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ABSTRACT: Non-small-cell lung cancer (NSCLC) invading the aorta is staged as T(4). Only 9% of T(4) tumors are resected; the alternative is chemoradiotherapy, but for peri-aortic NSCLC, radiation damage to the aortic wall can induce fatal rupture. We report the case of a 76 year-old man with a 3-cm left lower lobe NSCLC clearly invading the aortic wall. A thoracic stent graft was inserted prophylactically to prevent aortic rupture. He then received 64 Gy radiotherapy in 32 fractions, resulting in tumor shrinkage. Prophylactic aortic endografting, a less invasive treatment than open surgery, may enable high dose irradiation of the aortic wall.
Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 09/2011; 54(6):1795-7. · 3.52 Impact Factor
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ABSTRACT: A systematic review was conducted of all published cases of endovascular repair of retrograde Stanford type A dissection or intramural hematoma to determine mortality of this less invasive approach to treatment. Using the PRISMA guidelines, databases were searched for any of the terms 'dissect$', 'IMH', ('aortic ADJ wall'), 'intramur$', 'intra-mur$' in combination with any of 'stent$', 'perc$', 'endo$', 'TEVAR' in combination with any of ('type ADJ A'), 'ascend$' and 'retro$.' The search retrieved 3131 titles, 280 abstracts, and 108 papers. Of 23 relevant papers selected, mortality data could be extracted from 11 studies, representing 60 patients. Overall in-hospital mortality was 1.8% (95% CI 1.2% to 2.4%). Additional all-cause mortality during follow-up was 5.4% (95% CI 3.5% to 7.2%). The placement of an endoluminal device in the descending thoracic aorta to treat a DeBakey IIId/retrograde type A aortic dissection or intramural hematoma may be a safer procedure in the short to medium term than open surgical replacement of the ascending aorta (with or without the arch). Open surgical repair in these patients may therefore be unjustified.
Journal of Endovascular Therapy 08/2011; 18(4):591-600. · 2.86 Impact Factor
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Journal of Cardiovascular Magnetic Resonance. 01/2010;
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Journal of Cardiovascular Magnetic Resonance. 01/2010;
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ABSTRACT: The purpose of this study was to evaluate the early outcome of endovascular repair of abdominal aortic aneurysms (EVAR) with an unfavorable neck anatomy using extralarge stent-grafts. We carried out a retrospective review of all patients who underwent elective EVAR using large diameter stent-grafts between June 2006 and February 2008. All patients had computed tomography angiography (CTA) for procedure planning, and detailed assessment of the aneurysm neck was performed using a three-dimensional CTA workstation. All patients were followed up with CTA at 3 and 12 months and annual duplex thereafter when appropriate. This analysis included 25 patients (23 men, 2 woman; median age, 76 years; age range, 60-88 years). The median aneurysm diameter was 7 cm, and the median aneurysm neck diameter was 31 mm. Extralarge Cook-Zenith stent-grafts were used in all patients, with a top-end diameter of 36 mm (n=23) and 40 mm (n=2). The follow-up period ranged from 3 to 24 months, with a median of 6 months. Primary and assisted primary technical success rates were 80% and 96%, respectively. Reintervention was required to treat proximal type I endoleak (n=1), iliac limb kink (n=2), and occluded femorofemoral crossover graft (n=1). These early results show that EVAR using extralarge stent-grafts with suprarenal fixation can be a reliable modality to treat infrarenal aortic aneurysms with an unfavorable neck anatomy.
CardioVascular and Interventional Radiology 05/2009; 32(6):1161-4. · 2.09 Impact Factor
