Aortic Stent-graft Implantation Research Articles

DeBakey Type III Aortic Dissection Causing Bowel Necrosis: A Case Report

Rationale: Aortic dissection is a life-threatening medical emergency associated with high morbidity and mortality. Preoperative mesenteric malperfusion increases the surgical risk and mortality in patients with type B aortic dissection. For DeBakey type III B patients involving most of the thoracoabdominal aorta, endovascular treatment to improve true lumen perfusion may have limited benefits. Organ reperfusion on-time is crucial. Patient concerns: A 38-year-old man was admitted with sudden severe upper abdominal pain. Emergency CTA of the entire aorta revealed an aortic dissection with an entry tear in the descending aortic arch involving the celiac trunk, superior mesenteric artery, bilateral common iliac arteries and right external iliac artery, with thrombosis in the superior mesenteric artery. Diagnoses: The patient was diagnosed with DeBakey type III aortic dissection with mesenteric artery embolism. Enhanced chest CT showed the entry tear location and involvement of major arteries. Angiography confirmed partial blood flow in the superior mesenteric artery. Interventions: The patient underwent endovascular aortic stent-graft implantation through the left femoral artery, covering the descending aortic arch and sealing the entry tear. Postoperatively, the patient received intensive care, including ventilatory support, CRRT, anti-infection therapy, vasoactive drugs and lumbar cistern drainage. Outcomes: Two weeks postoperatively, the patient developed massive black stools, indicative of intestinal obstruction and necrosis. Exploratory laparotomy revealed ischemic necrosis and rupture of the stomach, small intestine, and colon. Despite surgical efforts, the patient’s condition deteriorated, leading to death from severe infection, acid-base imbalance and multiple organ failure.

Total Endovascular Repair of a Giant Iliac Vein Aneurysm: A Case Report and Review of Literature.

The iliac veins are the least frequent location for venous aneurysms, with only a few cases described globally. The etiology and clinical presentation of this extremely rare entity is diverse and unclear and no treatment consensus has been reached yet. Our purpose is to present an interesting iliac vein aneurysm (IVA) case that we treated in our department, with a brief review of the literature. We report a case of a 74-year-old male patient with a giant, 55 mm in diameter, asymptomatic, right common IVA, with concurrent aplasia of the left common iliac vein and an extensive network of venous collaterals. The patient was treated, under general anesthesia, with total endovascular iliocaval reconstruction through implantation of a 32 × 100 mm thoracic aortic tubular Ankura stent graft. The computed tomography venography at first-month follow-up showed the complete exclusion of the IVA, without any endoleak and the patient remains up to date free of symptoms and thromboembolic events. Twelve cases of endovascular treatment of IVA have been reported so far, and our case is the first with implantation of a thoracic aortic stent graft. Our results suggest that this technique is safe, effective, and may be considered for appropriately selected patients. This is the first case with total endovascular repair of an iliac vein aneurysm with contralateral iliac vein aplasia through endovenous implantation of a thoracic aortic stent-graft. Our results suggest that this technique is safe and effective and thus, may be considered for appropriately selected cases.

Device profile of EndoAnchors for aortic stent graft implantation: overview of their safety and efficacy

ABSTRACT Introduction Endovascular aneurysm repair (EVAR) and thoracic endovascular aneurysm repair (TEVAR) are established techniques to treat abdominal aortic aneurysms (AAA) and thoracic aortic aneurysms (TAA). However, there are limitations when challenging proximal neck anatomy is present. Heli-FX EndoAnchors have been used in addition to EVAR and TEVAR to improve proximal sealing of a stent-graft, but there are limited data available on their outcomes, safety, and efficacy. Areas Covered The properties and development of Heli-FX EndoAnchors are evaluated. The evidence of various clinical outcomes, safety, and efficacy is interrogated with the augmented use of Heli-FX EndoAnchors with EVAR or TEVAR. Expert Opinion Challenging proximal neck anatomy can be problematic during EVAR or TEVAR. EndoAnchors may be part of the solution – used either prophylactically or therapeutically. The safety and efficacy databases are building but long-term data are still not available for this device and there remains inadequate data to support its routine use. Judicious patient selection is still needed.

Interim Analysis of an Ongoing Study Evaluating Preventive Aortic Stent Graft Implantation Prior to Major Thoracic Tumor Resection and a Review of the Literature

Abstract Introduction There is limited data in the literature on the use of thoracic aortic stent graft implantation (TEVAR) to facilitate en-bloc resection of tumors that have invaded the aortic wall. After TEVAR, extended resections can be performed, avoiding aortic wall replacement or catastrophic situations such as life-threatening bleeding from aortic injury. Aims The aim of this interim analysis was to demonstrate the feasibility of TEVAR without increased risk of perioperative morbidity and mortality. Methods A retro- and prospective data analysis was performed including all consecutive patients with suspicious aortic wall infiltration on preoperative imaging, who received a TEVAR implantation prior to resection of thoracic malignancy between 1/2008 and 12/2022. In addition, a literature review was conducted. Results Thirteen patients (median age 67 years, range 23-75, 62% female) have been treated at our institution so far. Nine patients received neoadjuvant therapy. In all patients it was possible to implant the stent graft with sufficient overlap at the level of the tumor mass. In 69% the proximal landing zone was located in aortic zone 3 to 4. No postoperative endograft related morbidity, especially no spinal cord ischemia, no stroke, no postoperative bleeding or access site complications, as well as no dissection or aortic rupture was observed. In nine patients, aortic wall infiltration was confirmed intraoperatively, and a partial non-circumferential resection of the aortic wall was necessary. The 30-day mortality rate was 15% (one case) due to respiratory failure and ARDS as well as postoperative empyema. Eight patients died during a median follow up of 11 month (0.7-94). Conclusions In this, to the best of our knowledge, largest analysis to date, the results of previous smaller series were confirmed. Aortic stent grafting prior to thoracic tumor resection allows extensive resections while maintaining low morbidity and a low 30-day mortality risk.

Suture-mediated closure devices for percutaneous endovascular abdominal aneurysm repair.

Endovascular procedures such as endovascular aneurysm repair or transcatheter aortic valve implantation have become very common because of reduced patient traumatisation and the ability to use shorter or local anaesthesia. In these procedures large-bore sheath devices are used. Access with percutaneous closure is an alternative method to surgical cutdown in groins. The aim of the study was to assess the correlation between sheath size and unsuccessful haemostasis. In addition, the effectiveness of haemostasis after a percutaneous procedure and the number and type of complications were evaluated. There were 202 patients included in the study. Patients with abdominal aortic aneurysm were qualified to percutaneous aortic stentgraft implantation with Perclose Proglide preclosure technique. There were 384 access sites performed with 12F to 22F sheaths during aortic stentgraft implantation with Perclose Proglide (Abbott Vascular, Santa Clara, CA, USA) preclosure technique. High effectiveness of haemostasis (98%), low percentage of short- and mid-term complications (2.6%), and infinitesimal number of surgical conversions (n = 5) were stated in the study. There was no correlation between diameter of used introducer sheath and lack of haemostasis observed (Fisher-Freeman-Halton test; p = 0.122). No relationship between diameter of introducer sheath and number of closure devices was observed (c2 = 2.436; df = 5; p = 0.786). Large-bore device percutaneous procedures with closure devices are effective and safe. High effectiveness of haemostasis (98%) was observed in the study group, with a low percentage of complications (2.6%). There was no correlation between size of the vascular access and the lack of haemostasis found in the study.

Endovascular Surgery of Descending Thoracic Aorta Involved in T4 Lung Tumor

Purpose: Surgical treatment of primary lung T4 tumors is controversial especially when the cancer invades the mediastinal structures or the descending thoracic aorta. Conventional surgical treatment is associated with a high perioperative mortality and morbidity rate. Thoracic EndoVascular Aortic Repair has emerged as a valid off-label alternative to conventional surgery. We aimed to assess perioperative and midterm aortic-related outcome of patients who have undergone aortic stent-graft implantation, followed by en bloc surgical treatment of the involved aorta and lung cancer resection. Materials and Methods: From July 2017 to May 2020, we treated 5 patients diagnosed with a T4 lung cancer by the involvement of the descending thoracic aorta. When only the descending thoracic aorta is involved, a 2-stage procedure was considered, with aortic stent-graft implantation performed before tumor resection. One-stage strategy, with stent-graft implantation carried out before thoracotomy, was preferred for patients with the involvement of cardiac and/or other vascular mediastinal structures. Results: The mean age was 58.4 ± 6.2 years. All patients were affected by non–small cell lung cancer. All 5 patients required a single stent-graft to completely cover the involved segment of aorta. Four patients underwent a 2-stage procedure. One patient, with the involvement of the left inferior pulmonary vein, required a 1-stage en bloc resection of the left lower lobe, aortic wall adventitia, left inferior pulmonary vein, and reconstruction of the left atrial wall. Primary procedural success was achieved in all. At follow-up, no patient developed aortic-related complications. One patient died 2 years after surgery, due to local recurrence of the tumor. Conclusion: T4 lung resection combined with aortic stent-graft implantation can be safely performed. Endovascular surgery, by avoiding the use of cardiopulmonary bypass, aortic cross-clamping, and graft replacement, can reduce significant morbidity and mortality rate. Postoperative and long-term outcome of these patients treated with endovascular surgery is mainly related to pulmonary disease, not to aortic treatment.

Radiation-Free Thoracic Endovascular Aneurysm Repair with Fiberoptic and Electromagnetic Guidance: A Phantom Study

PurposeTo evaluate the feasibility and accuracy of a radiation-free implantation of a thoracic aortic stent graft employing fiberoptic and electromagnetic tracking in an anthropomorphic phantom. Materials and MethodsAn anthropomorphic phantom was manufactured based on computed tomography (CT) angiography data from a patient. An aortic stent graft application system was equipped with a fiber Bragg gratings and 3 electromagnetic sensors. The stent graft was navigated in the phantom by 3 interventionalists using the tracking data generated by both technologies. One implantation procedure was performed. The technical success of the procedure was evaluated using digital subtraction angiography and CT angiography (before and after the intervention). Tracking accuracy was determined at various anatomical landmarks based on separately acquired fluoroscopic images. The mean/maximum errors were measured for the stent graft application system and the tip/end of the stent graft. ResultsThe procedure resulted in technical success with a mean error below 3 mm for the entire application system and <2 mm for the position of the tip of the stent graft. Navigation/implantation and handling of the device were rated sufficiently accurate and on par with comparable, routinely used stent graft application systems. ConclusionsThe study demonstrates successful stent graft implantation during a thoracic endovascular aortic repair procedure employing advanced guidance techniques and avoiding fluoroscopic imaging. This is an essential step in facilitating the implantation of stent grafts and reducing the health risks associated with ionizing radiation during endovascular procedures.

Endovascular Repair of Thoracic Aorta Injury: 17 Years of Single-Center Experience.

BackgroundTraumatic thoracic aortic transection is one of the most severe complications of high-energy injuries, but patients rarely receive treatment, and it is fatal in the vast majority of cases. Due to the complexity of surgical revision for transection, endovascular repair with stent graft implantation is the preferred approach.Material/MethodsWe retrospectively analyzed the short-term and long-term treatment results for 31 patients (29 men, 2 women) treated at the Interventional Radiology Department, University Hospital Ostrava, for the isthmus part of a descending thoracic aorta injury between 2004 and 2020.ResultsThe median patient age was 48 years (interquartile range [IQR]: 28–63 years). The most common causes of injury were traffic accidents and falls or jumps, with the trauma location at the Ishimaru zones 2 to 4 of the aortic isthmus. Aortic stent grafts were successfully implanted in all patients; 13% of patients had complications and 10% died due to the trauma severity. The median procedure duration was 30 min (IQR: 25–43 min) and the median hospital stay was 29 days (IQR: 28–63 days).ConclusionsAortic stent graft implantation appears to be a safe and effective method for dealing with thoracic aorta injury, with a low complication rate and high patient survival. The endovascular approach is the method of choice for treating this severe disease, and a multidisciplinary approach for emergency medical treatment with a comprehensive trauma protocol is essential.

ГИБРИДНЫЕ ВМЕШАТЕЛЬСТВА В НЕОТЛОЖНОЙ АНГИОХИРУРГИИ

Objective. To improve the results of treatment of patients with multilevel atherosclerotic lesions and aortic dissection. Methods. In 2019 year 16 hybrid surgical interventions on arteries of lower extremities and 1 hybrid intervention for aortic dissection type B were made in Brest Regional Hospital. Most of the patients were men (15 out of 16), the average age was 60.2±6.4 (M±σ) years. Disease was staged according to the Fontaine-Pokrovsky classification: 4 patients (25%) - IIb, 8 (25%) - III, 4 (25%) - IV. The type of surgery was determined by the level of occlusion / stenosis (according to Doppler ultrasound and angiographic examination) and the state of the outflow tract. According to the TASC II classification, all patients were class C or D. Four groups of hybrid interventions on the arteries of the lower extremities were identified: hybrid on the ilio-femoral segment (n=9), hybrid on the femoral-popliteal segment (n=4), hybrid on the femoral segment (n=1), hybrid on the aorto-iliac segment (n=2). Results. Technical success was achieved in 100% of cases. In 1 case thrombosis of the superficial femoral artery occurred, which did not require reconstruction due to compensated collateral blood flow, and 1 case of death from acute heart failure. Primary patency was achieved in 93.75% of cases. Duration of hybrid surgery 174.2±67.3 (M±σ) min. Duration of the open stage of the operation - 72.85±30.3 (M±σ) min. The augmentation of the ankle-brachial index (ABI) was 0.26±0.15 (M±σ). Hybrid interventions were performed in the X-ray operating room and always from one vascular access. The amount of iodine-contrasting substance used is 150.8±68 (M±σ) ml. Conclusion. The use of hybrid interventions provides complete revascularization of lower extremities and minimizes risks of perioperative complications during implantation of aortic stent grafts in type B aortic dissection. Hybrid operations should be considered as the most perspective direction in the development of angiosurgery.

Non-O blood group is associated with lower risk of in-hospital mortality in non-surgically managed patients with type A aortic dissection

BackgroundThe association between different ABO blood groups and mortality of aortic dissection (AD) remains controversial. This study aimed to examine whether different ABO blood groups affect the prognosis of AD.MethodsDemographic and clinical data were collected from 877 patients diagnosed with AD from 2015 to 2019 in the First Affiliated Hospital of Shantou University Medical College. The association between in-hospital mortality of AD patients and ABO blood group was analyzed using Cox proportional hazards regression models.ResultsThis retrograde cohort study demonstrated that for 877 patients, male gender, non-O blood group, Stanford type B AD (TBAD), higher presenting systolic and diastolic blood pressure, and being a recipient of aortic arch replacement surgery (surgery) or endovascular stent-graft implantation (stent-graft) were associated with decreased in-hospital mortality of AD. In Cox proportional hazards models, non-O blood group was associated with lower risk of early mortality regardless of adjustment (HR = 0.668, 95% confidence interval [CI] 0.473–0.944 before adjustment, HR = 0.662, 95% CI 0.468–0.935 after adjustment for age and sex, and HR = 0.641, 95% CI 0.453–0.906 after adjustment for AD types, SBP and surgery). Further analyses revealed that for patients diagnosed with type A AD (TAAD), non-O blood group renders a significant 34.3% decrease in the risk of in-hospital mortality compared with blood group O. Specifically, this difference in mortality risk was found among TAAD patients who did not undergo surgery (HR = 0.579, 95% CI 0.377–0.889), rather than those who did. There was no significant difference in early mortality for patients with TBAD, whether or not stent-grafts were implanted.ConclusionsNon-O blood type decreases the risk of in-hospital mortality, especially for TAAD, in AD patients without surgical intervention. More attention must be paid to blood type O TAAD patients without surgical interventions, and early surgical intervention may be an effective means to decrease in-hospital mortality of TAAD.

Spondylodiscitis due to transmitted mycotic aortic aneurysm or infected grafts after endovascular aortic aneurysm repair (EVAR): A retrospective single-centre experience with short-term outcomes

PurposeTo report the challenging therapeutic approach and the clinical outcome of patients with pyogenic spondylodiscitis transmitted due to infected retroperitoneal regions of primary infected mycotic aortic aneurysms (MAAs) or secondary infected aortic stent grafts after endovascular aneurysm repair (EVAR).MethodsBetween 2012 and 2019, all patients suffering from spondylodiscitis based on a transmitted infection after the EVAR procedure were retrospectively identified. Patient data were analysed regarding the time between primary and secondary EVAR infection and spondylodiscitis detection, potential source of infection, pathogens, antibiotic treatment, complications, recovery from infection, mortality, numeric rating scale (NRS), COBB angle and cage subsidence.ResultsFifteen patients with spondylodiscitis transmitted from primary or secondary infected aortic aneurysms after EVAR were included. The median follow-up time was 8 months (range 1–47). Surgery for spondylodiscitis was performed in 12 patients. In 9 patients, the infected graft was treated conservatively. MAAs were treated in 4 patients first with percutaneous aortic stent graft implantation followed by posterior surgery of the infected spinal region in a two-step procedure. Infection recovery was recorded in 11 patients during follow-up. The overall mortality rate was 27% (n = 4). The mean pain intensity improved from an NRS score of 8.4 (3.2–8.3) to 3.1 (1.3–6.7) at the last follow-up.ConclusionEVAR was used predominantly to treat primary infected MAAs. Secondary infected grafts were treated conservatively. Independent of vascular therapy, surgery of the spine led to recovery in most cases. Thus, surgery should be considered for the treatment of EVAR- and MAA-related spondylodiscitis.

ISCHEMIC SPINAL CORD INJURY FOLLOWING AORTIC STENT GRAFT IMPLANTATION – CASE STUDY

Morbidity and mortality associated with aortic aneurysm remains high. Aneurysms involving the thoracic and lumbar part of the aorta (TAAA) are particularly burdened with mortality. They are also one of the biggest challenges that vascular surgeons can face. Despite several dozen years of progress in surgical techniques, as well as the constant development of accompanying methods of spinal protection, ischemic spinal cord injury with subsequent paresis or pareresis is still one of the most serious complications of both open and closed surgical treatment of aortic aneurysms. Ischemic complications of the spinal cord occur immediately after the procedure, when the patient wakes up with a neurological deficit (according to some authors within the first day after the procedure) or in a deferred manner. In the case of open surgery, immediate damage is more common, in the case of endovascular surgery - deferred. Factors such as low blood pressure, arrhythmias, cardiovascular failure, sepsis and anemia due to anemia contribute to an increased risk of deferred complications. The rehabilitation of a patient with limb paralysis as a consequence of vascular spinal injury is laborious and requires a comprehensive approach. Proper treatment and prompt intervention in the form of rehabilitation is a great therapeutic challenge. The aim of the paper was to present the importance of the ischemic injuries of spinal cord following aortic stent graft implantation through a case report.

Value of cone beam volumetric tomography (CBVT) after endovascular exclusion of AAAs

CBVT acquisition at the end of the procedure would make it possible diagnose more technical anomalies after implantation of aortic stentgrafts (SG) (plication, type 1 or 3 endoleaks) than with 2D angiography (2DA). A previous study on this cohort of patients showed a significant increase of unplanned intraoperative additional procedures to correct these anomalies. The objective of this study was to evaluate if the additional treatment of the anomalies detected by CBVT improved the long-term results in these patients.

Results of a simple technique of implantation of aortic stentgrafts with a minimal amount of contrast (

Severe chronic renal disease (CRD stage 4 or 5, GFR < 30mL/min) is a major risk factor during the treatment of abdominal aortic aneurysms (AAA). EVAR is recommended in these patients but the injection of iodized product of contrast (IPC) runs the risk of permanent dialysis. The alternatives to the IPC exist (CO2, fusion of image) but require specific equipment and expensive material. The objective of this study was to report our results with a simple and accessible technique in these patients.

Stent graft as a bridge to allograft to treat a septic thoracic aortic pseudoaneurysm after spinal fusion

A 29-year-old woman was admitted to our institution for severe septic syndrome. Her medical history included a T6-T8 posterior spinal fusion 7 years earlier for tuberculous spondylodiscitis. Contrast-enhanced computed tomography (CT) revealed a 70- × 58-mm pseudoaneurysm of the descending thoracic aorta extending from T6 to T8 level, surrounding the left T6 screw (A/Cover). A T6-T8 spondylodiscitis and bilateral paraspinal collections were also observed. Blood and T7 bone biopsy specimens grew Escherichia coli. To prevent an imminent pseudoaneurysm rupture and to allow cryopreserved aortic allograft (CAA) delivery, the patient first underwent conformable TAG 26- × 26- × 100-mm (W. L. Gore & Associates, Flagstaff, Ariz) thoracic aortic stent graft implantation under general anesthesia through a small left femoral incision. The procedure was uncomplicated. Exclusion of the pseudoaneurysm was assessed by final angiography and postoperative CT scan (B). Five days later, T2-T10 spinal fusion was conducted after infected hardware removal through a posterior approach along with drainage of the paraspinal collections. Aortic replacement using a 10-cm-long thoracic CAA was performed through a left posterolateral thoracotomy in the same operative course. A partial cardiopulmonary bypass at normothermia was established through a left femoral incision. An arterial perfusion cannula was positioned in the abdominal aorta and a venous cannula to the right atrium. During aortic replacement, a fistula was observed at the bottom of the aortic pseudoaneurysm communicating with the former location of the left T6 screw. The final step consisted of implantation in the vertebral defect of a titanium mesh cage containing autologous bone graft. Transdiaphragmatic epiploplasty was performed to isolate the CAA (C). The culture specimens of the removed orthopedic hardware and stent graft grew E. coli. Antibiotic treatment initially consisted of intravenous administration of cefotaxime and gentamycin switched postoperatively to intravenous administration of ceftriaxone for 12 weeks. Follow-up included visits at 1 month and 6 months postoperatively, and follow-up should be continued twice a year. Six months postoperatively, the patient was asymptomatic. The CT scan showed satisfactory coverage of the allograft by the omentum and the absence of allograft pseudoaneurysm or residual collection (D). Vascular injury after spinal instrumentation is a rare but life-threatening condition. Treatment of such injuries is not standardized. Previous studies have reported the use of stent grafts with good outcomes.1Zerati A.E. Leiderman D.B. Teixeira W.G. Narazaki D.K. Cristante A.F. Wolosker N. et al.Endovascular treatment of late aortic erosive lesion by pedicle screw without screw removal: case report and literature review.Ann Vasc Surg. 2017; 39: 285.e17-285.e21Abstract Full Text Full Text PDF Scopus (5) Google Scholar In our case, we believed that simple endovascular treatment was not possible because of the high risk of stent graft infection. We believed that CAA represented the best option in a septic field, as is the case with aortic graft infections.2Corvera J.S. Blitzer D. Copeland H. Murphy D. Hess Jr., P.J. Pillai S.T. et al.Repair of thoracic and thoracoabdominal mycotic aneurysms and infected aortic grafts using allograft.Ann Thorac Surg. 2018; 106: 1129-1135Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar Potential postoperative CAA pseudoaneurysm formation requires close and lifelong follow-up. The patient consented to the use of related medical history and images for educational purposes.

Thoracic endovascular aneurysm repair for coarctation of the aorta with dissecting aortic aneurysm: A rarity

Endovascular procedures aim to reduce the morbidity and mortality. Repair is indicated for aneurysms that are the source of pain and tenderness, which may indicate an impending rupture. The options for repair include traditional open aortic surgery or endovascular repair. Endograft has been used in patients with aortic dissection, noting the extremely complex nature of open surgical repair in these patients, while the results have been excellent. Aneurysm formation is a significant complication after therapy for Coarctation of aorta (CoA). Aneurysms develop after surgical as well as transcatheter repair procedures of CoA. We report a rare case of coarctation of the aorta with dissecting aortic aneurysm who presented with sudden onset of chest pain radiating to back and dyspnea for 3 days. He successfully underwent balloon dilatation of coarctation segment followed by aortic stent-graft implantation. Uneventful during procedure prompts recovery on follow-up.

Successful Surgical Abdominal Aortic Debranching Preceding Stent Graft Implantation: A Case Report

Background Acute endovascular aneurysm repair with stent grafts (thoracic endovascular aortic repair [TEVAR]) is safe and feasible. Case Description A 64-year-old female presented with a perforated aortic aneurysm of the thoracic descending aorta. Primary TEVAR resulted in good management of the perforation but a type Ib endoleakage remained postoperatively. To place another stent, abdominal debranching with saphenous vein bypass to the celiac trunk was required. In the same session, another endograft was inserted successfully. Conclusion Abdominal debranching is a safe alternative to open aortic repair in acute thoracic and abdominal aneurysms, instead of waiting for a custom-made device.

Resultados preliminares sobre cambios en la rigidez arterial tras reparación endovascular de aneurismas de aorta con endoprótesis bifurcadas, ramificadas y con sistema de sellado

IntroductionPatients with diagnosis of abdominal aortic aneurysm (AAA) are known to have an increased cardiovascular risk. Open surgery has been the traditional approach however, endovascular repair has widely expanded due to the lower peri-operative risk. Arterial stiffness has been suggested to change and elevate after aortic stent-graft implantation. Material and methodsAs part of a study registered in National Institutes of Health website (ClinicalTrials.gov) with NCT02642952, a description is presented of 3 groups with endovascular treatment of AAA with different endografts and mechanisms. GroupA with standard bifurcated endograft, groupB with a branched (4 branches) device, and groupC with a sac sealing device. Each group included 2 patients. A report is presented on the individual changes of arterial stiffness measured by carotid-radial pulse wave velocity (PWV) and Augmentation Index (AIx). ResultsAll the patients included were men, older than 70 years, with AAA greater than 55mm, and high-risk (ASAIII) patients. We observed a variable change in carotid-radial PWV and IA@75 in the postoperative period in all patients studied. ConclusionsIt seems that endovascular devices in the treatment of AAAs are implicated in the change of arterial stiffness measurements. More randomised studies, with larger samples comparing the different types of endografts are required. The long-term impact on cardiovascular outcomes needs further investigation.

Successful Surgical Abdominal Aortic Debranching Preceding Stent Graft Implantation: A Case Report

Background Acute endovascular aneurysm repair with stent grafts (thoracic endovascular aortic repair [TEVAR]) is safe and feasible. Case Description A 64-year-old female presented with a perforated aortic aneurysm of the thoracic descending aorta. Primary TEVAR resulted in good management of the perforation but a type Ib endoleakage remained postoperatively. To place another stent, abdominal debranching with saphenous vein bypass to the celiac trunk was required. In the same session, another endograft was inserted successfully. Conclusion Abdominal debranching is a safe alternative to open aortic repair in acute thoracic and abdominal aneurysms, instead of waiting for a custom-made device.

Clinical testing of Belarusian aortic stent graft system

Aim. The study looks at the results of clinical testing of the first Belarusian aortic stent graft system developed and manufactured by a team of specialists from RSPC "Cardiology", Minsk, Belarus, and Belarusian Technical University.Methods. The original system of aortic stent graft includes a delivery system and an aortic stent graft itself. It is used in surgical treatment of complicated and common aneurysms of the thoracic aorta, as well as in cases of concomitant thoracic aneurysms and heart pathology to be treated under cardiopulmonary bypass. Clinical testing of the stent graft was carried out according to the requirements of Ministry of Health of the Republic of Belarus on the basis of three different cardiac hospitals of the country. Results. All the three hospitals treated one patient each. The first patient underwent implantation of the stent graft into the descending thoracic aorta, with the thoracic aorta aneurysm isolated and the aortic valve replaced with bioprosthesis. The second patient underwent ascending aorta and aortic valve replacement with a conduit and implantation of aortic stent graft into the descending thoracic aorta. In the third patient the domestic aortic stent graft was implanted into the descending thoracic aorta with isolation of the thoracic aneurysm; aortic valve and ascending aorta were replaced with ‘MedEng' conduit and the aortic arch was also replaced, with the brachiocephalic arteries re-implanted in place. All the patients were followed-up for both early and long-term outcomes for more than 1 year and were examined by using CT angiography in the early postoperative period and after 1 year. Uncomplicated postoperative course was observed in all the patients. There were no complications in the long-term follow-up as well. CT angiography data confirmed good positioning of the stent graft and good isolation of the aneurysm lumen. Preoperative and postoperative СТ data of one patient are presented in the article.Conclusion. The Belarusian system of aortic stent graft successfully passed clinical testing and may be certified and used in clinical practice at a later time on the territory of Belarus.Received 21 June 2016. Accepted 11 November 2016.Funding: The research was financed by Ministry of Health Care of Republic of Belarus.Conflict of interest: The authors declare no conflict of interest.Author contributionsConceptualization and study design: Shket A.P.Material acquisition and analysis: Shket A.P., Nizhnikova O.G. Statistical data processing: Glybovskaya T.V.Article writing: Shket A.P., Krutov V.G.Review &amp; editing: Ostrovskii Y.P.