To evaluate the early and midterm outcomes after stent-graft implantation for dissection in the descending thoracic aorta.
Sixteen custom-made endovascular stent-grafts were implanted in 15 patients (10 men; mean age 55.9 +/- 13.7 years, range 32-82) with descending thoracic aortic dissection. Indications for stent-graft implantation were persistent symptoms unresponsive to medical treatment or progressive enlargement of the false lumen. Clinical and imaging surveillance with computed tomography was performed within 1 month of the procedure and at 3 to 6-month intervals in follow-up.
Endovascular stent-graft implantation at the target site was successful in 14 (93%) patients; 1 device migrated, leaving the false lumen open to flow in the failed case. One (7%) patient who was treated emergently for rupture died suddenly 2 days after the procedure. Over an average follow-up of 31.5 +/- 23.8 months, 1 (7%) patient died and 2 (14%) patients underwent surgical treatment due to recurrent dissection. The remaining 10 patients showed complete thrombosis of the false lumen; in 3, the false lumen completely resolved.
Endovascular stent-graft implantation in descending thoracic aortic dissection is a feasible, safe, and effective treatment modality. However, further studies are necessary in a greater number of patients to determine if wider application of this minimally invasive procedure is justified.
"The introduction of endovascular repair which was described as a less invasive method of treating descending thoracic aortic disease was a significant advance in the care of these high risk patients. Shim et al. (12) reported the feasibility and safety of stent-grafting type B dissections with a 93% technical success rate (13). White et al. recently reported acceptable 30-day and 1 year mortality and morbidity rates after emergency TEVAR for complicated type B aortic dissections (i.e. "
[Show abstract][Hide abstract] ABSTRACT: This study aimed to assess the surgical morbidity and mortality of thoracic endovascular repair (TEVAR) as compared with open surgical repair (OSR) for isolated descending thoracic aortic disease.
From January 1, 2006 through May 31, 2010, a total of 68 patients with isolated descending thoracic aortic disease were retrospectively reviewed for the presence of perioperative complication, 30-day mortality, and clinical success. The patients were divided into two groups (group 1, OSR, n = 40 vs. group 2, TEVAR, n = 28) and these groups were compared for major variables and late outcomes.
The mean age was 58 years (group I = 54 vs. group II = 63 years, p = 0.011). Significant perioperative complications occurred in 12 patients: 8 (20%) in group I and 4 (13%) in group II (p = 0.3). There were five 30 day mortalities of which 4 occurred in group I and 1 in group II (p = 0.23). Clinical success (effective aortic remodeling and complete false lumen obliteration or thrombosis) was achieved in 20 patients (71%). Mean Kaplan-Meier survival rate at 1 year was similar for both groups (group 1 = 87% vs. group 2 = 80%, p = 0.65).
Thoracic endovascular repair for isolated thoracic aortic disease shows comparable results to OSR. However, the potential for endoleak or rupture remains a challenge that needs to be addressed in the future. Therefore, close follow-up study is needed for the evaluation of satisfactory long-term outcomes.
Korean journal of radiology: official journal of the Korean Radiological Society 07/2012; 13(4):476-82. DOI:10.3348/kjr.2012.13.4.476 · 1.57 Impact Factor
". Its application has also been extended to various thoracic aortic pathologies including aneurysm , trauma  and dissection . Its use in mycotic aneurysms is controversial because of the concern of stent-graft infection. "
[Show abstract][Hide abstract] ABSTRACT: Salmonella mycotic thoracic aortic aneurysm is a rare but life-threatening condition. We report a 59-year-old man with two Salmonella mycotic thoracic aortic aneurysms, presented with fever and chills associated with hoarseness due to left vocal cord palsy (Cardiovocal syndrome). Successful endovascular repair was performed using two Talent thoracic stent-graft devices deployed separately to cover the two mycotic aneurysms. Subsequent computed tomography at 12 months after the operation confirmed exclusion of the two pseudoaneurysms with no endoleak. With potent antibiotics and careful surveillance program, endovascular repair is a possible alternative to conventional open surgery in the management of mycotic thoracic aortic aneurysms, especially in high-risk patients.
European Journal of Cardio-Thoracic Surgery 08/2004; 26(1):221-4. DOI:10.1016/j.ejcts.2004.03.035 · 3.30 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Traumatic aortic disruption is an uncommon but frequently emphasised condition in trauma management in the emergency department. We report a case in which a middle aged woman was hit by a moving vehicle, sustaining multiple severe injuries. Multidetector computed tomography revealed an unexpected but potentially fatal condition − traumatic aortic disruption. A pseudoaneurysm was detected over the aortic arch. In view of the multiple trauma, she was put on conservative treatment. Traumatic aortic disruption should be borne in mind during the emergency evaluation and management of unstable trauma victims, especially those with significant trauma mechanisms. Radiological evaluation plays an important diagnostic role. (Hong Kong j.emerg.med. 2007;14:107-112)
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