Research Information System
Charing Cross Aortic Vienna 2021, London, United Kingdom, 5 - 07 October 2021, pp.1-2, (Summary Text)
Aims:
A series of patients who required late open conversion for rare complications which are observed
after thoracic and abdominal endovascular aortic repair (EVAR) are presented in
this study.
Methods:
Case
1 is a 78-year old male patient who presented with acute aortic thrombosis
after EVAR for infrarenal abdominal aortic aneurysm. He was diagnosed with acute ischemia at lower limbs. We first performed
an axillobifemoral bypass surgery for limb salvage. Due to recurrent thromboses
of the left limb of the graft during longterm follow-up, we applied
aortobifemoral bypass procedure to provide adequate lower limb flow. Case 2 is a
56 year-old male patient who had undergone thoracic endovascular aortic repair
(TEVAR) for Stanford type B aortic dissection 6-months before and was admitted
to our clinic with uncontrolled hypertension for the last twelve hours and
history of a syncopal attack three days before. Retrograde ascending aortic
dissection (rAAD) was detected in computed tomography angiography. Ascending
aorta and hemiarch replacement with a Dacron graft was safely performed via hypothermic
circulatory arrest and antegrade cerebral perfusion for the treatment of rAAD
after TEVAR. Case 3 was a 67- year old male patient who was admitted
with a syncopal attack. He had a history of endovascular aneurysm repair five
years before. He was diagnosed as type 3
endoleak with rupture. An urgent aorto-bifemoral bypass was performed by
removing the endograft completely.
Results: At 24 months of follow-up after the aortobifemoral
bypass, the physical examination of Case 1 revealed palpable pulses of the
lower limb arteries and no graft failure was observed The
third month and subsequent CTA images of Case 2 revealed that the graft was
intact with no dissection, haematoma or pseudo-aneurysm in aortic root, arcus
aorta or the branches. He is in a good condition at 18th month. Case 3 was
discharged at twentieth day and had ordinary findings at one year follow-up.
Conclusions:
Unfavourable aortic anatomy is an
important limitation for EVAR treatment. Extra-anatomic bypass procedures
should be kept in mind in urgent conditions for limb salvage as for our Case 1.
However the long-term patency rates of extra-anatomic bypass procedures are not
excellent, whereas aortobifemoral bypass surgery is a conventional
gold-standard treatment modality which yields excellent long-term patency
rates. Time to intervention is an important issue for
acute Type B aortic dissection. Ascending aorta and hemiarch replacement was
safely performed via hypothermic circulatory arrest and antegrade cerebral
perfusion for the treatment of rAAD after TEVAR in our Case 2. The extension of
the retrograde dissection and the involvement of the branches may vary among
the different patients and the surgery should be modified according to the
pathology. The ruptured aneurysm due to type 3 endoleak as in our Case 3 is a
rare and catastrophic complication. It
is evident that a close surveillence for life time both after EVAR and TEVAR is
crucial. Also it should be noted here that open surgery and endovascular
treatment for aortic pathologies are not substitutional but complementary
therapies currently.