Current challenges in endovascular therapy for thoracic aneurysms

Terzi, Francesca; Rocchi, Guido; Fattori, Rossella

doi:10.1586/14779072.2016.1141677

Cited by 6 publications

(5 citation statements)

References 29 publications

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“…We also consider appropriate cardiovascular, respiratory, and neurological management to be necessary. However, the long-term outcomes of TEVAR are still unknown, and may be similar to conventional surgeries [8,11,12]. Therefore, the clinical benefits to the patients must be carefully considered when deciding treatment strategies.…”

Section: Discussionmentioning

confidence: 99%

Thoracic Endovascular Aortic Repair in a Patient with Dilated Cardiomyopathy and Low Ejection Fraction: A Case Report

Ando¹,

Umegaki²,

Yamaki³

et al. 2018

Anesth Pain Res

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Background: Thoracic endovascular aortic repair (TEVAR) is a common treatment for high-risk patients with thoracic aortic aneurysms. However, these aneurysms are relatively rare in patients with dilated cardiomyopathy. We successfully treated a thoracic aortic aneurysm in an older patient who presented with dilated cardiomyopathy and low ejection fraction using TEVAR under general anesthesia. Case Presentation: An 84-year-old man was admitted to our institution with a thoracic aortic aneurysm, as well as dilated cardiomyopathy and an extremely low ejection fraction (15.4%). We scheduled the patient for TEVAR. Before administering general anesthesia, an external defibrillator was prepared for possible arrhythmia. General anesthesia was induced with 3 mg of intravenous midazolam and 100 μg of fentanyl. After endotracheal intubation, anesthesia was maintained with sevoflurane (1.2-1.5%). Intra-operative transesophageal echocardiography revealed that an end-diastolic internal diameter was about 65-70 mm and ejection fraction was 15-20%. Successful hemodynamic management during surgery was achieved with dopamine (1.6-2.4 μg/kg/min), noradrenaline (0.02-0.06 μg/kg/min), and milrinone (0.06 μg/kg/min). TEVAR was successfully performed without complication, and the patient's postoperative clinical course was uneventful. He was discharged 14 days after surgery. Conclusions: We describe the uncommon use of TEVAR in an older patient with dilated cardiomyopathy and an extremely low ejection fraction. This case demonstrates that this minimally invasive surgery may be a suitable technique (under vigilant monitoring) to repair thoracic aortic aneurysms in older patients with low cardiac function.

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Section: Discussionmentioning

confidence: 99%

Thoracic Endovascular Aortic Repair in a Patient with Dilated Cardiomyopathy and Low Ejection Fraction: A Case Report

Ando¹,

Umegaki²,

Yamaki³

et al. 2018

Anesth Pain Res

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“… 43 Since the term “endoleak” was first published in 1997, the incidence of endoleak decreased from 20–50% to 5–10% with modern devices. 12 44 45 46 47 48 Endoleaks are classified according to the mechanism of persistent pressurization of aneurysmal sac. Each type of endoleak corresponds with a different management strategy ( Table 2 ).…”

Section: Endoleaksmentioning

confidence: 99%

“…Type II endoleak is the most common type, accounting for approximately 75% of all endoleaks in the EVAR literature, and its treatment is variable. 47 Most of the Type II endoleaks will remain stable, decrease in size, or spontaneously thrombose over time. 45 Treatment is required if symptoms persist or if an aneurysm expands, frequently with endovascular embolization of the supplying blood vessel.…”

Section: Endoleaksmentioning

confidence: 99%

Complications and Management of the Thoracic Endovascular Aortic Repair

et al. 2020

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Endovascular treatment in thoracic aortic diseases has increased in use exponentially since Dake and colleagues first described the use of a home-made transluminal endovascular graft on 13 patients with descending thoracic aortic aneurysm at Stanford University in the early 1990s. Thoracic endovascular aneurysm repair (TEVAR) was initially developed for therapy in patients deemed unfit for open surgery. Innovations in endograft engineering design and popularization of endovascular techniques have transformed TEVAR to the predominant treatment choice in elective thoracic aortic repair. The number of TEVARs performed in the United States increased by 600% from 1998 to 2007, while the total number of thoracic aortic repairs increased by 60%. As larger multicenter trials and meta-analysis studies in the 2000s demonstrate the significant decrease in perioperative morbidity and mortality of TEVAR over open repair, TEVAR became incorporated into standard guidelines. The 2010 American consensus guidelines recommend TEVAR to be “strongly considered” when feasible for patients with degenerative or traumatic aneurysms of the descending thoracic aorta exceeding 5.5 cm, saccular aneurysms, or postoperative pseudoaneurysms. Nowadays, TEVAR is the predominant treatment for degenerative and traumatic descending thoracic aortic aneurysm repair. Although TEVAR has been shown to have decreased early morbidity and mortality compared with open surgical repair, endovascular manipulation of a diseased aorta with endovascular devices continues to have significant risks. Despite continued advancement in endovascular technique and devices since the first prospective trial examined the complications associated with TEVAR, common complications, two decades later, still include stroke, spinal cord ischemia, device failure, unintentional great vessel coverage, access site complications, and renal injury. In this article, we review common TEVAR complications with some corresponding radiographic imaging and their management.

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“…43 Since the term "endoleak" was first published in 1997, the incidence of endoleak decreased from 20-50% to 5-10% with modern devices. 12, [44][45][46][47][48] Endoleaks are classified according to the mechanism of persistent pressurization of aneurysmal sac. Each type of endoleak corresponds with a different management strategy (►Table 2).…”

Section: Endoleaksmentioning

confidence: 99%

“…48 Type II endoleak is the most common type, accounting for approximately 75% of all endoleaks in the EVAR literature, and its treatment is variable. 47 Most of the Type II endoleaks will remain stable, decrease in size, or spontaneously thrombose over time. 45 Treatment is required if symptoms persist or if an aneurysm expands, frequently with endovascular embolization of the supplying blood vessel.…”

Section: Endoleaksmentioning

confidence: 99%

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2020

Aorta (Stamford)

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Endovascular treatment in thoracic aortic diseases has increased in use exponentially since Dake and colleagues first described the use of a home-made transluminal endovascular graft on 13 patients with descending thoracic aortic aneurysm at Stanford University in the early 1990s. Thoracic endovascular aneurysm repair (TEVAR) was initially developed for therapy in patients deemed unfit for open surgery. Innovations in endograft engineering design and popularization of endovascular techniques have transformed TEVAR to the predominant treatment choice in elective thoracic aortic repair. The number of TEVARs performed in the United States increased by 600% from 1998 to 2007, while the total number of thoracic aortic repairs increased by 60%. As larger multicenter trials and metaanalysis studies in the 2000s demonstrate the significant decrease in perioperative morbidity and mortality of TEVAR over open repair, TEVAR became incorporated into standard guidelines. The 2010 American consensus guidelines recommend TEVAR to be "strongly considered" when feasible for patients with degenerative or traumatic aneurysms of the descending thoracic aorta exceeding 5.5 cm, saccular aneurysms, or postoperative pseudoaneurysms. Nowadays, TEVAR is the predominant treatment for degenerative and traumatic descending thoracic aortic aneurysm repair. Although TEVAR has been shown to have decreased early morbidity and mortality compared with open surgical repair, endovascular manipulation of a diseased aorta with endovascular devices continues to have significant risks. Despite continued advancement in endovascular technique and devices since the first prospective trial examined the complications associated with TEVAR, common complications, two decades later, still include stroke, spinal cord ischemia, device failure, unintentional great vessel coverage, access site complications, and renal injury. In this article, we review commonTEVAR complications with some corresponding radiographic imaging and their management.

show abstract

Current challenges in endovascular therapy for thoracic aneurysms

Cited by 6 publications

References 29 publications

Thoracic Endovascular Aortic Repair in a Patient with Dilated Cardiomyopathy and Low Ejection Fraction: A Case Report

Thoracic Endovascular Aortic Repair in a Patient with Dilated Cardiomyopathy and Low Ejection Fraction: A Case Report

Complications and Management of the Thoracic Endovascular Aortic Repair

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