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Spontaneous sealing of a type Ia endoleak after ovation stent graft implantation in a patient with on-label aortic neck anatomy
Full text linkWe report a case of an early type Ia endoleak after endovascular aneurysm repair (EVAR) of an abdominal aortic aneurysm by Ovation Stent Graft implantation and spontaneously resolved without further reintervention. The patient presents a conical aortic neck, but EVAR was performed within the instruction for use proposed by manufactory. At completion angiography, a low-flow type Ia endoleak was present and left untreated. Computed tomographic angiography performed on the third postoperative day showed infolding of the 2 sealing rings. The patient was dismissed without further treatment. At 3-month follow-up, the leak appeared spontaneously sealed with partial expansion of the 2 rings.We report a case of an early type Ia endoleak after endovascular aneurysm repair (EVAR) of an abdominal aortic aneurysm by Ovation Stent Graft implantation and spontaneously resolved without further reintervention. The patient presents a conical aortic neck, but EVAR was performed within the instruction for use proposed by manufactory. At completion angiography, a low-flow type Ia endoleak was present and left untreated. Computed tomographic angiography performed on the third postoperative day showed infolding of the 2 sealing rings. The patient was dismissed without further treatment. At 3-month follow-up, the leak appeared spontaneously sealed with partial expansion of the 2 rings
Superficial femoral artery stent disruption treated by peripheral endograft
No full textWe report a case of superficial femoral artery (SFA) stent fractures (SF) with atypical symptoms and site of disruption. Patient was hospitalized for sudden onset of right thigh pain, nonrelated to steno-obstructive disease. Preoperative ultrasound suspected and computed tomographic angiography (CTA) confirmed multiple proximal SFA SFs with concurrent pseudoaneurysms. A peripheral endograft was deployed covering the entire SFA, achieving a complete "relining" with exclusion of the pseudoaneurysm. Pain disappeared and postoperative control demonstrated good patency of the SFA. After 1 month, patient reported no further events and CTA revealed patency of the endograft and exclusion of the pseudoaneurysm. At 1 year follow-up, Viabahn is patent with no further symptoms reported by the patient
Simultaneous open surgical treatment of aortic coral reef and Leriche syndrome: case report and literature review
No full textThe coral reef aorta (CRA) is a rare syndrome commonly referred to a distribution of calcified plaques in the visceral part of the aorta. Since those plaques can cause malperfusion of the lower limbs, visceral ischemia or renovascular hypertension, surgical treatment is recommended. Transaortic endarterectomy is accepted as a standard repair and it is often performed through an extensive thoraco-abdominal approach. CRA has been reported in association with polidistrectual atherosclerotic disease, such as Leriche syndrome. When these two conditions coexist, surgical invasivity increases raising several issues concerning the type of surgical access as well as the revascularization techniques. We report the case of a patient with CRA and Leriche syndrome treated by simultaneous aortic endarterectomy and aortibifemoral bypass at our institution. Intervention was performed through left lumbotomy at 10th intercostal space extended by a left pararectal abdominal incision with section of 11th rib. Through extraperitoneal access visceral vessels were isolated. Aortic cross clamping was performed at supraceliac and infrarenal levels and a longitudinal arteriotomy was performed on the posterolateral wall of visceral aorta for an overall 4 cm extension. Aortic endarterectomy was then performed and complete plaque excision was easily achieved. SMA angioplasty was then performed by a DeBakey dilator, gaining an optimal backflow. The aortotomy was then closed with running 3-0 polypropilene suture. Subsequently, through a trans-peritoneal access an aortobifemoral bypass was performed by a dacron knitted graft. Post-operative course was uneventful. At a 6 months follow-up the patient is in good clinical condition with normal patency of visceral vessels
Open conversion after aortic endograft infection. Caused by colistin-resistant, carbapenemase-producing Klebsiella pneumoniae
Full text linkA 62-year-old man presented with fever, abdominal pain, and malaise 13 months after
emergency endovascular aortic repair. Computed tomographic angiograms showed a
periprosthetic fluid and gas collection, so infection was diagnosed. Open conversion was
performed, involving endograft explantation and in situ aortic reconstruction. Cultures and
the explanted prosthesis were positive for carbapenemase-producing Klebsiella pneumoniae,
resistant to colistin. Because of the sparse data on endograft infections caused
by this pathogen, we placed the patient on an empiric double-carbapenem regimen for
4 weeks. Symptomatic recovery occurred after 21 days. On the 30th day, we deployed
a stent to treat a new pseudoaneurysm. Three years later, the patient had no signs of
persistent or recurrent infection. We think that this is the first report of aortic endograft
infection caused by colistin-resistant, carbapenemase-producing K. pneumoniae.A 62-year-old man presented with fever, abdominal pain, and malaise 13 months after
emergency endovascular aortic repair. Computed tomographic angiograms showed a
periprosthetic fluid and gas collection, so infection was diagnosed. Open conversion was
performed, involving endograft explantation and in situ aortic reconstruction. Cultures and
the explanted prosthesis were positive for carbapenemase-producing Klebsiella pneumoniae,
resistant to colistin. Because of the sparse data on endograft infections caused
by this pathogen, we placed the patient on an empiric double-carbapenem regimen for
4 weeks. Symptomatic recovery occurred after 21 days. On the 30th day, we deployed
a stent to treat a new pseudoaneurysm. Three years later, the patient had no signs of
persistent or recurrent infection. We think that this is the first report of aortic endograft
infection caused by colistin-resistant, carbapenemase-producing K. pneumoniae
Not Only the Proximal Neck. Comment on "Initial Single-center Experience with the Ovation Stent-graft System in the Treatment of Abdominal Aortic Aneurysms: Application to Challenging Iliac Access Anatomies".
No full textSilent stroke and cognitive decline in asymptomatic carotid stenosis revascularization
No full textThe aim of this study was to assess the relationship between serum levels of S100 beta and neuron-specific enolase (NSE), postoperative diffusion-weighted magnetic resonance imaging (DW-MRI) and Mini-Mental State Examination (MMSE) score in asymptomatic patients affected by >= 70% carotid stenosis submitted to carotid endarterectomy (CEA) or carotid artery stenting (CAS), and to compare MMSE scores and DW-MRI findings at follow-up evaluations. Between April 2008 and April 2009, 60 patients were submitted to carotid intervention. All patients underwent DW-MRI and MMSE preoperatively, at 24 hours postoperatively, at 6 months and at 12 months. Neurobiomarkers were assessed for each patient at six time-points. Thirty-two patients were submitted to CEA and 28 to CAS. No mortality was observed. One CAS patient presented with an ischemic stroke. In six CAS patients and one CEA patient, new subclinical ischemic lesions were detected at postoperative DW-MRI (21.4% versus 3%, P = 0.03). In CAS patients, new DW-MRI lesions were significantly associated with MMSE score decline (P = 0.001). At 12 months, patients presenting with new postoperative ischemic lesions showed lower MMSE scores (P = 0.08). CAS patients showed increasing neurobiomarker levels compared with CEA patients (P = 0.02). In conclusion, microembolization effects may persist over time, so it should be avoided whenever possible. Carotid revascularization procedures should be evaluated and compared not only with respect to death/stroke but also to microembolism rates
Pushing forward the limits of evar: new therapeutic solutions for extremely challenging AAAs using the Ovation® stent graft.
No full textEmergent Treatment of a Ruptured Thoracoabdominal Aortic Aneurysm by Off-Label Rescue Implantation of the Ovation Stent Graft in Nonagenarian Patients.
No full textWe report a case of a compassionate treatment of a ruptured thoracoabdominal aortic aneurysm in a 92-year-old patient. The patient was admitted to our emergency department for acute onset of pain irradiating to the back. Computed tomography angiography showed the presence of a thoracoabdominal aortic aneurysm with a contained rupture at infrarenal level. Given the presence of a relative healthy visceral aorta, we decided to treat the patient by Ovation (Endologix, Irvine, CA) implantation in an off-label fashion. Procedure was performed by bilateral percutaneous access. Completion angiography showed the good stent-graft apposition with complete aneurysm exclusion. The patient was discharged on the third postoperative day. The 1-month follow-up confirmed the good procedural result; aneurysm was completely excluded without further thoracic dilatation
Retrograde Type B Aortic Dissection as a Complication of Standard Endovascular Aortic Repair.
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