Stent Graft Research Articles

Aortoesophageal fistula nineteen years after radiotherapy for esophageal cancer: a case report

Abstract Background Aortoesophageal fistula (AEF) is a life-threatening disease that causes massive bleeding, sepsis, and ultimately death. Therefore, emergency treatments are required. Recently, cases of AEF treated with thoracic endovascular aortic repair (TEVAR) have been reported. Case Summary An 84-year-old man was referred to a local hospital with massive hematemesis and transient loss of consciousness. The patient’s medical history included radiotherapy for esophageal cancer 19 years before presentation. Gastrofiberscopy revealed an ulcer in the thoracic esophagus and no recurrence of esophageal cancer. Computed tomography (CT) showed that the same area was adjacent to the thoracic aorta and that there was no thoracic aortic aneurysm. The patient was then transferred to our institution for surgical treatment. We diagnosed the patient with an aortoesophageal fistula caused by radiotherapy of the esophagus. Therefore, thoracic endovascular aortic repair (TEVAR) was performed. Due to the patient’s advanced age, condition, and the possibility of strong adhesions, there was a high risk that they would be unable to tolerate esophagectomy to prevent stent graft infection. Therefore, antibiotic therapy was initiated. However, CT revealed a stent graft infection 24 days after TEVAR. The patient died of sepsis 27 days after the procedure. Discussion We describe the first case of AEF as a very late complication of radiotherapy for esophageal cancer. Surgery to repair esophageal defects is necessary to prevent stent graft infection. However, the decision for such surgery should be made on a case-by-case basis, taking into account the patient’s condition and ability to tolerate the procedure.

Treatment Experience Using a Stent Graft for Lumbar Artery Injury that Failed Coil Embolization

Transcatheter embolization currently constitutes the primary treatment for lumbar artery injury due to blunt trauma. We present a case where a stent graft effectively treated a lumbar artery injury after coil embolization failed to achieve hemostasis. Aortic stent graft implantation is a safe procedure that can prevent surgical morbidity and has minimal complications. It may serve as an effective alternative for achieving hemostasis when coil embolization is not feasible or is unsuccessful.

Different endovascular solutions for short, wide and conic shaped neck

Hostile neck anatomy is the most important issue in prediction of outcomes of endovascular procedures. Surgeon modified fenestrated stent graft (SMFSG) may be an effective and available solution in proper patients by changing the proximal sealing of EVAR to the abdominal visceral aorta. Here we present two frail, comorbid, symptomatic infrarenal abdominal aortic aneurysm (iAAA) cases with reverse tapered wide necks treated with different endovascular techniques.

Endovascular treatment of postoperative gastrointestinal bleeding

Objective. To analyze the results of endovascular treatment of postoperative gastrointestinal bleeding. Materials and methods. During the period 2014–2024, 328 endovascular interventions were performed in 297 patients with postoperative gastrointestinal bleeding. The most common was vesicovaginal bleeding after pancreatic surgery. A total of 304 embolizations were performed and 24 stent grafts were installed. Results. In 253 (85.2%) patients, it was possible to diagnose the source of bleeding angiographically, and the bleeding was stopped with the help of embolization devices and stent grafts. In 44 (14.8%) patients, it was not possible to accurately diagnose the source of bleeding, and they underwent prophylactic embolization of the most likely source of bleeding. In 12 patients, embolization was repeated: in 6 patients it was performed twice, in 5 patients – three times, and in 1 patient – four times. In 16 (5.4%) patients, including 15 after prophylactic embolization, endovascular hemostasis was ineffective and they required surgical intervention. Conclusions. Endovascular treatment due to its minimal invasiveness, the possibility of repeated use, and the combination of diagnostic and therapeutic stages is the primary method in the treatment of postoperative gastrointestinal bleeding.

Long Term Outcomes of Endovascular Repair in Blunt Traumatic Aortic Injury: A Twenty Year Multicentre Follow Up Study.

This retrospective, multicentre, observational study analysed patients who underwent endovascular repair for blunt traumatic aortic injury at four tertiary trauma referral centres over twenty years. It aimed to determine early and long term survival, analyse aortic and device related complications, and assess the re-intervention rate after endovascular repair for blunt traumatic aortic injury. All patients treated from 1 January 2001 to 31 October 2021 were identified using local hospital registries and two national registries: the Swedish vascular registry (Swedvasc) and Swedish trauma registry (SweTrau). Patient, treatment, and follow up data were extracted from medical records and radiology data by review of congregated imaging. The report was structured according to the STROBE checklist. Ninety five patients were included: 80 were male (84%), median age was 42 years (IQR 27, 64), and median follow up time was 6.1 years (IQR 0.7, 12.4). Thirty day mortality was 16% (15 of 93), 40% of these were caused by traumatic brain injury and 33% of aortic related causes. Estimated overall survival was 57% (SE 6.6) at fifteen years after index treatment. Aortic re-intervention procedures (re-stenting, coiling, or explantation) were performed in 14 of 86 (16%) patients, six of whom underwent stent graft explantation. Seven of the 14 patients (50%) who underwent aortic re-intervention presented with symptoms and six of 14 had a device related complication. All complications that required aortic re-intervention were diagnosed within 18 months after the index procedure. There was no association between injury grade and aortic re-intervention. Thoracic endovascular aortic repair is an effective treatment for patients with blunt traumatic aortic injury needing intervention. It carries low rates of device related complications and mortality, and the long term outcomes are acceptable. As all aortic complications requiring re-intervention were identified during the first two years after index treatment, with half of the patients reporting symptoms, future follow up protocols should be adjusted accordingly.

Abstract 4138322: Do branched stent grafts for dissecting aortic aneurysms really improve long-term outcomes?

Backgrounds: We have previously used a handmade branched stent graft (SG) to treat thoracic aortic aneurysms. In this study, we examined the long-term results of treatment for dissecting thoracic aortic aneurysms. Methods: Between 2004 and 2014, we treated 28 patients with dissecting thoracic aneurysms using the branched SGs. Results: The mean age was 65 ± 14 years; 17 were over 70, and 22 were male. The mean time from the onset of dissection was 5.7 ± 6.3 years; 6 were operated within one year. The mean aneurysm diameter was 59 ± 8 mm. All dissecting aneurysms were located after zone 3. SG branches were one in 24 cases, two in 2, and three in 2. Twenty-two were treated for entry closure and distal landing in the true lumen. Six with limited dissecting aneurysms were treated for entry closure and distal landing in a non-dissected lumen. The cause of perioperative death was pneumonia in 1. The mean follow-up was 8.3 ± 5.3 years. Entry closure was achieved at 86%, branch patency was 94%, and aneurysm diameter was reduced by an average of 5 ± 14%. There were 6 aneurysm-related deaths. Two were aneurysm ruptures, and each of the 4 was additional operative death, sudden death, SMA occlusion, and type A dissection. The aneurysm-related mortality was 26% at eight years; there was no difference between under 70 and over 70 years old. The cumulative risk of additional procedures was 57% at eight years, and the risk was higher in those over 70 than those under 70 (p<0.05). Thirteen required additional procedures, and 5 required multiple. In detail, re-TEVAR to distal SINE was in 7, re-TEVAR for aneurysm enlargement due to residual false lumen was in 1, re-TEVAR for type 1a endoleak (EL) was in 4, open repair was in 3, stenting for stenosis of true lumen in iliac artery was in 1, stenting for SG branches were in 2, and embolization of the left subclavian artery after re-TEVAR was in 1. Details of open repair were partial arch and thoracic descending replacement for type 1a EL in 1, ascending and partial arch replacement for type 1a EL followed by partial arch and thoracoabdominal replacement in 1, partial arch and thoracoabdominal replacement for distal SINE and aneurysm enlargement in 1. Conclusion: The branched SG for dissecting thoracic aneurysms successfully achieved the initial goal of entry closure, which concept is promising, but requires careful observation for appropriate additional procedures.

Abstract 4145821: Serial Vascular Responses of Balloon-expandable Stent with Biodegradable Film-type Graft in a Rabbit Iliac Artery Dissection Model (BioGard Study)

Introduction and Background: Arterial dissection during endovascular therapy rarely occurs but can be lethal. A significant blood volume extravasation during coronary artery interventions is related to the very high mortality (20-30%). In this hyperacute emergent clinical situation, covered stents have been considered as a primary measure to prevent further serious arterial events. A fabric-based covered graft stents yield poor clinical outcomes. To overcome these challenges, the balloon-expandable stent with biodegradable film-type graft for treating arterial dissection was invented. Research Questions and Objectives: A novel balloon-expandable stent with biodegradable film graft for overcoming these issues would be valid for efficacy and safety in a rabbit iliac artery dissection model. Method and Approach: Eighteen iliac artery dissections were induced by balloon over-inflation on angiography (Ellis type 2 or 3) and treated using the test device (3.0 x 24 mm). Subsequently, twelve animals underwent histologic examinations and micro-computed tomography (CT) at 0, 2, 4, and 8 weeks and 3, 6, 9, and 12 months and angiography at one-year. Results and Data: There were no adverse cardiovascular events during the one-year. Early-stage histologic examination revealed complete sealing of disrupted vessels by the device, exhibiting mural hematoma, peri-stent red thrombi, and dense infiltration of inflammatory cells. Mid- and long-term histologic examination showed patent stents with neointimal hyperplasia over the stents (% area stenosis: 11.8 at 2weeks, 26.1 at 1month, 29.7 at 3months, 49.2 at 9months, and 51.0 at 1year), along with mild peri-strut inflammatory response (Grade: 1-2 at mid-term and 0-1 at long-term). The graft film became scarcely visible after six months. Both CT and angiography revealed no instances of thrombotic occlusion or in-stent restenosis (% diameter stenosis: 5.7 at 2weeks, 12.3 at 1month, 14.2 at 3months, 25.1 at 9months, and 26.6 at 1 year). Conclusion: The novel balloon-expandable stent with a biodegradable film graft demonstrates feasibility in managing severe artery dissection and preventing lethal vascular events in animal model. Future human studies are warranted to validate these findings and elucidate the clinical outcomes of the study.

Management of internal carotid artery pathology with a covered stent: illustrative cases.

Endovascular treatment of internal carotid artery (ICA) pathology includes reconstructive or deconstructive options. One reconstructive option is covered stent placement, although this is limited by a lack of devices designed specifically for neurointervention. The PK Papyrus is a balloon-mounted covered coronary stent that has a lower profile and is more flexible than other stent grafts, which makes it more suitable for treating ICA lesions. The PK Papyrus was used to treat patients with iatrogenic cavernous ICA injury and symptomatic cervical ICA pseudoaneurysms. In both cases, the stent could be easily delivered without the use of an intermediate catheter or stiff microwire. Stent deployment resulted in immediate angiographic resolution of the pathology, and there were no peri- or postoperative complications. The PK Papyrus covered coronary stent is a good option for treating cervical and cavernous carotid pathology. Its single-layer design makes it more flexible and deliverable than other stent grafts, but additional case series are needed. https://thejns.org/doi/10.3171/CASE24517.

In Situ Forming Supramolecular Nanofiber Hydrogel as a Biodegradable Liquid Embolic Agent for Postembolization Tissue Remodeling.

Embolic agents have been widely used to treat blood vessel abnormalities in interventional radiology as a minimally invasive procedure. However, only a few biodegradable liquid embolic agents exhibit high embolization performance, biodegradability, and operability. Herein, the design of in situ-forming supramolecular nanofiber (SNF) hydrogels is reported as biodegradable liquid embolic agents with the assistance of Bayesian optimization through an active learning pipeline. Chemically modified gelatin with hydrogen-bonding moieties produces fibrin-inspired nanofiber-based hydrogels with a high blood coagulation capacity. The low viscosity of the SNF hydrogels makes them injectable using a microcatheter, and the hydrogel shows sufficient tissue adhesion to the blood vessel walls and very weak adhesion to the catheter tubes. Moreover, the SNF hydrogels exhibit high blood compatibility, cytocompatibility, cell-adhesive properties, and biodegradability (in vitro and in vivo). Intravascularly delivered SNF hydrogels induce embolization of rat femoral arteries. This biodegradable liquid embolic agent could be a powerful tool for interventional radiology in the treatment of various diseases, including aortic aneurysm stent grafting, gynecological diseases, and liver cancer.

Utility of balloon-expandable covered stent graft endoprosthesis in congenital heart disease.

Utility of balloon-expandable covered stent graft endoprosthesis in congenital heart disease.

A Revolutionary Device for Endovascular Aortic Repair of Abdominal Aortic Aneurysm: A Pilot Study

Background Endovascular repair for abdominal aortic aneurysms (AAA) has been the gold standard since it was established in 1991. Various graft configurations have been developed to overcome the limitations of endovascular aortic repair (EVAR), including contralateral gate cannulation (CGC). We propose a new device and technique intended to simplify endovascular AAA repair, along with reports of its application in six patients. Intervention The Taofan and Kang (T&K) bidirectional endovascular aortic repair (B-EVAR (B-EVAR) device uses a main-body stent graft, two-limb extensions, and bare metal stent. The procedure involved accessing the right and left femoral arteries, followed by standard aortography evaluation using a pigtail catheter through the contralateral femoral access. The main body stent graft is deployed through ipsilateral femoral access using a balloon catheter, while the contralateral gate is cannulated with a hydrophilic coated wire. Both balloons were inflated simultaneously to ensure that the wires were in different lumens. Contralateral and ipsilateral extensions were deployed using a limb extension stent graft. Standard aortography evaluation was repeated. Result T&K B-EVAR pilot procedures proved successful in various cases, from simple to complex anatomy, and even with varied graft stent deployment strategies. None of the patients had complications or prolonged length of stay (LOS). Follow-up CT did not reveal any high-pressure endoleaks. Conclusion T&K B-EVAR has been proven to simplify endovascular AAA repair in six patients with excellent results. It is also reproducible, potentially universally applicable, and can offer operators ease of use, faster procedure times, reduced fluoroscopy times, and reduced contrast usage.

Primary Aortic Coarctation Repair in Adolescents and Adults

ObjectiveOptimal management of primary aortic coarctation in adolescents and adults remains controversial. We assess early and late mortality of repair, longitudinal anti-hypertensive regimens, and freedom from reintervention for repair-related complications. MethodsFrom 01/01/1999–07/01/2023, 110 adolescents or adults, mean age 39±16 years, underwent primary aortic coarctation repair at Cleveland Clinic. Patients were grouped by repair strategy: stented (60, 55%), grafted (interposition graft or extra-anatomic bypass; 36, 33%), or other (14, 13%). Longitudinal anti-hypertensive regimens were assessed parametrically. Freedom from reintervention and survival were assessed by the Kaplan-Meier method. Median follow-up for survival was 9.2 years. ResultsOne patient (0.91%) died in-hospital. Major morbidity included stroke (2/107, 1.9%), tracheostomy (2/107, 1.9%), acute renal failure requiring dialysis (1/108, 0.93%), iatrogenic aortic dissection (1/107, 0.93%) and vascular access complication (1/56, 1.8%). Prevalence of patients requiring zero anti-hypertensive medications postoperatively peaked within two years. Twelve-year freedom from reintervention was 69% in the stented group and 97% in the grafted group (P log-rank = .003). Most reinterventions were for in-stent restenosis of bare metal stents. Overall freedom from reintervention at one, five, and 12 years was 91%, 80%, and 76%. Overall survival was 98%, 95%, and 80% at five, 10, and 14 years. ConclusionsA tailored approach to coarctation repair in adolescents and adults utilizing stented repair when anatomically feasible yields excellent short-term outcomes, but patients require persistent hypertension monitoring and have lower than expected long-term survival. Covered stents or stent grafts are preferred to bare metal stents which are subject to in-stent restenosis.

Creation of 6-10mm Diameter Transjugular Intrahepatic Portosystemic Shunts Using a Novel TIPS Stent Graft in a Swine Model

PurposeTo assess the delivery, function, and patency of a new expanded polytetrafluoroethylene encapsulated TIPS stent- graft ("Liverty") in an animal model. Materials and MethodsTIPS were created in 2 successive groups: 14 single & 10 overlapping devices, in swine weighing 52-64kg. Explants occurred at 30 (n=10) and 60 (n=14) days. These were evaluated by histomorphometry and histopathologic evaluations, and electron microscopy. ResultsSeven 6mm, five 7mm, and twelve 10mm diameter TIPS were created using varied human TIPS access sets without complications; both sheathed and unsheathed advancement and deployment of the devices within liver tracts. One animal was sacrificed at 35d due to encephalopathy; remainder survived to endpoints. 22/24 TIPS were patent at 30 and 60-day endpoints; Mean stenosis at 30 days was 13.3% +/- 10.1%, and for 60 days was 18.44% ± 5.04%. Two shunts were occluded by tissue overgrowth at unstented native hepatic vein end and downgrowth into TIPS. Histology and electron microscopy showed well-apposed, incorporated devices lined with smooth, uniform neointimal tissue averaging 0.48mm (single devices) and 0.74mm thick (overlapped devices) with minimal adventitial inflammation. ConclusionThe new Liverty TIPS stent graft was straightforward to deploy for TIPS creation and resulted in patent 6,7, and 10mm diameter shunts in both single and overlapping configurations. One- and 2-month histology showed desired tissue healing without in-stent stenosis.

PROGNOSTIC IMPACT OF JUXTA-RENAL INNER VESSEL DIAMETER AND VERTICAL DISTANCE IN RENAL ARTERY OUTCOMES AFTER FENESTRATED ENDOVASCULAR REPAIR

The aim of this retrospective multicenter study is to evaluate the impact of juxta-renal inner vessel diameter (JR-IVD) and vertical distance between renal arteries (RA-VerDi) on renal artery instability (RAI) and associated complications in patients undergoing fenestrated endovascular aortic repair (FEVAR) for complex aortic pathology. Patients undergoing FEVAR with custom-made stent grafts at six referral hospitals between 2017 and 2023 were included. Data on patient demographics, anatomical characteristics, stent configurations, and outcomes were collected. Patients were divided into tertiles and categorized into three groups: JR-IVD <20mm, JR-IVD 20-24mm, and JR-IVD >24mm. RA-VerDi was determined by measuring the distance between the center of the lowest renal artery and the highest renal artery, based on the planning specifications for each custom-made graft. The primary outcome was freedom from RAI, with secondary outcomes including renal artery stenosis/occlusion, endoleak, and reintervention. Statistical analyses were performed using MedCalc software, with logistic regression and Kaplan-Meier survival curves employed to assess outcomes. In total, 520 RAs among 260 patients were analyzed. The technical success rate was 98.7%, with a 30-day mortality rate of 2.3%. After a mean follow-up of 26.9 months (±28.1, range 1-154), RAI was observed in 5.6% of cases, including stenosis/occlusion (3.2%) and endoleak (2.2%). Freedom from RAI at 12, 24, and 48 months was 95.8% (SE 0.01), 93.5% (SE 0.01), and 90.7% (SE 0.01), respectively. JR-IVD <20 mm was identified as a significant risk factor for renal artery stenosis/occlusion (p=0.01), though it did not increase the risk of RAI or reintervention compared to larger JR-IVDs. A correlation was found between RA-VerDi and RAI, with smaller vertical distances associated with higher RAI risk (OR: 0.89, 95% CI: 0.82-0.99, p=0.05), but no significant cutoff was determined. Severe renal artery stenosis was an independent predictor of RAI (OR: 13.28, 95% CI: 3.1-55.86, p=0.004). The use of fenestrated custom-made grafts in patients with JR-IVD <20 mm may increase the risk of renal artery complications, particularly stenosis/occlusion. Although a correlation between RA-VerDi and RAI was observed, a definitive predictive cutoff could not be established. Attention should be given to patients with severe renal artery stenosis, as this condition seems to be an independent predictor of RAI.

Novel Modified Iliac Artery Stent Graft with Side Branch Extension Facilitating Kidney Transplant in Severe Aortoiliac Occlusive Disease

Novel Modified Iliac Artery Stent Graft with Side Branch Extension Facilitating Kidney Transplant in Severe Aortoiliac Occlusive Disease

Intraoperative Position System guided with Augmented Reality Improves the Learning Curve of Endovascular Navigation in Endovascular Naïve Operators

ObjectiveThis study aimed to compare the completion of gate cannulation task performed by participants of varying experience using fluoroscopy, the Intra-Operative Positioning System (IOPS) – an FDA-cleared endovascular navigation system that has been developed to reduce dependence on fluoroscopy – or an investigational augmented reality electromagnetic navigation technology based on IOPS. MethodsThe task consisted in the cannulation of the gate of a GORE Excluder AAA endoprosthesis bifurcated aortic stent graft (W.L. GORE & Associates, Flagstaff, AZ USA) deployed into a 3D printed abdominal aortic aneurysm (AAA) model connected to a 7000 MDX flow pump (Sarns Inc/3M, Ann Arbor, MI USA) reproducing physiological conditions. The procedure was performed in a hybrid operating room (GE Allia IGS 7). Each participant performed the cannulation task with fluoroscopy, standard IOPS guidance with flat screen display (IOPS-FS), and the investigational IOPS with augmented reality headset (IOPS-AR), in a randomly assigned order. All participants used the same sensorized guidewire and steerable 6Fr catheter during their three cannulation tasks. A total of 26 participants were classified in three groups of experience: Group 1 (endovascular naïve; n = 13), Group 2 (surgeon in training; n = 12) and Group 3 (one expert surgeon). Primary endpoints included cannulation time and technical success, which was defined as the advancement of the catheter over the guidewire within the main body of the aortic stent graft within a maximum 15 minutes cutoff time for each trial. ResultsIn group 1, the mean cannulation time was shorter using IOPS-AR versus fluoroscopy (4.3 ±4.4 min vs 7.1±4.9 min; P=.04), but not statistically different when comparing IOPS-FS and fluoroscopy (6.3±4.5 min vs 7.1±4.9 min; P=.63). In group 1, technical success was 77% with fluoroscopy and 92% with both IOPS-FS and IOPS-AR (P=.59). In group 2, although there was no significant difference between cannulation time amongst the three different endovascular approaches, there was a trend towards shorter cannulation times with IOPS-FS or IOPS-AR as compared to fluoroscopy (mean time of 2.5±0.9, 4.4±4.0 and 5.2±4.5 min, respectively). In group 2, technical success was 92% with fluoroscopy and 100% with both IOPS-FS and IOPS-AR (P>.99). The expert vascular surgeon repeated the cannulation task four times for each endovascular approach, with 100% technical success and no difference in mean cannulation time between the imaging modalities (P=.89). ConclusionsAugmented reality allows for reducing the gate cannulation time as compared to fluoroscopy in participants with no previous exposure to any endovascular procedure. This suggests that augmented reality can be beneficial for individuals early in their career and can mitigate the learning curve. As individuals become experts, their ability to adapt to different endovascular modalities increases, eliminating the learning curve altogether.

Characterization of cerebrospinal fluid markers as indicators of spinal cord ischemia following an endovascular aortic aneurysm repair procedure.

Spinal cord ischemia (SCI) remains one of the most devastating complications in both open and endovascular stent graft repair of thoracoabdominal aortic aneurysms. The endovascular aortic aneurysm repair (EVAR) can be either thoracic (TEVAR) when it targets the thoracic aortic aneurysm or fenestrated branched when repair involves the visceral and/or renal arteries. Even though EVAR interventions are less invasive than open repair, they are still associated with a significant risk of SCI. The current primary strategy to prevent SCI after TEVAR is to increase and/or maintain spinal cord perfusion pressure (blood flow) by increasing the mean arterial pressure while simultaneously draining CSF. Although the benefit of CSF drainage in EVAR procedures remains uncertain, it provides an opportunity to study the changes in cytokine and oxidative stress markers that may signal the pathophysiology of SCI following EVAR. The aim of this study was to evaluate the temporal relationship between stent deployment and CSF cytokine and oxidative stress marker levels as predictors of delayed SCI in patients undergoing an EVAR procedure. There were 16 EVAR cases across 15 patients enrolled in this study, with 1 patient undergoing the procedure twice 1 year apart. The levels of oxidative stress (8-hydroxy-2'-deoxyguanosine [8-OHdG], glial fibrillary acidic [GFAP], and lactic acid) and proinflammatory (tumor necrosis factor-alpha [TNF-α], interleukin (IL)-6, and IL-1β) and antiinflammatory (IL-4) markers were quantified at different time points between 0 and 48 hours after EVAR by enzyme-linked immunosorbent assay. The changes in protein levels of both oxidative stress and inflammatory markers were expressed as fold change from the time of the lumbar drain insertion prior to surgery. Following the EVAR procedure, 8-OHdG resulted in the highest upregulation at later time points postoperatively (48 hours) and this increase was positively correlated with TNF-α level. The data also revealed that IL-6 peaked during the stent deployment intervention and this pattern of expression was positively correlated with the expression of lactic acid. No significant changes were noted in the expression levels of GFAP, lactic acid, and IL-1β. There appears to be a temporal relationship between lumbar CSF drainage and CSF cytokines and oxidative stress markers that may help 1) identify patients at risk for developing delayed SCI and 2) modify patient management to prevent the damage from delayed SCI.

The Frozen Elephant Trunk Procedure-8 Years of Experience from Poland.

Background: The frozen elephant trunk method combines the implantation of a Dacron prosthesis with a self-expanding stent graft, which allows for complex repairs of the aortic arch and thoracic aorta in one procedure. Despite the advantages of hybrid treatment for aortic arch aneurysms, in Poland, only a few such surgeries are performed annually compared to in Western countries. The aim of this study was to demonstrate the 8-year outcomes of treatment at the center where the Aortic Team operates, which is one of the centers in Poland with the most extensive experience in hybrid FET treatment. Methods: Patients who underwent frozen elephant trunk surgery for chronic and acute pathologies of the aortic arch and thoracic aorta between March 2016 and March 2024 were comprehensively analyzed retrospectively. Frozen elephant trunk procedures were performed under three consecutive clinical conditions: acute aortic dissection, chronic aortic dissection and redo surgery. Results: A total of 40 patients (median age: 60 years (53-66), 67.5% male) were admitted to our hospital and underwent an FET procedure. The median Euroscore II was 25.9% and the 30-day mortality was 7.5%. The 1-year and 5-year mortalities were the same, equal to 15%, with mortality cases observed only in the first and second groups of consecutive patients during the first two months of follow-up. Spinal cord injury was observed in 2.5% of patients. Conclusions: The FET technique can be successfully used to treat aortic aneurysms with optimal results and low complication rates. The surgery length, including the cardiopulmonary bypass and aortic cross-clamp times, decreased significantly with increasing experience.

Aortic Stent Graft Treatment in a Medium-Size Aortic Center Performed by a Cardiac Surgeon Only-The 9 Years Experience in Poland.

Background: The incidence of thoracic aortic aneurysms is estimated at 3.0-8.3/100,000 persons per year. There is a lack of reports in the literature on the outcomes of small- and medium-sized thoracic endovascular aortic repairs. The aim of this study is to present the results of thoracic endovascular aortic repairs at a single medium-sized center performed exclusively by a cardiac surgeon. Methods: Ninety patients who had undergone aortic stent graft implantations for the treatment of thoracic aortic anomalies were comprehensively, retrospectively evaluated. The detailed preoperative, surgical, and postoperative parameters of the patients, including the survival rate up to five years, were recorded and further analyzed. Results: The patients' Euroscores were four (2.1-9). The 30-day mortality rate was 8.9%, the 1-year mortality rate was 15.6%, and the 5-year mortality rate was 38.9% for all causes. Postoperative complications were observed in 10% of the patients. Statistically significant differences were observed between the urgency of surgery at 30 days and survival at one year, but not at five years. The most common complications were related to respiratory (4.4%), renal (3.3%), and neurological (3.3%) dysfunction. Conclusions: Thoracic endovascular aortic repair can be safely performed in small- and medium-sized centers with optimal long-term results.

Stent Graft Restenosis: Insights From Optical Coherence Tomography Imaging and Treatment Considerations

Stent Graft Restenosis: Insights From Optical Coherence Tomography Imaging and Treatment Considerations