Thoracic endovascular aortic repair (TEVAR) is a less invasive method for treating thoracic and some thoracoabdominal aortic aneurysms, dissections of the thoracic aorta and blunt traumatic aortic injury, compared with conventional open surgery. Maximizing the likelihood of a successful outcome requires diligent multidisciplinary (surgical, critical care, nursing, pharmacy, nutrition and physical therapy) perioperative care. In this article, we discuss fundamentals for managing patients after endovascular aortic aneurysm repair. These principles focus on the transition between the operating room and the intensive care unit, prevention and management of spinal cord deficits (SCD), and vital neurological, respiratory, cardiovascular, renal, gastrointestinal and hematological concerns. The better the care team understands the expected postoperative course, the earlier that deviations can be recognized and the more likely that successful rescue can be achieved to reduce the incidence and severity of adverse outcomes. Achieving optimal results after TEVAR requires attention to detail across the preoperative, intraoperative and postoperative phases of care.
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http://dx.doi.org/10.21037/acs-2021-taes-74 | DOI Listing |
Ann Vasc Surg
December 2024
MemorialCare Heart and Vascular Institute, 2801 Atlantic Ave., Long Beach, CA 90806.
Aortic dissection is the most common thoracic aortic emergency and is associated with significant morbidity and mortality. Initial complications are dependent on reduction of sheer stress against the aortic wall to protect against rupture and minimize progression of the aortic wall injury. In patients with dissection starting at or distal to the left subclavian artery (Stanford type B), initial management includes strict blood pressure and heart rate control with monitoring for any complications such as malperfusion, rupture or hemodynamic instability.
View Article and Find Full Text PDFAnn Vasc Surg
December 2024
Department of Cardiac and Vascular Surgery, University Medical Centre Mainz, Johannes Gutenberg University, Mainz, Germany.
An aorto-oesophageal fistula (AOF) is a pathological communication between the thoracic aorta and the oesophagus. It can induce life-threatening hematemesis, which is unique among the other types of gastrointestinal haemorrhage in that the vomiting is bright red and represents an arterial bleed. Nevertheless, it is notable that over 70% of cases are associated with thoracic aortic aneurysms, particularly as a postoperative complication following open surgery, and arguably more so following endovascular repair.
View Article and Find Full Text PDFAnn Vasc Surg
December 2024
Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre Essen, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany.
Objectives: A multicentre European randomized control trial - European Uncomplicated Type B Aortic Repair (EU-TBAR) is being developed to compare pre-emptive TEVAR with custom-made devices vs conventional OMT. The pre-trial set-up is confluent on different pillars, including evaluation of 1) European activity, trends, and governance, 2) outcome reporting, and 3) cost evaluation. This article aimed to demonstrate the observational cross-sectional survey results from participating centres and highlight the risk assessment, activity, practices, and governance of uncomplicated type B aortic dissection (uTBAD).
View Article and Find Full Text PDFJ Endovasc Ther
December 2024
Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China.
Background: The aim of this study is to explore the value of different systemic inflammatory response indicators in the long-term prognosis of type B aortic dissection (TBAD) patients undergoing thoracic endovascular aortic repair (TEVAR).
Methods: This study retrospectively reviewed the case data of 540 patients with TBAD at our center from January 2013 to January 2019. Based on the occurrence of aorta-related adverse events (ARAEs) during follow-up, patients were divided into two groups: the ARAEs group and the non-ARAEs group.
Eur J Vasc Endovasc Surg
December 2024
Department of Vascular Surgery, University Hospital RWTH Aachen, Aachen, Germany. Electronic address:
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