Pericardial Fat Pad and Thoracic Aortic Surgery

Pericardial fat pads have been successfully used for many years by thoracic and cardiac surgeons for a number of applications. We recently used a pedicled and well-vascularized pericardial fat pad in a patient who underwent replacement of a distal aortic arch aneurysm with a Dacron tube graft, in order to avoid contact between the anastomoses and the oesophagus in an effort to reduce the risk of subsequent infection and fistula formation. This simple technique may provide a source of vital tissue that may be useful for protecting anastomoses after thoracic aortic surgery, particularly in cases requiring re-operation. To our knowledge the use of pericardial fat pads has not been previously reported in the English literature for this purpose Pericardial fat pads have been successfully used for many years by thoracic and cardiac surgeons for a number of applications. We recently used a pedicled and well-vascularized pericardial fat pad in a patient who underwent replacement of a distal aortic arch aneurysm with a Dacron tube graft, in order to avoid contact between the anastomoses and the oesophagus in an effort to reduce the risk of subsequent infection and fistula formation. This simple technique may provide a source of vital tissue that may be useful for protecting anastomoses after thoracic aortic surgery, particularly in cases requiring re-operation. To our knowledge the use of pericardial fat pads has not been previously reported in the English literature for this purpose. © 2003 Elsevier Science Ltd. All rights reserved

Disappointing results with a new commercially available thoracic endograft

AbstractIntroductionNew devices for endovascular treatment of thoracic aortic diseases were recently approved for clinical use by European authorities, obtaining the Conformité Européenne (CE) mark. In all patients who underwent endovascular treatment of a thoracic aortic disease in 2002, we used a new CE-marked device, the Endofit stent graft. The device is constituted of nitinol stents and polytetrafluoroethylene fabric, and has a simple design and delivery system.MethodsDuring 2002, 11 patients (mean age, 75 years; range, 66-85 years) underwent treatment of atherosclerotic aneurysm (n = 9), chronic type B dissection (n = 1), and intramural hematoma (n = 1). Disease involved the descending thoracic aorta in 7 patients and the distal aortic arch in 4 patients.ResultsIn all cases the Endofit stent grafts were successfully deployed in the intended position. No postoperative paraplegia or paraparesis was recorded. There were two in-hospital deaths: 1 patient died in the operating room (postmortem examination showed a kinked graft); and the other patient died in the intensive care unit on postoperative day 30, after an intraoperative stroke. One surgical conversion was performed 2 weeks after the procedure, because of total collapse of the graft due to rupture of three stents. Other graft-related complications included type I endoleak (n = 2), type II endoleak (n = 1), and incomplete opening of the device (n = 1).ConclusionEndovascular treatment of thoracic disease with the Endofit graft in this small heterogeneous group of patients resulted in several complications, which may arise from both the delivery system and the graft itself. At present, other commercially available endografts may be safer for endovascular treatment of thoracic aortic diseases

Use of a novel hybrid vascular graft for sutureless revascularization of the renal arteries during open thoracoabdominal aortic aneurysm repair

Objective: The aim of this study was to assess the safety and short-term effectiveness of a novel hybrid vascular graft used to address renal revascularization during open thoracoabdominal aortic aneurysm (TAAA) repair, performing a sutureless distal anastomosis. Methods: Between 2012 and 2013, 25 patients (16 men; mean age, 66 ± 8 years) underwent revascularization of one (24 patients) or both (one patient) renal arteries with the Gore Hybrid Vascular Graft (GHVG; W. L. Gore and Associates, Flagstaff, Ariz) during open TAAA repair. Specific indications included remote location of the ostium of the renal artery, severe atherosclerotic wall degeneration, focal dissection, and stenosis. All surviving patients underwent computed tomography angiography and follow-up visit at 1 month. Preoperative characteristics, intraoperative data, and short-term results were compared with those of 49 concurrent TAAA patients operated on within the same period by standard renal revascularization (SRR) techniques. Results: All GHVG target renal vessels (26 of 26) were successfully revascularized without technical concerns. No significant differences were found between GHVG and SRR groups in preoperative and intraoperative data, except for a relative prevalence of aortic dissection (28% vs 6%; P =.026) and renal artery stenosis (44% vs 12%; P =.003) in the GHVG group and for intraoperative renal bare stenting that was predominantly used in the SRR group (12% vs 28%; P =.036). The 30-day mortality was 4% in both groups. Postoperative acute renal failure (doubling of creatinine level and creatinine level >3.0 mg/dL) occurred in two GHVG patients (8%) and seven SRR patients (14%; P = NS). Perioperative peak decrease of estimated glomerular filtration rate was lower in the GHVG group (26 ± 18 mL/min/1.73 m2 vs 37 ± 22 mL/min/1.73 m2; P =.034). At 1-month computed tomography angiography, renal artery patency was 92% for the GHVG vessels, 91% for the contralateral to GHVG renal vessels, and 92% for the SRR group arteries. No GHVG-related complications requiring reintervention or cases of new-onset renal failure requiring dialysis were observed at follow-up. Conclusions: Renal revascularization during open TAAA repair by the GHVG with distal sutureless anastomosis is feasible, especially in cases of aortic dissection, remote location of the renal vessel, and severe atherosclerotic disease of the ostium. Short-term results are satisfactory, at least comparable to those of SRR. Larger series and longer follow-up are needed to assess clinical advantages and durability of this new device. Copyright © 2014 by the Society for Vascular Surgery