Journal of vascular surgery
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Spinal cord ischemia (SCI) is a potentially devastating complication of thoracic endovascular aortic repair (TEVAR) that can result in varying degrees of short-term and permanent disability. This study was undertaken to describe the clinical outcomes, long-term functional impact, and influence on survival of SCI after TEVAR. ⋯ The minority of patients experience complete return to baseline function after SCI with TEVAR, and outcomes in patients without early functional recovery are particularly dismal. Patients experiencing delayed SCI are more likely to have FI and may anticipate similar life-expectancy with neurologic recovery compared with patients without SCI. Timing of drain placement does not appear to have an impact on postdischarge FI or long-term mortality.
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In 2002, the Society for Vascular Surgery created the anatomic severity grading (ASG) score to classify abdominal aortic aneurysms (AAAs). Our objective was to identify the predictive capability and cutoff value of preoperative ASG score for reintervention after endovascular aneurysm repair (EVAR). ⋯ Preoperative total ASG score strongly predicts reintervention after EVAR. Use of a cutoff ASG value predictive of prohibitive reintervention rates could help guide the decision between endovascular vs open AAA repair.
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Thoracic aorta blunt injury (BAI) is a highly lethal lesion. A large number of victims die before obtaining emergency care. Thoracic endovascular aneurysm repair (TEVAR) is a less invasive method compared with open surgery and may change protocols for BAI treatment. ⋯ In one case (3.2%), a type I endoleak was detected, proximal endograft infolding in two cases (7.4%) and endograft distal migration in further two cases were detected during follow-up (6-110 months). Thoracic endovascular aneurysm repair of BAI showed encouraging results in terms of perioperative mortality and morbidity. Concerns still remain about the potential mid- and long-term complications in younger patients.
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Complex endovascular procedures such as fenestrated endovascular aneurysm repair (FEVAR) are associated with higher radiation doses compared with other fluoroscopically guided interventions (FGIs). The purpose of this study was to determine whether surgeon education on radiation dose control can lead to lower reference air kerma (RAK) and peak skin dose (PSD) levels in high-dose procedures. ⋯ Surgeon education on the appropriate use of technical factors during FGIs improved operating practice, reduced patient radiation dose, and decreased the number of non-FEVAR cases that exceeded 6 Gy. It is essential that vascular surgeons be educated in best operating practices to lower PSD; nonetheless, FEVAR remains a high-dose procedure.
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To present our initial experience and technical considerations for the use of chimney grafts in the treatment of patients that require endovascular aneurysm repair with aortic branch preservation. ⋯ Until off-the-shelf fenestrated or branched stent grafts become available, the chimney procedure offers a minimally invasive treatment option in patients requiring aneurysm exclusion with side branch revascularization. Although long-term follow-up has to be awaited, the initial results show that chimney grafts can help to decrease or stabilize the aneurysm diameter in most patients, but aneurysm rupture was not prevented in all patients.