Secondary surgical procedures after endovascular stent grafting of the thoracic aorta: Successful approaches to a challenging clinical problem

Abstract

Secondary surgical procedures after stenting of the thoracic aorta can be performed with very good results, despite the challenging clinical scenarios. Identification of successful surgical strategies for this difficult clinical problem is important in the era of increasing endovascular therapy.

Secondary aortoesophageal fistula after thoracic endovascular aortic repair for a huge aneurysm: case report and review of the literature

“…Conservative managements with broad-spectrum antibiotics and proton-pump inhibitor treatment, or secondary interventional treatment, such as total enteral feeding via percutaneous gastrostomy, esophageal stents and re-TEVAR, are frequently associated with a fatal outcome due to recurrent hemorrhage or chronic mediastinitis (2, 4, 12, 14-17, 19, 20). Thus, definitive surgical treatment involving effective debridement, esophageal resection and staged reconstruction, and aortic reconstruction using a graft appears to be the only effective method of saving patients with an AEF (3,5,8,10). On the other hand, as most AEF patients have contraindications to open surgery, owing to their poor general condition or comorbidities, surgical therapy is not frequently undertaken, as was the case with our patient.…”

“…Approximately 24 cases of secondary AEF have been previously reported in the literature (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), with most (54.2%) occurring within four months after TEVAR with various types of endograft, and only six patients (25%) surviving, with a mean followup period of 11.6 months (Table).…”

Emergent Thoracic Endovascular Aortic Repair forAcute Type-B Aortic Dissection with Malperfusionby Matsui-Kitamura Stent Graft

“…Since these complications can occur early or late after TEVAR, stringent follow-up imaging is recommended in all patients with additional re-interventions as required. 6,7) In Japan, two commercially available devices (GORE ® TAG ® , Medtronic TAL-ENT ® ) are commonly used for the follow up of these patients. However, these devices are not recommended for acute type B dissection patients.…”

Management of aorto-esophageal fistula secondary after thoracic endovascular aortic repair: a review of literature

“…Previous studies suggested that the radical force of a rigid graft expansion might cause direct erosion through the aorta into the esophagus, or pressure necrosis in the native aortic wall. As a result, the inflammation in the hematoma, mechanical compression by a large aneurysm or the force from the graft expansion might cause higher pressure in the mediastinum, resulting in further expansion of pressure necrosis due to occlusion of the aortic side branches that feed the esophagus [31,39,40]. Additionally, the largest risk factor for the development of its formation was reported to be infection of the implanted graft.…”