Comparison of perioperative costs with fast-track vs standard endovascular aneurysm repair.

Background: Perioperative health care utilization and costs in patients undergoing elective fast-track vs standard endovascular aneurysm repair (EVAR) remain unclear.

Methods: The fast-track EVAR group included patients treated with a 14 Fr stent graft, bilateral percutaneous access, no general anesthesia or intensive care monitoring, and next-day hospital discharge. The standard EVAR group was identified from Medicare administrative claims using a matching algorithm to adjust for imbalances in patient characteristics.

Perioperative Outcomes From the Prospective Multicenter Least Invasive Fast-Track EVAR (LIFE) Registry.

Purpose: To determine the feasibility, perioperative resource utilization, and safety of a fast-track endovascular aneurysm repair (EVAR) protocol in well-selected patients.

Methods: Between October 2014 and May 2016, the LIFE (Least Invasive Fast-track EVAR) registry ( ClinicalTrials.gov identifier NCT02224794) enrolled 250 patients (mean age 73±8 years; 208 men) in a fast-track EVAR protocol comprised of bilateral percutaneous access using the 14-F Ovation stent-graft, no general anesthesia, no intensive care unit (ICU) admission, and next-day discharge.

Fast-track endovascular aortic repair: Interim report from the prospective LIFE registry.

Objective: To assess the feasibility, safety, and clinical utility of a fast-track endovascular aneurysm repair (EVAR) protocol.

Background: Despite recent advances in EVAR technology and techniques, considerable opportunity exists to further improve EVAR efficiency and outcomes.

Methods: Eligible patients underwent elective EVAR with the Ovation Prime stent graft.

Comparison of the boomerang wire vascular access management system versus manual compression alone during percutaneous diagnostic and interventional cardiovascular procedures: The boomerang™ wire vascular access management trial II.

Objectives: To evaluate the use of the Boomerang™ Wire as an adjunct to manual compression (MC) in patients requiring diagnostic (Dx) or interventional (Ix) percutaneous procedures.

Background: MC remains the standard of care for closure of femoral artery access sites. Adjunctive use of a device to facilitate closure, reduce time to hemostasis (TTH) and ambulation (TTA) without increasing complication rates could reduce costs and hospital resource demands.

Endovascular management of recurrent adult coarctation of the aorta.

Traditional open surgical repair has proven to be an effective treatment for the management of primary and recurrent coarctation of the thoracic aorta. Potential complications at short-term and long-term follow-up have included recurrent coarctation, hypertension, premature coronary artery disease, cerebrovascular disease, and anastomotic pseudoaneurysm. Endovascular repair of recurrent coarctation of the thoracic aorta offers a less invasive treatment approach in potential high-risk surgical patients.

Is endovascular repair the new gold standard for primary adult coarctation?

Objective: Primary adult aortic coarctation (PAAC) is an unusual cause of hypertension. The standard of care includes surgical repair, which can be associated with considerable morbidity and operative risk. Although balloon angioplasty has been successfully used in paediatric and adolescent patients with coarctation, little information exists regarding the endovascular repair of PAAC.

"Cracking and paving": a novel technique to deliver a thoracic endograft despite ilio-femoral occlusive disease.

Background: The use of endoluminal grafts to treat thoracic aortic aneurysms has been associated with a decreased morbidity and mortality compared with open thoracic aortic aneurysm repair. High-risk surgical patients with ilio-femoral occlusive disease may not be amenable to general anesthesia and the construction of a retroperitoneal conduit.

Methods And Results: We report the use of a novel technique consisting of cracking and paving of the ilio-femoral vessels with balloon angioplasty, followed by deployment of an endoconduit to deliver an endoluminal graft under local sedation to treat a high-risk 80-year-old patient with a thoracic aneurysm.

Treatment of type II endoleaks associated with left subclavian artery coverage during thoracic aortic stent grafting.

Objective: Increasing experience with thoracic aortic stent grafts has led to a more aggressive approach to thoracic aortic pathologies in the distal aortic arch and proximal descending thoracic aorta. To increase the length of the proximal landing zone, it is sometimes necessary to cover the left subclavian artery with the thoracic stent-graft, introducing the risk of retrograde filling of the excluded aorta from the left subclavian artery. It is currently unclear how best to manage these patients to prevent persistent risk of aneurysm expansion or rupture.

Intravascular ultrasound imaging as applied to the aorta: a new tool for the cardiovascular surgeon.

Intravascular ultrasound is a novel endovascular imaging technology that is useful as an imaging tool for diagnosis and treatment of arterial and venous pathologies. Intravascular ultrasound is particularly useful as a decision-making tool in the endovascular management of vascular pathologies. Recently the aorta has become increasingly amenable to endovascular technology, and with the advent of intravascular ultrasound detailed imaging, using intravascular ultrasound permits the diagnosis and endovascular management of various complex aortic pathologies affecting the abdominal and thoracic aorta.

Endovascular repair of the thoracic aorta in octogenarians.

Background: To evaluate the feasibility and safety of thoracic endografting in the octogenarian population.

Methods: Between February 2000 and August 2005, 249 patients with a mean age of 69+/-12.3 years (range 23-91) underwent thoracic endografting.

Management of endoleaks associated with endovascular treatment of descending thoracic aortic diseases.

Objective: Endoluminal grafting is emerging as a less invasive alternative to the treatment of descending thoracic aorta diseases. Endoleaks (continued pressurization of the treated aorta external to the endoluminal graft) are a potential complication. We reviewed our cumulative endovascular experience for descending thoracic aorta pathologies with respect to the management of endoleaks and associated patient outcomes.

Retrograde type A dissection after endovascular stenting of the descending thoracic aorta. Is the risk real?

Objective: Retrograde type A dissection during or after endoluminal graft repair of the descending thoracic aorta is a potentially lethal complication unique to thoracic endografting. Our aim is to increase its awareness and to review possible etiological factors.

Methods: Two hundred and eighty-seven patients with different thoracic aortic pathologies were treated with endovascular prostheses over the last 6 years (February 2000 to March 2006) under a single-site protocol.

Customized endoluminal graft to treat a suspected saccular thoracoabdominal mycotic aneurysm.

Open surgical repair of mycotic aneurysm is associated with a high surgical morbidity and mortality. The role of endovascular graft repair of mycotic aneurysm remains controversial because the graft material remains in contact with possibly infected tissue. We report an endovascular technique of customizing an abdominal endoluminal graft component to treat a suspected saccular thoracoabdominal mycotic aneurysm involving the takeoff of the celiac trunk.

Endoluminal graft therapy for the treatment of an aorto-bronchial fistula: mid-term follow-up.

Open surgical repair of aorto bronchial fistulas is associated with a high morbidity and mortality. Endovascular stent graft as an alternative therapy, though limited, has produced acceptable initial results, but few reports of mid-term follow-up are available. We report the mid-term results with the use of an endograft to treat a patient with both an aorto bronchial fistula and a contained rupture of the thoracic aorta.

A novel approach for the endovascular repair of the small thoracic aorta: customizing off-the-shelf endoluminal grafts to treat a post-coarctation pseudoaneurysm.

Surgical repair of post-coarctation pseudoaneurysm is associated with high morbidity and mortality. Endovascular stent grafting is a minimally invasive approach to manage this condition. The small thoracic aorta provides a dilemma for endovascular stent grafting using available commercially available thoracic endografts.

Successful management of a combined ruptured Stanford type B aortic dissection and malperfusion syndrome with an endoluminal graft.

Thoracic endografting has been recently approved in the USA for the treatment of thoracic aortic aneurysms. The application of endoluminal graft therapy to treat acute type B dissection has been shown to be effective but is still not considered standard of care. We describe the use of an endoluminal graft to treat a patient with an acute type B dissection associated with malperfusion and thoracic aortic rupture.

A novel technique of deployment of a thoracic endograft in the hybrid treatment of a patient with thoracoabdominal aneurysm.

Repair of thoracoabdominal aneurysm is associated with high morbidity and mortality. We describe a hybrid approach to repair a Crawford type III thoracoabdominal aneurysm with antegrade deployment of the endoluminal graft through a side limb of the bifurcated inflow conduit. The advantage of this technique includes avoidance of thoracotomy, left heat bypass, hypothermia, and aortic cross clamping.

Use of the right brachio-femoral wire approach to manage a thoracic aortic aneurysm in an extremely angulated and tortuous aorta with an endoluminal stent graft.

The presence of a tortuous, elongated thoracic aorta and an angulated arch poses a technical challenge for the delivery of an endoluminal graft to the target site to exclude management of a thoracic aortic aneurysm. Despite the availability of a flexible delivery sheath system, adjunct techniques are necessary to deal with extremely tortuous thoracic aortas. The use of a brachio-femoral wire with tension applied at both ends is a useful technique to deliver an endoluminal graft in an angulated thoracic arch.

Endovascular grafts for thoracic aortic pathologies.

Endovascular aortic repair (EVAR) is rapidly being adopted to capture a substantial proportion of surgical candidates with aneurysmal disease of the descending thoracic aorta. This new technique requires both special equipment (hybrid operating room, full range of catheterization tools) and additional technical skills, which an average cardiothoracic surgeon usually lacks, not being exposed to this particular training during his formative years. Presently, EVAR is applied to high-risk surgical candidates, its main advantages being the avoidance of cardiopulmonary bypass, minimal invasiveness (no large incisions) and often the ability to perform the procedure under local anesthesia.

Endovascular repair of an ascending aortic pseudoaneurysm with a septal occluder device: mid-term follow-up.

Ascending pseudoaneurysm is an infrequent complication of ascending aortic surgery. Redo operations are often associated with a high surgical morbidity and mortality. Endovascular management of ascending aortic pathologies with endoluminal graft therapies are challenging due to short landing zones and the fear of flow obstruction to the coronaries and brachiocephalic circulation.

Endovascular management of a thoracic aortic disruption following failure of deployment of a parachute.

Traumatic thoracic aortic disruption is a life-threatening lesion associated with a high surgical mortality. Endovascular stent graft repair is a minimal invasive approach that does not require a thoracotomy, aortic cross clamping and cardiopulmonary bypass. We report the use of an endoluminal graft to treat a 58-year-old male, who sustained multiple injuries including thoracic aortic disruption in a sky-diving accident due to failure of deployment of his parachute.

Novel endovascular repair of the small thoracic aorta: customizing off-the-shelf endoluminal grafts.

Treatment of the small thoracic aorta is not currently amenable to standard endovascular repair. New customized endovascular approaches are necessary for these patients who are not candidates, for open repair. We describe a novel endovascular repair of a thoracic aortic pseudoaneurysm associated with a prior coarctation repair.

Have we gone too far? Endovascular stent-graft repair of aortobronchial fistulas.

Objective: Although endovascular repair of the descending thoracic aorta has emerged as a viable treatment option, little is known about its potential to treat patients diagnosed with aortobronchial fistulas. We reviewed our comprehensive thoracic endografting experience with regard to the endovascular management and subsequent outcome of patients with aortobronchial fistulas to assess whether endoluminal graft repair is a realistic option.

Methods: Between February 2000 and November 2005, 255 patients were successfully treated with an endoluminal graft to the descending thoracic aorta.

Endovascular management of a descending thoracic mycotic aneurysm: mid-term follow-up.

Open surgical repair of mycotic aneurysm is associated with a high surgical morbidity and mortality. Endovascualr graft management of thoracic aortic aneurysm has been associated with a less surgical risk. The role of endovascular graft repair of mycotic aneurysm remains controversial since graft material remains in contact with possible infected tissue.