Custom Made Fenestrated Stent Graft Collapse after Thoracic Endovascular Aortic Repair: A Case Report

We present a case of stent graft collapse after performing thoracic endovascular aortic repair with a custom-made fenestrated stent graft. The patient was a 70-year-old woman with an asymptomatic aneurysm of the distal aortic arch, and thoracic endovascular aortic repair was performed. The patient showed a blood pressure difference between the left arm and the right arm on postoperative day (POD) 17 prompting the performance of a chest computed tomography scan which revealed stent graft collapse. She then underwent staged debranching of thoracic endovascular aortic repair. Stent graft collapse is a rare but well-described complication of thoracic endovascular repair. Therefore, patients who undergo such a procedure should be carefully monitored for signs and symptoms, which suggest the possibility of stent collapse.

Thoracic Endovascular Aortic Repair for Cardiopulmonary Arrest Due to Aortic Dissection

Background and Aim: Reports on recovery from Stanford type A aortic dissection (TAAD) leading to cardiopulmonary arrest (CPA) are few. In retrograde TAAD (r-TAAD) cases, some authors reported the efficacy of thoracic endovascular aortic repair (TEVAR). However, only a few reports chose TEVAR for the treatment of r-TAAD resulting in cardiac arrest before hospital arrival. We report a case of r-TAAD presenting with cardiac arrest before hospital arrival not indicated for surgery but TEVAR as treatment. Case: A 65-year-old woman with a history of Marfan syndrome presented to the emergency department after a CPA. Sequential return of spontaneous circulation was achieved 27 min after CPA. Contrast-enhanced computed tomography showed retrograde r-TAAD with an entry tear to the false lumen in the thoracic descending aorta. Therefore, thoracic endovascular aortic repair (TEVAR) was performed with r-TAAD. Afterward, the clinical course was stabilized. This patient suggests that TEVAR is an effective option for the treatment of patients with hemodynamically unstable r-TAAD, even after CPA. Conclusion: TEVAR can lead to a successful recovery from cardiac arrest due to r-TAAD.

Thoracic endovascular aortic repair of chronic type B aortic dissection in 84 patients

Objective The optimal treatment for chronic type B dissection remains controversial. The purpose of this study was to report early and mid-term results of thoracic endovascular aortic repair (TEVAR) of chronic type B aortic dissection. Methods From June 2001 to September 2007, 84 patients with chronic type B aortic

Endovascular repair of thoracic aortic dissection associated with right-sided aortic arch：report of four cases

Aortic dissection involving a right-sided aortic arch（RAA）is extremely rare with an incidence in adults of 0.04%to 0.1%^（[1]）.Thoracic aortic dissection associated with RAA is even a more uncommon and life-threatening condition.For complicated aortic dissection,conventional open surgical repair is considered a standard therapy^（[2]）.However,

Antegrade in situ laser fenestration of aortic stent graft during endovascular aortic repair:A case report

BACKGROUND The endovascular repair of juxtarenal abdominal aortic aneurysms(JAAA)usually requires combination treatment with various stent graft modifications to preserve side branch patency.As a feasible technique,according to the situation,antegrade in situ laser fenestration still needs to be improved.CASE SUMMARY This report describes a case that was successfully treated with endovascular repair facilitated by antegrade in situ laser fenestration while maintaining renal arterial flow.Laser fenestration was performed using a steerable sheath positioned in the stent graft lumen in front of the renal artery ostium.With the bare stent region unreleased,renal artery perfusion could be maintained and accurate positioning could be achieved by angiography in real time.CONCLUSION This study suggests the feasibility and short-term safety of this novel antegrade in situ laser fenestration technique for select JAAA patients.

A pilot study of aortic hemodynamics before and after thoracic endovascular repair with a double-branched endograft

Branched endografts have been developed to treat complex pathology in the aortic arch and ascending aorta.This study aims to evaluate the haemodynamic performance of a double-branched thoracic endograft by detailed comparison of flow patterns and wall shear stress in the aorta and supra-aortic branches before and after stentgraft implantation.Pre-and post-intervention CT images were acquired from two patients who underwent thoracic endovascular aortic repair(TEVAR)with a double-branched endograft for thoracic aortic aneurysms.These images were used to reconstruct patient-specific models,which were analysed using computational fluid dynamics employing physiologically realistic boundary conditions.Our results showed that there was sufficient blood perfusion through the arch branches.The presence of inner tunnels caused flow derangement and asymmetric wall shear stress in the ascending aorta,where shear range index was up to 6 times higher than in the preintervention model.Wall shear stress in the aortic arch increased considerably after intervention as a result of accelerated flow.The maximum flow-induced displacement forces on the branched endografts were around 22 N for both patients,which was below the threshold for device migration.Results from this pilot study demonstrated that aortic flow patterns were significantly altered by the branched endograft which caused increased spatial variation of wall shear stress in the ascending aorta and the arch.Although no obvious adverse hemodynamic features were found immediately after intervention for the cases we analysed,follow-up studies will be needed to assess durability of the device.

Analysis of imaging characteristics of blunt traumatic aortic dissection: an 8-year experience

BACKGROUND:Traumatic aortic dissection(TAD)has a low incidence but extremely high mortality.It always presents atypical clinical manifestations that are easily missed or misdiagnosed.This study mainly aims to describe the imaging characteristics and management of TAD patients.METHODS:A retrospective analysis of 27 blunt TAD patients was performed between 2013 and 2020.Demographic features,imaging characteristics,and management were analyzed.RESULTS:Twenty-seven patients with type B aortic dissection(age 56.04±16.07 years,20 men)were included.Aortic intimal tears were mostly initiated from the aortic isthmus.The sizes of the proximal intimal tears in the greater curvature were larger than those in the lesser curvature(1.78±0.56 cm vs.1.24±0.52 cm,P=0.031).Compared with those in the control group,the maximum diameters of the aortic arch,thoracic aorta,and abdominal aorta in the TAD patients were all significantly widened(all P<0.050).Multivariate logistic regression analysis showed that the maximum diameter of the thoracic aorta was an independent risk factor for TAD,with a predictive value with an area under the receiver operating characteristic curve(AUC)of 0.673.Finally,26 patients successfully underwent delayed thoracic endovascular aortic repair(TEVAR),and the remaining one patient was treated conservatively.No progression of aortic dissection or death occurred during the six-month follow-up period.CONCLUSIONS:In blunt trauma,the aortic isthmus is the most common site of proximal intimal tears.An accurate diagnosis of TAD requires an overall consideration of medical history and imaging characteristics.Delayed TEVAR might be an eff ective therapeutic option for TAD.

Short-term results in canines of novel stent-graft design for chimney technique in TEVAR

Introduction:Parallel stent-stent grafting is a major endovascular technique used to preserve the supra-aortic branches during thoracic endovascular aortic repair(TEVAR)of aortic pathologies involving the aortic arch.The short-and mid-term results of this technique are satisfactory;however,endoleak remains a major concern.Thus,here we designed a new chimney stent-graft to decrease the endoleak rate.Aim:To testify the feasibility and safety of the new chimney stent-graft system in a canine model.Material and methods:Six Labrador retrievers were used.Pre-operative data were collected and all operations were performed under general anesthesia.The main and chimney stent-grafts were implanted through the abdominal aorta and left subclavian artery approaches,respectively.Completion digital subtraction angiography(DSA)was performed to confirm the immediate outcomes.All dogs were fed separately for 6 months and sacrificed after aortic angiography.The thoracic aorta and the main and chimney stent-grafts were harvested for histopathologic examination.Results:No complications were found in follow-up DSA.All branch arteries were patent.In?ammatory responses were observed around the stent-grafts in 3 experimental animals,and slight hyperplasia was observed in the surrounding tissues compared with the normal vessels.There was no mural thrombus in the stent,endothelial cells were noted on the inner surface of the stent,and thrombus was formed in the outer skirt and gutter area.The histopathologic examinations revealed similar results to those of gross necropsy observations.Conclusions:This study demonstrated the feasibility and safety of the Longuette stent-graft and the first to report a revised stent-graft specific for chimney technique.

Short-term efficacy of unibody single-branched stent in the treatment of lesions involving the left subclavian artery:two-year follow-up outcomes

The development of thoracic endovascular aortic repair(TEVAR)technology avoids the risk of patients opening the chest and is widely used in Stanford B-type dissection.[1–3]However,because TEVAR technology has clear requirements for vascular anatomy of the lesion,it limits its application to some patients.In the shortcomings of the proximal anchor zone,coverage of the left subclavian artery(LSA)origin without revascularization during TEVAR appears to have increased risk of stroke,upper extremity ischemia and paraplegia.[4]

Application of the multi-planar reconstruction in endovascular treatment of type B aortic dissection

Background Although Multi-planar reconstruction （MPR） has been considered a diagnostic imaging technique that observes more perspectives for diseases,few people have applied it surgically.In fact,MPR is also very useful to clinical operation,especially for patients with type B aortic dissection.It helps the surgeon to locate accurately with more information about aortic dissection,so that the safety and effectiveness of operation can be improved.This study examined the application of the MPR in intraoperative DSA imaging for precise positioning by accurately obtaining a crosssection,a spin angle of the coronal plane,and a tilt angle of the sagittal plane in treatment of type B aortic dissection.Methods The conventional and the MPR approaches were compared on positioning the aortic arch for surgery.A group of 40 patients （group A） and another group of 42 patients （group B） was sampled.About the comparison of baseline characteristics,a fourfold table X2 test was conducted on gender,and two independent samples t-test was applied to age between group A and group B.Spin as well as tilt angles for group A were obtained from the patients using both approaches,and their effectiveness was compared with pair t-tests; The MPR data guided stent-grafting in this group.Stent graft placement of group B was based on the conventional approach.Percentages of proximal distributed markers as well as incidences of complications were collected from both groups after stent graft placement.They were also compared with a fourfold table X2 test.Results Gender difference was not found between group A and group B （X2=0.80,P ＞0.05）,and age difference was not statistically significant （F=2.55,homogeneity of variance,t=-1.46,P ＞0.05）.A significant difference was found between the conventional and the MPR approaches for spin angle （t=9.17） as well as tilt angle （t=-2.07）,P ＜0.05.Percentage of proximal distributed markers （5.0％） of group A was significantly lower than that of group B （42.9％）,X2=15.92,P ＜0.05;and incidence of complications （5.0％） of group A was also significant lower than that of group B （21.4％）,X2=4.76,P ＜0.05.Conclusions Application of the MPR facilitated intraoperative angle adaption and led to satisfactory DSA.It is feasible in endovascular treatment of type B aortic dissection,and can effectively and safely guide surgical operations.

Successful management of life-threatening aortoesophageal fistula: A case report and review of the literature

BACKGROUND Aortoesophageal fistula(AEF)is a rare but life-threatening cause of upper gastrointestinal bleeding.Only a handful of cases of successful management of AEF caused by esophageal cancer have been reported.The purpose of this study is to report a case of AEF managed by endovascular aortic repair and review the relevant literature.CASE SUMMARY A 66-year-old man with upper gastroenterology bleeding presented at the Emergency Department of our hospital complaining of chest pain,fever and hematemesis for 6 h.He had vomited 400 mL of bright-red blood and experienced severe chest pain 6 h prior.He had a past medical history of advanced esophageal cancer.He received chemoradiotherapy but stopped 8 mo prior because of intolerance.A chest contrast computed tomographic scan revealed communication between the esophagus and the descending aorta as well as a descending aortic pseudoaneurysm.According to the symptoms and imaging findings,AEF was our primary consideration.The patient underwent aortic angiography,which indicated AEF and descending aortic pseudoaneurysm.Emergency percutaneous thoracic endovascular aortic repair(TEVAR)of the descending aorta was performed,and bleeding was controlled after TEVAR.He received antibiotics and was discharged after treatment.However,he died 2 mo after the TEVAR due to cancer progression.CONCLUSION Although AEF is a lethal condition,timely diagnosis and TEVAR may successfully control bleeding.

Hemodynamic evaluation of different stent graft schemes in aortic arch covered stent implantation

Implantation of the left subclavian artery(LSA)stent graft used in fenestration technique of the thoracic endovascular aortic repair(TEVAR)may interfere with the aortic helical blood flow that is believed to have important protective functions against atherogenesis.The present study investigated four different LSA stent graft implantation schemes for their resulted blood flow patterns in the thoracic aortic with hemodynamic computational simulation methods:the flush branch(FB),the protruding branch(PB),the straight cuff branch(SCB)and the cured cuff branch(CCB).The results showed that the PB scheme could slightly enhance helicity of the swirling flow in the aorta,but the other three schemes had less effect on blood flow helicity.The PB scheme produced lowTAWSS,high-OSI and high-RRT around the LSA root,and the FB scheme had similar TAWSS,OSI and RRT in both value and distribution to those in the aorta without LSA stent graft implantation.The SCB and CCB schemes led to less area of high-OSI and high-RRT values along the walls of the LSA branch arteries.The results also showed that the PB scheme would significantly reduce blood supply to the LSA,on the contrary,the CCB scheme enhanced LSA blood supply and less effect on the total blood supply to the three branches of the thoracic aorta.In summary,all of the four schemes have no significant effect on the aortic swirling flow,however,in the terms of TAWSS,OSI,RRT and blood supply to the LSA,the CCB model might be the best option with less area of low-WSS,high-OSI,high-RRT and well blood supply in the LSA.