medigraphic.com
Órgano Oficial de la Sociedad Mexicana de Angiología y Cirugía Vascular

2019, Number 1

<< Back Next >>

Rev Mex Angiol 2019; 47 (1)

Manejo endovascular de pseudoaneurisma aórtico torácico secundario a úlcera ateroesclerótica penetrante

Silva-González M, Lecuona-Huet NE, Regalado-Solís F, Nieto-Zepeda D, López-Valdivia J, Farro-Moreno A, Ziga-Martínez A

Language: Spanish
References: 31
Page: 43-46
PDF size: 302.99 Kb.


ABSTRACT

Acute aortic syndromes (AAS) encompass three entities; aortic dissection, intramural hematoma and penetrating aortic ulcer (UAP). In the UAP there is a focal alteration of the intimal layer and the lamina that extends towards the middle layer and a more extensive and diffuse atherosclerotic disease involving the aorta and the coronary arteries. The extension of the ulcer to the medial lamina may favor the formation of a hematoma (localized dissection), pseudoaneurysm, or transmural rupture. We present the clinical case of a 65-year-old patient with UAP who had a saccular pseudoaneurysm in the descending aorta as a complication, to which endovascular management was successful with Zenith TX2 stent. Endovascular therapy is considered especially effective for type B UAP when pain and hypertension are difficult to control when signs of early spread or expansion are observed. Endovascular management has become the treatment of the choice of UAP with good results in the medium term.


REFERENCES

  1. Kratimenos T, Baikoussis N, Tomais D, Argiriou M. Ascending Aorta Endovascular Repair of a Symptomatic Penetrating Atherosclerotic Ulcer with a Custom-Made Endograft. Ann Vasc Surg. 2018; 47: 280.e1-280.e4.

  2. Natalicchio G, Biello A, Castriotta G, La Marca M, Sorino G, Salcuni M. Endovascular Repair of a Penetrating Aortic Ulcer with a Custom-made Relay Stent Graft Featuring a Single Celiac Trunk Fenestration and a Superior Mesenteric Artery Scallop. Ann Vasc Surg 2018; 52: 314.e1-314.e5.

  3. Patel H, Williams D, Upchurch G, Dasika N, Deeb G. The challenge of associated intramural hematoma with endovascular repair for penetrating ulcers of the descending thoracic aorta. J Vasc Surg 2010; 51(4): 829-835.

  4. Nathan D, Boonn W, Lai E, Wang G, Desai N, Woo E, et al. Presentation, complications, and natural history of penetrating atherosclerotic ulcer disease. J Vasc Surg 2012; 55(1): 10-5.

  5. El Hassani I, Van Damme H, Creemers E, Boesmans E, Defraigne J. Penetrating atherosclerosis aortic ulcer: a re-appraisal. Acta Chirurgica Belgica 2016; 117(1): 1-7.

  6. Bonaca M, O'Gara P. Diagnosis and Management of Acute Aortic Syndromes: Dissection, Intramural Hematoma, and Penetrating Aortic Ulcer. Current Cardiology Reports 2014; 16(10).

  7. Baliyan V, Parakh A, Prabhakar A, Hedgire S. Acute aortic syndromes and aortic emergencies. Cardiovascular Diagnosis and Therapy 2018; 8(S1): S82-S96.

  8. Oderich G, Kärkkäinen J, Reed N, Tenorio E, Sandri G. Penetrating Aortic Ulcer and Intramural Hematoma. CardioVascular and Interventional Radiology 2018.

  9. DeMartino R, Sen I, Huang Y, Bower T, Oderich G, Pochettino A, et al. Population-Based Assessment of the Incidence of Aortic Dissection, Intramural Hematoma, and Penetrating Ulcer, and Its Associated Mortality From 1995 to 2015. Circulation: Cardiovascular Quality and Outcomes 2018; 11(8).

  10. Bossone E, LaBounty T, Eagle K. Acute aortic syndromes: diagnosis and management, an update. Eur Heart J 2017; 39(9): 739-749d.

  11. Giri S, Dhakal P, Hwang I, Siwakoti K, Alsafwah S. Penetrating aortic ulcer leading to aortic dissection. Journal of the American Academy of Physician Assistants 2017; 30(8): 23-5.

  12. Kawabori M, Kaneko T. Acute aortic syndrome: A systems approach to a time-critical disease. Best Practice & Research Clinical Anaesthesiology 2016; 30(3): 271-81.

  13. Corvera J. Acute aortic syndrome. Ann Cardiothoracic Surg 2016; 5(4): 188-93.

  14. Ciccone M, Dentamaro I, Masi F, Carbonara S, Ricci G. Advances in the diagnosis of acute aortic syndromes: Role of imaging techniques. Vasc Med 2016; 21(3): 239-50.

  15. Matsumura JS, Lee WA, Mitchell RS, Farber MA, Murad MH, Lumsden AB, et al. The Society for Vascular Surgery Practice Guidelines: Management of the left subclavian artery with thoracic endovascular aortic repair. J Vasc Surg 2009; 50(5): 1155-8. Disponible en: http:// dx.doi.org/10.1016/j.jvs.2009.08.090

  16. Lee TC, Andersen ND. Results with a Selective Revascularization Strategy for Left Subclavian Artery Coverage During Thoracic Endovascular Aortic Repair. Ann Thorac Surg 2011; 92(1): 97-103. Doi: 10.1016/ j.athoracsur.2011.03.089

  17. Bradshaw RJ, Ahanchi SS, Powell O, Larion S, Brandt C, Soult MC, et al. Left subclavian artery revascularization in zone 2 thoracic endovascular aortic repair is associated with lower stroke risk across all aortic diseases. J Vasc Surg 2010; 1-10. Disponible en: http://dx.doi.org/ 10.1016/j.jvs.2016.10.111

  18. Rizvi AZ, Murad MH, Fairman RM, Erwin PJ. The effect of left subclavian artery coverage on morbidity and mortality in patients undergoing endovascular thoracic aortic interventions: A systematic review and meta-analysis. YMVA 2008; 50(5): 1159-69. Available from: http:// dx.doi.org/10.1016/j.jvs.2009.09.002

  19. Weigang E, Parker JATC, Czerny M, Lonn L, Bonser RS, Carrel TP, et al. Should intentional endovascular stent-graft coverage of the left subclavian artery be preceded by prophylactic revascularisation? Eur J Cardio- Thorac Surg 2011; 40(4): 858-68.

  20. Ince H, Nienaber CA. Etiology, pathogenesis and management of thoracic aortic aneurysm. Nat Clin Pract Cardiovasc Med 2007; 4(8): 418-27.

  21. Buth J, Harris PL, Hobo R, Eps R Van. Neurologic complications associated with endovascular repair of thoracic aortic pathology: Incidence and risk factors. A study from the European Collaborators on Stent / Graft Techniques for Aortic Aneurysm Repair (EUROSTAR) Registry. J Vasc Surg 2007; 46(6): 1103-11.e2.

  22. Dake MD, Miller G. Transluminal placement of endovascular stent-graft for the treatment of descending Thoracic aortic aneurysm. N Eng J Med 1994; 331: 1729- 34. Disponible en: nejm.org.

  23. Patterson BO, Holt PJ, Nienaber C, Fairman RM, Heijmen RH, Thompson MM. Management of the left subclavian artery and neurologic complications after thoracic endovascular aortic repair. J Vasc Surg 2010; 60(6): 1491-8.e1. Disponible en: http://dx.doi.org/10.1016/ j.jvs.2014.08.114

  24. Maldonado TS, Dexter D, Rockman CB, Veith FJ, Garg K, Arko F, et al. Left subclavian artery coverage during thoracic endovascular aortic aneurysm repair does not mandate revascularization. J Vasc Surg 2013; 57(1): 116- 24. Disponible en: http://dx.doi.org/10.1016/j.jvs.2012. 06.101

  25. Contrella BN, Sabri SS, Tracci MC, Stone JR, Kern JA, Upchurch GR, et al. Outcomes of Coverage of the Left Subclavian Artery during Endovascular Repair of the Thoracic Aorta. J Vasc Interv Radiol 2015; 26(11): 1609- 14. Disponible en: http://dx.doi.org/10.1016/j.jvir.2015. 07.022

  26. Zamor KC, Eskandari MK. Outcomes of Thoracic Endovascular Aortic Repair and Subclavian Revascularization Techniques. J Am Coll Surg 2015; 221(1): 93-100. Doi:10.1016/j.jamcollsurg.2015.02.028

  27. Dunning J, Muneretto C, Schueler S, Segesser L Von, Sergeant P, Turina M. Endovascular Aortic Repair Versus Open Surgical Repair for Descending Thoracic Aortic Disease A Systematic Review and Meta-Analysis of Comparative Studies. JAC 2010; 55(10): 986-1001. Disponible: http://dx.doi.org/10.1016/j.jacc.2009.11.047

  28. Uzun I, Shah A, Khoynezhad A. Left Subclavian Arterial Coverage and Stroke During Thoracic Aortic Endografting: A Systematic Review. Ann Thorac Surg 2016; 101(1): 381-9. Doi: 10.1016/j.athoracsur.2015.05.138

  29. Hughes GC, Daneshmand MA, Swaminathan M, Nienaber JJ, Bush EL, Husain AH, et al. “Real World” Thoracic Endografting: Results With the Gore TAG Device 2 Years After U.S. FDA approval. Ann Thorac Surg 2008; 86(5): 1530-7; discussion 1537-8. Doi: 10.1016/j.athoracsur. 2008.07.089

  30. Hausegger KA, Oberwalder P, Tiesenhausen K, Tauss J, Stanger O, Schedlbauer P, et al. Intentional Left Subclavian Artery Occlusion by Thoracic Aortic Stent-Grafts Without Surgical Transposition J Endovasc Ther 2001; 472-6.

  31. Hajibandeh S, Hajibandeh S, Antoniou SA, Torella F, Antoniou GA. Meta-analysis of Left Subclavian Artery Coverage With and Without Revascularization in Thoracic Endovascular Aortic Repair. J Endovasc Ther 2016; 23(4): 634-41. Doi: 10.1177/1526602816651417




2020     |     www.medigraphic.com