Objective; In literature it is reported that only 50% of patients with ruptured thoracic aneurysm reaches the hospital alive, and 75% of these die within 24 hours. The high percentage of mortality and paraplegia after surgical treatment of a ruptured thoracic aortic aneurysm, limits indications to this procedure. Endovascular treatment offers a less invasive alternative to traditional surgery, as it avoids thoracotomy, anticoagulant therapy and aortic clamping. In this paper we report our initial experience regarding the endovascular treatment in emergency of broken thoracic aortic aneurysm. Methods: Our experience began in May 2004, since then we have treated 11 patients with frank rupture of the thoracic aortic aneurysm (10 aneurysms and a case of dissecting aneurysm). These patients had a mean age of 76.2 years (min. 69, max 88), 10 males and one female. All cases except one, were presented to the emergency department under hemodynamically stable (BP> 70 mm Hg) and were subjected to CT angiography of the thoracic aorta, abdominal aorta and iliac femoral axis. The clinical and instrumental evaluation have shown the possibility of endovascular treatment. In one case, presenting in hemorrhagic shock, the endovascular feasibility was made in the operating theater, after a careful study with angiography and IVUS (Intavascular Ultrasound). Results: All patients were treated within 12 hours of arrival in hospital and all procedures were performed in the operating room under general anesthesia. The endoprostheses used were in 9 cases Endofit / Endomed, in a case Talent / Medtronic and in another Zenith / Cook, with a surgical femoral access and percutaneous one. Only in one case it was necessary to cover the left subclavian artery, while in another case it was necessary to cover the origin of the subclavian artery and left common carotid artery after carotid-carotid bypass. The technical success was 100%, in two cases the presence of endoleaks on type 1 has necessitated the use of proximal cuffs. The post-operative mortality was 54.5% (6/11), in all cases the patients were very compromise in cardiac and respiratory systems. Conclusions: The results of our limited experience and related literature show an acceptable percentage of postoperative complications, in terms of mortality. In our experience, the success rate in terms of exclusion of the aneurysm, was 100% and the majority of post-operative complications occurred in patients with preexisting cardiopulmonary disease. Endovascular treatment of ruptured aneurysms of the thoracic aorta appears to be, from the literature, quite promising. The presence of an endovascular team prepared and always available and the availability of equipment and prosthetic materials are absolutely necessary for best results.

Obiettivo; In letteratura è riportato che solo il 50% dei pazienti con aneurisma toracico rotto raggiunge l’Ospedale ancora in vita, ed il 75% di questi muore nelle 24 ore successive. L’elevata percentuale di mortalità e paraplegia, in seguito a trattamento chirurgico di un aneurisma dell’aorta toracico rotto, limita di molto tale procedura. Il trattamento endovascolare offre un’alternativa meno invasiva alla chirurgia tradizionale, in quanto evita la toracotomia, la terapia anticoagulante e il clampaggio aortico. In questo lavoro riportiamo la nostra iniziale esperienza riguardante il trattamento endovascolare in urgenza dell’aneurisma dell’aorta toracico rotto. Metodi: La nostra esperienza è iniziata nel maggio 2004, da allora abbiamo trattato 11 pazienti con rottura franca di aneurisma dell’aorta toracica (10 aneurismi toracici rotti ed un caso di aneurisma dissecante rotto). I pazienti trattati presentavano un’età media di 76.2 anni (min. 69, max 88), 10 maschi ed una femmina. Tutti i casi, tranne uno, si sono presentati in Pronto Soccorso in condizioni emodinamicamente stabili (PA>70mmHg) e sono stati sottoposti ad un esame Angio TC dell’aorta toracica, addominale e degli assi iliaco femorali. Le condizioni cliniche e la valutazione strumentale hanno evidenziato la possibilità di un trattamento endovascolare. In un solo caso, presentandosi in shock emorragico, la diagnosi e la fattibilità endovascolare è stata fatta direttamente in sala operatoria, dopo un accurato studio angiografico e con IVUS (Intavascular Ultrasound). Risultati: Tutti i pazienti sono stati trattati entro 12 ore dall’arrivo in Ospedale e tutte le procedure sono state eseguite in sala operatoria e in anestesia generale. Le endoprotesi utilizzate sono state in 9 casi Endofit/Endomed, in un caso Talent/Medtronic ed in un altro Zenith/Cook, con un accesso femorale chirurgico ed uno percutaneo. Solo in un caso è stato necessario coprire l’arteria succlavia sinistra, mentre in un altro caso è stato necessario coprire l’origine dell’arteria succlavia e della carotide comune sinistra previo bypass carotido-carotideo. Il successo tecnico è stato del 100%, in due casi la presenza di on endoleak di tipo 1° ha reso necessario l’utilizzo di cuffs prossimali. La mortalità post-operatoria è stata del 54,5% (6/11), in tutti i casi si trattava di pazienti molto compromessi dal punto di vista cardiologico e respiratorio. Conclusioni: I risultati della nostra limitata esperienza e della letteratura evidenziano una percentuale di complicanze post-operatorie, in termini di mortalità, accettabile. Nella nostra esperienza la percentuale di successo, in termini d’esclusione dell’aneurisma, è stata del 100% e la maggior parte delle complicanze post-operatorie si è verificata in pazienti con preesistenti patologie cardiorespiratorie. Il trattamento endovascolare degli aneurismi rotti dell’aorta toracica sembra essere, dai dati della letteratura, abbastanza promettente. La presenza di un team endovascolare preparato e sempre reperibile e la disponibilità di apparecchiature e di materiale protesico a disposizione sono assolutamente necessarie per l’ottimizzazione dei risultati.

Deleo, G., Camesasca, V., Benatti, C., Palermo, R., Cova, M., Piglionica, M., et al. (2007). Trattamento endovascolare degli aneurismi dell’aorta toracica rotti. ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, 14(3(1)), 28-29.

Trattamento endovascolare degli aneurismi dell’aorta toracica rotti

MINGAZZINI, PAOLO;
2007

Abstract

Objective; In literature it is reported that only 50% of patients with ruptured thoracic aneurysm reaches the hospital alive, and 75% of these die within 24 hours. The high percentage of mortality and paraplegia after surgical treatment of a ruptured thoracic aortic aneurysm, limits indications to this procedure. Endovascular treatment offers a less invasive alternative to traditional surgery, as it avoids thoracotomy, anticoagulant therapy and aortic clamping. In this paper we report our initial experience regarding the endovascular treatment in emergency of broken thoracic aortic aneurysm. Methods: Our experience began in May 2004, since then we have treated 11 patients with frank rupture of the thoracic aortic aneurysm (10 aneurysms and a case of dissecting aneurysm). These patients had a mean age of 76.2 years (min. 69, max 88), 10 males and one female. All cases except one, were presented to the emergency department under hemodynamically stable (BP> 70 mm Hg) and were subjected to CT angiography of the thoracic aorta, abdominal aorta and iliac femoral axis. The clinical and instrumental evaluation have shown the possibility of endovascular treatment. In one case, presenting in hemorrhagic shock, the endovascular feasibility was made in the operating theater, after a careful study with angiography and IVUS (Intavascular Ultrasound). Results: All patients were treated within 12 hours of arrival in hospital and all procedures were performed in the operating room under general anesthesia. The endoprostheses used were in 9 cases Endofit / Endomed, in a case Talent / Medtronic and in another Zenith / Cook, with a surgical femoral access and percutaneous one. Only in one case it was necessary to cover the left subclavian artery, while in another case it was necessary to cover the origin of the subclavian artery and left common carotid artery after carotid-carotid bypass. The technical success was 100%, in two cases the presence of endoleaks on type 1 has necessitated the use of proximal cuffs. The post-operative mortality was 54.5% (6/11), in all cases the patients were very compromise in cardiac and respiratory systems. Conclusions: The results of our limited experience and related literature show an acceptable percentage of postoperative complications, in terms of mortality. In our experience, the success rate in terms of exclusion of the aneurysm, was 100% and the majority of post-operative complications occurred in patients with preexisting cardiopulmonary disease. Endovascular treatment of ruptured aneurysms of the thoracic aorta appears to be, from the literature, quite promising. The presence of an endovascular team prepared and always available and the availability of equipment and prosthetic materials are absolutely necessary for best results.
Abstract in rivista
Thoracic Aorta, Ruptured Aneurysm, Endovascular Repair
Aneurisma, Aorta Toracica, Aneurisma Rotto, Trattamento Chirurgico Endovascolare;
Italian
set-2007
14
3(1)
28
29
none
Deleo, G., Camesasca, V., Benatti, C., Palermo, R., Cova, M., Piglionica, M., et al. (2007). Trattamento endovascolare degli aneurismi dell’aorta toracica rotti. ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, 14(3(1)), 28-29.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/16434
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