TEVAR for non-aneurysmal thoracic aortic pathology

Sean D'Souza, Audra Duncan, Fernando Aguila, Gustavo Oderich, Joseph Ricotta, Manju Kalra, Peter Gloviczki, Thomas Bower, Thoralf Sundt

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Objective: Management of penetrating atherosclerotic ulcers (PAU), intramural hematomas (IMH), and acute aortic dissections (AD) of the thoracic aorta remain controversial in the endovascular era. Methods: Between 2001 and 2007, patients with PAU (13 patients), and/or IMH (7 patients) were treated with thoracic endografts (TEVAR) in the endovascular suite under general anesthesia. Indications for intervention were intractable chest pain, expanding hematoma or contained rupture, or distal malperfusion. End-points were early morbidity and mortality, incidence of endoleak, device-related complications, and secondary interventions. Results: Of the 20 patients with a median age of 67 (25-83), 13 (65%) were men, 2 (10%) had contained aortic rupture, and 10 were symptomatic. One patient had carotid-subclavian bypass debranching before endograft implantation. Ten patients had cerebrospinal fluid drainage. Mean length of aorta treated was 122.1 mm (range 36-300). All endografts were technically successful. Average blood loss was 50 mL. Thirty-day mortality was 0%. Symptoms resolved in all patients; there were no neurologic complications. Average length of stay was 5 days. Mean follow-up was 2.0 years (range 0.1-5.8). All patients remained asymptomatic. Three had early (<180 days) endoleaks: Two type II and 1 type I treated successfully with an additional cuff, which was the only patient requiring reintervention. Two patients had late (>180 days) endoleaks (type 2) observed with no aortic expansion. Two deaths at 5.4 and 5.8 years were due to severe aortic valve stenosis and metastatic lung cancer. Conclusion: TEVAR is a feasible option for repair of non-aneurysmal thoracic aortic pathology with resolution of symptoms, no mortality, and no neurologic complications.

Original languageEnglish (US)
Pages (from-to)783-786
Number of pages4
JournalCatheterization and Cardiovascular Interventions
Volume74
Issue number5
DOIs
StatePublished - Nov 1 2009

Fingerprint

Thorax
Pathology
Hematoma
Endoleak
Nervous System
Ulcer
Mortality
Intractable Pain
Aortic Rupture
Aortic Valve Stenosis
Chest Pain
Thoracic Aorta
General Anesthesia
Aorta
Dissection
Rupture
Length of Stay
Lung Neoplasms
Morbidity
Equipment and Supplies

Keywords

  • Acute aortic syndrome
  • Penetrating aortic ulcer
  • Stent-graft
  • Thoracic aorta

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

D'Souza, S., Duncan, A., Aguila, F., Oderich, G., Ricotta, J., Kalra, M., ... Sundt, T. (2009). TEVAR for non-aneurysmal thoracic aortic pathology. Catheterization and Cardiovascular Interventions, 74(5), 783-786. https://doi.org/10.1002/ccd.22123

TEVAR for non-aneurysmal thoracic aortic pathology. / D'Souza, Sean; Duncan, Audra; Aguila, Fernando; Oderich, Gustavo; Ricotta, Joseph; Kalra, Manju; Gloviczki, Peter; Bower, Thomas; Sundt, Thoralf.

In: Catheterization and Cardiovascular Interventions, Vol. 74, No. 5, 01.11.2009, p. 783-786.

Research output: Contribution to journalArticle

D'Souza, S, Duncan, A, Aguila, F, Oderich, G, Ricotta, J, Kalra, M, Gloviczki, P, Bower, T & Sundt, T 2009, 'TEVAR for non-aneurysmal thoracic aortic pathology', Catheterization and Cardiovascular Interventions, vol. 74, no. 5, pp. 783-786. https://doi.org/10.1002/ccd.22123
D'Souza, Sean ; Duncan, Audra ; Aguila, Fernando ; Oderich, Gustavo ; Ricotta, Joseph ; Kalra, Manju ; Gloviczki, Peter ; Bower, Thomas ; Sundt, Thoralf. / TEVAR for non-aneurysmal thoracic aortic pathology. In: Catheterization and Cardiovascular Interventions. 2009 ; Vol. 74, No. 5. pp. 783-786.
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abstract = "Objective: Management of penetrating atherosclerotic ulcers (PAU), intramural hematomas (IMH), and acute aortic dissections (AD) of the thoracic aorta remain controversial in the endovascular era. Methods: Between 2001 and 2007, patients with PAU (13 patients), and/or IMH (7 patients) were treated with thoracic endografts (TEVAR) in the endovascular suite under general anesthesia. Indications for intervention were intractable chest pain, expanding hematoma or contained rupture, or distal malperfusion. End-points were early morbidity and mortality, incidence of endoleak, device-related complications, and secondary interventions. Results: Of the 20 patients with a median age of 67 (25-83), 13 (65{\%}) were men, 2 (10{\%}) had contained aortic rupture, and 10 were symptomatic. One patient had carotid-subclavian bypass debranching before endograft implantation. Ten patients had cerebrospinal fluid drainage. Mean length of aorta treated was 122.1 mm (range 36-300). All endografts were technically successful. Average blood loss was 50 mL. Thirty-day mortality was 0{\%}. Symptoms resolved in all patients; there were no neurologic complications. Average length of stay was 5 days. Mean follow-up was 2.0 years (range 0.1-5.8). All patients remained asymptomatic. Three had early (<180 days) endoleaks: Two type II and 1 type I treated successfully with an additional cuff, which was the only patient requiring reintervention. Two patients had late (>180 days) endoleaks (type 2) observed with no aortic expansion. Two deaths at 5.4 and 5.8 years were due to severe aortic valve stenosis and metastatic lung cancer. Conclusion: TEVAR is a feasible option for repair of non-aneurysmal thoracic aortic pathology with resolution of symptoms, no mortality, and no neurologic complications.",
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T1 - TEVAR for non-aneurysmal thoracic aortic pathology

AU - D'Souza, Sean

AU - Duncan, Audra

AU - Aguila, Fernando

AU - Oderich, Gustavo

AU - Ricotta, Joseph

AU - Kalra, Manju

AU - Gloviczki, Peter

AU - Bower, Thomas

AU - Sundt, Thoralf

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AB - Objective: Management of penetrating atherosclerotic ulcers (PAU), intramural hematomas (IMH), and acute aortic dissections (AD) of the thoracic aorta remain controversial in the endovascular era. Methods: Between 2001 and 2007, patients with PAU (13 patients), and/or IMH (7 patients) were treated with thoracic endografts (TEVAR) in the endovascular suite under general anesthesia. Indications for intervention were intractable chest pain, expanding hematoma or contained rupture, or distal malperfusion. End-points were early morbidity and mortality, incidence of endoleak, device-related complications, and secondary interventions. Results: Of the 20 patients with a median age of 67 (25-83), 13 (65%) were men, 2 (10%) had contained aortic rupture, and 10 were symptomatic. One patient had carotid-subclavian bypass debranching before endograft implantation. Ten patients had cerebrospinal fluid drainage. Mean length of aorta treated was 122.1 mm (range 36-300). All endografts were technically successful. Average blood loss was 50 mL. Thirty-day mortality was 0%. Symptoms resolved in all patients; there were no neurologic complications. Average length of stay was 5 days. Mean follow-up was 2.0 years (range 0.1-5.8). All patients remained asymptomatic. Three had early (<180 days) endoleaks: Two type II and 1 type I treated successfully with an additional cuff, which was the only patient requiring reintervention. Two patients had late (>180 days) endoleaks (type 2) observed with no aortic expansion. Two deaths at 5.4 and 5.8 years were due to severe aortic valve stenosis and metastatic lung cancer. Conclusion: TEVAR is a feasible option for repair of non-aneurysmal thoracic aortic pathology with resolution of symptoms, no mortality, and no neurologic complications.

KW - Acute aortic syndrome

KW - Penetrating aortic ulcer

KW - Stent-graft

KW - Thoracic aorta

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