1,721,180 research outputs found
Delayed Upstream Migration of an Iliac Stent
No full textIntroductionStent migrations are described after peripheral endovascular treatments. We report a case of an unusual iliac stent movement after a successful angioplasty.ReportAn occlusive distal intimal flap after aorto-iliac endoarterectomy was successfully fixed by stenting of the left external iliac artery. One month later, the patient was readmitted due to contralateral limb acute ischemia. Angiography revealed a right iliac artery thrombosis due to upstream stent migration from the left external iliac artery into the right common iliac artery. The patient underwent a combined surgical and endovascular rescue technique.ConclusionTurbulent and pulsatile flow, associated with wall remodelling may explain this unexpected complication
Pericardial fat pad and thoracic aortic surgery
No full textPericardial fat pads have been successfully used for many years by thoracic and cardiac surgeons for a number of applications. We recently used a pedicled and well-vascularized pericardial fat pad in a patient who underwent replacement of a distal aortic arch aneurysm with a Dacron tube graft, in order to avoid contact between the anastomoses and the oesophagus in an effort to reduce the risk of subsequent infection and fistula formation. This simple technique may provide a source of vital tissue that may be useful for protecting anastomoses after thoracic aortic surgery, particularly in cases requiring re-operation. To our knowledge the use of pericardial fat pads has not been previously reported in the English literature for this purposePericardial fat pads have been successfully used for many years by thoracic and cardiac surgeons for a number of applications. We recently used a pedicled and well-vascularized pericardial fat pad in a patient who underwent replacement of a distal aortic arch aneurysm with a Dacron tube graft, in order to avoid contact between the anastomoses and the oesophagus in an effort to reduce the risk of subsequent infection and fistula formation. This simple technique may provide a source of vital tissue that may be useful for protecting anastomoses after thoracic aortic surgery, particularly in cases requiring re-operation. To our knowledge the use of pericardial fat pads has not been previously reported in the English literature for this purpose. © 2003 Elsevier Science Ltd. All rights reserved
Endovascular treatment of aortic arch aneurysms
No full textIntroduction: The aim of this study was to review our clinical experience with endovascular treatment of aortic arch aneurysms using different commercially available grafts (Gore, Talent, Endomed, Cook). Methods: From 1999 to 2004, 97 patients received endovascular treatment for diseases of the thoracic aorta. In 30 cases (26 males, 4 females) the aortic arch was involved. The left subclavian artery was overstented (Ishimaru zone '2') in 18 cases (60%). Only in the first three cases had the subclavian artery been revascularized. The left common and subclavian arteries were covered (zone '1') in 6 (20%) cases-all had the carotid artery reconstructed, either simultaneously (five cases) or as a staged procedure (one case). Finally, the whole aortic arch was over-stented (zone '0') in 6 (20%) cases, with simultaneous (five cases) or staged (one case) grafting of the supra-aortic vessels from the ascending aorta. Results: Perioperative mortality was 2/30 (7%), due to graft migration (zone '2') and intra-operative stroke (zone '0'), respectively. One minor stroke was observed. No cases of paraplegia were recorded. Three type I endoleaks were observed. Two resolved at 6 months follow-up; one zone '0' graft is still being followed. There was one surgical conversion for endograft failure 2 weeks after implantation. Thus, the technical success rate was 87% (26/30) cases. The mean follow-up time was 23±17 months. No new onset endoleaks or aneurysm-related deaths were recorded. Conclusions: Currently available grafts may be deployed in the aortic arch in most instances. De-branching of the aortic arch with surgical revascularization for zone '0' and '1' seems to be adequate to obtain a satisfactory proximal landing zone
Aortic and esophageal endografting for secondary aortoenteric fistula
No full textThe aorto-esophageal fistula is a well-recognized and potentially fatal complication of thoracic aortic surgery. Several strategies regarding its prevention and subsequent management have been described. We report the management of a large midthoracic fistula complicating redo thoraco-abdominal aortic surgery by the placement of covered stents in the aorta and esophagus to successfully exclude the lesion. While long term durability is uncertain, endografts and long-term antibiotics provide a therapeutic option for palliation in patients unfit for immediate surgery
Resolution of an anastomotic aortic pseudoaneurysm - 4 years after endovascular treatment
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