Endovascular Repair of Ascending Aortic Disease in High-Risk Patients Yields Favorable Outcome (Commentary)
Publication date: Available online 28 September 2019Source: The Annals of Thoracic SurgeryAuthor(s): Justin M. Schaffer, William T. Brinkman
This study investigates primarily the influence of different acquisition systems (Allura ClarityIQ vs. Allura Xper, Philips Healthcare, Best, the Netherlands) on radiation dose. Secondly, radiation exposure was analysed for operator positions as well as for procedure and patient specific parameters.
This study aimed to clarify the impact of endovascular aneurysm repair (EVAR) on clinical outcomes in Japanese patients of advanced age with ruptured abdominal aortic aneurysm (rAAA).
The objective of this study was to review complications associated with lumbar drain (LD) placement perioperatively for endovascular aneurysm repair (EVAR).
In the accompanying meta-analysis, the authors provide us with a methodical review of the literature describing the treatment of type II endoleaks after endovascular aneurysm repair (EVAR) and conclude that a translumbar approach may be preferred to the transarterial route.1 On reading this paper, I am struck by how little progress we have made in our understanding of the pathophysiologic mechanism, significance, and treatment of type II endoleaks. In fact, this analysis comes to similar conclusions as reviews published as long as 6 years ago,2 highlighting the static nature of our understanding.
Endovascular aneurysm repair (EVAR) is a minimally invasive approach to repair of thoracoabdominal aneurysms (TAA) in patients who are poor surgical candidates. Aneurysms that involve the origin of the visceral branches of the abdominal aorta can be challenging to manage due to the inability of conventional stents to manage blood flow to vital organs when using fenestration and snorkeling approaches. Here, we review the efficacy and potential adverse effects of a novel modified octopus technique using an iliac branch device (IBD) in the management of these patients.
CT angiography offers excellent anatomic detail necessary for vascular procedural planning including endovascular aneurysm repair (EVAR). However, patients with renal insufficiency are at risk for acute renal failure due to iodinated contrast administration. Catheter-directed CT angiography is a technique in which dilute iodinated contrast is injected into an intra-aortic pigtail catheter during the CT scan. The purpose of this study was to evaluate the safety and efficacy of this technique.
ConclusionsWhole-aorta tMIP-CTA on time-resolved imaging is useful for maintaining contrast enhancement and image quality for EVAR planning, and can substantially reduce the amount of CM.
We describe three patients with acute type B aortic dissection complicated by retrograde arch extension and visceral malperfusion who were successfully treated with a total arch replacement and frozen elephant trunk.In patients with acute complicated type B aortic dissection without adequate proximal landing zone, thoracic endovascular aortic repair (TEVAR) is not feasible. While some uncomplicated patients with retrograde aortic arch extension can be managed non-operatively, patients with distal malperfusion present a challenge. We describe three patients who presented with an acute type B aortic dissection with associate...
Several observational analyses (including from within the IMPROVE trial, the UK's National Vascular Registry, and the US Vascular Quality Initiative) have suggested significant reductions in mortality associated with the use of local anaesthesia for ruptured aneurysm repair.1,2 There are no randomised studies of anaesthetic techniques for elective standard endovascular aneurysm repair, and in this context Dovell et al.3 have performed a detailed analysis using data from the UK's National Vascular Registry.
ConclusionsTEVAR is an effective treatment for chronic type B dissection, with acceptable mid-term results. The preoperative distal aortic diameter is a significant risk factor for late aorta-related events. When the maximum distal aortic diameter is ≥ 40 mm, a therapeutic strategy should be developed taking into consideration the possible need for aortic re-intervention.