Morphologic outcome after endovascular treatment of complicated type B aortic dissection.

PURPOSE: To investigate the long-term morphologic changes of the aorta after thoracic endovascular aortic repair (TEVAR) for acute complicated type B aortic dissection and to analyze whether these changes differed between DeBakey class IIIa and IIIb dissections. MATERIALS AND METHODS: During the period 1999-2009, 58 patients with acute complicated type B aortic dissection were treated with TEVAR. Seven patients lacked follow-up data, leaving 51 patients-17 patients with DeBakey IIIa aortic dissection and 34 patients with DeBakey IIIa aortic dissection IIIb-for inclusion in the study. Computed tomography scans performed before and after TEVAR were evaluated. Maximum thoracic and abdominal aortic diameters and diameters of the true lumen and false lumen at the level of the maximum aortic diameter in the thorax and abdomen were analyzed as well as degree of thrombosis of the false lumen. RESULTS: There was an overall significant reduction of the thoracic aortic diameter, increased true lumen diameter, and reduced false lumen diameter (P < .05). Total thrombosis of the false lumen, with or without reintervention, was seen in 53% of all patients, in 41% primarily and in 12% after reintervention. The IIIa group had a higher degree of total false lumen thrombosis. All patients in the IIIb group had total thrombosis of the false lumen along the stent graft. CONCLUSIONS: Long-term follow-up showed favorable aortic remodeling after TEVAR for acute complicated type B aortic dissection. Total thrombosis of the false lumen occurred more often in patients with DeBakey IIIa aortic dissection compared with patients with DeBakey IIIb aortic dissection.

Outcome of endovascular treatment of traumatic aortic transection.

OBJECTIVE: The purpose of this study was to analyze our experience of thoracic endovascular aortic repair (TEVAR) in patients with traumatic aortic transection. METHODS: This was a single-center consecutive case series that was conducted at the Uppsala University Hospital, Tertiary Referral Center. There were a total of 17 consecutive patients undergoing TEVAR for traumatic thoracic aortic transection. All patients undergoing TEVAR for aortic transection were registered prospectively and their medical records were reviewed regarding technical details, mechanism of injury, and concomitant injuries. Long-term outcome was analyzed with respect to need for reintervention and survival. RESULTS: Between 2001 and 2010, 17 patients underwent TEVAR for traumatic aortic injury. Median age was 42 years (range, 18-77 years), and 15 of 17 patients (88%) were men. Fourteen patients had been involved in motor vehicle accidents, two had fallen from heights, and one fell off a bicycle on a slope. In all cases, the aortic injury was located in the proximity of the origin of the left subclavian artery. All patients had concomitant injuries. In all patients, a single stent graft was sufficient to exclude the injured part of the aorta. The median cover length was 120 mm (range, 100-200 mm). In-hospital mortality was 24% (4 of 17 patients). One patient died perioperatively and three postoperatively, two from brain injuries and one from multiorgan failure. After a median follow-up of 36 months (range, 10-98 months), three patients underwent reintervention (18%), each patient only once; one for a type I endoleak, and two for pseudocoarctation secondary to stent graft infolding. Two were treated endovascularly, and one had a stent graft explantation. CONCLUSIONS: Endovascular repair allows rapid and minimally invasive therapy in patients with traumatic aortic injury with good technical results. The outcome is highly dependent on the severity of other concurrent injuries.

The value of intravascular phased-array imaging in endovascular treatment of thoracic aortic pathology.

BACKGROUND: Careful pre-, intra- and postoperative diagnostics in endovascular treatment of thoracic aortic pathology is crucial for a favourable outcome. Computer tomography (CT) and digitally subtracted angiography (DSA) do not always provide sufficient diagnostic information. PURPOSE: To report our primary experiences of using intraluminal phased-array imaging (IPAI) as an additive tool for diagnostics and endovascular treatment of thoracic aortic pathology. MATERIAL AND METHODS: Eleven patients, nine men and two women (mean age 60, range 45) were examined intraoperatively with IPAI in stentgraft procedures of thoracic aortic pathology. RESULTS: IPAI could detect and visualize the entries and re-entries in the intima. Aortic branch vessels could be visualized for patency both during and immediately after stentgraft deployment. It was also possible to detect ceased blood flow in the false lumen or aneurysmal sac after stentgraft deployment. CONCLUSION: IPAI is a helpful tool for diagnostics and for guiding stentgraft placing in the treatment of thoracic aortic pathology.

First report of a late type III endoleak from fabric tears of a Zenith stent graft.

We report a case of a late type III endoleak from a hole in the fabric of the main body of a Zenith bifurcated endograft 7 years after implantation. Abdominal pain and a rapidly expanding aneurysm were eventually followed by rupture. The defect was detected at open surgery, whereas no evidence of endoleak was found at preoperative computed tomography (CT) or angiogram. The defect was repaired by a relining procedure with an Excluder stent graft. The patient, however, died 3 weeks after admission.

Whole-body magnetic resonance angiography of patients using a standard clinical scanner.

The purpose of this study was to evaluate the technique of whole-body magnetic resonance angiography (MRA) of patients with a standard clinical scanner. Thirty-three patients referred for stenoses, occlusions, aneurysms, assessment of patency of vascular grafts, vasculitis and vascular aplasia were examined in a 1.5-T scanner using its standard body coil. Three-dimensional sequences were acquired in four stations after administration of one intravenous injection of 40 ml conventional gadolinium contrast agent. Different vessel segments were evaluated as either diagnostic or nondiagnostic and regarding the presence of stenoses with more than 50% diameter reduction, occlusions or aneurysms. Of 923 vessel segments, 67 were not evaluable because of poor contrast filling (n=31), motion artefacts (n=20), venous overlap (n=12) and other reasons (n=4). Stenoses of more than 50%, occlusions or aneurysms were observed in 26 patients (129 segments). In nine patients additional unsuspected pathology was found. In 10 out of 14 patients (71/79 segments) there was conformity between MRA and digital subtraction angiography regarding the grade of stenosis. This study shows that whole-body MRA with a standard clinical scanner is feasible. Motion artefacts and the timing of the contrast agent through the different segments are still problems to be solved.