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Isselbacher EM, Preventza O, Hamilton Black J, Augoustides JG, Beck AW, Bolen MA, Braverman AC, Bray BE, Brown-Zimmerman MM, Chen EP, Collins TJ, DeAnda A, Fanola CL, Girardi LN, Hicks CW, Hui DS, Schuyler Jones W, Kalahasti V, Kim KM, Milewicz DM, Oderich GS, Ogbechie L, Promes SB, Ross EG, Schermerhorn ML, Singleton Times S, Tseng EE, Wang GJ, Woo YJ, Faxon DP, Upchurch GR, Aday AW, Azizzadeh A, Boisen M, Hawkins B, Kramer CM, Luc JGY, MacGillivray TE, Malaisrie SC, Osteen K, Patel HJ, Patel PJ, Popescu WM, Rodriguez E, Sorber R, Tsao PS, Santos Volgman A, Beckman JA, Otto CM, O'Gara PT, Armbruster A, Birtcher KK, de Las Fuentes L, Deswal A, Dixon DL, Gorenek B, Haynes N, Hernandez AF, Joglar JA, Jones WS, Mark D, Mukherjee D, Palaniappan L, Piano MR, Rab T, Spatz ES, Tamis-Holland JE, Woo YJ. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: A report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Thorac Cardiovasc Surg 2023; 166:e182-e331. [PMID: 37389507 PMCID: PMC10784847 DOI: 10.1016/j.jtcvs.2023.04.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
AIM The "2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease" provides recommendations to guide clinicians in the diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and long-term surveillance of patients with aortic disease across its multiple clinical presentation subsets (ie, asymptomatic, stable symptomatic, and acute aortic syndromes). METHODS A comprehensive literature search was conducted from January 2021 to April 2021, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through June 2022 during the guideline writing process, were also considered by the writing committee, where appropriate. STRUCTURE Recommendations from previously published AHA/ACC guidelines on thoracic aortic disease, peripheral artery disease, and bicuspid aortic valve disease have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with aortic disease have been developed. There is added emphasis on the role of shared decision making, especially in the management of patients with aortic disease both before and during pregnancy. The is also an increased emphasis on the importance of institutional interventional volume and multidisciplinary aortic team expertise in the care of patients with aortic disease.
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Isselbacher EM, Preventza O, Hamilton Black J, Augoustides JG, Beck AW, Bolen MA, Braverman AC, Bray BE, Brown-Zimmerman MM, Chen EP, Collins TJ, DeAnda A, Fanola CL, Girardi LN, Hicks CW, Hui DS, Schuyler Jones W, Kalahasti V, Kim KM, Milewicz DM, Oderich GS, Ogbechie L, Promes SB, Gyang Ross E, Schermerhorn ML, Singleton Times S, Tseng EE, Wang GJ, Woo YJ. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation 2022; 146:e334-e482. [PMID: 36322642 PMCID: PMC9876736 DOI: 10.1161/cir.0000000000001106] [Citation(s) in RCA: 296] [Impact Index Per Article: 148.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AIM The "2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease" provides recommendations to guide clinicians in the diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and long-term surveillance of patients with aortic disease across its multiple clinical presentation subsets (ie, asymptomatic, stable symptomatic, and acute aortic syndromes). METHODS A comprehensive literature search was conducted from January 2021 to April 2021, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through June 2022 during the guideline writing process, were also considered by the writing committee, where appropriate. Structure: Recommendations from previously published AHA/ACC guidelines on thoracic aortic disease, peripheral artery disease, and bicuspid aortic valve disease have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with aortic disease have been developed. There is added emphasis on the role of shared decision making, especially in the management of patients with aortic disease both before and during pregnancy. The is also an increased emphasis on the importance of institutional interventional volume and multidisciplinary aortic team expertise in the care of patients with aortic disease.
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Affiliation(s)
| | | | | | | | | | | | | | - Bruce E Bray
- AHA/ACC Joint Committee on Clinical Data Standards liaison
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- AHA/ACC Joint Committee on Clinical Practice Guidelines liaison
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3
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Isselbacher EM, Preventza O, Hamilton Black Iii J, Augoustides JG, Beck AW, Bolen MA, Braverman AC, Bray BE, Brown-Zimmerman MM, Chen EP, Collins TJ, DeAnda A, Fanola CL, Girardi LN, Hicks CW, Hui DS, Jones WS, Kalahasti V, Kim KM, Milewicz DM, Oderich GS, Ogbechie L, Promes SB, Ross EG, Schermerhorn ML, Times SS, Tseng EE, Wang GJ, Woo YJ. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2022; 80:e223-e393. [PMID: 36334952 PMCID: PMC9860464 DOI: 10.1016/j.jacc.2022.08.004] [Citation(s) in RCA: 95] [Impact Index Per Article: 47.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AIM The "2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease" provides recommendations to guide clinicians in the diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and long-term surveillance of patients with aortic disease across its multiple clinical presentation subsets (ie, asymptomatic, stable symptomatic, and acute aortic syndromes). METHODS A comprehensive literature search was conducted from January 2021 to April 2021, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through June 2022 during the guideline writing process, were also considered by the writing committee, where appropriate. STRUCTURE Recommendations from previously published AHA/ACC guidelines on thoracic aortic disease, peripheral artery disease, and bicuspid aortic valve disease have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with aortic disease have been developed. There is added emphasis on the role of shared decision making, especially in the management of patients with aortic disease both before and during pregnancy. The is also an increased emphasis on the importance of institutional interventional volume and multidisciplinary aortic team expertise in the care of patients with aortic disease.
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Mezzetto L, Mastrorilli D, Bravo G, Scorsone L, Gennai S, Leone N, D'Oria M, Veraldi E, Veraldi GF. Celiac Artery Coverage After Thoracic Endovascular Aortic Procedure: A Meta-Analysis of Early and Late Results. J Endovasc Ther 2022:15266028221090443. [PMID: 35466769 DOI: 10.1177/15266028221090443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND/AIM Clinical outcomes of celiac artery (CA) coverage during aortic procedures are often contradicting and the fate of this additional maneuver is still unclear. This study summarizes the results of available literature and aims to clarify the impact of CA coverage during thoracic endovascular aneurysm repair (TEVAR) in patients with inadequate distal sealing zone. METHODS Prospective and retrospective, observational original articles focused on CA coverage during elective/urgent TEVAR for descending thoracic aortic pathology (DTAP) were included. PubMed/MEDLINE, Embase, and Cochrane Central Register of Controlled Trials database were examined to identify articles published from January 2007 to December 2020, according to PRISMA guidelines. Early and late visceral (any sign or symptom reported) and neurological (both transient and permanent) complications were considered as primary outcomes. Onset of any endoleak, type IB endoleak, need of reintervention, and TEVAR-related mortality were considered as secondary outcomes. RESULTS A total of 5618 articles were extracted for analysis and 13 studies were finally included in the synthesis. A total of 178 CAs were covered during 2653 TEVAR (7%). Spinal cord ischemia was 8% (95% CI, 5-14%, I2 0%) Any endoleak and type IB endoleak was observed in 12% (95% CI, 6-21%, I2 17%) and 5% (95% CI, 2-11%, I2 0%), respectively. Thoracic endovascular aneurysm repair-related reoperation was necessary in 8% (95% CI, 4-14%, I2 0%), the majority of which (14/18, 78%) performed for distal sealing failure; mortality rate was 9% (95% CI, 5-14%, I2 0%). Out of 178 patients, 168 (94%) were available for follow-up, ranged 12 to 42 months. Visceral complications, any endoleak, and type IB endoleak were identified in 15% (95% CI, 10-23%, I2 45%), 20% (95% CI, 13-29%, I2 8%), and 8% (95% CI, 4-15%, I2 0%), respectively. Thoracic endovascular aneurysm repair-related reintervention was required in 8% (95% CI, 4-14%, I2 0%). Mortality rate was 17% (95% CI, 12-25%, I2 4%). CONCLUSIONS Celiac artery coverage in DTAP should be regarded as a "bailout" procedure especially in urgent/emergent settings but requires caution in elective cases. Even if transient visceral ischemia is frequent, life-threatening complications are rare. Early and late mortality rates are similar to standard TEVAR although the risk of type IB endoleak and reintervention may be an issue.
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Affiliation(s)
- Luca Mezzetto
- Vascular Surgery, Integrated University Hospital of Verona, Verona, Italy
| | - Davide Mastrorilli
- Vascular Surgery, Integrated University Hospital of Verona, Verona, Italy
| | - Giulia Bravo
- Department of Medicine, University of Udine, Udine, Italy
| | - Lorenzo Scorsone
- Vascular Surgery, Integrated University Hospital of Verona, Verona, Italy
| | - Stefano Gennai
- Vascular Surgery, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Nicola Leone
- Vascular Surgery, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Mario D'Oria
- Vascular and Endovascular Surgery, Trieste University Hospital, Trieste, Italy
| | - Edoardo Veraldi
- Vascular Surgery, Integrated University Hospital of Verona, Verona, Italy
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Upchurch GR, Escobar GA, Azizzadeh A, Beck AW, Conrad MF, Matsumura JS, Murad MH, Perry RJ, Singh MJ, Veeraswamy RK, Wang GJ. Society for Vascular Surgery clinical practice guidelines of thoracic endovascular aortic repair for descending thoracic aortic aneurysms. J Vasc Surg 2021; 73:55S-83S. [DOI: 10.1016/j.jvs.2020.05.076] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 05/29/2020] [Indexed: 12/17/2022]
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Mid-Term Results of Thoracic Endovascular Aneurysm Repair with Intentional Celiac Artery Coverage for Crawford Type I Thoracoabdominal Aortic Aneurysms with the TX2 Distal Component Endograft. Ann Vasc Surg 2020; 66:193-199. [DOI: 10.1016/j.avsg.2019.11.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/14/2019] [Accepted: 11/18/2019] [Indexed: 11/22/2022]
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7
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King RW, Gedney R, Ruddy JM, Genovese EA, Brothers TE, Veeraswamy RK, Wooster MD. Occlusion of the Celiac Artery during Endovascular Thoracoabdominal Aortic Aneurysm Repair Is associated with Increased Perioperative Morbidity and Mortality. Ann Vasc Surg 2020; 66:200-211. [PMID: 32035263 DOI: 10.1016/j.avsg.2020.01.102] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/25/2020] [Accepted: 01/26/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Some studies suggest that 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. METHODS The Society for Vascular Surgery Vascular Quality Initiative database was queried for TEVAR and complex EVAR cases from 2012 to 2018. Inclusion criteria included TAAA pathology and endograft extension to aortic zone 6. Patients with aortic rupture, trauma, prior thoracic aortic surgery, known preoperative occlusion of the left subclavian superior mesenteric, or celiac arteries were excluded. Cases with intraoperative celiac artery occlusion (CAO) were compared retrospectively to cases with celiac artery preservation (CAP). Primary outcomes included 30-day mortality and a composite end point of 30-day mortality, spinal cord ischemia (transient or permanent lower extremity neurologic deficit), and bowel ischemia (colonoscopic evidence of ischemia, bloody stools in a patient who dies prior to colonoscopy or laparotomy, or other documented clinical diagnosis). Univariable comparisons were performed using chi-squared tests and Student's t-tests, as appropriate. Multivariable logistic regression analyses were employed to identify independent predictors of outcome. RESULTS There were 628 cases identified for inclusion in the study. Patients undergoing CAO (n = 44) were more likely to be female or to have higher rates of preoperative spinal drain use, American Society of Anesthesiologists score ≥3, low preop hemoglobin, and/or symptomatic presentation, but fewer mean number of aortic zones covered. CAO was associated with higher 30-day mortality (5 of 44, 11%) compared to CAP (23 of 584, 4%), P = 0.039. The composite end point occurred at a significantly greater proportion for those who had CAO (10 of 44, 23%) compared to CAP (53 of 584, 9%, P = 0.008), driven by higher rates of 30-day mortality and bowel ischemia (9% vs. 2%, P = 0.026). By multivariate analysis, CAO was predictive of 30-day mortality (odds ratio [OR] = 3.9, 95% confidence interval [CI] = 1.1-13.8, P = 0.04) and the composite endpoint (OR = 3.0, 95% CI = 1.1-8.5, P = 0.03). Increasing procedure time was also associated with 30-day mortality (OR = 1.4, 95% CI = 1.1-1.7, P < 0.001) and the composite end point (OR = 1.4, 95% CI = 1.1-1.6, P < 0.001). CONCLUSIONS For those treated for TAAAs, CAO was independently predictive of increased 30-day mortality and a composite end point of perioperative mortality, spinal cord ischemia, and bowel ischemia. When treating patients with extensive aortic aneurysmal disease, physicians should attempt to preserve the celiac artery, by revascularization or avoiding ostium coverage, whenever feasible.
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Affiliation(s)
- Ryan W King
- Division of Vascular Surgery, Medical University of South Carolina, Charleston, SC.
| | - Ryan Gedney
- College of Medicine, Medical University of South Carolina, Charleston, SC
| | - Jean Marie Ruddy
- Division of Vascular Surgery, Medical University of South Carolina, Charleston, SC; Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, SC
| | - Elizabeth A Genovese
- Division of Vascular Surgery, Medical University of South Carolina, Charleston, SC; Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, SC
| | - Thomas E Brothers
- Division of Vascular Surgery, Medical University of South Carolina, Charleston, SC; Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, SC
| | - Ravi K Veeraswamy
- Division of Vascular Surgery, Medical University of South Carolina, Charleston, SC
| | - Mathew D Wooster
- Division of Vascular Surgery, Medical University of South Carolina, Charleston, SC
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Current status of endovascular treatment for thoracoabdominal aortic aneurysms. Surg Today 2019; 50:1343-1352. [PMID: 31776776 DOI: 10.1007/s00595-019-01917-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 10/10/2019] [Indexed: 10/25/2022]
Abstract
Open surgical repair (OSR) for thoracoabdominal aortic aneurysms (TAAAs) is maximally invasive and associated with high rates of operative mortality and perioperative complications including spinal cord ischemia (SCI), despite improvements in surgical techniques and perioperative care. Elderly patients, patients with a history of aortic surgery, and patients with severe comorbidities are often considered ineligible for this surgery and endovascular treatment may be their only treatment option. Total endovascular aneurysm repair (t-EVAR) without debranching surgery does not require thoracotomy and laparotomy and could improve the outcomes of these patients. t-EVAR includes fenestrated EVAR (f-EVAR), multi-branched EVAR (b-EVAR), and physician-modified fenestration endograft (PMFG). Although these techniques have achieved lower mortality rates than OSR, there are concerns about perioperative complications including limb ischemia, SCI, and long-term outcomes such as endograft migration and endoleaks (ELs). This article provides an overview of available endovascular devices for TAAAs and reviews the short and mid-term results of t-EVAR, as well as alternative options.
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9
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Mochida Y, Morinaga H, Shimizu Y, Sakamoto T, Miyakuni Y, Kaita Y, Tarui T, Yamaguchi Y. Critical Malperfusion Caused by Central Aortic Repair for Acute Aortic Dissection: A Case Report. Ann Vasc Dis 2019; 12:404-407. [PMID: 31636757 PMCID: PMC6766767 DOI: 10.3400/avd.cr.19-00046] [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] [Indexed: 11/13/2022] Open
Abstract
We encountered a case of hepatic malperfusion resulting from central repair for Stanford type A acute aortic dissection (AAD). A 78-year-old woman had AAD, for which ascending aortic repair was performed. Hepatic malperfusion developed 3 days postoperatively. The superior mesenteric and celiac arteries were occluded by a false lumen (FL). We believed that the surgery caused a change in the blood flow in FL. Percutaneous transluminal angioplasty and stenting of the superior mesenteric artery were performed, and the patient's condition improved. Thus, intervention for the branched artery should be performed prior to central repair, depending on the type of malperfusion.
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Affiliation(s)
- Yuki Mochida
- Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Hiroyuki Morinaga
- Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Yusuke Shimizu
- Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Takaaki Sakamoto
- Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Yasuhiko Miyakuni
- Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Yasuhiko Kaita
- Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Takehiko Tarui
- Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Yoshihiro Yamaguchi
- Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
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Maeda K, Ohki T, Kanaoka Y. Endovascular Treatment of Various Aortic Pathologies: Review of the Latest Data and Technologies. Int J Angiol 2018; 27:81-91. [PMID: 29896040 DOI: 10.1055/s-0038-1645881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The technologies and innovations applicable to endovascular treatment for complex aortic pathologies have progressed rapidly over the last two decades. Although the initial outcomes of an endovascular aortic repair have been excellent, as long-term data became available, complications including endoleaks, endograft migration, and endograft infection have become apparent and are of concern. Previously, the indication for endovascular therapy was restricted to descending thoracic aortic aneurysms and abdominal aortic aneurysms. However, its indication has expanded along with the improvement of techniques and devices, and currently, it has become possible to treat pararenal aortic aneurysms and Crawford type 4 thoracoabdominal aortic aneurysm (TAAA) using the off-the-shelf devices. Additionally, custom-made devices allow for the treatment of arch or more extensive TAAAs. Endovascular treatment is applied not only to aneurysms but also to acute/chronic dissections. However, long-term outcomes are still unclear. This article provides an overview of available devices and the results of endovascular treatment for various aortic pathologies.
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Affiliation(s)
- Koji Maeda
- Division of Vascular Surgery, Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Yuji Kanaoka
- Division of Vascular Surgery, Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
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Bae E, Vo TD. Endovascular Repair of Concomitant Celiac and Splenic Artery Aneurysms Using a Combination of Coil Embolization and Aortic Cuff Stent Graft. Ann Vasc Surg 2017; 42:62.e1-62.e4. [PMID: 28286185 DOI: 10.1016/j.avsg.2016.10.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 08/28/2016] [Accepted: 10/24/2016] [Indexed: 11/29/2022]
Abstract
Large celiac artery aneurysms are associated with a high rupture and mortality risk. Traditionally, open surgical repair has been the mainstay of treatment. Endovascular alternatives have been increasingly described, ranging from coil embolization to exclusion with covered stent grafts. Certain features such as a short wide neck, small vessel diameters, and severe vessel tortuosity can limit these two options. We describe a 75-year-old man with a splenic and celiac trunk aneurysm that was treated using a combination of coil embolization to occlude the outflow artery and aneurysm sac, followed by an aortic stent graft cuff to block the inflow. This resulted in successful exclusion of the splenic and celiac artery aneurysms while preserving flow to both the spleen and liver through collateral pathways.
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Affiliation(s)
- Esther Bae
- Department of General Surgery, Arrowhead Regional and Kaiser Permanente Fontana Medical Centers, Fontana, CA
| | - Trung Duong Vo
- Department of General and Vascular Surgery, Kaiser Permanente Fontana, CA.
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12
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Lajos PS, Marin ML. Thoracic Endovascular Aortic Aneurysm Repair. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Paul S. Lajos
- Icahn School of Medicine at Mount Sinai; New York NY USA
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13
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Emergency Endovascular Interventions for Ruptured Descending Thoracic Aortic Aneurysm. Ann Vasc Surg 2016; 39:160-166. [PMID: 27671448 DOI: 10.1016/j.avsg.2016.06.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 06/17/2016] [Accepted: 06/18/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Ruptured descending thoracic aortic aneurysm (rDAA) is a rare but devastating condition. Open aortic surgery which uses cardiopulmonary bypass is associated with a high mortality. Thoracic endovascular aortic repair (TEVAR) is a less-invasive approach for which it remains unclear whether outcomes are superior or equivalent to open aortic surgery. In this study, we report our early and midterm outcomes with TEVAR for rDAA. METHODS This is an observational, retrospective, single-center study which included patients with rDAA and treated by TEVAR. The main objective was the 30-day in-hospital mortality. Secondary end points were 30-day in-hospital morbidity, 2-year mortality, and technical problems encountered during procedures. RESULTS Twenty-five patients were included: 14 men and 11 women with a median age of 76 years (69-82 years). Thirty-day in-hospital mortality rate was 36% (95% confidence interval [CI], 20.6-57.9; n = 9), and the 2-year mortality rate was 44% (95% CI, 27.94-66.72; n = 11). Fifteen patients (60%) presented at least 1 major complication, and 8 of those patients had a second surgery because of it. There were 9 technical problems encountered that required additional open procedures to successfully deploy the aortic stent graft: lack of vascular access in 2 cases (8%), short proximal neck in 3 cases (12%), and short distal neck in 4 cases (16%). CONCLUSIONS Mortality and morbidity remain high in patients treated for rDAA by TEVAR. Nonetheless, TEVAR remains an interesting alternative to open aortic surgery especially for older patients with a poor general health and functional status.
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14
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Preoperative Diagnostic Angiogram and Endovascular Aortic Stent Placement for Appleby Resection Candidates: A Novel Surgical Technique in the Management of Locally Advanced Pancreatic Cancer. HPB SURGERY : A WORLD JOURNAL OF HEPATIC, PANCREATIC AND BILIARY SURGERY 2015; 2015:523273. [PMID: 26491217 PMCID: PMC4600866 DOI: 10.1155/2015/523273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 08/01/2015] [Accepted: 08/26/2015] [Indexed: 11/18/2022]
Abstract
Background. Pancreatic adenocarcinoma of the body and tail usually presents late and is typically unresectable. The modified Appleby procedure allows resection of pancreatic body carcinoma with celiac axis (CA) invasion. Given that the feasibility of this technique is based on the presence of collateral circulation, it is crucial to confirm the presence of an anatomical and functional collateral system. Methods. We here describe a novel technique used in two patients who were candidates for Appleby resection. We present their clinical scenario, imaging, operative findings, and postoperative course. Results. Both patients had a preoperative angiogram for assessment of anatomical circulation and placement of an endovascular stent to cover the CA. We hypothesize that this new technique allows enhancement of collateral circulation and helps minimize intraoperative blood loss when transecting the CA at its takeoff. Moreover, extra length on the CA margin may be gained, as the artery can be transected at its origin without the need for vascular clamp placement. Conclusion. We propose this novel technique in the preoperative management of patients who are undergoing a modified Appleby procedure. While further experience with this technique is required, we believe that it confers significant advantages to the current standard of care.
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Abstract
The development of thoracic endovascular aortic repair (TEVAR) has allowed a minimally invasive approach for management of an array of thoracic aortic pathologies. Initially developed specifically for exclusion of thoracic aortic aneurysms, TEVAR is now used as an alternative to open surgery for a variety of disease pathologies due to the lower morbidity of this approach. Advances in endograft technology continue to broaden the applications of this technique.
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Affiliation(s)
- David A Nation
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania
| | - Grace J Wang
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania
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16
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Rose MK, Pearce BJ, Matthews TC, Patterson MA, Passman MA, Jordan WD. Outcomes after celiac artery coverage during thoracic endovascular aortic aneurysm repair. J Vasc Surg 2015; 62:36-42. [DOI: 10.1016/j.jvs.2015.02.026] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 02/12/2015] [Indexed: 10/23/2022]
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Ayad M, Senders ZJ, Ryan S, Abai B, DiMuzio P, Salvatore DM. Chronic Mesenteric Ischemia after Partial Coverage of the Celiac Artery during TEVAR, Case Report, and Review of the Literature. Ann Vasc Surg 2014; 28:1935.e1-6. [DOI: 10.1016/j.avsg.2014.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 07/23/2014] [Accepted: 08/01/2014] [Indexed: 10/24/2022]
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18
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Ito T, Yasuda N, Kuroda Y, Sugawara M, Koyanagi T, Higami T. Acute gallbladder necrosis in a patient with acute type B aortic dissection. Ann Vasc Dis 2013; 6:748-50. [PMID: 24386028 DOI: 10.3400/avd.cr.13-00077] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 09/27/2013] [Indexed: 11/13/2022] Open
Abstract
Although vascular complications induced by acute aortic dissection are varied and common, gallbladder necrosis induced by acute aortic dissection is rare. We experienced the case of a 42-year-old woman who suffered from acute gallbladder necrosis that occurred the following day after the onset of acute type B aortic dissection. Contrasted computed tomography, which showed the thickened wall of the gallbladder and the pericholecystic fluid, as well as the occluded celiac artery, was an effective diagnostic procedure. We performed cholecystectomy and revascularization of the celiac artery using autologous saphenous vein. Her postoperative course was uneventful, and she was discharged after 20 postoperative days.
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Affiliation(s)
- Toshiro Ito
- Department of Cardiovascular Surgery, Sapporo Medical University, School of Medicine, Sapporo, Hokkaido, Japan
| | - Naomi Yasuda
- Department of Cardiovascular Surgery, Sapporo Medical University, School of Medicine, Sapporo, Hokkaido, Japan
| | - Yohsuke Kuroda
- Department of Cardiovascular Surgery, Sapporo Medical University, School of Medicine, Sapporo, Hokkaido, Japan
| | - Motoshi Sugawara
- Department of Cardiovascular Surgery, Sapporo Medical University, School of Medicine, Sapporo, Hokkaido, Japan
| | - Tetsuya Koyanagi
- Department of Cardiovascular Surgery, Sapporo Medical University, School of Medicine, Sapporo, Hokkaido, Japan
| | - Tetsuya Higami
- Department of Cardiovascular Surgery, Sapporo Medical University, School of Medicine, Sapporo, Hokkaido, Japan
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19
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Li M, Shu C, Li QM, Wang T, Fang K, Wang ZG. Midterm Results of Intentional Celiac Artery Coverage During TEVAR for Type B Aortic Dissection. J Endovasc Ther 2013; 20:276-82. [DOI: 10.1583/12-4176mr-r.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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20
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Balloon-assisted coil embolization of the celiac trunk before endovascular aortic repair of thoracoabdominal aortic aneurysm. Jpn J Radiol 2013; 31:215-9. [PMID: 23315017 DOI: 10.1007/s11604-012-0167-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2012] [Accepted: 11/07/2012] [Indexed: 12/13/2022]
Abstract
PURPOSE Celiac trunk coil embolization before thoracic endovascular aneurysm repair (TEVAR) of a thoracoabdominal aortic aneurysm involving the celiac trunk can prevent type II endoleaks. One disadvantage of conventional coil embolization is the risk of coil displacement. We performed coil embolization under balloon occlusion of the celiac trunk to address this issue. MATERIALS AND METHODS Between December 2008 and January 2011, 5 patients (3 men and 2 women, mean age 76 years) were included in this study. For all patients, after confirming the collateral blood flow from the superior mesenteric artery via the pancreaticoduodenal arcades by using the balloon occlusion test, celiac trunk coil embolization proceeded under balloon occlusion of the proximal part of the celiac trunk. RESULTS Balloon-assisted coil embolization of the celiac trunk was completed for all patients without any complications. All coils were deployed as planned in the short segment of the celiac trunk without displacement. Coil migration, ischemic complications, and endoleaks via the celiac trunk did not arise in any of the patients over a follow-up period of 77-637 (mean 258) days. CONCLUSIONS Balloon-assisted coil embolization of the celiac trunk before TEVAR could be a feasible treatment option for suitable patients.
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Alric P, Canaud L, Branchereau P, Marty-Ane C. Traitement endovasculaire des anévrismes de l’aorte thoracique descendante. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/s0246-0459(12)43886-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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22
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Planer D, Bliagos D, Gray WA. Redo thoracic endovascular aortic repair due to endoleak with celiac artery snorkeling. Ann Vasc Surg 2011; 25:979.e1-5. [PMID: 21835581 DOI: 10.1016/j.avsg.2011.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Revised: 04/08/2011] [Accepted: 05/15/2011] [Indexed: 10/17/2022]
Abstract
Reintervention due to endoleak of aortic endograft repair is often challenging. Herein, we report endovascular endoleak repair in a patient with previous thoracic and abdominal endovascular grafts with extensive coverage of the aorta. The present technique included snorkeling of the celiac trunk to preserve antegrade flow in the celiac artery and to maintain future options for reintervention.
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Affiliation(s)
- David Planer
- Center for Interventional Vascular Therapy, Division of Cardiology, Columbia University Medical Center, New York, NY 10032, USA.
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23
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Burdick TR, Hoffer EK, Kooy T, Ghodke B, Starnes BW, Valji K, Goldberg S, Hallam D, Andrews RT. Which Arteries Are Expendable? The Practice and Pitfalls of Embolization throughout the Body. Semin Intervent Radiol 2011; 25:191-203. [PMID: 21326510 DOI: 10.1055/s-0028-1085925] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This article outlines general concepts of, and strategies for, therapeutic embolization throughout the body, touching on all major arterial distributions. Clinical scenarios that allow or prevent safe embolization of vessels are presented. Specific agents are recommended where appropriate, as are alternate approaches when embolization is not an option. Pre-embolization precautions and adjunctive measures are described in high-risk areas.
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Affiliation(s)
- Thomas R Burdick
- Department of Radiology, University of Washington, Seattle, Washington
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24
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Abstract
The emergence of endovascular repair of the thoracic aorta (TEVAR) quickly followed the development of technology for the exclusion of infrarenal abdominal aortic aneurysms. Stent grafts comprised of metal struts covered with fabric made of Dacron/polyester or polytetrafluoroethylene were developed for the purpose of achieving an adequate seal at the proximal and distal aspects of thoracic aneurysms, thus excluding sac flow. The recognition of the decreased morbidity of this approach compared with open repair was readily apparent, as it avoided left thoracotomy, aortic cross-clamping, and left heart bypass. Since then, TEVAR is increasingly being used for other aortic pathologies such as complicated type B dissection, traumatic aortic transection, and aneurysmal disease extending into the arch or visceral segment, requiring debranching procedures.
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Affiliation(s)
- Grace J Wang
- Division of Vascular Surgery and Endovascular Therapy, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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25
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Belli AM, Markose G, Morgan R. The role of interventional radiology in the management of abdominal visceral artery aneurysms. Cardiovasc Intervent Radiol 2011; 35:234-43. [PMID: 21674280 DOI: 10.1007/s00270-011-0201-3] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Accepted: 05/22/2011] [Indexed: 12/14/2022]
Abstract
Abdominal visceral artery aneurysms (VAA) include true and false aneurysms. The majority are asymptomatic and are discovered on cross-sectional imaging performed for unrelated clinical indications. With the maturation of techniques and devices used for embolization procedures and the treatment of aneurysms in other locations, most VAAs are now suitable for treatment by minimally invasive transcatheter techniques. The choice of technique used greatly depends on the local anatomy of the VAA and the experience of the interventional radiologist in complex vascular interventional techniques.
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26
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Baril DT, Cho JS, Chaer RA, Makaroun MS. Thoracic aortic aneurysms and dissections: endovascular treatment. ACTA ACUST UNITED AC 2011; 77:256-69. [PMID: 20506451 DOI: 10.1002/msj.20178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The treatment of thoracic aortic disease has changed radically with the advances made in endovascular therapy since the concept of thoracic endovascular aortic repair was first described 15 years ago. Currently, there is a diverse array of endografts that are commercially available to treat the thoracic aorta. Multiple studies, including industry-sponsored and single-institution reports, have demonstrated excellent outcomes of thoracic endovascular aortic repair for the treatment of thoracic aortic aneurysms, with less reported perioperative morbidity and mortality in comparison with conventional open repair. Additionally, similar outcomes have been demonstrated for the treatment of type B dissections. However, the technology remains relatively novel, and larger studies with longer term outcomes are necessary to more fully evaluate the role of endovascular therapy for the treatment of thoracic aortic disease. This review examines the currently available thoracic endografts, preoperative planning for thoracic endovascular aortic repair, and outcomes of thoracic endovascular aortic repair for the treatment of both thoracic aortic aneurysms and type B aortic dissections. Mt Sinai J Med 77:256-269, 2010. (c) 2010 Mount Sinai School of Medicine.
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Affiliation(s)
- Donald T Baril
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
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27
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Sachdev-Ost U. Visceral artery aneurysms: review of current management options. ACTA ACUST UNITED AC 2011; 77:296-303. [PMID: 20506455 DOI: 10.1002/msj.20181] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Visceral artery aneurysms are relatively rare clinical entities, although their detection is rising due to an increased use of cross-sectional imaging. Rupture is the most devastating complication, and is associated with a high morbidity and mortality. For this reason, elective repair is preferable in the appropriately chosen patient. In general, splenic artery aneurysms measuring 2 cm or larger and those found in women of childbearing age and in persons undergoing liver transplantation should be treated. Hepatic artery aneurysms 2 cm or larger and those that are multiple or nonatherosclerotic in nature should be repaired in the appropriate patient due to a higher risk of rupture. Endovascular coil embolization has excellent success rates and is the first-line treatment for anatomically suitable splenic artery aneurysms and intrahepatic hepatic artery aneurysms. However, reperfusion is an important complication of endovascular management. Aneurysms involving the celiac, superior mesenteric, pancreaticoduodenal, gastroduodenal, and inferior mesenteric arteries, as well as visceral artery pseudoaneurysms, are unpredictable and should be repaired in the appropriate medical patient. These aneurysms are often amenable to ligation due to the presence of collateral circulation. Endovascular management is particularly useful in the treatment of pseudoaneurysms where comorbidities and previous surgery make open surgical repair less desirable. Mt Sinai J Med 77:296-303, 2010. (c) 2010 Mount Sinai School of Medicine.
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Delle M, Lönn L, Henrikson O, Formgren J, Vogt K, Falkenberg M. Celiac trunk coverage in endovascular aneurysm repair. Scand J Surg 2011; 99:226-9. [PMID: 21159593 DOI: 10.1177/145749691009900409] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS This retrospective study was undertaken to examine the risks associated with obstruction of the coeliac trunk in the process of treating aneurysms with endografting. MATERIAL AND METHODS 120 patients were treated by endografting for aneurysmal disease. Of these, a subgroup of 9 patients had their celiac trunk covered. If possible, a preoperative angiography was performed to evaluate collateral flow from the superior mesenteric artery. This was considered to predict the risk for ischemia. RESULTS None of the patients had any severe clinical event of the celiac trunk occlusion or clinical signs of intestinal ischemia. Three patients had transient increase of liver enzymes. CONCLUSIONS In cases where the distal landing zone of the descending thoracic aorta is to short for endografting, covering of the celiac trunk may be an option if no other surgical alter-native is apparent. Preoperative angiography to visualise the presence of collateral vessels from the superior mesenteric artery is recommended.
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Affiliation(s)
- M Delle
- Department of Radiology, Södersjukhuset, Stockholm, Sweden
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29
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Tholpady A, Hendricks DE, Bozlar U, Turba UC, Sabri SS, Angle JF, Arslan B, Cherry KJ, Dake MD, Matsumoto AH, Saad WEA, Park AW, Bonatti H, Hagspiel KD. Percutaneous occlusion of the left subclavian and celiac arteries before or during endograft repair of thoracic and thoracoabdominal aortic aneurysms with detachable nitinol vascular plugs. J Vasc Interv Radiol 2011; 21:1501-7. [PMID: 20801685 DOI: 10.1016/j.jvir.2010.05.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Revised: 05/14/2010] [Accepted: 05/19/2010] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To review an experience with the Amplatzer vascular plug (AVP) for prevention of type II endoleaks during endovascular aneurysm repair (EVAR) of thoracic and thoracoabdominal aneurysms. MATERIALS AND METHODS Retrospective review was undertaken of 14 patients undergoing transcatheter occlusion of the left subclavian (n = 12) or celiac artery (n = 2) with the AVP as part of EVAR of thoracic and thoracoabdominal aneurysms at a single institution. Procedural criteria evaluated were success at target vessel occlusion, the number of AVPs used, use of adjunctive embolization devices, and embolization-related ischemic end-organ events. Follow-up imaging criteria included evaluation of persistent target vessel occlusion, evidence of device migration, and the presence and characterization of endoleak secondary to AVP failure. RESULTS Complete target vessel occlusion was documented for all cases. In six cases, more than one AVP was placed, with an average of 1.5 devices per patient. In two cases, adjunctive coils were placed. Computed tomographic or magnetic resonance angiography follow-up was available for all patients (mean follow-up, 419 days; range 28-930 d). No case showed evidence of device migration or type II endoleak resulting from AVP failure. There was a single instance of left subclavian artery recanalization without type II endoleak. There were no embolization-related ischemic end-organ events. CONCLUSIONS Transcatheter arterial occlusion of the subclavian and celiac arteries with the AVP is a valuable adjunct to endografting in cases in which side branch embolization is necessary to extend the landing zone.
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Affiliation(s)
- Ashok Tholpady
- Department of Radiology, University of Virginia Health System, Box 800170, Lee Street, Charlottesville, VA 22908, USA
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Heye S, Vaninbroukx J, Daenens K, Maleux G. Transcatheter embolization of a type II endoleak after hybrid repair for thoracoabdominal aortic aneurysm. J Vasc Interv Radiol 2011; 22:379-84. [PMID: 21277795 DOI: 10.1016/j.jvir.2010.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Revised: 10/12/2010] [Accepted: 11/04/2010] [Indexed: 10/18/2022] Open
Abstract
Hybrid stent-graft procedures with visceral revascularization have been reported as an alternative treatment option for thoracoabdominal aortic aneurysms (TAAAs), although the potential advantages of reduced morbidity and mortality compared with open surgical repair have not been definitively demonstrated. Endovascular aneurysm repair is associated with endoleaks in as many as 20% of cases in some series, often requiring repeat intervention. In the present case, during follow-up after a hybrid TAAA repair, a patient developed a type II endoleak originating from a celiac artery that was not ligated at its origin. The endoleak was successfully treated by transcatheter coil embolization.
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Affiliation(s)
- Sam Heye
- Department of Radiology, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium.
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31
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Srivastava SD. Visceral reconstruction techniques. J Vasc Surg 2010; 52:82S-5S. [PMID: 20875615 DOI: 10.1016/j.jvs.2010.06.150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Revised: 06/19/2010] [Accepted: 06/21/2010] [Indexed: 10/19/2022]
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32
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Outcomes of planned celiac artery coverage during TEVAR. J Vasc Surg 2010; 52:1153-8. [DOI: 10.1016/j.jvs.2010.06.105] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Revised: 06/14/2010] [Accepted: 06/17/2010] [Indexed: 11/18/2022]
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Brinster CJ, Szeto WY, Bavaria JE, Woo EY, Fairman RM, Jackson BM. Endovascular repair of extent I thoracoabdominal aneurysms with landing zone extension into the aortic arch and mesenteric portion of the abdominal aorta. J Vasc Surg 2010; 52:460-3. [PMID: 20541342 DOI: 10.1016/j.jvs.2010.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Revised: 03/04/2010] [Accepted: 03/05/2010] [Indexed: 11/30/2022]
Abstract
Thoracic endovascular aortic repair (TEVAR) has emerged as an alternative for patients at prohibitive risk for open thoracic or thoracoabdominal surgery, decreasing perioperative morbidity and mortality. Aneurysms that involve both the left subclavian artery (LSA) proximally and the celiac artery (CA) distally present a unique challenge to the use of TEVAR. We report a series of six high-risk patients presenting with extent I thoracoabdominal aortic aneurysms who were successfully treated with TEVAR including coverage of the LSA and the CA.
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Affiliation(s)
- Clayton J Brinster
- Division of Vascular Surgery and Endovascular Therapy, Hospital of the University of Pennsylvania, Philadelphia, Pa 19104, USA.
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Da Rocha M, Riambau VA. Experience with a Scalloped Thoracic Stent Graft: A Good Alternative to Preserve Flow to the Celiac and Superior Mesenteric Arteries and to Improve Distal Fixation and Sealing. Vascular 2010; 18:154-60; discussion 161. [DOI: 10.2310/6670.2010.00036] [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 endografting has been proposed as an effective alternative to open repair to treat several aortic pathologies. Cranial migration is one of the critical issues concerning long-term durability. The scalloped thoracic endograft was proposed to improve distal sealing and fixation crossing the diaphragm. The objective of this study was to evaluate technical feasibility and experience with a custom-made scalloped thoracic endograft using the Relay platform (Bolton Medical, Sunrise, FL) in selected cases. From January 2006 to June 2009, 57 patients (40 men) were treated in Europe with a customized distal scalloped thoracic endograft. Forty-five patients presented with thoracic aortic aneurysm, nine presented with type B dissection, and three had a pseudoaneurysm. Successful and accurate deployment was achieved in all cases except one partial rotation in an extremely tortuous anatomy. Technical success was achieved in 96.4%. Good sealing and no mortality, paraplegia, or visceral embolization were observed. At a mean follow-up of 6 months, no complications were registered. The Relay endograft with the distal scallop represents a feasible alternative for distal short necks. This approach may increase the applicability and durability of the endograft in short distal necks.
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Affiliation(s)
- Marcio Da Rocha
- *Thorax Institute, Division of Vascular Surgery, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Vicent A. Riambau
- *Thorax Institute, Division of Vascular Surgery, Hospital Clinic, University of Barcelona, Barcelona, Spain
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Shu C, He H, Li QM, Li M, Jiang XH, Li X. Endovascular percutaneous treatment of tuberculous pseudo-aneurysm involving the coeliac artery: a case report. Eur J Vasc Endovasc Surg 2010; 40:230-3. [PMID: 20399125 DOI: 10.1016/j.ejvs.2010.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Accepted: 03/02/2010] [Indexed: 10/19/2022]
Abstract
Pseudo-aneurysms involving the coeliac artery caused by tuberculosis infection are extremely rare and are highly susceptible to rupture.(1) It's difficult to make the correctly diagnosis preoperative and select reconstructive procedures. We report a case of tuberculous pseudo-aneurysm in the abdominal aorta involving the coeliac artery. The active phase of the tuberculous makes it impossible to perform open surgery, so endovascular percutaneous treatment was performed, inflow to the pseudo-aneurysm was excluded by placing a custom-made stent graft at the coeliac artery orifice. The patient recovered very well and was prescribed anti-tuberculosis treatment for up to 6 months. Endovascular repair for tuberculous pseudo-aneurysm may be a life-saving option, covering the coeliac artery with stent graft is considered safe and suitable.
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Affiliation(s)
- C Shu
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Middle Ren-Min Road No 139, Changsha, Hunan 410011, China.
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Abstract
Adequate seal at the proximal and distal extent of stent grafts in the aorta is paramount to the success of thoracic endovascular aortic repair (TEVAR). Thoracoabdominal aneurysms pose a formidable challenge given their extension into the arch branches proximally and the visceral segment distally. Extension of the landing zone of even 3 to 5 mm can possibly increase the durability of the stent graft and may decrease the chances of future migration or collapse. Although coverage of the subclavian artery to extend the proximal landing zone has been met with initial success, the outcome of coverage of the celiac axis in order to extend the distal landing zone has not been as well studied. Because of the abundance of rich collateral vessels in the foregut, it has been perceived as a potentially safe practice. However, careful angiographic anatomic delineation and patient selection is vital to determine whether concomitant revascularization procedures are warranted.
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Affiliation(s)
- Atul S Rao
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15232, USA
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Celiac Trunk Embolization, as a Means of Elongating Short Distal Descending Thoracic Aortic Aneurysm Necks, Prior to Endovascular Aortic Repair. Cardiovasc Intervent Radiol 2009; 32:923-7. [DOI: 10.1007/s00270-009-9602-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2009] [Revised: 04/09/2009] [Accepted: 04/23/2009] [Indexed: 10/20/2022]
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38
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Ishibashi H, Ishiguchi T, Ohta T, Sugimoto I, Kawanishi J, Yamada T, Hida N, Kamei S. Endovascular repair for a descending thoracic aortic aneurysm with a stent-graft covering the celiac artery: report of two cases. Surg Today 2009; 39:518-22. [PMID: 19468809 DOI: 10.1007/s00595-008-3868-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2008] [Accepted: 10/30/2008] [Indexed: 10/20/2022]
Abstract
An adequate landing zone for fixation and sealing is necessary for endovascular aneurysm repair (EVAR). This report presents two cases of a successful EVAR for thoracic aortic aneurysms (TAA) with a stent-graft covering the celiac artery (CA) to secure a distal landing zone. Case 1 was a 61-year-old man with a chronic traumatic descending TAA 12 mm away from the CA. Case 2 was a 79-year-old man with a descending TAA proximal to the CA. Preoperative angiography and computed tomography (CT) scan revealed a normal visceral blood flow including the peripancreatic arteries. Endovascular aneurysm repair with coverage of the CA was performed in both cases. Angiography after the EVAR demonstrated good blood flow to the CA branches via the peripancreatic arteries and a CT scan showed thrombosed aneurysms. Both patients were discharged without any abdominal symptoms. Endovascular aneurysm repair with a stent-graft covering the CA may therefore be an acceptable endovascular approach in treating selected TAA patients with a limited distal landing zone.
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Affiliation(s)
- Hiroyuki Ishibashi
- Department of Vascular Surgery, Aichi Medical University, Nagakute, Aichi, 480-1195, Japan
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Shimazaki T, Kawaguchi S, Yokoi Y, Koide K, Matsumoto M, Shigematsu H. Celiac artery coverage after occlusion test during endovascular stent grafting for thoracoabdominal aortic aneurysm. J Thorac Cardiovasc Surg 2009; 139:e59-62. [PMID: 19660334 DOI: 10.1016/j.jtcvs.2008.11.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Revised: 10/28/2008] [Accepted: 11/19/2008] [Indexed: 10/21/2022]
Affiliation(s)
- Taro Shimazaki
- Department of Vascular Surgery, Tokyo Medical University, Tokyo, Japan
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40
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McDonnell CO, Haider SN, Colgan MP, Shanik GD, Moore DJ, Madhavan P. Endovascular management of thoracic aortic pathology. Surgeon 2009; 7:24-30. [PMID: 19241982 DOI: 10.1016/s1479-666x(09)80063-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Endovascular technology has revolutionised the management of abdominal aortic aneurysmal disease but the less frequent occurrence of pathology in the thoracic aorta has meant that evidence demonstrating the primacy of endovascular treatment strategies in this portion of the vessel is less convincing. Herein we summarise the best available evidence to date. METHODS A comprehensive search of the surgical and radiological literature using the search term 'endovascular thoracic aorta' was conducted. FINDINGS AND CONCLUSIONS The vast majority of patients treated by thoracic aortic stent grafting have had their treatment outside the context of a randomised trial. While it would seem that endovascular repair is the treatment of choice for the thoracic aorta, the present evidence is based on single centre case series and is anecdotal at best.
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Affiliation(s)
- C O McDonnell
- Department ofVascular Surgery, Mater Misericordiae University Hospital, Dublin, Ireland.
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Hyhlik-Dürr A, Geisbüsch P, von Tengg-Kobligk H, Klemm K, Böckler D. Intentional Overstenting of the Celiac Trunk During Thoracic Endovascular Aortic Repair: Preoperative Role of Multislice CT Angiography. J Endovasc Ther 2009; 16:48-54. [DOI: 10.1583/08-2549.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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42
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Aneurisma de aorta torácica con cuello distal corto: técnica para aumentar la zona de sellado. A propósito de un caso. ANGIOLOGIA 2009. [DOI: 10.1016/s0003-3170(09)12006-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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43
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Afifi R, Salamon T, Manhaim D, Kvasha V, Karmeli R. Endovascular repair of ruptured aortic penetrating ulcer via carotid artery. Ann Vasc Surg 2008; 23:536.e1-3. [PMID: 18945583 DOI: 10.1016/j.avsg.2008.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2008] [Revised: 09/07/2008] [Accepted: 09/08/2008] [Indexed: 11/18/2022]
Affiliation(s)
- R Afifi
- Department of Vascular and Endovascular Surgery, Carmel Medical Center, Haifa, Israel.
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Leon LR, Mills JL, Jordan W, Morasch MM, Kovacs M, Becker GJ, Arslan B. The Risks of Celiac Artery Coverage During Endoluminal Repair of Thoracic and Thoracoabdominal Aortic Aneurysms. Vasc Endovascular Surg 2008; 43:51-60. [DOI: 10.1177/1538574408322655] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The risks of purposeful celiac artery coverage during endovascular thoracic aortic aneurysm repair (TEVAR) to obtain an adequate distal landing zone have received scant scientific attention. Patients undergoing TEVAR at 6 tertiary centers from January 2000 to June 2007 were identified (n = 434); cases requiring celiac artery exclusion (n = 19; 4.4% of the total) were analyzed. The mean follow-up was 8.7 months (range, 0.2-21.2). The mean patients' age was 73.6 years (range, 56-86); 57.9% were men. The mean aneurysm diameter was 6.7 cm (range, 5-8.6). In 2 patients, the celiac artery balloon occlusion test was performed prior to TEVAR. In both, intact collateral foregut circulation was seen. Both underwent TEVAR without celiac artery revascularization; 1 did well, whereas the other developed foregut ischemia. In 16 cases (84.2%), the celiac artery was not revascularized prior to TEVAR. In those patients, 19 complications were reported (3 deaths; 2 paraplegia). No similar events occurred in those who underwent celiac artery revascularization (n = 3). Celiac artery coverage during TEVAR is required in 4.4% of cases. TEVAR correlated with a nonnegligible number of major complications. Complications were more frequent and severe in patients who did not have celiac artery revascularization prior to TEVAR. Specific celiac artery coverage complications are rare and not readily predictable based on preprocedure arteriography.
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Affiliation(s)
- Luis R. Leon
- Southern Arizona Veterans Affairs Health Care System (SAVAHCS), Tucson, Arizona, , University of Arizona Health Science Center (AHSC), Tucson, Arizona
| | - Joseph L. Mills
- University of Arizona Health Science Center (AHSC), Tucson, Arizona, Southern Arizona Veterans Affairs Health Care System (SAVAHCS), Tucson, Arizona
| | | | | | - Margaret Kovacs
- Baptist Cardiac & Vascular Institute of Miami, Miami, Florida
| | - Gary J. Becker
- Southern Arizona Veterans Affairs Health Care System (SAVAHCS), Tucson, Arizona, University of Arizona Health Science Center (AHSC), Tucson, Arizona
| | - Bulent Arslan
- University of Virginia Health System, Charlottesville, Virginia
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45
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Libicher M, Reichert V, Aleksic M, Brunkwall J, Lackner KJ, Gawenda M. Balloon Occlusion of the Celiac Artery: A Test for Evaluation of Collateral Circulation Prior Endovascular Coverage. Eur J Vasc Endovasc Surg 2008; 36:303-5. [DOI: 10.1016/j.ejvs.2008.04.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2007] [Accepted: 04/13/2008] [Indexed: 10/22/2022]
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46
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Waldenberger P, Bendix N, Petersen J, Tauscher T, Glodny B. Clinical outcome of endovascular therapeutic occlusion of the celiac artery. J Vasc Surg 2007; 46:655-61. [PMID: 17764875 DOI: 10.1016/j.jvs.2007.05.033] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2007] [Accepted: 05/10/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Endovascular occlusion of the celiac artery can be performed along with occlusion of a celiac trunk aneurysm or stenting of a thoracoabdominal aortic aneurysm to prevent a type II endoleak. Because only a few individual cases have been previously available for study, the aim of this study was to examine the technical details, clinical course, and outcome of this procedure based on a group of patients. METHODS This retrospective study included 10 patients who underwent endovascular occlusion of the celiac artery between 1998 and 2006 (female/male = 1:4, mean age, 62.5 +/- 9.8 years). There were five aneurysms of the celiac artery, two cases each of thoracoabdominal aortic aneurysms and dissecting thoracoabdominal aortic aneurysms, and one mycotic pseudoaneurysm of the aorta. The mean follow-up period was 21.4 +/- 29.1 months. RESULTS The celiac artery was successfully occluded in all cases, along with exclusion of the celiac artery aneurysm or thoracoabdominal aortic aneurysm, respectively. The pancreaticoduodenal arteries were the main collateral pathways, but other anastomoses and, especially, vascular variations of the celiac artery and its territory were also significant. In one patient, abdominal angina was treated by percutaneous angioplasty and stenting of the superior mesenteric artery. CONCLUSIONS Endovascular occlusion of the celiac artery is both safe and feasible. Some vascular variations may make occlusion of the celiac trunk impossible. Liver function disorder is a relative contraindication for this procedure.
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Affiliation(s)
- Peter Waldenberger
- Department of Radiology, Innsbruck Medical University, Innsbruck, Austria.
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