Ourania Preventza, MD, Matthew J. Henry, MD, Benjamin Y. C

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Presentation transcript:

Endovascular Repair of the Ascending Aorta: When and How to Implement the Current Technology Ourania Preventza, MD, Matthew J. Henry, MD, Benjamin Y.C. Cheong, MD, Joseph S. Coselli, MD The Annals of Thoracic Surgery Volume 97, Issue 5, Pages 1555-1560 (May 2014) DOI: 10.1016/j.athoracsur.2013.11.066 Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A) Computed tomography angiography (CTA) shows a pseudoaneurysm with active extravasation of contrast (arrowhead). The pseudoaneurysm was also partially thrombosed (*). (B) After placement of a Gore Excluder endostent (W.L. Gore & Associates, Flagstaff, AZ), the pseudoaneurysm was excluded. The 3-month follow-up CTA showed the pseudoaneurysm was completely thrombosed (**), and its size was reduced substantially. (Ao = ascending aorta.) The Annals of Thoracic Surgery 2014 97, 1555-1560DOI: (10.1016/j.athoracsur.2013.11.066) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 (A) Computed tomography angiography (CTA) in the oblique sagittal orientation shows a large pseudoaneurysm (*) with a narrow neck (arrowhead) arising from the proximal ascending aorta and protruding through the sternum into the anterior chest wall. (B) A postoperative CTA after placement of a Gore TAG endostent (W. L. Gore & Associates, Flagstaff, AZ) in the ascending thoracic aorta (arrow) showed no evidence of extravasation of contrast with thrombosis of the pseudoaneurysm (**). Although the pseudoaneurysm was still protruding into the chest wall, its size was reduced. The Annals of Thoracic Surgery 2014 97, 1555-1560DOI: (10.1016/j.athoracsur.2013.11.066) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 (A) Computed tomography angiography (CTA) of the thoracic aorta in the oblique sagittal projection shows an iatrogenic focal narrowing of the ascending aortic graft (arrowhead). (B) Gradient echo cine magnetic resonance (MR) imaging in the same orientation as panel A shows turbulence distal to the site of narrowing. (C) Phase-contrast MR angiography at the same orientation as panel A shows dephasing, with peak velocity quantified to be 3.8 m/s, suggesting significant stenosis. (D) Postoperative CTA shows a new Dacron (DuPont, Wilmington, DE) aortic graft placed in the ascending aorta and proximal transverse arch. (* = residual dissection in the descending aorta.) The Annals of Thoracic Surgery 2014 97, 1555-1560DOI: (10.1016/j.athoracsur.2013.11.066) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions