4. Physician modified endovascular stent-graft in patient with dissecting thoracic aortic aneurysm. Case report.

Authors

  • AORTIC ANEURYSM. CASE REPORT THORACIC JSC, Almaty, Kazakhstan, г. Алматы, Казахстан
  • A.V. Sapunov JSC, Almaty, Kazakhstan, г. Алматы, Казахстан
  • I.Y. Sagatov JSC, Almaty, Kazakhstan, г. Алматы, Казахстан
  • B.K. Ormanov JSC, Almaty, Kazakhstan, г. Алматы, Казахстан

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Abstract

Increasement in the diameter of the thoracic aorta ≥ 50% of the norm of 40 mm in men and 34 mm in women (99 percentile) is considered to be an aneurysmal expansion. The risk of rupture is proportional to the size of the aneurysm and is associated with the development of fatal complications. Diagnosis is usually verified by computed tomographic angiography (CTA), magnetic resonance angiography (MRA), or transesophageal echocardiogram. Treatment consists of endovascular stent graft placement or open surgery in combination with optimal medical therapy. The article presents the experience of treating a patient with a dissecting aneurysm of the thoracic aorta type IIIB according to DeBakey using a stent graft modified by a doctor “on table” by forming a fenestration modeled after the anatomy of the left subclavian artery orifice. The aim of the work was to evaluate the short-term and medium-term results and prognosis of treatment using the technique of endovascular prosthesis with a modified graft. Such modifications on the table or in situ make it possible to model the prosthesis according to the variant of the anatomy of a particular patient, which allows optimizing the apposition of the prosthesis, eliminating additional stages of complex surgical treatment, reducing the undesirable effects of standard approaches, including preliminary endovascular occlusion of the left subclavian artery and/or the formation of a carotid-subclavian shunt, reduce the time of stationary observation. The use of the described technique will reduce the radicalness of surgical treatment of patients with dissecting aneurysms and increase economic efficiency. This technique is a promising direction in the development of endovascular and surgery and requires further study to assess long-term results and prognosis in a large number of patients. Thoracic aortic aneurysm (TAA) is an abnormal enlargement of the aorta above the diaphragm. TAA account for 1/4 of all aortic aneurysms, occurring in 40 people per 100,000 population. Men and women get sick equally.

Keywords

thoracic aorta, aneurysm, TEVAR, Stent-graft, endovascular surgery

References

  1. Rogers I.S., Massaro J.M., Truong Q.A., Mahabadi A.A., Kriegel M.F., Fox C.S., Thanassoulis G., Isselbacher E.M., Hoffmann U., O’Donnell C.J. Distribution, determinants, and normal reference values of thoracic and abdominal aortic diameters by computed tomography (from the Framingham Heart Study). Am J Cardiol. 2013;111:1510-1516
  2. Sampson U.K.A., Norman P.E., Fowkes G.R., Aboyans V., Song Y., Harrell F.E., Forouzanfar M.H., Naghavi M., Denenberg J.O., McDermott M.M., Criqui M.H., Mensah G.A., Ezzati M., Murray C. Global and regional burden of aortic dissection and aneurysms. Global Heart. 2014;8:171-180
  3. Kouchoukos N.R., Dougeins D. Surgery of the Thoracic Aorta // N. Engl. J. Med. - 1997. - 336. - 17876-1888)
  4. Salameh M.J., Black J.H. 3rd, Ratchford E.V. Thoracic aortic aneurysm. Vasc Med. 2018 Dec; 23(6):573-578. doi:10.1177/­1358863X18807760.Epub2018Oct29.PMID:30370834.5.vonKodolitschY.,CsoszS.K.,KoschykD.H.,SchalwatI.,LooseR.,KarckM.,DieckmannC.,FattoriR.,HaverichA.,BergerJ.,MeinertzT.,NienaberC.A.Intramuralhematomaoftheaorta:predictorsofprogressiontodissectionandrupture.Circulation.2003;107:1158-1163
  5. Faiza Z., Sharman T. Thoracic Aorta Aneurysm. In: Stat Pearls [Internet]. Treasure Island (FL): Stat Pearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554567/
  6. Dohle D.S., Tsagakis K., Janosi R.A. [et al.] Aortic remodelling in aortic dissection after frozen elephant trunk / // Eur. J. Cardiothorac. Surg. – 2016. – Vol. 49, No 1. – P. 111–117. – doi:10.1093/ejcts/ezv045
  7. Jennifer Canonge, Jérémie Jayet, Frédéric Heim, Nabil Chakfé, Marc Coggia, Raphaël Coscas, Frédéric Cochennec. Comprehensive Review of Physician Modified Aortic Stent Grafts: Technical and Clinical Outcomes. European Journal of Vascular and Endovascular Surgery, V.61/I4,2021,P560-569, doi:10.1016/j.ejvs.2021.01.019
  8. Chassin-Trubert L., Mandelli M., Ozdemir B.A., Alric P., Gandet T., Canaud L. Midterm Follow-up of Fenestrated and Scalloped Physician-Modified Endovascular Grafts for Zone 2 TEVAR. J EndovascTher. 2020 Jun;27(3):377-384. doi:10.1177/1526602819881128.Epub2019Oct24.PMID:31645219
  9. Benjamin W. Starnes, MD, FACS. Physician-modified endovascular grafts for the treatment of elective, symptomatic, or ruptured juxtarenal aortic aneurysms. Open ArchivePublished: May 03, 2012 DOI: https://doi.org/10.1016/j. jvs.2012.02.011

Published

2022-06-22

Issue

No. 2 (2022)

Section

Статьи