흉부 대동맥류에서 좌쇄골하동맥 보존을 위한 주문 제작된 천공형 대동맥 스텐트 그래프트의 치험

허 균 순천향대학교 순천향대학교 순천향의학연구소 2012 Journal of Soonchunhyang Medical Science Vol.18 No.2

Endovascular repair for thoracic aortic aneurysm is widespread and recently, the advent of new device-fenestrated stent graft enables endovascular repair for aortic aneurysm to be close or involved in the orifice of left subclavian artery. However, fenestrated stent graft is not available in Korea. We report herein a case in which endovascular repair for thoracic aortic aneurysm closed to the orifice of left subclavian artery using custom made fenestrated stent graft. The aneurysm was successfully repaired by a total endovascular approach without open surgical repair.

흉부 대동맥류에서 좌쇄골하동맥 보존을 위한 주문 제작된 천공형 대동맥 스텐트 그래프트의 치험

허균 순천향대학교 순천향의학연구소 2012 Journal of Soonchunhyang Medical Science Vol.18 No.2

Endovascular repair for thoracic aortic aneurysm is widespread and recently, the advent of new device-fenestrated stent graft enables endovascular repair for aortic aneurysm to be close or involved in the orifice of left subclavian artery. However, fenestrated stent graft is not available in Korea. We report herein a case in which endovascular repair for thoracic aortic aneurysm closed to the orifice of left subclavian artery using custom made fenestrated stent graft. The aneurysm was successfully repaired by a total endovascular approach without open surgical repair.

Rescue Technique for Malposition Caused by Mislabeled Stent Graft in Thoracic Aneurysm

정혁재,손봉수,김도형,이상수 대한혈관외과학회 2017 Vascular Specialist International Vol.33 No.4

The aim of this paper is to report a salvage treatment for malpositioned stent graft due to mislabeled product during thoracic endovascular aortic repair (TEVAR) in descending thoracic aneurysm (DTA). A 78-year-old male presented with 6.7×4.1 cm sized saccular DTA and 7.1×7.3 cm sized abdominal aortic aneurysm (AAA). DTA was initially treated by TEVAR and 2 months later AAA was treated by open aortic repair. Unfortunately, although the stent graft was correctly labeled for DTA, the actual size of product wrapped in a box was different contrary to our expectations. On completion angiography, proximal sealing zone showed no endoleak, however, celiac trunk and superior mesenteric artery (SMA) was found to be accidentally occluded. Through an emergent thoracotomy, distal part of stent graft was removed by cutting distal segment of stent graft and pulling out maneuver to restore blood flow. The completion angiography presented no endoleak, and celiac trunk and SMA were secured. Cutting distal segment of stent graft and pulling out maneuver is one of feasible rescue technique to maintain blood flow of occluded celiac trunk during TEVAR.

Two-stage Surgery for an Aortoesophageal Fistula Caused by Tuberculous Esophagitis

신화균,최창우,임재웅,허균 대한의학회 2015 Journal of Korean medical science Vol.30 No.11

An aortoesophageal fistula (AEF) is an extremely rare, potentially fatal condition, and aortic surgery is usually performed together with extracorporeal circulation. However, this surgical method has a high rate of surgical complications and mortality. This report describes an AEF caused by tuberculous esophagitis that was treated successfully using a two-stage operation. A 52-yr-old man was admitted to the hospital with severe hematemesis and syncope. Based on the computed tomography and diagnostic endoscopic findings, he was diagnosed with an AEF and initially underwent thoracic endovascular aortic repair. Esophageal reconstruction was performed after controlling the mediastinal inflammation. The patient suffered postoperative anastomotic leakage, which was treated by an endoscopic procedure, and the patient was discharged without any further problems. The patient received 9 months of anti-tuberculosis treatment after he was diagnosed with histologically confirmed tuberculous esophagitis; subsequently, he was followed as an outpatient and has had no recurrence of the tuberculosis or any further issues.

A Staged Surgical Treatment for Aortoesophageal Fistula in Esophageal Cancer

Chang Woo Choi 순천향대학교 순천향의학연구소 2016 Journal of Soonchunhyang Medical Science Vol.22 No.2

An aortoesophageal fistula (AEF) is a rare and lethal disorder. However, aortic surgery is usually performed with extracorporeal circulation, and there is a high rate of surgical complications and mortality. This report describes a case of AEF caused by radiotherapy for esophageal cancer. A 59-year-old man was treated with preoperative chemoradiation, and developed a tracheoesophageal fistula (TEF) 3 months later (3 cycles of cisplatin and 5-fluorouracil). He complained of hemoptysis and hematemesis. Based on computed tomography and diagnostic endoscopic findings, he was diagnosed with an AEF and TEF, and initially underwent endovascular coiling, which failed. Because of bleeding, emergent thoracic endovascular aortic repair was performed. Esophageal resection and reconstruction were performed 45 days later to control mediastinal inflammation. The patient was followed up as an outpatient. He has had no recurrence of cancer or any further complications.

Simultaneous Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm Combined with Saccular Thoracic Aortic Aneurysm

Minju Kim,Jeong Hee Han,Dae Hwan Kim,Myunghee Yoon,Hyuk Jae Jung 대한혈관외과학회 2023 Vascular Specialist International Vol.39 No.3

With the recent increase in imaging tests, coexisting abdominal aortic aneurysms (AAAs) and thoracic aortic aneurysms (TAAs) are being discovered accidentally. We report two cases of simultaneous endovascular aortic repair (EVAR) and thoracic endovascular aortic repair (TEVAR) for AAA and TAA. Both 74-year-old and 79-year-old male with infrarenal AAA and saccular TAA were treated simultaneously with EVAR and TEVAR. Saccular TAAs were identified in the upper thoracic aorta during the evaluation of AAA. During endograft placement, carotid-subclavian bypass and cerebrospinal fluid (CSF) drainage were performed. Both patients were successfully discharged without spinal cord ischemia. Simultaneous EVAR and TEVAR can be considered for patients with AAA and saccular TAA in the upper thoracic aorta. Moreover, CSF drainage may be necessary to protect the spinal cord.

Endovascular Reintervention for Stent-Graft Dislocation after Open Surgical Conversion for Thoracoabdominal Aortic Aneurysm Treated by Thoracic Endovascular Aortic Repair

Tomoki Nakatsu,Shinsuke Kikuchi,Hiroyuki Miyamoto,Fumiaki Kimura 대한혈관외과학회 2022 Vascular Specialist International Vol.38 No.4

Complex anatomical restrictions can lead to further interventions after the emergence of a postoperative aneurysm enlargement in thoracic endovascular aortic repair (TEVAR) for a thoracoabdominal aortic aneurysm (TAAA). A 75-year-old male underwent a TEVAR for a Crawford extent I TAAA. The main device and the distal extension were placed using a fenestrated technique, outside of the instructions for use. The aneurysm expanded because of an endoleak and stent graft migration; and was surgically repaired by fully salvaging the previous endografts 38 months after the first TEVAR. However, the distal extension, which was the proximal anastomosis site with a prosthetic graft, became completely dislocated from the main device eight months after the open surgical conversion, resulting again in the enlargement of the aneurysm. An additional TEVAR was successfully performed to correct the dislocated stent graft. An appropriate treatment strategy is crucial to prevent multiple reinterventions for TAAA with complex anatomical restrictions.

Evaluation of Zone 2 Thoracic Endovascular Aortic Repair Performed with and without Prophylactic Embolization of the Left Subclavian Artery in Patients with Traumatic Aortic Injury

Bae Miju,Jeon Chang Ho,Kwon Hoon,김진혁,Choi Seon Uoo,Song Seunghwan 대한영상의학회 2021 Korean Journal of Radiology Vol.22 No.4

Objective: To report the authors’ experience in performing thoracic endovascular aortic repair (TEVAR) for zone 2 lesions after traumatic aortic injury (TAI). Materials and Methods: This retrospective review included 10 patients who underwent zone 2 TEVAR after identification of aortic isthmus injury by CT angiography (CTA) upon arrival at the emergency room of a regional trauma center from 2016 to 2019. Patients were classified into two groups: those who underwent left subclavian artery (LSA) embolization concurrently with the main TEVAR procedure, and those in whom LSA embolization was not performed during the main procedure, but was planned as a bailout treatment if type II endoleak was noted on follow-up CTA images. Pre-procedural and procedurerelated factors and post-procedure prognosis were compared between the groups. Results: There were no differences in pre-procedural factors, occurrence of endoleaks, and post-procedure prognosis (including mortality) between patients in the two groups. The duration of the procedure was shorter in the non-LSA embolization group (61 minutes vs. 27 minutes, p = 0.012). During follow-up, type II endoleak did not occur in either group. Conclusion: Delaying preventative LSA embolization until stabilization of the patient would be desirable when performing zone 2 TEVAR for TAI, in the absence of endoleak on the completion aortography image taken after complete deployment of the stent graft.

Endovascular Treatment of Type II Endoleak Following Thoracic Endovascular Aortic Repair for Thoracic Aortic Aneurysm: Case Report of Squeeze Technique to Reach the Aneurysmal Sac

강현정,김창원,이태홍,송승환,이충원,정성운 대한영상의학회 2014 대한영상의학회지 Vol.71 No.6

Type II endoleaks are common after thoracic endovascular aortic repair (TEVAR). Various strategies are introduced to manage type II endoleaks, such as the use of coils, plugs, or liquid embolic agents (histoacryl, thrombin, onyx, etc.) through a transarterial approach or a direct puncture of the aneurysmal sac. We herein report a case of a type II endoleak caused by reverse blood flow through intercostal artery after TEVAR which was successfully treated with n-butyl cyanoacrylate (histoacryl)-lipiodol mixture by a squeeze technique to reach the aneurismal sac using a microcatheter.

The Risk Factors and Outcomes of Acute Kidney Injury after Thoracic Endovascular Aortic Repair

전윤호,배지훈 대한흉부외과학회 2016 Journal of Chest Surgery (J Chest Surg) Vol.49 No.1

Background: We aimed to evaluate the incidence, predictive factors, and impact of acute kidney injury (AKI) after thoracic endovascular aortic repair (TEVAR). Methods: A total of 53 patients who underwent 57 TEVAR operations between 2008 and 2015 were reviewed for the incidence of AKI as defined by the RIFLE (risk, injury, failure, loss, and end-stage kidney disease risk) consensus criteria. The estimated glomerular filtration rate was determined in the perioperative period. Comorbidities and postoperative outcomes were retrospectively reviewed. Results: Underlying aortic pathologies included 21 degenerative aortic aneurysms, 20 blunt traumatic aortic injuries, six type B aortic dissections, five type B intramural hematomas, three endoleaks and two miscellaneous diseases. The mean age of the patients was 61.2±17.5 years (range, 15 to 85 years). AKI was identified in 13 (22.8%) of 57 patients. There was an association of preoperative stroke and postoperative paraparesis and paraplegia with AKI. The average intensive care unit (ICU) stay in patients with AKI was significantly longer than in patients without AKI (5.3 vs. 12.7 days, p=0.017). The 30-day mortality rate in patients with AKI was significantly higher than patients without AKI (23.1% vs. 4.5%, p=0.038); however, AKI did not impact long-term survival. Conclusion: Preoperative stroke and postoperative paraparesis and paraplegia were identified as predictors for AKI. Patients with AKI experienced longer average ICU stays and greater 30-day mortality than those without AKI. Perioperative identification of highrisk patients, as well as nephroprotective strategies to reduce the incidence of AKI, should be considered as important aspects of a successful TEVAR procedure.