Endovascular Stent-graft Placement Research Articles

Endovascular Repair of a Right-Sided Descending Thoracic Aortic Aneurysm With a Right-Sided Aortic Arch and Aberrant Left Subclavian Artery

Aneurysms involving a right-sided aortic arch and a right-sided descending thoracic aorta with an aberrant origin of the left subclavian artery are rare. We describe the successful surgical repair of this vascular anomaly by the combined use of a left carotid to subclavian artery bypass followed by endovascular stent-graft placement to exclude the aortic aneurysm. We also review the literature associated with this particular anatomic presentation.

Results after endovascular stent-graft placement in atherosclerotic aneurysms involving the descending aorta

Aims: To determine durability and need for reinterventions after endovascular stent-graft placement in atherosclerotic aneurysms involving the descending aorta.

Mid-term results after endovascular stent-graft placement due to perforating atherosclerotic ulcers of the thoracic aorta

Aims: To determine mid-term durability of endovascular stent-graft placement in patients with perforating atherosclerotic ulcers (PAU) involving the thoracic aorta and to identify risk factors for death as well as early and late cardiovascular events.

Endoscopic controlled stent-treatment of a „Swiss cheese“ aorta

Endovascular stent-graft placement has developed as effective treatment in various diseases of the descending aorta. However, retrograde aortic stenting may be impossible in the absence of an appropriate aortic landing zone or in case of barred femoral vessels. In these cases we recommend antegrade stenting via the aortic arch during circulatory arrest with deep hypothermia. This method allows secure fixation or the proximal stent rim, thus avoiding typical stent-related problems like migration and type I endoleak. However, to overcome the lack of fluoroscopic control, we strongly recommend intraoperative endoscopic control to evaluate the distal pathology and to assure complete stent expansion. Our video presented the endoscopic controlled stent-placement in a 62-year old female patient with chronic Type-B-dissection. A sufficient proximal landing zone was not available due to the close distance (less than 10mm) between the first entry and the left carotid artery. Preoperative CT-scan showed further entries of the descending aorta. The intraoperativ inspection revealed an aortic wall like a „Swiss cheese“. With the help of endoscopic control it was possible to place the aortic stent safely in the true lumen with coverage of all entries. Postoperative control showed a perfect treatment of the pathologies without endoleaks. Note: This case is presented as a video sequence

Endovascular stent-graft placement of aneurysms involving the descending aorta originating from chronic type B dissections

Endovascular stent-graft placement of aneurysms involving the descending aorta originating from chronic type B dissections

Treatment of chronic type B dissection by transluminally endovascular stent-graft placement

Treatment of chronic type B dissection by transluminally endovascular stent-graft placement

Unusual Representation of a Common Iliac Artery Double Aneurysm

This case discusses an unusual representation of a 3.1-cm double aneurysm of the right common iliac artery with an ectatic distal abdominal aorta. The patient was a 64-year-old asymptomatic male who participated in a routine ultrasound screening at his church. On the basis of the findings, a full ultrasound study was ordered and conducted at the request of his primary physician. The patient's history included smoking cessation in 1975. He currently had hypertension and hyperlipidemia. He was physically active and ran 40 miles per week until developing right Achilles tendonitis. Because of this injury, the patient biked daily. The patient's medications included atenolol and daily vitamins. The ultrasound findings revealed two aneurysms of the right common iliac artery. Both areas were fusiform and measured 3.1 and 2.9 cm, respectively. The dilation extended to the right internal iliac artery. The left common iliac was mildly dilated and kinked to the left. There was mild enlargement of the distal abdominal aorta measuring 3.4 cm by ultrasound and 3.1 cm by computed tomography angiogram. There is no evidence of internal thrombus. Usually asymptomatic, iliac artery aneurysms can be lethal if large (above 3.0 cm) and undetected. With appropriate, timely intervention the aneurysm can be safely repaired before rupture. Various aneurysm treatment options include conventional open abdominal surgery or endovascular stent graft placement with coil embolization. This patient discussed options with the vascular surgeon and was scheduled to have a cardiac catheterization with right internal iliac coil embolization. Staging of the endovascular graft was planned to follow. This case presents the uncommon finding of a large iliac artery aneurysm. This patient's disease was made more unusual by the presence of two distinct aneurysms present within the same vessel. It further reinforces the common practice of fully examining patients with aneurismal disease bilaterally and over multiple levels as a significant portion of patients have multilevel disease.

Endovascular treatment of painless aortic ulcer detected by transesophageal echocardiography as an incidental finding

Penetrating aortic ulcer (PAU) is defined as an ulcerating atherosclerotic lesion that disrupts the aortic wall layers, penetrating the internal elastic lamina. The natural history of the disease and the preferred treatment are still debated. We report a case of painless PAU in a 78-year-old man detected by transesophageal echocardiography at the level of proximal descending aorta as an incidental finding. The patient underwent endovascular stent-graft placement without any complications at early and late follow-up.

Endovascular Management of Chronic Type B Dissecting Aortic Aneurysm Utilizing Aortic and Renal Stents

Over the last 10 years endovascular stent-graft placement has been increasingly used to treat complicated acute Type B thoracic aortic dissections. While studies have demonstrated the use of additional aortic stent-grafts to treat continued false lumen perfusion and case reports have detailed the use of renal artery stents to treat renal ischemia related to aortic dissection, to our knowledge the adjuvant use of renal artery stents to reduce false lumen perfusion has not been reported. We present the case of a 72-year-old male who had previously undergone endovascular repair of a complicated Type B thoracic aortic dissection and presented with an expanding false lumen in the peridiaphragmatic aorta despite coverage of the entire thoracic aorta. This was treated by closure of a right renal fenestration using a renal stent.

Surgical Strategy in Aortoesophageal Fistulae

The surgical treatment of aortoesophageal fistulae (AEF) has a high morbidity and mortality rate. We report our experience with the sequential use of endovascular thoracic stentgrafts and cryopreserved aortic homografts for in situ repair of the descending thoracic aorta. In a 7-year period, 6 patients with AEF were treated at our center. After primary endovascular repair in all cases, 4 patients subsequently underwent in situ repair of the descending thoracic aorta with cryopreserved homografts. Long-term antibiotic therapy was given in all cases. Recent clinical status and radiologic findings on follow-up studies of each patient were analyzed. The mean follow-up time was 35 months (range, 2-76). Endovascular stentgraft repair was technically successful in all cases. Two patients were not candidates for open surgical repair because of their medical condition; they both died within 8 weeks after discharge from the hospital, 1 from recurrent septic episodes, and the other from upper gastrointestinal bleeding. One of 4 patients who had undergone open surgical repair died 1 year later from upper gastrointestinal bleeding that occurred presumably due to an infectious degeneration of the homograft after secondary infection with a methacillin-resistant Staphyloccocus aureus. In 1 case persistent paraplegia and in another case persistent renal failure occurred. The use of cryopreserved homografts is a valuable alternative to in situ repair with prosthetic vascular grafts or extra-anatomic reconstructions in the surgical treatment of AEF. Endovascular stentgraft placement plays a role as a bridging procedure in emergency situations.

Endovascular management of acute blunt traumatic thoracic aortic injury: A single center experience

Traumatic injury of the thoracic aorta is a life-threatening complication in patients who sustain deceleration or crush injuries. The magnitude of force necessary to cause blunt thoracic aortic injury results in a high proportion of concomitant injuries, posing a significant challenge for prioritizing management. Open surgical mortality is increased in the presence of coexisting head, lung, and abdominal injuries. Spinal cord ischemia may occur following aortic cross-clamping and operative hypotension. Endovascular stent-graft placement offers a safe, effective, and timely treatment option. The aim of this study was to assess our single center experience of endovascular repair following acute blunt traumatic aortic injury. Data from thirteen consecutive patients (mean age, 43.2 years; range, 16 to 84 years) with acute blunt traumatic aortic injury treated by endovascular stent-graft insertion between October 2001 and March 2007 was prospectively collected. Demographics, injury characteristics, technique, and complications were recorded. Follow-up data consisted of computed tomographic angiography and plain chest radiography at regular intervals. Mean and median follow-up after stent-graft implantation were 28.9 and 29 months, respectively. All patients underwent endovascular repair within a median of 9 hours from hospital presentation. Two patients underwent carotico-carotid bypass immediately prior to endovascular stenting during a single anesthetic. Stent-graft implantation was technically successful in all patients. No patient required conversion to open surgical repair of the acute blunt traumatic aortic injury. Procedure-related paraplegia was zero. Complications included proximal migration of initial stent-graft in one patient and iliac artery avulsion in another patient with consequent ilio-femoral bypass. The median hospital stay was 17 days. There were no in-hospital deaths. Endovascular repair is evolving as the procedure of choice for acute blunt traumatic aortic injury. Treatment of lesions that extend into the aortic arch is feasible with extra-anatomical bypass. In our study, endovascular repair of blunt traumatic aortic injury is a safe procedure with low morbidity and a mortality rate of zero.

Brucella spondylitis complicated by an infected abdominal aortic aneurysm and deep venous thrombosis: case report and review of the literature

Brucellosis is a common zoonosis, which still remains as a major health problem in certain parts of the world. Spondylodiscitis is the most frequent osteoarticular complication of brucellosis. Herein is reported an uncommon case of a middle-aged male treated for brucellosis who developed 2 years after the treatment brucellar spondylodiscitis complicated by a psoas muscle abscess, an infected abdominal aorta aneurysm and deep venous thrombosis of IVC, common iliac, external iliac and common femoral veins. CT and CT angiography were the imaging modalities depicting the findings. After an endovascular stent graft placement in abdominal aorta aneurysm, a CT guided drainage of retroperitoneal abscess revealed Brucella melitensis as the pathogen microorganism. Diagnosis of spondylodiscitis and contiguous psoas abscess is usually simple but aortic involvement is difficult to identify and can be easily overlooked. A high degree of suspicion is essential to reduce the delay for the treatment.

Endovascular stent-graft treatment of thoracic aortic syndromes: A 7-year experience

Thoracic aortic diseases (TAD) are relatively frequent conditions associated with high mortality. Recently, several reports have demonstrated the safety and efficacy of endovascular stent-graft (EVG) placement for TAD as an alternative to open surgery. We report our experience in management of thoracic aortic syndrome on 56 consecutive patients with TAD that underwent endovascular stent-graft repair. MDCT angiography was used in all patients to provide preprocedure evaluation and measurements. In particular it is necessary to evaluate the proximal and distal landing zones of the stent-graft. All EVGs in our series were placed successfully. Conversion to open surgery was never required. Six patients (10.7%) died early after the stent-graft deployment. During follow-up four more patients died. The endoleak rate was 16.7% (no. 10 pt). We did not observe any case of paraplegia. The present study shows the efficacy of EVG in the long-term follow-up, with an overall survival of 82.1%, which is comparable to that reported in recent studies. In conclusion this technique is emerging as an alternative approach in the treatment of TAD because this approach offers a less invasive therapeutic option to standard surgical techniques, even in patients who have associated diseases that make them poor surgical candidates.

Endovascular treatment of thoracic aortic disease: Mid‐term follow‐up

The aim of this study was to evaluate the mid-term follow-up in a cohort of patients with acute or chronic descending aortic disease treated by stent-graft repair. Since 1999, endovascular stent-graft placement has been reported as an alternative treatment to surgical approach for a variety of thoracic aortic diseases; however, results beyond initial short-term follow-up are not widely available for the broad range of applications. From March 2001, 43 consecutive patients with traumatic aortic transection (group A = 16) and complicated type B aortic dissection or aneurysm (group B = 27) underwent stent-graft implantation. All patients underwent computed tomography (CT) scan as preoperative assessment and in 26 a transesophageal echo (TEE) exam was performed. Technically successful stent-graft deployment was achieved in all patients. No patient required surgical conversion and no cases of paraplegia occurred. The overall in-hospital mortality was 9.3%. A residual endoleak (type II) was detected in one group B patient who was managed conservatively. The mean follow-up was 29 +/- 8 months (range 10-48 months). No patient died during late follow-up after hospital discharge. At 12 months, one patient (2.5%) who had stent graft repair of an aortic dissection developed an asymptomatic type I endoleak. Three asymptomatic patients with chronic dissection had a persistent retrograde perfusion of the thoracic false lumen via a distal tear(s) in the dissection septum. Our results of stent-graft treatment of complicated and uncomplicated diseases of the descending aorta confirms that this alternative to open repair is a safe, less invasive, and relatively low risk approach. Medium-term follow-up results suggest that it is effective and durable therapy with low associated mortality and morbidity rates.

Endovascular Repair of Thoracic Aortic Disease: Early and Midterm Experience

Thoracic aorta disease remains a challenging problem, and despite improvements, open repair techniques are still associated with significant morbidity and mortality. This is a retrospective review of 53 consecutive patients with thoracic aortic pathology who were treated with endovascular repair between September 1998 and December 2004 at a tertiary-care hospital. Endovascular stent graft placement was performed on 23 elective and 30 emergent patients (34 male patients, mean age 66 years, 21 to 85 years). Completion angiography revealed no endoleak in 47 (89%) patients, a type I endoleak in 4 patients, and a type II endoleak in 2 patients. Operative 30-day mortality for elective aneurysms (n = 22), emergent aneurysms (n = 10), dissection (n = 3), penetrating aortic ulcers (n = 7), and trauma (n = 11) was 0%, 40%, 0%, 29%, and 9%, respectively. In total, 46 (87%) patients survived 30 days, and 36 (78.3%) of the survivors were discharged home free of complications. Two patients (4%) experienced paraplegia. Median follow-up was 22 months (1 to 72 months). Intermediate-term results revealed 41 (89%) patients free of endoleak, stent migration, or aneurysmal expansion. Two (4%) patients required reintervention with an additional stent graft. There were 2 (4%) patients with late aortic-related deaths and four (9%) patients with non-aorticrelated late deaths. Endovascular stent graft placement for thoracic aorta disease can be performed successfully and safely with good perioperative and intermediate-term outcomes. Stent graft complication and reintervention rates are low, whereas intermediate survival rates are good. Long-term efficacy still needs to be evaluated.

Endovascular Stent-Graft Placement of Aneurysms Involving the Descending Aorta Originating From Chronic Type B Dissections

The performance of endovascular stent-graft placement in patients suffering from aneurysms involving the descending aorta originating from chronic type B dissections is unclear. Within a 2-year period, we treated 6 patients with this pathology. Four patients required extension of the proximal landing zone (autologous double transposition, n = 2; subclavian-to-carotid artery transposition, n = 2) before stent-graft placement. Supra-aortic rerouting procedures and endovascular stent-graft placement were performed successfully in all patients. Closure of the primary entry tear, full expansion of the stent-graft, and eventually, thrombosis of the false lumen was achieved in 5 patients. In 1 patient with a short proximal landing zone, a persisting type Ia endoleak was observed. In all patients with successful primary entry closure, a reduction in aneurysm diameter occurred. Mean follow-up is 16 months (range, 4 to 25). Endovascular stent-graft placement of aneurysms involving the descending aorta originating from chronic type B dissections may serve as a valuable treatment option in this complex pathology. The chronic dissection membrane can be successfully compressed against large areas of the native aortic wall. A sufficient proximal landing zone is mandatory for early and late success.

Spontaneous Rupture of a Non Aneurysmal Atherosclerotic Superficial Femoral Artery: A Case Report

Spontaneous rupture of a non aneurysmal atherosclerotic artery is very rare. We report the second case in the literature of a patient with spontaneous rupture of a non aneurysmal atherosclerotic superficial femoral artery. It has been described as a result of a penetrating atheromatous ulcer. Exclusion of arterial wall rupture is required. Open surgery and endovascular stent-graft placement has been successfully reported. Respective indications depend on anatomical considerations. We opted for open surgical treatment in preference to endovascular stent-graft placement. Spontaneous Rupture of a Non Aneurysmal Atherosclerotic Superficial Femoral Artery: A Case ReportEJVES ExtraVol. 13Issue 5PreviewSpontaneous rupture of a non aneurysmal atherosclerotic artery is very rare. We report the second case in the literature of a patient with spontaneous rupture of a non aneurysmal atherosclerotic superficial femoral artery. It has been described as a result of a penetrating atheromatous ulcer. Exclusion of arterial wall rupture is required. Open surgery and endovascular stent-graft placement has been successfully reported. Respective indications depend on anatomical considerations. We opted for open surgical treatment in preference to endovascular stent-graft placement. Full-Text PDF Open Access

Spontaneous Rupture of a Non Aneurysmal Atherosclerotic Superficial Femoral Artery: A Case Report

Spontaneous rupture of a non aneurysmal atherosclerotic artery is very rare. We report the second case in the literature of a patient with spontaneous rupture of a non aneurysmal atherosclerotic superficial femoral artery. It has been described as a result of a penetrating atheromatous ulcer. Exclusion of arterial wall rupture is required. Open surgery and endovascular stent-graft placement has been successfully reported. Respective indications depend on anatomical considerations. We opted for open surgical treatment in preference to endovascular stent-graft placement.

Hemolytic Anemia Caused by Iatrogenic Arteriovenous Iliac Fistula and Successfully Treated by Endovascular Stent-Graft Placement

Hemolytic Anemia Caused by Iatrogenic Arteriovenous Iliac Fistula and Successfully Treated by Endovascular Stent-Graft Placement A 33-year-old man was admitted to our hospital for investigation and treatment of lower back pain. MRI of the lumbar spine revealed degenerative change and significant disk protrusion at the L5–S1 level, which was treated by lumbar diskectomy and laminectomy. Postoperatively, the patient developed back pain that was managed conservatively, and he was discharged. He was readmitted 3 months later with lethargy and persisting back discomfort. Physical examination was unremarkable. Laboratory investigations revealed anemia with elevated reticulocytes and lactate dehydrogenase (LDH) with reduced serum haptoglobins, consistent with hemolytic anemia from intravascular hemolysis. CT scans revealed indirect evidence of an arteriovenous fistula with opacification of a distended inferior vena cava in the arterial phase (Fig. 1A). A conventional angiogram confirmed the fistula between the right common iliac artery and left common iliac vein (Fig. 1B). The fistula developed secondary to the previous spinal surgery because of inadvertent trauma to the iliac vessels, and the rapid flow within the fistula resulted in hemolytic anemia. The fistula was subsequently treated with a covered stent-graft (Fig. 1C) with successful resolution of the patient’s hematologic parameters. The patient was discharged and remains well. Hemolytic anemias are generally classified into intravascular and extravascular hemolysis. In this case, the hemolytic anemia was intravascular and related to destruction of erythrocytes from high flow through the iliac fistula. Fistulas usually develop as a result of inflammation or trauma to the vessel or surrounding tissue. Trauma to the iliac vessels occurred inadvertently during surgery in this case. Vascular injury during spinal surgery is a known but unusual complication reported to occur with an incidence of 0.017% [1]. Retroperitoneal hemorrhage is well documented, but fistula formation is rare. The precise incidence of this complication is unknown, but one series reported arteriovenous fistula in 5 of 3,500 cases [2]. Previously, conventional angiography was necessary to make the diagnosis of a fistula; however, CT is now performed in the initial assessment of such patients [3]. CT findings include early filling and distention of the venous system and direct visualization of the fistula. Until recently, open surgical repair was the only treatment, and it had a significant operative mortality. In recent years, however, covered stent-graft technology has allowed for many fistulas of this kind to be treated in a minimally invasive fashion [4]. In the case we have presented, a covered stent-graft was successful in eliminating the iliac arteriovenous fistula and, thus, the patient’s hemolysis.

Invited Commentary: The Hybrid Total Arch Repair: Brachiocephalic Bypass and Concomitant Endovascular Aortic Arch Stent Graft Placement

Journal of Cardiac SurgeryVolume 22, Issue 2 p. 103-104 Invited Commentary: The Hybrid Total Arch Repair: Brachiocephalic Bypass and Concomitant Endovascular Aortic Arch Stent Graft Placement Grayson H. Wheatley III M.D., Grayson H. Wheatley III M.D. Arizona Heart Institute, Phoenix, AZSearch for more papers by this author Grayson H. Wheatley III M.D., Grayson H. Wheatley III M.D. Arizona Heart Institute, Phoenix, AZSearch for more papers by this author First published: 02 March 2007 https://doi.org/10.1111/j.1540-8191.2007.00377.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume22, Issue2March/April 2007Pages 103-104 RelatedInformation