Endovascular treatment of aortoesophageal and aortobronchial fistulae

none6Background: Even when promptly recognized and treated, aortoesophageal (AEF) and aortobronchial (ABF) fistulae are highly lethal conditions. Open surgical repair also carries a high risk of mortality and morbidity. Several alternative strategies have been recently reported in the literature including thoracic endovascular aortic repair (TEVAR). However, relatively little is known about results of TEVAR for AEF and ABF due to their rarity and the lack of large surveys. Methods: A voluntary national survey was conducted among Italian universities and hospital centers with an endovascular program. Questionnaires were distributed by e-mail to participating centers and aimed to evaluate the results of endovascular repair of established AEF or ABF. Results: Seventeen centers agreed to participate and provided data on their patients. Between 1998 and 2008, a total of 1138 patients were treated with TEVAR. In 25 patients (2.2%), the indication to treatment was an AEF and/or an ABF. In 10 of these cases (40%), an associated open surgical procedure was also performed. Thirty-day mortality rate of AEF/ABF endovascular repair was 28% (7 cases). No cases of paraplegia or stroke were observed. Mean follow-up was 22.6 months (range, 1-62). Actuarial survival at 2 years was 55%. Among the 18 initial survivors, five patients (28%) underwent reintervention due to late TEVAR failure. Conclusions: Stent grafting for AEF and ABF represents a viable option in emergent and urgent settings. However, further esophageal or bronchial repair is necessary in most cases. Despite less invasive attempts, mortality associated with these conditions remains very high. Copyright © 2010 by the Society for Vascular Surgery.Chiesa, R.; Melissano, G.; Marone, E.M.; Kahlberg, A.; Marrocco-Trischitta, M.M.; Tshomba, Y.Chiesa, R.; Melissano, G.; Marone, ENRICO MARIA; Kahlberg, A.; Marrocco Trischitta, M. M.; Tshomba, Y

Haemodynamic Crosstalk Between Carotid Arteries and Implications for Wall Shear Stress Measurements

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Thoracic Endovascular Aortic Repair for Type B Acute Aortic Dissection Complicated by Descending Thoracic Aneurysm

OBJECTIVES: To analyse the results and review the literature about thoracic aortic endovascular repair (TEVAR) for type B acute aortic dissection (TBAAD) complicated by descending thoracic aortic aneurysm (DTA) in the hyperacute or acute phases. METHODS: This was a multicentre, observational descriptive study. Inclusion criteria were TBAAD with a DTA of 6550 mm, TBAAD on an already known aneurysmal descending thoracic aorta, and TBAAD presenting with an enlarged aorta with a total diameter <50 mm, but with >50% diameter increase compared with a previous computed tomography angiography (CTA) showing a non-dissected aorta with normal sizing. Primary endpoints were early and long-term survival, freedom from TEVAR and aortic related mortality (ARM), and freedom from re-intervention. RESULTS: Twenty-two patients were included in the analysis. The mean aortic diameter was 66 \ub1 26 mm (range 42-130; IQR 51-64). The in hospital TEVAR related mortality was 14% (n = 3). The mean radiological follow-up was 56 \ub1 45 months (range 6-149; IQR 12-82), and the follow-up index 0.97 \ub1 0.1. All surviving patients were available for follow-up. During follow-up the cumulative mortality was 26% (n = 5) and TEVAR related mortality was 5% (n = 1). Overall the estimate of survival was 82% (95%CI: 61.5-93) at 1 year, and 64% at 5 years. Ongoing primary clinical success was 79% (re-intervention n = 4). Freedom from aortic related mortality was 86% (95%CI: 66-95) at 1 and 5 year, while freedom from re-intervention was 95% (95%CI: 75.5-95) at 1 year, and 77% (95%CI: 50-92) at 5 years. CONCLUSIONS: In our experience, DTA is a frequent complication from the very beginning of the clinical onset of TBAAD. In this high-risk cohort, TEVAR showed satisfactory results, better than those predicted by the risk score for open repair, with favourable stability of the aortic diameter and no aortic related adverse events during follow-up

Endovascular repair of thoracic and thoraco-abdominal aortic lesions

BACKGROUND: We report our "real-world" experience of endovascular repair of thoracic/thoraco-abdominal aortic lesions in patients treated from May 2002 to May 2017. METHODS: Data of all consecutive treated patients were retrospectively collected in a database and analyzed. Patients were divided into 4 groups: atherosclerotic thoracic/thoraco-abdominal aneurysms (TAA/TAAA) and floating thrombus (group A); acute complicated type B dissection (TBD), penetrating aortic ulcers (PAU) and intra-mural hematomas (IMH) in group B; chronic TBD evolving in TAA (group C); traumatic injuries (group D). Mortality, reinterventions and occurrence of neurological complications, both at 30 days and in the long term, were analyzed as primary outcomes for each group. RESULTS: Ninety-four patients were treated complessively, most for a TAA (55.3%). Thirty-days deaths and neurological complications were observed in group A only (5 cases each, 5.3%). A reintervention was necessary in 6 patients (64%) of group A. At 5 years, in group A survival was 62.8%+/- 63% and freedom from neurological complication was 88.3%+/- 4.2%. Neither deaths nor neurological complications were recorded in the other groups. No late aortic ruptures were recorded. Freedom from reintervention in group A was 54.7%+/- 7.6% at 5 years and a reintervention was needed in all patients of group D. Overall, the main cause for reintervention was a type I endoleak. CONCLUSIONS: The endovascular repair of thoracic/thoraco-abdominal aortic lesions had acceptable mortality and neurological complication rates, both at 30 days and in the long term. Reinterventions in the long term occurred more frequently after TAA/TAAA and traumatic injuries, and were mainly required for a type I endoleak

Vitamin D deficiency isassociated with increased osteocalcin levels in acute aortic dissection : a pilot study on elderly patients

An imbalance between degradation and reconstruction of the aortic wall is one of the leading causes of acute aortic dissection (AAD). Vitamin D seems an intriguing molecule to explore in the field of AAD since it improves endothelial function and protects smooth muscle cells from inflammation-induced remodeling, calcification, and loss of function, all events which are strongly related to the aging process. We quantified 25-hydroxy vitamin D, calcium, parathormone, bone alkaline phosphatase, and osteocalcin levels in 24 elderly AAD patients to identify a potential pathological implication of these molecules in AAD. Median 25-hydroxy vitamin D (10.75\u2009ng/mL, 25th\u201375th percentiles: 6.86\u201319.23\u2009ng/mL) and calcium levels (8.70\u2009mg/dL, 25th\u201375th percentiles: 7.30\u20138.80\u2009mg/dL) suggested hypovitaminosis D and a moderate hypocalcemia. Thirty-eight percent of AAD patients had severe (<10\u2009ng/mL), 38% moderate (10\u201320\u2009ng/mL), and 24% mild 25-hydroxy vitamin D deficiency (20\u201330\u2009ng/mL). A significant inverse correlation was observed between 25OHD and osteocalcin levels. All the other molecules were unchanged. A condition of hypovitaminosis D associated to an increase in osteocalcin levels is present in AAD patients. The identification of these molecules as new factors involved in AAD may be helpful to identify individuals at high risk as well to study preventing strategies