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  • 1
    Keywords: AGE, aneurysm, ANEURYSMS, Aorta, ARCH, ARTERY, COMPLEX, COMPLICATIONS, DESCENDING THORACIC AORTA, DI
    Abstract: Objective: We report our 6-year experience with the visceral hybrid procedure for high-risk patients with thoracoabdominal aortic aneurysms (TAAA) and chronic expanding aortic dissections (CEAD). Methods. Hybrid procedure includes debranching of the visceral and renal arteries followed by endovascular exclusion of the aneurysm. A series of 28 patients (20 male, mean age 66 years) were treated between January 2001 and July 2007. Sixteen patients had TAAAs type I-III, one type IV, four thoracoabdominal placque ruptures, and seven patients CEAD. Patients were treated for asymptomatic, symptomatic, and ruptured aortic pathologies in 20, and 4 patients, respectively. Two patients had Marfan's syndrome; 61% had previous infrarenal aortic surgery. The infrarenal aorta was the distal landing zone in 70%. In elective cases, simultaneous approach (n = 9, group I) and staged approach (n = 11, group 11) were performed. Mean follow-up is 22 months (range 0.1-78). Results: Primary technical success was achieved in 89%. All stent grafts were implanted in the entire thoracoabdominal aorta. Additionally, three patients had previous complete arch vessel revascularization. Left subclavian artery was intentionally covered in three patients (11%). Thirty-day mortality rate was 14.3% (4/28). One patient had a rupture before the staged endovascular procedure and died. Overall survival rate at 3 years was 70%, in group 180%, and in group II 60% (P =.234). Type I endoleak rate was 8%. Permanent paraplegia rate was 11%. Three patients required long-term dialysis (11%). Peripheral graft occlusion rate was 11% at 30 days. Gut infarction with consecutive bowel resection occurred in two patients. There was no significant difference between group I and II regarding paraplegia and complications. Conclusions. Early results of visceral hybrid repair for high-risk patients with complex and extended TAAAs and CEADs are encouraging in a selected group of high risk patients in whom open repair is hazardous and branched endografts are not yet optional
    Type of Publication: Journal article published
    PubMed ID: 18381133
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  • 2
    Abstract: We report a case with spinal cord ischemia and consecutive paraplegia following spontaneous isolated abdominal aortic dissection (IAAD). A 63-year-old female was admitted to the surgical emergency room with severe lumbar back pain and accompanying paresthesia of both legs. Contrast enhanced computed tomograpy (CT) of the abdomen showed an infrarenal IAAD in a normal size aorta with patent lumbar arteries. It was assumed that a surgical or interventional approach would not be helpful to improve spinal cord perfusion. Therefore, non operative therapy consisted of lowering blood pressure to prevent further dissection. The patient developed an anterior spinal artery syndrome with permanent paraplegia. Thus, blood pressure was raised for optimal spinal cord perfusion. To lower the spinal pressure, cerebrospinal fluid drainage was attempted. A three month follow-up CT scan showed spontaneous remodelling of the aorta. The neurological deficit persisted. IAAD is a rare differential diagnosis of lumbar back pain and can be associated with paraplegia as the leading symptom. Individualized treatment is indicated. Surgical treatment options concerning paraplegia are limited
    Type of Publication: Journal article published
    PubMed ID: 19736638
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  • 3
    Keywords: AGE ; ANGIOPLASTY ; aneurysm ; Aorta ; ANEURYSMS ; aortic dissection ; Aortic pathologies ; thoracic
    Abstract: Since its introduction by Dake et al., more than 20 years ago, thoracic endovascular aortic repair (TEVAR) has been used with increasing frequency for a variety of different pathologies of the thoracic aorta. Although long-term data are still missing, TEVAR is well-established and has meanwhile replaced conventional open repair (OR) as the first treatment option in many vascular centers. This evolution is based on a minimal invasive approach associated with a potentially lower morbidity and mortality rate. Nevertheless, TEVAR bares several procedure specific complications (e.g. endoleak, stent-graft migration, material fatigue) and technical pitfalls which must be kept in mind while dealing with this treatment option. The aim of this paper was, therefore, to present the lessons learned in I I years with thoracic endografting for different thoracic aortic pathologies focusing on applicability, results and device related problems. Over a period between January 1997 and September 2008 a total of 355 thoracic aortic stent-grafts were implanted in 221 patients (159 males, mean age 62 years), 59% under emergency conditions. Indications included patients with atherosclerotic and post-traumatic aneurysms, aortic dissections, aortobronchial fistulas, and traumatic ruptures. Besides the morphological classification of thoracic aortic lesions, preoperative modern 3-D imaging for adequate procedure planning, current devices and their specific aspects during placement will be discussed. Furthermore, our own experience and results in selected indications will be presented. Thoracic endovascular reconstruction appears to be a safe and effective alternative to OR for many patients with thoracic aortic diseases, especially in emergencies. Prospective trials for individual diseases will be necessary to define its ultimate role
    Type of Publication: Journal article published
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  • 4
    Abstract: BACKGROUND: To analyze the sequelae of the intentional left subclavian artery (LSA) coverage during thoracic endovascular aortic repair (TEVAR). METHODS: Retrospective analysis of prospectively collected data in a single center. Between March 1997 and October 2008, 88 of 220 patients (40%) had thoracic aortic lesions that required LSA coverage during TEVAR. Thirty-four of our patients (39%) were treated under urgent or emergent conditions for acute pathologies. The proximal landing zone was zone 0 in 10 patients (11%), zone 1 in 24 patients (27%), and zone 2 in 54 patients (61%). Debranching procedures of the supra-aortic vessels were performed in patients who were to undergo zone 0 or zone 1 deployment. Primary LSA revascularization was performed in 22 of the 88 patients (25%) at a median of 6 days before TEVAR. Median follow-up was 26.4 months (1-98 months). RESULTS: Technical success was achieved in 97%. Five primary (9%) and two secondary (4%) type Ia endoleaks in patients who underwent zone 2 deployment were observed and required further interventions. Fourteen (16%) primary type II endoleaks were observed; 10 of them fed by the LSA. Paraplegia rate was lower in patients with LSA coverage without revascularization than in other patients (1.5% vs 1.9%; odds ratio [OR], 0.774; 95% confidence interval [CI], 0.038-6.173; P = 1.000). Prior or concomitant infrarenal aortic replacement (P = .0019), renal insufficiency (glomerular filtration rate 〈 90 mL/min/1.73 m(2)) (P = .0024) and long segment aortic coverage (〉200 mm) (P = .0157) were associated with significant higher risk of postoperative paraplegia. Stroke rate was lower in patients with LSA coverage without revascularization than in other patients (3% vs 3.9%; OR, 0.570; 95% CI, 0.118-2.761; P = .7269). Two patients (3%) developed left upper extremity symptoms and another two patients (3%) subclavian steal syndrome and required secondary LSA revascularization. The technical success rate for LSA revascularization was 94%. CONCLUSION: By using a selective approach to the LSA revascularization, coverage of the LSA can be used to extend the proximal seal zone for TEVAR without increasing the risk of spinal cord ischemia or stroke. Indications for revascularization include long segment aortic coverage, prior or concomitant infrarenal aortic replacement, and renal insufficiency. In addition, a hypoplastic right vertebral artery, a patent left internal mammary artery graft, and a functioning dialysis fistula in the left arm would also be indications to perform revascularization
    Type of Publication: Journal article published
    PubMed ID: 19837529
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