1/21. Poststernotomy mediastinitis treated by rectus muscle flap plugging.The current standard treatment of mediastinitis following median sternotomy is radical sternal curettage and plugging of the anterior mediastinal dead space with muscle flap or omentum. This paper will report our experience with a pediculated flap of the rectus muscle after mediastinal irrigation and drainage. The patient was a 75-year-old man diagnosed as having aortic arch aneurysm. The patient underwent a total aortic arch replacement with the bovine-collagen sealed vascular prosthesis (Hemashield). As an early postoperative complication, he was diagnosed with mediastinitis which was the result of infection of the drainage fluid. Mediastinal curettage and plugging of the rectus muscle flap was successfully performed. Without recurrence of infection, the wound healed completely. We conclude that early curettage and rectus muscle flap plugging are the most effective treatment of the poststernotomy mediastinitis.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
2/21. Type A dissection of the ascending thoracic aorta during percutaneous coronary intervention.Retrograde dissection of the aorta is extremely rare during percutaneous coronary intervention (PCI), but is a recognized and potentially life-threatening complication. We describe a case in which retrograde dissection of the aorta, necessitating urgent surgical repair, occurred during an attempt to open a chronically occluded right coronary artery. Initially localized, the dissection extended during an attempt to seal the right coronary ostium. Our experience suggests that if localized aortic retrograde dissection occurs, the management will depend on the stability of the distal coronary vessel. If stable, a conservative approach may be preferable to an attempt to seal the dissection.- - - - - - - - - - ranking = 2keywords = seal (Clic here for more details about this article) |
3/21. Hybrid open-endoluminal technique for repair of thoracoabdominal aneurysm involving the celiac axis.PURPOSE: To describe a technique combining endoluminal and open approaches for the repair of thoracoabdominal aneurysms involving the celiac axis. CASE REPORT: Two patients with type I thoracoabdominal aneurysm and suboptimal cardiac reserve underwent transluminal stent-graft implantation. To achieve satisfactory distal seal, the caudal end of the endograft was circumscribed with a Dacron band that was sutured to the aorta and endograft through a midline incision. The patent celiac artery in both patients was ligated to stop retrograde filling of the aneurysm sac. The patients developed no problems perioperatively, and exclusion of the aneurysms was confirmed by follow-up imaging. Three years after endografting, both patients had excluded aneurysms without evidence of endoleak or device migration. CONCLUSIONS: This combined approach is another treatment option for thoracic aneurysms that have an anatomically suitable proximal attachment zone with a compromised distal neck.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
4/21. Intentional left subclavian artery occlusion by thoracic aortic stent-grafts without surgical transposition.PURPOSE: To report the consequences of endoluminal deployment of stent-grafts in the thoracic aorta with intentional occlusion of the left subclavian artery. case reports: Three patients with an aortic type-B dissection and 1 with a thoracic aneurysm were treated endoluminally with Talent stent-grafts implanted over the ostium of the left subclavian artery without prior surgical subclavian-carotid transposition. The primary intimal tears were sealed and the degenerative aneurysm excluded; blood pressure in the left arm was significantly diminished immediately after the stent-graft was released, but adequate collateral retrograde perfusion via the left vertebral artery was apparent in all patients. No neurological deficit and no symptoms of left arm ischemia were observed in a follow-up that ranged from 14 to 20 months. CONCLUSIONS: Our limited experience shows that occlusion of the left subclavian artery with a stent-graft is well tolerated. If ischemic symptoms occur, a transposition procedure can be performed on an elective basis.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
5/21. Aneurysm expansion after stent-graft placement in the absence of endoleak.Sixty-three patients with thoracic or abdominal aortic aneurysms were treated with endovascular stent-grafts. No endoleak was identified at any interval of follow-up in 58 patients. In four of them (7%), the aneurysms expanded by 10 mm or more during follow-up and additional interventions were required. Aneurysm expansion was caused by inappropriate sealing at the aneurysmal necks in two patients and transgraft seroma in the other two. Although some aneurysm expansion could be avoided by proper patient selection and accurate placement of stent-grafts, it seems difficult to predict aneurysm expansion in most cases.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
6/21. Endoluminal stenting of the aorta as treatment of aortoesophageal fistula due to primary aortic disease.A 78-year-old woman with severe chronic obstructive pulmonary disease was admitted to the emergency room with hematemesis. With use of esophagoscopy, chest computed tomographic scanning, and aortography, we found a large descending aortic aneurysm and a penetrating ulcer of the proximal descending aorta. We determined that the patient had an aortoesophageal fistula and pseudoaneurysm that had originated from a ruptured penetrating ulcer of the mid-descending aorta. We deployed two 100-mm stent grafts to seal the ruptured thoracic aorta. Six months later, the pseudoaneurysm was almost completely resolved, with no infection or endoleak. We advocate the use of endoluminal aortic stenting for aortoesophageal fistulas of aortic origin, particularly in patients with severe concomitant disease.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
7/21. Side-branched modular endograft system for thoracoabdominal aortic aneurysm repair.PURPOSE: To describe a side-branched modular endograft system that provides adequate visceral artery perfusion with perfect seal during thoracoabdominal aortic aneurysm (TAAA) repair. CASE REPORT: A 76-year-old man with a 57-mm TAAA involving the celiac artery was treated with a customized Talent endograft consisting of a 46-mm x 18-cm stented main body and a 6-mm x 30-mm nonstented Dacron side branch. The graft was delivered through a surgical exposure of the left common femoral artery. A 6-mm x 10-cm Hemobahn stent-graft was introduced in the 30-mm side branch from the aorta to the celiac trunk through a long 8-F sheath via the left brachial artery. The patient recovered uneventfully except for a mild reactive inflammatory syndrome. Postoperative computed tomography demonstrated total exclusion of the TAAA sac and good antegrade perfusion of the celiac and superior mesenteric arteries, which has been maintained at the 6-month follow-up. CONCLUSIONS: Endovascular treatment of TAAA is feasible with further technical refinements of available technology.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
8/21. Open surgical intervention to recurrent aortic dissection after endovascular stent grafting.We report the case of a 49-year-old man who received open-heart surgery for recurrent aortic dissection after endovascular stent grafting. Stent grafting had been successfully performed in the acute phase. Recurrent dissection became obvious 5 months later, and at the same time, aneurysmal change was detected between the left subclavian artery and the proximal end of the stent graft. We employed a "Y arch" surgical procedure and "elephant trunk" technique to treat, and the entry tear was completely sealed and the aneurysm was excluded by elephant trunk segment. We believe that this approach could be a new option for treatment for complicated aortic aneurysms.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
9/21. False aortic aneurysm at site of previous coarctation repair: the role of cardiovascular magnetic resonance.We describe a 37-year-old who presented with hemoptysis. Twenty-one years previously he had undergone Dacron patch aortoplasty for coarctation. Initial investigations failed to reveal the cause of the hemoptysis. Cardiovascular magnetic resonance (CMR) demonstrated an aneurysm at the site of the repair. He underwent successful repair of the aneurysm with a Gelseal interpositional graft.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
10/21. Iatrogenic aortic dissection during coronary intervention.Iatrogenic acute dissection of the ascending aorta following coronary angiography and percutaneous intervention is rare. Localized aortic dissections have been treated by sealing the entry with a coronary stent. Extensive dissections may require a surgical intervention. We describe a coronary dissection with retrograde extension to the ascending aorta that occurred during angioplasty of the right coronary artery. The extensive dissection, which was limited to the ascending aorta, was successfully treated by stenting of the right coronary artery and monitoring the aortic dissection by means of transesophageal echocardiography.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
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