Endovascular repair of ruptured thoracic aortic aneurysms is associated with high perioperative mortality and morbidity

PurposeTo analyze early and midterm results after endovascular treatment of ruptured thoracic aortic aneurysms (rTAA).MethodsBetween January 1997 and January 2009, a total of 236 patients received thoracic aortic repair in our institution; 23 patients (14 men; median age, 75 years; range, 60-88 years) due to a ruptured thoracic aortic aneurysm (rTAA). Rupture was defined according to computed tomography angiograpy (CTA) criteria with definite sign for hemorrhage outside the aortic wall. Patients with symptomatic TAA but with normal CT scans were excluded. A retrospective analysis of these patients was performed. Median follow up was 28 months (range, 0.1-82.5 months) and included serial aortic imaging at discharge, six, and 12 months and annually thereafter.ResultsTechnical success rate was 87%. The overall in hospital mortality was 48% with predominantly (50%) cardiac complications. Neurological complications occurred in three patients, two patients suffered from a transient ischemic attack (TIA)/stroke, and one patient experienced paraplegia after early conversion to open surgery. Primary endoleaks were seen in four of 25 patients (16%); no secondary endoleak was observed. Early conversion was necessary in two patients caused by an aortoesophageal fistula. The one- and three-year survival rates were 37.3% and 29.9% with no aortic or procedure-related death during follow up. Reintervention was necessary in four of 25 patients (16%). Cox regression analysis revealed preoperative renal insufficiency (hazard ratio [HR] 5.85, P = .0073) as an independent predictor of perioperative death.ConclusionsThe endovascular treatment of ruptured thoracic aortic aneurysms is associated with a high perioperative mortality and morbidity as well as poor midterm survival. Renal insufficency proved to be an independent risk factor for perioperative death

Early and midterm results after endovascular stent graft repair of penetrating aortic ulcers

PurposeTo present early and midterm results after endovascular stent graft repair of patients with penetrating aortic ulcers (PAU).MethodsBetween January 1997 and March 2008, a total of 202 patients received thoracic aortic endografting in our institution, 48 patients (32 men, median age 70 years, range, 48-89) with PAU. A retrospective analysis of these patients was performed. Thirty-one patients (65%) showed an acute aortic syndrome (8 contained rupture, 23 symptomatic). Follow-up scheme included postoperative computed tomography angiography prior to discharge, at 3, 6, and 12 months, and yearly thereafter. Mean follow-up was 31.3 months (1.3-112.6).ResultsTechnical success was achieved in 93.7%. Primary clinical success rate was 81.2%. In-hospital mortality was 14.6%. Perioperative mortality was significantly (P = .036) higher in patients with acute aortic syndrome compared to asymptomatic patients (22.5% vs 0%). Postoperative complications occurred in 15 patients (31%), including 2 patients with minor strokes and 6, respectively, 5 patients with cardiac and/or respiratory complications. Early endoleaks were observed in 9 patients (19%), late endoleaks in another 2 patients. Reintervention was necessary in 4 out of 48 patients (8.4%). The actuarial survival estimates at 1, 3, and 5 years were 78% ± 6%, 74% ± 7%, and 61% ± 10%, respectively. There was no aortic-related death during follow-up. Cox regression showed age (hazard ratio [HR]; 1.08, P = .036) and a maximum aortic diameter >50 mm (HR, 4.92; P = .021) as independent predictors of death.ConclusionEndovascular treatment of penetrating aortic ulcers is associated with a relevant morbidity and mortality rate in frequently highly comorbid patients. Midterm results could prove a sustained treatment success regarding actuarial survival and aortic-related death. Emergencies show a significantly worse outcome, but treatment is still warranted in these symptomatic patients

Magnetic resonance imaging-based assessment of cartilage loss in severe osteoarthritis: accuracy, precision, and diagnostic value.

OBJECTIVE: To examine the in vivo accuracy and precision of magnetic resonance imaging (MRI)-based assessment of cartilage loss in patients with severe osteoarthritis (OA) of the knee. METHODS: High-resolution MRI images of the tibial cartilage were obtained in 8 patients prior to total knee arthroplasty, using a water-excitation gradient-echo MRI sequence (acquisition time 6 minutes 19 seconds; spatial resolution 1.2 x 0.31 x 0.31 mm3). The MRI measurements were repeated after joint repositioning. The precision of the cartilage volume and thickness computations was determined after 3-dimensional reconstruction. During surgery, the tibial plateaus were resected, and the MRI data were compared with water displacement of surgically retrieved cartilage. RESULTS: The standard deviation (coefficient of variation) of repeated tibial cartilage volume measurements was 56 mm3 (5.5%) medially and 59 mm3 (3.8%) laterally. The deviation from surgically removed tissue was -13%, on average, with a high linear correlation between both methods (r = 0.98). In patients with varus OA, the tissue loss was estimated to be 1,290 mm3 in the medial tibia and 1,150 mm3 in the lateral tibia, compared with the data in healthy volunteers. CONCLUSION: Noninvasive quantitative MRI-based analysis of cartilage morphometry in severe OA is accurate, precise, and displays high potential diagnostic value

Precision of tibial cartilage morphometry with a coronal water-excitation MR sequence.

The aim of this study was to analyze the precision of tibial cartilage morphometry, by using a fast, coronal water-excitation sequence with high spatial resolution, to compare the reproducibility of 3D thickness vs volume estimates, and to test the technique in patients with severe osteoarthritis. The tibiae of 8 healthy volunteers and 3 patients selected for total knee arthroplasty were imaged repeatedly with a water-excitation sequence (image time 6 h 19 min, resolution 1.2 × 0.31 × 0.31 mm3), with the knee being repositioned between each replicate acquisition. After 3D reconstruction, the cartilage volume, the mean, and the maximal tibial cartilage thickness were determined by 3D Euclidean distance transformation. In the volunteers, the precision of the volume measurements was 2.3 % (CV%) in the medial and 2.6 % in the lateral tibia. The reproducibility of the mean cartilage thickness was similar (2.6 and 2.5 %, respectively), and that of the maximal thickness lower (6.5 and 4.4 %). The patients showed a considerable reduction in volume and thickness, the precision being comparable with that in the volunteers. We find that, using a new imaging protocol and computational algorithm, it is possible to determine tibial cartilage morphometry with high precision in healthy individuals as well as in patients with osteoarthritis