Emergent endovascular stent grafting for saccular arch aneurysm complicated by aorto-esophageal fistula

Abstract

Aneurysms of aortic arch are rare but amenable to endovascular therapy. Arch aneurysm presenting with aorto-esophageal fistula and hematemesis is a feared, but relatively rare complication. The extrapolation of the safety and rapidity of emergent endovascular repair for bleeding arch aneurysms has been infrequently reported. A bovine arch anatomy confers distinct advantages for endovascular therapy often avoiding a preceding debranching surgery. However, its endovascular treatment might be complicated by the nonhealing of fistula and potential risk for mediastinitis. Here, we report a case of a bovine aortic arch cystic aneurysm complicated by bleeding aorto-esophageal fistula, which warranted an emergent endovascular therapy. The prevertebral part of LSCA was plugged to interrupt the retrograde filling and a future endoleak. A nonhealing aorto-mediastinal fistula at follow-up was successfully treated by covered esophageal stenting. This report reiterates the importance of multidisciplinary approach with multispecialty collaboration to such complex spectrum of diseases.

Feasibility of using bulk metallic glass for self-expandable stent applications

“…Being a less invasive alternative technique, endovascular aneurysm repair, has been developed and in use over the last two decades . In this technique, the aneurysm sac is excluded from the main stream circulation by the endovascular insertion of a stent‐graft (SG) via the femoral arteries . A typical SG is a combination of a metallic stent stitched to a polymeric fabric with the metallic stent typically fabricated with nitinol or self‐expanding 316 L stainless steel .…”

“…66,67 In this technique, the aneurysm sac is excluded from the main stream circulation by the endovascular insertion of a stent-graft (SG) via the femoral arteries. 68 A typical SG is a combination of a metallic stent stitched to a polymeric fabric 69,70 with the metallic stent typically fabricated with nitinol or self-expanding 316 L stainless steel. 71 Here, we considered the Zenith TX2 TAA Endovascular Graft 72 with Pro-Form which is a two-piece cylindrical endovascular graft consisting of proximal and distal components.…”

Femoral artery access site closure with perclose suture mediated device in coronary interventions

“…Earlier studies have reported device failure rate of 3–7 percent. 9 , 10 , 12 , 19 , 20 , 21 , 22 An Indian study has reported a failure rate of 4% in 323 patients studied. 9 Device failure rates have reduced over time with evolving operator experience.…”

“…There are only two small observational studies without the control arm on PP device published from India. 9 , 12 The present study was designed with the aim to understand the performance and clinical outcome of femoral artery closure with PP in patients undergoing PCI for coronary lesions compared to the conventional MC.…”

Total Endovascular Repair of Post-dissection Aortic Arch Aneurysm With Chimney Technique

“…(Ann Thorac Surg 2017;103:e241-3) Ó 2017 by The Society of Thoracic Surgeons A ortic dissection results from a disruption of the aortic intima, leading to a dissection plane and the formation of a false lumen within the aortic media. Transverse aneurysms of the aortic arch are rare, with the reported incidence being only 11% [1]. Hybrid repair, with total arch debranching and subsequent thoracic endovascular aortic repair (TEVAR), is an accepted strategy for patients requiring total arch reconstruction.…”