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PubMed2006

Initial and midterm results for repair of aortic diseases with handmade stent grafts.

BACKGROUND: The purpose of this study was to determine the initial and midterm results for repair of thoracic and abdominal aortic diseases using handmade stent-grafts (SGs). METHODS AND RESULTS: Between 1999 and 2004, 41 consecutive patients (31 patients with thoracic and 10 patients with abdominal aortic disease) underwent endovascular stent-graft repair using handmade SGs. The follow-up averaged 24.8+/-17.6 months. The technical and initial clinical success rates were 82.9% (34/41) and 80.5% (33/41), respectively. Primary type I or III endoleaks occurred in 12.2% (5/41) of the patients. The hospital mortality rate was 4.9% (2/41). Persistent type I or III endoleaks occurred in 9.8% (4/41) and SG migrations occurred in 4.9% (2/41) of the patients. Open surgical conversion was undertaken in 12.2% (5/41) of the patients because of an endoleak and/or migration. The mean change observed in the aneurysm diameter was -6.2+/-10.5 mm, and shrinkage in the diameter occurred in 51.4% (18/35) of the cases. There was 1 patient death because of aneurysm rupture. Neither stent fracture nor graft hole was observed. The overall clinical success rate during follow-up was 78.0% (32/41). CONCLUSION: The initial and midterm results obtained after repair of the aortic diseases using handmade SGs were considered to be satisfactory. More surgical experience and long-term patient follow-up are both required to further reassess the effect of this treatment.

Adult↗

PubMed1984

Magnetic resonance imaging of aortic disease: preliminary results.

Fourteen patients with a variety of aortic diseases were evaluated with magnetic resonance imaging (MRI). These included abdominal aortic aneurysms (eight cases), aortoiliac aneurysm (one), thoracoabdominal aneurysm (one), aortic dissections (four), and Takayasu arteritis (one). The size and extent of aneurysms, the presence of thrombus or atherosclerotic debris, the relation to renal and iliac arteries, and the effect of aneurysms on adjacent structures were readily demonstrated by MRI. The size of the residual lumen in a variety of vascular diseases and abnormal blood flow patterns could be assessed. In aortic dissection, MRI permitted identification of intimal flaps and determination of the origin of aortic branches from either of two lumina. Thickening of the wall and luminal narrowing of the aorta and arch vessels in Takayasu arteritis were clearly defined. These early results indicated that MRI achieved precise and complete assessment of a number of aortic abnormalities without the administration of any type of contrast material. Thus, early experience suggests that an important application of MRI will be as a totally noninvasive and reliable method for evaluating aortic disease.

Adult↗

PubMed2006

Long-term results from a 12-year experience with endovascular therapy for thoracic aortic disease.

BACKGROUND: Endovascular approaches promise to revolutionize therapy for thoracic aortic disease. This study describes a long-term analysis of endovascular thoracic aortic repair. METHODS: Seventy-three patients (mean age, 67.4 years) underwent endovascular thoracic aortic repair from 1993 to 2005. Indications for intervention included aneurysm (38%), dissection (23%), or penetrating ulcer or pseudoaneurysm (34%). Rupture was present in 16 patients (22%). Seventy-one percent were considered high risk for open surgery for reasons of age or comorbid conditions. Treated segments included ascending aorta (n = 1), distal arch (n = 24), and proximal (n = 50) or distal (n = 55) descending aorta. The total descending thoracic aorta was covered in 31 patients. Procedural success was achieved in 96%. Devices were delivered by femoral (79%), retroperitoneal iliac (18%), or carotid (2.7%) exposure. Devices used included Excluder (n = 30), Talent (n = 23), Zenith (n = 3), AneuRx (n = 5), and custom-fabricated (n = 14). Follow-up was 100% complete. RESULTS: Thirty-day mortality was 5.5%. Significant morbidity included stroke (8.2%) and need for dialysis (4.1%). Although 3 patients had transient spinal cord ischemia (4.1%), none had permanent sequelae. Intervention for fusiform aneurysm was independently associated with a composite end point of 30-day mortality, need for dialysis, and stroke (p = 0.015). Eight patients (11%) had new or persistent endoleaks, and aortic reintervention was performed in 7 patients (9.6%). Mean survival for the entire cohort was 46.8 +/- 5.1 months. Intervention for penetrating ulcer or pseudoaneurysm (p = 0.045) was independently associated with long-term all-cause mortality. CONCLUSIONS: An endovascular approach produces acceptable results for a broad range of thoracic aortic disease. However, the potential for endoleak or need for reintervention mandates continued close follow-up to achieve satisfactory long-term results.

Aged↗

PubMed1988

Aortic disease associated with pregnancy.

Our experience with the management of two patients with life-threatening aortic disease during pregnancy is presented with a review of the literature. One of our patients had intimal disruption caused by trauma; the other had probable Ehlers-Danlos type IV syndrome, causing an acute dissection of the descending thoracic aorta and eventually requiring replacement of the aorta from the left subclavian artery to common iliac arteries. The challenge of treating both the pregnant woman and the fetus was managed successfully by an emergent cesarean section followed by Dacron graft replacement of the descending thoracic aorta. The literature reviewed disclosed that aneurysm expansion producing symptoms and dissection is most common during the third trimester and during labor and delivery in patients with or without Marfan's syndrome. Half of the aortic dissections in women less than 40 years of age occur in association with pregnancy. The available evidence indicates that patients with known valvular or aortic disease should have surgical repairs during the first or second trimester and thereafter have delivery by cesarean section. However, patients with acute aortic problems near term appear to be better managed by cesarean section followed promptly by treatment of the aortic disease.

Adult↗

PubMed2003

Endoluminal stent grafts for aortic diseases: experience at a major teaching hospital in Hong Kong.

BACKGROUND: The purpose of the present paper was to review the initial experience of an endovascular aortic stent graft program at a major teaching hospital in Hong Kong. METHODS: Demographics, operative details, complications and follow-up data of all the patients receiving endovascular repair for aortic disease were recorded prospectively. RESULTS: Between July 1999 and December 2001, endovascular repairs were attempted in 39 patients with aortic disease. The procedural success rate was 97.4%. Thirty-three procedures were for abdominal aorto-iliac aneurysms. Graft configuration was bifurcated in 28 patients (85%) while an aorto-uni-iliac device with a femoro-femoral bypass was carried out in the remaining five patients. Thoracic procedures were carried out for one thoracic aortic aneurysm, two traumatic thoracic aortic injuries, one thoracic aortic dissection, and one thoracic aortic pseudoaneurysm with aorto-oesophageal fistula. There was one hospital mortality (2.6%) from a type A thoracic aortic dissection with cardiac tamponade. Postoperative complications were seen in seven patients (18%). With a mean follow-up of 11.6 +/- 8.1 months, there was no open conversion or rupture. The endoleak rate was 27% at discharge, 15% at 6 months and 5% at 12 months postoperatively. For aneurysm endografts, the aneurysm sac decreased in size in 21 patients (62%), and remained static in 13 patients (38%). CONCLUSIONS: The endoluminal stent graft appears to be a promising device that can be used safely in selected patients with aortic disease. Continued follow-up is required to monitor the presence of endoleak and the size of the aneurysm sac.

Aged↗

PubMed2001

Clinical evaluation of aortic diseases using nonenhanced MRA with ECG-triggered 3D half-Fourier FSE.

The efficacy of the nonenhanced magnetic resonance angiography (MRA) technique known as fresh-blood imaging (FBI), using electrocardiograph (ECG)-triggered 3D half-Fourier fast spin-echo (FSE), was evaluated for the detection and characterization of aortic diseases. Seventy-five consecutive patients with aortic disease underwent the FBI examination on a 1.5-T clinical imager. The results showed that the FBI technique permits clear visualization of aortic diseases, and the vessel branches and their relationship, which provides valuable information. Therefore, the nonenhanced FBI technique is appropriate to use for screening purposes.

Aged↗

PubMed2000

Electron beam tomography with three-dimensional reconstruction in the diagnosis of aortic diseases.

BACKGROUND: This study was performed to evaluate the protocols of electron beam tomographic angiography and three-dimensional reconstruction for assessing the diagnostic value of aortic diseases. METHODS EXPERIMENTAL DESIGN: Retrospective and comparative study. SETTINGS: University hospital. PATIENTS: Between 1996 and 1998, 189 cases who underwent electron beam tomographic angiography and diagnosed with aortic diseases were analyzed retrospectively. The results were compared with surgical and pathological findings in 68 cases. Electron beam tomographic angiography was used single-slice-scanning with ECG-triggering for screening of the thoracic aorta, continuous-volume-scanning, permitted by continuous X-ray exposure with table incremention, was performed for the abdominal aorta scanning without ECG-triggering. Three-dimensional reconstructions were performed with shaded-surface display, multiplanar reformatting and/or maximum intensity projection methods. RESULTS: Electron beam tomography angiography with ECG-triggered sections of single-slice-scanning improved the image quality of the ascending aorta without motion artifacts. Continuous-volume-scanning was suitable for screening of the abdominal aorta because of minimizing exposure time (10-14 sec) and saving contrast media (total contrast material of 45.5+/-6.6 ml was needed). One hundred eighty-nine cases were diagnosed with aortic dissection (97 cases), aortic aneurysm (26 cases), pseudoaneurysm (8 cases), Marfan's syndrome (39 cases), Takayasu's arteritis (5 cases) and congenital aortic malformations (14 cases). Electron beam tomography results were compared with the findings of surgery (as gold standard) in 68 cases, the diagnostic accuracy was 97% (2 cases with aortic aneurysm were erroneously diagnosed with pseudoaneurysm). CONCLUSIONS: Electrocardiographically triggered, contrast-enhanced electron beam tomography is feasible for the diagnosis of all kinds of aortic diseases, with excellent three-dimensional images competitive in quality with conventional selective aortic angiography or digital subtraction angiography.

Adolescent↗

PubMedDate not supplied

Aneurysm shrinkage after endovascular repair of aortic diseases.

BACKGROUND: There are two graft materials for endovascular repair of aortic diseases, i.e., polyester and expanded polytetrafluoroethylene (ePTFE). The latest reports have suggested that there is graft-specific difference in outcomes. The purpose of this article was to evaluate the difference in terms of aneurysm shrinkage. PATIENTS AND METHODS: Eighty-six patients who underwent endovascular repair of aortic diseases were included. Forty patients had true aortic aneurysms, 8 had aortic pseudoaneurysms, and 38 had aortic dissections. Eighteen patients with true aortic aneurysms were treated with stent grafts fabricated with polyester, while the other 68 patients, including 22 patients with true aneurysms, 8 patients with pseudoaneurysms, and 38 patients with aortic dissections, were treated with stent grafts fabricated with ePTFE. All patients were followed-up by computed tomography (CT) for more than 1 year. The mean follow-up term was 28 months. Computed tomography confirmed that there were sufficiently long necks, and the aneurysm or the entry tear was completely excluded without any endoleak in all patients. The diameter of the preoperative lesion was compared with that measured on follow-up CT at 1 year and at the end of the follow-up term. Increase or decrease in the diameter by more than 5 mm was defined as a significant diameter change. RESULTS: Aneurysm shrinkage was observed in 40% of patients with true aneurysms, 88% of patients with pseudoaneurysms, and 55% of patients with aortic dissections at 1 year. There was no significant increase in patients with aneurysm shrinkage at the end of follow-up in any groups. In the case of true aortic aneurysms, shrinkage of aneurysms was observed more frequently with polyester-fabricated stent grafts (67%, 13/18) than with ePTFE-fabricated ones (18%, 4/22) at 1 year (P<.01). In contrast, expansion of aneurysms was observed only in patients treated with ePTFE (14%, 3/22). Shrinkage of the descending aorta was observed in 55% of patients with acute aortic dissections and 36% of patients with chronic aortic dissections. There was no case with aortic enlargement in either group. There was no significant difference between acute and chronic dissection in terms of shrinkage of the descending aorta. CONCLUSION: Expanded polytetrafluoroethylene appears to be effective for the treatment of pseudoaneurysms and aortic dissections. However, polyester seems to be more effective than ePTFE when true aneurysms are to be treated.

Aortic Dissection↗

PubMed1981

Hypotensive central spinal cord infarction: a clinicopathological study of 3 cases of aortic disease.

Neuropathological studies of 3 cases of aortic disease, complicated by severe prolonged hypotension, revealed a spectrum of central spinal cord infarction not corresponding to a specific arterial territory. The findings support the concept that the central grey matter of the caudal spinal cord is most vulnerable to oligaemic hypoxia. Variation in the longitudinal distribution of ischaemic damage in the individual case depends primarily on the anatomical pattern of the spinal arterial net and on the nature and distribution of the vascular pathology.

Aged↗

PubMed2001

Endovascular stent-graft management of thoracic aortic diseases.

The traditional standard therapy for descending thoracic aortic aneurysm (TAA) is open operative repair with graft replacement of the diseased aortic segment. Despite important advances in surgical techniques, anesthetic management, and post-operative care over the last 30 years, the mortality and morbidity of surgery remains considerable, especially in patients at high risk for thoracotomy because of coexisting severe cardiopulmonary abnormalities or other medical diseases. The advent of endovascular stent-graft technology provides an alternative to open surgery for selected patients with TAA. The initial experience suggests that stent-graft therapy potentially may reduce the operative risk, hospital stay and procedural expenses of TAA repair. These potential benefits are especially attractive for patients at high risk for open TAA repair. Current results of endovascular TAA therapy document operative mortalities of between 0 and 4%, aneurysm thrombosis in 90 and 100% of cases, and paraplegia as a complication in 0 and 1.6% of patients. The early success of stent-graft repair of TAA has fostered the application of these devices for the management of a wide variety of thoracic aortic pathologies, including acute and chronic dissection, intramural hematoma, penetrating ulcer, traumatic injuries, and other diseases. The results of prospective controlled trials that compare the outcomes of stent-graft therapy with those of surgical treatment in patients with specific types of aortic disease are anxiously awaited before recommendations regarding the general use of these new devices can be made with confidence.

Aortic Aneurysm, Thoracic↗

PubMed1985