Treatment of an asymptomatic penetrating aortic ulcer in a young patient

We want to report and discuss the indication for open surgery for an asymptomatic penetrating aortic ulcer (PAU) in the era of thoracic endovascular aortic repair (TEVAR). A 31-year-old female presented with the diagnosis of an aneurysm in the distal aortic arch. With respect to the patients young age, the controversial status of connective tissue disorders and in the absence of concomitant disease, open repair was indicated. There was no proof of a mycotic plaque or connective tissue disease in the microbiological-, pathological analysis and at electron-microscopy. The patient was discharged on the thirteenth postoperative day. In spite of good preliminary results of TEVAR in PAU, in selective cases there is still an indication for open surgery.

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Aortic endovascular stenting in patients with systemic connective tissue disorders: does the prohibitive dogma still stand tall?

Journal of International Medical Research ◽

10.1177/0300060519863963 ◽

2019 ◽

Vol 48 (2) ◽

pp. 030006051986396 ◽

Cited By ~ 1

Author(s):

Amer Harky ◽

Rizwan Iqbal ◽

Vincenzo Giordano ◽

Ahmed Al-Adhami

Keyword(s):

Connective Tissue ◽

Aortic Arch ◽

Standard Method ◽

Gold Standard ◽

Open Repair ◽

Current Evidence ◽

Connective Tissue Disorders ◽

Aortic Diseases ◽

Endovascular Stenting ◽

Gold Standard Method

Endovascular repair of thoracic aortic diseases can provide satisfactory outcomes in elective and certain emergency cases involving the descending thoracic and aortic arch. However, open repair remains the gold standard method of aortic root pathologies and certain aortic arch pathologies, such as extended dissection. Nevertheless, the use of endovascular stenting in patients with connective tissue disorders has not been fully explored because the aortic tissues are fragile and the likelihood of keeping the stent in place is low because of its progressive dilatation and subsequent requirement for open repair at a later stage when the stent graft fails. Our brief review focuses on current evidence of the use of stents in patients with connective tissue disorders and whether such practice can be expanded further.

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A Case of Open Surgery for Endoleak after Thoracic Endovascular Aortic Repair of the Aortic Arch

Japanese Journal of Cardiovascular Surgery ◽

10.4326/jjcvs.47.26 ◽

2018 ◽

Vol 47 (1) ◽

pp. 26-30

Author(s):

Yuki Mochida ◽

Junichi Shimamura ◽

Shigeru Sakurai ◽

Kensuke Ozaki ◽

Susumu Oshima ◽

...

Keyword(s):

Aortic Arch ◽

Open Surgery ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Aortic Repair

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Outcomes of Thoracic Endovascular Aneurysm Repair (TEVAR) in Patients With Connective Tissue Disorders

Vascular and Endovascular Surgery ◽

10.1177/1538574420945070 ◽

2020 ◽

Vol 54 (8) ◽

pp. 676-680

Author(s):

Khalil Qato ◽

Allan Conway ◽

Eileen Lu ◽

Nhan Nguyen Tran ◽

Gary Giangola ◽

...

Keyword(s):

Connective Tissue ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Acute Type ◽

Type B ◽

Connective Tissue Disorders ◽

Aortic Repair ◽

Type B Dissection ◽

Significant Difference

Objectives: Thoracic endovascular aortic repair (TEVAR) remains controversial in patients with connective tissue disorders given the concern for durability. We report on the largest series to date on outcomes of patients with thoracic aortic disease and connective tissue disorders treated with TEVAR. Methods: The Vascular Quality Initiative registry identified 12 207 patients treated with TEVAR from January 2010 to December 2018, including 102 with Marfans, Ehlers-Danlos, or Loey-Dietz syndrome. Outcomes were analyzed per the Society for Vascular Surgery reporting standards. Results: Median age was 50.6 years (interquartile range: 57.0-75.0), and 62 (60.7%) were male. Eighty-eight (86.3%) patients had Marfan, 9 (8.8%) had Ehlers-Danlos, and 5 (4.9%) had Loey-Dietz syndrome. Twenty-six (25.5%) patients were treated for degenerative aneurysmal disease and 76 (74.5%) patients for type B dissections (33 acute, 31 chronic). Most common indications for interventions in patients with type B dissection were pain (n = 41), aneurysmal degeneration (n = 16), and malperfusion (n = 8), with 3 patients who presented ruptured. There was no significant difference in perioperative complications between acute/chronic dissections and aneurysms ( P = .14). Percutaneous access was utilized in 61.7% of patients, with a 2.9% rate of arterial injury requiring reintervention. Follow-up data were available for 75 (73.3%) patients at a mean follow-up of 15.6 months. Overall mortality was 5.3%. There were 30 patients with follow-up endoleak data, and 8 (26.7%) endoleaks were identified. All endoleaks were in patients treated for acute type B dissection, and all resolved after a mean of 2.1 reinterventions. Three patients treated for acute Type B Aortic Dissection (TBAD) had retrograde dissections requiring intervention. Discussion: Thoracic endovascular aortic repair for patients with connective tissue disorders can be performed with low perioperative mortality, spinal cord ischemia, or Cerebrovascular Accident (CVA). On follow-up, acute type B aortic dissections represent a higher risk subgroup with increased rates of endoleak and retrograde dissection. Closer follow-up for these patients and early reintervention may be beneficial.

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Abstract 19354: Management and Outcomes of Acute Type B Dissection in IRAD Treated with Open Surgery, Endovascular Flap Fenestration or TEVAR

Circulation ◽

10.1161/circ.130.suppl_2.19354 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Nathaniel I Costin ◽

Peter Levanovich ◽

Eduardo Bossone ◽

Mark D Peterson ◽

Truls Myrmel ◽

...

Keyword(s):

Aortic Dissection ◽

Open Surgery ◽

Acute Aortic Dissection ◽

Open Repair ◽

Surgical Intervention ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Acute Type ◽

Type B ◽

Aortic Repair

Background: The debate for the optimal treatment of complicated Type B Acute Aortic Dissection (TBAAD) is primarily focused upon open surgical intervention versus thoracic endovascular aortic repair (TEVAR). The technique of fenestration with stenting has been proposed to resolve malperfusion. This study evaluated post-procedural outcomes of all three approaches for TBAAD. Methods: TBAAD patients enrolled in the International Registry of Acute Aortic Dissection were stratified by management type: TEVAR, fenestration and stenting, and surgery. Results: Of the 552 patients with TBAAD, 231 (41.8%) underwent TEVAR, 214 (38.8%) standard open surgery, and 107 (19.4%) fenestration and stenting. TEVAR or fenestration and stenting were more likely to be performed in classic double barrel aortic dissection when compared to open surgery (73.2%, 76.6%, 52.8% respectively; p<0.001). Patients treated with open repair were less likely to have distal extension into the abdominal aorta than those with TEVAR or fenestration and stenting (47.7%, 62.7%, 86.4%, respectively; p<0.001). In-hospital mortality was similar between groups (11.7% TEVAR, 14.0% fenestration and stenting, 15.9% surgery). At five years, Kaplan-Meier post-discharge all-cause survival estimates were highest for TEVAR, followed by endovascular fenestration and finally open surgical intervention (85.2%, 78.3%, 67.2%, respectively; p=0.039). Conclusion: Patients treated by endovascular approaches, whether with flap fenestration or thoracic endovascular aortic repair, had lower five year mortality when compared to patients who required open repair in the setting of TBAAD. Either endovascular approach may be helpful in the treatment of TBAAD. Further research is needed to determine how much of the observed difference represents patient selection versus differential effects of treatment.

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A case report of a hybrid procedure (visceral and partial aortic arch debranching) in the treatment of a challenging aneurysm of the thoracoabdominal aorta in the endovascular era

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh190731011s ◽

2020 ◽

Vol 148 (5-6) ◽

pp. 360-363

Author(s):

Milos Sladojevic ◽

Igor Koncar ◽

Petar Zlatanovic ◽

Sanja Jovanovic ◽

Lazar Davidovic

Keyword(s):

High Risk ◽

Aortic Arch ◽

Thoracic Aortic Aneurysm ◽

Open Repair ◽

Hybrid Approach ◽

Hybrid Procedure ◽

Thoracic Endovascular Aortic Repair ◽

Thoracoabdominal Aorta ◽

Alternative Treatment Option ◽

Visceral Arteries

Introduction. This paper aimed to present a hybrid approach as a less invasive and acceptable treatment. Case outline. Because of respiratory failure, the patient was deemed at high risk for open repair. Standard thoracic endovascular aortic repair (TEVAR) was unfeasible, so the patient underwent the hybrid procedure ? partial aortic arch debranching at the first stage, followed by visceral debranching and endovascular exclusion of thoracic aortic aneurysm as a final procedure. The postoperative course was uneventful and the patient was discharged 10 days after TEVAR and visceral debranching. Conclusion. Staged hybrid procedure with combined debranching of the aortic arch and visceral arteries is feasible and should be considered as an alternative treatment option in patients with high-risk for open repair.

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Two-Vessel Branched Stent Graft for Severely Angulated Aortic Arch Aneurysm in a Jehovah’s Witness

Vascular and Endovascular Surgery ◽

10.1177/1538574417747426 ◽

2018 ◽

Vol 52 (2) ◽

pp. 154-158 ◽

Cited By ~ 1

Author(s):

Chung S. Lim ◽

A. Dhutia ◽

Celia Riga ◽

A. Dharmadasa ◽

Richard G. J. Gibbs ◽

...

Keyword(s):

Aortic Arch ◽

Open Surgery ◽

Open Repair ◽

Significant Risk ◽

Mortality And Morbidity ◽

Jehovah’S Witness ◽

Jehovah's Witness ◽

Risk Of Mortality ◽

Custom Made ◽

Arch Aneurysm

Aneurysmal disease involving the origins of supra aortic vessels often requires complex open and/or endovascular repair that is not only associated with significant risk of mortality and morbidity but also often with perioperative blood loss requiring transfusion. We report a successful repair of a large thoracic aortic aneurysm (TAA) involving the aortic arch with a custom-made Bolton Relay 2-vessel branched thoracic aortic endograft in a 42-year-old Jehovah’s Witness who would otherwise be very unlikely to survive an open repair. Branched thoracic aortic endografting offers a potentially safe, minimally invasive, and effective alternative for TAA disease involving the supra-aortic arteries, especially in patients who are at high risk of open surgery.

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