ABSTRACT
We present the case of a 63-year-old man with a bovine aortic arch variation, who presented episodes of mild hemoptysis secondary to a 4.5-cm (diameter) aneurysm of the innominate artery that compressed the trachea and obliterated the right subclavian artery. Surgery, performed through a median sternotomy, consisted of a bypass from the ascending aorta to both common carotid arteries using a Dacron graft, and exclusion of the aneurysm by ligature and direct thrombin injection. Computed tomography angiography at 30 days showed a patent bypass, successful aneurysm exclusion, and improvement of the tracheal compression. The patient is currently asymptomatic at 12 months following the procedure.
Subject(s)
Airway Obstruction/etiology , Aneurysm/complications , Aorta, Thoracic/abnormalities , Brachiocephalic Trunk , Hemoptysis/etiology , Tracheal Stenosis/etiology , Vascular Malformations/complications , Airway Obstruction/diagnosis , Aneurysm/diagnosis , Aneurysm/surgery , Aorta, Thoracic/diagnostic imaging , Aorta, Thoracic/surgery , Aortography/methods , Blood Vessel Prosthesis Implantation , Brachiocephalic Trunk/diagnostic imaging , Brachiocephalic Trunk/surgery , Carotid Artery, Common/abnormalities , Carotid Artery, Common/surgery , Hemoptysis/diagnosis , Humans , Injections, Intralesional , Ligation , Male , Middle Aged , Sternotomy , Subclavian Steal Syndrome/etiology , Thrombin/administration & dosage , Tomography, X-Ray Computed , Tracheal Stenosis/diagnosis , Treatment Outcome , Vascular Malformations/diagnosis , Vascular Malformations/surgeryABSTRACT
BACKGROUND: The aims of this study were to analyze the predictive factors for intragraft mural thrombus formation and evolution during follow-up after endovascular treatment of abdominal aortic aneurysms and to evaluate its relationship with the subsequent appearance of complications. METHODS: A retrospective study was performed by selecting those patients who underwent endovascular repair of an abdominal aortoiliac aneurysm between June 1998 and September 2004, with a minimum follow-up of 24 months. Preoperative clinical data, anatomical characteristics of the aneurysm, and endograft type were analyzed. In addition, clinical evaluation and abdominal computed tomography angiography (CT scans) performed at 1, 6, 12, and 24 months after the surgery were reviewed. RESULTS: Eighty-nine patients were submitted for endovascular aneurysm repair in this period, and 75 completed the 24-month follow-up. Eighteen patients developed intragraft mural thrombus (24% incidence), 13 (72.2%) appearing at 1 month of follow-up, and up to 16 (88.9%) appearing during the first 6 months. Logistic regression analysis showed that the lumen percentage of mural thrombus in the native aorta and the use of aortouniiliac endografts were independent predictors of intragraft mural thrombus formation (odds ratio, 1.065; 95% confidence interval, 1.022-1.110, and odds ratio, 8.014; 95% confidence interval, 1.598-40.181, respectively). No spontaneous regression of the thrombus was observed. The area of intragraft mural thrombus had increased at 12 and 18-24 months after their diagnosis (Wilcoxon signed rank test, p = 0.028 and 0.028, respectively). The presence of intragraft mural thrombus was associated with a greater tendency to endograft body or branch occlusion (5 of 18 cases with intragraft mural thrombus (27.8%) versus 1 of 57 cases without it (1.8%), (p = 0.003). CONCLUSION: Intragraft formation of mural thrombus is a common finding during the follow-up of abdominal aortic endografts, particularly in aneurysms with large mural thrombus of the native aorta, and is associated with the use of aortouniiliac endografts. The area occupied by the mural thrombus was shown to gradually increase during follow-up and was associated with a greater tendency for endograft occlusion.
Subject(s)
Aortic Aneurysm, Abdominal/surgery , Blood Vessel Prosthesis Implantation/adverse effects , Graft Occlusion, Vascular/etiology , Thrombosis/etiology , Aged , Aortic Aneurysm, Abdominal/diagnostic imaging , Aortic Aneurysm, Abdominal/mortality , Aortography/methods , Blood Vessel Prosthesis , Blood Vessel Prosthesis Implantation/instrumentation , Blood Vessel Prosthesis Implantation/mortality , Disease Progression , Female , Graft Occlusion, Vascular/epidemiology , Humans , Incidence , Logistic Models , Male , Odds Ratio , Prosthesis Design , Retrospective Studies , Risk Assessment , Risk Factors , Thrombosis/epidemiology , Time Factors , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
The case of a 17-year-old adolescent boy with severe polytrauma is reported. Among other injuries, he presented with aortic rupture distal to the origin of the subclavian artery with no bleeding into the mediastinum. The lesion was repaired by placement of a Cook TX2 endovascular graft (Cook Incorporated, Bloomington, Ind). One year later, he was hospitalized with acute heart failure. Computed tomography angiography showed nearly complete stent graft occlusion and no evidence of altered integrity of the device. A right axillofemoral bypass was performed, allowing conversion to successful definitive repair consisting of an extra-anatomic bypass from the ascending aorta to the supraceliac abdominal aorta.
