Complex Regional Pain Syndrome with Aortic Distress after Thoracic Endovascular Aortic Repair and False Lumen Exclusion with "Candy Plug" Technique

A 41-year-old male presented for pain treated with oxycodone. A zone-2 thoracic endovascular aortic repair with distal PETTICOAT (provisional extension to induce complete attachment) for complicated Type-IIIb aortic dissection was performed 18 months before. Repeated hospitalizations did not show any issues to justify the recurrent pain. The aortic nature of the pain was suspected considering the plug as a pain trigger. Through a left thoracoabdominal incision in the eighth intercostal space, the candy plug was removed. Pain diminished after thoracoabdominal surgery steadily

HIGH PREVALENCE OF TYPE III ARCH CONFIGURATION IN PATIENTS WITH TYPE B AORTIC DISSECTION

Introduction - Patients with Type B aortic dissection (TBD) in whom the proximal entry tear is located within 2 cm from the left subclavian (i.e. in Zone 3 for TEVAR) have been reported to have a worse prognosis suggesting the presence of an anatomic risk factor (1). We previously showed that in Type III arches, Zone 3 is associated with a consistent pattern of severe angulation and tortuosity (2), and higher pulsatile forces (3). Our aim was to investigate the prevalence of Type III arch configuration in TBD patients. Methods - We retrospectively reviewed 61 cases of TBD in whom CT images were available. Exclusion criteria were previous arch surgery and bovine arches. Forty-seven suitable cases were stratified according to Aortic Arch Classification. A literature review was conducted to assess the prevalence of Type III arch in non TBD and non aneurysmatic patients. A total of 2357 cases were collected from 7 studies. Results - TBD cases presented a 72.3% (34/47) prevalence of Type III arch compared to 19.5% (459/2357) in controls (P<.0001). In all Type III TBD cases, the proximal entry tear was located in Zone 3. TBD patients were significantly younger than controls (65.25\ub113 vs mean pooled age 69.8\ub1 9.1) (P=.0013). Conclusion - Our data indicate an association between Type III arch configuration and the occurrence of TBD. Such association appears even more relevant when considering the younger age of TBD patients, being Type III arch more common in the elderly. These findings warrant further studies to disclose the potential role of Type III arch configuration as an anatomic risk factor for TBD

Late patency of reconstructed visceral arteries after open repair of thoracoabdominal aortic aneurysm

Background: In the era of rising endovascular treatment of thoracoabdominal aortic aneurysms (TAAAs), the analysis of visceral vessel (VV) patency after open surgical repair is crucial to provide a future benchmark between these different approaches. This study reports the late outcomes of a single-center experience with open TAAA repair, focusing on the results of different techniques adopted for renal and splanchnic revascularization. Methods: Data were analyzed for 382 consecutive open TAAA repairs performed between January 2009 and July 2015 (284 men; mean age, 66 \ub1 10 years). Follow-up of surviving patients was carried out by computed tomography angiography and office checkups at 3 and 12 months and yearly afterward. Kaplan-Meier analysis was performed for overall survival, patency of reconstructed VVs (celiac trunk, superior mesenteric artery, right renal artery, left renal artery), and reinterventions on visceral arteries. Furthermore, VV long-term patency was analyzed in subgroups of patients according to the revascularization strategy (patch inclusion of all vessels, group 1; one-vessel separate reattachment and patch inclusion of the remaining vessels, group 2; separate reattachment of all VVs, group 3). Results: In-hospital mortality and paraparesis/paraplegia occurred in 7.6% and 8.1% of patients, respectively. Among the 353 survivors, 338 complied with the follow-up protocol, and adequate computed tomography angiography images were available in 247 patients (952 VVs were analyzed). Overall follow-up survival was 94%, 91%, and 70% at 1 year, 2 years, and 5 years, respectively. At the same time points, VV patency was 99%, 98%, and 98% for celiac trunk; 100%, 100%, and 100% for superior mesenteric artery; 100%, 96%, and 96% for right renal artery; and 91%, 87%, and 82% for left renal artery (log-rank test, P &lt; .0001). Estimates for reinterventions on VVs were 1.2%, 6.3%, and 17% at the same time points. Freedom from occlusion of any VV at 1 year and 3 years was 95% and 87% for group 1, 89% and 79% for group 2, and 92% and 92% for group 3, respectively (log-rank test, P = .13). Conclusions: Long-term patency of VVs after open TAAA repair performed in high-volume centers is high, regardless of the technique employed for revascularization. The left renal artery appears to be most prone to occlusion over time