Endovascular Repair Of Traumatic, Degenerative And Mycotic Aortic Aneurysms: A Single Center Experience

Transcription

1 Endovascular Repair Of Traumatic, Degenerative And Mycotic Aortic Aneurysms: A Single Center Experience Poster No.: C-2349 Congress: ECR 2014 Type: Scientific Exhibit Authors: Y. M. H. Al Bulushi, R. ALSukaiti; Muscat/OM Keywords: Arteries / Aorta, Interventional vascular, Vascular, CTAngiography, Catheter arteriography, Stents, Arterial access, Outcomes analysis, Aneurysms, Outcomes, Trauma DOI: /ecr2014/C-2349 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 19

2 Aims and objectives Background: Endovascular aortic aneurysms repair has considerably affected patient outcome (1) and provided a reliable approach in patients unfit for surgical interventions. Of particular note are patients with traumatic aortic pseudoaneurysms who often present (2-4) with complicated multi-organ injuries. This approach has also revolutionized the management of degenerative thoracic and abdominal aortic aneurysms with reports indicating low morbidity and mortality rates comparable and even superior to open surgery. (5-11) Endovascular repair has recently been reported as a feasible approach to mycotic aortic aneurysms with promising results. (12,13) Learning Objective: To report our experience with endovascular repair of traumatic, degenerative and mycotic aortic aneurysms Assess associated pre-operative and post-operative comorbidities. Page 2 of 19

3 Methods and materials Retrospective review of 11 patients who underwent endovascular aortic repair at Sultan Qaboos University Hospital between January 2011 and November Data were analyzed for pre-procedure comorbidities, immediate complications and postprocedure morbidity and mortality. Standard CT protocols are performed using MDCT with IV contrast administration and rapid data acquisition. Degenerative Abdominal and Thoracic aortic aneurysms present with persistent aortic dilatation on CT. These are evaluated for morphology, location and associated complications in attempt to plan proper intervention. Traumatic aortic pseudoaneurysms, present an important diagnosis for the emergency radiologist. Identification on CT examinations is aided by multiplanner (MPR) and Three-dimensional (3D) reconstruction techniques. Timely intervention with endovascular approach is commonly associated with great technical success. Procedures were performed through femoral artery access via cut-down. A pigtail catheter was advanced over guide wire and the tip was left at the aorta. A stent graft was then advanced over a super-stiff guide wire up to the level of the aortic arch and an angiogram was performed. The stent graft was then deployed and a final angiogram was performed to confirm exclusion of the aneurysm. The guide wire sheath and introducer device were then removed. Cut-down was then closed. The groin hemostasis was achieved with manual compression. Follow up examinations in post-endovascular repair patients are mainly performed using MDCT with MPR and 3D reconstructions aiding the identification of endoleak and local complications. Page 3 of 19

4 Images for this section: Fig. 1: Aneurysm involving the thoracic aorta. Page 4 of 19

5 Fig. 2: Thoracic Aortic Aneurysm Page 5 of 19

6 Fig. 3: Thoracic Aortic Aneurysm Page 6 of 19

7 Fig. 4: Mycotic Abdominal Aortic Aneurysm Page 7 of 19

8 Fig. 5: Mycotic Abdominal Aortic Aneurysm Page 8 of 19

9 Fig. 6: Traumatic Pseudoaneurysm involving the Thoracic Aorta Page 9 of 19

10 Fig. 7: Traumatic Pseudoaneurysm involving the Thoracic Aorta Page 10 of 19

11 Fig. 8: Traumatic Pseudoaneurysm involving the Thoracic Aorta Page 11 of 19

12 Fig. 9: Traumatic Pseudoaneurysm involving the Thoracic Aorta Page 12 of 19

13 Results The mean age for patients who underwent endovascular aortic repair was (46.7 ± 21.8 years). Seven Patients underwent EVAR for traumatic thoracic aortic pseudoaneurysm. Three Patients underwent endovascular repair for degenerative aortic aneurysms and one patient underwent endovascular repair of mycotic aneurysm. Mean follow up period was (11.1 ± 7.9 months). All patients with degenerative aortic aneurysms had a history of hypertension and two patients had history of heavy smoking. The patient diagnosed to have mycotic aneurysm had co-existing uncontrolled diabetes and hypertension. All patients undergoing repair for traumatic pseudoaneurysms had significant co-existing injuries. Primary technical success was achieved in ten patients. Immediate post-procedure distal arterial occlusion occurred in the case of mycotic abdominal aortic aneurysm and it was promptly identified and managed with endovascular approach. No significant complications were encountered on follow up. Zero incidence of 30-day post-procedure mortality and no deaths were reported on long-term follow up. Page 13 of 19

14 Images for this section: Fig. 10: Post Endovacular Repair of Degenerative Thoracic Aortic Aneurysm Page 14 of 19

15 Fig. 11: Post Endovacular Repair of Mycotic Abdominal Aortic Aneurysm and Placement of IVC Filter. Page 15 of 19

16 Fig. 12: Post Endovacular Repair of Traumatic Thoracic Aortic Pseudo-aneurysm Page 16 of 19

17 Conclusion In our experience we report a low rate of post-procedure complications 9% and no incidence of mortality. On subsequent follow up, no complications were observed and no incidence of mortality. Endovascular aortic aneurysm repair offers a reliable and safe alternative to open surgery with high success rate and low morbidity and mortality rates. Page 17 of 19

18 References 1. Amabile, P., Collart, F., Gariboldi, V., Rollet, G., Bartoli, J. M., & Piquet, P. (2004). Surgical versus endovascular treatment of traumatic thoracic aortic rupture. Journal of vascular surgery, 40(5), Lobato, A. C., Quick, R. C., Phillips, B., Vranic, M., Rodriguez-Lopez, J., Douglas, M., & Diethrich, E. B. (2000). Immediate endovascular repair for descending thoracic aortic transection secondary to blunt trauma. Journal of Endovascular Therapy, 7(1), Bortone, A. S., Schena, S., D'Agostino, D., Dialetto, G., Paradiso, V., Mannatrizio, G.,... & Schinosa, L. D. L. T. (2002). Immediate versus delayed endovascular treatment of post-traumatic aortic pseudoaneurysms and type B dissections: retrospective analysis and premises to the upcoming European trial. Circulation, 106(12 suppl 1), I Orford, V. P., Atkinson, N. R., Thomson, K., Milne, P. Y., Campbell, W. A., Roberts, A.,... & Tatoulis, J. (2003). Blunt traumatic aortic transection: the endovascular experience. The Annals of thoracic surgery, 75(1), De Bruin, J. L., Baas, A. F., Buth, J., Prinssen, M., Verhoeven, E. L., Cuypers, P. W.,... & Blankensteijn, J. D. (2010). Long-term outcome of open or endovascular repair of abdominal aortic aneurysm. New England Journal of Medicine, 362(20), Lederle, F. A., Freischlag, J. A., Kyriakides, T. C., Padberg Jr, F. T., Matsumura, J. S., Kohler, T. R.,... & Peduzzi, P. N. (2009). Outcomes following endovascular vs open repair of abdominal aortic aneurysm. JAMA: the journal of the American Medical Association, 302(14), Bavaria, J. E., Appoo, J. J., Makaroun, M. S., Verter, J., Yu, Z. F., & Mitchell, R. S. (2007). Endovascular stent grafting versus open surgical repair of descending thoracic aortic aneurysms in low-risk patients: a multicenter comparative trial. The Journal of thoracic and cardiovascular surgery, 133(2), Prinssen, M., Verhoeven, E. L., Buth, J., Cuypers, P. W., van Sambeek, M. R., Balm, R.,... & Blankensteijn, J. D. (2004). A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. New England Journal of Medicine, 351(16), Schermerhorn, M. L., O'Malley, A. J., Jhaveri, A., Cotterill, P., Pomposelli, F., & Landon, B. E. (2008). Endovascular vs. open repair of abdominal aortic aneurysms in the Medicare population. New England Journal of Medicine, 358(5), Greenhalgh, R. M., & Powell, J. T. (2008). Endovascular repair of abdominal aortic aneurysm. New England Journal of Medicine, 358(5), Rayt, H. S., Sutton, A. J., London, N. J. M., Sayers, R. D., & Bown, M. J. (2008). A systematic review and meta-analysis of endovascular repair (EVAR) for ruptured abdominal aortic aneurysm. European Journal of Vascular and Endovascular Surgery, 36(5), Page 18 of 19

19 12. Sörelius, K., Mani, K., Björck, M., Nyman, R., & Wanhainen, A. (2009). Endovascular repair of mycotic aortic aneurysms. Journal of vascular surgery, 50(2), Kan, C. D., Lee, H. L., & Yang, Y. J. (2007). Outcome after endovascular stent graft treatment for mycotic aortic aneurysm: a systematic review. Journal of Vascular Surgery, 46(5), Page 19 of 19