Stent-graft Placement For Treatment Research Articles

Stent-graft placement for treatment of massive hemobilia caused by porto-biliary fistula

Stent-graft placement for treatment of massive hemobilia caused by porto-biliary fistula

Endovascular longitudinal fenestration and stent graft placement for treatment of aneurysms developing after chronic type B aortic dissection

The thickened intimal flap present in cases of chronic aortic dissection can present a challenge to attempts at endovascular stent graft treatment performed for subsequent aneurysmal degeneration by precluding adequate landing zones for the endograft and by constraining the endograft from full expansion. In this report we describe our technique and outcome for longitudinal endovascular fenestration of chronic aortic dissection flaps to facilitate endovascular stent graft treatment for thoracic aortic aneurysms developing after aortic dissection.

Perioperative aortic dissection rupture after endovascular stent graft placement for treatment of type B dissection

Background The perioperative aortic dissection (AD) rupture is a severe event after endovascular stent graft placement for treatment of type B AD. However, this life-threatening complication has not undergone systematic investigation. The aim of the study is to discuss the reasons of AD rupture after the procedure. Methods The medical record data of 563 Stanford type B AD patients who received thoracic endovascular repair from 2004 to December 2011 at our institution were collected and analyzed. Double entry and consistency checking were performed with Epidata software. Results Twelve patients died during the perioperation after thoracic endovascular repair, with an incidence of 2.1%, 66.6% were caused by aortic rupture and half of the aortic rupture deaths were caused by retrograde type A AD. In our study, 74% of the non-rupture surviving patients had the free-flow bare spring proximal stent implanted, compared with 100% of the aortic rupture patients (74% vs. 100%, P=0.213). The aortic rupture patients are more likely to have ascending aortic diameters ≥4 cm (62.5% vs. 9.0%, P=0.032), involvement the aortic arch concavity (62% vs. 27%, P=0.041) and have had multiple stents placed (P=0.039). Conclusions Thoracic AD endovascular repair is a safe and effective treatment option for AD with relative low in-hospital mortality. AD rupture may be more common in arch stent-graft patients with an ascending aortic diameter ≥4 cm and with severe dissection that needs multi-stent placement. Attention should be paid to a proximal bare spring stent that has a higher probability of inducing an AD rupture. Post balloon dilation should be performed with serious caution, particularly for the migration during dilation.

TCT-121 Thoracic Aortic Pseudoaneurysm Following Endovascular Stent Graft Placement for Treatment of Type B Dissection: What causes it?

Background: To analyze early technical success and late clinical success after endovascular entry sealing for chronic type B dissection with special emphasis on the development of pseudoaneurysm, reintervention, false lumen and aortic remodeling. Methods: Retrospective analysis of a prospective database. We observed 151 patients (mean age 62,2 12,6 years, 67% male) in the period July 1999 to May 2010 with acute or chronic type B dissection treated by endovascular entry sealing. Serial contrastenhanced computed tomography (CT) scans of 151 type B dissection patients (mean age 62,2 12,6 years, 67% male) who underwent TEVAR were analyzed. True and false lumen diameter at baseline and follow-up were quantified. In 6 of 8 patients with pseudoaneurysm a complete follow-Up by CT was available which was compared with the other 143 patients: The angle between distal stent ending and the further aorta in patients without and with pseudoaneurysm was measured. Results: Eight of 151 patients developed a distal pseudoaneurysm after TEVAR. The incidence of development of pseudoaneurysm after TEVAR was 5.3 %. Seven patients were treated by distal extension of the stent graft, one denied reintervention. There was a significant difference in the angle between distal stent ending and the further aorta in patients without and with pseudoaneurysm (167,1° 12,4 vs. 148,2° 16,5, p 0,05). In mean a pseudoaneurysm was diagnosed after 22,5 months (3,2-115,2 months). By TEVAR an aortic remodeling was achieved with a significant gain of the true lumen (1,6 0,8 cm vs. 2,9 0,5 cm, p 0,001). Conclusions: Endovascular treatment in chronic type B dissection has a high technical success rate and low mortality. Pseudoaneurysm of the thoracic aorta following endovascular stent graft placement is a rare and potentially fatal condition.

Circulation: Clinical Summaries

<i>Circulation:</i> Clinical Summaries

Blunt traumatic aortic transection: the endovascular experience

BackgroundThoracic aortic transection resulting from blunt trauma is usually fatal. It is almost always associated with multiple, complex, nonaortic injuries that could be adversely affected by standard surgical repair of the aorta. Endovascular stenting techniques offer these patients a less physiologically disruptive treatment option. We studied the feasibility and safety of endovascular stent graft placement for treatment of acute traumatic aortic transection. MethodsBetween 1994 and 2001, 9 patients were treated emergently for aortic transections with stent graft placement. The first patient had a custom-made prototype, and the other 8 patients had the Cook-Zenith thoracic stent graft implanted. All were polyester-covered Z-stent construction and deployed through a femoral 20- to 24-F delivery sheath. ResultsStent graft placement successfully sealed the aorta in all patients. One patient died as a result of a cerebrovascular accident. One patient required a brachial thrombectomy to relieve arm ischemia. The remaining eight patients were alive and without complications during the follow-up period (mean 21 months). ConclusionsEndovascular repair for acute aortic transection is a safe, effective, and timely treatment option. It may be the treatment of choice in patients with extensive associated injuries.