Repair Of Aortic Disease Research Articles

Pre-fenestration endovascular repair of aortic diseases in patients with zone 2 segment: A single-center experience

The present study aims to analyze the outcomes of three cases of pre-fenestration and branch stent-graft endovascular repair of aortic disease with zone 2 aortic lesions. From August 2017 to June 2018, three patients with zone 2 aortic lesions underwent thoracic endovascular repair with innominate artery, left common carotid artery, and left subclavian artery recannulation using pre-fenestration and branched stent-grafts to preserve the patency of the aortic arch branches. The technical success rate was 100%. One patient had a proximal type I endoleak with no need for additional treatment. The overall mortality was 0%. All branches were patent. The follow-up period lasted for 2-15 months, with one patient lost to follow-up. There were no conversions to open surgical repair, aortic rupture, paraplegia, or retrograde type A aortic dissection. The use of a pre-fenestration and branch stent-graft for the thoracic endovascular repair of zone 2 aortic lesions is a feasible and effective method for aortic arch branch revascularization. The risk of this surgical procedure is high, requiring significant expertise. The procedure should be conducted only in experienced centers. Durability concerns should be assessed in future studies with long-term follow-up.

Unusual complications of endovascular repair of the thoracic aorta: MDCT findings

With the development of minimally invasive surgical techniques, endovascular stent-graft placement has become an accepted and widely used alternative to the traditional surgical repair of aortic disease and is gaining acceptance as the treatment of choice. Many studies show that endovascular stent-graft therapy is safe and effective, although complications related to this treatment are also recognised. Although the incidence of major complication is low, neurological sequelae remain the major concern of endovascular repair. With growing experience, however, the spectrum of mid- and long-term complications has broadened to include potentially disastrous events, other than paraplegia or stroke, that require diligent surveillance. Three-dimensional data sets acquired quickly by multidetector computed tomography (MDCT) allow multiplanar reformations and 3D viewing, as well as quantitative assessment of vessel lumens, walls and surroundings. Although a large portion of radiologists will not be involved in the actual endograft deployment, many will be involved in the interpretation of postprocedural surveillance studies. Accordingly, the goal of this report is to summarise our experience with the presentation, diagnostic approach, management and outcomes of these unusual, but potentially catastrophic, postendovascular aortic repair complications to highlight their significance and increase familiarity with them among the imaging community. Increasing awareness of these complications may facilitate rapid diagnosis and/or triage and treatment.

Risiken der Aortenchirurgie

In the last few decades the surgical therapy of aortic diseases has enormous improved. However, aortic surgery still carries a high risk of complications. Nearly 80 % of patients with aortic diseases are older than 65 years. Every year the number of operated old and multimorbid patients increases. Nowadays there are two surgical methods available: the endovascular and open repair of aortic diseases. Besides the usual hazards of any anesthesia and operation, there are several particular postoperative problems which may arise following aortic grafting for aneurysm, dissection or occlusive disease. The most common complications may be classified as those that occur after open and endovascular repair, including bleeding, intestinal, kidney and spinal ischemia, graft infection, aortoenteric fistula and impotence and those that appear only after endovascular stent graft repair, including endoleaks, postimplantation syndrome, stent thrombosis, complications due to contrast media and exposure to radiation and cholesterol crystal embolism. The endovascular and open repair have different advantages and the indication for one of them depends of individual patient‘s risk-benefit analysis. That is why both surgical methods should be considerd as complementary procedures in the aortic surgery.