Intentional coverage of the left subclavian artery during endovascular repair of traumatic descending thoracic aortic transection

ObjectiveThis single-center, prospective study aimed to investigate the technical success and outcome of intentional coverage of the left subclavian artery (LSA) in patients undergoing thoracic endovascular aortic repair (TEVAR) for traumatic rupture of the aortic isthmus at a tertiary care medical center.MethodsFrom January 2005 to June 2011, patients who presented with traumatic aortic transection underwent TEVAR with coverage of the LSA when the distance between the artery and the rupture was <2 cm. At 12, 24, and 72 hours postoperatively, clinical and neurologic evaluation including transcranial Doppler insonation of the brachial artery was performed. A decrease in peak systolic velocity (PSV) >60% with respect to the contralateral one was considered relevant. Functional status of the left arm was evaluated using a provocative test. Thoracoabdominal computerized tomographic angiography was performed postoperatively at 3-, 6-, and 12-month follow-up.ResultsThirty-one patients (mean age 35 years) underwent emergency TEVAR for traumatic aortic transection with intentional LSA coverage during the study period. In four cases (12.9%) coverage was partial. Two patients (6.4%) died during the postoperative period due to associated lesions. No signs of vertebrobasilar insufficiency, stroke, or paraplegia were observed in any of the patients. Nine patients (36%) had severe arm claudication (ischemic pain within 60 seconds of beginning arm exercise and decrease of PSV between 50% and 60%). Risk factors for the condition were left vertebral artery diameter <3 mm (P < .0001). A significant correlation was found between the degree of PSV reduction and left arm symptoms (P < .0001). There was an improvement in ischemic arm symptoms (P < .0001) during mean follow-up of 36 months (range, 6-65 months), with only one patient (4.2%) presenting with severe claudication. Freedom from reintervention at 48 months was 93.5%. No signs of endoleaks or graft migrations were detected on computerized tomographic angiography control scans.ConclusionsCoverage of the LSA during TEVAR for traumatic aortic injuries appears to be a feasible, safe method for extending the endograft landing zone without increasing the risk of paraplegia, stroke, or left arm ischemia. Left vertebral artery diameter can be used to identify patients at risk for postoperative left arm ischemia

Three-Dimensional Printing Application in a Challenging Case of Type II Endoleak

Purpose: To highlight the importance of 3-dimensional (3D) arterial printing in a case of type II endoleak (EL) embolization. Case Report: An 81-year-old patient, previously treated with endovascular aortic repair (EVAR), developed a type II EL requiring treatment. The EL's main origin was the median sacral artery (MSA). Initial attempts in embolization via a transsealing and transarterial approach were unsuccessful owing to extremely tortuous arterial communications between the left hypogastric artery and the MSA. The construction of a clear resin 3D model of the aorta and iliolumbar arteries improved anatomy understanding and moreover allowed a preoperative simulation. The subsequent transarterial attempt in embolization was resolutive, significantly reducing total procedural time and radiation dose. Conclusion: Printing of clear resin 3D arterial models facilitates type II EL transarterial embolization, improving anatomy understanding and allowing simple fluoroscopy-free simulations. Clinical Impact The aim of our work is to highlight the additional value of three-dimensional (3D) printing during preoperative planning of challenging endovascular cases. To our best knowledge, this is the first report about 3D printing use in a case of type II endoleak (EL). We believe that realizing life-size aortic models in selected cases where a complex type II EL embolization procedure is indicated, could lead to a better understanding of arterial anatomy, thus allowing to increase procedural success and reduce operative and most importantly fluoroscopy time

A SIMPLE SQUARE-WAVE VOLTAMMETRIC METHOD FOR THE DETERMINATION OF SCOPOLAMINE IN PHARMACEUTICALS USING A BORON-DOPED DIAMOND ELECTRODE

A simple procedure is described for the determination of scopolamine by square-wave voltammetry using a cathodically pretreated boron-doped diamond electrode. Cyclic voltammetry studies indicate that the oxidation of scopolamine is irreversible at a peak potential of 1.59 V (vs. Ag/AgCl (3.0 mol L-1 KCl)) in a 0.50 mol L-1 sulfuric acid solution. Under optimized conditions, the analytical curve obtained was linear (r = 0.9996) for the scopolamine concentration range of 1.0 to 110 µmol L-1, with a detection limit of 0.84 µmol L-1. The method was successfully applied to the determination of scopolamine in pharmaceutical formulations with minimum sample preparation

Endovascular exclusion of the entire aortic arch with branched stent-grafts after surgery for acute type A aortic dissection

none9The treatment of residual pathology of the aortic arch after surgical repair for type A acute dissection (AAD) represents a therapeutic challenge. Recently, new branched endovascular devices have expanded the possibility of aortic arch stent-grafting (ASG) with proximal landing in zone 0. The aim of this retrospective, single-center study was to evaluate outcomes of patients with a history of surgical repair for AAD undergoing ASG with branched devices.noneD'Onofrio, Augusto; Cibin, Giorgia; Antonello, Michele; Battocchio, Piero; Piazza, Michele; Caraffa, Raphael; Dall'Antonia, Alberto; Grego, Franco; Gerosa, GinoD'Onofrio, Augusto; Cibin, Giorgia; Antonello, Michele; Battocchio, Piero; Piazza, Michele; Caraffa, Raphael; Dall'Antonia, Alberto; Grego, Franco; Gerosa, Gin