Endovascular Repair Of Type Research Articles

Endovascular Repair of Type I Endoleak Following Open Abdominal Aortic Aneurysm Repair

Failure of conventional abdominal aortic aneurysm (AAA) repair may occur as a result of late para-anastomotic aneurysm due to the breakdown of the anastomotic suture line as a result of aortic wall fragility or erosion by infection. Conventional management usually requires open surgical revision of the anastomosis. We report the unusual case of an 81-year-old man who had early development of aneurysm re-expansion 3 months after initial open AAA repair treated successfully with a bifurcated endograft.

Extension of Dissection in Stent-Graft Treatment of Type B Aortic Dissection:Lessons Learned from Endovascular Experience

Endovascular treatment is becoming the most important treatment modality in the complex management of type B dissection, providing benefits to both acute and chronic patients. Growing technical experience and improving stent-graft devices have resulted in better patient outcome and expanded clinical indications. Nevertheless, similar to any treatment option, this less invasive method has its inherent risks. Several cases of iatrogenic dissection have been reported in the literature, underlying the need for guidelines to minimize this risk and improve procedural safety. Extension of the dissection after endovascular repair of type B dissection does not appear to be device-specific, but related primarily to aortic wall alterations or adverse anatomy that arise most frequently in hypertensive patients or those with challenging aortic configuration. An accurate examination of the aortic wall and dissection anatomy and careful intraprocedural device manipulation and balloon molding may help avoid this potentially life-threatening complication.

Combined Surgical and Endovascular Repair of Type B Thoracic Aortic Dissecting Aneurysm after Failed Endovascular Treatment

Endovascular stent grafting is an innovative technique for the treatment of acute type B aortic dissections. Proper patient selection, with regard to treatment as well as the use of experienced centers is necessary for successful results. We present a case in which a 50year-old male patient who suffered from an acute type B dissection was treated by endovascular repair in another hospital. Due to the insertion of an undersized proximal stent graft, improper sealing was obtained resulting in a type I endoleak. The patient was transferred to our hospital where a combined surgical and endovascular repair was successfully performed to treat the endoleak. We suggest considering this combined approach when the thoracic dissections/aneurysms involve the aortic arch.

Iatrogenic iliac artery rupture and type a dissection after endovascular repair of type B aortic dissection

We report a case of two iatrogenic complications after endovascular repair of a type B aortic dissection treated for abdominal aortic branch ischemia. A rupture of the common iliac artery occurred first during the procedure. A type A dissection occurred 12 days later. The proximal part of the aortic endovascular graft had created a tear in the aortic wall resulting in a retrograde type A dissection. Although aortic endovascular grafting is apparently associated with less morbidity and mortality, potentially lethal complications, both acute and delayed, may arise.

An adjustable, percutaneously placed helical coil: Control of left ventricular filling pressure during cardiopulmonary bypass in severe left ventricular failure

since 1969, when Dot ter ~ initially inserted stainless steel coils as a vascular stent in canine popli teal arteries. Clinical endovascular placement of straight stent grafts for the t reatment of aortic dissection has already been reported, 4 but placement of these stent grafts was limited to sites that did not include the origin of the major aortic arterial branches. With the branched graft, we succeeded in endovascular repair of type B dissection with intimal tear just beyond the left subclavian artery. If long-term results are favorable, endovascular repair of larger dissections in patients with type B dissection would be possible. Careful long-term evaluation and further improvement in devices and techniques will, however, be necessary for extensive clinical use. R E F E R E N C E S 1. Inoue K, Htay T, Kida M, Fujiwara H. Percutaneous implantation of aortic endovascular graft for created aneurysm: animal experiment [abstract]. Circulation 1991;84(Suppl):II421. 2. Inoue K, Htay T. Long-term follow-up of percutaneously placed aortic endovascular graft: animal experiment [abstract]. Circulation 1992;86(Suppl 1):I636. 3. Dotter CT. Transluminally-placed coilspring endoarterial tube grafts: long-term patency in canine popliteal artery. Invest Radiol 1969;4:329-32. 4. Dake MD, Miller DC, Semba CP, Mitchell RS, Walker PJ, Liddell RP. Transluminal placement of endovascular stentgrafts for the treatment of descending thoracic aortic aneurysms. N Engl J Med 1994;331:1729-34.