Total endovascular repair of the aortic arch: initial experience in the Netherlands
ConclusionsTotal endovascular aortic arch repair using the Relay Branch device is technically feasible and effective in excluding aortic arch pathology. The observed stroke rate in the initial experience, however, was considerable. Although appealing, this new lesser-invasive technique should be carefully introduced, and its progress thoroughly evaluated.
The location of blunt thoracic aortic injuries (BTAI) frequently results in inadequate proximal seal for thoracic endovascular aortic repair (TEVAR) unless the stent graft is advanced into aortic zone 2, covering the left subclavian artery. Although well described for aneurysm treatment, the risks associated with this coverage are perceived as less important in trauma, with up to 50% reported rates of left subclavian artery coverage (LSAC) during BTAI repair. We aimed to estimate current rates of LSAC during TEVAR for BTAI and assess the complications associated with LSAC.
This study aims to develop a score to predict the risk of in-hospital stroke after TEVAR.
ConclusionThoracic endovascular aortic repair could be a useful alternative surgical option for patients with retrograde acute type A aortic dissection with an entry in the descending aorta who are not suitable for conventional open surgery. Careful follow-up of such patients is mandatory.
We present a patient with a prior coronary artery bypass grafting who was referred for an incidental 3cm saccular ascending aortic pseudoaneurysm who was successfully treated with frame coiling under total cerebral embolic protection using the SENTINEL device.
This case highlights the importance of diagnosing Grade I aortic injuries after trauma. Although the prognosis for minimal aortic injury is typically quite good, the patient in this case suffered the unlikely complication of minimal intimal injury progression with resultant thromboembolism and massive stroke. Due to motion artifact and CT resolution limitations, the initial aortic injury was not detected. Thus, potentially life-saving measures such as serial CT monitoring of injury, blood pressure control, and endovascular repair were unable to be performed.
The stroke rate after endovascular aneurysm repair (EVAR), particularly complex EVAR such as fenestrated EVAR (FEVAR) and chimney EVAR (chEVAR), is not well defined. Whereas stroke is a well-established risk of thoracic endovascular aortic repair (TEVAR), the impact of procedural characteristics on stroke remains unclear. Therefore, we characterized the risk of stroke after endovascular aortic interventions in the Vascular Quality Initiative database and identified procedural characteristics associated with stroke.
CONCLUSIONS: Retrograde TEVAR in combination with total arch replacement via an upper ministernotomy might be safe and effective in treating acute type A aortic dissection, with fairly low mortality and perioperative complications, and a very good rate of total false lumen thrombosis in midterm follow up. PMID: 32364906 [PubMed - as supplied by publisher]
ConclusionsThis multicenter clinical trial describes excellent 5-year outcomes and durable exclusion of blunt thoracic aortic injury using a novel stent graft system. TEVAR with this endograft appears to be a safe and effective treatment option for patients with BTAI.
CONCLUSIONS: This multicenter clinical trial describes excellent 5-year outcomes and durable exclusion of blunt thoracic aortic injury using a novel stent graft system. TEVAR with this endograft appears to be a safe and effective treatment option for patients with BTAI. PMID: 31991136 [PubMed - as supplied by publisher]
Extracranial carotid artery aneurysm is an extremely rare peripheral arterial aneurysm. The treatments of extracranial CAAs include open surgical, endovascular, and conservative options. Main surgical indications are transient ischemia attacks, strokes, or progressive growth. But both open surgery and endovascular repair have disadvantages and complications.