Emergent endovascular interventions for contained rupture of thoracic aortic aneurysms.

BACKGROUND: The purpose of our study was to assess in an emergency setting the feasibility of endovascular stent graft treatment of contained ruptures of thoracic aortic aneurysms.

METHODS: Seven patients with contained ruptures of thoracic aortic aneurysms from a series of 54 endovascular interventions were treated by the deployment of an aortic stent graft. In all cases, hemothorax was present. Acute deployment was performed with the patient under general anesthesia, and access was gained via the common femoral or iliac arteries. After a follow-up o f 12 months, the patients were evaluated by computed tomography.

RESULTS: One patient died perioperatively. The procedure was technically successful in 5 patients. Perioperatively and at follow-up, there were no cases of paraplegia, stent graft migration, or endoleaks. There were, however, 2 cases of access failure, 1 case of temporary renal failure, and 2 patients who required prolonged mechanical ventilation.

CONCLUSION: The acute treatment of contained ruptures of thoracic aortic aneurysms is feasible. This form of treatment seems to be a promising option in the treatment of these high-risk patients.

Author(s): Doss M, Balzer J, Martens S, Fieguth HG, Vogl T, Moritz A, Wimmer-Greinecker G.

in: Heart Surg Forum. 2003;6(6):E133-7.

PMID: 14721999 [PubMed - indexed for MEDLINE]

Ultrafast computed tomography for quality control of automated proximal anastomoses.

BACKGROUND: The Symmetry aortic connector uses a nitinol implant to create proximal anastomoses with saphenous vein grafts. Multiple detector-row cardiac computed tomography (MDCT) is used as a noninvasive method of quality control at our institution.

METHODS: In 50 elective coronary artery bypass grafting patients who participated in a randomized trial comparing automated with conventionally hand-sewn proximal anastomoses, MDC T was performed on postoperative day 5. Fifty-three automated Symmetry anastomoses were created in 34 patients (group 1). Twenty-five conventionally hand-sewn anastomoses created in 16 patients served as controls (group 2). Graft patency and the presence or absence of high-grade stenosis at the proximal anastomotic site were evaluated.

RESULTS: In group 1, 2 (3.8%) of the grafts were found occluded at MDCT or coronary angiography, and no further relevant stenosis was observed. In group 2, at postoperative MDCT all grafts were found patent without significant narrowing of the proximal anastomotic site.

CONCLUSIONS: The feasibility of proximal anastomoses using the Symmetry device has been reported. Patency control with invasive angiography has been performed by other groups. With MDCT, noninvasive evaluation of proximal anastomotic quality and graft patency is possible, even if nitinol is implanted.

Author(s): Martens S, Herzog C, Dietrich M, Doss M, Wimmer-Greinecker G, Moritz A.

in: Heart Surg Forum. 2003;6(6):E170-3.

PMID: 14722005 [PubMed - indexed for MEDLINE]