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A Timeline From Index Procedure To Complex Reinterventions For Thoracoabdominal Aortic Dissection.
Port J Card Thorac Vasc Surg
October 2024
Department of Vascular and Endovascular Surgery, St Francis Hospital & Heart Center, Roslyn, NY, USA.
The optimal management of acute type A aortic dissection (ATAAD) remains a controversial subject. While some surgeons opt for a hemiarch approach to minimize bypass and cross-clamping time, others prefer partial or total arch replacement to prevent the need for additional operations. The advent of hybrid approaches offers a variety of options to the aortic surgeon in treating ATAAD.
View Article and Find Full Text PDFA Bleed From the Distal Anastomosis Site of a Bypass Graft From the Left Common Iliac Artery to the Celiac Trunk Treated With a Surgeon-Modified Fenestrated Endograft.
J Endovasc Ther
January 2025
Vascular Unit, Department of Surgery, Mater Dei Hospital, Msida, Malta.
Purpose: The use of surgeon-modified fenestrated endograft to treat a bleeding complication in the common iliac artery.
Technique: An Endurant limb graft was modified on back table in theater after planning the fenestration using a semi-automated centerline. The Endurant stent was planned to land flush at the aortic bifurcation.
Recurrent peripheral ischemia following endovascular repair of an infrarenal aortic aneurysm: what did we miss?
J Surg Case Rep
January 2025
Vascular Surgery Department, Bonifatius Hospital, Wilhelmstraße 13, 49808 Lingen, Germany.
We document a case of a 75-year-old patient with a history of hypercholesterolemia and hypertension, who underwent endovascular aortic repair (EVAR) for an infrarenal abdominal aortic aneurysm (AAA) with common iliac artery ectasia. Despite an initially successful procedure, the patient experienced recurrent episodes of acute limb ischemia in his right leg. Subsequent imaging revealed thrombus formation distal to the stent graft, constituting a potential source of embolization, which warranted a reevaluation of the treatment strategy.
View Article and Find Full Text PDFIntraoperative rescue of a dislodged renal stent during fenestrated endovascular aortic repair for treatment of type 1A endoleak.
J Vasc Surg Cases Innov Tech
February 2025
Division of Vascular and Endovascular Surgery, Cardio-Thoracic-Vascular Department, Integrated University Healthcare Giuliano-Isontina, University Hospital of Cattinara, Trieste, Italy.
In the past 15 years, fenestrated-branched endovascular aortic repair (F-BEVAR) has progressively become the first-line option for management of most complex abdominal aortic aneurysms (AAAs); with increasing experience, as well as persistent technological refinements, F-BEVAR indications have been expanded to include rescue of failures after prior EVAR. Despite the feasibility and effectiveness, F-BEVAR procedures in the presence of prior infrarenal endografts may come with higher technical complexity that should be properly anticipated, and several anatomical challenges can be expected. Among these, presence of suprarenal bare stents from prior EVAR device are certainly a frequent scenario and may sometimes make target vessel cannulation more difficult because of encroachment on the target vessel origins.
View Article and Find Full Text PDFNeed for and update on clinical trials for uncomplicated type B aortic dissection.
JVS Vasc Insights
January 2024
Academic Department of Vascular Surgery, South Bank Section, School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, British Heart Foundation Centre of Research Excellence, St Thomas' Hospital, London, UK.
The mainstay of management for uncomplicated type B aortic dissection is currently optimal medical therapy, targeting blood pressure and heart rate, along with serial imaging. There is a paucity of data that informs whether early intervention with thoracic endografting in this group of patients will promote aortic remodeling and better long-term outcomes. Investigations to date, including the Investigation of Stent Grafts in Aortic Dissection (INSTEAD), INSTEAD-XL, and Acute Dissection: Stent Graft or Best Medical Therapy (ADSORB) studies, have compared thoracic endovascular aortic repair (TEVAR) with optimal medical therapy in patients with uncomplicated type B aortic dissection but have not shown a benefit for TEVAR conclusively.
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