA, no stent stenosis and displacement, and no signs of endoleak. Conclusion: The outcome suggested that this technique might be a feasible, safe, and alternative treatment for such patients. Further studies with larger samples and longer follow-up periods are needed to confirm our findings. [ABSTRACT FROM AUTHOR]

Background Aortobronchial fistulas (ABFs) are rare but potentially life-threatening conditions, often presenting with haemoptysis. They can develop following various thoracic aortic conditions or procedures. Case Presentation A 70-year-old patient with a history of descending aorta replacement and ischaemic stroke presented with chest pain and upper gastrointestinal bleeding. Imaging revealed a fistula between the aortic prosthesis and the lung, along with other cardiovascular abnormalities. Despite the indication for anticoagulant therapy, tranexamic acid was initiated due to bleeding risk. The patient showed clinical improvement with tranexamic acid treatment but experienced recurrence of bleeding after discontinuation. Endovascular treatment for the contained rupture at the proximal stent anastomosis was indicated. Discussion Haemoptysis is the primary symptom of ABFs, often recurring until the fistula enlarges. Postoperative aortic fistulas into the airways are uncommon and can occur years after surgery. Thoracic endovascular aortic repair has become the primary treatment for high-risk patients with thoracic aortic disease. Various diagnostic modalities can visualize a fistula tract, but practical visualization is rare. Untreated ABFs invariably lead to death. Conclusion This case highlights the challenges in diagnosing and managing ABFs, emphasizing the need for a multidisciplinary approach and regular follow-up. Patient education and prompt reporting of symptoms are essential. Early intervention upon suspicion of recurrence is crucial for optimizing patient outcomes. [ABSTRACT FROM AUTHOR]

The text discusses the evaluation of custom-made thoracic endovascular aortic repair (TEVAR) devices for uncomplicated type B aortic dissection (unTBAD). It highlights the prevalence and challenges of unTBAD, the benefits of proactive TEVAR over medical therapy alone, and the technical considerations involved in the TEVAR procedure. The emergence of custom-made devices (CMDs) for unTBAD treatment is explored, with promising results in improving patient outcomes. Further research is needed to establish the safety, efficacy, and cost-effectiveness of CMDs compared to standard devices in managing unTBAD. [Extracted from the article]

Background: The Najuta stent-graft (Kawasumi Laboratories Inc., Tokyo, Japan) is usually easily advanced to the correct deployment position in the ascending aorta thanks to the pre-curved delivery J-sheath with all fenestrations automatically oriented towards the supra-aortic vessels. Aortic arch anatomy and delivery system stiffness could however represent limitations for proper endograft advancement, especially when the aortic arch bends sharply. The aim of this technical note is to report a series of bail-out procedures that could be useful to overcome the difficulties encountered during the Najuta stent-graft advancement up to the ascending aorta. Main body: The insertion, positioning and deployment of a Najuta stent-graft requires a through-and-through guidewire technique using a.035″ 400 cm hydrophilic nitinol guidewire (Radifocus™ Guidewire M Non-Vascular, Terumo Corporation, Tokyo, Japan) with right brachial and both femoral accesses. When standard maneuver to put the endograft tip into the aortic arch, some bail-out procedures can be applied to obtain proper positioning. Five techniques are described into the text: positioning of a coaxial extra-stiff guidewire; positioning of a long introducer sheath down to the aortic root from the right brachial access; inflation of a balloon inside the ostia of the supra-aortic vessels; inflation of a balloon inside the aortic arch (coaxial to the device); and transapical access technique. This is a troubleshooting guide for allowing physicians to overcome various difficulties with the Najuta endograft as well as for other similar devices. Short conclusion: Technical issues in advancing the delivery system of Najuta stent-graft could occur. Therefore, the rescue procedures described in this technical note could be useful to guarantee the correct positioning and deployment of the stent-graft. [ABSTRACT FROM AUTHOR]

Background: Acute aortic regurgitation (AR) is uncommon condition and usually results in an emergent situation because the left ventricle does not adapt quickly due to a sudden increase in end-diastolic volume caused by the regurgitant flow. Thoracic endovascular aortic repair (TEVAR) is a procedure that places a stent-graft on the lesion of thoracic aorta through a minimally invasive approach. Case presentation: Here we report that a catheter-induced aortic valve injury associated with TEVAR can cause delayed AR, exemplified by the case of a patient who developed acute AR 42 months after TEVAR. For this, aortic valve replacement was performed and the patient was discharged without complications. Conclusion: Our results demonstrate that when a catheter-related procedure is performed around the aortic valve, slight injury of the valve can cause aortic insufficiency even 3 years after surgery. Consequently, when performing a catheter-related procedure around the aortic valve, special attention is always required. [ABSTRACT FROM AUTHOR]

Background: The management of aortic arch pathologies represents a great challenge and is associated with high rates of mortality and morbidity. The invasive and radical open surgical repair (OSR) is the standard of care for this group of patients. A superior endovascular approach via thoracic endovascular aortic repair (TEVAR) has been introduced to treat arch pathologies with specifically designed endografts. This approach was shown to benefit patients who are deemed "high risk" for undergoing OSR as it is a greatly less invasiveness option and thus, yields lower rates of morbidity and mortality.Aims: This commentary aims to discuss the recent study by Tan and colleagues, which reports original data on the neurological outcomes after endovascular repair of the aortic arch using the RELAY™ Branched device.Methods: We carried out a literature search on multiple electronic databases, including PubMed, Ovid, Google Scholar, Scopus, and EMBASE, to collate research evidence on the neurological outcomes of endovascular aortic arch repair with TEVAR.Results: Tan and colleagues showed through their original clinical data that the RELAY™ Branched device has a high rate of technical success and favorable neurological outcomes. There were no reported neurological deficits in patients who received the triple-branched RELAY™ Branched device.Conclusion: The RELAY™ branched endograft is well-established for candidates for aortic arch endovascular repair with favorable neurological outcomes. Multiple considerations can help control the incidence of stroke following endovascular repair. These include optimization of the supra-aortic vessels' revascularization, weighting the embolic risk in patients with atheromatous disease, and careful preoperative assessment to select the best candidates for arch endovascular repair. [ABSTRACT FROM AUTHOR]

‐Aortic dissection of descending aorta was detected by intraoperative TEE in a case of 67‐year‐old man with symptomatic severe aortic stenosis after TAVR. ‐Transesophageal echocardiogram after TAVR procedure is helpful to detect this rare complication. [ABSTRACT FROM AUTHOR]

Introduction: To evaluate the clinical outcomes and aortic remodelling rates following thoracic endovascular aortic repair (TEVAR) for acute or subacute type B aortic dissection (TBAD) based on technique. Material and Methods: All TEVARs for acute/subacute TBAD between 01/01/2008 and 01/06/2020 were included. TEVARS were grouped by technique (TEVAR only, PETTICOAT and STABILISE). Aortic remodelling was assessed at three aortic levels on follow-up CT. Thirty-day technical/clinical success rates, re-intervention rates and complications were recorded. Results: A total of 29 patients were included. The median age was 55 years (31–82). The median duration from initial presentation to TEVAR was 7 days (0–84). Intra-procedural complications included one aortic rupture from balloon moulding in a STABILISE case. Thirty-day mortality, stroke, spinal cord ischaemia and visceral ischaemia were 3% (n = 1), 3% (n = 1), 3% (n = 1) and 3% (n = 1), respectively. (All occurred in acute TBAD.) Overall survival was 50.5 months (18–115). Median follow-up was 31 months (1–115). Six patients (21%) required re-intervention, with a median time of 5 months (5–46) from first TEVAR. Overall complete aortic remodelling rates were: 89% at the proximal descending thoracic aorta, 78% at the distal thoracic aorta and 50% at the infra-renal abdominal aorta. At the infra-renal aorta, the STABILISE group (n = 11) had a higher complete aortic remodelling rate (82%) compared to TEVAR alone (n = 12) (20%). Conclusion: Endovascular intervention for acute and subacute TBAD is safe with a high rate of technical success. STABILISE results in higher aortic remodelling at the infra-renal aorta (82%) compared to TEVAR alone (20%) but risks aortic rupture from balloon moulding. [ABSTRACT FROM AUTHOR]

A case of a 46-year-old car driver struck with great force by a tram through the driver's door is presented. The main trauma consisted in chest injury with multi-rib fracture along with rupture and dissection of the thoracic aorta. Immediate medical rescue actions consisted only in procedures necessary to support vital functions; the patient survived owing to being promptly transported to the Emergency Department to undergo thoracotomy and laparotomy with massive blood transfusion. Polytrauma angio-CT scan revealed a posttraumatic thoracic aorta lesion which in turn was treated by deployment of an endovascular thoracic stent graft. This way, the immediate risk of death was averted, and the remaining traumatic lesions and conditions could be treated. Patient was discharged to a Rehabilitation Center on the 49th day of treatment. The authors stress that trauma resulting from accidents with this particular mechanism, i.e. lateral car crash on the driver's side with the driver's door being staved in by the tram, should be managed by immediate transport of the patient to the Emergency Center. In such cases early drainage of the pleural cavity can deteriorate patient's status by increasing the bleeding from the ruptured aorta. [ABSTRACT FROM AUTHOR]

A type B dissection involves the aorta distal to the subclavian artery, and accounts for 25–40% of aortic dissections. Approximately 75% of these are uncomplicated with no malperfusion or ischemia. Multiple consensus statements recommend thoracic endovascular aortic repair (TEVAR) as the treatment of choice for acute complicated type B aortic dissections, while uncomplicated type B dissections are traditionally treated with medical management alone, including strict blood pressure control, as open repairs have a prohibitively high morbidity of up to 31%. However, with medical treatment alone, the morbidity, including aneurysm degeneration of the affected segment, is 30%, and mortality is 10% over 5 years. For both chronic and acute uncomplicated type B aortic dissections, emerging evidence supports the use of both best medical therapy and TEVAR. This paper reviews the current diagnosis and treatment of uncomplicated type B aortic dissections. [ABSTRACT FROM AUTHOR]

Background: Traumatic aortic arch rupture with pseudoaneurysm is a rare high fatal injury. Thoracic endovascular aortic repair(TEVAR) is widely used in the treatment of aortic diseases. However a unified traumatic aortic injury risk stratification tool still lacks. The patients' disease assessment and operation method still rely on the doctors' subjective anticipation of disease and surgical results.Case Presentation: A 31-year-old male presented with chest pain and hoarseness of recent onset. Imageological examination showed aortic rupture with mediastinal pseudoaneurysm in Zone 1. Debranching + TEVAR hybrid operation was considered: Using artificial blood vessels rebuild the arch branches, the covered stent was placed in aortic arch for endovascular repair via femoral artery. The follow-up was good in postoperative 7d, 1 year and > 2 years.Conclusion: The traumatic aortic arch rupture with pseudoaneurysm treated by Debranching+TEVAR hybrid operation is feasible. The short-term and medium-term follow-up results are satisfactory. For traumatic aortic arch injury, hybrid operation is recommended to reduce the risk of cardiopulmonary bypass and deep hypothermia circulatory arrest under no open operation conditions or emergency situation. [ABSTRACT FROM AUTHOR]