Endovascular repair of descending thoracic aortic aneurysms: an early experience with intermediate-term follow-up Roy Greenberg, MD, Timothy Resch, MD,

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Presentation transcript:

Endovascular repair of descending thoracic aortic aneurysms: an early experience with intermediate-term follow-up Roy Greenberg, MD, Timothy Resch, MD, Ulf Nyman, MD, Matts Lindh, MD, Jan Brunkwall, MD, PhD, Per Brunkwall, MD, PhD, Martin Malina, MD, PhD, Bansi Koul, MD, Bengt Lindblad, MD, PhD, Krassnador Ivancev, MD, PhD Journal of Vascular Surgery Volume 31, Issue 1, Pages 147-156 (January 2000) DOI: 10.1016/S0741-5214(00)70076-0 Copyright © 2000 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 This intraoperative angiogram was performed during the treatment of a contained ruptured aneurysm. The tortuosity of the aorta precluded access to the upper portion of the descending thoracic aorta. A minithoracotomy was performed to assist with access. Despite the accurate placement of the device with complete aneurysm exclusion, the patient experienced massive distal embolization and died shortly after the procedure. This amount of tortuosity, with or without atheromatous debris, is now viewed as a contraindication to endovascular repair. Journal of Vascular Surgery 2000 31, 147-156DOI: (10.1016/S0741-5214(00)70076-0) Copyright © 2000 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 This distal endoleak was detected on the 3-month CT scan (A ) and further evaluated with angiography (B ). Coil embolization was performed with a radiographic seal of the leak (C ). However, although there is no evidence of perigraft flow, it may be possible that the aneurysm would still be exposed to systemic pressures transmitted through the thrombus. Journal of Vascular Surgery 2000 31, 147-156DOI: (10.1016/S0741-5214(00)70076-0) Copyright © 2000 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 These two lateral chest films were taken 12 months apart. A , Note the position of the proximal and distal stents with respect to the vertebral bodies. On the follow-up examination (B ) the proximal stent has migrated distally, and the distal stent has migrated proximally. Although the aneurysm remained excluded, continued migration would surely result in an unprotected state. Journal of Vascular Surgery 2000 31, 147-156DOI: (10.1016/S0741-5214(00)70076-0) Copyright © 2000 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 This diagram shows the forces of a column of blood traveling into the descending thoracic aorta (A ) that will exert a force on an endovascular graft in the mid-descending aorta (B ) because of the curvature typically seen in the descending thoracic aorta. The force, into the middle of the stent-graft, drives the endograft into the aneurysm, pulling upward on the distal stent and downward on the proximal stent. The result is telescoping of the graft (C ), with the potential to expose the aneurysm sac to systemic pressures (Fig 3). Journal of Vascular Surgery 2000 31, 147-156DOI: (10.1016/S0741-5214(00)70076-0) Copyright © 2000 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions