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Meyermann K, Trani J, Caputo FJ, Lombardi JV. Descending thoracic aortic mural thrombus presentation and treatment strategies. J Vasc Surg 2017; 66:931-936. [DOI: 10.1016/j.jvs.2017.05.109] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 05/15/2017] [Indexed: 10/19/2022]
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Biancari F, Mariscalco G, Mariani S, Saari P, Satta J, Juvonen T. Endovascular Treatment of Degenerative Aneurysms Involving Only the Descending Thoracic Aorta. J Endovasc Ther 2016; 23:387-392. [DOI: 10.1177/1526602815626560] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Purpose: To determine the efficacy of thoracic endovascular aortic repair (TEVAR) for degenerative aneurysm involving only the descending thoracic aorta (DTAA). Methods: An English-language literature review was performed through PubMed, Scopus, and Google Scholar to identify any study evaluating the outcomes of TEVAR for DTAA. The main endpoints of this analysis were all-cause 30-day and late postoperative mortality. Secondary outcome measures were procedure success, vascular access complications, paraplegia, stroke, early endoleaks during the index hospitalization, aneurysm-related death, reinterventions, and conversion to open repair. To control for the anticipated heterogeneity among small observational studies, absolute values and means were pooled using random effects models; the results are expressed as pooled proportions, means, or risk ratio (RR) with 95% confidence intervals (CIs). Results: Eleven studies reporting on 673 patients (mean age 72.6 years, mean aneurysm diameter 62.9 cm) with DTAA were selected for the analysis. Technical success was reported in 91.0% of patients, and vascular access complications requiring repair were encountered in 9.7% of cases. Pooled overall 30-day, 1-year, 2-year, and 3-year survival rates were 96.0%, 80.3%, 77.3%, and 74.0%, respectively. Five studies compared the results of TEVAR after elective (n=151) and urgent/emergent procedure (n=77); the latter was a predictor of 30-day mortality (17.1% vs 1.8%, RR 3.83, 95% CI 1.18 to 12.40, p=0.025). Paraplegia occurred in 3.2% of patients and was permanent in 1.4% of patients. The stroke rate was 2.7%. Early type I endoleak was observed in 7.3%, type II endoleak in 2.0%, and type III in 1.2% of patients. The mean follow-up of 9 studies was 22.3 months. At 3 years, freedom from reintervention was 90.3%. Death secondary to aneurysm rupture and/or fistula was reported in 3.2% of patients. Conclusion: Current results indicate that TEVAR for DTAA can be performed with rather high technical success, low postoperative morbidity, and good 3-year survival.
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Affiliation(s)
- Fausto Biancari
- Department of Surgery, Oulu University Hospital, Oulu, Finland
| | - Giovanni Mariscalco
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Leicester, UK
| | - Silvia Mariani
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Leicester, UK
| | - Petri Saari
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Jari Satta
- Department of Surgery, Oulu University Hospital, Oulu, Finland
| | - Tatu Juvonen
- Department of Surgery, University of Oulu, Finland
- Department of Cardiac Surgery, HUCH Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland
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Noly PE, Mercier O, Angel C, Fabre D, Mussot S, Brenot P, Riou JY, Bourkaib R, Planché O, Dartevelle P, Fadel E. [Management of the traumatic aortic blunt injury in 2014]. Presse Med 2014; 44:305-16. [PMID: 25542710 DOI: 10.1016/j.lpm.2014.06.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 05/08/2014] [Accepted: 06/03/2014] [Indexed: 11/28/2022] Open
Abstract
Diagnosis of blunt thoracic aortic injury (BAI) should be considered in any serious polytrauma. The diagnosis is mainly based on the CT scan at baseline. Life-threatening lesions are often associated with BAI. Hospital mortality is mainly due to associated lesions. Except the complete rupture of the aorta, treatment should be initiated after hemodynamic and respiratory stabilization of the patient and after the treatment of a lesion involving the immediate prognosis. Endovascular treatment of BAI became the treatment of choice, especially for patients with severe associated injuries and bleeding risk. Additional data on the long-term stents are necessary in these young patients. Conventional surgical treatment is always indicated for young subjects with stable hemodynamic, low risk of bleeding and when surgery may be delayed several hours.
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Affiliation(s)
- Pierre-Emmanuel Noly
- Centre chirurgical Marie-Lannelongue, service de chirurgie thoracique et vasculaire, 92350 Le Plessis Robinson, France
| | - Olaf Mercier
- Centre chirurgical Marie-Lannelongue, service de chirurgie thoracique et vasculaire, 92350 Le Plessis Robinson, France.
| | - Claude Angel
- Centre chirurgical Marie-Lannelongue, service de cardiologie et radiologie interventionnelle, 92350 Le Plessis Robinson, France
| | - Dominique Fabre
- Centre chirurgical Marie-Lannelongue, service de chirurgie thoracique et vasculaire, 92350 Le Plessis Robinson, France
| | - Sacha Mussot
- Centre chirurgical Marie-Lannelongue, service de chirurgie thoracique et vasculaire, 92350 Le Plessis Robinson, France
| | - Philippe Brenot
- Centre chirurgical Marie-Lannelongue, service de cardiologie et radiologie interventionnelle, 92350 Le Plessis Robinson, France
| | - Jean-Yves Riou
- Centre chirurgical Marie-Lannelongue, service de cardiologie et radiologie interventionnelle, 92350 Le Plessis Robinson, France
| | - Riad Bourkaib
- Centre chirurgical Marie-Lannelongue, service de cardiologie et radiologie interventionnelle, 92350 Le Plessis Robinson, France
| | - Olivier Planché
- Centre chirurgical Marie-Lannelongue, service de cardiologie et radiologie interventionnelle, 92350 Le Plessis Robinson, France
| | - Philippe Dartevelle
- Centre chirurgical Marie-Lannelongue, service de chirurgie thoracique et vasculaire, 92350 Le Plessis Robinson, France
| | - Elie Fadel
- Centre chirurgical Marie-Lannelongue, service de chirurgie thoracique et vasculaire, 92350 Le Plessis Robinson, France
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Brewster LP, Kasirajan K. Thoracic Endovascular Aneurysm Repair for Thoracic Aneurysms: What We Know, What to Expect. Ann Vasc Surg 2011; 25:856-65. [DOI: 10.1016/j.avsg.2011.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Revised: 02/17/2011] [Accepted: 03/08/2011] [Indexed: 11/24/2022]
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Mustafa ST, Sadat U, Majeed MU, Wong CM, Michaels J, Thomas SM. Endovascular repair of nonruptured thoracic aortic aneurysms: systematic review. Vascular 2010; 18:28-33. [PMID: 20122357 DOI: 10.2310/6670.2010.00003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Thoracic aortic aneurysms represent a major health problem. Untreated thoracic aortic aneurysms may rupture, which has a dismal outcome. The standard treatment for thoracic aneurysms is open surgical repair, but it is associated with high mortality and morbidity. Endovascular repair provides a less invasive and safer alternative. A systematic review was performed of all published literature on the above subject. Our primary objective was to measure 30-day mortality for nonruptured thoracic aortic aneurysms. Studies describing other pathologies, such as aortic dissection, mycotic aneurysms, penetrating ulcers, traumatic transactions, and pseudoaneurysms, and studies from which independent data for thoracic aortic aneurysm could not be separately extracted were excluded. Case series describing less than 10 patients and all case series describing ruptures or concealed ruptures were excluded as well. Twenty-six case series and one comparative study were identified. This formed a cohort of 1,038 patients. Technical success was possible in more than 97% of patients. The 30-day mortality was calculated to be 5.1% even though the group under study was mostly those who were refused surgery by a surgeon or had a higher surgical risk. The incidence of paraplegia and stroke was 3.1% and 4.7%, respectively. Early endoleak was seen in 16.7% of patients, whereas 11.7% of patients developed late endoleak, but most did not require any additional procedure. The rate of reintervention was 14.9%. The 12-month mortality rate was 14.2%. Endovascular repair shows encouraging short-term results. It is associated with significantly less mortality and morbidity, but long-term results need to be further investigated.
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Affiliation(s)
- Syed T Mustafa
- Academic Vascular Department, Sheffield University, Sheffield, United Kingdom.
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Qu L, Raithel D. Two-Year Single-Center Experience With Thoracic Endovascular Aortic Repair Using the EndoFit Thoracic Stent-Graft. J Endovasc Ther 2008; 15:530-8. [DOI: 10.1583/08-2364.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Inglese L, Mollichelli N, Medda M, Sirolla C, Tolva V, Grassi V, Fantoni C, Neagu A, Pavesi M. Endovascular Repair of Thoracic Aortic Disease With the EndoFit Stent-Graft:Short and Midterm Results From a Single Center. J Endovasc Ther 2008; 15:54-61. [DOI: 10.1583/07-2158m.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Lioupis C, Medda M, Inglese L. Thoracic aneurysm repair: managing severe tortuosity with brachiofemoral traction. Catheter Cardiovasc Interv 2007; 70:1041-5. [PMID: 18044774 DOI: 10.1002/ccd.21298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Challenging anatomy of the thoracic aorta is often encountered, and aortic tortuosity may be a major impediment to the propulsion of the stent-graft. Traction on both ends of a guidewire, with one end exiting the right upper extremity and the other end exiting the lower extremity, is an excellent option to manage thoracic aorta tortuosity. Careful application of simple guidelines may lessen associated risks and improve safety.
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Affiliation(s)
- Christos Lioupis
- Department of Cardiovascular Radiology, Policlinico San Donato, Milan, Italy.
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