• Journal of Trauma and Injury
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• v.32 no.3
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• pp.172-175
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• 2019

Although thoracic endovascular aortic repair (TEVAR) has grown to become the standard of care to treat blunt thoracic aortic injury (BTAI), the long-term effects of TEVAR are still unclear. We here present a 72-year-old man with BTAI due to a traffic accident. He successfully underwent TEVAR and was transferred to another rehabilitation hospital 2 months after the accident. However, 1 month later, he underwent gastroscopy with fever and hematemesis and was diagnosed with aorto-esophageal fistula (AEF). After being re-transferred to Niigata University Medical and Dental Hospital, we tried to convince him to undergo surgical treatment, but he strongly refused. He received palliative care and died due to rupture of the aortic pseudoaneurysm 3 days after the hospital transfer. Fatal complications like AEF may occur after TEVAR, so clinicians need to carefully follow patients who underwent TEVAR.

• Journal of Chest Surgery
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• v.44 no.2
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• pp.148-153
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• 2011

Background: The number of cases employing thoracic endovascular aortic repair (TEVAR) has been increasing due to lower morbidity and mortality compared to open repair technique. The aim of this study is to evaluate the outcome of TEVAR for thoracic aortic diseases. Materials and Methods: Sixteen patients underwent TEVAR from October 2003 to April 2010. Mean age at operation was 59 years (20~78 years), and 11 were male. Indications for TEVAR were large aortic diameter (>5.5 cm) upon presentation in 6 patients, increasing aortic diameter during the follow-up period in 4, traumatic aortic rupture in 3, persistent chest pain in 2, and ruptured aortic aneurysm in one. The mean diameter, length and the number of the stents were 33 mm (26~40 mm), 12 cm (9.5~16.0 cm), and 1.25 (1~2), respectively. Aortography employing Multi-detector computerized tomography (MDCT) technique was performed at one week, and patients were followed up in the out-patient department at one month, 6 months, and one year postoperatively. Results: Primary technical success showing complete exclusion of the aneurysm was achieved in 15 patients. One patient showed a small endo-leak (type 1). Four patients developed perioperative stroke: Three recovered without sequelae, and one showed mild right-side weakness. There was no operative mortality. Diameter of the thoracic aorta covered by stent graft changed within 10% range in 12 patients, decreased by more than 10% in 3, and increased by more than 10% in one during mean follow-up duration of 18 months (1~73 months). There was no recurrence-related death during this period. Conclusion: Intermediate-term outcome after TEVAR was encouraging. Indications for TEVAR could be extended for other thoracic aortic diseases.

• Journal of Trauma and Injury
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• v.28 no.4
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• pp.232-240
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• 2015

Purpose: Thoracic aortic injury is a life-threatening injury that has been traditionally treated by using surgical management. Recently, thoracic endovascular aortic repair (TEVAR) has been conducted pervasively as a better alternative treatment method. Therefore, this study will focus on analyzing the outcome of TEVAR in patients suffering from a blunt thoracic aortic injury. Methods: Of the blunt thoracic aortic injury patients admitted to Eulji University Hospital, this research focused on the 11 patients who had received TEVAR during the period from January 2008 to April 2014. Results: Seven of the 11 patients were male. At the time of admission, the mean systolic pressure was $105.64{\pm}24.60mm\;Hg$, and the mean heart rate was $103.64{\pm}20.02per$ minute. The median interval from arrival to repair was 7 (4, 47) hours. The mean stay in the ICU was $21.82{\pm}16.37hours$. In three patients, a chimney graft technique was also performed to save the left subclavian artery. In one patient, a debranching of the aortic arch vessels was performed. In two patients, the left subclavian artery was totally covered. In one patient whose proximal aortic neck length was insufficient, the landing zone was extended by using a prophylactic left subclavian artery to left common carotid artery bypass before TEVAR. There were no operative mortalities, but a patient who was covered of left subclavian artery died from ischemic brain injury. Complications such as migration, endovascular leakage, collapse, infection and thrombus did not occur. Conclusion: Our short-term outcomes of TEVAR for blunt thoracic aorta injury was feasible. Left subclavian artery may be sacrificed if the proximal landing zone is short, but several methods to continue the perfusion should be considered.

• Korean Journal of Radiology
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• v.22 no.4
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• pp.577-583
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• 2021

Objective: To report the authors' experience in performing thoracic endovascular aortic repair (TEVAR) for zone 2 lesions after traumatic aortic injury (TAI). Materials and Methods: This retrospective review included 10 patients who underwent zone 2 TEVAR after identification of aortic isthmus injury by CT angiography (CTA) upon arrival at the emergency room of a regional trauma center from 2016 to 2019. Patients were classified into two groups: those who underwent left subclavian artery (LSA) embolization concurrently with the main TEVAR procedure, and those in whom LSA embolization was not performed during the main procedure, but was planned as a bailout treatment if type II endoleak was noted on follow-up CTA images. Pre-procedural and procedure-related factors and post-procedure prognosis were compared between the groups. Results: There were no differences in pre-procedural factors, occurrence of endoleaks, and post-procedure prognosis (including mortality) between patients in the two groups. The duration of the procedure was shorter in the non-LSA embolization group (61 minutes vs. 27 minutes, p = 0.012). During follow-up, type II endoleak did not occur in either group. Conclusion: Delaying preventative LSA embolization until stabilization of the patient would be desirable when performing zone 2 TEVAR for TAI, in the absence of endoleak on the completion aortography image taken after complete deployment of the stent graft.

• Journal of Chest Surgery
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• v.54 no.3
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• pp.172-178
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• 2021

Background: Complicated acute type B aortic dissection is a life-threatening condition with high morbidity and mortality. The aim of this study was to report a single-center experience with endovascular stent-graft repair of acute type B dissection of the thoracic aorta and to evaluate the mid-term outcomes. Methods: We reviewed 18 patients treated for complicated acute type B aortic dissection by thoracic endovascular aortic repair (TEVAR) from September 2011 to July 2017. The indications for surgery included rupture, impending rupture, limb ischemia, visceral malperfusion, and paraplegia. The median follow-up was 34.50 months (range, 12-80 months). Results: The median interval from aortic dissection to TEVAR was 5.50 days (range, 0-32 days). There was no in-hospital mortality. All cases of malperfusion improved except for 1 patient. The morbidities included endoleak in 2 patients (11.1%), stroke in 3 patients (16.7%), pneumonia in 2 patients (11.1%), transient ischemia of the left arm in 1 patient (5.6%), and temporary visceral ischemia in 1 patient (5.6%). Postoperative computed tomography angiography at 1 year showed complete thrombosis of the false lumen in 15 patients (83.3%). Conclusion: TEVAR of complicated type B aortic dissection with a stent-graft was effective, with a low morbidity and mortality rate.

• Investigative Magnetic Resonance Imaging
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• v.16 no.2
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• pp.159-168
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• 2012

The proximity of thoracic aortic aneurysm to the left subclavian artery (LSA) has made the coverage of LSA during thoracic endovascular aortic repair (TEVAR) be essential. Despite controversy concerning the safety of LSA coverage and the indications for LSA revascularizations, the cerebral hemodynamic change after LSA coverage has not been demonstrated. We prospectively examined two patients who would undergo TEVAR with LSA coverage by using 2D cine phase contrast MR imaging. After LSA coverage, the left subclavian steal was properly compensated by the increased flow volumes of both carotid arteries and right vertebral artery, which is the major collateral supply. The total brain supply after TEVAR did not lessen, which showed good correlation with uneventful clinical outcome. Therefore, 2D phase contrast MR imaging can be recommended as a useful technique to evaluate the hemodynamic change of the LSA coverage during TEVAR and to triage the candidate for LSA revascularization.

• Journal of Chest Surgery
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• v.50 no.4
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• pp.287-290
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• 2017

Herein, we report the case of a 60-year-old man, a smoker with a history of arterial hypertension and diabetes mellitus. After computed tomography (CT) for an episode of hemoptysis, the patient underwent elective thoracic endovascular aortic repair (TEVAR) because of a degenerative aneurysm of the descending thoracic aorta. The area of perianeurysmal pulmonary atelectasis reported on the CT scan was not considered. Three months later, he developed an aortopulmonary fistula without endoleaks. Although TEVAR is a relatively safe procedure, no detail should be overlooked in the preoperative evaluation in order to avoid life-threatening complications. Further, the effectiveness and modality of prolonged antibiotic prophylaxis and/or preoperative respiratory physiotherapy should be assessed in such cases.

• Journal of Chest Surgery
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• v.49 no.4
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• pp.298-301
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• 2016

Thoracic endovascular aortic repair (TEVAR) has emerged as an effective therapy for a variety of thoracic aortic pathologies. However, various types of endoleak remain a major concern, and its treatment is often challenging. We report a case of type I endoleak occurring 19 months after zone II hybrid TEVAR. The endoleak was successfully repaired by the frozen elephant trunk technique, without removal of a previous stent graft, combined with ascending aorta and total arch replacement.

• Journal of Chest Surgery
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• v.43 no.6
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• pp.758-763
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• 2010

In current era, thoracic endovascular aortic repair (TEVAR) has gained popularity. But, it bears the risk of serious complications such as treatment failure from endoleak, retrograde aortic dissection caused by injury of aortic wall at landing zone, or aortic rupture resulting from stent graft infection. We report two cases of surgical repair of retrograde aortic dissection after TAVAR applied to acute Stanford type B aortic dissection or traumatic aortic disruption.

• Journal of Chest Surgery
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• v.49 no.1
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• pp.15-21
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• 2016

Background: We aimed to evaluate the incidence, predictive factors, and impact of acute kidney injury (AKI) after thoracic endovascular aortic repair (TEVAR). Methods: A total of 53 patients who underwent 57 TEVAR operations between 2008 and 2015 were reviewed for the incidence of AKI as defined by the RIFLE (risk, injury, failure, loss, and end-stage kidney disease risk) consensus criteria. The estimated glomerular filtration rate was determined in the perioperative period. Comorbidities and postoperative outcomes were retrospectively reviewed. Results: Underlying aortic pathologies included 21 degenerative aortic aneurysms, 20 blunt traumatic aortic injuries, six type B aortic dissections, five type B intramural hematomas, three endoleaks and two miscellaneous diseases. The mean age of the patients was $61.2{\pm}17.5years$ (range, 15 to 85 years). AKI was identified in 13 (22.8%) of 57 patients. There was an association of preoperative stroke and postoperative paraparesis and paraplegia with AKI. The average intensive care unit (ICU) stay in patients with AKI was significantly longer than in patients without AKI (5.3 vs. 12.7 days, p=0.017). The 30-day mortality rate in patients with AKI was significantly higher than patients without AKI (23.1% vs. 4.5%, p=0.038); however, AKI did not impact long-term survival. Conclusion: Preoperative stroke and postoperative paraparesis and paraplegia were identified as predictors for AKI. Patients with AKI experienced longer average ICU stays and greater 30-day mortality than those without AKI. Perioperative identification of high-risk patients, as well as nephroprotective strategies to reduce the incidence of AKI, should be considered as important aspects of a successful TEVAR procedure.