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Endovascular strategies for treatment of embolizing thoracoabdominal aortic lesions.
- Source :
-
Journal of vascular surgery [J Vasc Surg] 2014 May; Vol. 59 (5), pp. 1256-64. Date of Electronic Publication: 2014 Jan 14. - Publication Year :
- 2014
-
Abstract
- Objective: Aortic sources of peripheral and visceral embolization remain challenging to treat. The safety of stent graft coverage continues to be debated. This study reports the outcomes of stent coverage of these complex lesions.<br />Methods: Hospital records were retrospectively reviewed for patients undergoing aortic stenting between 2006 and 2013 for visceral and peripheral embolic disease. Renal function, method of coverage, and mortality after stent grafting were reviewed.<br />Results: Twenty-five cases of embolizing aortic lesions treated with an endovascular approach were identified. The mean age was 65 ± 13 years (range, 45-87 years), and 64% were female. Sixteen (64%) patients presented with peripheral embolic events, six with concomitant renal embolization. Five patients presented with abdominal or flank pain, and two were discovered incidentally. Three patients had undergone an endovascular procedure for other indications within the preceding 6 months of presentation. Nineteen patients had existing chronic kidney disease (stage II or higher), but only three had stage IV disease. Of the eight patients tested, four had a diagnosed hypercoagulable state. Eight of the patients had lesions identified in multiple aortic segments, and aortic aneurysm disease was present in 24%. Coverage of both abdominal and thoracic sources occurred in eight patients, whereas 17 had only one segment covered. Minimal intraluminal catheter and wire manipulation was paired with the use of intravascular ultrasound in an effort to reduce embolization and contrast use. Intravascular ultrasound was used in the majority of cases and transesophageal echo in 28% of patients. Two patients with stage IV kidney disease became dialysis-dependent within 3 months of the procedure. No other patients had an increase in their postoperative or predischarge serum creatinine levels. No embolic events were precipitated during the procedure, nor were there any recurrent embolic events detected on follow-up. The 1-year mortality rate was 25%.<br />Conclusions: Endovascular coverage of atheroembolic sources in the aorta is feasible and is safe and effective in properly selected patients. It does not appear to worsen renal function when performed with the use of specific technical strategies.<br /> (Copyright © 2014 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.)
- Subjects :
- Aged
Aged, 80 and over
Algorithms
Aortic Aneurysm, Thoracic complications
Aortic Aneurysm, Thoracic diagnosis
Aortic Aneurysm, Thoracic mortality
Aortography methods
Critical Pathways
Embolism diagnosis
Embolism etiology
Embolism mortality
Female
Humans
Male
Middle Aged
Prosthesis Design
Retrospective Studies
Risk Factors
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
Ultrasonography, Interventional
Aortic Aneurysm, Thoracic surgery
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation adverse effects
Blood Vessel Prosthesis Implantation instrumentation
Blood Vessel Prosthesis Implantation mortality
Embolism surgery
Endovascular Procedures adverse effects
Endovascular Procedures instrumentation
Endovascular Procedures mortality
Stents
Subjects
Details
- Language :
- English
- ISSN :
- 1097-6809
- Volume :
- 59
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Journal of vascular surgery
- Publication Type :
- Academic Journal
- Accession number :
- 24433783
- Full Text :
- https://doi.org/10.1016/j.jvs.2013.11.068