Endovascular aortic repair of a chronic ascending and arch aortic aneurysm

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Response to comment on: ‘Synchronous multiple non-small cell lung cancers in an allograft lung recipient’

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Factors Favoring Retrograde Type A Aortic Dissection After Endovascular Aortic Repair

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Chest Wall Vasculopathy in a Patient with Type 1 Neurofibromatosis

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Synchronous multiple non-small cell lung cancers in an allograft lung recipient

International audienceWe described a case report of synchronous non-small cell lung cancers arising in lung transplants after allograft. Immunosuppressive therapy of the recipient induced an accelerated growth rate of primary tumour and metastases as was been observed in orthotopic liver allograft for hepatocellular carcinoma

Homemade fenestrated stent-graft for thoracic endovascular aortic repair of zone 2 aortic lesions

International audienceOBJECTIVE : The aim of this retrospective analysis was to evaluate the outcomes of homemade fenestrated stent-grafts for thoracic endovascular aortic repair of zone 2 aortic lesions.METHODS : From November 2013 to January 2017, 24 patients underwent thoracic endovascular aortic repair with left subclavian artery revascularization using a homemade fenestrated stent-graft to preserve the patency of the left subclavian artery. Elective cases accounted for 54% (n = 13) of the sample. Indications included acute complicated type B aortic dissection (n = 9), degenerative aneurysm (n = 9), penetrating aortic ulcer (n = 5), and intramural hematoma (n = 1). Routine postoperative follow-up imaging with computed tomography angiography was performed to assess thoracic endovascular aortic repair and left subclavian artery fenestration patency and endoleak.RESULTS : Median duration for stent-graft modification was 16 minutes (range, 14-17 minutes). The technical success rate was 100%. One patient had a distal type I endoleak requiring additional stent-graft placement. One patient had partial coverage of the left common carotid artery requiring left common carotid artery stenting. One patient had a stroke without permanent sequelae (4.1%). Overall mortality was 0%. All left subclavian arteries were patent. Two type III endoleaks required additional left subclavian artery covered stent placement. One type II endoleak is currently observed. During a mean follow-up of 13.2 ± 2 months, there were no conversions to open surgical repair, aortic rupture, paraplegia, or retrograde dissection.CONCLUSIONS : The use of a homemade fenestrated stent-graft for thoracic endovascular aortic repair of zone 2 aortic lesions is both feasible and effective for left subclavian artery revascularization during thoracic endovascular aortic repair involving a spectrum of thoracic aortic pathology. Durability concerns will need to be assessed in additional studies with long-term follow-up

Systemic air embolism depicted on systematic whole thoracic CT acquisition after percutaneous lung biopsy: Incidence and risk factors

International audienceObjectives: To evaluate the incidence and risk factors of systemic air embolism (SAE) depicted on systematic whole thoracic CT performed after percutaneous lung biopsy.Methods: A total of 559 CT-guided lung biopsies performed between April 2014 and May 2016 were retrospectively evaluated. SAE was defined by the presence of air in the aorta or left cardiac cavities seen on whole thorax CT images acquired after needle withdrawal. Analyzed data focused on patient (age, sex, spirometry data, emphysema on CT, therapeutics received), target lesion (location, depth, size and feature) and procedure (patient position, length of intrapulmonary needle path, number of pleural passes and of biopsy samples, operator’s experience). A regression logistic model was used to identify risk factors of SAE.Results: SAE was observed after 27 of the 559 lung biopsies, corresponding to a radiological incidence of 4.8% (95%CI: 3.3–7.0). Clinical incidence was 0.17% (n = 1). For 21/27 patients (78%), a targeted acquisition in the nodule area would not have included the cardiac cavities meaning SAE would have been missed. On multivariate analysis, the independent risk factors were needle path length through ventilated lung (OR: 1.13, 95%CI: 1.02–1.25, p = 0.024), number of samples (OR: 1.48, 95%CI: 1.01–2.17, p = 0.046) and prone position (OR: 3.12, 95%CI: 1.11–8.31, p = 0.031) or right-sided lateral decubitus (OR: 6.15, 95%CI: 1.66–22.85, p = 0.005).Conclusions: Asymptomatic systemic air embolism can be depicted in almost 5% of post biopsy CT examinations, when they are not limited to the targeted nodule area but include the entire thorax

Should diffuse bronchiectasis still be considered a CFTR-related disorder?

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Titanium Implant Failure After Chest Wall Osteosynthesis

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Persistent severe hypereosinophilic asthma is not associated with airway remodeling

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