Fenestrated endovascular aneurysm repair is frequently used for juxtarenal and pararenal aortic aneurysms. In urgent cases, however, the use of premanufactured patient-specific devices is not an option. Physician-modified endografts may be used to treat these patients but require experience and a steep learning curve for accurate planning to position fenestrations and to perform the graft modifications. Despite experience, a margin of error in placing fenestrations always exists, and a mismatch possibility between the fenestration and vessel ostium can lead to increased cannulation time and stent complications, including target vessel loss. Aortic three-dimensional printing has been widely described in medicine for simulation, training, and surgical planning. Commercial software is currently under investigation for planning of fenestrated endovascular aneurysm repair at high costs. We describe an effective and inexpensive technique using free computer-aided design software to create a real 1:1 aortic 3D model that can easily be printed and quickly sterilized. This aortic model can be used to create a physician-modified endograft and to place fenestrations in an accurate way, with potential for shorter and more precise procedures and better long-term results. Two cases are presented to illustrate the technique, demonstrating that 3D printing is a valuable tool to plan, design, and create fenestrated devices more accurately.
La perforación concomitante de esófago y aorta se puede presentar después de la ingestión de cuerpos extraños. El reparo aórtico por técnica endovascular, a pesar de ser reciente, es un tratamiento de primera línea por tratarse de un abordaje poco invasivo, rápido y que permite la estabilización hemodinámica, en comparación con la reparación abierta tradicional. Se presentan dos casos de perforación aórtica, en los cuales se llevó a cabo el reparo endovascular con éxito. El primer paciente sufrió una ruptura contenida de la aorta torácica, secundaria a la ingestión de un cuerpo extraño (espina de pescado), y presentó mediastinitis. El segundo paciente sufrió una ruptura aórtica en el arco distal a la arteria subclavia, la cual se corrigió por vía endovascular, pero desarrolló una fístula aorto-esofágica y, finalmente, murió.Palabras clave: aorta torácica; rotura de la aorta; perforación del esófago; aneurisma falso; cuerpo extraño; diagnóstico; procedimientos endovasculares.
Purpose: Thoracic endovascular aortic repair (TEVAR) has been described to be superior to an open surgical approach, and previous studies have found superiority in TEVAR by reducing overall morbidity and mortality rates. This study aimed to describe the outcomes of TEVAR for patients with thoracic aortic disease at a high complexity. Materials and Methods: Descriptive study, developed by a retrospective review of a prospectively collected database. Patients aged above 18 years who underwent TEVAR between 2012 and 2022 were included. Patient demographics, perioperative data, surgical outcomes, morbidity, and mortality were described. Statistical and multivariate analyses were made. Statistical significance was reached when p values were <0.05. Results: A total of 66 patients were included. Male patients were 60.61% and the mean age was 69.24 years. Associated aortic diseases were aneurysms (68.18%), ulcer-related (4.55%), intramural-related hematoma (7.58%), trauma-related pathology (1.52%), and aortic dissection (30.30%). The mean hospital stay was 18.10 days, and intensive care unit was required for 98.48%. At 30 days, the mortality rate was 10.61% and the reintervention rate was 21.21%. Increased intraoperative blood loss (p=0.001) and male sex (p=0.04) showed statistical relationship with mortality. Underweight patients have 6.7 and 11.4 times more risk of complications and endoleak compared with higher body mass index values (p=0.04, 95% confidence interval [CI]=0.82–7.21) and (p=0.02, 95% CI=1.31–12.57), respectively. Conclusion: Thoracic endovascular aortic repair seems to be a feasible option for patients with thoracic aortic pathologies, with adequate rates of mortality and morbidity. Underweight patients seem to have an increased risk of overall morbidity and increased risk for endoleak. Further prospective studies are needed to prove our results. Clinical Impact Obesity and BMI are widely studied in the surgical literature. According to our study, there is a paradox regarding the outcomes of patients treated with TEVAR in terms of postoperative complications and mortality related to the body mass index. And shouldn’t be considered as a high-risk feature in terms of postoperative morbidity and mortality in this procedure.
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