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Objectives To analyse the results and review the literature about thoracic aortic endovascular repair (TEVAR) for type B acute aortic dissection (TBAAD) complicated by descending thoracic aortic aneurysm (DTA) in the hyperacute or acute phases. Methods This was a multicentre, observational descriptive study. Inclusion criteria were TBAAD with a DTA of ≥50 mm, TBAAD on an already known aneurysmal descending thoracic aorta, and TBAAD presenting with an enlarged aorta with a total diameter <50 mm, but with >50% diameter increase compared with a previous computed tomography angiography (CTA) showing a non-dissected aorta with normal sizing. Primary endpoints were early and long-term survival, freedom from TEVAR and aortic related mortality (ARM), and freedom from re-intervention. Results Twenty-two patients were included in the analysis. The mean aortic diameter was 66 ± 26 mm (range 42–130; IQR 51–64). The in hospital TEVAR related mortality was 14% ( n = 3). The mean radiological follow-up was 56 ± 45 months (range 6–149; IQR 12–82), and the follow-up index 0.97 ± 0.1. All surviving patients were available for follow-up. During follow-up the cumulative mortality was 26% ( n = 5) and TEVAR related mortality was 5% (n = 1). Overall the estimate of survival was 82% (95%CI: 61.5–93) at 1 year, and 64% at 5 years. Ongoing primary clinical success was 79% (re-intervention n = 4). Freedom from aortic related mortality was 86% (95%CI: 66–95) at 1 and 5 year, while freedom from re-intervention was 95% (95%CI: 75.5–95) at 1 year, and 77% (95%CI: 50–92) at 5 years. Conclusions In our experience, DTA is a frequent complication from the very beginning of the clinical onset of TBAAD. In this high-risk cohort, TEVAR showed satisfactory results, better than those predicted by the risk score for open repair, with favourable stability of the aortic diameter and no aortic related adverse events during follow-up. [ABSTRACT FROM AUTHOR]

Objectives The aim was to describe and analyze the management of hemothorax (HTX) and the occurrence of respiratory complications after endovascular repair of thoracic aortic rupture (TEVAR). Methods This was a multicenter study with retrospective analysis. Between November 2000 and December 2012, all patients with confirmed HTX due to rupture of the descending thoracic aorta treated with TEVAR were included. Respiratory function (acid base status, Pa o 2 , Pa co 2 , lactate, and respiratory index) was monitored throughout hospitalization. Primary endpoints were survival and post-operative respiratory complications. Results Fifty-six patients were treated. The mean age was 62 ± 21 years (range 18–92 years). Etiology included traumatic rupture ( n = 23, 41%), atherosclerotic aneurysm ( n = 20, 36%), Debakey type IIIa dissection ( n = 8, 14%), and penetrating aortic ulcer ( n = 5, 9%). The primary technical success of TEVAR was 100%. The in hospital mortality rate was 12.5% ( n = 7). Hemothorax was drained in 21 (37.5%) cases. In hospital respiratory complications occurred in 23 (41%) patients who required a longer intensive care unit stay (days 2.3 ± 0.7 vs. 1.9 ± 0.8, p = .017), and hospitalization (26 ± 17 vs . 19 ± 17, p = .021). Those who developed post-operative respiratory complications had lower pre-operative PO 2 values (mmHg, 80 ± 24 vs. 91 ± 21, p = .012). Respiratory complications and in hospital mortality did not differ among aortic pathologies ( p = .269 and p = 1.0, respectively), nor did in hospital mortality differ between patients with and without respiratory complications (13% vs. 12%; p = .990). Conclusions Thoracic aortic rupture still has a high mortality rate. Respiratory complications have not been eliminated by endovascular repair. HTX evacuation may have had a positive influence on the survival in these patients. Although traumatic and degenerative ruptures are two significantly different scenarios, survival and respiratory outcomes were similar and were not affected by the underlying aortic disease. [ABSTRACT FROM AUTHOR]

Objective: To report the mid-term results of 63 patients who received a new commercially-available retrievable vena cava filter, ALN. Methods: Between January 2001 and October 2005, 63 patients (mean age 65±15 years) underwent placement of ALN filters. Filter removal was performed when anti-thrombotic prophylaxis was considered unnecessary or when the patient could safely resume full anticoagulant therapy. Results: Thirty-five patients (55%) had ilio-femoral venous thrombosis and 28 patients (45%) had ilio-caval thrombosis. Overall, 49% had pulmonary embolism. Technical success for filter insertion was 100%, without any complications. None of the procedures aborted or was converted due to technical difficulties. After a median follow-up of 21-months (range 1–48, median 18), there were no cases of pulmonary embolism or vena cava thrombosis. Two patients died of a cause unrelated to deep venous thrombosis during the follow-up period, without clinical evidence of pulmonary embolism or filter-associated complications. No device migration was observed. There were 20 (31.7%) retrieval attempts: in 16 cases filters were retrieved successfully, but 4 cases were aborted. The mean implantation period of the retrieved filter was 179 days (range 53–370). Conclusion: Our results confirm the clinical efficacy of the ALN filter for preventing potentially fatal pulmonary embolism whilst implanted and in absence of post-insertion complications, even when left in place indefinitely. [Copyright &y& Elsevier]

Abstract: We report a case of giant extracranial carotid aneurysm treated by carotid aneurysmectomy. A 70-year-old female was referred with a palpable swelling on left lateral region of the neck, associated with dizziness and dysarthria. Spiral-CT scan showed a 5-cm aneurysm of the internal carotid artery (ICA), kinking of ICA and increased flow in the right vertebral artery. Angiography showed, a fusiform ICA aneurysm, with lengthening and tortuosity of intracranial vessels. An aneurysmectomy was performed with end-to-end repair of ICA. The patient was discharged on the 12 post-operative day. Twelve months after the operation, the patient showed a complete recovery from the neurological deficit and patency of ICA. We recommend surgical treatment in order to avoid rupture, thromboembolism and cerebrovascular insufficiency. [Copyright &y& Elsevier]

Abstract: We report a case of giant extracranial carotid aneurysm treated by carotid aneurysmectomy. A 70-year-old female was referred with a palpable swelling on left lateral region of the neck, associated with dizziness and dysartria. Spiral-CT scan showed a 5-cm aneurysm of the internal carotid artery (ICA), kinking of ICA and increased flow in the right vertebral artery. Angiography showed, a fusiform ICA aneurysm, with lengthening and tortuosity of intracranial vessels. An aneurysmectomy was performed with end-to-end repair of ICA. The patient was discharged on the 12 postoperative day. Twelve months after the operation, the patient showed a complete recovery from the neurological deficit and patency of ICA. We recommend surgical treatment in order to avoid rupture, thromboembolism and cerebrovascular insufficiency. [Copyright &y& Elsevier]