Transluminal Placement of Endovascular Stent-Grafts for the Treatment of Descending Thoracic Aortic Aneurysms

El traumatismo de aorta torácica es una lesión asociada a una alta morbimortalidad en el lugar del accidente. En los años noventa se generalizó el tratamiento mediante la colocación de un stent endovascular con buenos resultados. En este trabajo presentamos una serie de cinco casos clíni-cos de pacientes ingresados en la Unidad de Cuidados Intensivos de nuestro hospital durante el año 2006. De un total de 619 pacientes ingresados en el mismo periodo, 121 (19,5%) fueron traumá-ticos y 5 (4,13%) sufrían traumatismos de aorta torácica. Todos los pacientes fueron diagnosticados por tomografía computarizada helicoidal torácica al ingreso. Cuatro pacientes tenían un pseudoaneurisma de aorta y fueron intervenidos. Tres recibieron tratamiento endovascular dentro de las 36 primeras horas y el otro al vigesimoctavo día del ingreso. El quinto paciente presentó una lesión de la íntima y no se intervino. La evolución posterior fue buena en todos los casos.PALABRAS CLAVE: traumatismo de aorta torácica, tratamiento endovascular, politraumatismo. MANAGEMENT OF THORACIC AORTA TRAUMATISM IN 5 MULTIPLE TRAUMATIZED PATIENTSThoracic aorta traumatism is a lesion associated to high morbidity-mortality at the site of the accident. In the 90's, treatment by placement of an endovascular stent was generalized with good results. In this work, we present a series of 5 clinical cases of patients admitted to the Intensive Care Unit of our hospital during the year 2006. Out of a total of 619 patients admitted in the same period, 121 (19.5%) were traumatic and 5 (4.13%) had thoracic aorta traumatisms. All of the patients were diagnosed by thoracic helical computed tomography on admission. Four patients had a pseudoaneurism of the aorta and underwent an operation. Three received endovascular treatment within the first 36 hours and the fourth on day 28 of admission. The fifth patient had a lesion of the intima and was not operated on. Posterior evolution was good in all the cases. KEY WORDS: thoracic aorta traumatism, endovascular treatment, multiple traumatism.

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“…En 1994 Dake et al 13 publicaron el éxito del tratamiento endovascular para la reparación de aneurismas de aorta torácica.…”

Section: Discussionunclassified

Manejo del traumatismo de aorta torácica en cinco pacientes politraumatizados

et al. 2008

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“…For the subsequent report, patients are divided into an ABF group [1][2][3][4][5] and an AEF group 6-9 (►Table 1). Preoperative imaging protocol consisted of high-resolution spiral computed tomography (CT) scan and additional magnetic resonance image in selected cases.…”

Section: Methodsmentioning

confidence: 99%

“…Therefore, less invasive concepts to reduce perioperative mortality have been evaluated with special attention on thoracic endovascular aortic repair (TE-VAR). Since the first report of TEVAR in TAA (13 patients) in 1994, 5 the technique has rapidly evolved and currently is the primary recommendation for treatment of aneurysms of the thoracic aorta. 6 Although until today, no randomized trials of open versus endovascular TEVAR have been performed.…”

Section: Introductionmentioning

confidence: 99%

Strategies for Endovascular Aortic Repair in Aortobronchial and Aortoesophageal Fistulas

Dorweiler

Weigang

Duenschede

et al. 2013

Thorac cardiovasc Surg

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Objective To report our experience of thoracic endovascular aortic repair (TEVAR) for acute bleeding originating from the thoracic aorta in patients with aortobronchial fistula (ABF) or aortoesophageal fistula (AEF). Patients and Methods A total of nine patients (three woman) were treated from September 1995 to March 2012 by TEVAR for ABF (n ¼ 5) and AEF (n ¼ 4). The implants (N ¼ 14) were introduced with fluoroscopic guidance via the aorta (n ¼ 1), the iliac (n ¼ 2), or femoral (n ¼ 11) artery, respectively. Results All aortic lesions could be sealed successfully. Perioperative morbidity was 0% in the ABF group and 50% (2 of 4) in the AEF group and no procedure-related morbidity was noted except one patient who received aortofemoral reconstruction because of iliac occlusive disease. After an overall mean follow-up of 56 months, three patients of the ABF group are alive and well and two patients died of nonrelated cause. Of the AEF group, one patient is alive after 22 months, and one died from metastasized esophageal cancer after 7 months. Conclusion TEVAR is a safe and reliable procedure in the management of ABF. For AEF, TEVAR provides a successful first-line treatment to seal the fistula and control bleeding. However, prognosis is limited by the esophageal lesion and by ongoing mediastinitis/ sepsis.

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“…A terapia endoluminal foi introduzida na prática cirúrgica como uma nova modalidade terapêutica no tratamento das doenças da aorta, tais como aneurismas [1][2][3][4][5] , dissecções 6,7 , úlceras aórticas penetrantes 8,9 , rotura traumática da aorta 10,11 , entre outras. Contudo, apesar dos altos índices de sucesso técnico e melhora nas taxas de morbidade e mortalidade, os seus resultados em longo prazo permanecem incertos 12 .…”

Section: Introductionunclassified

Fístula aorto-esofágica secundária a fratura de endoprótese torácica: relato de caso

Nasser

Neser²,

Ingrund³

et al. 2006

J. vasc. bras.

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The endovascular treatment of thoracic aortic aneurysms has undergone considerable development over the past years. However, late complications of this new therapeutic modality have only recently been observed and analyzed. Aortoesophageal fistulas are rare complications of the endovascular treatment of aortic aneurysms, and there are few reports in the literature. We report a case of a patient with thoracic aortic aneurysm treated 4 years ago and with complications due to stent-graft fracture. After a new endovascular intervention, there was extrusion of the old graft through the esophagus with fistula formation. Despite the treatment, the patient died 9 days later due to massive digestive hemorrhage. Technical aspects and review of the literature are discussed.Keywords: Aneurysm, fistula, graft implantation. ResumoO tratamento endovascular dos aneurismas aórticos torácicos tem se desenvolvido consideravelmente nos últimos anos. No entanto, complicações tardias desta nova modalidade terapêutica apenas agora estão sendo observadas e analisadas. Fístulas aorto-esofágicas são complicações raras do tratamento endovascular dos aneurismas aórticos, sendo encontrados poucos relatos na literatura. O presente caso reporta um paciente com aneurisma aórtico torácico tratado há 4 anos e complicado com fratura da endoprótese. Após nova intervenção endovascular, foi observada extrusão da antiga endoprótese através do esôfago com formação de fístula. Apesar do tratamento realizado, o paciente evoluiu a óbito 9 dias após por hemorragia digestiva maciça. Aspectos técnicos e revisão de literatura são discutidos.Palavras-chave: Aneurisma, fístula, implante de prótese.RELATO DE CASO IntroduçãoA terapia endoluminal foi introduzida na prática cirúrgica como uma nova modalidade terapêutica no tratamento das doenças da aorta, tais como aneurismas 1-5 , dissecções 6,7 , úlceras aórticas penetrantes 8,9 , rotura traumática da aorta 10,11 , entre outras. Contudo, apesar dos altos índices de sucesso técnico e melhora nas taxas de morbidade e mortalidade, os seus resultados em longo prazo permanecem incertos 12 . Até o presente momento, a maioria dos eventos adversos encontra-se associada ao material protético e é manifestada principalmente através dos endoleaks 12 . Complicações como lesão arterial, isquemia de membros superiores, embolização distal, acidente vascular cerebral e paraplegia também têm sido reportadas 13 .Fístulas aorto-esofágicas (FAE) e aorto-brônquicas (FAB) são complicações raras dos tratamentos cirúrgi-co e endovascular das doenças da aorta, porém quase sempre fatais na ausência de tratamento adequado, além de considerável morbidade e mortalidade [14][15][16][17][18] .O propósito deste artigo é o de descrever a ocorrên-cia de extrusão para o esôfago de endoprótese previamente implantada em um paciente com aneurisma torácico da aorta descendente.

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Transluminal Placement of Endovascular Stent-Grafts for the Treatment of Descending Thoracic Aortic Aneurysms

Abstract: These preliminary results demonstrate that endovascular stent-graft repair is safe in highly selected patients with descending thoracic aortic aneurysms. This new method of treatment will, however, require careful long-term evaluation.

Cited by 1,506 publications

References 19 publications

Manejo del traumatismo de aorta torácica en cinco pacientes politraumatizados

Manejo del traumatismo de aorta torácica en cinco pacientes politraumatizados

Strategies for Endovascular Aortic Repair in Aortobronchial and Aortoesophageal Fistulas

Fístula aorto-esofágica secundária a fratura de endoprótese torácica: relato de caso

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