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Custom Made Fenestrated Stent Graft Collapse after thoracic endovascular aortic repair: A Case Report

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Case Reports in Clinical Medicine 2023年第8期12卷 299-305页

作者： Yasuhiko Kobayashi Mitsugu Fukuda Shoji Sakaguchi Yoshihisa Nakao Kiyoshi Nishimine Department of Cardiovascular Surgery Yao Tokushukai General Hospital Osaka Japan Department of Treatment in aortic Stent Graft/Blood Vessel Matsubara Tokushukai Hospital Osaka Japan

We present a case of stent graft collapse after performing thoracic endovascular aortic repair with a custom-made fenestrated stent graft. The patient was a 70-year-old woman with an asymptomatic aneurysm of the distal aortic arch, and thoracic endovascular aortic repair was performed. The patient showed a blood pressure difference between the left arm and the right arm on postoperative day (POD) 17 prompting the performance of a chest computed tomography scan which revealed stent graft collapse. She then underwent staged debranching of thoracic endovascular aortic repair. Stent graft collapse is a rare but well-described complication of thoracic endovascular repair. Therefore, patients who undergo such a procedure should be carefully monitored for signs and symptoms, which suggest the possibility of stent collapse.

关键词： thoracic endovascular aortic repair Collapse Custom Made Fenestrated Stent Graft Bird-Beak Deformity

Successful management of life-threatening aortoesophageal fistula: A case report and review of the literature

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World Journal of Clinical Cases 2022年第12期10卷 3814-3821页

作者： Xue-Qing Zhong Guo-Xiong Li Department of Gastroenterology and Hepatology Hangzhou Normal University Affiliated HospitalHangzhou 310015Zhejiang ProvinceChina Medical College Hangzhou Normal UniversityHangzhou 311121Zhejiang ProvinceChina

BACKGROUND Aortoesophageal fistula(AEF)is a rare but life-threatening cause of upper gastrointestinal *** a handful of cases of successful management of AEF caused by esophageal cancer have been *** purpose of this study is to report a case of AEF managed by endovascular aortic repair and review the relevant *** SUMMARY A 66-year-old man with upper gastroenterology bleeding presented at the Emergency Department of our hospital complaining of chest pain,fever and hematemesis for 6 *** had vomited 400 mL of bright-red blood and experienced severe chest pain 6 h *** had a past medical history of advanced esophageal *** received chemoradiotherapy but stopped 8 mo prior because of intolerance.A chest contrast computed tomographic scan revealed communication between the esophagus and the descending aorta as well as a descending aortic *** to the symptoms and imaging findings,AEF was our primary *** patient underwent aortic angiography,which indicated AEF and descending aortic *** percutaneous thoracic endovascular aortic repair(TEVAR)of the descending aorta was performed,and bleeding was controlled after *** received antibiotics and was discharged after ***,he died 2 mo after the TEVAR due to cancer *** Although AEF is a lethal condition,timely diagnosis and TEVAR may successfully control bleeding.

关键词： Upper gastrointestinal bleeding Aortoesophageal fistula thoracic endovascular aortic repair Esophageal cancer Chest pain Case report

Antegrade in situ laser fenestration of aortic stent graft during endovascular aortic repair:A case report

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World Journal of Clinical Cases 2022年第4期10卷 1401-1409页

作者： Zhi-Wei Wang Zhen-Tao Qiao Ming-Xing Li Hua-Long Bai Yuan-Feng Liu Tao Bai Department of Vascular and endovascular Surgery First Affiliated Hospital of Zhengzhou UniversityZhengzhou 450003Henan ProvinceChina

BACKGROUND The endovascular repair of juxtarenal abdominal aortic aneurysms(JAAA)usually requires combination treatment with various stent graft modifications to preserve side branch *** a feasible technique,according to the situation,antegrade in situ laser fenestration still needs to be *** SUMMARY This report describes a case that was successfully treated with endovascular repair facilitated by antegrade in situ laser fenestration while maintaining renal arterial *** fenestration was performed using a steerable sheath positioned in the stent graft lumen in front of the renal artery *** the bare stent region unreleased,renal artery perfusion could be maintained and accurate positioning could be achieved by angiography in real *** This study suggests the feasibility and short-term safety of this novel antegrade in situ laser fenestration technique for select JAAA patients.

关键词： Juxtarenal abdominal aortic aneurysm In situ fenestration thoracic endovascular aortic repair Antegrade Case report

Short-term efficacy of unibody single-branched stent in the treatment of lesions involving the left subclavian artery:two-year follow-up outcomes

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Journal of Geriatric Cardiology 2020年第2期17卷 120-123页

作者： Bai-Lang CHEN Xian-Mian ZHUANG Min-Xin WEI Department of Cardiovascular Surgery the Seventh Affiliated HospitalSun Yat-sen UniversityShenzhenChina Department of Cardiovascular Surgery Fuwai HospitalChinese Academy of Medical SciencesShenzhenChina

The development of thoracic endovascular aortic repair(TEVAR)technology avoids the risk of patients opening the chest and is widely used in Stanford B-type dissection.[1–3]However,because TEVAR technology has clear requirements for vascular anatomy of the lesion,it limits its application to some *** the shortcomings of the proximal anchor zone,coverage of the left subclavian artery(LSA)origin without revascularization during TEVAR appears to have increased risk of stroke,upper extremity ischemia and paraplegia.[4]

关键词： aortic dissection Left subclavian artery Single-branched stent graft thoracic endovascular aortic repair

Hemodynamic evaluation of different stent graft schemes in aortic arch covered stent implantation

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Medicine in Novel Technology and Devices 2022年第1期13卷 79-86页

作者： Jingxin Liu Xinyong Cai Yuliang Zhan Hongmin Zhu Haiyong Ao Yizao Wan Honglin Luo Zhiwei Yang Quanchao Zhang Jiangxi Key Laboratory of Nanobiomaterials Institute of Advanced MaterialsEast China Jiaotong UniversityNanchang330013China Department of Cardiology Jiangxi Provincial People's Hospital Affiliated to Nanchang UniversityNanchang330006China School of Materials Science and Engineering Tianjin UniversityTianjin300072China

Implantation of the left subclavian artery(LSA)stent graft used in fenestration technique of the thoracic endovascular aortic repair(TEVAR)may interfere with the aortic helical blood flow that is believed to have important protective functions against *** present study investigated four different LSA stent graft implantation schemes for their resulted blood flow patterns in the thoracic aortic with hemodynamic computational simulation methods:the flush branch(FB),the protruding branch(PB),the straight cuff branch(SCB)and the cured cuff branch(CCB).The results showed that the PB scheme could slightly enhance helicity of the swirling flow in the aorta,but the other three schemes had less effect on blood flow *** PB scheme produced lowTAWSS,high-OSI and high-RRT around the LSA root,and the FB scheme had similar TAWSS,OSI and RRT in both value and distribution to those in the aorta without LSA stent graft *** SCB and CCB schemes led to less area of high-OSI and high-RRT values along the walls of the LSA branch *** results also showed that the PB scheme would significantly reduce blood supply to the LSA,on the contrary,the CCB scheme enhanced LSA blood supply and less effect on the total blood supply to the three branches of the thoracic *** summary,all of the four schemes have no significant effect on the aortic swirling flow,however,in the terms of TAWSS,OSI,RRT and blood supply to the LSA,the CCB model might be the best option with less area of low-WSS,high-OSI,high-RRT and well blood supply in the LSA.

关键词： Helical flow thoracic endovascular aortic repair Fenestration technique Hemodynamic LSA stent Graft

Short-term results in canines of novel stent-graft design for chimney technique in TEVAR

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Journal of Interventional Medicine 2020年第3期3卷 128-131页

作者： Ming Li Chang Shu Benhao Xiao Dingxiao Liu Weichang Zhang Department of Vascular Surgery The Second Xiangya HospitalCentral South UniversityChangsha410011China Department of Vascular Surgery Fuwai HospitalChinese Academy of Medical SciencesBeijing100037China Lifetech Scientific Co.Ltd China

Introduction:Parallel stent-stent grafting is a major endovascular technique used to preserve the supra-aortic branches during thoracic endovascular aortic repair(TEVAR)of aortic pathologies involving the aortic *** short-and mid-term results of this technique are satisfactory;however,endoleak remains a major ***,here we designed a new chimney stent-graft to decrease the endoleak ***:To testify the feasibility and safety of the new chimney stent-graft system in a canine *** and methods:Six Labrador retrievers were ***-operative data were collected and all operations were performed under general *** main and chimney stent-grafts were implanted through the abdominal aorta and left subclavian artery approaches,*** digital subtraction angiography(DSA)was performed to confirm the immediate *** dogs were fed separately for 6 months and sacrificed after aortic *** thoracic aorta and the main and chimney stent-grafts were harvested for histopathologic ***:No complications were found in follow-up *** branch arteries were ***?ammatory responses were observed around the stent-grafts in 3 experimental animals,and slight hyperplasia was observed in the surrounding tissues compared with the normal *** was no mural thrombus in the stent,endothelial cells were noted on the inner surface of the stent,and thrombus was formed in the outer skirt and gutter *** histopathologic examinations revealed similar results to those of gross necropsy ***:This study demonstrated the feasibility and safety of the Longuette stent-graft and the first to report a revised stent-graft specific for chimney technique.

关键词： thoracic endovascular aortic repair Chimney technique Canine model In vivo experiment Stent-graft

Application of the multi-planar reconstruction in endovascular treatment of type B aortic dissection

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Chinese Medical Journal 2013年第23期126卷 4499-4503页

作者： LI Yong-sheng HOU Kai XU Xin YANG Jue ZHU Ting DONG Zhi-hui YUE Jia-ning WANG Yu—qi FU Wei-guo Department of Vascular Surgery Fudan University Shanghai 200032 China Zhongshan Hospital Institute of Vascular Surgery Fudan University Shanghai 200032 China Shanghai Medical Imaging Institute Shanghai 200032 China

Background Although Multi-planar reconstruction （MPR） has been considered a diagnostic imaging technique that observes more perspectives for diseases,few people have applied it *** fact,MPR is also very useful to clinical operation,especially for patients with type B aortic *** helps the surgeon to locate accurately with more information about aortic dissection,so that the safety and effectiveness of operation can be *** study examined the application of the MPR in intraoperative DSA imaging for precise positioning by accurately obtaining a crosssection,a spin angle of the coronal plane,and a tilt angle of the sagittal plane in treatment of type B aortic *** The conventional and the MPR approaches were compared on positioning the aortic arch for surgery.A group of 40 patients （group A） and another group of 42 patients （group B） was *** the comparison of baseline characteristics,a fourfold table X2 test was conducted on gender,and two independent samples t-test was applied to age between group A and group *** as well as tilt angles for group A were obtained from the patients using both approaches,and their effectiveness was compared with pair t-tests; The MPR data guided stent-grafting in this *** graft placement of group B was based on the conventional *** of proximal distributed markers as well as incidences of complications were collected from both groups after stent graft *** were also compared with a fourfold table X2 *** Gender difference was not found between group A and group B （X2=0.80,P ＞0.05）,and age difference was not statistically significant （F=2.55,homogeneity of variance,t=-1.46,P ＞0.05）.A significant difference was found between the conventional and the MPR approaches for spin angle （t=9.17） as well as tilt angle （t=-2.07）,P ＜*** of proximal distributed markers （5.0％） of group A was significantly lower than that of group B （42.9％）,X2=15.

关键词： multi-planar reconstruction thoracic endovascular aortic repair spin angle tilt angle

Direct visualization of postoperative aortobronchial fistula on computed tomography

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World Journal of Radiology 2024年第8期16卷 337-347页

作者： Nanae Tsuchiya Hitoshi Inafuku Satoko Yogi Yuko Iraha Gyo Iida Mizuki Ando Takaaki Nagano Shotaro Higa Tatsuya Maeda Yuya Kise Kojiro Furukawa Koji Yonemoto Akihiro Nishie Department of Radiology Graduate School of Medical ScienceUniversity of the RyukyusOkinawa 903-0215Japan Department of thoracic and Cardiovascular Surgery Graduate School of Medical ScienceUniversity of the RyukyusOkinawa 903-0215Japan Department of Biostatistics School of Health SciencesFaculty of MedicineUniversity of the RyukyusOkinawa 903-0215Japan

BACKGROUND Postoperative aortobronchial fistula(ABF)is a rare complication that can occur in 0.3%-5.0%of patients over an extended period of time after thoracic aortic *** visualization of the fistula via imaging is *** To investigate the relationship between computed tomography(CT)findings and the clinical signs/symptoms of ABF after thoracic aortic *** Six patients(mean age 71 years,including 4 men and 2 women)with suspected ABF on CT(air around the graft)at our hospital were included in this retrospective study between January 2004 and September *** CT findings included direct confirmation of ABF,peri-graft fluid,ring enhancement,dirty fat sign,atelectasis,pulmonary hemorrhage,and bronchodilation,and the clinical course were retrospectively *** proportion of each type of CT finding was *** ABF detection after surgery was found to have a mean and median of 14 and 13 years,*** signs and symptoms were asymptomatic in 4 patients,bloody sputum was found in 1 patient,and fever was present in 1 *** complications of ABF included graft infection in 2 patients and graft infection with hemoptysis in 2 *** the 6 patients,3 survived,2 died,and 1 was lost to *** locations of the ABFs were as follows:1 in the ascending aorta;1 in the aortic arch;2 in the aortic arch leading to the descending aorta;and 2 in the descending *** were directly confirmed by CT in 4/6(67%)***-graft dirty fat(4/6,67%)and peri-graft ring enhancement(3/6,50%)were associated with graft infection,endoleaks and pseudoaneurysms were associated with hemoptysis(2/6,33%).CONCLUSION Asymptomatic ABF after thoracic aortic surgery can be confirmed on chest *** is useful for the diagnosis of ABF and its complications.

关键词： Peri-graft air Aortobronchial fistula Chest computed tomography Postoperative thoracic endovascular aortic repair Complication thoracic aorta surgery