Proximal aortic perforation after endovascular repair of a type B dissection in a patient with Marfan syndrome

Keulen, Jasper W. van; Moll, Frans L.; Jahrome, A. Khodadade; Herwaarden, Joost A. van

doi:10.1016/j.jvs.2009.01.045

Cited by 19 publications

(8 citation statements)

References 7 publications

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“…Although a proximal bare stent improves the apposition of the sealing segment, this is not an ideal remedy in all situations. Bare stents have been associated with iatrogenic retrograde dissections, 6 perforations by the exposed crown of the stent, 7 and asymmetric deployment of the bare stent, which can only be prevented by a tip-capture mechanism.…”

Section: Discussionmentioning

confidence: 99%

First United States experience of the TX2 Pro-Form thoracic delivery system

Lee

Martin

Hess

et al. 2010

Journal of Vascular Surgery

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Section: Discussionmentioning

confidence: 99%

First United States experience of the TX2 Pro-Form thoracic delivery system

Lee

Martin

Hess

et al. 2010

Journal of Vascular Surgery

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“…Patients undergoing TEVAR for aortic dissections are particularly prone to RAAD after TEVAR [5,10]. Our case was a true aneurysm, so there was little wall calcification and no mural thrombus.…”

Section: Discussionmentioning

confidence: 71%

Stent strut penetration during thoracic endovascular aortic repair: report of a case

et al. 2011

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We experienced a serious complication of proximal stent strut penetration (PSSP) during thoracic endovascular aortic repair in a 74-year-old man who underwent two-stage hybrid treatment for a distal arch thoracic aortic aneurysm. First, a debranching right common carotid-left common carotid-left subclavian artery bypass was performed. Second, a TALENT Thoracic Stent Graft (Medtronic, Tokyo, Japan) was inserted at Zone 1 (Ishimaru). At deployment, a proximal bare strut accidentally everted and penetrated the aortic wall vertically. Postoperative computed tomography revealed that one crown of the proximal strut had penetrated the aortic wall vertically and had produced an intramural hematoma around the strut. The patient was observed carefully and discharged from the hospital without any sequelae. Seven months after the procedure, there was no remarkable change and his aneurysm was well excluded. PSSP can cause retrograde type-A aortic dissections. A bare strut tends to cause proximal strut penetration more frequently than a covered strut. More caution should be taken in the deployment of a stent graft with a bare strut.

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“…19 Clearly, the long-term durability and threat to the fixation zones in the setting of chronic outward radial force of the device against an abnormal host vessel may increase secondary interventions. Emerging reports suggest stent-graft therapy in connective tissue disorders may be wrought with complications with perforation and erosion at fixation zones and very high rates of secondary reintervention.…”

Section: Discussionmentioning

confidence: 99%

Contemporary management of vascular complications associated with Ehlers-Danlos syndrome

Brooke

Arnaoutakis

McDonnell

et al. 2010

Journal of Vascular Surgery

107

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Objectives There has been debate regarding the safety of performing elective procedures in patients with vascular manifestations associated with Ehlers-Danlos syndrome (EDS). The purpose of this study was to review the surgical management and clinical outcomes of EDS patients undergoing vascular procedures at a tertiary medical center with multimodality expertise in connective tissue disorders. Methods All patients with EDS undergoing endovascular and open vascular procedures at a single-institution academic medical center from 1994 to 2009 were retrospectively reviewed. Clinical data were evaluated including patient demographics, length of stay (LOS), and mortality outcomes during hospital course and long-term follow-up. Results A total of 40 patients with EDS were identified, including individuals diagnosed with classic (n = 15), hypermobility (n = 16), and vascular (n = 9) types of EDS. These patients collectively underwent 45 endovascular and 18 open procedures for vascular disease during the time period, including embolization (n = 37), angioplasty (n = 8), arterial bypass (n = 5), and aortic aneurysm repair (n = 13). All cases were performed electively, except for one (2%) urgent endovascular and one (5%) emergent open procedure. Endovascular procedures were associated with a median LOS (interquartile range [IQR]) of 2 (1 to 3) days with no procedure-related mortality or in-hospital deaths among all EDS types, whereas open vascular procedures had median LOS (IQR) of 6 (5 to 8) days with one (6%) in-hospital death occurring in a vascular EDS patient. Survival free of any complication at 5 years was 85% and 54% following endovascular and open procedures, respectively. Conclusions The elective surgical management of vascular disorders in EDS patients using open and endovascular procedures has been associated with good outcomes. Our results suggest that vascular interventions in these EDS patients can be safely performed and should not be withheld until rupture or acute symptoms arise.

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Proximal aortic perforation after endovascular repair of a type B dissection in a patient with Marfan syndrome

Cited by 19 publications

References 7 publications

First United States experience of the TX2 Pro-Form thoracic delivery system

First United States experience of the TX2 Pro-Form thoracic delivery system

Stent strut penetration during thoracic endovascular aortic repair: report of a case

Contemporary management of vascular complications associated with Ehlers-Danlos syndrome

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