Descending Thoracic Aortic Rupture: Role of Endovascular Stent-Grafting

Morishita, Kiyofumi; Kurimoto, Yoshihiko; Kawaharada, Nobuyoshi; Fukada, Johji; Hachiro, Yoshikazu; Fujisawa, Yasuaki; Abe, Tomio

doi:10.1016/j.athoracsur.2004.05.014

Cited by 64 publications

(62 citation statements)

References 12 publications

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“…The procedure has been described in detail in a previous report [4]. Briefly, the patient was placed on a radiolucent operating table under general anesthesia in the operating room.…”

Section: Stent-graft Placementmentioning

confidence: 99%

Spinal cord ischemia after elective endovascular stent-graft repair of the thoracic aorta☆

Kawaharada

Morishita

Kurimoto

et al. 2007

European Journal of Cardio-Thoracic Surgery

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Background: We reviewed our experience to investigate the determinants of paraplegia/paraparesis after endovascular stent-graft repair of the thoracic aorta, to assess the influence of the artery of Adamkiewicz (ARM) detected by preoperative magnetic resonance angiography (MRA) and to identify patients at risk. Methods: Over a 5-year period (March 2001-June 2006, 149 patients underwent elective endovascular stentgraft repair of the descending thoracic aorta. Patient demographics and perioperative factors relating to the endovascular procedure were evaluated by using univariate statistical analyses. To assess the influence of the ARM in the thoracolumbar region, patients in whom ARM was detected by preoperative MRA were divided into two groups: patients who had occlusion of the intercostal artery for ARM due to stent-graft (group A, n = 33) and patients who had patency of the intercostal artery for ARM following stent-graft (group B, n = 38). Results: Five (3.6%) of the 144 patients had paraparesis/paraplegia. Two of these five patients had previously undergone operation for total arch replacement with elephant trunk and one had surgery for descending aortic repair. Univariate analyses identified only prior aortic surgery as a significant risk factor ( p = 0.04). Paraparesis/paraplegia rates were 10% (three patients) in group A and 0% in group B ( p = 0.09). Conclusion: Prior thoracic aortic replacement was found to be a significant predictor of spinal cord ischemia, and therefore vigilance is needed regarding occlusion of the intercostal artery for ARM detected prior to stent-graft repair. #

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“…The procedure has been described in detail in a previous report [4]. Briefly, the patient was placed on a radiolucent operating table under general anesthesia in the operating room.…”

Section: Stent-graft Placementmentioning

confidence: 99%

Spinal cord ischemia after elective endovascular stent-graft repair of the thoracic aorta☆

Kawaharada

Morishita

Kurimoto

et al. 2007

European Journal of Cardio-Thoracic Surgery

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“…In this context, the development of endovascular SG had a substantial impact, providing a completely different treatment option for patients with BAI. As we previously reported, 4 this technique has become widely used during the past decade for treating not only non-ruptured aortic aneurysms but also ruptured aortic aneurysms, including BAI. 7 Endovascular SG has several benefits for multiple trauma patients, including making cardiopulmonary bypass unnecessary.…”

Section: Discussionmentioning

confidence: 99%

“…The procedure has been described in detail in a previous report. 4 Briefly, the patient was placed on a radiolucent operating table under general anesthesia in the operating room. The hand-made stent graft was manually loaded into the proximal end of an 18-20Fr long sheath (Cook Inc).…”

Section: Endovascular Sgmentioning

confidence: 99%

Initial Experiences in Management of Blunt Aortic Injury Taking Associated Brain Injury Into Consideration

Kurimoto¹,

Morishita²,

Kawaharada³

et al. 2006

Circ J

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“…Die Autoren haben bisher bei der Anwendung der temporären tachykarden Schrittmacherstimulation bei 10 Patienten keine relevanten Rhythmusstörungen oder myokardiale Ischämien beobachtet. Über ähnlich positive Erfahrungen berichten auch andere Gruppen aus Auckland/Neuseeland (n=16; [48]) und Rostock (n=27; [42]). …”

Section: Perioperatives Anästhesiologisches Managementunclassified

Traumatische thorakale Aortenruptur

et al. 2008

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Traumatic aortic rupture is a life-threatening injury which is frequently associated with blunt thoracic trauma or found coincidentally in heavily traumatized patients. Depending on the degree of disruption of the damaged aortic wall, vascular injury is associated with a high primary mortality rate and a significant risk of secondary aortic rupture. Early clinical signs which may indicate a ruptured thoracic aorta are left sided thoracic pain, reduced ventilation, tachycardia and dyspnoe as well as hypotension in the lower extremities. The primary aim for emergency treatment is to maintain vital organ function and to hemodynamically stabilize the patient. Surgical treatment was previously performed by either direct aortic suture or segmental alloplastic graft interposition using the clamp and sew technique with or without extra-anatomic shunts or extracorporeal circulation. However, endovascular stent graft implantation has now become another treatment option for traumatic aortic rupture. According to the reported data and our own experience there is increasing evidence that endovascular aortic repair might become the treatment of choice for patients with traumatic aortic rupture, with the option of an early, less invasive intervention thus avoiding thoracotomy. Regular follow-up is necessary to detect possible stent graft migration or leakage which could require additional endovascular or open surgical re-interventions.

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Descending Thoracic Aortic Rupture: Role of Endovascular Stent-Grafting

Cited by 64 publications

References 12 publications

Spinal cord ischemia after elective endovascular stent-graft repair of the thoracic aorta☆

Spinal cord ischemia after elective endovascular stent-graft repair of the thoracic aorta☆

Initial Experiences in Management of Blunt Aortic Injury Taking Associated Brain Injury Into Consideration

Traumatische thorakale Aortenruptur

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