CT appearance of complications related to thoracic endovascular aortic repair (TEVAR): a pictorial essay

Pua, Uei; Tay, Kiang-Hiong; Tan, Bien Soo; Htoo, M M; Sebastian, Mathew; Sin, Kenny Yoong Kong; Chua, Yeow Leng

doi:10.1007/s00330-008-1276-3

Cited by 14 publications

(3 citation statements)

References 22 publications

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“…During the TEVAR procedure, the bronchial artery is one of the aortic branches that can suffer an endoleak type II, which is conservatively treated in most cases. However, the complete occlusion of the bronchial artery may cause insufficient bronchopulmonary circulation [8]. Bronchial arterial flow is indispensable for peripheral pulmonary circulation, which has been proved by perfusion scintigraphy following a lung transplant [9].…”

Section: Discussionmentioning

confidence: 99%

Bronchopleural fistula after lower lobectomy of the right lung following thoracic endovascular aortic repair

Hino

Murakawa

Nagayama

et al. 2012

Interactive CardioVascular and Thoracic Surgery

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A 77-year old male patient was admitted for the treatment of a thoracic aortic aneurysm (TAA) and primary lung cancer. A saccular aneurysm, 4.8 cm in diameter, located in the proximal segment of the descending thoracic aorta and a pulmonary tumour, 3 cm in diameter, located at the right lower lobe, with lymph node swelling, were detected simultaneously. First, a thoracic endovascular aortic repair (TEVAR) was performed for TAA, and then 45 days later, a lobectomy and radical lymph node dissection by open thoracotomy were performed safely for primary lung cancer. The postoperative course was complicated by a bronchopleural fistula (BPF). Massive necrotic changes to the bronchial stump and the intercostal muscle flap were observed during an open window thoracotomy. Both the chronic use of corticosteroids and TEVAR may have been among the predisposing factors for the occurrence of the fistula. The patient died as a result of respiratory failure 68 days after the lobectomy. This is a first case report of a BPF after a staged operation of TEVAR and major lung surgery. We reviewed and discussed the surgical strategy and timing for both the primary lung cancer and the thoracic aortic aneurysm.

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Section: Discussionmentioning

confidence: 99%

Bronchopleural fistula after lower lobectomy of the right lung following thoracic endovascular aortic repair

Hino

Murakawa

Nagayama

et al. 2012

Interactive CardioVascular and Thoracic Surgery

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“…From a methodological standpoint, the proposed fast-approximate approach only requires patient-specific aortic geometry and a measure of central aortic pressure, both of which are available during TEVAR planning. The patient-specific anatomy can be accurately extracted from the computed tomography, which is already exploited because of its speed and ease of use to navigate and assess the patient-specific aortic anatomy, 29,30 eg, through commercial and clinically oriented semi-automated platforms. Central aortic pressure is recorded in routine clinical practice and generally estimated using noninvasive methods, 31,32 eg, through brachial cuff sphygmomanometer.…”

Section: Discussionmentioning

confidence: 99%

Fast Approximate Quantification of Endovascular Stent Graft Displacement Forces in the Bovine Aortic Arch Variant

et al. 2022

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Purpose: Displacement forces ( DFs) identify hostile landing zones for stent graft deployment in thoracic endovascular aortic repair (TEVAR). However, their use in TEVAR planning is hampered by the need for time-expensive computational fluid dynamics (CFD). We propose a novel fast-approximate computation of DFs merely exploiting aortic arch anatomy, as derived from the computed tomography (CT) and a measure of central aortic pressure. Materials and Methods: We tested the fast-approximate approach against CFD gold-standard in 34 subjects with the “bovine” aortic arch variant. For each dataset, a 3-dimensional (3D) model of the aortic arch lumen was reconstructed from computed tomography angiography and CFD then employed to compute DFs within the aortic proximal landing zones. To quantify fast-approximate DFs, the wall shear stress contribution to the DF was neglected and blood pressure space-distribution was averaged on the entire aortic wall to reliably approximate the patient-specific central blood pressure. Also, DF values were normalized on the corresponding proximal landing zone area to obtain the equivalent surface traction ( EST). Results: Fast-approximate approach consistently reflected (r2=0.99, p<0.0001) the DF pattern obtained by CFD, with a −1.1% and 0.7° bias in DFs magnitude and orientation, respectively. The normalized EST progressively increased (p<0.0001) from zone 0 to zone 3 regardless of the type of arch, with proximal landing zone 3 showing significantly greater forces than zone 2 (p<0.0001). Upon DF normalization to the corresponding aortic surface, fast-approximate EST was decoupled in blood pressure and a dimensionless shape vector (S) reflecting aortic arch morphology. S showed a zone-specific pattern of orientation and proved a valid biomechanical blueprint of DF impact on the thoracic aortic wall. Conclusion: Requiring only a few seconds and quantifying clinically relevant biomechanical parameters of proximal landing zones for arch TEVAR, our method suits the real preoperative decision-making process. It paves the way toward analyzing large population of patients and hence to define threshold values for a future patient-specific preoperative TEVAR planning.

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“…However, twisting may cause yarn shifting, possibly allowing blood percolation through the fabric. Percolation of low volumes of blood through multiple sites of damage to the fabric may explain the endotension phenomenon [59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84]. …”

Section: Discussionmentioning

confidence: 99%

An in Vitro Twist Fatigue Test of Fabric Stent-Grafts Supported by Z-Stents vs. Ringed Stents

Jing

Guidoin

et al. 2016

Materials

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Whereas buckling can cause type III endoleaks, long-term twisting of a stent-graft was investigated here as a mechanism leading to type V endoleak or endotension. Two experimental device designs supported with Z-stents having strut angles of 35° or 45° were compared to a ringed control under accelerated twisting. Damage to each device was assessed and compared after different durations of twisting, with focus on damage that may allow leakage. Stent-grafts with 35° Z-stents had the most severe distortion and damage to the graft fabric. The 45° Z-stents caused less fabric damage. However, consistent stretching was still seen around the holes for sutures, which attach the stents to the graft fabric. Larger holes may become channels for fluid percolation through the wall. The ringed stent-graft had the least damage observed. Stent apexes with sharp angles appear to be responsible for major damage to the fabrics. Device manufacturers should consider stent apex angle when designing stent-grafts, and ensure their devices are resistant to twisting.

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CT appearance of complications related to thoracic endovascular aortic repair (TEVAR): a pictorial essay

Cited by 14 publications

References 22 publications

Bronchopleural fistula after lower lobectomy of the right lung following thoracic endovascular aortic repair

Bronchopleural fistula after lower lobectomy of the right lung following thoracic endovascular aortic repair

Fast Approximate Quantification of Endovascular Stent Graft Displacement Forces in the Bovine Aortic Arch Variant

An in Vitro Twist Fatigue Test of Fabric Stent-Grafts Supported by Z-Stents vs. Ringed Stents

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