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Kim KT, Wang TI, Gregory Conway R, Toursavadkohi S, Cherian J. A direct aorta to segmental artery bypass for prevention of spinal cord ischemia after endovascular aortic repair. J Vasc Surg Cases Innov Tech 2024; 10:101446. [PMID: 38510088 PMCID: PMC10951524 DOI: 10.1016/j.jvscit.2024.101446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/24/2024] [Indexed: 03/22/2024] Open
Abstract
Spinal cord ischemia remains a persistent challenge after endovascular aortic aneurysm repair. We present a novel direct aorta to segmental artery bypass before aneurysm repair in a 64-year-old woman presenting with an enlarging aneurysm following dissection. Through an eighth intercostal incision, a polyester graft was sewn into the aorta using pledgeted sutures. An entry needle was used to directly access the previously treated aortic segment, and the opening was stented and angioplasty was performed to create inflow. Anastomoses were performed to a prominent left T10 segmental artery with a harvested saphenous vein. The patient remained neurologically intact postoperatively and the 1-month follow-up angiography demonstrated bypass patency.
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Affiliation(s)
- Kevin T. Kim
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD
| | - Ting I. Wang
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD
| | - R. Gregory Conway
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Shahab Toursavadkohi
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Jacob Cherian
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD
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Branzan D, Geisler A, Steiner S, Scheinert D, Funk K, Schmidt A. Endovascular occlusion of segmental arteries feeding the anterior spinal artery to stage endovascular thoracoabdominal aortic repair. JTCVS OPEN 2024; 18:1-8. [PMID: 38690411 PMCID: PMC11056496 DOI: 10.1016/j.xjon.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/23/2024] [Accepted: 02/07/2024] [Indexed: 05/02/2024]
Abstract
Objective Minimally invasive segmental artery coil embolization was introduced to prevent spinal cord ischemia after endovascular repair of thoracoabdominal aortic aneurysms. There is no consensus on whether the endovascular occlusion of segmental arteries feeding directly the anterior radiculomedullary artery and anterior spinal artery can be safely performed without causing spinal cord ischemia. Our aim was to investigate the feasibility and clinical impact of endovascular occlusion of segmental arteries supplying the anterior spinal artery during minimally invasive segmental artery coil embolization in patients with thoracoabdominal aortic aneurysms. Methods Between January 2018 and July 2020, 54 patients (36 male; mean age, 71.1 ± 9.3 years) underwent direct embolization of segmental arteries feeding the anterior radiculomedullary artery before endovascular repair of thoracoabdominal aortic aneurysms. End points included technical success of minimally invasive segmental artery coil embolization of segmental arteries, anterior radiculomedullary artery, neurological complications, and in-hospital mortality after minimally invasive segmental artery coil embolization and endovascular repair of thoracoabdominal aortic aneurysms. Results The thoracoabdominal aortic aneurysm classification was type I (n = 8), type II (n = 24), type III (n = 11), and type IV (n = 11). During minimally invasive segmental artery coil embolization, 388 segmental arteries were occluded, each patient having 7.2 ± 3.1 coiled segmental arteries occluding 64.5% (25-100%) of open segmental arteries within the treated aortic segment. Altogether, 66 anterior radiculomedullary arteries were seen originating between Th8 and L3 levels from 85 (21.9%) segmental arteries. In 10 patients (18.5%), 2 large anterior radiculomedullary arteries were identified, and 1 patient (1.9%) showed 3 anterior radiculomedullary arteries on the spinal arteriography. No spinal cord ischemia or procedure-related complications occurred after minimally invasive segmental artery coil embolization. After 47.9 ± 39.4 days, all patients received endovascular repair of their thoracoabdominal aortic aneurysms. There was no in-hospital mortality. One male patient developed incomplete temporary spinal cord ischemia after endovascular repair. Conclusions Minimally invasive segmental artery coil embolization of segmental arteries feeding the anterior spinal artery in patients with thoracoabdominal aortic aneurysms to prevent spinal cord ischemia after endovascular repair is feasible and clinically safe.
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Affiliation(s)
- Daniela Branzan
- Department of Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Zentrum München at the University of Leipzig and University Hospital Leipzig, Leipzig, Germany
| | - Antonia Geisler
- Department of Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Sabine Steiner
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Zentrum München at the University of Leipzig and University Hospital Leipzig, Leipzig, Germany
- Division of Interventional Angiology, Department of Internal Medicine, Neurology and Dermatology, University Hospital Leipzig, Leipzig, Germany
| | - Dierk Scheinert
- Division of Interventional Angiology, Department of Internal Medicine, Neurology and Dermatology, University Hospital Leipzig, Leipzig, Germany
| | - Katharina Funk
- Department of Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Andrej Schmidt
- Division of Interventional Angiology, Department of Internal Medicine, Neurology and Dermatology, University Hospital Leipzig, Leipzig, Germany
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Georgakarakos E, Papadopoulou M, Karangelis D, Fiska A. Teaching vascular anatomy: the anatomy we know, the anatomy we see or the anatomy we need? Surg Radiol Anat 2023; 45:1155-1164. [PMID: 37458825 DOI: 10.1007/s00276-023-03203-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 07/03/2023] [Indexed: 09/22/2023]
Abstract
PURPOSE This article presents the evolution of the subject of vascular anatomy and discusses the associated clinical applicability. METHODS Clinically-driven surgical examples met in our everyday practice were used to depict characteristic anatomical paradoxes raised by the inconsistencies between classical anatomical perception, current imaging modalities and modern surgical techniques. RESULTS Consequent anatomy-driven modifications of medical devices comprise a characteristic example of the vivid, modern and meaningful role that anatomy can have on clinical decision-making and improvement of technical and clinical success. Clinical experience provides a feedback that shifts the focus of anatomic research towards new fields of interest, such as the role of arterial collateral networks as therapeutic targets. The clinical feedback brings into light queries and issues where traditional anatomical answers may be vague and inadequate to apply, thereby necessitating further research, refinement and reevaluation. CONCLUSION While the traditional teaching of vascular anatomy is based on information and illustrations derived from dissection and prosection courses, the development of modern imaging technologies applied in large numbers of living patients and application of minimally invasive techniques challenge our understanding of what should be perceived as fixed and permanent. Moreover, the recently introduced evidence-based philosophy in anatomy elaborate more robust data which not only update, validate and enrich the existing knowledge of anatomical variations but also enable subgroup analyses with respect to race, age and sex, identifying specific anatomic features associated with a significant impact on patient treatment.
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Affiliation(s)
- Efstratios Georgakarakos
- Department of Vascular Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace, Medical School, 68100, Dragana, Alexandroupolis, Greece.
| | - Myrto Papadopoulou
- Department of Anatomy, Medical School of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Dimos Karangelis
- Department of Cardiac Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Aliki Fiska
- Department of Anatomy, Medical School of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
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Becker LS, Becker ER, Stuebig T, Hinrichs JB. Preoperative Coil-Embolization of a Large, Myelon-Compressing Vertebral Metastasis Involving the Artery of Adamkiewicz. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2023. [DOI: 10.1055/s-0043-1761623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
Abstract
Background Metastatic spinal cord compression causes neurologic impairment and pain, potentially improved by decompression surgery at the risk of heavy intraoperative bleeding. Preoperative embolization carries the risk of nontarget embolization, potentially causing spinal ischemia. Current evidence indicates that knowledge of artery of Adamkiewicz (AKA) location and the amount of collateralization may help estimate the risk of postinterventional spinal cord injury.
Case Presentation In this case of a 73-year-old female patient with progression of a large, myelon-compressing vertebral metastasis of L1, protective, blood-flow-controlling occlusion of the proximal-most points of the AKA and segmental spinal arteries was safely performed prior to tumor embolization, surgical decompression, and tumor debulking.
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Affiliation(s)
- LS Becker
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hanover, Germany
| | - ER Becker
- Private Neurological Practice, Braunschweig, Germany
| | - T. Stuebig
- Department of Traumatology, Hannover Medical School, Hanover, Germany
| | - JB Hinrichs
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hanover, Germany
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5
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MacGillivray TE, Gleason TG, Patel HJ, Aldea GS, Bavaria JE, Beaver TM, Chen EP, Czerny M, Estrera AL, Firestone S, Fischbein MP, Hughes GC, Hui DS, Kissoon K, Lawton JS, Pacini D, Reece TB, Roselli EE, Stulak J. The Society of Thoracic Surgeons/American Association for Thoracic Surgery clinical practice guidelines on the management of type B aortic dissection. J Thorac Cardiovasc Surg 2022; 163:1231-1249. [PMID: 35090765 DOI: 10.1016/j.jtcvs.2021.11.091] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 11/08/2021] [Indexed: 01/16/2023]
Affiliation(s)
| | - Thomas G Gleason
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Himanshu J Patel
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Gabriel S Aldea
- Division of Cardiothoracic Surgery, University of Washington School of Medicine, Seattle, Wash
| | - Joseph E Bavaria
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa
| | - Thomas M Beaver
- Division of Thoracic and Cardiovascular Surgery, University of Florida, Gainesville, Fla
| | - Edward P Chen
- Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, NC
| | - Martin Czerny
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
| | - Anthony L Estrera
- Department of Cardiothoracic and Vascular Surgery, The University of Texas Health Science Center at Houston and Memorial Hermann Hospital, Houston, Tex
| | | | - Michael P Fischbein
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, Calif
| | - G Chad Hughes
- Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, NC
| | - Dawn S Hui
- Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Tex
| | | | - Jennifer S Lawton
- Division of Cardiac Surgery, Johns Hopkins University, Baltimore, Md
| | - Davide Pacini
- Department of Cardiac Surgery, University of Bologna, Bologna, Italy
| | - T Brett Reece
- Department of Cardiothoracic Surgery, University of Colorado School of Medicine, Aurora, Colo
| | - Eric E Roselli
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - John Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
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6
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MacGillivray TE, Gleason TG, Patel HJ, Aldea GS, Bavaria JE, Beaver TM, Chen EP, Czerny M, Estrera AL, Firestone S, Fischbein MP, Hughes GC, Hui DS, Kissoon K, Lawton JS, Pacini D, Reece TB, Roselli EE, Stulak J. The Society of Thoracic Surgeons/American Association for Thoracic Surgery Clinical Practice Guidelines on the Management of Type B Aortic Dissection. Ann Thorac Surg 2022; 113:1073-1092. [PMID: 35090687 DOI: 10.1016/j.athoracsur.2021.11.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 11/08/2021] [Indexed: 02/07/2023]
Affiliation(s)
| | - Thomas G Gleason
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Himanshu J Patel
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Gabriel S Aldea
- Division of Cardiothoracic Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Joseph E Bavaria
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thomas M Beaver
- Division of Thoracic and Cardiovascular Surgery, University of Florida, Gainesville, Florida
| | - Edward P Chen
- Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Martin Czerny
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
| | - Anthony L Estrera
- Department of Cardiothoracic and Vascular Surgery, The University of Texas Health Science Center at Houston and Memorial Hermann Hospital, Houston, Texas
| | | | - Michael P Fischbein
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, California
| | - G Chad Hughes
- Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Dawn S Hui
- Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | | | - Jennifer S Lawton
- Division of Cardiac Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Davide Pacini
- Department of Cardiac Surgery, University of Bologna, Bologna, Italy
| | - T Brett Reece
- Department of Cardiothoracic Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Eric E Roselli
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - John Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
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Saadeh YS, Strong MJ, Muhlestein WE, Koduri S, Park P. Commentary: Posterior Nerve-Sparing Corpectomy With Ventral Cage Reconstruction for a Lumbar Burst Fracture: A Video Illustration: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2022; 22:e102-e103. [PMID: 35007239 DOI: 10.1227/ons.0000000000000061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 09/19/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Yamaan S Saadeh
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
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8
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OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6561271. [DOI: 10.1093/ejcts/ezac196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 02/23/2022] [Accepted: 03/24/2022] [Indexed: 11/13/2022] Open
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López-de la Cruz Y, Quintero-Fleites YF, Nafeh-Abi-Rezk MS, Chávez-González E. Fisiología y anatomía quirúrgica de la arteria mamaria interna: ¿qué debe saberse durante su disección esqueletizada? CIRUGIA CARDIOVASCULAR 2021. [DOI: 10.1016/j.circv.2021.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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10
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Falasa MP, Scali ST, Beaver TM. Commentary: Protecting the artery of Adamkiewicz: Highest imperative. JTCVS Tech 2021; 6:37-38. [PMID: 34318134 PMCID: PMC8300957 DOI: 10.1016/j.xjtc.2021.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Matheus P Falasa
- General Surgery Residency Program, University of Florida, Gainesville, Fla
| | - Salvatore T Scali
- Division of Vascular, Department of Surgery, University of Florida, Gainesville, Fla
| | - Thomas M Beaver
- Division of Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Fla
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Takebayashi K, Shiwa T, Ishikawa T, Taira T, Kawamata T. Spinal cord infarction six months after thoracic endovascular aortic repair- A case report. Heliyon 2020; 6:e04869. [PMID: 32964161 PMCID: PMC7490530 DOI: 10.1016/j.heliyon.2020.e04869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/02/2020] [Accepted: 09/04/2020] [Indexed: 11/24/2022] Open
Abstract
Spinal cord infarction is reported to account for less than 1% of all strokes and is a relatively rare disease. In recent years, thoracic endovascular aortic repair (TEVAR) has become a common treatment for aortic aneurysms, and spinal cord ischemia is one of its complications. Most cases occur in the perioperative period; however, a few cases have been reported in the chronic stage. Here, we report a case of spinal cord infarction, 6 months after TEVAR. A 77-year-old man experienced sudden onset paraparesis following dumbbell exercises and defecation. He had a history of an infectious thoracoabdominal aortic aneurysm treated by TEVAR 6 months prior. Paralysis and disturbance of the thermal pain and tactile sensations of the lower limbs were observed, but proprioception and deep sensation were preserved. Computed tomography (CT) showed no evidence of intraspinal hemorrhage, new aortic dissection, or endoleak around the aortic stent placed from Th11 to L3. Magnetic resonance imaging (MRI) showed intramedullary hyperintensity from Th11 to the conus 2 days after onset. Anticoagulant therapy and rehabilitation were performed, and the lower-limb muscle strength gradually improved. After aortic stenting, particularly including the level of the Adamkiewicz artery, the risk of spinal cord ischemia must be monitored, because spinal circulation depends on collateral circulation.
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12
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Tan T, Rutges J, Marion T, Fisher C, Tee J. The Safety Profile of Intentional or Iatrogenic Sacrifice of the Artery of Adamkiewciz and Its Vicinity's Spinal Segmental Arteries: A Systematic Review. Global Spine J 2020; 10:464-475. [PMID: 32435568 PMCID: PMC7222674 DOI: 10.1177/2192568219845652] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVES There is paucity of consensus on whether (1) the artery of Adamkiewicz (AoA) and (2) the number of contiguous segmental spinal arteries (SSAs) that can be safely ligated without causing spinal cord ischemia. The objective of this review is to determine the risk of motor neurological deficits from iatrogenic sacrifice of the (1) AoA and (2) its vicinity's SSAs. METHODS Systematic review of the spine and vascular surgery was carried out in accordance to PRISMA guidelines. Outcomes in terms of risk of postoperative motor neurological deficit with occlusion of the AoA, bilateral contiguous SSAs, or unilateral contiguous SSAs were analyzed. RESULTS Ten articles, all retrospective case series, were included. Three studies (total N = 50) demonstrated a postoperative neurological deficit risk of 4.0% when the AoA is occluded. When 1 to 6 pairs of SSAs (without knowledge of AoA location) were ligated, the postoperative neurological deficit risk was 0.6%, as compared with 5.4% when more than 6 bilateral pairs of SSAs were ligated (relative risk [RR] = 0.105, 95% CI 0.013-0.841, P = .0337). For unilateral ligation of SSAs of two to nine levels, the risk of postoperative neurological deficit does not exceed 1.3%. CONCLUSION The current best evidence indicates that (1) occlusion of the AoA and (2) occlusion of up to 6 pairs of SSAs is associated with a low risk of postoperative neurological deficit. This limited number of low quality studies restrict the ability to draw definitive conclusions. Ligation of AoA and SSAs should only be undertaken when absolutely required to mitigate the small but devastating risk of paralysis.
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Affiliation(s)
- Terence Tan
- The Alfred Hospital, Melbourne, Victoria, Australia,National Trauma Research Institute Melbourne, Victoria, Australia
| | | | - Travis Marion
- Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Charles Fisher
- University of British Columbia and Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Jin Tee
- The Alfred Hospital, Melbourne, Victoria, Australia,National Trauma Research Institute Melbourne, Victoria, Australia,Jin Tee, Department of Neurosurgery, Level 1, Old Baker Building, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia.
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13
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D’Oria M, Chiarandini S, Pipitone M, Calvagna C, Ziani B. Coverage of visible intercostal and lumbar segmental arteries can predict the volume of cerebrospinal fluid drainage in elective endovascular repair of descending thoracic and thoracoabdominal aortic disease: a pilot study. Eur J Cardiothorac Surg 2018; 55:646-652. [DOI: 10.1093/ejcts/ezy371] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 09/23/2018] [Accepted: 09/26/2018] [Indexed: 12/22/2022] Open
Affiliation(s)
- Mario D’Oria
- Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Cattinara ASUITs, Trieste, Italy
| | - Stefano Chiarandini
- Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Cattinara ASUITs, Trieste, Italy
| | - Marco Pipitone
- Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Cattinara ASUITs, Trieste, Italy
| | - Cristiano Calvagna
- Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Cattinara ASUITs, Trieste, Italy
| | - Barbara Ziani
- Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Cattinara ASUITs, Trieste, Italy
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Alvarez García L, Vidal Fernández P, García Gimeno MF, González Arranz MA, González González ME, López García D, Tagarro Villalba S, Rodríguez Camarero S. Aortic polyaneurysmal disease: case report. J Thorac Dis 2017; 9:S544-S546. [PMID: 28616352 DOI: 10.21037/jtd.2017.04.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We report a 78-year-old man who presents progression of his aneurysmatic pathology with previous abdominal infrarenal aortic surgery 20 years later. The computed tomography (CT) scan showed proximal degeneration of the infrarenal aorta, left iliac aneurysm and a new descending thoracic aneurysm close to the aortic arch. The surgical treatment was staged in two times due to the evolution of the aneurysm measures. First, the thoracic and the infrarenal aneurysms were covered each one with endoprosthesis. Four years later the iliac disease was solved with a branched specific iliac endograft.
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Affiliation(s)
- Lucas Alvarez García
- Department of Angiology and Vascular/Endovascular Surgery, San Pedro Hospital, Logroño, La Rioja, Spain
| | - Paula Vidal Fernández
- Department of Angiology and Vascular/Endovascular Surgery, San Pedro Hospital, Logroño, La Rioja, Spain
| | | | | | | | - Diego López García
- Department of Angiology and Vascular/Endovascular Surgery, San Pedro Hospital, Logroño, La Rioja, Spain
| | - Salvador Tagarro Villalba
- Department of Angiology and Vascular/Endovascular Surgery, San Pedro Hospital, Logroño, La Rioja, Spain
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15
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Choke E. Commentary on "Development of Collaterals to the Spinal Cord After Endovascular Stent Graft Repair of Thoracic Aneurysms". Eur J Vasc Endovasc Surg 2016; 52:808. [PMID: 27836192 DOI: 10.1016/j.ejvs.2016.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 10/20/2016] [Indexed: 10/20/2022]
Affiliation(s)
- E Choke
- Singapore General Hospital, Academia, 20 College Road, 169856, Singapore.
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