Endovascular Stent-Graft Treatment of a Ruptured Thoracic Aortic Ulcer

Abstract

ࡗ ࡗPurpose: To describe a ruptured ulcer of the descending thoracic aorta treated with an endovascular stent-graft deployed under transesophageal echocardiographic (TEE) guidance. Case Report: An 82-year-old man with severe chronic obstructive pulmonary disease and congestive heart failure presented with sharp pain in the back radiating to the left flank. Computed tomography (CT) and angiography demonstrated a penetrating ulcer of the descending thoracic aorta associated with aortic dissection commencing 6 cm from the origin of the left subclavian artery with extravasation of contrast outside the aortic wall. The patient remained symptomatic with a decrease in hematocrit from 36% to 23%. Endovascular repair was performed using self-expanding nitinol stents sutured to a 35-mm ϫ 12cm Dacron conduit. The device was deployed with a 24-F delivery system under TEE guidance and fluoroscopy. Successful exclusion of the ruptured ulcer was demonstrated by TEE Doppler, arteriography, and CT. The patient remains asymptomatic 18 months after the procedure with no CT evidence of endoleak. Conclusions: Endovascular stent-graft repair under TEE guidance assists in the oftentimes difficult treatment of ruptured penetrating thoracic aortic ulcer. J Endovasc Ther 2002;9:II-20-II-24

Role of Endovascular Therapies in the Management of Diverse Thoracic Aortic Pathology

“…Medical therapy with 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors ("statins") and angiotensinconverting enzyme inhibitors have been used in an effort to stabilize the plaque. 33 Systemic anticoagulation with warfarin poses a theoretic risk of inducing intraplaque hemorrhage and exacerbating the Aidinian et al, 11 2007 1 1 (100) 0 (0) 0 (0) Khoynezhad et al, 12 2007 14 0 (0) 0 (0) Brinster et al, 13 2006 21 21 (100) 0 (0) 0 (0) 0 (0) 0 (0) Caronno et al, 14 2006 4 4 (100) 0 (0) 0 (0) 0 (0) Jin et al, 15 2006 14 14 (100) 1 ( 8) 2 (17) Khamaisi et al, 16 2006 1 1 (100) 0 (0) (0) Eggebrecht et al, 17 2006 22 21 ( 95) 0 (0) 1 ( 5) 0 (0) 1 (5) Melissano et al, 18 2005 2 2 (100) 0 (0) 0 (0) Eichhofer et al, 19 2004 1 1 (100) (0) Demers et al, 20 2004 26 24 (92) 3 ( 12) 2 ( 8) 0 (0) 1 (4) Heidenreich et al, 21 2003 1 1 (100) 0 (0) 0 (0) 1 (100) D'Ancona et al, 22 2003 1 1 (100) 0 (0) Schoder et al, 23 2002 8 8 (100) 0 (0) 0 (0) 1 ( 13) Kos et al, 24 2002 10 10 (100) 1 ( 10) 5 ( 50) 1 ( 10) 0 (0) Faries et al, 25 2002 1 1 (100) 0 (0) 0 (0) 0 (0) 0 (0) Brittenden et al, 26 1999 2 2 (100) Murgo et al, 27 1998 4 4 (100) 0 (0) 1 ( 25) 1 ( 25) 0 (0) atheroemboli syndrome. 34 Despite this theoretic risk, several other studies have demonstrated reduced rates of embolization with systemic anticaoagulation.…”

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

“…However, despite advancement in surgical, anesthetic and postoperative care over the past few decades, morbidity and mortality rates remain considerable [1,2]. This is partly compounded by the fact that the population affected is often elderly, and these patients frequently have associated diseases that increase surgical risk [3,4]. In the largest surgical series, the surgical mortality ranged from 5 to 20%, with complications frequently resulting in prolonged hospital stay [5].…”