Background: The present study evaluates aneurysmal sac remodeling and the loss of the intercostal arteries after the first step of staged treatment of thoracoabdominal aortic aneurysms (TAAAs). The purpose of this approach is to keep the aneurysmal sac temporarily perfused to induce progressive thrombosis of the aneurysm while simultaneously allowing the spinal cord to establish adequate perfusion thereby promoting the development of collateral circulation.
Methods: All patients with type II or type III TAAAs, having undergone 2-step endovascular treatment with at least a 2-branch endoprosthesis at our institution between April 2017 and May 2019, were retrospectively evaluated. Thirty-day mortality and spinal cord ischemia was assessed. The mean number of the intercostal and lumbar arteries, coverage length between the left subclavian artery and the stent graft proximal landing zone, total volume of the aneurysmal sac, lumen volume, and thrombosis volume were measured by preoperative and first-step postoperative computed tomography angiography. Patients were also grouped based on the chosen endoprosthesis (group A: double-branch aneurysmal sac reperfusion; group B: single-branch aneurysmal sac reperfusion).
Results: Eleven patients (mean age: 76.5 years; range: 61-86) were considered. No 30-day mortality was observed after the first-step procedure, and 1 patient died after second-step treatment. No permanent paraplegia was observed after either the first or second endovascular steps. The lumen volume significantly decreased (27%; P < 0.001) after first-step endovascular treatment although there was a significant increase in aneurysm thrombosis (34% to 54%). The mean number of the intercostal arteries decreased from 19.7 to 9.3 (P < 0.001) after first-step endovascular treatment. Volume variations and percentage of intercostal loss did not significantly differ between the 2 groups.
Conclusions: Although aneurysm volume continued to increase after first-step treatment, two-step endovascular treatment is a feasible alternative to reduce the risk of severe ischemia in patients with extended TAAAs.
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http://dx.doi.org/10.1016/j.avsg.2020.03.011 | DOI Listing |
AJNR Am J Neuroradiol
January 2025
From the Institute of Neurointervention (C. Hecker, C. Hufnagl, A.O., C.J.G., M.K-O.), Paracelsus Medical University, Salzburg, Austria
Background And Purpose: This animal study was designed to evaluate in vivo the acute and short-term safety and efficacy of the new Artisse intrasaccular device (ISD) for aneurysm occlusion and to gain knowledge about the behavior in the aneurysms.
Materials And Methods: The device was implanted in 7 white New Zealand rabbits with bifurcation aneurysms. Immediate and 90-day angiographic follow-up as well as histologic and scanning electron microscope imaging were evaluated.
J Clin Med
December 2024
Department of Vascular Surgery and Transplantation, Medical University of Bialystok, 15-276 Bialystok, Poland.
Stent-graft implantation is a widely recognized method for endovascular treatment of aortic aneurysms. In cases where the aneurysm involves the thoracic and abdominal aorta, repair including fenestrated and branched stent grafts provides a viable alternative. This approach, initially reserved for patients unsuitable for open surgery, has become preferred for anatomically appropriate thoracoabdominal aortic aneurysms.
View Article and Find Full Text PDFVascular
January 2025
Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, QLD, Australia.
Objectives: Embolizing an abdominal aortic aneurysm sac through a transcaval approach is a novel approach to treat type-II endoleaks that occur following aortic endografting. This study reviews the outcomes of this treatment in one of the few centres in Australia that offers this procedure.
Methods: A retrospective cohort study was conducted, including patients who had received transcaval embolisation of type-II endoleak over a 9-year period.
Front Surg
December 2024
School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
Background: Current guidelines recommend preserving at least one of the bilateral pelvic flows in patients with aortoiliac aneurysms. The sandwich parallel graft, using commercially available devices, provides a viable option for patients who fall outside the instructions for use of iliac branch devices. However, gutter endoleak remains a significant challenge.
View Article and Find Full Text PDFSci Rep
December 2024
Department of Biomedical Engineering, National University of Singapore, Block E7 #06-02, 15 Kent Ridge Cres, Singapore, 119276, Singapore.
Cardiovascular diseases remain a leading cause of morbidity and mortality worldwide with abdominal aortic aneurysm (AAA) and renal artery stenosis (RAS) standing out as significant contributors to the vascular pathology spectrum. While these conditions have traditionally been approached as distinct entities, emerging evidence suggests a compelling interdependent relationship between AAA and RAS, challenging the conventional siloed understanding. The confluence of AAA and RAS represents a complex interplay within the cardiovascular system, one that is often overlooked in clinical practice and research.
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