Occlusion of the Celiac Artery During Endovascular Thoracoabdominal Aortic Aneurysm Repair is Associated with Increased Perioperative Morbidity and Mortality

Some studies suggest celiac artery coverage during elective endovascular thoracoabdominal aortic aneurysm (TAAA) repair is safe given sufficient collateralization of visceral organ perfusion from the superior mesenteric artery. However, there is concern that celiac artery coverage may lead to increased risk of foregut or spinal cord ischemia with an attendant increased risk of mortality. We sought to investigate rates of bowel ischemia, spinal cord ischemia and 30-day mortality associated with celiac artery coverage during TEVAR and complex EVAR.
Source: Annals of Vascular Surgery - Category: Surgery Authors: Tags: Clinical Research, Basic Science Source Type: research

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The present study evaluates aneurysmal sac remodeling and the loss of intercostal arteries after the first step of staged treatment of thoraco-abdominal aortic aneurysms (TAAA). The purpose of this approach is to keep the aneurysmal sac temporarily perfused in order to induce progressive thrombosis of the aneurysm while simultaneously allowing the spinal cord to establish adequate perfusion thereby promoting the development of collateral circulation.
Source: Annals of Vascular Surgery - Category: Surgery Authors: Tags: Clinical Research, Basic Science Source Type: research
Introduction: Two-stage-procedures is a common strategy in the endovascular repair of thoraco-abdominal aortic aneurysms (TAAA), in order to maintain a temporary sac perfusion for spinal cord preconditioning to ischemia. However, the temporary sac perfusion can lead to coagulative disorders determined by platelet and coagulative factors consumption. Aim of present study was to evaluate possible coagulative disorders and spontaneous haemorrhagic events in two-stage vs single stage endovascular TAAA treatment.
Source: European Journal of Vascular and Endovascular Surgery - Category: Surgery Authors: Source Type: research
Introduction - Branched endovascular aortic repair (BEVAR) has become an accepted option for treatment of thoracoabdominal aortic aneurysms (TAAA). Staged procedures with temporary aneurysm sac perfusion (TASP) were shown to reduce the risk of spinal cord ischemia in patients with extended aortic aneurysmal disease. However, only few data about the risk of perioperative mesenteric ischemia are available.
Source: European Journal of Vascular and Endovascular Surgery - Category: Surgery Authors: Source Type: research
ConclusionsAscending aortic stent placement for ascending aortic disease is feasible and is associated with favorable aortic remodeling. Despite persistent perfusion to the false lumen in a subset of patients, there is minimal aortic dilation at short-term follow-up with excellent survival.
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
This study investigated whether preservation of pelvic perfusion with iliac branch devices (IBDs) decreases the incidence of ischemic colitis.
Source: Journal of Vascular Surgery - Category: Surgery Authors: Source Type: research
The ultimate and durable exclusion of an abdominal aortic aneurysm requires adequate proximal and distal sealing zones. Fenestrated devices offer a solution for proximal extension. However, distal targetting into the external iliac arteries (EIA) denies direct perfusion to the internal iliac arteries and leads to a non-negligible rate of buttock claudication, or even more serious complications, such as bowel ischaemia, plexopathy, or erectile dysfunction. Preserving internal iliac artery (IIA) blood flow was initially achieved with oversized bell bottom components, although deploying these inside unhealthy common iliac art...
Source: European Journal of Vascular and Endovascular Surgery - Category: Surgery Authors: Tags: Invited Commentary Source Type: research
Abdominal aortic aneurysm (AAA) is an individual and socioeconomic burden in today's ageing society. Treatment relies on surgical exclusion of the dilated aorta by open or endovascular repair. For research purposes, animal models are necessary and the elastase induced aneurysm model closely mimics end stage human aneurysm disease. To improve the translational value of this model, four modifications to the classic elastase perfusion procedure (PPE) in relation to human aneurysm morphology were conducted.
Source: Journal of Vascular Surgery - Category: Surgery Authors: Tags: Selected Abstract from the July Issue of the European Journal of Vascular and Endovascular Surgery Source Type: research
CONCLUSIONS: We found no RCTs that compared controlled hypotension and normotensive resuscitation strategies in the management of haemorrhagic shock in patients with ruptured abdominal aortic aneurysm that assessed mortality, presence of coagulopathy, intensive care unit length of stay, and the presence of myocardial infarct and renal failure. High quality studies that evaluate the best strategy for managing haemorrhagic shock in ruptured abdominal aortic aneurysms are required. PMID: 29897100 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - Category: General Medicine Authors: Tags: Cochrane Database Syst Rev Source Type: research
CONCLUSION: Open TAA(A) repair as a secondary procedure after previous endovascular aortic therapy is an important treatment option even in the endovascular era. It represents a durable treatment that can produce respectable outcomes. Yet the peri-operative morbidity and mortality are relevant and a specialised team and infrastructure are mandatory for these complex procedures. Therefore, centralisation is required. PMID: 29705559 [PubMed - as supplied by publisher]
Source: PubMed: Eur J Vasc Endovasc ... - Category: Surgery Authors: Tags: Eur J Vasc Endovasc Surg Source Type: research
Abdominal aortic aneurysm (AAA) is an individual and socioeconomic burden in today's ageing society. Treatment relies on surgical exclusion of the dilated aorta by open or endovascular repair. For research purposes, animal models are necessary and the elastase induced aneurysm model closely mimics end stage human aneurysm disease. To improve the translational value of this model, four modifications to the classic elastase perfusion procedure (PPE) in relation to human aneurysm morphology were conducted.
Source: European Journal of Vascular and Endovascular Surgery - Category: Surgery Authors: Source Type: research
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