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Thoracic Endovascular Aortic Repair in “Shaggy Thoracic Aortic Aneurysms”

  • Clinical Investigation
  • Arterial Interventions
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CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Objectives

To report the outcomes of thoracic endovascular aortic repair (TEVAR) for shaggy thoracic aortic aneurysms (STA).

Methods

It is a single center, retrospective, observational, cohort study. Data were collected prospectively between January 2005 and May 2019. STA was defined, based on computed tomography angiography findings, as the presence of an irregular/ulcerated atheroma protruding and/or thrombus thickness ≥ 5 mm protruding into the aortic lumen, and/or occupying more than two thirds of the circumference of the aortic diameter axially. Primary outcomes were early (≤ 30 days) and late survival and freedom from major complication due to end-organ or peripheral ischemic embolization.

Results

Nine (2.3%) of 391 patients met the inclusion criteria. Mean age was 71 years ± 10 (range 55–83). Mean aneurysm diameter was 68 mm ± 0.5 (range 60–75). Four patients presented symptomatic: rupture (n = 2), blue toe syndrome (n = 2). TEVAR was performed in 7 of the 9 patients. Operative-related embolization occurred in 1 patient (transient ischemic attack and acute kidney injury). In-hospital mortality was observed in 1 patient following spinal cord ischemia and multiple organ failure development. Median follow-up was 48 months (IQR 5–84). Freedom from major complication due to end-organ or peripheral ischemic embolization was achieved in all patients. No patient developed further localization of STA in the proximal or distal aorta, and did not experience reno-visceral or peripheral atheroembolization episodes.

Conclusions

Risk of atheroembolism in STA is still threatening but TEVAR proved to be an effective and durable treatment in this high-risk cohort.

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Funding

This study was not supported by any funding.

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Authors and Affiliations

  1. Vascular Surgery-Department of Medicine and Surgery, ASST Settelaghi University Teaching Hospital, University of Insubria School of Medicine, Via Guicciardini, 9, 21100, Varese, Italy

    Marco Franchin, Gabriele Piffaretti & Matteo Tozzi

  2. Vascular Surgery-IRCCS Ospedale Maggiore Policlinico Fondazione Cà Granda, Milan, Italy

    Viviana Grassi & Chiara Lomazzi

  3. University of Houston College of Medicine, Houston, TX, USA

    Ruth L. Bush

Authors
  1. Marco Franchin
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  2. Viviana Grassi
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  4. Ruth L. Bush
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Contributions

Study design: GP. Data collection: MF, GP, GM. Data analysis: GP, MF. Writing: GP, CL. Critical revision and final approval: MF, GP, GM, MT, VG, CL.

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Correspondence to Gabriele Piffaretti.

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Appendix: Stent-Graft

Appendix: Stent-Graft

TAG/C-TAG® (W.L. Gore and Associates; Flagstaff – AZ; USA).

Valiant/Captivia® (Medtronic Vascular; Santa Rosa – CA; USA).

Relay® (Bolton Medical; Sunrise – FL; USA).

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Franchin, M., Grassi, V., Piffaretti, G. et al. Thoracic Endovascular Aortic Repair in “Shaggy Thoracic Aortic Aneurysms”. Cardiovasc Intervent Radiol 44, 220–229 (2021). https://doi.org/10.1007/s00270-020-02676-2

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  • DOI: https://doi.org/10.1007/s00270-020-02676-2

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