Background: The objective of this case series is to investigate the outcomes of double-fenestrated physician-modified endografts (PMEGs) in patients with distal anastomotic aneurysms after open repair of the ascending aorta or proximal arch replacement.
Methods: All consecutive patients with a distal anastomotic aneurysm after open ascending aorta surgery who underwent aortic arch repair with a homemade double-fenestrated stent-graft from 2017 to 2023 were reviewed. Study endpoints included technical success, 30-day, and long-term follow up analysis of mortality, morbidity, and reinterventions.
Results: 10 patients were treated with double-fenestrated PMEGs for anastomotic aneurysms after open surgery of the ascending aorta. Of these, 9 were male with a mean age of 58 years. Nine patients were initially treated for acute dissection, and 2 had mechanical aortic valves. The mean time between open surgery and the treatment of the pseudoaneurysm was 4.15 years. Technical success was 100%. The proximal landing zone was consistently in zone 0, and all endografts were deployed via femoral access. Early outcomes revealed one endoleak (type 1a), which was successfully treated by prompt reintervention. No deaths or strokes occurred during the early postoperative period. During long-term follow up (mean time 35 months), no endoleaks requiring intervention occurred, and there were no reports of stent fractures or migrations. No patient died from an aortic-related cause.
Conclusions: Aortic arch repair with double-fenestrated PMEGs for distal anastomotic aneurysms after open surgery is feasible and represents a promising alternative in patients ineligible for redo surgery.
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http://dx.doi.org/10.1016/j.avsg.2024.07.093 | DOI Listing |
J Vasc Surg Cases Innov Tech
April 2025
Department of Surgery, University of Rochester School of Medicine, Rochester, NY.
Type B aortic dissection (TBAD) represents a serious medical emergency with up to a 50% associated 5-year mortality caused by thoracic aorta, dissection-associated aneurysmal (DAA) degeneration, and rupture. Unfortunately, conventional size-related diagnostic methods cannot distinguish high-risk DAAs that benefit from surgical intervention from stable DAAs. Our goal is to use DAA stiffness measured with magnetic resonance elastography (MRE) as a biomarker to distinguish high-risk DAAs from stable DAAs.
View Article and Find Full Text PDFJ Vasc Surg Cases Innov Tech
April 2025
Atrium Health, Sanger Heart and Vascular Institute, Division of Vascular Surgery, Charlotte, NC.
We report a case of mesenteric ischemia after thoracic endovascular aortic repair (TEVAR) for chronic type B aortic dissection performed at a different institution. Computed tomography angiography findings indicated that the previous TEVAR had been deployed distally into the false lumen. To mitigate this, a large fenestration was created between the false lumen and true lumen.
View Article and Find Full Text PDFRes Pract Thromb Haemost
January 2025
Division of Vascular Surgery, St. Michael's Hospital, Toronto, Ontario, Canada.
Background: Abdominal aortic aneurysm (AAA) is characterized by the proteolytic breakdown of the extracellular matrix, leading to dilatation of the aorta and increased risk of rupture. Biomarkers that can predict major adverse aortic events (MAAEs) are needed to risk stratify patients for more rigorous medical treatment and potential earlier surgical intervention.
Objectives: The primary objective was to identify the association between baseline levels of these biomarkers and MAAEs over a period of 5 years.
J Cardiothorac Surg
January 2025
The First Hospital of Tsinghua University, Tsinghua University, Beijing, China.
Background: Patients with pulmonary atresia and ventricular septal defect (PA/VSD) are prone to progressive aortic dilation. However, there are relatively few reports of progressive development of aortic aneurysm or aortic dissection in adult patients who missed early corrective surgery.
Presentation Of Cases: Case 1: A 38-year-old man with PA/VSD and a bicuspid aortic valve (BAV), underwent VSD repair, aortic valve replacement, and PA correction at age 21.
Intern Med
January 2025
Department of Respiratory Medicine, National Hospital Organization Iwakuni Clinical Center, Japan.
Aortic intimal sarcoma is a rare disease with no established treatment and a poor prognosis. A 70-year-old man who underwent surgery for a mass shadow extending from the ascending aorta to the left common carotid artery on contrast-enhanced computed tomography was diagnosed with intimal sarcoma and underwent postoperative radiotherapy (66 Gy/33 Fr). Three brain metastases were identified after 1.
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